Imagine you have back pain or knee pain that seems to be getting worse and not better. You have done everything over-the-counter that you can think of to help with the pain. But no heat, ice, or ‘magic rub’ seems to be doing the trick. The pain continues to get worse and worse, causing you to stop more and more activity.
What if I told you the answer wasn’t stopping activity — but actually adding activity? I know it seems like the complete opposite of what you should do when you have pain. Adding activity? But why? And can’t that wind up hurting worse than when it started?
What most people don’t realize is that the reason they have pain is due to muscle imbalances. One or several muscles work harder than the others, which causes knots that can lead to pain. One of the biggest problems with weakness we see in the body is with the hamstrings.
Hamstrings: A Brief Overview
Your hamstrings are a group of three muscles located on the back of the leg — the semitendinosus, semimembranosus, and the biceps femoris muscles. They run from the top of your thigh to your knee joint and contribute to posture, pelvic positioning, knee support, and leg movement.
Every action of the muscles in the front of your leg creates an opposite reaction in the hamstrings. These two groups of muscles work in unison to extend and contract, allowing you to bend your knees, straighten your hips, and rotate your legs. When the quadricep-hamstring strength ratio is unbalanced, individuals may experience low-back pain and an increased risk of hamstring strains or tears.
The Relationship Between Quadriceps and Hamstrings
Here’s what I run into: The quadriceps (or the muscles in the front of the leg) are very well defined, and the hamstrings (the muscles in the back of the leg) are nonexistent. But your body can’t let the quads work harder. Otherwise, you would not be able to walk. Imagine someone pulling extremely hard on one side of the rope, and another person barely resisting on the other side. The rope would be pulled in the direction of the person pulling harder, and if the person pulled too hard, the other person would fall over.
Same thing with the quad and hamstring relationship. And the truth is, the quads are pulling hard enough to pull the hamstrings over, so the hamstrings recruit help from the other muscle groups. This is where the pain starts. The other muscle groups are not used to working that hard and give out, possibly cramping up on you.
How Do Tight or Weak Hamstrings Result in Knee Pain?
The hamstrings are biarticular muscles, which means they cross two joints instead of just one — the hip and the knee. As such, they affect the health of the knee, hip, and even back. This means that athletes that experience tight hamstrings can suffer myriad problems.
For example, when squatting with added weight, they won’t be able to lower their hips past 90 degrees, keeping them working in a relatively safe mid-range zone, exacerbating the issue as the hamstring will not be fully lengthened. When the time comes to lift from the squat, the hamstrings\’ full length isn’t utilized.
If tight hamstrings do not allow full hip extension, the quadriceps will take over and place a substantial strain on the knee. All four quadriceps converge to form a single tendon above the knee attached to the patella\’s sides. If the quadriceps group works too hard over time, the knee will be the victim.
This improper use of other muscles is what begins to cause pain in the back and the knee. That is why strengthening is the answer in this case. If you strengthen the hamstrings, the other muscles do not have to work as hard and, therefore, will relax enough to allow the pain to stop.
The problem is with hamstring exercises. Most people cheat because their hamstring is so weak. Today, I’m going to take you through a couple of progressions and show you what to do — and what not to do — to perform the exercises correctly.
How Can Tight Hamstrings Cause Back Pain?
Tight hamstring muscles are a common contributor to lower back pain. They pull on the ischial tuberosities, one of the areas of the pubic bone. This tends to tilt the pelvis back. Joints adjacent to this move in what’s referred to as a “coupled” fashion. When the pelvis tilts back, the vertebrae in the lower back flex forward.
This can strain ligaments surrounding the vertebrae and make bulging disks in the back even worse. Lengthening the hamstrings is crucial to having the body move as it’s intended to and not putting extra stress on the spine.
Exercises to Strengthen Weak Hamstrings
The first exercise is going to use a ball. You don’t have to use a ball, but when you get to that point, it is necessary to make the exercise more challenging. We will start with a bridge. This is where some people need to start. Then you want to progress to a hamstring curl.
If you’re just starting off exercising your hamstrings, you probably don’t want to do the curl right away. So start with the bridge. For the bridge, you’re just going to push your butt off the table nice and easy, as high as you can. The goal is to get it as high as you can; you’re going to lower it down nice and slow. If you really want to make it a challenge, don’t rest all the way down. Just keep going nice and easy through the motion.
To make it even harder, you can lift one leg up. As you do that, you want to make sure that your hips stay level. If your feet are flat on the floor, you want to make sure you imagine there are four points on the bottom of your foot, little toe, big toe, inside of your heel, outside of your heel. You want to be pushing through those equally to push your butt off the table. A common mistake is people using their toes to push themselves up.
Another suggestion to activate the core and the hamstrings is to put a pillow between your knees and squeeze. That’s going to allow you to further engage that hamstring and core. Then to go right into the hamstring curl, you are going to roll the ball out and in. Make sure that as you do this, you aren’t dropping your hips down as you roll the ball in. Make sure the hips stay level, and you’re rolling it in nice and easy. If you want to make it challenging, keep the hips up the whole time. If this is too difficult, drop the hips back to the table each time.
You also want to make sure that you are extending your leg almost all the way straight and then bringing it all the way to your butt. If you can’t do that, you’re not ready for that single leg step up yet. You want to do about 30 repetitions on both legs. If you cramp up, stop and take a break, then continue. If it causes pain, then stop and consult your physical therapist.
The next exercise is a full squat. The only way to activate your hamstrings and your glute medius is to go below 90 degrees. There is nothing wrong if you do squat in proper form that you can’t go below 90 degrees. It actually puts more pressure on your knees if you wind up just going to 90 and stopping. All you’re doing is a quad exercise at that point.
You really need to start with 30 bodyweight squats with perfect form going up and down before you load anything onto your back. This is probably one of the biggest mistakes I see happen in the gym; people are so eager to put a bar on their back and squat with weight, and they can’t do 30 bodyweight squats.
You have to watch as you go down that your knees do not go in. They still go out, in line with your toes, but that they do not go over your toes. Also, as you go all the way down to the ground, you wind up, bringing your knees together to stand up. That’s an indication of weakness. Start with just doing squats to a bench. Then progress to single-leg squats to a bench.
The last exercise we’re going to do is a single leg deadlift. People like to load these pretty quickly with weight, and I see maybe 15% of the population doing them correctly. Your leg, back, and upper body has to move as one unit. Your leg should go first, and your back should only follow after your leg moves. The only reason your back should start to come forward is that your leg is so high it cannot go any further without moving your back. You should do these in front of the mirror.
A big mistake that people make when doing this exercise is they rotate their hips. You want to keep your hips square to the floor. If one hip starts to rotate up, you need to stop and reset yourself. And the other mistake that people make is that they do not stay in a straight line, their hips, legs, and back. Usually, the back begins to drop, and they wind up in a “V” position. There should be a solid straight line from the upper back through the leg.
Once you can do 30 on each leg nice and slow and controlled, you can progress to adding weight in front.
Click here to watch a video on these exercises.
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