As just a freshman in high school, Chris was coming off an incredibly successful fall cross-country season. He had regularly placed among the top performers during races — often one of the lone freshmen amongst all upperclassmen — and had even placed first once during the season. He had his sights set on the winter track season, which came with equally high expectations.
But just two days before Christmas, while competing in the 300-meter track event at the Reggie Lewis Center in Boston, Chris’ season was cut short. In the middle of the race, he felt his hamstring go from loose to tight very quickly, culminating in a snapping sensation and a sharp pain in his leg. He fell to the track, unable to continue the race.
Despite the pain and inability to run, Chris and his family didn’t think the injury was too serious — likely just a hamstring pull that would get better with rest. They went to their local doctor, who recommended that Chris give it a few weeks to rest and see if it would heal on its own.
Seeking a second opinion
But on the recommendation of a family friend, the Tilton family headed to Boston Children’s for a second opinion. After meeting with Dr. Benton Heyworth, an orthopedic surgeon in Boston Children’s Sports Medicine Division, they discovered that Chris’ injury wasn’t a hamstring strain. Instead, it was a pelvic-ischial tuberosity avulsion fracture, a rare type of fracture that occurs only in growing adolescents.
This injury happens when the hamstring contracts quickly, causing the tendon to pull a piece of bone off the pelvis. “In an adult this would be a hamstring or tendon rupture,” explains Heyworth. “But in a developing adolescent, it results in a fracture, as the tendon is actually stronger than the tendon’s attachment to the bone, which has a small area of cartilage within it that is still in the process of ossification, or turning into bone. This small area of cartilage within the bone is the weak point in the system, and this is where the fracture occurs.”
It’s not uncommon for physicians not familiar with the rare condition to diagnose a hamstring avulsion fracture as a simple hamstring muscle pull, prescribing rest instead of fixing the fracture. In some cases, this can lead to failed healing of the bone, and an inability of the tendon to reattach. “Adolescents who go without proper treatment can have pain while sitting or running, as well as weakness,” says Heyworth, “which obviously would have been a major issue for a dedicated athlete like Chris.”
Deciding on surgery
Heyworth gave Chris the option of either letting the injury try to heal on its own, or undergoing a rarely used surgical procedure. Given that the size and displacement of Chris’ bone fragment could cause future complications if they went the conservative route, Chris chose surgery.
“Once it became clear how serious and rare his injury was, and that it required specialized treatment, we were really glad we had gone to Boston Children’s,” says Chris’ mom, Laura.
Knowing that Dr. Heyworth had performed this procedure on other serious athletes in the past with great success, the Tilton family felt comfortable in their decision to go ahead with the surgery.
“There are not a lot of surgeons that do this procedure frequently, because many of these injuries can be treated non-operatively,” says Heyworth. “But with the extent of Chris’ injury, I was concerned there could be problems in the future if the bone didn’t heal properly.”
Achieving his goals
The surgery went as planned, and Chris left the hospital with one thing on his mind: getting back to running. “It was difficult,” he says. “But I really became focused on the recovery. I knew that I wanted to come back better than I was before.”
This would mean strict dedication to his recovery plan and physical therapy. “I remember helping him do leg exercises,” Laura recalls. “Even when I had felt he had done enough, he pushed through and wanted to do even more. He wanted to work hard and meet his goals.”
Chris’s goal was to make it back in time to participate in the last track meet of the spring season. Due to the success of the surgery and his unwavering dedication to recovery, Chris was able to achieve that goal. “It was great,” he remembers. “Even though I wasn’t competitive in the least, it was a big morale booster.” For a runner who was winning cross-country races as a freshman, the lack of success in the race felt abnormal, but being out there running once again made Chris feel right at home. His teammates even presented him with the Captains’ Award at the spring track banquet in recognition of his hard work and dedication.
Inspired by her family’s experience, Laura started a Facebook group for families of teens who have experienced hamstring avulsion fractures while participating in sports. The members of this small but specialized group span from the US to the UK, and even as far as Australia. “These types of social media groups have proven to be much more powerful that I would’ve ever thought,” says Heyworth. “This injury is uncommon enough that Laura didn’t know where to go to find people who had the same experience. She felt she owed it to other families who were going through what they had gone through.”
Not just getting back, getting better
Now in his sophomore fall cross-country season, Chris is back to winning races and is serving as a team captain. When Chris expressed disappointment at only gaining a few seconds over the previous fall’s performance on a particular course, Laura was quick to remind him of all that he had been through in the time between those two events.
In the end, Chris handled his recovery the same way he handles his races: always striving to get better. For him, simply showing up doesn’t count, and neither does maintaining a similar level of accomplishment. Chris is committed to working hard to continue to improve his performance, never settling on simply getting back to where he was before.
Learn more about Boston Children’s Sports Medicine Division.