OPTM Therapy | Differentiating Nerve Pain vs Hamstring Pain
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Differentiating Nerve Pain vs Hamstring Pain

Posterior thigh pain is a common complaint in active patients under 55 years old. They often describe a pain that has been present for many months. These patients may try self-treating the symptoms with hamstring strengthening and stretching exercises which actually exacerbates the posterior pain.  The healthcare provider needs to differentiate the source of the pain since it dramatically affects the treatments.



  • Patient can attribute pain to a specific incident – usually during a quick eccentric contraction.
  • Local pain in posterior thigh. May be a localized tightness.
  • Activity tends to increase symptoms
  • Better in sitting

Physical Findings:

  • Initial injury frequently associated with profuse hemorrhage and ecchymosis
  • Pain with stretch, contraction, and focal palpation (proximal middle muscle, less frequent Ischial Tuberosity)
  • Muscle healing may take 6-8 weeks. Responds well with modalities, strengthening, and stretching.
  • Lingering focal tenderness to palpation up to a year post-injury.

Sciatic Nerve Pain


  • May be a nonspecific incident with a gradual onset.
  • Pain may radiate distal to the hamstring. Focal location of pain can change
  • Often worse with sitting, running, or pressure on the gluteal/upper posterior thigh area
  • Better with walking or standing
  • May or may not have low back pain.

Physical Findings:

  • No superficial visual cutaneous changes
  • Pain: Increases with stretch and may decrease with active knee flexion. Spinal position can effect pain.
  • Neurology: Positive Slump test (figure 1), Bowstring test. Reflex, strength, or sensation changes in the lower extremity.
  • Local pain with palpation along the course of the nerve or in the muscles it innervates.

The persistent posterior thigh pain which is not improving is often an irritation of the sciatic nerve. The patient needs to discontinue stretching the irritated tissue and pay attention to aggravating factors. A lumbar spine evaluation should be performed to identify the site or tissue causing the nerve irritation. Physical therapy treatment often includes body mechanics and ergonomic training, spinal decompression, specific dynamic control exercises, and manual therapy to promote a proper healing environment.