Hamstring tightness

Hamstring spasticity?This was the question which confused me when I saw a 61 year old man who also have right sided hemiparesis for last 11 years. He developed right side hamstring stiffness with severe pain for the last one month which developed almost insidiously without any relevant history. At first instance its looks like severe spastic case as he is an right side hemiparetic, but it turns out to be a different case. Let us have a look at an interesting case study.

Case Study

He is 61 year old male who is also right sided hemiparetic for last 11 years. He has a complain of right side hamstring stiffness with severe pain and any attempt to straighten the leg is very painful. Thinking it to be a normal pain they continued with the massage of thigh from their family masseuses. They could not find any relief even after 10 days of massage which made them to contact their family physician. The family physician suggested them to contact orthopaedic doctor.
Orthopaedic doctor diagnosing it to be a spastic case referred it to physiotherapist for further management.  The physiotherapist used to give stretching which was very painful for him and after 2 weeks for of continuous physiotherapy there was slight changes but without any significant improvement in pain and stiffness. Right after this they approached us for physiotherapy; our findings were quite different when we closely examined the case.

Our findings.

  He is an averagely built 61 year old man. Since he is an right sided hemiparetic there is still slight tightness in the postural muscle of upper and lower limb. There is absence of finger movement and grasp strength is nil. He walks with stick and there in no dorsi-flexion in the ankle joint. He has developed hamstring stiffness which keeps knee in flexed position of around 100 degree. Upon palpation we found that the hamstring in tout position especially the medial part of hamstring. He described that one month back pain first started to develop in the ankle, and then pain ascended upward in the calf muscle. After one week there was severe swelling with pain in the knee. With painful knee he gradually experience severe pain in back of thigh which ultimately led to stiffness. Out of panic they applied hot treatment over the knee and back of thigh which further aggravated the condition.  All this developed within the span of one week.

Due to his hemiparesis its give an impression that it is case of severe spasticity, but the insidious onset of pain, swelling, stiffness and the way pain progressed gives an idea that it could be case of severe hamstring spasm.

Our treatment.

We took the case as severe spasm and planned our treatment. We initially thought that hot fomentation would work but his history reveals that it has aggravated the pain. So we decided to give brief icing using ice pack or cold pack over the knee and hamstring. Brief icing greatly reduced the pain and to some extent the stiffness. Icing combined with brief stretching for 15 days was enough to make the patient come to normal.

Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.