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

Tendon of biceps femoris

Lower back muscles and fascia

Sacrotuberous ligament

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, 73–81.

• 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), 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.