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Thigh Pain Physiotherapy

Thigh pains refers to any forms of pain or discomfort that affects the thigh, from the pelvis to the knee.

The femur is the thigh bone that supports the entire length of the thigh and it is surrounded by

• muscles
  
• nerves
• soft tissue
• blood supply
• etc

There are ligaments which connects and secures the femur (thigh) bone to the hip, pelvic and knee bones; and tendons connect muscles to these bones as well.

Because there are so many tissues and structures that go through and in the thigh, that'd mean that there are more potential issues that can cause thigh pain.

This article covers four (4) types of thigh pains:

1. Pain at front of thigh
2. Pain at outer side of thigh
3. Pain at inner side of thigh
4. Pain at back of thigh
   

Pain at front of thigh

Quadriceps Contusion

Our quadriceps femoris is the group of muscles that's located at the front of our thigh.

They're our main thigh muscles at the front, and unfortunately any forms of direct forces to these muscles can cause damage and bleeding of the blood vessels that can lead to

• thigh bruising
• thigh swelling
• thigh pain
• decrease movement in and of the knee
  

Physiotherapy for this will depend on how severe the muscle injury is.

If it's mild injury, then what our senior physiotherapists will do is to decrease bleeding and swelling, decrease thigh and knee pain and accelerate thigh pain recovery with a combination of

• gentle to moderate clinical massage
• compression therapy
• ultrasound therapy
• exercise therapy
• manual therapy 
• and more

as well as take you through a gradual progressive thigh physiotherapy program to restore full thigh muscle power, stamina, movement and stability.

If the injury is more severe, then there will be a period of rest first before we can start thigh pain / injury physiotherapy.

Quadriceps Muscle Strain

The quadriceps femoris muscles includes four (4) muscles and is located in the front of the thigh.

The muscles are called

• vastus lateralis
• vastus medialis
  
• vastus intermedius
  
• and the rectus femoris

All and any of these muscles can be injured and strained and there are different grades of strain with regards to the injury severity.

Again, physiotherapy management and treatment is determined by the severity of the injury and strain.

Patients can expect a combination of

• cold therapy
• gentle clinical massage
• soft tissue management
• stretching exercises
• ultrasound therapy
• taping

We will also gradually progress you to improve your flexibility, strength, stability, power and function to get you back to life, work and sports.

Sartorius Muscle Strain

The sartorius muscle is long and thin that attaches to the ASIS (anterior superior iliac spine) which is at the top front of the pelvis and then it runs down and across the front of the thigh to attach to the inside of the main shin bone (tibia). T

Like any muscles, the sartorius muscle can also be strained.

Physiotherapy can help with advice, ultrasound, massage, taping and setting exercises to regain strength and flexibility of the muscle.

Femoral Nerve Pain

Our femoral nerve is formed from nerve roots that exit at the lumbar spine level and travels through the pelvis and down the front of the thigh.

The nerve can be affected where it exits the lumbar spine or any of the muscles it passes through if the space becomes tight, which causes compression / suffocation damage on the nerve.

Also nerve symptoms can occur if the nerve is directly injured ie. by pelvic fracture or if prolonged compressive pressure is applied on the nerve.

Symptoms of nerve compression will include

• pain down the front of the thigh
  
• numbness
  
• pins and needles
• the knee may feel weak and like it will give way
  
• there may be weakness felt in the knee and leg

Physiotherapy can help by working on any structures that may be affecting the nerve and provide nerve gliding / stretching exercises for the affected nerve.

Slipped Capital Femoral Epiphysis

This refers to a problem with the femur which can cause pain on the inside of the knee.

It is more common in boys around the age of 12-15 and being overweight can increase the risk of this occurrence.

The slip of the growth plate over the femur can happen suddenly or more gradually.

Perthes Disease

This is a breakdown of bone over the femoral head (top of the thigh bone) which in particular affects males between the age of 4 and 10.

Symptoms commonly include

• limp in the thigh, groin and knee
• aching pain in the thigh, groin and knee
• movement of the hip may be stiff and decreased
  

Physiotherapy can help with providing appropriate exercises to improve recovery and movement of the hip and thigh.

Referred Pain

In some cases, pain in the thigh can be caused by problem outside of the thigh, such as from

• hip
• back
• pelvis / pelvic

Trigger point in muscles outside of the thigh can also refer / radiate pain to the thigh too.

Stress Fracture of the Femur

Sometimes, patients may develop stress fracture in the femur (thigh) bone which can be caused by

• overuse
• underlying medical conditions
• direct trauma / impact

and this will cause patients to experience a deep dull-like ache in the pain which tends to worsen whenever there is pressure to the middle of the thigh.

