Table 4 Pathoanatomic approach; posterior to the triangle (diagnoses appear in order of frequency in an athletic population)
Define and AlignPathologyListen and LocalisePalpate and RecreateAlleviate and Investigate
Medial to the triangleHamstring tendinopathySudden pain in buttock/posterior thigh. Walking painful.37Tenderness of muscle belly or tendon from common origin.Magnetic resonance imaging,37 association between proximity of muscle defect to ischial tuberosity and recovery.38
Referred painDiffuse ache, may not have back pain.“Lasègue” straight leg raise (sensitivity 72–97%, specificity 11–66%).39 Braggard’s sign (94% +ve).40Response to lumbar mobilisation,41 guided nerve root injection,42 magnetic resonance imaging.
Ischial tuberosity apophysitisAge group 15–25 years.23 Shooting pain following high-energy kick or change of direction.Pain standing on one leg and Hop test,39 associated deep buttock pain.Plain film x-ray, magnetic resonance imaging.43
Piriformis tendinopathyHamstring origin pain with gradual rather than sudden onset and/or sciatic referred pain.Tenderness over sciatic notch and aggravated by flexion, adduction, and internal rotation (Lasègue sign) of the hip44; also FAIR test,45 Pace Test.39Ultrasound-guided injection.46