Well isn’t that the million dollar question these days? I see all walks of life in the clinic from the corporate warrior to the yogi to the enthusiastic Cross Fitter all asking the same question. Why are my hamstrings so *bleeping* tight? They could all have something different going on but there is a common thread between all their stories. Let’s break down the basic anatomy right now.

If you want the quick and simple, there are four muscles that make up the hamstrings. Three of them attach to the iscial tuberosity of the pelvis and the fourth attaches to the femur. The other ends of the four muscles attach to the leg bone below the knee. Now skip to Option 1 reason your hamstring may be tight.

If you are an anatomy nerd like me, lets go on a ride.

Semitendinosus and bicep femoris originate at the ischial tuberosity next to one another. Semitendinosus attaches to the tibia but actually wraps around to the anterior side. It is 4cm from the tibial plateau and 7mm from the tibial tuberosity, which gives it great torque potential on the knee.

Bicep femoris long head also attaches to the sacrotuberous ligament which has fascial attachments to the SI joint, contributing to pelvic control and pelvic pain. Bicep femoris short head originates on the linea aspera, crosses only one joint, and joins the long head to attach at the fibula as a single tendon. Bicep femoris long head is unique because the proximal end of the muscle near the hip is more stretchable and the fibers near the knee are used more for force production. Why is this significant? Its the most injured of the hamstring muscles and usually gets injured during eccentric lengthening under high load or high speed. Think the end stage of swing phase of the swing leg during gait. Ouch!

Bicep femoris short head shares fiber orientation with adductor magnus, aka the fourth hamstring which drives hip extension at different degrees of hip flexion. The hamstrings do knee extension during heel strike and helps protect the ACL by stabilizing the shear forces on the knee by the quad muscles.

Semimembranosus originates on ishcial tuberosity but more lateral than semitendinosus and twists around down the thigh to the medial knee but doesn’t wrap around the knee like the semiteninosus but rather attaches attaches to the MCL, medial meniscus, and oblique ligament of the knee.

Option 1 – Scar Tissue is the culprit

In many of our clients, there is scar tissue in the hamstring causing true contractile shortness. Scar tissue can come from:

• repetitive overuse (long distance runners)
• a blow to the hamstring (I’m thinking of our hockey and soccer players)
• decreased blood and oxygen flow to the muscle (hello corporate warriors who sit all day, I’m talking to you)

How do you test if this is you? Lie on your back and with your pelvis square on the floor, lift one leg high to the sky with a straight knee. Normal range is around 80 degrees or just shy of straight into the air. Try not to have the other leg fall open and try to keep those toes pointing toward the sky. If you are more like 45 degrees (remember straight knee) then you may have scar tissue shortening your hammies.

If this is the case, some Active Release Technique might just do the trick. I usually look first at the adductors as well, the 6 muscles on the inner thigh that squeeze the legs together are also called the “other hamstring” since they can refer pain to the same area the hamstring is located.

The foam roller can bring relief to your jammed up hammies

For self care, the best tool is the humble foam roller. Rolling the hamstrings 3-5 times per week will help increase hip range of motion and bring relief to your jammed up hammies.

Option 2 – Core Compensation

Do you fall into this category….Doc, I stretch my hamstrings all the time but they won’t let up, they just keep getting tight, what can I do? Maybe, just maybe your hamstrings are over-working trying to stabilize for an energy leak or weakness in another part of the body. We see this compensation everyday. Our hamstrings hold us up against gravity and walk us around. If you fully tear your hamstring off the bone, you physically cannot walk and propel yourself. The other thing that holds us up and propels us around is our tank of strength, our deep core stabilizers-Transverse abdominus, diaphragm, pelvic floor, multifidii, and some may argue the posterior fibers of our internal obliques. If our intrinsic core is weak, our hamstrings will overwork to hold us up and propel us. Simple as that.

What turns off our core? Shallow chest breathing 20,000 times a day, sitting for hours on end, poor posture, stress, and over activity of our sexy superficial 6 pack muscle just to name a few. How can we reverse this?

• Breath better – from the diaphragm and exhale twice as long as you inhale. Look for 360 expansion of the abdomen.
• Work on telling the brain, let my hamstring go while stabilizing my core thru rehab exercises. We love an DNS or PRI approach for this. We do both;

This may seem ridiculous but this sh*t works! Remember those neurons that wire together, fire together!:)

Option 3 – Overstretching

What if that poor hamstring is hanging on for dear life because it has been so stretched it is weakened and cannot integrate? Yogis I’m talking to you babes!

I love yoga, I teach yoga on a weekly basis, I love the community it created but even I had to rehab myself of a weak overstretched hamstring. I loved the feeling of getting into triangle or the splits and going deep, but I would suffer the rest of the week.

Yoga ranges of motion should not be considered the norm or a baseline for our hamstrings. If you want healthy, engaged hamstrings, in a forward fold your hands should not be flat to the floor, your chest should not touch your thighs, and you should not hear a pop when you do trikonasana or hanumanasana. It’s a hard truth to swallow, but we see yogis all day in the clinic limping in with SI (sacroiliac) joint pain, SI joint instability, midback tightness, and pinching in the hips. Ever ask a yogi to go for a run? They will be hurting all over for days because their hamstrings are so long and weak that they can’t propel themselves forward.

Let’s go back to the anatomy for you body nerds. The 3 of the 4 hamstrings attach to the ischial tuberosity. When they are overstretched, there is less anchoring down of the ischium so the SI joints will start to jam into flexion causing a deep dull ache right over the joint and low back. We find in the clinic that an overstretch hamstring goes hand in hand with an inhibited glut max which both attach to the sacrotuberous ligament. Yikes, what is taking you up those 5 story walk-ups? Probably the facet joints in your low back, the SI joints, or some neck extensors playing a good compression strategy game to help propel you in place of those weak hamstrings.

How did I rehab myself?

• Lots of PRI breathing exercises like this one
• Thousands of deadlifts and kettlebell swings
• Giving up my favorite zero drop shoes and wearing nerdy neutral stability running shoes to give my hamstrings back some integrity while I was working and standing all day
• Laying off deep forward folds for two months

This is just the tip of the iceberg, but the point is there’s hope for a future of pain free hamstrings. Get assessed so you know what is really going on and which approach to take. At Urban Wellness Clinic, we are here to help!

Best in health,
Dr Emily Kiberd