Referred hamstring pain is pain felt in the back of the thigh which originates from another structure, usually the lower back, buttock, pelvis, or sciatic nerve. Unlike a true hamstring strain, the hamstring muscles themselves may not be injured.
Pain can radiate down the back of the thigh from the lumbar spine, sacroiliac joint, piriformis muscle, or surrounding nerves and soft tissues. Symptoms are often mistaken for a pulled hamstring, especially in runners and athletes.
Medically reviewed by Dr Chaminda Goonetilleke, 21st Feb. 2022
What is referred hamstring pain?
Referred pain occurs when pain is felt in one part of the body, but the source of the pain comes from another area.
For example, you may feel pain or tightness in the hamstring region even though the actual problem originates in the lower back or buttocks. This commonly happens when irritation of the sciatic nerve causes pain to radiate into the leg.
In some cases, symptoms develop suddenly. However, they often build gradually over time.
Symptoms of referred hamstring pain
Symptoms can vary depending on the underlying cause. Common symptoms include:
- Pain or tightness in the back of the thigh
- Symptoms which radiate from the buttocks or lower back
- Tingling, burning, or pins and needles
- Pain which worsens with sitting, bending, or driving
- Symptoms which come and go during activity
- Hamstring tightness without a clear muscle injury
- Pain which feels different to a typical hamstring strain
Referred pain is often less severe than a hamstring tear, although sharp twinges can still occur.
Referred hamstring pain vs hamstring strain
A true hamstring strain usually occurs suddenly during sprinting, acceleration, or kicking movements and causes local tenderness in the muscle.
Referred hamstring pain is more likely to develop gradually and may be associated with lower back stiffness, buttock pain, or nerve symptoms such as tingling or numbness.
The slump test is commonly used to assess tension or irritation of the sciatic nerve. A positive test may indicate neural involvement.
What causes referred hamstring pain?
Several injuries and conditions can cause pain to radiate into the hamstring region.
Prolapsed disc (slipped disc)
A prolapsed or herniated lumbar disc can irritate the sciatic nerve as it exits the spine.
Intervertebral discs act as cushions between the vertebrae. If part of a disc bulges or herniates, it can place pressure on nearby nerves and cause pain to radiate into the buttock and hamstring region.
Read more on slipped disc.
Lower back muscle strain
Muscle strains in the lower back can cause muscle spasm, inflammation, and irritation around the sciatic nerve.
This may lead to pain radiating into the back of the thigh. Symptoms are often associated with stiffness or discomfort in the lumbar spine.
Read more on back muscle strains.
Piriformis syndrome
Piriformis syndrome occurs when the piriformis muscle irritates or compresses the sciatic nerve.
The piriformis sits deep within the buttock region. Tightness or spasm in this muscle can cause pain which radiates into the hamstring and lower leg.
Other deep gluteal muscles may also contribute to referred symptoms.
Read more on Piriformis syndrome.
Treatment for referred hamstring pain
Treatment depends on identifying and addressing the underlying cause of symptoms.
Common treatment options include:
- Relative rest from aggravating activities
- Improving lower back and hip mobility
- Stretching tight gluteal and hip muscles
- Strengthening the core and hip stabilisers
- Soft tissue massage to the lower back, buttocks, and hamstring muscles
- Neural mobility exercises for the sciatic nerve
- Gradual return to running and sport
If symptoms include significant weakness, numbness, or persistent nerve pain, seek professional medical assessment.
