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.
Even with this brief history, what would be your differential diagnosis for this patient?
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.
How are muscle strains classified?
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).
How is hamstring length assessed?
Hamstring length can be assessed using a number of methods. The most common method is the straight leg raise.
What tests would you use to rule out a lumbar disk herniation as the cause?
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).
What are some of the intrinsic and extrinsic factors associated with a hamstring strain?
Describe the various findings of the grading system used for tendon injuries.
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?
How would you describe the pathological process behind this condition to the patient?
Why is eccentric muscle strengthening so important in patients with a tendon injury?
Which activities would you recommend the patient avoid until full healing has occurred?
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?
How would you determine when a patient with a hamstring injury is ready to return to sport?
What is the prognosis for a patient with a hamstring injury in terms of healing time based on the three grades?