Puranen-Orava Test

Whether you're a beginner or an expert, this guide will help you master the Puranen-Orava Test and achieve your goals.

By Telita Montales on Aug 2, 2025.

Fact Checked by Nate Lacson.

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What is proximal hamstring tendinopathy?

Proximal hamstring tendinopathy is a chronic condition affecting the tendons of the hamstring muscles near the hip. It often causes deep, dull pain in the posterior thigh and buttocks, which worsens everyday tasks like running, sitting, or climbing stairs. This condition primarily affects athletes, especially runners and soccer players, but it can also occur in non-athletes who engage in activities that strain the hamstring muscles excessively.

Common risk factors for chronic proximal hamstring tendinopathy include overuse or a sudden increase in physical activity, poor biomechanics, inadequate warm-up or stretching routines, and previous injuries to the hamstring muscles. Due to its similar symptoms, this condition can also be misdiagnosed as sciatica or lower back pain.

Proximal hamstring tendinopathy symptoms

The most common symptom of proximal hamstring tendinopathy is pain in the posterior thigh or buttocks, in the region of the ischial tuberosity (sit bones), which can range from mild to severe. This pain occurs when stretching or contracting the hamstring, such as running, jumping, or sitting for prolonged periods.

Other symptoms of affected proximal hamstring tendons may include stiffness, weakness in the affected leg, and difficulty performing normal daily activities. In some cases, the affected area may also have swelling and tenderness.

If left untreated, proximal hamstring tendinopathy can become chronic and significantly impact an individual's ability to participate in physical activities. It is important to seek medical attention if symptoms persist or worsen.

Causes of this type of tendinopathy

There are several potential causes of proximal hamstring tendinopathy. Some of these include:

Overuse or repetitive strain: Engaging in activities that involve frequent and forceful stretching or contracting of the hamstring, such as running, jumping, or sitting for prolonged periods.
Muscle imbalances: Weakness in the gluteal muscles and tightness in the hamstring can strain the tendon excessively.
Age-related degeneration: Our tendons become less elastic and more prone to injury as we age.
Previous injuries: A history of previous hamstring injuries, like knee flexion or tendon thickening, can increase the likelihood of developing proximal hamstring tendinopathy.
Poor biomechanics or posture: Improper movement patterns or poor posture can place extra stress on the hamstring tendon.

Puranen-Orava Test Template

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What is the Puranen-Orava Test?

The Puranen-Orava Test is a physical examination designed to assess proximal hamstring tendinopathy. It was first introduced in 1995 by Dr. Sakari Orava and Dr. Juhani Puranen, two renowned surgeons specializing in sports medicine. This test involves a series of exercises that target the hamstring muscles and their tendons, helping to identify any abnormalities or weaknesses.

How is this test conducted?

Here are the steps to the Puranen-Orava Test:

Ask the patient to stand with the hip flexed as close to 90 degrees as possible and the knee of the symptomatic leg extended, foot resting on an elevated surface.
Instruct the patient to lean forward while keeping the knee of the symptomatic leg fully extended.
The patient should reach as far forward as possible, aiming to touch their toes.
Carefully observe the patient's movement and facial expressions for any pain or discomfort. You may also ask the patient to indicate if they experience any pain or discomfort during the test.

How are the results interpreted?

If the patient experiences pain in the hamstring or buttocks, it is a positive test, indicating possible proximal hamstring tendinopathy or the presence of scar tissue that forms after hamstring injuries. However, some level of discomfort is to be expected as some people may not have flexible hamstrings. Moreover, if the patient feels pain in the buttocks, other potential causes should be investigated such as sciatic nerve irritation because this test can trigger it in some patients. As such, this test is often used with other physical assessments and pain provocation tests, such as palpation of the hamstring tendon and range-of-motion tests, to confirm a diagnosis of proximal hamstring tendinopathy.

How is this different from the Bent Knee Stretch Test?

The Puranen-Orava Test test is similar to the Bent Knee Stretch Test because they are both assessments for hamstring tendinopathy, but the main difference is that the Puranen-Orava Test is done standing up and without assistance from an examiner. In the Puranen-Orava Test, the patient extends their leg, rests it on a raised platform, and reaches for their own toes; in the Bent Knee Stretch Test, the examiner flexes the hip and the knee before extending the knee.

To learn more about the Bent Knee Stretch test, click this link.

How to use our Puranen-Orava Test template

We offer a detailed template to assist healthcare practitioners in conducting and recording the Puranen-Orava Test. Follow these steps to use our template:

Download the template: Download our free Puranen-Orava Test template on the Carepatron app or via the button on this page.
Fill in patient details: Enter the patient's information and medical history.
Conduct the test: Follow the steps outlined here. They are also in the template.
Record observations: Document the patient's reactions and any pain experienced.
Interpret results: Use the recorded data to determine the presence of proximal hamstring tendinopathy.

It is important to remember that early diagnosis and treatment of proximal hamstring tendinopathy can greatly improve recovery time and prevent further injury.

Benefits of conducting this test

The Puranen-Orava Test is a quick and simple test that can help identify the presence of proximal hamstring tendinopathy. By using our template and conducting this test, healthcare professionals can accurately diagnose this condition and develop appropriate treatment plans for their patients. Early detection of proximal hamstring tendinopathy can prevent further damage and improve recovery time.

Moreover, documenting the results of the Puranen-Orava Test provides valuable information for future reference. It allows healthcare professionals to track the condition's progression and monitor the effectiveness of treatment methods. It can also serve as evidence for insurance claims or legal purposes.

In addition, this test can help identify potential risk factors for proximal hamstring tendinopathy, such as poor form during physical activities or muscle imbalances. This information can be used to prevent future injuries and optimize performance.

Proximal hamstring tendinopathy treatments

Treatment for proximal hamstring tendinopathy typically involves a combination of rest, physical therapy, and other non-invasive methods. In severe cases, surgery may be necessary.

Rest: Avoiding activities that trigger the condition is crucial in allowing the tendon to heal. This may mean taking a break from sports, modifying daily activities, and avoiding anything that entails knee extension.
Physical therapy: A physical therapist can prescribe exercises and stretches to help strengthen and stretch the affected muscles and tendons. They can also guide proper form during activities to prevent future injuries.
Anti-inflammatory medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help reduce pain and inflammation in the affected area.
Corticosteroid injections: In some cases, corticosteroid injections may temporarily relieve pain and inflammation.
Extracorporeal Shock Wave Therapy (ESWT): This non-invasive treatment uses high-energy sound waves to stimulate healing in the affected tendons.
Surgery: Surgery may be necessary in rare cases where conservative treatment methods are ineffective. This typically involves removing damaged tissue or reattaching torn or ruptured tendons.

Recovery time for proximal hamstring tendinopathy can vary depending on the severity of the injury and individual factors. In most cases, following a treatment plan and allowing adequate rest and rehabilitation will result in a full recovery within several weeks or months. However, following proper preventative measures is also crucial to avoid future re-injury.

Commonly asked questions

The Puranen-Orava Test diagnoses proximal hamstring tendinopathy by eliciting posterior thigh pain or buttocks pain.

To test for proximal hamstring tendinopathy, healthcare professionals use three pain provocation tests: the Puranen-Orava Test, the Bent Knee Stretch Test, and palpation of the hamstring tendon.

Chronic hamstring tendinopathy can be managed effectively with a combination of rest, physical therapy, and other non-invasive treatments, but complete recovery may take time and depend on adherence to the treatment plan. There are also surgical options for it.