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Massage Today
April, 2007, Vol. 07, Issue 04

Upper Hamstring Pain

By Ben Benjamin, PhD

Question: What is the best assessment test for identifying an upper hamstring tendon injury?

Answer: Resisted flexion of the knee at 90 degrees.

All three hamstrings are attached via a common tendon at the ischial tuberosity.

This is a frequent site of injury. An injured upper hamstring tendon will cause you to feel pain when sitting on a hard surface, as well as when stretching or performing strenuous physical activity.

Sometimes this injury is confused with a low back injury, which can refer pain to the lower buttock. Orthopedic testing is a good way to differentiate between these two types of injuries. Resisted flexion of the knee at 90 degrees places the greatest stress on the upper hamstring tendon, so it will cause pain if that structure is injured, but not if only the low back is injured. Another way to differentiate between these injuries is to palpate the hamstrings on both the right and left sides. If the hamstring on the painful side is more tender, you know that structure is contributing to the pain. If not, you know the pain is being referred from another location.

Resisted flexion of the knee at 90 degrees. - Copyright – Stock Photo / Register Mark

Question: How do you perform friction therapy for this injury?

Answer: When treating an upper hamstring injury at the ischial attachment, it is most effective to have the muscle-tendon unit slightly on the stretch. This is easily done by propping the lower leg on a stack of pillows or by having the client's foot on your shoulder while you sit on the table. Perform friction strokes away from the midline, compressing the tendon against the ischia.

Friction therapy performed on a upper hamstring injury. - Copyright – Stock Photo / Register Mark

Click here for more information about Ben Benjamin, PhD.


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