Proximal Hamstring Tendinopathy: Differential Diagnosis Guide for PTs
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In today's video we go over, Proximal Hamstring Tendinopathy: Differential Diagnosis Guide for PTs:
Struggling to confidently differentiate proximal hamstring tendinopathy from the dozen other causes of posterior hip pain? This video is your clinical cheat sheet.
As a physical therapist, you know how easy it is to misdiagnose posterior hip pain — and how costly that mistake is for your patient's recovery. In this video, we'll walk you through a systematic, evidence-informed approach to diagnosing proximal hamstring tendinopathy so you can stop second-guessing your clinical reasoning.
What You'll Learn:
Key subjective presentation clues (sitting pain, uphill running, warm-up effect)
How to accurately palpate the ischial tuberosity
Resisted hamstring testing: prone vs. supine variations
Special tests: Puranen-Orava Test, Bent Knee Stretch Test & Modified Bent Knee Stretch Test
Full differential diagnosis walkthrough to rule out what's not a hamstring tendon issue
Differentials Covered (So You Don't Miss Them):
- Complete hamstring tear/avulsion fracture
- Lumbar spine & SI joint pathology
- Hip OA, FAI & labral pathology
- Ischiofemoral impingement
- Piriformis syndrome / sciatic nerve irritation
- Pelvic/femoral bone stress injury
TIMELINE
- 0:00 - Intro – Why Accurate Diagnosis Matters
- 0:14 - Who Gets Proximal Hamstring Tendinopathy?
- 0:42 - Subjective Presentation & Symptoms
- 1:40 - Palpation of the Ischial Tuberosity
- 2:12 - Resisted Knee Flexion – Prone Testing
- 2:35 - Resisted Knee Flexion – Supine Testing
- 3:05 - The Puranen-Orava Test
- 4:07 - Bent Knee Stretch Test
- 4:23 - Modified Bent Knee Stretch Test
- 4:34 - Differential Diagnosis Overview
- 4:39 - Hamstring Tear & Avulsion Fracture
- 5:36 - Lumbar Spine & SI Joint Pathology
- 6:24 - Hip OA, FAI & Labral Pathology
- 7:02 - Ischiofemoral Impingement (IFI)
- 7:48 - Piriformis Syndrome & Sciatic Nerve
- 8:55 - Bone Stress Injury
- 9:21 - Summary
Hamstring?!?
- Dan Pope DPT,OCS,CSCS
Show Notes / Relevant Articles:
- FPF Mini Course - 7 Reasons Why Injuries Happen in the Gym and What to do About it
- What Physical Therapists NEED to Know About Hamstring Strain Injuries
- Patellofemoral Pain MASTER Class
- What Physical Therapists Need to Know About Adult Hip Dysplasia
- What Physical Therapists Need to Know About Femoral Acetabular Impingement Syndrome
- Femoral Acetabular Impingement Treatment WITHOUT Surgery! [Physical Therapist's Guide]
Want to earn some CEUs for physical therapists, physical therapy assistants & ATCs for watching this content? Click HERE to sign up for FPF "Insiders Academy" for just a dollar. You can earn CEUs for watching this content. Plus, you'll gain access to over 14 MASTER courses, 50+ cheat sheets, 100+ webinars, e-books and complete guides. You'll also get private access to the "Insiders Academy" community where you can have all of your questions answered by me.
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Thank you!
Dan Pope DPT, OCS, CSCS
References:
- Grimaldi A, Mellor R, Nasser A, Vicenzino B, Hunter DJ. Current and future advances in practice: tendinopathies of the hip. Rheumatol Adv Pract. 2024 Apr 10;8(2):rkae022. doi: 10.1093/rap/rkae022. PMID: 38601140; PMCID: PMC11003818.
- Cacchio A, Borra F, Severini G, Foglia A, Musarra F, Taddio N, De Paulis F. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med. 2012 Sep;46(12):883-7. doi: 10.1136/bjsports-2011-090325. Epub 2012 Jan 4. PMID: 22219215.
- Gómez-Hoyos J, Martin RL, Schröder R, Palmer IJ, Martin HD. Accuracy of 2 Clinical Tests for Ischiofemoral Impingement in Patients With Posterior Hip Pain and Endoscopically Confirmed Diagnosis. Arthroscopy. 2016 Jul;32(7):1279-84. doi: 10.1016/j.arthro.2016.01.024. Epub 2016 Mar 25. PMID: 27020393.