This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
Hamstring strain
The hamstring muscle has three parts and is located in the back of the thigh. These 3 parts are called the semiteninosis, semimembranosis and the biceps femoris. All 3 can be strained and there are different grades of strain with concern to the severity. A grade I strain means that only a small number of fibers of the muscle are affected and there will be pain felt at that point. A grade II strain means that a significant number of fibers have been torn and there is pain, swelling, reduced strength and movement may be reduced. A grade III strain means that the muscle is completely torn.
Physiotherapy can help with advice, ice, massage, soft tissue techniques, stretching, working on the back, ultrasound and taping. Exercises can be set to regain flexibility and strength of the muscle and return you to sport.
Sciatic nerve pain
The sciatic nerve runs down the back of the thigh and originates from your lower back. Pain can arise from this nerve and feels quite deep and dull. Special tests can be done by your physiotherapist to see if the pain is originating from this nerve.
Physiotherapy can help by working on the lower back, increasing the mobility of the nerve itself and working on any tissues that surround the nerve that may be causing compression or restriction on the nerve.
Referred pain
Pain can be felt down the back of the thigh but the origin of the pain is coming from somewhere else. The pain may be coming from trigger points in muscles in the buttock such as gluteus medius, gluteus minimus and piriformis. Structures in the lumbar spine (lower back) such as the disc, facet joint, muscles and ligaments can cause pain in the back of the thigh. Conditions such as lumbar spondylolisthese and spondylosis can cause back of the thigh pain. Also there can be compression where the nerves exit out of the lower back causing back of the thigh pain. When the pain is referred the symptoms normally start gradually and there may be a feeling of tightness. The symptoms are not normally as severe as when the hamstring muscle is strained and often walking and jogging is painfree.
Physiotherapy can help by carrying out an thorough assessment to work out where the pain in the back of your thigh is coming from. The physiotherapist will then be able to treat the problem appropriately.
Upper hamstring tendinopathy
The hamstring tendon (tendon attaches muscle to bone) which attaches the top of the hamstring muscle to the bone on the bottom of the pelvis can become painful. This tends to be associated with frequent sprinting and tends to be worse when warming up for activity and after activity.
Physiotherapy can help with soft tissue techniques, taping and going through a rehab exercise programme.
Ischial bursitis
The ischium is bone which is at the bottom of the pelvis deep in the buttock. There is a small fluid filled sac known as a bursa which is located between the ischium bone and the hamstring tendon. This bursa can become inflamed and often people complain on pain when they sit on hard surfaces where this piece of bone is under pressure.
Often a referral for having a cortisone injection for the inflammation is required. We can recommend a top London specialist who can carry out this procedure.
Lower hamstring tendinopathy
This is pain in the lowest end of the hamstrings where the tendon attaches to the knee. The pain is often worst when warming up for activity or after activity and is found at the bottom end of the back of the thigh. Happens most often in sports that involve a lot of knee bending ie sprinters.
Physiotherapy can help with advice, icing, soft tissue techniques, taping, acupuncture and setting of appropriate rehabilitation exercises.
Adductor magnus strain
This muscle is one of the muscles on the inner thigh which brings the leg inwards but pain when this muscle is strained can give the mistaken idea that a hamstring strain has occurred. There are 3 different grades of strain as defined under hamstring strain.
Physiotherapy can help to determine with certain tests whether you have strained your adductor muscle or the hamstring. They can then help with advice, icing, soft tissue techniques, stretching, ultrasound and taping. Exercises can be set to regain flexibility and strength of the muscle.
Compartment syndrome
There are several compartments within the body. The compartment at the back of the thigh includes the hamstring muscles and sciatic nerve. With compartment syndrome there is an increased pressure in the compartment with reduced blood flow to the muscles and can lead to pain. When the person tries to exercise the muscles try to expand in size but are unable to do so. People most likely to develop it are endurance athletes and those who have had a history of injury to their hamstrings. The pain is often dull and the leg feels stiff. Cramps and weakness in the back of the thigh can happen during and after training.
Physiotherapy can help determine if this may be the cause of your pain. If present a medical referral will be required. We can recommend a top London consultant to see if this is the case.
Avulsion of the hamstring
This is when the top of the hamstring separates from the bone it is attached to. There will be sudden severe pain. Common ways of this happening are waterskiing and power lifting.
A medical referral is urgently required. We can recommend a top London consultant to see if this is the case.
Vascular pain
The external iliac artery is located on the front and outside of the thigh but when affected there can been pain felt in the back of then thigh. The pain is normally found with cycling and is present when the person exercises and stops when the person stops.
Physiotherapy can assess you to determine if this is the possible cause of your pain. If believed to be the case then a medical referral is required and we can recommend a top London consultant to you.
Stress fracture of the femur
With overuse a stress fracture of the thigh bone can occur which leads a deep dull ache in the thigh which is worse if leg hangs over the edge of a bed and pressure applied. If this is suspected then immediate medical referral is required and we can recommend a top London consultant to you.
Physiotherapy can help to maintain strength in the rest of the body while healing and to restore movement, strength and function in the affected leg once the stress fracture has healed.
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants who can help you.
Other possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
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