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TIGHT HAMSTRINGS AND LOW BACK PAIN by ACE Physical Therapy and Sports Medicine Institute

When treating low back pain, healthcare professionals first seek to diagnose the primary cause of symptoms. There are a variety of causes for this type of pain such as muscle strains and physical weakness. If a patient experiences both tight hamstrings and low back pain, the treatment protocol usually includes some type of stretching exercise for the hamstring muscle group. This may not be a good idea. A strengthening regiment may be more effective.


The hamstring muscle group is positioned on the back of the thigh bone. Hamstring muscles are part of a muscle group that stretches across most of the leg. The muscles start at the bone where we sit called the Ischial Tuberosity.  Then they continue down the back of the thigh bone (femur), cross the knee joint, and attach (insert) into the back side of the shin bone (tibia).  The hamstring muscles are active during nearly every motion that occurs in the lower extremities.  They are able to extend the hip and flex the knee joint.  During these motions, the muscles contract and pull on the bony attachments.


Almost all healthcare professionals will tell you that tight or shortened hamstring muscles can cause low back pain.  The misconception is that anyone with tight hamstrings is pre-disposed to low back pain. There is very little concrete evidence or data that links “tight” hamstrings to being a cause of low back pain or pre-disposing someone to it in the future. Recent theories actually encourage clinicians to reduce the intensity and frequency of hamstring stretching.


Many people have shortened hamstring muscles that are not too tight and do not have a negative effect on the lumbar spine.  When healthcare professionals evaluate a patient complaining of low back pain, they usually assess the patient’s ability to flex the hip.


When the total amount of flexion is less than 80 degrees, patients are deemed to have shortened, tight hamstrings.  This is often times listed as a primary cause of symptoms.  The hamstring is most likely not tight but is taut which limits motion in a similar manner.  The tension within the muscle cells is elevated in either condition, but the treatment should be significantly different.

Taut hamstring muscles can be caused by overactive or tight opposing musculature which in this case are the hip flexor and adductor muscles. If these muscles are shortened and tight (oftentimes due to sitting too much) they can change the static position of the pelvis.  They can make the hamstring muscles be lengthened and taut.  Prolonged lengthened positioning leads to high tension levels in the muscle cells. Stretching these lengthened muscles leads to an increase in pain.  In many instances, the pain that occurs when someone stretches a “tight” hamstring muscle originates from the nerves that occupy the same area of the buttock and leg. Nerves are not very elastic and can become irritated if they are stretched too far or too often.


Treatment for hamstrings that present as “tight” should include a thorough strengthening routine and a minimal amount of stretching.  The high tension that develops can lead to a weakened muscle mass.  If the muscle is not strengthened, it will not be able to handle the force that is generated by the opposing muscles that have become truly tight and short.


Seek the advice and treatment from a Physical Therapist.  They will assess your condition and then devise a treatment program that will address all of your needs.  The program will include exercises that will strengthen any tight or taut muscle and stretch any tight muscle that have become too short.  Visiting a Physical Therapist does not require a doctor’s prescription but your insurance company might require that you get a referral from your general practitioner.


If you have been told that you have “tight” hamstrings and it is the cause of your low back pain, you might want to seek out a healthcare professional who can assess your condition differently.  There is slight chance that these muscles can be a primary cause for low back pain, but it would be highly unlikely.

The contributor of this article ACE Physical Therapy and Sports Medicine Institute has Physical Therapy offices in Arlington / Clarendon, Alexandria, Fair Oaks / Fairfax, Falls Church, Herndon / Reston, Great Falls, Leesburg /Lansdowne and Tysons / Vienna . If your back Hurts, contact ACE PT  First! 

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