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A 25-year-old male presents with right posterior thigh pain that began two weeks previously. The patient reports that he was running for a bus when he suddenly felt a burning sensation on the middle part of the back of his thigh that forced him to stop running. The patient went to see his physician who gave him a prescription for physical therapy with a diagnosis of hamstring strain. The patient rates his pain currently at 4/10.

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Even with this brief history, what would be your differential diagnosis for this patient?

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The differential diagnosis for this patient could include a low back injury, ischial tuberosity apophysitis, or an avulsion fracture. However, the most likely diagnosis is a hamstring strain.

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How are muscle strains classified?

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Muscle strains may be classified as first-degree (mild to minimal strain), second-degree (moderate disruption of the myotendinous unit), or third-degree (severe strain involving total disruption of the muscle).

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How is hamstring length assessed?

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Hamstring length can be assessed using a number of methods. The most common method is the straight leg raise.

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What tests would you use to rule out a lumbar disk herniation as the cause?

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A lumbar disk herniation would be suspected if there were any positive findings in the following three simple tests -- deep tendon reflex testing (hyporeflexive), manual muscle testing (weak and painless), and adverse neural tension testing (positive straight leg raise test with neck flexion superimposed).

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What are some of the intrinsic and extrinsic factors associated with a hamstring strain?

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Describe the various findings of the grading system used for tendon injuries.

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Having made the provisional diagnosis, outline your intervention in terms of the 3 phases of healing and the number of visits that will be required?

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How would you describe the pathological process behind this condition to the patient?

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Why is eccentric muscle strengthening so important in patients with a tendon injury?

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Which activities would you recommend the patient avoid until full healing has occurred?

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How could the Slump (neural tension) test be used to help determine or rule out a hamstring injury in a patient with posterior thigh pain?

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How would you determine when a patient with a hamstring injury is ready to return to sport?

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What is the prognosis for a patient with a hamstring injury in terms of healing time based on the three grades?

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