In an article by Jeffrey Tucker, DC titled “Hamstring tightness and chronic pain patients,” he discusses the role of tight hamstrings in chronic pain injuries. Many people are familiar with the association of chronic back pain and tight hamstrings. People have been told in the past that they need to stretch. They may stretch for a week or two and then stop as the pain subsides.
Most patients are unfamiliar with exactly why tight hamstrings play a role in their chronic pain. Tight hamstring muscles alter normal knee and pelvic motions. Exceptionally tight hamstrings start to change normal gait and walking movements, increasing the strain and pounding applied to the knee joint. The knee begins to suffer because hamstrings are altering its motion and increasing strain to the joints.
The same process is occurring in the pelvis. Tight hamstrings tip and rock the pelvis, which places more strain on the sacroiliac and lumbosacral spine. This is specifically noted with sitting. The pelvis is unable to rock or tip to a comfortable position when sitting in chairs or benches. Many patients will describe being able to sit in their work chair comfortably, but their kitchen chair causes back pain after 20 minutes. The changes of pain with sitting at the kitchen table are caused by the posture and position of the low back and pelvis, which were unable to completely rock in the uncomfortable chair.
These are the same patients who might report relief with a couple weeks of stretching and find they are able to sit longer before the onset of pain. By gaining that little bit of flexibility, their pelvis was able to rock in a comfortable position and reduce the damaging forces during sitting. Tight hamstrings also limit pelvis rocking during walking or running. This can lead to increased low back pain when walking through the mall or grocery store.
Chronically tight hamstrings change our normal walking, sitting, and laying movements. Eventually other muscles in the body will begin to tighten and spasm because of the limitation of the hamstring muscles. This is very commonly found in the piriformis or gluteal muscles. As they continue to tighten they further tip and rock the pelvis into improper positions, increasing the likelihood of low back sprains and pain. The combination of tight hamstrings and piriformis muscles increases the number of low back injuries per year and the likelihood of severe sprains.
People shouldn't be surprised that the body works together in a system. Disrupting any aspect of the system will cause repercussions somewhere else throughout the sequence. With years of tight hamstrings and piriformis muscle spasms, it is amusing to hear people say “all I need to do is stretch for a week or two.” That was probably true 20 years ago. But today a week or two of stretching is not going to produce significant flexibility changes in the hamstrings or piriformis muscles. Stretching two or three times a day for a month will produce about an inch of hamstring flexibility. Stretching closer to 15 times per day for a month will produce about 3 inches of flexibility. Stretching is an important aspect of the recovery, but it is not the most effective.
Patients with chronically tight hamstrings, piriformis, and low back muscles respond well to Graston Technique, massage therapy, and Active Release Technique (ART). These treatments help break up the scar tissue or fascial adhesions that have functionally shortened the muscles. It enhances stretching and flexibility performed in the office and at home. These treatments accelerate healing and recovery in acute and chronic injuries. They are also important factors for reducing the likelihood of reoccurrence injuries in the back, lumbosacral, sacroiliac, and knee.
Combine stretching, Graston Technique, massage therapy, and Active Release Technique with therapeutic exercises to stabilize the core and low back muscles. These muscles have become weakened with chronic hamstring shortening.
Bridging exercises are a great activity that require the low back and core muscles to work together to stabilize the spine during movements. Patients with chronic low back pain and hamstring tightness very quickly fatigue during the exercise. These patients who moments before said they only need to stretch for a week or two to get rid of the pain, suddenly realize how weak their low back has become over the years. They look at the exercise that they had just performed and realize they are at the bottom of our scale.
This is often the point when everything they have heard about chronic back pain, hamstring tightness, low back sprains, disc injuries, and arthritis ties together. They realize how years of neglecting their back and muscle flexibility has led to their current state of weakness and increased risk of back injury.