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. Lumbar lordotic curve (50)

B. Lumbosacral angle (140)
C. Sacral angle (30)
D. 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 intra-
subject 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 non-
specific 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, 7381.
Duenwald, S., Vanderby, R., & Lakes, R. (2009).
Viscoelastic relaxation and recovery of tendon.
Annals of Biomedical Engineering, 37(6), 1131-
1140.
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, 232-
238.
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), 209213.
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 Obers test in
people with lumbopelvic pain. Physiotherapy
Canada, 65(1), 4-11.