Pain at the back of the thigh is known as posterior thigh pain. Here we explain the common causes including hamstring strains.
Medically reviewed by Dr Chaminda Goonetilleke, 27th Jan. 2022
Sudden onset (acute) thigh pain | Gradual onset (chronic) thigh pain | Rehab programs
Sudden onset/acute posterior thigh pain
The following are causes of sudden onset or acute pain at the back of the thigh:
Pulled hamstring/hamstring strain
Hamstring strains are very common in sports. They usually occur either from sprint-0related activities or from overstretching the muscles. Symptoms include:
- Sudden onset pain at the back of the thigh.
- Hamstring strains are graded one to three depending on how bad they are.
- A mild strain can simply be tightness in the muscle.
- However, if you have a more severe strain then you will be unable to continue playing and be in severe pain.
- More on Hamstring strain
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Cramp in the hamstrings
A cramp is a painful involuntary contraction of the muscle. It is very common in the hamstring muscles. Symptoms consist of:
- A sudden involuntary muscle spasm at the back of your thigh.
- Significant pain.
- You will find it very difficult to relax the muscle and straighten your leg.
- Cramp often follows a bout of hard, or unaccustomed exercise.
- More on Cramp
A hamstring contusion involves a direct blow to the back of your thigh. Symptoms include:
- Pain at the back of the thigh, particularly at the point of impact.
- You may or may not have noticeable swelling depending. This depends on how bad your injury is.
- Bruising also may or may not develop. This depends on the type of contusion and tissue damage.
- More on Contusions
Hamstring tendon avulsion
An avulsion strain occurs when the tendon tears, pulling a small part of the bone away with it. This is more common in younger athletes aged 14 to 18 years old. Or in older people who may have had a history of chronic hamstring tendinitis.
if you are a young athlete and have severe pain at the back of your thigh, specifically at the top, you should always suspect an avulsion strain. As a result, seek professional advice. An X-ray or bone scan confirms the diagnosis.
- More on Hamstring tendon avulsion
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Gradual onset/chronic posterior thigh pain
The following injuries cause gradual onset pain at the back of the thigh. You are unlikely to be able to pinpoint a specific time when your injury occurred.
Referred hamstring pain
Pain in the hamstring region can originate from your lower back, sacroiliac joints, or buttocks. This results in symptoms of:
- Gradual onset pain at the back of your thigh.
- Pain is usually less severe than a hamstring strain, although you may feel occasional acute ‘twinges’.
- The slump test, which is used to test tension in the sciatic nerve is likely to be positive, but not in all cases.
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Hamstring tendonitis (or tendinopathy) occurs at the origin of the hamstring muscles. More specifically, at the ischial tuberosity of the pelvis.
Bursitis is inflammation of the small sac of fluid between the tendon and bone. It is often difficult to distinguish between the two. Symptoms include:
- Pain just under the crease of the buttocks.
- You may have tenderness and thickening of the tendon at the site of pain.
Tight hamstring muscles
Although not a specific injury, nor a cause of posterior thigh pain, tight hamstring muscles are common in athletes. Most of the time will not cause a problem.
However, if you have tight hamstrings you may be more prone to other problems such as back pain and postural issues. As a result, you are not training and competing at full capacity.
- More on tight hamstrings
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Posterior compartment syndrome
Compartment syndromes occur when the muscle swells up too big for the sheath that surrounds it. As a result, pressure increases causing pain. Symptoms include a dull pain in the back of the thigh, cramps, and weakness.
It is caused either by overuse as might be seen in endurance runners or repeated trauma from redcurrant hamstring strains.
Surgery is thought to be the most effective form of treatment.
Other injuries causing posterior thigh pain
Other injuries causing pain at the back of the thigh which should not be missed include Myositis ossificans, Tumors, and Iliac artery endofibrosis.
Further information & research
- Posterior Thigh Muscle Injuries in Elite Track and Field Athletes. Nikolaos Malliaropoulos, MD, MSc, PhD, Emmanuel Papacostas, MD, Olga Kiritsi, MD, Am.J.SportsMed.
Rehabilitation & exercises
Hamstring strain Rehabilitation Program
Our step by step rehabilitation program takes you from initial injury to full fitness.