The hamstrings are a group of three powerful muscles on the back of the thigh that are responsible for flexing the knee, extending the hip, and stabilising the knee joint. The three muscles, Semimembranosus, Semitendinosus, and Bicep Femoris, originate on the ischial tuberosity at the bottom of the pelvis, and runs down to the medial tibial condyle, medial tibial surface, and lateral head of fibula respectively.
Hamstring tightness is a common risk factor among athletes and non-athletes alike that can result in soft-tissue damage to the muscle group. Hamstring strains are classified into three different groups. A Grade I hamstring strain is a slight muscle strain, which can resolve in 0-2 weeks. Grade II describes partial tears which may take 2-4 weeks to heal, and finally, Grade III is indicative of a full tear, which may take 4 weeks-12 weeks to resolve. Hamstring injuries are one of the most commonly seen in sports, with the AFL seeing 5.1 new injuries per club, with 18.5 matches being missed at each club in the 2019 season.
Those most at risk of a hamstring injury such as a strain or tear include athletes that participate in intense movements with rapid acceleration/deceleration, such as sprinters, AFL players, netballers, and basketballers to list a few. Whether you are an athlete who participates in these types of sports or not, there is a high chance that you currently, or at some point in your life, have experienced hamstrings. Luckily, once recognised, there are a range of different treatment options, to help you reduce the tightness in your hamstrings, and decrease the risk of sustaining a muscle injury.
Causes of Tight Hamstrings
Tight hamstrings are a common symptom that can be caused by a range of different risk factors. The most common cause of hamstring muscle tightness we see include the following:
- Sudden Intense Exercise: A sudden increase in exercise intensity without an appropriate warm up is one of the more common causes of hamstring tightness. Too often, a good warm up is disregarded, as athletes are eager to get straight into an intense activity or game! If the muscles are not allowed to warm adequately, the muscle can become overloaded or stressed, and begin to tighten.
- Poor Cool Down: After exercises, an appropriate cool down is also important to allow the muscle to slowly return to a resting state after being worked. This cool-down should consist of slower movements, followed by static stretching of the muscle.
- Overuse: Excessive overuse of the muscle through the means of overloading, can cause hamstring tightness. This is often seen when an athlete is training at a high intensity, too frequently, or for too long. If the hamstrings do not have an adequate strength or length to deal with the load it is being placed under, the muscle fibres can seize up and become tight.
- Decreased Strength: When the hamstring muscles are weak, they will be more prone to injuries through movement and in lengthened positions. As a result, the nervous system can shorten the muscle in an attempt to increase stability.
- Compensation: When the muscles surrounding the hamstrings with similar or opposing actions such as the glutes or hip flexors are not activating or functioning correctly, the hamstrings may try to compensate for these muscle groups. This can then cause overloading, resulting in tightness of the muscles.
- Tightness of Surrounding Muscles: When the surrounding muscles such as glutes or calf muscles become tight, the surrounding connective tissue will also tighten, which will restrict the body’s range of motion in this area. This will mean that the hamstring will not be able to move through its full range of motion, which will cause tightness.
- Previous Injury: Previous injuries to the hamstring can cause scar tissue build up, which will cause shortening of surrounding muscle fibres, and subsequently tightness. Likewise, injuries to the surrounding areas may cause pain and restricted range of motion through the knee or hip, meaning the hamstrings movement will also be restricted.
Other common causes of hamstring tightness include, but are not limited to genetics, weight, pelvic position being pulled anteriorly out of neutral (anterior pelvic tilt), and inadequate movement.
Are My Hamstrings Tight?
Tight hamstring symptoms can often range from being non-noticeable in rest, to extremely painful when walking. Stiffness or heaviness over the hamstrings is a common feeling, along with a stretching sensation when extending the knee, even if the knee is not fully extended. Other symptoms of tight hamstring can include resting lower back pain, or hamstring pain on knee extension, in addition to tenderness, or cramping. During exercise such as running, these symptoms are often worsened, which is especially seen in exercises that require rapid acceleration or deceleration of the knee or hip, such as sprinting, or kicking a ball.
If you are experiencing these symptoms, your physical therapist may use some objective tests to help measure your hamstring tightness. One of these tests is looking at the muscle length through a straight leg raise. A normal hamstring range in this test is 70-80° in men, and 80-90° in women. If you fall under this range, this may indicate tight hamstrings.
We can also use a Nord Board to measure eccentric hamstring strength. Strength in Newtons is measured whilst completing a Nordic hamstring curl, in which we aim to achieve 4 x (body weight) + 40N. If the patient measures below this, they may be categorised with being at an increased risk of hamstring tightness, or sustaining a hamstring injury.
