Paul O’Connell’s Hamstring Injury RWC 2015

Paul O’Connell’s Hamstring Injury RWC 2015

I was lucky enough to be pitch-side for the Ireland v France game at the Millennium stadium on Saturday. As well as witnessing a game of unbelievable intensity and commitment from both sides, I also witnessed the last International game involving the Irish captain Paul O’Connell due to what has since been confirmed as a hamstring injury.

Paul Oconnell Hamstring Injury RWC 2015
Paul Oconnell Hamstring Injury RWC 2015 Copyright


At the end of the first half O’Connell was taken from the field on a buggy while using entonox, a mixture of oxygen and nitrogen, for pain relief. While I do not know the exact details of Paul O’Connell’s injury, the mechanism in itself would make me suspicious of a proximal hamstring avulsion.

Proximal Hamstring Injury

While hamstring injuries are common in sport, a proximal hamstring avulsion is a rare but serious injury.  The hamstrings are a group of 3 muscles located at the posterior thigh that flex the knee and extend the hip. The proximal hamstrings attach to the pelvis via the proximal hamstring tendon. If you sit on your hands you will be able to feel the bony tuberosity where the tendon attaches. In an avulsion the tendon pulls from this bone and if not diagnosed correctly this can lead to poor outcome. The published data suggests that hamstring muscle strains involve 2 different mechanisms; the first involves high speed running and second when stretching occurs in an extreme joint position (Askling et al, 2007). It was the latter mechanism that appeared to injure the Irish captain on Saturday.

Hamstring Injuries - Vivomed Sports Injuries
Hamstring Injuries – Vivomed Sports Injuries

Mechanism of Injury

The mechanism of injury is the first thing that the medical team consider when making their initial assessment. The position that O’Connell got into while competing at the breakdown, in effect the splits with knees straight and hips flexed puts an enormous amount of stress on the hamstring tendon. The tendon, which attaches the hamstring muscle group to the pelvis, can literally pull off the bone causing significant pain and a loss of function. This injury is not restricted to rugby players however. Chakravarthy et al (2005) describes the injury in water skiers when being pulled out of the water and bull riders when they get their foot caught in the steer’s waist rope and are flung around violently.


The athlete typically describes feeling a “pop” or “snap” followed by extreme pain in the back of the thigh. They often have poor leg control and are unable to walk from the field. On examination there may be extensive bruising and swelling in the thigh as well as weak knee flexion and potentially a gap can be felt between the tendon and the pelvic attachment. Magnetic Resonance Imaging (MRI) and Ultrasound can help to confirm the diagnosis.

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Proximal hamstring ruptures involving 2 or more of the 3 tendon complex are managed surgically to avoid long term disability in what is a potentially career ending injury (Wood et al, 2008). Early surgical repair results in fewer complications and a better outcome, meaning that early diagnosis and correct management is vital with this injury (Harris et al, 2011). O’Connell has the benefit of immediate access to an experienced medical team and is without doubt in the right environment to have the best chance of a return to action after his significant hamstring injury . A rehabilitation period of 6 to 9 months following surgery is normally needed before returning to sport after sustaining a proximal hamstring avulsion.


Author – Richard Mack MSc Sports Medicine, BSc (Hons) Physiotherapy HCPC MCSP PGCert

Associate Lecturer

University of the West of England


Physiotherapist at Bethesda Clinic

The Homend




Phone: 01531 633895



Askling CM, Tengvar M, Saartok T, et al. (2007). Acute first-time hamstring strains during slow-speed stretching: Clinical, magnetic resonance imaging, and recovery characteristics. Am J Sports Med. 10:1716- 1724.

  • John H. M. Brooks, Colin W. Fuller, Simon P. T. Kemp, and Dave B. Reddin. (2006).

Incidence, Risk, and Prevention of Hamstring Muscle Injuries in Professional Rugby Union. Am J Sports Med. 34: 1297-1306

J Chakravarthy, N Ramisetty, A Pimpalnerkar, N Mohtadi. (2005).  Surgical repair of complete proximal hamstring tendon ruptures in water skiers and bull riders: a report of four cases and review of the literature. Br J Sports Med. 39:569-572.

Harris JD, Griesser MJ, Best TM, Ellis TJ. (2011). Treatment of proximal hamstring rupture-a systematic review. Int J Sports Med. 32:490—5.

Wood DG, Packham I, Trikha SP, et al. (2008).  Avulsion of the proximal ham- string origin. J Bone Joint Surg Am 11:2365-2374.

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