Tight Hamstrings and Knee Pain: Your Tight and Weak Hammys May Be Frying Your Knees

By Chris Centeno, MD /

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tight hamstrings knee pain

Are Tight Hamstrings and Knee Pain Connected?

The single most consistent complaint I hear from my patients who come to see me for knee arthritis or low back pain is that they have tight hamstrings. This creates the obvious question…Are tight hamstrings and knee pain related?

I’ve blogged a number of times on the connections between mild low back nerve irritation (that you may not notice as back pain) and chronically tight muscles like hamstrings. I’ve also written about how my tight hamstrings have caused knee meniscus issues. However, does the research support that the hamstrings may have something to do with knee arthritis and pain?

Tight Hamstrings and Their Impact on Knee Pain

A group of researchers looked at the size of the hamstrings muscle versus the quadriceps (thigh muscle). Why would size matter? A muscle gets smaller either when it’s not being used or its nerve supply is poor. Remember big strapping ex-superman Christopher Reeves? After a spinal cord injury, despite having the best electrical stimulation exercise equipment money could buy, his muscles shriveled up. This is mostly because a muscle gets naturally smaller (starts to die off) when its nerve supply is disrupted. This research group also looked at these ratios against fancy MRI images of the knee that measured early signs of cartilage and meniscus wear and tear. They found that patients with smaller hamstrings muscles versus quadriceps had more MRI signs of cartilage and meniscus swelling and degeneration. In addition, when the inside quadriceps muscle was bigger than the outside portion, the researchers found the same thing.

Why might this be happening? We’ve seen an association for years (and the research is now supporting) a big link between subtle nerve irritation in low back nerves and knee arthritis. This is discussed in more detail in our e-book, Orthopedics 2.0. The most common nerves in the low back that get irritated happen to go to your hamstrings. I believe that this leads to weak and tight hamstrings that get smaller over time and are less able to protect the knee structures like cartilage and meniscus. For example, in other common low back nerve supplied muscles like the gluts, weakness is associated with overload of the knee cap area on running.

The upshot? If your hamstrings are tight, you may want to hit the gym to see if they’re also weak. If you can do much more weight on the knee extension machine (quads) than you can do on the knee flexion machine (hamstrings), you may have a problem with muscular imbalance. You may also want to consider having a qualified specialist (like a physician from the Regenexx Network) check to see if a low back nerve may be the problem. Regardless, strengthening weak hamstrings to help your aching knees may well be worth a shot!

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12 thoughts on “Tight Hamstrings and Knee Pain: Your Tight and Weak Hammys May Be Frying Your Knees

  1. Ann Phillips

    I’ve hurd that tight hamstrings can cause you to have.back muscle spasms, is this tru????? I have very bad muscle spasms in my back

  2. Ann Phillips

    I hav chronic back pain bulging disk, scoliosis, degenerative disk disease, can regenexx, help me???

    1. Regenexx Team Post author

      Ann,
      It sounds like there is a lot going on from the biomechanical and nerve issues caused by the scoliosis. We do treat bulging discs, Degenerative Disc Disease, and tight hamstrings. The trick is being examined by someone who can sort out what cased what and get ahead of the ball with treatment. http://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/

  3. Ann Phillips

    My sister is 61. She had had polio in her right leg since she was 3 weeks old and has wore a long leg brace, all of her life., lots of back problems, but my main concern is the polio syndrome has come back on her affecting her good left leg, distroying the muscle. I’m so afraid it will get her down where she can’t walk, can regenexx help her???

    1. Regenexx Team Post author

      Ann,
      Unfortunately, No, I don’t think Regenexx will help post-polio syndrome, our focus would be only on helping an arthritic joint caused by the long standing weakened muscles.

  4. PATRICK LENNON

    I HAVE RECENTLY HAD A TOTAL KNEE REPLACEMENT (NOV 2015)OP WENT FINE NO INFECTIONS, BUT WHEN I GO AND LIE DOWN TO SLEEP MY LEG BENDS AND KNEE TIGHTENS UP AND HAMSTRING GOES SOLID VERY PAINFUL PUTTING ICE PACK ON TO TRY AND GET A SLEEP, DOC HAS PRESCRIBED CODIENE 30 AND AMITRIPYLINE 20mg NIGHTLY, ALSO I DO THE EXERCISES THE PHYSIO HAS GIVEN ME TO DO, BUT EVERY MORNING WHEN I GET UP I HAVE GOT TO GO UP AND DOWN MY HOUSE STAIRS TO GET THE LEG/KNEE MOVING A BIT EASIER I WOULD BE GRATEFUL IF YOU CAN RECOMMEND ANYTHING ELSE I CAN DO TO RELIEVE SYMTOMS ABOVE. KIND REGARDS PATRICK LENNON

    1. Regenexx Team Post author

      Patrick,
      While there is nothing we can do for your knee itself as there is no longer a biological joint to treat, we can take a look and see if the low back nerve associated with the Hamstrings is causing the problem. If that is the case, we can treat that. There is a Regenexx Candidate form on this page. If you fill that out, it will result in a phone consultation with one of our docs who can discuss your case in detail and let you know what we can do for you: http://www.regenexx.com

  5. PT

    Ok tight hamstrings. But what is the cause of tight and weak hammies?
    Maybe poor activation of the butt muscles, cuz we sit for a long time?
    I thinks the best way too get rid of tight hammies is self self myofascial release of the hammies, perform deadlift and hit the glutes (bridges, side lying raises).

    1. Regenexx Team Post author

      PT,
      Generally an irritated S1 low back nerve. http://www.regenexx.com/blog/just-new-video-morning/

  6. Lindsey

    About 8 weeks ago I had back spasms over a couple of days, a week later after playing 18 holes I felt as though I had a medial ligament strain in my right knee which has lasted for 6 weeks and is now better, I now have pain deep in my right hamstring when sitting or driving for long periods I presume these are all connected and started with the back spasms? should I now be working to strengthen my hamstrings so that none of these return

    1. Regenexx Team Post author

      Lindsey,

      No on the hamstring work, yes on the problem beginning with the back spasms: Please see: http://www.regenexx.com/blog/just-new-video-morning/ and http://www.regenexx.com/back-causing-your-knee-pain/

    2. Chris Centeno Post author

      Lindsey, yes that sounds right-i.e. your back is most likely causing these leg issues.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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