The Correlation between Hamstring Tightness and
Low Back Pain in Seated Workers
Ahmed Radwan PT, DPT, PhD Thomas A. Crist, PhD
Ahmed Radwan, PT, DPT, Ph.D.
Associate Professor
Physical Therapy Program
Thomas A. Crist, Ph.D.
Professor
Physical Therapy Program
Copyright © 2015 Ahmed Radwan and Thomas A. Crist
Anatomy of the Hamstrings
Description of the Hamstrings
• Three long muscles that move the hip and knee joints
• Located from medial to lateral:
• Semimembranosus
• Semitendinosus
• Biceps femoris
• Actions:
• Extend the thigh at the hip
• Flex the leg at the knee
• Medially and laterally rotate leg when knee is bent
Copyright © 2007 Raymond A. Long
Attachments of the Hamstrings
• Proximally, attach to the pelvis at the ischial tuberosity
• Distally, attach to the tibia and fibula
• Also attached to the sacrotuberous ligament
• Resists anterior displacement of the sacrum
• Indirectly attached to the lower back muscles and fascia
• Extensors of the spine – superficial and deep groups
Copyright © 2014 Wolters Klower
Lower back muscles and fascia
Sacrotuberous ligament
Tendon of biceps femoris
Copyright © 2014 Wolters Klower
Transversospinalis
muscles
Erector spinae
muscles
Copyright © 2014 Wolters Klower
Lateral
Medial
Sciatic Nerve
Mechanics of the Hamstrings
We know what the hamstrings do, right?
Do they affect sacro-iliac joint stability?
Lumbar Curvature
• Normal curvature (lumbar lordotic angle) when standing
is 20-45 degrees
• When sitting, lordosis is 50% less on average than in
standing position
• Pelvis tilts posteriorly and hamstrings tighten
Copyright © 2014 Wolters Klower
Copyright © Jason Martuscello
Could tightness affect all of
these angles?
•
Pelvic tilt angle (7-15°)
A.
B.
C.
D.
Lumbar lordotic curve (50°)
Lumbosacral angle (140°)
Sacral angle (30°)
Pelvic angle (30°)
•
Neutral pelvic position
• ASIS & pubic symphysis are on
the same plane
Pathomechanics
of
Hamstring Tightness
Lumbar-pelvic Rhythm
Effect of Pelvic Tilting
on Lumbar Spine Curvature
Correlation between
Hamstring Tightness and LBP
Correlation between
Tightness and Mechanical LBP
• Radwan et al. (2014) evaluated the relationship between
hamstring tightness and LBP
• The authors examined hamstring flexibility in 72 seated
workers with history of LBP
• All participants in the study had tight hamstrings
Measurement of Hamstring Tightness
Correlation between
Tightness and Mechanical LBP
• Additionally, participants presented significant intrasubject differences in hamstring flexibility
• All dominant lower extremities were significantly more
flexible than the non-dominant sides
• There was a significant mean difference of two degrees
Correlation between
Tightness and Mechanical LBP
• Scores were positively and significantly correlated with
the extent of their back discomfort as reported by
Oswestry scores
• Similarly, Halbertsma et al. (2001) confirmed the
presence of hamstring tightness in patients with nonspecific LBP when assessed during passive straight-leg
raising tests
Oswestry Score Correlations to
Hamstring Tightness Values
Y= 0.234 * x + 1.823
Values of Right and Left Lower Extremity Tightness
SIJ is a Six-degree of Freedom Joint
•Average active
movement of
0.2-2 degrees
SI Dysfunction is a Major Cause of LBP
Stretching Tight Hamstrings
With Ease
Creeping Phenomenon
Anterior Tilting of Pelvis + Hip Flexion
+ Knee Extension for 30-60 Seconds
References
• Baumgartner, D., Zemp, R., List, R., Stoop, M.,
Naxera, J., Elsig, J.P., & Lorenzetti, S. (2012).
The spinal curvature of three different sitting
positions analyzed in an open MRI scanner. The
Scientific World Journal, 2012, 1-7.
• Cher, D., Polly, D., & Berven, S. (2014).
Sacroiliac joint pain: burden of disease. Medical
Devices (Auckland, N.Z.), 7, 73–81.
• Duenwald, S., Vanderby, R., & Lakes, R. (2009).
Viscoelastic relaxation and recovery of tendon.
Annals of Biomedical Engineering, 37(6), 11311140.
• Halbertsma, J.P.K., Goeken, L.N.H., Hof, A.L.,
Groothoff, J.W., & Eisma, W.H. (2001).
Extensibility and stiffness of the hamstrings in
patients with nonspecific low back pain. Archives
of Physical Medicine Rehabilitation, 82, 232238.
• Hall S.J. (2007). Chapter 9. The Biomechanics of
the Human Spine. In Hall S.J. (Eds.), Basic
Biomechanics, 5e.
• Kennedy, C., Kassab, O., Gilkey, D., Linnel, S., &
Morris, D. (2008). Psychosocial factors and low back
pain among college students. Journal of American
College Health, 57, 191-196.
• Lim, K.-I., Nam, H.-C., & Jung, K.-S. (2014). Effects
on hamstring muscle extensibility, muscle activity,
and balance of different stretching techniques.
Journal of Physical Therapy Science, 26(2), 209–213.
• Long, M.J., Small, J.M., Dinsay, J.M., and Watkins,
R.G. (1997). Lumbar lordosis. Effects of sitting and
standing. Spine, 22(21), 2571-2574.
• Neumann, D. (2010). Kinesiology of the
musculoskeletal system: Foundations for
rehabilitation (2nd ed.). St. Louis, Mo.:
Mosby/Elsevier.
• Patel, A.T., & Ogle, A.A. (2000). Diagnosis and
management of acute low back pain. American
Family Physician, 61, 1778-1790.
References
• Radwan, A., Bigney, K.A., Buonomo, H.N.,
Jarmak, M.W., Moats, S.M., Ross, J.K.,
Tatarevic, E., & Tomko, M.A. (2014). Evaluation
of intra-subject difference in hamstring flexibility
in patients with low back pain: An exploratory
study. Journal of Back and Musculoskeletal
Rehabilitation, [Epub ahead of print].
• Rodriguez, P.L., Santonja, F.M., Lopez-Minarro,
P. A., Sainz de Baranda, P., & Yuste J.L. (2008).
Effect of physical education stretching
programme on sit-and-reach score in
schoolchildren. Science & Sports, 23, 170-175
• Tenney, H.R., Boyle, K.L., and DeBord, A.
(2013). Influence of hamstring and abdominal
muscle activation on a positive Ober’s test in
people with lumbopelvic pain. Physiotherapy
Canada, 65(1), 4-11.