Pain at the back of the thigh is known as posterior thigh pain and can be acute or sudden onset, or they may be chronic and develop gradually over time. It may also develop following an acute injury which fails to heal properly. The most common is a hamstring strain
- Hamstring stain
- Hamstring contusion
- Referred pain
- Pain at the top of the hamstring
Pulled hamstring/hamstring strain
Hamstring strains are graded one to three depending on the severity of the damage. A mild strain can simply be tightness in the muscle but a severe strain involves a tear. Treatment involves immediate first aid in applying the PRICE principles of protection, rest, ice, and compression followed by a full rehabilitation and exercise program. Deep tissue sports massage may help with recovering from pulled hamstrings.
Read more on:
- Hamstring strain (including diagnosis, causes & anatomy, treatment, sports massage, kinesiology taping, stages of rehabilitation & expert interviews)
- Hamstring strain exercises (progressive strengthening & stretching exercises)
A hamstring muscle contusion involves a direct blow to the back of the thigh causing the muscle to be crushed against the bone. Pain and bruising at the point of impact are some of the main symptoms, but the condition of the leg should be monitored over several days to make a more accurate and specific diagnosis. Contusions are graded depending on their severity, which you can read more about here.
Read more on hamstring contusions.
Cramp in the hamstrings
Cramp is a painful contraction of the muscle that happens involuntarily. Leg cramps affect most people training hard at some point in time, with the hamstring muscles commonly affected. Although leg cramp recedes naturally, it can damage the muscle and make it sore and tender. Read more about the causes of cramp, its effects and how you can help it.
Read more on Cramp.
Tight hamstring muscles
Although not a specific injury, tight hamstring muscles are common and 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.
Read more on tight hamstrings.
Referred hamstring pain
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. When hamstring pain originates from an injury to another part of the body, it is called a referred pain. Identifying the underlying injury and cause of the pain will help you to recover and get back training.
Symptoms include pain which may be sudden onset but can also be of gradual onset. 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.
Conditions such as a torn back muscle or problems with the spine or intervertebral discs can put pressure on the sciatic nerve and refer pain down into the hamstrings and lower leg. The patient will be likely to have a history of lower back pain if the pain is coming from the lumbar spine. Pain referred from the buttocks may present with reduced hip rotation and tenderness to palpate the glute muscles.
Treatment involves identifying and treating the underlying cause. Deep tissue massage to the lower back, buttocks, and hamstrings can be beneficial in loosening the area and restoring full function. Stretching the muscles of the lower back and buttocks may be helpful.
Pain at the top of the hamstring
Upper hamstring tendinopathy/bursitis
Hamstring tendonitis (or tendinopathy) can occur at the origin of the hamstring muscles at the ischial tuberosity (or bony bits in the backside that you sit on). Symptoms include tenderness and thickening of the tendon at the site of pain and may be very similar to ischial bursitis. Hamstring tendinitis in the buttocks might be caused by repetitive sprinting or overuse. Treatment includes rest, ice or cold therapy and cross friction massage.
Ischiogluteal bursitis is inflammation of the bursa that lies between the ischial tuberosity and the tendon of a hamstring muscle. A bursa helps movement between the tendon and the bone so when this becomes inflamed it can be painful. It can occur with a hamstring or tendon injury, which have similar symptoms to Ischiogluteal bursitis.
Hamstring tendon avulsion
An avulsion strain is one where 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 until an X-ray or bone scan can prove otherwise. Treatment of a severe case will require surgery. It may also be advisable for less severe cases to be operated on as conservative treatment methods (rest, ice etc) may leave the young athlete with a weakness of the hamstrings in the future.
Posterior thigh 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 pain at the back of the thigh which should not be missed include Myositis