Physiotherapy can help to maintain strength in the rest of the body while healing and to restore movement, strength and function in the affected leg once the stress fracture has healed.

Chronic Pain

Acute pain is typically due to acute / new / fresh injuries that anyone can get from falls, trauma and the like.

In contrast to acute pain, there is a long term pain that is termed as "chronic pain", which refers to pain that keeps going and continuing even though the healing has happened and there is no new injuries that surfaced.

Physiotherapy for chronic pain needs to consider and involve many aspects and address other factors that come into play rather than just the pain itself.

We will treat the pain and also use methods to help you manage your pain including

• advice on pacing and coping with flare ups and negative thoughts
• graduated exercise programmes
  
• lifestyle and work modifications
  
• goal setting

We aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can (and will) also recommend pain specialists who can help you.

Other Possible Causes

Our senior physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination.

There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment.

In this case we will recommend you to your GP or an appropriate specialist doctor or specialist consultant.

These possible causes include:

• cardiovascular symptoms
• respiratory (breathing) symptoms
• gynaecological symptoms
• urinary or genital symptoms
• digestive symptoms
• immune system symptoms
• lymph system symptoms
• hormonal symptoms
• neurological symptoms
• dermatological (skin) symptoms
• medication side-effects
• virus
• infection
• cancer
• disease process
• psychological problem ie. depression, anxiety

Pain at outer side of thigh

Iliotibial band syndrome

The iliotibial band (often abbreviated to ITB) is a large piece of connective tissue that runs down the outside of the thigh and it attaches to the top to the

1. pelvis
   
2. gluteal (buttock) muscles and
   
3. at the bottom to the outside of the knee

If there is direct damage to the iliotibial band and/or repetitive bending and straightening of the knee then this can cause or lead to pain along the main iliotibial band itself or where it inserts into the knee.

That being said, there are number of factors that can contribute to the iliotibial band becoming overused and sore, and only with a thorough assessment by our senior physiotherapists then we can determine those factors and variables (and deal with them of course).

Physiotherapy is quite effective for iliotibial tract injuries and conditions, which may include

• myofascial trigger point release
• stretching exercises
• strengthening exercises
  
• acupuncture by our in-house Chinese Physician Acupuncturist
• etc

Regular deep tissue and sports massage will be useful as well, which we provide in our Phoenix physio clinics.

Meralgia Paraesthetica

We have a nerve that is called the lateral cutaneous nerve of the thigh and it functions to supply sensation to the skin on the outer side of the thigh.

If this nerve is injured or compressed, it may lead to:

1. tingling
2. numbness
3. loss of sensation
4. burning pain
5. hypersensitivity to heat, cold etc
   

at the outer thigh.

Some of the contributing factors that can cause this condition includes:

• obesity / overweight
• seat belts that are defective or too tight
• direct trauma
• disease
• others
  

Physiotherapy can help with

• weight loss (in conjunction with our dietitian, personal trainer and Chinese Physician)
  
• strengthening exercises
  
• stretching exercises
• ultrasound therapy
• etc
  

We may also refer you to neurologists and/or orthopedist to assess and get to the bottom of the nerve compression for you.

Slipped capital femoral epiphysis

This is a problem with the femur (thigh) bone which can cause pain on the inside of the knee.

It tends to be more common in boys around the age of 12-15 and unfortunately a contributing factor is obesity / being overweight.

The slip of the growth plate over the femur can happen suddenly or more gradually.

Perthes disease

Perthes disease is a rare childhood condition that affects the hip.

It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis, leading to a breakdown of bone over the femoral head (top of the thigh bone) which typically affects males between the age of 4 and 10.

Symptoms commonly include

• a limp 
• ache in the thigh, groin and knee
• movement of the hip may be stiff and reduced

Physiotherapy can help with providing appropriate exercises and advice.

Referred pain

Pain on the outside of the thigh can actually be caused by a problem in another joint such as the hip, back and pelvis. Trigger points in muscles which are not on the outside of the thigh can also refer pain there.

Stress fracture of the femur

In some cases, patients may have overused and overloaded the femur bone causing a stress fracture, and this causes a sense of deep but dull ache in the thigh.

The pain intensifies with 

• force / pressure
• pulling forces such as hanging thigh over an edge

Immediate medical assessment and treatment is required.

Physiotherapy can help to / with

• maintain strength in the rest of the body
  
• healing and
  
• restoring movement, strength and function in the affected leg once the stress fracture has healed.