How To Fix Tight Hamstrings
If you are experiencing hamstring tightness, there are a range of treatment options your physical therapist will be able to do to help improve your hamstring flexibility, First we will complete a subjective examination, in an attempt to determine the cause of your tight hamstring symptoms. A primary factor we may look at is your training history to see if your hamstrings may be being overloaded with your current training schedule, and if so, make changes to correct this.
There are a range of manual therapies we can use to stimulate the nervous system and help decrease your hamstring tightness. These may include soft tissue release, massage, and dry needling to name a few. Whatever individual, or combination of manual therapies that may be chosen together by yourself and your physio, they will always be used in conjunction with a range of hamstring stretches and strengthening exercises in order to get long lasting results.
Hamstring Flexibility Exercises
- Seated Hamstring Stretch: stretching is completed by extending the hip and knee joint completely, and holding this position until you feel a stretch. This stretch can be completed in laying or sitting, and by using a band around your foot to get an increased stretch. Try adding in 2 x 40second holds, twice per day, as well as adding this to part of your cool down following a training session or game.
- Leg Swings: Leg Swings are a great way to dynamically warm up and increase your hamstring flexibility. Try standing on one leg whilst swinging your alternative leg forward and backward as high as possible. Aim for 2 x 10 reps on each side in your warm-up!
- Single Leg Russian Dead Lifts (RDL’s): A Single Leg RDL is performed similar to a normal RDL, but as the performer is standing on one leg, you are able to target the hamstrings whilst moving through a greater range of motion. This one is great for those who suffer hamstring tightness due to decreased strength, whilst also helping to improve your balance.
- Hamstring Bridges: The hamstring bridge is another great beginner strengthening exercise for the hamstrings. This exercise involves laying on your back with your legs up on a chair and pushing up through your heels whilst straightening your knees. This exercise can be progressed by completing it single-legged, or putting a weight over your hips.
- Nordic Hamstring Curl: The Nordic Hamstring curl is one of my favourite exercises to reduce hamstring tightness. The exercise is an eccentric exercise, which means the muscle lengthens under load. These types of exercises are great for lengthening muscle fibres, whilst also increasing strength. Having a partner holding your ankles, keep your hips and back straight whilst slowly lowering your core down as close as you can to the ground, before catching yourself.
Whilst these are only a few of many different exercises for tight hamstrings, your physiotherapist can help you come up with a personalised home exercise program to help you reach your goals.
How to Warm Up Hamstrings
Warming up your hamstrings prior to exercise is pivotal to avoiding hamstring tightness. The best way to warm up your hamstrings is through dynamic stretching and gradually increasing intensity. Activities like leg swings, hamstring bridges, lunges, squats, single leg RDL’s, and star jumps are great ways to warm up the muscle group. Prior to running, shuttle runs at low intensities such as a 40m run at 50%, and slowly building up 5-10% speed between intervals are a great way to slowly warm up the hamstrings, and decrease the risk of injury.
Frequently Asked Questions
Does walking cause tight hamstrings?
Walking does not cause tight hamstrings and is a great way to get the legs and hamstrings moving and blood following through the muscle. This is proven to be a great way to reduce tightness.
Is heat good for hamstrings?
Heat can be a good way to begin to decrease hamstring tightness. Heat will help to relax the muscles by promoting blood flow, and changing the stimuli to the nervous system to help reduce tension.
How can you tell the difference between sciatica and hamstring pain?
Sciatica can sometimes be confused with tightness-related pain or injuries. Key differentiating factors for this are that sciatica symptoms may be shooting from the lower back all the way down through the calf muscle to your ankle. Symptoms may also change following movements that do not move the hamstring muscle itself, such as ankle dorsiflexion. There is a range of objective tests your physical therapist can do to differentiate this.
How do you test for weak hamstrings?
In the clinic, we use a Force Frame and Nord Board to objectively test hamstring strength. Here, we are aiming for 4 x (body weight) + 40N of force produced whilst performing a nordic hamstring curl, with the left and right sides being equal. We also look at your hamstring strength in relation to surrounding muscle groups such as your quadriceps to look for muscle group imbalances.
Does sitting cause tight hamstrings?
Whilst sitting on its own does not cause hamstring tightness, sitting for prolonged periods every day without using your hamstrings can be a risk factor for hamstring tightness. Your body loves movement, so make sure you’re aiming to get some form of daily exercise in!