Posterior Thigh Pain (Back)

Posterior thigh pain refers to pain at the back of the thigh and can be caused by various factors. These include hamstring strain, cramps, contusions, and hamstring tendonitis. The pain can arise suddenly from acute injuries or gradually develop over time, leading to chronic posterior thigh pain.

Medically reviewed by Dr Chaminda Goonetilleke, 27th Jan. 2022

Sudden onset posterior thigh pain

Causes of sudden onset or acute pain at the back of the thigh include the following:

Hamstring strain

Pulled hamstrings, commonly observed in sports, can occur from sprinting or overstretching the muscles.

Symptoms include:

  • Sudden onset of pain at the back of the thigh.
  • Muscle tightness.
  • Swelling and/or bruising, severity dependent.

Read more on Hamstring strain 

Cramp in the hamstrings

Muscle cramp, a painful and involuntary muscle contraction, frequently affects the hamstring muscles.

Symptoms include:

  • Sudden, involuntary muscle spasm at the back of the thigh.
  • Intense pain.
  • Difficulty in relaxing the muscle and straightening the leg.
  • Cramps often occur after intense or unaccustomed exercise.

Read more on Cramp

Hamstring contusion

Hamstring contusion, also known as a dead leg or charley horse occurs when the back of the thigh suffers a direct blow.

Symptoms include:

  • Pain at the back of the thigh, especially at the impact site.
  • Presence or absence of noticeable swelling, depending on the severity of the injury.
  • Development or absence of bruising, depending on the type of contusion and tissue damage.

Read more on hamstring contusion

Hamstring tendon avulsion

An avulsion strain is characterized by the tearing of the tendon, which pulls a small fragment of the bone along with it. This type of injury is more prevalent among younger athletes, typically aged 14 to 18 years old. Symptoms resemble those of a hamstring tendon strain, underscoring the importance of seeking professional guidance. Hamstring avulsions can also affect older individuals with a history of chronic hamstring tendinitis.

Read more on Hamstring tendon avulsion.

Gradual onset/chronic posterior thigh pain

The following injuries are associated with gradual onset pain at the back of the thigh, making it difficult to pinpoint an exact time of occurrence.

Referred hamstring pain

Pain in the hamstring region can stem from the lower back, sacroiliac joints, or buttocks.

Symptoms include:

  • Gradual onset pain at the back of the thigh.
  • Generally less severe than a hamstring strain, but occasional acute twinges may be felt.
  • Positive result on the slump test (though not always).

Read more on Referred pain

Hamstring Tendonitis

Hamstring tendonitis (or tendinopathy) commonly develops at the origin of the hamstring muscles, specifically at the ischial tuberosity of the pelvis.

Bursitis, on the other hand, refers to inflammation of the small sac of fluid located between the tendon and bone. Differentiating between the two conditions can be challenging.

Read more on hamstring tendonitis

Symptoms include:

  • Pain experienced just under the crease of the buttocks.
  • Possible tenderness and thickening of the tendon at the site of pain.

For further information, you can refer to Ischiogluteal bursitis/tendinopathy.

Tight hamstring muscles

While not considered a specific injury or direct cause of posterior thigh pain, athletes frequently experience tight hamstring muscles. In most cases, tight hamstrings do not pose a significant problem.

However, individuals with tight hamstrings may be more susceptible to other issues, such as back pain and postural issues. Consequently, their ability to train and compete at full capacity may be compromised.

Read more on tight hamstrings

Posterior compartment syndrome

Compartment syndromes develop when a muscle becomes excessively swollen, surpassing the capacity of its surrounding sheath. This heightened pressure leads to pain. Symptoms comprise dull pain in the back of the thigh, cramps, and weakness.

The condition can arise from either overuse, as seen in endurance runners, or repeated trauma resulting from recurrent hamstring strains.

Surgery is commonly regarded as the most effective treatment approach.

Other injuries causing posterior thigh pain

Other Causes of Thigh Pain:

In addition to the aforementioned conditions, it is essential not to overlook other significant causes of pain at the back of the thigh, including:

  1. Myositis Ossificans
  2. Tumours
  3. Iliac Artery Endofibrosis

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