Back pain from hamstrings can occur due to pelvic misalignment, muscle imbalances and changes to spinal curvature all enacted by the interactions of the major posterior leg muscles and tendons. Hamstrings have long been implicated in the involvement of many lower back pain complaints and we now know for sure that there are various causative processes that can create pain due to problems involving these major muscular tissues.
There has been a growing trend towards blaming the hamstrings as being causative or contributory in many low back pain problems. The diagnosis is most often made by sports medicine specialists, physical therapists, chiropractors and other hands-on practitioners who can actually visualize the changes in posture and gait caused by tight hamstrings, as well as feel the actual tautness in the muscular tissues. On the other hand, hamstring involvement in lower back pain is rarely suspected or suggested by more traditional back pain specialists, such as orthopedists and neurologists, although this is not an absolute rule.
This vital essay examines the role played by tight hamstrings in the creation of lumbar pain, sacral pain and related symptomatic complaints, including sciatica. We will discuss the anatomy of the hamstrings and how these tissues can enact pain in the lower spinal region. We will investigate simple and effective treatment options for hamstring-related back pain. Finally, we will also shed light on why many patients do not recover from the condition, despite a positive diagnosis and wholehearted attempts at using seemingly indicated therapies.
Hamstrings are a common layman’s term for the three major muscular tissues, and their attaching tendons, residing in the posterior side of the upper leg. The hamstrings consist of major muscular tissue groupings including the biceps femoris, semimembranosus and semitendinosusmusces and their respective tendons. These tissues are responsible for providing many important motor activities in the legs and are also instrumental to providing humans with proper posture in an upright position.
The hamstrings attach from the pelvis at the origin to the knee at their destination. They are greatly involved in moving the hips and knees. Since the pelvis also attaches directly to the sacrum, which resides in the spine between the lumbar region and the coccyx, pressure enacted by the hamstrings can affect the functionality of the backbone itself through several possible processes:
Tight hamstrings are almost universally deemed to be the problem involving these powerful muscular tissues, when it comes to their role in generating lower back pain concerns. Hamstring injuries might create some degree of low back pain, but usually concentrate symptomology in the legs themselves. The overwhelming majority of patients diagnosed with hamstring-related back pain demonstrates no discernible injury to the hamstring tissues, but instead simply demonstrates a shortening of the length of the tissues, commonly caused by various lifestyle factors.
Tight hamstrings can create muscular imbalances that might be painful unto themselves. Muscular tightness is known to cause pain upon stressful motion and this pain might be expressed in the origin of the muscular tissues near the pelvis.
Tight hamstrings can also change the alignment and anatomical positioning of the pelvis itself, pulling the posterior surface downwards and thereby altering the connections to every other tissue that ties into the pelvic region, including the lower spine. Changes to pelvic alignment can produce hypolordosis in the lower lumbar spine, reducing the necessary curvature that helps to support the body, resist shock and provide safe and functional motion through a complete range of physical activities.
Unilateral hamstring tightness can pull the pelvis out of alignment on only one side, potentially creating similar imbalanced hypolordosis and the possibility of scoliotic curvature, as well in some patients.
Severe changes to the lumbar spinal positioning might also create a cascade effect, setting the ideal circumstances for other spinal problems to occur. It is well known that significant changes in lumbar lordosis can contribute to intervertebral bulging and herniation. Additionally, there is some evidence that pelvic misalignment might be a factor in the development of spondylolisthesis, especially in patients who demonstrate or develop certain lumbar structural abnormalities, such as spondylolysis.
Tight hamstrings can be caused by many possible factors, including traumatic injury. However, as recent acute injury is rarely a reported factor in lower back pain complaints, we will focus on treating muscular and tendon tightness in patients without a history of hamstring trauma. Obviously if trauma has occurred, the path towards successful treatment involves possible repair of the damage to the hamstring tissues and proper rehabilitation, which should correct the underlying reason for all the symptoms to occur.
In cases of no known injury, the usual circumstance that leads to excessive hamstring tautness involves leading a sedentary lifestyle. People who sit excessively are prone to hamstring tension. People who do not stretch or exercise enough are prone to developing tight hamstrings. Finally, people with a past history of damage to the hamstrings might suffer from shortness of the muscles or tendons related to the injury, even if the trauma is in the distant past.
In most cases of hamstring tightness, physical therapy can successfully re-balance and lengthen the anatomy to reduce or eliminate symptoms. Typically, this involves the implementation of special stretches and exercises designed to act on these muscles and tendons to reduce pressure asserted against the pelvis. Increasing general physical activity and reducing time spent sitting can also be very helpful and are known to provide a range of positive health enhancements, besides hamstring tension reduction.
Some patients become surgical candidates in select circumstances that do not respond well to conservative care. Treatment results for surgical hamstring releases are not overly promising in cases of chronic tightness and many patients continue to suffer similar or different painful symptoms postoperatively.
Although many patients may demonstrate tight hamstrings, there are many possible scenarios where the muscular tautness is unrelated to the pain or may even be a consequence of the pain, rather than its causation. This is a frequently seen problem in the back pain treatment arena and one topic that we cover in great detail on the sites of The Cure Back Pain Network. Misdiagnosis of the actual cause of pain is the single most prevalent reason explaining the poor therapy outcomes that we see on a daily basis in back pain sufferers. Below are some of the more often seen examples of mistaken diagnosis of tight hamstrings in lower back pain problems:
Hamstring tension might result from previous changes to pelvic or spinal alignment caused by structural issues that originate in the vertebral anatomy or elsewhere, such as in the pelvic ilium, hip joint or knee joint. Similarly, changes to spinal curvature caused by vertebral or intervertebral issues might create tension in the hamstrings over time, especially in cases where the patient is sedentary (common in lower back pain sufferers) and has suffered a posterior tilt to the pelvis in relation to a change in lumbar lordotic profile.
Some patients might have tight hamstrings and even seemingly related structural changes, such as hypolordosis, but still suffer from other causes of pain. Possible explanations can include neuropathies not related to structural abnormality, systemic disease conditions, localized injury or mindbody syndromes. It should be noted that a great number of chronic back pain expressions are psychogenic and unfairly blamed on all manner of structural irregularities, such as hamstring tension. In some cases, the hamstring tension might even be the primary result of mindbody ischemia to the hamstring tissues, creating the syndrome not due to structural length issues, but instead by dysfunction enacted by oxygen deprivation, similar to that seen in distance runners.
In summary, hamstring tension is one possible source of pain in the lower back. However, the condition can easily be a result, rather than a cause of said symptomatic activity. This classic cause/result enigma remains a huge diagnostic problem in the lower back pain therapy sector, so all patients are encouraged to become involved in their own care by learning everything possible about their conditions and using their own logic to advocate towards better treatment outcomes. Failure to follow this simple recommendation explains why so many patients suffer for years and often endure unneeded surgeries that never cure their pain.