Most thigh injuries are sudden onset or 'acute' such as a thigh strain, groin strain or hamstring strain. But thigh pain can also be chronic occuring gradually over time. Here we explain the common causes of thigh pain. Click on the links for more detailed information.
Pain at the Back of the Thigh
Sudden onset (acute):
The most common cause of pain at the back of the thigh is a hamsting strain or pulled hamstring. Symptoms include a sudden sharp pain at the back of the thigh, usually when running or kicking. It is not likely the athlete will be able to continue running after a torn hamstring and it is not a good idea to try. Treatment includes immediate first aid applying cold therapy and compression (PRICE principles) followed by a full hamstring rehabilitation program. Emergency treatment for cramp is to stretch the muscle. Get help from someone else to help if needed.
Cramp is a sudden and often painful involuntary contraction of the hamstring muscle. The athlete will have difficulty straightening the leg for a while but cramp usually wears off. However, severe cramp can cause injury to the muscle resulting in a hamstring strain. The exact cause of cramp is not known although dehydration, low salt levels, low carbohydrate and tight muscles are thought to conribute.
A contusion is injury to the muscle caused by a direct blow or impact. Often this is mild but contusions can be very serious and if not treated correctly result in permenant damage to muscle and nerves. All contusions should be treated immediately with cold therapy and compression. Applying heat or massage is definitely not advised. Treatment and rehabilitation will vary depending how bad the injury is (graded 1, 2 or 3).
An avulsion strain occurs when the tendon tears pulling a small piece of the bone away with it. This is more common in younger athletes (14-18-year-olds) and older people who may have had a history of chronic hamstring tendinitis. If a young person suffers pain right at the top of the hamstrings near the buttocks then an avulsion strain should always be suspected and professional medical advice sought.
Gradual onset (chronic):
Hamstring tendinitis is inflammation of the hamstring tendon as it attaches to the ischial tuberosity at the top of the back of the thigh. It may occur following a hamstring tendon strain which has failed to heal properly. Symptoms include pain and tenderness just under the buttocks at the top of the hamstring tendon.
Ischiogluteal bursitis is inflammation of the bursa that lies between the bottom of the pelvis (Ischial tuberosity) and the tendon of a hamstring muscle. Symptoms are identical to hamstring origin tendonitis.
Pain in the hamstring region can originate from the lower back, sacroiliac joints or muscles of the buttocks such as the gluteus maximus and piriformis muscle. This is called a referred pain and identifying the underlying injury and cause of the pain is needed. Symptoms include pain which may be sudden onset but is usually gradual onset where no specific point of injury can be identified.
A less common cause of thigh pain, compartment syndrome occurs when the muscle swells up too big for the sheath that surrounds it causing pressure and pain. Symptoms include a dull pain in the back of the thigh, cramp, 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.
Probably the most common cause of pain on the inside of the thigh. A groin strain is a tear to one of the adductor muscles causing pain on the inside of the thigh. A sudden sharp pain is felt, usually whilst sprinting or turning sharply. Depending on how bad the strain is there may be swelling and bruising. Immediate treatment is applying cold therapy and compression followed by a full gron strain rehabilitation program.
An inguinal hernia occurs when part of the internal tissue which can be fat, muscle or intestine bulge through a weakness in the overlying abdominal wall causing pain in the groin, discomfort and other complications. The pain is likely to increase when coughing or sneezing and there may be a bulge in the groin area which often disappears when you lay down. It is essential to seek professional medical advice if you suspect a hernia.
Gradual onset (chronic):
The adductor muscles can become inflamed through overuse or following injury resulting in pain and stiffness at the top of the groin and can travel down the leg. Overuse or previous injury can make the tendons that attach the muscles to the bone inflamed.
Gilmore's Groin can also be known as a Sportsmans Hernia, athletic pubalgia, slap shot gut and a sports hernia. However, a true Gilmore's Groin has nothing to do with a hernia. Symptoms include groin pain that's increased by running, sprinting, twisting and turning and is common in kicking sports such as rugby and football.
Sudden onset (acute):
The most common cause of pain at the front of the thigh is a thigh strain or quadriceps muscle strain. This is a tear of the muscle fibres in one of the quadriceps muscles. A sudden sharp pain is felt at the front of the thigh and depending on how bad the injury is and wht type of strain has occured swelling and bruising may develop.
Also known as a dead leg or charley horse is a bruise or contusion caused by a direct blow or impact. The muscle is crushed and damaged causing pain and sometimes swelling and bruising depending on severity. If contusions are not treated properly with cold therapy, compression and rest then Myositis ossificans may occur which is a more serious chronic condition.
A tear to the tendon of the rectus femoris muscle will cause instant upper thigh pain. A sudden sharp pain is felt at the very top of the muscle where it attaches to the pelvis. If not treated correctly this can turn into chronic rectus femoris tendon inflammation. In some cases the tendon may tear taking a small piece of pelvis bone with it. This is known as an avulsion strain and if suspected professional advice should be sought.
Gradual onset (chronic):
Myositis ossificans can occur as a complication of not treating a contusion correctly and involves a small growth of bone within the muscle. Symptoms of include pain in the muscle, particularly during exercise and a hard lump will be felt in the muscle. An X-ray can confirm the diagnosis and show bone growth.
Inflammation and pain occurs at the front of the hip where the quadriceps tendon attaches. Symptoms include a gradual onset of pain and tenderness at the front of the hip. It may occur following a tendon strain or avulsion strain which has failed to heal properly.
A traumatic femur fracture is serious and usually fairly obvious injury caused by accident or severe impact. The patient will feel severe pain in the thigh. There may be deformity in the thigh for example the leg may be at an angle or the injured leg appearing shorter than the other. A considerable amount of swelling may be visible and the patient will be unable to move their leg.
The femur bone is the long thigh bone. Prolonged overuse can cause a stress fracture known as a femoral stress fracture. Pain may come on gradually as a dull ache which intensifies if a bending force is applied to the femur. Rest is the key to recovering from this injury.
It is rare that thigh injuries need to seen by a doctor as most are muscular injuries that will heal given the appropriate treatment and rest. However, there are certain circumstances and conditions in which case it is a good idea to seek medical advice:
- Very severe pain in the thigh following a high impact collision such as a high impact collision on a sports field or a Road Traffic Accident. This may indicate a fracture of the femur which is a very serious injury as they tend to be associated with excessive bleeding internally.
- Severe pain in the thigh after and direct impact e.g. opponents knee to the front of the thigh. In some rare cases, the resulting bleeding that occurs can be excessive and lead to compartment syndrome which is a very serious condition.
- Severe pain in the thigh followed by an inability to straighten or bend the knee and a palpable (able to feel) gap in the muscle. This may be a grade 3 rupture of the muscle and may need surgery if it occurs at either end of the muscle at the junction with the bone.
- Altered sensation (“pins and needles” feeling or loss of feeling) in the lower leg following a thigh injury.
If you have a more long-term injury or one which recurs then also seek professional advice. Most muscle injuries will benefit from sports massage to increase blood flow and healing to the area as well as make scar tissue more elastic helping to prevent the injury from recurring.