Task 6: Diagnosis methods & assessment

According to P. Brukner, patients presenting with posterior thigh pain usually have one of two main symptoms. These are:

1. May present with sudden onset of moderate to severe pain.
2. May present with milder pain or poorly localized pain.

The first presentation is more commonly associated with injuries to the hamstring muscles, whereas the second are most likely referred from the lumbar spine or neuromeningeal structures.

When diagnosing patients, physiotherapists must determine whether the pain is local or referred (Brukner, 1993). In order to assess the patient's injury, a number of observation and active movement techniques should be performed which can be seen in the below images. These include:

  1. Observation techniques
  • Standing (Check for swelling, abnormalities)
  • Walking (Check for abnormalities, pain)
  • Lying prone (See above)

2. Active movement tests
  • Hip extension (Resist movement to determine pain, location)
  • Knee flexion & extension (Resist movement to determine pain, location)

external image Prone%20Knee%20Flexion%20Extension.jpgexternal image back-hip-extension_~MM203001.jpg

When diagnosing patients hamstring injuries, important consideration to their injury history must be taken.

Hamstring strains are graded from 1 to 3, determining the severity of the injury (See table 1)
Grade 1
Mild strain with few muscle fibres being torn.
Grade 2
Moderate strain with definite loss in strength.
Grade 3
Complete tear of the hamstrings or avulsion.
Table 1 (Oakes, H, 2004)

Patients that present with 'niggling' pain, recurrent cramping or tightness, or an ache in the hamstring region are likely to have a grade 1 hamstring strain (Khan, 1993).