The assessment and management of chronic hamstring/posterior thigh pain

Hamstring injuries have a high incidence and recurrence rate. Much is understood with regards to the mechanism of hamstring injury, with eccentric loading at fast rates being important. Little is known about the aetiology of hamstring injury, with age and previous injury being the only causative factors with robust scientific support. Clinically, it can be difficult to differentiate between a lesion occurring in hamstring tissue and pain that is experienced in the hamstrings that is referred from elsewhere. The use of specific examination procedures such as the slump test and the straight leg raise, supplemented with other sensitive and specific tests can help in the differential diagnosis. This chapter will explore the aetiology of chronic hamstring injury/posterior thigh pain, will discuss the differential diagnosis of chronic hamstring/posterior thigh pain, and present a model for the management of these injuries.