Tight Hamstrings and Low Back Pain: Unlocking the Hidden Connection

When it comes to lower back pain the hamstrings are commonly spoken of in the same breath. The hamstring tightness, pain and spasm is a frequent feature associated with lower back injuries. Whether the injury is a minor back strain, a herniated disc, or if there are some more long standing chronic back pain causes such as degenerative disc disease, the case remains that it is incredibly likely for the hamstrings to be a factor. 

The real question we will explore today however is, to what degree are the hamstrings a causative factor and to what degree are they simply a knock on effect from the lower back injury itself, and realistically how much of a role do they play in the continuation of your back pain. 

Hopefully by better understanding the role of this group of muscles on the back of your thigh, and how they relate to the normal functioning of your lower back, hip and knee, you’ll be better informed moving forwards. And being better informed leads to getting better outcomes, especially when it comes to lower back pain.

Anatomy of the hamstrings and their impact on your low back

The hamstrings are a group of three muscles which run down the back of your thigh: biceps femoris, semitendinosus, and semimembranosus. These muscles group together to form the bulk of the musculature on the back of our thigh. At the top end, they attach onto the sitting bones of your pelvis, and at the bottom end to various points around our lower leg bones, the tibia and fibula. These interesting muscles run across two joints, the hip and knee and have wide reaching effects with their actions. 

When it comes to the knee, we’re all too familiar with their actions of bending the knee. The hamstrings can also work to rotate your lower leg internally and externally when your knee is bent too. At the top end the hamstrings extend the hip, for example, when running or walking driving your leg backwards to propel you forwards along with the gluteal muscles of the buttocks region. 

When it comes to the hamstrings and your lower back, the hamstrings have an indirect effect. When they contract, without any external control from other muscles, they pull your pelvis backwards, this is known as a posterior pelvic tuck, a movement many of you will be familiar with during activities like yoga and pilates. This posterior pelvic tuck has a pronounced knock on effect in the lower lumbar spine, flattening out and eliminating the lordosis with most pronounced effects being noticeable at L5,S1 and L4, L5. 

One final consideration for the hamstrings is their controlling spinal segments. As you probably know, all our muscles are controlled by the brain via various sections of our spine, in the case of the hamstrings the nerves that leave the lower lumbar spine in the regions of the L5 and S1 in particular. This is very important for later on when we start to think about how lower back injuries can complicate the hamstrings functioning.

Common causes of tight hamstring muscles

There are several common causes of tight hamstrings, one of the most prevalent, which would affect all our muscles would be the sedentary lifestyle. As we’ve mentioned so many times before, the average working age adult spends 9.5 hours a day sitting. Whether at the desk, in the car, or at home, the sitting position with the knee’s bent at 90 degrees puts the hamstrings into a shortened position and holds them there for extended periods. 

As a knock on effect of this inactivity, tightness in the hamstrings frequently co-occurs with weakness in the muscles themselves. This weakness is detrimental to overall low back health as the hamstrings make up a long section of the posterior chain. The chain of muscle tissue that runs the length of the back of our bodies and provides support for our good posture and drives us through the world by way of walking, running or just being active. 

Weakness in muscles is never a strength and as we will see weakness and tightness is a common duo of muscular dysfunction that confuses so many and plagues those with back pain.

How healthy, strong hamstrings contribute to lower back health

When everything is working well, you’re active, with strong hamstring muscles, and good flexibility. By the way, good flexibility doesn’t mean you need to do the splits as sometimes is the impression people have. 

Your hamstrings should work together with the muscles of your trunk and core, as well as the muscles of your lower leg too. In particular movements such as getting out of a chair, or bending over, the hamstrings work alongside the gluteal muscles to generate power for many of these motions. Strong hamstrings that are mobile pull on the lower back region. 

