Table 5 Problem based approach: Ischial tuberosity (diagnoses appear in order of frequency in an athletic population)

Define and align	Pathology	Listen and localise	Palpate and recreate	Alleviate and investigate
Ischial tuberosity	Hamstring origin tendonopathy	Sudden pain in buttock/posterior thigh. Walking painful.57	Tenderness of muscle belly or tendon from common origin	MRI57 58
	Proximal hamstring tear	Sudden pain on acceleration or deceleration, localised to hamstring muscle belly. Weakness, stiffness	Tenderness, palpable haematoma or defect in muscle	Ultrasound scan,34 MRI57
	Ischial bursitis	Pain on sitting, worsens on movement. Likely to be co-existent injury with hamstring injury	Tenderness of ischial tuberosity37	Ultrasound scan38guided local anaesthetic injection34
	Ischial tuberosity apophysitis/ avulsion fracture	Shooting pain following high energy kick or change of direction.	Bogginess of ischial tuberosity tenderness to palpation59	Plain film60
	Stress fracture of pubic ramus	Gradual onset, change in training load	Pain standing on one leg and Hop test,40 associated deep buttock pain	Plain film, bone scan17 MRI18