Proximal hamstring tendinopathy as a cause of ischial pain in a wheelchair user with multiple sclerosis: the diagnostic value of dynamic seating assessment—a case report

OBJECTIVE: We report the case of a 73-year-old man with advanced multiple sclerosis who developed right ischial pain while seated in a manual wheelchair, despite pressure overload being documented on the left. METHODS: The patient used right-hand and right-foot propulsion for indoor mobility. Static and dynamic postural analysis revealed fixed asymmetries, while clinical examination reproduced the pain during resisted knee flexion and passive hamstring stretch. A diagnosis of right proximal hamstring tendinopathy was made, attributed to repeated contractions during foot propulsion. To our knowledge, no previously published cases were identified of this complication in a wheelchair user. Two postural correction attempts were unsuccessful. Pain resolved completely after transitioning to a power wheelchair and stopping foot propulsion. IMPACT: This case highlights an underrecognized musculoskeletal complication in wheelchair users and demonstrates the importance of an interdisciplinary approach combining pressure mapping, dynamic seating analysis, and clinical examination, integrating medical diagnostics with occupational therapy expertise in equipment optimisation. It also underlines the psychological benefit of providing a clear explanation and effective solution, which improved patient adherence and satisfaction. The patient reported no desire to return to manual propulsion.