Bilateral hamstring pain from DISC (even though MRI is clean?)

1st Order:

• 37 YO Female
• L – Bilateral posterior thigh
• Q – ache
• I – 5/10
• P+:
• • contracting the hamstrings,
  • walking up stairs (feels like it’s about to pull), 1x/week it does pull and its sore for a few days
  • bending (5 mins of yoga or any exercise)
  • can’t deadlift 40 pounds for 1 rep (used to be able to do much more)
• P-:
• • rest
  • static stretching

Initial Dx Hypothesis:

1. Significant hamstring adhesion
2. Low back disc referral

Not happy with this Dx. I don’t like hamstring adhesion alone.

2nd Order:

Onset: 14 months ago, the symptoms started 1 week after her last fitness competition during rest, progressively worse since.

6 YA – slipped a disc in low back and her “hips go out a lot”

She can’t squat deep, thinks she is compensating with calves and feet because of this (had 1 month episode of plantar fasciitis in Feb 2018). Upon further questioning, she has bilateral foot pain when she isn’t wearing her crocs.

Upon the history, it was very apparent that there are psychosocial aspects to her pain. She was hyper-concerned about her body image. She claims to be hyper-sensitive to pain.

 Dx Hypothesis:

1. Significant hamstring adhesion
2. Low back disc referral
3. Psychosocial layer

Exam:

SLR:

• R – 95 degrees, severe tightness distal posterior thigh
• L – 97 degrees, moderate stretch distal posterior thigh to calf

SHF:

• R – 1f, mild right anterior hip pain
• L – 0f, mild left anterior hip discomfort

QLF:

• 3/4″ – 4 1/4″ extended – no symptoms (20%)

KHE:

• R – 12.5″, severe pain whole right anterior thigh and the left thigh feels weak (confirms disc?)
• L – 12.5″, moderate tightness whole left anterior thigh

SLPF:

• full, mild bilateral posterior thigh tightness

Sitting and bending to lace shoes up:

• Right posterior thigh tingling.

Glute bridge:

• right posterior proximal thigh, mild increase in tension (confirms disc?).

– Cannot do a standing quad stretch (did not have her test).

Palpation:

• significant adhesion in lumbar erectors
• moderate adhesion at R Sci n @ ext rots
• mild adhesion at L Sci n @ ext rots
• I did not palpate hamstrings because I was convinced of disc referral after exam (esp. with SLR being full)

Diagnosis:

1. Adhesion
2. LB Disc Referral
3. Psychosocial

MRI ordered after exam before treatment started:

I haven’t seen the images myself yet, but the only finding was “Slight disc bulge at L4-L5 without stenosis”.

Questions:

1. I’m not super clear on how much we can trust an MRI or MRI report for disc pathology. I believe Bill says “History and Exam findings trump imaging.”  I still think this is a combination of DISC + Psychosocial. Would I be right or is DISC ruled out? KHE on the R confirms that for me.

She comes in today and I will palpate the hamstrings directly. But at 95 degrees, I don’t expect to find much. I know she can be an outlier.

Anything else I may be missing?