Hamstring Strain vs. Sciatica

Posted On: September 1, 2017

This is the nineteenth case review from my past practice. I am Dr. David Johnson a chiropractor and physical therapist in Highland Park and Lake Bluff. I am the director of North Shore Spinal and Sports Rehabilitation. I started as a chiropractor in Lake Forest Il in 1988. I integrated physical therapy into my practice in 1990.

This is a composite case one that has played out in my practice with many a distance runner in my practice over the years. The case I am going to describe is a 35-45 year old, male who comes in with a “hamstring strain” on a particular side that has been bothering them for 3-4 months.

I typically ask them how did you strain your hamstring? The response is typically, “I don’t know it just started acting up one day.” I then ask does it hurt when you run up hills. This type of patient will typically respond that it doesn’t and that running actually makes it feel better. I then ask does it hurt on long car rides? Often times the answer is yes that long car rides are the worst.

I proceed with my exam. I will have them lie on their back and raise their leg stretching the hamstring. I will elevate slowly to see if it starts to bother them. If it does I stop and have them push their heel into my hand with about 10% of their effort. I hold my hand in place. In 9 out of 10 cases this relieves their discomfort. I then pull on their foot to flex the ankle. If this increases their pain I know it’s not their hamstring.

I explain to the patient you don’t have a chronic hamstring strain but rather a subtle sciatic problem. Typically I get some push back, at this point. I then explain that a hamstring strain usually has an acute injury at the start and hurts when you run up hill. I also explain that prolonged sitting in a forward flexed posture. Loads the discs of the lumbar spine and can provoke sciatic complaints causing sciatica. I then point out that when I had them contact their hamstrings it didn’t provoke their problem but when I put more tension on the sciatic nerve it did.

Then I examine their lumbar ranges of motion and perform appropriate neurologic testing. Typically in this type of case the patient responds to extension orientated exercises like prone press ups popularized by the McKenzie Method. At North Shore Spinal and Sports Rehabilitation we then progress them into spinal stabilization and nerve mobilization.

These patients often respond quite favorably and have recovered within two-three months and continue to do well if they keep up with their home exercises.