Pain at inner side of thigh

Adductor muscle strain

Our thigh adductor muscles refer to the group of muscles that is located on the inner thigh and their main function is to bring your thighs together.

There are three (3) adductor muscles called the

1. adductor magnus
2. adductor longus and
   
3. adductor brevis

Again, like all muscles, unfortunately ALL three (3) of these muscles can be strained and there are different grades of strain with concern to the severity.

Physiotherapy can help with

• cold therapy
• clinical deep tissue massage
• soft tissue techniques
• stretching exercises
• working on the back
• ultrasound therapy and
  
• taping

Exercises can be set to regain flexibility and strength of the muscle and increase general core stability around the pelvis.

Gracilis strain

The gracilis muscle is a very thin muscle that runs down the inner side of the thigh, and it can be easily strained and graded as with adductor muscle strain to extent of the injury.

Physiotherapy can help with

• cold therapy
• clinical deep tissue massage
• soft tissue techniques
• stretching exercises
• working on the back
• ultrasound therapy and
  
• taping

Exercises can be set to regain flexibility and strength of the muscle and increase general core stability around the pelvis.

Obturator nerve injury

The obturator nerve can be injured or be compromised by any one of the structures it passes through.

If the nerve is injured or compromised, then that can cause discomfort, pain and nerve-related issues to arise in the inner thigh and weakness of the adductor muscles that move your thighs towards each other can occur.

Sartorius muscle strain

The Sartorius muscle refers to a long and thin muscle of the thigh that attaches to the ASIS (anterior superior iliac spine) which is at the top front of the pelvis and runs down and across the front of the thigh to attach to the inside of the main shin bone (tibia).

Again, like all muscles, this particular thigh muscle can definitely also be strained and if strained at its lower part near the knee may feel like pain on the inside of the thigh ie it may feel like knee pain.

Physiotherapy can help with advice, ultrasound, massage, taping and setting exercises to regain strength and flexibility of the muscle.

Femoral nerve pain

Our femoral nerve is formed from nerve roots that exits the lumbar spine and travels down the front of the thigh.

This nerve can be affected

1. where it exits the lumbar spine or
   
2. any of the muscles it passes through if become tight can cause compression on the nerve
3. direct injury or
   
4. causes the symptoms if prolonged pressure is applied on the nerve.
   

Symptoms include

• pain down the front of the thigh and
  
• numbness or pins and needles in the thigh

Some patients may experience weakness in the knee like it may unbuckle or give way anytime.

Slipped capital femoral epiphysis

This is a problem with the femur which can cause pain on the inside of the knee.

This condition tends to be more common in boys around the age of 12-15 and being obese or overweight can accelerate or make this condition to worsen.

The slip of the growth plate over the femur cslian happen suddenly or more gradually.

Perthes disease

Perthes Disease refers to a breakdown of bone over the femoral head (top of the thigh bone) which typically affects males between the age of 4 and 10.

Symptoms commonly includes

• limping gait / walk
  
• ache in the thigh, groin and knee
• movement of the hip may be stiff and reduced

Physiotherapy can help with providing targeted exercises to improve muscle and joint strength and stability

Pain at back of thigh

Hamstring strain

The hamstring muscle has three parts and is located in the back of the thigh.

These 3 parts are the

1. semiteninosis
2. semimembranosis and 
3. biceps femoris

Unfortunately all and each of these muscles can be strained (yes) and there are different grades of strain with concern to the severity.

Physiotherapy can help with

• cold therapy
• deep tissue massage
• soft tissue management
• stretching exercises
• range of motion work
• ultrasound therapy
• taping

Exercise therapy will be gradually progressive to regain flexibility, stability, stamina and strength of the muscle and return you to normal lifestyle as well as sport.

Sciatic nerve pain

Our sciatic nerve is a big nerve that runs down the back of the thigh and its origin is from your lower back. If it's injured or compressed, it can cause sciatica, which has a whole slew of effects (read more in the sciatica article) but typically the sensations and pains is deep and dull.

Our senior spinal physiotherapists will do thorough back and neck pain tests to differentiate and test if your back pain or thigh pain is coming from this nerve being damaged or compressed.

We treat and help our patients with sciatica issues by

• working on the lower back
• increasing the mobility of the nerve itself
  
• working on any tissues that surround the nerve that may be causing compression or restriction on the nerve

Referred pain

Sometimes if location A is painful, the pain source may come from one or more locations away from location A.