The lower back muscles themselves are also strong and hold the spine in a neutral position as the hamstrings in particular try to pull the pelvis into a posterior pelvic tuck. Instead of the pelvic tuck happening, the lower back remains stiff and stable and acts like a bridge or “draw bridge”. When you go to get out of the chair, your trunk and core keep the spine stable in neutral with their strong tension, the hamstrings pull on this strong core region and slowly the body climbs out of the chair, with the hip moving through from flexion (sitting posture) into extension (standing posture). 

When everything is working well, we have a body that is in good condition and certain areas are able to provide static stabilising strength, while others provide dynamic strength to drive our body through a particular movement. 

How tight hamstrings contribute to low back pain

Granted there are some who are perhaps bodybuilders or powerlifters and they may have tight and strong hamstrings, but the vast majority of our members and the public at large do not fall into this category and so the following is extremely important to reiterate. 

Your hamstrings will be tight AND weak, plus, it is HIGHLY likely that if they are in this reduced health condition, then the other muscles in the region are at the very least weaker than they should be, perhaps with varying degrees of tightness. 

The very problem with tight hamstrings is that they often occur within a body that is not strong and therefore the tightness in the hamstrings overwhelms other areas of the body. We discussed a moment ago about the other muscles of the trunk and core needing to be strong for the various movements of life, to maintain stability in the lower back. Where the hamstrings are tight, these muscles are often overwhelmed. 

The major consequence that worsens back pain is that these hamstrings pull the pelvis into the posterior pelvic tuck and this stresses the low lumbar discs as well as disengaging the sacroiliac joints. This position of flexion in the lower back is not good for herniated discs which are already being compressed in this fashion. And those with a diagnosed sacroiliac joint issue will also be negatively affected. 

We discussed common exercises for herniated discs recently and how so many of them involve forward bending or flattening of the lower back. When it comes to hamstring tightness, so frequently the same sort of stretches are employed, “just reach down and touch your toes” for example. Unaware that 95% of that movement is just your lower back rounding. And therein lies the major complicating factor when it comes to hamstrings and lower back pain.

Complications of tight hamstrings and lower back pain

Unfortunately so frequently poor back health creeps up on us, and injuries are very commonly in the lower lumbar spine. This section of the spine is the region with the nerves that control the hamstrings. Commonly when these nerves are irritated you can get symptoms of sciatica, shooting pain down the back of the leg. Firstly, if you have shooting pain occasionally during the day, firing down the leg. 

Is that going to make the hamstrings go tighter or looser? You wince in pain and so tighten up…

Then we have the control, nerve function is frequently affected, nerves carry a number of “signals” various types of sensation, such as soft touch, sharp touch (pain) and muscle function. It is very common that one of the signals being sent “erroneously” to the muscles of the injured spinal segment is to tighten up which brings us to issue number two. This is that the very back injury itself is telling your hamstrings to tighten up. 

This creates the situation whereby your hamstring was tight and weak before, then your back is injured and that is sending signals to the hamstrings to tighten, and everytime you aggravate your back, you get that shooting pain which makes you reflexively wince and tighten up in response. On top of this, these drivers of tightness in the hamstring further exacerbate the issues such as the pull on the lower back via the hamstrings pulling the pelvis towards a posterior tuck direction. 

Stretching exercises for tight hamstrings

The big problem we see time and time again is that people focus solely on stretching tight hamstrings when they have a back injury instead of a smarter approach. Hopefully from the previous section we can see that it is going to be a fruitless exercise. But we’ll cover why in a little more detail. Firstly, stretching the hamstrings is so commonly done in a way that rounds the lower back, this is primarily because people who have long-standing back issues often cannot hip hinge. 

Hip hinging is the mechanism of isolating the hip movement from the lower back. So as the hip moves in any manner of directions, the lower back remains steady and unmoved. This vital skill is missing in so many with back problems and is likely a factor that led to the issue in the first place. Trying to stretch the hamstrings without this hip hinging movement mastered only serves to aggravate the very lower back issues that are contributing in a significant way to the ongoing hamstring tightness and pain. In many ways this is just like other stretches, for example, child’s pose stretch for the lower back which serves to round the back and perpetuate the low back issue.

