Hamstring Strain

Procedure

Patient supine, examiner passively flexes the hip with knee extended until resistance or pain is encountered. Note the angle of hip flexion at which symptoms occur.

Positive Finding

Pain or tightness in the posterior thigh limiting the range, or reproduction of the patient's hamstring symptoms, with asymmetry compared to the unaffected side.

Interpretation

Reduced or painful straight leg raise is consistent with hamstring injury or reduced posterior chain extensibility, and comparison with the unaffected side is more informative than any absolute angle. Bear in mind the straight leg raise also loads the sciatic nerve, so a positive result does not distinguish muscle from neural involvement on its own — add the slump test or ankle dorsiflexion to differentiate. The previously cited source was a textbook rather than primary research, and the accuracy figures it was said to support could not be traced to any study.

Procedure

Patient sits upright at the edge of the plinth, hands behind the back. In sequence: slump the thoracic and lumbar spine, flex the neck (chin to chest), extend the knee on the tested side, then dorsiflex the ankle. Stop at the first symptoms. Then ask the patient to lift the head (release neck flexion) and note any change.

Positive Finding

The patient's posterior thigh pain is reproduced in the slumped position and eases when the neck is released. Pain that does not change with neck movement points to the muscle rather than the nerve.

Interpretation

Suggests a neural contribution to posterior thigh pain rather than isolated muscle injury. Useful alongside the straight leg raise to separate neural tension from hamstring strain, particularly where symptoms extend below the knee. Published accuracy figures for the slump test concern lumbar disc pathology and neural tension, not hamstring strain, so no figures are shown here.

Procedure

Patient prone. Examiner passively flexes the knee, bringing the heel toward the buttock, and notes the range achieved and where symptoms are felt. If symptoms are unclear, the hip may then be passively extended to add femoral nerve tension.

Positive Finding

Pain or tightness in the ANTERIOR thigh, or reproduction of anterior thigh or groin symptoms. Anterior thigh pain indicates rectus femoris tightness; pain extending into the anterior thigh with added hip extension suggests femoral nerve involvement.

Interpretation

This test loads the quadriceps and femoral nerve, not the hamstrings — knee flexion SHORTENS the hamstrings, so it cannot stretch them. On a hamstring page its value is exclusionary: it helps confirm that anterior thigh structures are not the source of the patient's pain. A negative prone knee bend alongside a positive straight leg raise supports a posterior (hamstring) origin. Note that cramping in the posterior thigh during this test reflects the hamstrings working in a shortened position and is not evidence of hamstring strain.

Procedure

Patient prone or side-lying. Examiner palpates the medial hamstrings (semimembranosus/semitendinosus) and lateral hamstring (biceps femoris) for tenderness, swelling, or palpable defect.

Positive Finding

Localized tenderness, muscle spasm, palpable gap or induration, or reproduction of patient's reported pain

Interpretation

Localises the injury and helps grade its severity. Point tenderness maps the lesion along the muscle; a palpable gap or defect raises concern for a high-grade tear or avulsion and warrants imaging. Palpation is sensitive but not specific — tenderness is common in the days after any posterior thigh injury — so use it to locate the problem rather than to confirm the diagnosis. The figures previously shown were attributed to a hamstring injury classification study that does not report palpation accuracy.

Procedure

Patient supine at edge of table. One knee is flexed to chest to flatten lumbar spine. Opposite leg hangs. Note hip extension range and any posterior thigh tightness.

Positive Finding

Inability to achieve hip extension on the hanging leg; increased hamstring tightness or pain in posterior thigh when attempting full hip extension

Interpretation

Identifies hip flexor tightness and compensation patterns that may contribute to hamstring overload, particularly in recurrent strains. This is a contributing-factor assessment used to guide rehabilitation; the Thomas test does not diagnose hamstring strain and has no accuracy figures for it. The previously cited source was a textbook rather than primary research, and the accuracy figures it was said to support could not be traced to any study.

Procedure

Patient supine with the uninjured leg strapped or stabilised. The patient actively raises the injured leg as fast as possible with the knee straight, keeping the ankle relaxed. Compare the maximum active range and the confidence of the movement with the uninjured side.

Positive Finding

Insecurity, apprehension or reproduction of symptoms during the fast active raise, or a reduced active range compared with the uninjured leg.

Interpretation

A return-to-sport readiness test rather than a diagnostic one. It is performed actively and at speed because that reproduces the demand under which hamstring injuries recur, and the patient's own sense of insecurity during the movement is a meaningful finding in its own right. Persisting apprehension or a side-to-side deficit suggests the athlete is not ready to return to sprinting, even when strength testing appears normal. Use it to time return to play, not to make the diagnosis.

Procedure

Patient performs a series of single-leg hops on the affected leg. Assess pain reproduction, hop distance or height, and quality of landing, comparing with the unaffected side.

Positive Finding

Pain during hopping or landing, inability to complete the task, or a meaningful deficit compared with the unaffected leg.

Interpretation

A functional loading test used to judge readiness to progress rehabilitation, not to diagnose hamstring strain. Comparison with the unaffected leg is what carries the information. Note this test is unrelated to the Askling H-test and the two are performed for different purposes — the hop test assesses tolerance to impact loading, the H-test assesses tolerance to rapid lengthening.