Posterior thigh pain in a pole dancer.

Hi All,

I was hoping that someone could come up with some ideas for me in terms of assessment and treatment for this tough case.


S/
27yo Female. 6/12 Hx L posterior thigh pain. Insidious onset. Believed it was a hamstring tear - but there was no traumatic incident and pain is only when stretching the hamstring for stretch class when at pole dancing (no 24hr pattern). The pain is very sharp in nature, and is mildly eased with repeated stretching. There is no P+N/Numb/C/Ce symptoms at all. There is no LBP or other leg pain at all. SHx- x2/7 poledancing classes, Runs 10km on flat ground x1/7, x2/7 stretching classes when at pole dancing. Works in full time in IT (sedentary job).

Prior to first treatment the patient was treated twice a week for 3 weeks by another physio who got her to sit on icepacks then massaged it for 5 mins. There was no result from this treatment. This physio diagnosed it as a Hamstring tear.

O/
SLR R) 120deg R1 140deg R2; L) 90deg P2
Resisted HS R weaker
Tender on Palpation Mid HS belly (semimem/ten)
Tight L Lateral gastroc +++
Tight R IlioPsoas++
Tight L Adductor long +(mild)

I/
Bent leg raise technique (mulligan)
Deep tissue massage lateral gastroc and hamstring
Myofascial release lateral gastroc and right hipflexor
Dry needling Hamstring
HEP - stretching HS, calf and R hipflexors x5-10 per day.
- self bent leg raise technique.

E/
SLR R=L 120deg R1, 140deg R2

Well there are all the details. Any ideas? My initial thoughts was just multiple Hamstring trigger points. Now after findings in the calf and contralateral hipflexors I'm not sure. Perhaps there is scar tissue build up in the posterior thigh which is contacting the hamstring and sciatic nerve?

Any and all suggestions would be greatly appreciated.

Thanks,
JayPhysio

Hi Jay,

Have you tried a slump test or any other types of neural mobilisation work (sliders) and if so have you found them helpful?

Also what is her core and pelvic stability like?

One technique that I was meaning to try next session was an active sciatic nerve slider. Pelvic stability was also on the cards to be assessed next, although on quick assessment both gluts had good dynamic stability.

The bent leg raise technique (Mulligan technique) does work similar to a slider, and does give good immediate change in the SLR.

Hi Jay

Have you looked at thoracic and lumbar ROM, with the pts socail history there may be some compensation issues when shes doing pole dancing and possibly lack of movement in these areas may be having a knock on effect. Just an idea m8

Hmm, considering the bent raise technique has a good immediate effect I think that it sounds like you're on the right track. I agree with 'physicol' that lumbar Ax/ mobs may be appropriate if dysfunctional but you may also (if you have not already) want to ax for piriformis tightness (again dry needling may do wonders).

Hope this has been of some assistance :)

Hi
Have you checked strength (L) versus (R) hammies with dynamometer?
Pain pattern sounds like it might be hamstring origin tendinopathy/partial tear or central tendon tear- slow to heal like most tendinopathies and aggravated by aggresive stretching - could confirm with ultrasound diagnosis?
If so she probably should stop stretching it and focus on hammy strength training(eccentric/concentric inner and outer ROM)