Secondly, when the lower back is so vulnerable, the regular aggravations that happen on a daily basis will frequently result in muscle spasm that’s reflexive, if you’re only strategy is to stretch your hamstrings, you’re going to get stuck in this frustrating loop of stretching and then a flare up knocking you back to square one. 

Importance of hamstring flexibility for back health

You’d be forgiven for thinking we are against hamstring stretching for those with back pain, this is not the case. We are however against the way so many approach it when they have back pain because it misses major factors that result in endless stretching with little to no relief. Make no mistake, we recommend the sensible incorporation of hamstring stretching work into the Back In Shape Program, but it is done so in a correct way.

Good hamstring flexibility will allow for full ranges of motion when performing movements like bending, lifting and squatting. You might be thinking that you do not need to do those activities and you would be wrong. Whether it is out in the garden, playing with your young children or grandchildren, getting in and out of chairs or just living life, you will benefit from more competent ranges of motion in the hips. This is undeniable. However how we go about this should observe the realities of lower back injuries that are so heavily associated with issues in the muscles of the thigh, the interconnectedness of the whole body and the important reality that you simply cannot have good competent movement ranges without good strength in a muscle. 

Strengthening exercises for the hamstrings are a priority

The most effective way to start to restore lasting recovery for your tight hamstrings and lower back pain at the same time is to work on strength. We talk about exercises like the marching bridges, hip thrusts, squats, hip hinges and lunges as great integrated options to strengthen the hamstrings with real integrated movement. This allows you to move your body in a real-to-life way instead of an isolated environment like a machine.

As you carry out movements like the hip hinge, strengthening the hamstrings and how they work with the muscles of the trunk and core. You will find that you get stronger, and as you get stronger, you will be able to safely push yourself a little more on the range of motion front. Going a little lower, whilst all the other muscles which are strengthening can manage the new forces. This happens slowly over time, and as you are working on strengthening two fantastic things happen. 

Firstly while you’re still stiff, you start to build good healthy movement patterns which mean you’re learning skills which cannot be taken away from you. Like we mentioned earlier with the stretching only approach which works for a moment until your next flare up. What happens with the strengthening in the early days is you immediately start to move better, decreasing the frequency of flare ups and aggravation.

Secondly, as you strengthen you have literally transformed the muscles around your lower back as well as the hamstrings, these will all work better now to protect your lower back from re-injury and sending those signals to your hamstrings every day to tighten up! 

Intelligent approach to improve your hamstring tightness and back health

This is the essence of what we teach in the Back In Shape Program. Yes your hamstrings are tight, we now know why, they’re weak too and the injury in your low back is telling them to tighten up all day every day! 

Learn to do hamstring stretching correctly, it makes up part of the Phase One routine of the program and something worth doing for the long term, BUT it is only a small part of this and the effects in the early days are temporary and short-lived. 

At the same time, work on strengthening these muscles and others through real-to-life movements discussed above, these will immediately build good movement patterns which will still be limited in their range because your hamstrings are tight and weak.

Over time as you progress your STRENGTHENING you will be more and more stable and healing will continue to take place, becoming more and more established, the signals to your hamstrings from the now healing segment of your lower back will be less and less. So your stretching can have longer lasting effects!

As you continue STRENGTHENING you’ll find you start to consciously push your range of motion whilst maintaining good form in the exercises, this will add to the improvement in flexibility of your hamstrings and other muscles allowing for ever more robust joint mobility.

From there it becomes a positive loop, the more you do, the more you can do the more all of these metrics improve, strength, competence, flexibility and healing. If you do this right, you’ll not only feel the difference in your day to day life, you’ll fix your lower back pain and you’ll find you’re stronger and more active too, and your lower back will be pain free! 
For more help with your back pain and hamstring tightness check out some of our other episodes of the Back In Shape Podcast and the full Back In Shape Program for support through the step-by-step process of fixing back pain for good.