Hamstring syndrome

Findings

An athlete gives a history of sciatica, with night pain, leg pain, “pins and needles” and numbness that is worse with exercise. This is differentiated from spinal sciatica by testing the athlete whilst sitting. When the back is tested with the patient standing, the back movements will also stress the leg muscles, which may be the source of pain. If the back is tested with the athlete seated then the leg muscles do not contribute and pain is likely to be from the back. Peripheral nerve stress tests, straight leg raise and Lasegue’s test are positive, but slump test, Valsalva and Kernig’s test are negative. Straight leg raise might be worsened with internal rotation of the hip, as this bows the sciatic nerve across the biceps femoris at its attachment to the ischial tuberosity. Localized tenderness over the lateral ischeal tuberosity may be palpated and may produce leg pain.

Cause

The sciatic nerve is bowed and irritiated by the biceps femoris attachment to the ischeal tuberosity.

Treatment

Adverse neural tensioning with the leg internally rotated, together with perineural cortisone injection around the lateral ischeal tuberosity to reduce inflammation. Surgical release of the biceps femoris origin.

Sports

None are clinical relevance. Rehabilitation will go via Hamstring ladder.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English