This sounds weird, but the truth of the matter is that pain may come from trigger points in muscles in the buttock such as

• gluteus medius
• gluteus minimus and
  
• piriformis muscle

Conditions such as lumbar spondylolistheses and spondylosis can cause back of the thigh pain.

Also there can be compression where the nerves exit out of the lower back which may cause and / or contribute to pain at the back of the thigh.

When the pain is referred the symptoms normally start gradually and there may be a feeling of tightness. The symptoms are typically not as severe as compared to hamstring muscle strain and often walking and jogging is painfree.

Physiotherapy can help by carrying out an thorough assessment to work out where the pain in the back of your thigh is coming from. We will then be able to treat the problem appropriately.

Upper hamstring tendinopathy

Our hamstring tendon attaches the top of the hamstring muscle to the bone on the bottom of the pelvis can get strained, leading to inflammation and pain.

This particular condition tends to be associated with frequent sprinting and tends to be worse when warming up for activity and after activity.

Physiotherapy will help with

• clinical deep tissue release
  
• soft tissue techniques
• ultrasound therapy
  
• sports taping and 
• manual therapy
  
• going through a physiotherapy exercise program

Ischial bursitis

Our ischium is bone which is at the bottom of the pelvis deep in the buttock.

There is a small fluid filled sac known as a bursa which is located between the ischium bone and the hamstring tendon and unfortunately this bursa can become inflamed and cause pain.

For these kinds of injuries, the quickest solution is actually a referral to a sports or orthopedic doctor for a cortisone injection, followed with thigh and hip physiotherapy for full recovery.

Lower hamstring tendinopathy

For this condition, the pain is located in the lowest end of the hamstrings where the tendon attaches to the knee (which makes it sometimes diagnosed as knee pain).

The pain is often worst when warming up for activity or after activity and is found at the bottom end of the back of the thigh and most of the pain incidences with this injury particularly happens most often in sports that involve a lot of knee bending ie

• sprinting
• running
• soccer / football
  

Physiotherapy can help with

• cold therapy
• manual therapy
• ultrasound therapy
• soft tissue techniques
• taping
• stretching exercises
  
• acupuncture and
  
• appropriate physiotherapy rehabilitation exercises.

Adductor magnus strain

Our adductor magnus muscle is one of the muscles on the inner thigh which brings the leg inwards (towards the middle) and is very unfortunately often misdiagnosed as a hamstring muscle strain when it's injured due to its proximity to the hamstring muscle.

As usual, there are there (3) different grades of muscle strain as defined under hamstring strain.

Our experienced physiotherapists can help to determine with certain tests whether you have strained your adductor muscle or the hamstring.

Physiotherapy can help with

• cold therapy
• manual therapy
• ultrasound therapy
• soft tissue techniques
• taping
• stretching exercises
  
• acupuncture and
  
• appropriate physiotherapy rehabilitation exercises.

Thigh Compartment Syndrome

The compartment at the back of the thigh includes the hamstring muscles and sciatic nerve.

With specific reference to compartment syndrome there is an increased pressure in the compartment with constricts and reduce blood flow to the muscles and can lead to pain.

When the patient tries to exercise, what happens is that the muscles try to expand and contract (as how muscles work in movement) in size but are unable to do so.

Most of the time, people who develop thigh compartment syndrome are endurance athletes and those who have had a history of injury to their hamstrings.

Symptoms include:

• pain is typically dull
  
• affected leg may feel stiff
• cramps and weakness in the back of the thigh can happen during and after training

Physiotherapy can help determine if this may be the cause of your pain and we will be able to refer you to a very experienced and senior orthopedic surgeon who can help you immediately.

Hamstring Avulsion

In hamstring avulstions, what happen is top of the hamstring separates from the bone it is attached to.

Typically

• there will be sudden severe acute pain
• the hamstring muscle will curl into a ball (popeye) in the middle of the thigh at the back
• there will be a lot of swelling and bruising
  

Most of the time, hamstring avulsion happens due to high-power / demand activities and sports such as

• power lifting
• water skiing
• sports with sudden powerful sprints such as soccer, football, sprinting
• etc

A referral to an orthopedic surgeon is urgently required, and we are more than happy to recommend top orthopedic surgeons to you as added value service.

Vascular pain

The external iliac artery is located on the front and outside of the thigh but when affected patients may experience pain felt in the back of the thigh.

This particular pain is sports / activity dependent and is normally experienced with cycling and is present when the person exercises and stops when the person stops.

Physiotherapy can assess you to determine if this is the possible cause of your pain. A referral to an orthopedic surgeon is typically required, and we are more than happy to recommend top orthopedic surgeons to you as added value service.