Posterior Thigh Pain (Back)

Posterior thigh pain

Pain at the back of the thigh is known as posterior thigh pain. Here we explain the common, and less common injuries and causes of hamstring/back of the thigh pain.

Did your injury occur suddenly, or develop gradually over time?

Sudden onset/acute

Gradual onset/chronic

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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 strain
Hamstring Strain Pulled hamstring

A hamstring strain or pulled hamstring is very common in sport. It usually occurs from sprint related activities, or when performing high kicks and overstretching the hamstring 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.
  • If you have a more severe strain then you will be unable to continue playing and may have suffered is a partial or even complete rupture of the muscle.

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Cramp in the hamstrings

Hamstring cramp

Cramp is a painful contraction of the muscle that happens involuntarily and is very common in the hamstring muscles. Symptoms consist of:

  • A sudden involuntary spasm of the hamstring muscles.
  • Significant pain.
  • You will find it very difficult to relax the muscle on your own.
  • Cramp is most likely to occur following a bout of hard, unacustomed exercise.

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Hamstring contusion

Hamstring contusion
Hamstring - Contusion

A hamstring muscle contusion involves a direct blow to the back of the thigh. Symptoms include:

  • Pain at the back of the thigh, particularly at the point of impact.
  • There may or may not be noticeable swelling depending on how bad your injury is.
  • Bruising also may or may not develop. This will depend on the type of contusion and whether the muscle fascia has been damaged.
  • If bleeding is contained within the muscle then bruising will not be visible, but these injuries may take longer to heal.

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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 (14-18-year-olds) and older people who may have had a history of chronic hamstring tendinitis.
  • A young athlete with severe hamstring pain at the point of origin should always be suspected of having an avulsion strain.
  • An X-ray or bone scan will be needed to confirm the diagnosis.

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Gradual onset/chronic posterior thigh pain

The following are causes of pain at the back of thigh which occurs gradually over time as opposed to a sudden ‘pull’ or muscle strain:

Referred hamstring pain

Pain in the hamstring region can actually originate from the lower back, sacroiliac joints or muscles of the buttocks such as the gluteus maximus and piriformis muscle. Symptoms include:

  • Pain at the back of the leg which may be sudden onset gradual.
  • Pain is usually less severe than a hamstring strain although twinges may be felt.
  • The slump test 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) can occur at the origin of the hamstring muscles, specifically at the ischial tuberosity. 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.
  • Hamstring tendinitis in the buttocks may be caused by overuse.
  • Ischiogluteal bursitis is inflammation of the bursa (small sack of fluid) which sits between the tendon and bone.

More on Ischiogluteal bursitis/tendinopathy

Tight hamstring muscles

Although not a specific injury, nor a cause of posterior thigh pain, tight hamstring muscles are common. Most of the time will not cause a problem. However, they may be more prone to severe strains or contribute to other problems such as back pain and postural issues. Tight hamstrings mean you can’t train and compete at full capacity as the muscles aren’t fully healthy.

More on tight hamstrings

Posterior compartment syndrome

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.

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

Futher 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.
This article has been written with reference to the bibliography.
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