Posterior Thigh Pain Part 2 - Management of Muscle Pain

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One of the most common presentations I see is posterior thigh pain. However, depending on the source of symptoms, the management of posterior thigh pain, especially in the early stages, can be very different. While there are just a handful of common reasons for pain in this area, they can occur concurrently, or the mechanism behind the symptoms can change over time, making management tricky.

Rehabilitation is required to resolve most posterior thigh pain and extended rest is never best, but unless you (and your health professional) recognise the source of your symptoms, recovery can be drawn out. It’s not uncommon for me to meet clients that have posterior thigh pain that limits their training for YEARS. It honestly shouldn’t be this way. In general, posterior thigh pain is very ‘treatable’.

The first post in this series briefly outlined the most common reasons for posterior thigh pain. Read the blog here.

This post will focus on management if the source of your posterior thigh pain is muscular.

Posterior thigh pain Part 2 - Management of Muscle Pain

Posterior thigh pain is most commonly related to one of the hamstring muscles (semitendinosus, semimembranosus and biceps femoris) or adductor muscles (usually adductor magnus, gracilis). Luckily pain related to these muscles doesn’t always mean that you have damaged a muscle, but appropriate management means making an early educated call.

Delayed Onset Muscle Soreness (DOMS)

DOMS is muscular pain that occurs after intense training that peaks 24-48 hrs post-workout and resolves completely within 3-5 days. The exact mechanism behind this phenomenon is not entirely understood, but the pain is likely a symptom of increased inflammation in response to the workout demands. As DOMS is not felt during the workout or for some time after, it’s not best explained by damage, trauma or lactic acid. 

It’s most likely DOMS if;

• You experience deep achy pain 24-48 hours after an intense workout or doing something new.
• It settles after a few days.
• While training, you didn’t notice it and have no bruising or pins and needles.
  

What to do:

• Don’t be worried. DOMS is a sign your body is adapting to increase your capacity
• Try walking, gentle stretching, massage, release, and heat to settle the pain.
• It is ok to train with DOMS, but it may be an excellent opportunity to prioritise recovery to get the most out of your training.
  

Be aware:

• If the pain does not settle, you should seek professional advice.
• It isn’t advantageous to push yourself until you experience DOMS after every workout, especially if you aren’t prioritising recovery.
  

Muscle strain‍

A muscle strain is a clinical diagnosis of muscle pain that reflects a low likelihood of muscle tear but recognises probable micro-trauma to the muscle. Simply, You probably haven’t torn the muscle, but it’s injured and requires healing (In contrast, with DOMS the muscle isn’t injured, so doesn’t require time to heal.)‍

It’s most likely a strain if;‍

• You notice mild tightness and pain during or straight after training that’s local to one muscle group.
• You have been overtraining, under recovering, or both.
• You experience mild pain activating and stretching the muscle, without bruising, swelling, pins & needles, numbness or weakness.
• Your symptoms are much better after a week.
  

What to do:

• If you notice increasing tightness with pain as you train, don’t push through this. You can keep training but minimise the loading of this muscle group. Prioritise things that feel good or train other areas.
• Prioritise recovery activities and sleep. 
• Try relative rest, general movement, gentle stretching, massage, and heat to settle the pain.
• It’s ok to train, but deload that muscle group for a week or two. Your risk of injury at this time is increased.
  

Be aware:

• If the pain remains after two weeks, you should seek professional advice.
• No recovery technique, training or nutrition is a substitute for good sleep or training too much too soon.‍

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‍Muscle tear
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A muscle tear means that muscle fibres have been damaged, and the integrity and function of the muscle are impaired. A muscle tear can usually be seen on a scan, but often low-grade tears are diagnosed clinically according to the presenting signs and symptoms.‍

It’s most likely a tear if:

• You experience sudden, local pain in a muscle you are loading.
• You are loading a muscle group heavily, at end range or suddenly/without control.
• It’s painful to stretch or activate the muscle.
• You will often experience reduced range, strength and function.
• You are likely to notice bruising and swelling, though this may not show for hours/days.
• You may hear or feel a pop.
  

What to do:

• PEACE

• P- Protect- Stop training immediately and avoid aggravating activities for at least a week or until you receive guidance from your health professional. If you cannot walk without limping, this means crutches for at least a few days.

• E- Elevate- Rest the leg up, ideally above your heart, as often as you can for the first few days.

• A- Avoid anti-inflammatories and ice unless you cannot manage the pain in other ways. Inflammation is an essential part of the bodies healing process. Minimising local inflammation can reduce the tissues healing capacity.

• C-Compression- While it is hard to compress the posterior thigh effectively, compression tights and bandaging can help manage pain, which will allow you to move more normally.

• E-Education. Consult with a healthcare professional who is experienced in managing muscle tears. They will make sure you are on the right track and get you started on the right rehabilitation protocol as soon as possible.

Be aware:

• All muscle tears require a period of relative rest, deload and rehabilitation. 
• It can take up to a year for muscle fibres to heal to close to pre-tear strength. You may experience symptoms for this length of time.
• A healed muscle will be at a greater risk of re-injury than non-injured tissue, so it’s crucial to increase the capacity of the tissue beyond its pre tear level.
• In the case of a high-grade tear or total rupture of a hamstring muscle, surgical intervention may be required.

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Want to learn more? Check out these related blog posts!

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Stretching and Injury Risk

Stretching and flexibility training are actually relatively low-risk forms of exercise compared with things like team sports and running. 

Pain and Stretching

Pain and Stretching. Think pain means you are stretching incorrectly? Read on! 

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