Thigh Pain

Thigh pain can be divided into pain at the front of the thigh and pain at the back of the thigh.

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The most common causes of pain at the front of the thigh are quadriceps strains and quadriceps muscle contusions. Pain at the back of the thigh is most commonly caused by a hamstring strain.

Below we outline some of the common causes of thigh pain, less common causes as well as important conditions that should not be missed.

Most common causes of front thigh pain

Quadriceps contusion is the resultQuadriceps muscles of a direct impact to the muscle which gets crushed against the bone underneath causing damage and bleeding. Also known as a Charley horse or Dead leg this injury can vary in severity from very mild to disabling. It is important a contusion is treated correctly with RICE; rest, ice, compression and elevation as a poorly managed contusion can develop debilitating and long term complications such as Myositis ossificans.

Quadriceps muscle strain is a strain or tear to one or more of the four quadriceps muscles. Symptoms include a sudden sharp pain in the muscle and swelling or bruising may develop. Muscle strains are graded 1 to 3 depending on how bad they are. Again initial first aid applying cold therapy and compression is essential and a full rehabilitation program to restore strength and flexibility to the torn muscle is important.

Myositis ossificans can occur following a contusion that is not managed correctly. it is a small bone growth within the muscle which develops over time. Symptoms include pain in the muscle during exercise and the athlete may have restricted movement. A small lump may be felt in the muscle and an X-ray will confirm the diagnosis.

Groin strain is a tear or strain of one the the adductor muscles.

Less common causes of front thigh pain

Femur fractureStress fracture of the femur is a hairline fracture or crack in the thigh bone caused by over use. Symptoms include a dull ache deep in the thigh which may be difficult to pin point. Pain will be triggered when applying a bending force to the thigh (called the hang test). There may also be pain referred down into the knee. X-ray may or may not show up the stress fracture until it has already started to heal but a bone scan or MRI should give a more accurate diagnosis.

Sartorius muscle strain is a tear or strain of the Sartorius muscle which runs from the outside of the hip to the inside of the knee. When contracted it flexes the hip, bends the knee and rotates the thigh outwards.

Groin strain in particular of the gracilis muscle is a tear to one of the two long adductor muscles which attach below the knee.

Rectus femoris muscleReferred pain is where a problem or injury elsewhere causes pain in the front of the thigh. Pain can be referred from the lumbar spine, sacroiliac joint or the hip joint. It is important to get a thorough examination to identify the cause of the pain and not just deal with the symptoms in the thigh.

Rectus femoris avulsion fracture occurs where a strong contraction of the rectus femoris quadriceps muscle pulls the tendon and a small piece of bone away from the attachment point. Symptoms include pain at the front of the hip, usually after a sudden fast movement of the hip or knee. Tenderness will be felt when pressing in at the point of injury.

Important do not miss

Slipped femoral epiphysis occurs when there is a fracture at the top of the thigh bone. The fracture usually occurs gradually over a period of time and the two parts of the bone then 'slip' apart, with the head of the Femur moving backwards.

Perthes' disease is a hip problem which affects children, most commonly aged between four and eight, but can also occasionally occur in younger children and teenagers. Symptoms include tiredness and pain in the groin and sometimes in the knee. Pain can be felt in the knee only even though the disease only affects the hip.

Tumurs such as osteosarcoma of the femur can cause pain in the thigh.

Most common causes of posterior thigh pain

Hamstring strain is oneHamstring muscles of the most common sports injuries and is a tear to one of the hamstring muscles at the back of the thigh. The athlete will feel a sudden sharp pain in the back of the thigh and from then on running will be difficult if not impossible depending on how bad the injury is. Immediate first aid of cold therapy and compression is essential and a full rehabilitation program of stretching and strengthening exercises should be done to prevent recurrence in the future.

Hamstring contusion is a direct impact or blow to the muscles at the back of the thigh. The muscle gets crushed against the bone underneath bleeding and damage. A contusions is also known as a Charley horse or Dead leg this injury can vary in severity from very mild to disabling. It is important a contusion is treated correctly with RICE; rest, ice, compression and elevation as a poorly managed contusion can develop debilitating and long term complications such as Myositis ossificans.

Gluteal trigger points are tiny localized knots in the muscles of the buttock. Tension in these muscles can cause pain to radiate into the back of the thigh. Deep tissue sports massage is an excellent form of treatment to release trigger points and encourage circulation of blood through the muscles.

Referred pain from the lumbar spine is where a problem in the lower back causes pain to radiate down into the back of the leg via the sciatic nerve.

Less common causes of posterior thigh pain

Hamstring tendinitis is inflammation of the hamstring tendon at its origin. Symptoms include pain and tenderness at the ischial tuberosity or bony bit you sit on at the bottom of the pelvis. There is likely to be pain when stretching the hamstring muscles and pain when bending the knee against resistance. This is likely to come on gradually after fast sprinting type exercise.

Bursitis is inflammation of a small sack of fluid which sits between a tendon and the bone to help lubricate movement and protect the tendon. Symptoms will be similar to hamstring tendinitis.

Referred pain from the sacroiliac joint is when a problem or poorly functioning sacroiliac joint in the pelvis causes pain to radiate down into the back of the thigh.

Biceps femoris avulsion fracture is a when the tendon of the biceps femoris muscle and sometimes a small piece of bone comes away. An avulsion can happen as a result of a very fast or violent movement where the knee straightens and the hip flexes such as kicking a ball. There may be swelling at the point of injury just below the buttocks. If a bone fragment has come away then this may be felt through the skin.

Important do not miss

Vascular problems where blood supply is restricted can cause pain in the back of the thigh. Endofibrosis of the iliac artery usually causes pain in the front and side of the thigh but occasionally pain can result in the back of the thigh. This is more common in cyclists and triathletes. Symptoms include pain which comes on 20 minutes or so into exercise but goes immediately exercise stops.

Tumurs such as osteosarcoma of the femur can cause pain in the thigh.

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