Few things are more stubborn in a runner’s body than tight hamstrings. Stiffness, tension, and pain in the posterior thigh can be painful, prevent fast and far running, and even make running miserable.
Yet, despite the effort runners put into massaging, stretching, and strengthening, hamstring flexibility and pain relief remain elusive for many.
But what if there was a reason for that stubborn stiffness? And what if the key to solving this issue isn’t a key at all, but a different location of the lock itself?
Tightness in the hamstrings may actually arise from tight quadriceps. Photo: iRunFar/Eszter Horanyi
Background: The Complex Hamstrings
The biggest challenge to pain and stiffness in the hamstring is that, in most instances, the cause of the pain isn’t actually the hamstrings. Rather, the posterior thigh is a collection zone of dysfunction from the low back, pelvis, and sciatic nerve, among other things.
Thus, runners with “tight hamstrings” often have something else going on that can cause ongoing pain, tension, and strain in the back of the upper leg.
Yet, despite my ability to identify and treat global causes of hamstring pain, sustained hamstring mobility remained a difficult clinical — and personal — goal. That is until I studied the anatomy of the upper leg more deeply and considered the myofascial relationships of the entire thigh.
Liberating The Circumferential Thigh
Although I am approaching 15 years as an orthopedic physiotherapist, this practice continues to blow my mind. Every few months, I encounter a powerful new treatment theory or strategy that radically changes my approach to clinical challenges.
Some strategies are truly cutting-edge, while others are often basic concepts reframed in a way that’s new to me. This new-to-me strategy for hamstring mobility is mind-blowing because it is as simple as it is potent.
While my inspiration for clinical innovation is often borne from a challenge with a real-life client, sometimes it also comes from a personal struggle. This one is personal.
I have struggled with pain, severe stiffness, and slow- and miserable-feeling running for years. Much of my malaise is due to complex nerve tension: tight nerves in my legs increase tension and stiffness, making running slow and painful. Much thought and work with a medical team — namely addressing issues in my back, neck, and even head — has resulted in significant improvements.
Now, I am feeling a lot better. My mobility and pain have improved, and I can run farther and faster with greater enjoyment. Yet, as of a few weeks ago, I was still experiencing hamstring and sciatic nerve tension that was significant enough to cut short a few runs and reinvigorate my frustration.
Then, on a particularly tight run, I thought back to a discussion I had with colleagues a couple of years earlier about how the fascia of the quadriceps — the muscle that lives on the front of the thigh — actually inserts posteriorly on the femur at the linea aspera.
Like an upholstered kitchen chair, the fascia wraps around the “cushion” of the quads and tucks neatly into the back! The implication is that tensions at the fascial insertion on the back of the thigh could cause quads tension, weakness, or pain on the front of the thigh.
Then, the “a-ha!” moment: What if the opposite were also true?
The large red section is all quadriceps, while the smaller green and blue sections are adductors and hamstrings, respectively. Image: Hermann Braus/Public Domain
As you can see in the above image, two realities:
- The quads (red) are much larger and lateral than most of us realize — and they wrap around to the back of the femur.
- The quads and adductors (green) make up about 75% of the total circumferential area of the thigh!
Then, I considered: What if extensive quad stiffness was — through fascial interactions — compressing the hamstrings — and sciatic nerve?
As such, it is quite possible that fascial tensions (even tension that causes no local pain) in the expansive quad muscles — which cover two-thirds of the femur — could cause stubborn compression of the hamstrings that no amount of focal hamstring treatment would improve.
Historically, after a decade of mountain ultrarunning, and more recently, after completing a few steep, mountainous up-and-down runs, my quadriceps have been very stiff. Yet, I did nearly nothing to address that quad stiffness because they were only mildly symptomatic.
When it comes to loosening tight hamstrings, it might be time to focus on the quads. Photo: iRunFar/Eszter Horanyi
I cut short the run and headed home. And for the next couple of hours, I extensively:
- Foam-roll massaged my thigh in three dimensions, but in particular, the anterior and lateral thigh and medial thigh
- Stretched my hip flexors, quads, and adductors, but not my hamstrings
The results:
- My toe-touch hamstring flexibility improved
- My running-related hamstring tension greatly improved
These results are consistent with similar findings at the hip: unconventional, non-intuitive “side-door strategies” to improving inner and outer hip joint mobility resulted in substantial gains in flexion and extension.
Once I appreciated the thigh’s similar three-dimensional nature and myofascial relationships, I freed everything around its circumference. Only then did I gain significant and sustained improvement in hamstring mobility and running comfort.
Hamstrings Liberation How-To
To improve hamstring flexibility — as well as whole-thigh mobility — try these strategies:
Massage in Three Dimensions
Mobilize all parts of the thigh. If the hamstrings are tight, it may be that some, or all, of the adjacent tissues around the femur are tight. Foam roll and massage not just the front of the thigh but:
- The anterior-lateral thigh, which includes the lateral quad and front and side of the iliotibial (IT) band
- The medial thigh (adductor muscles)
- The posterior-lateral thigh, which is the lateral end-point of the vastus lateralis quad muscle, a muscle so wide that — like the upholstered kitchen chair — it wraps nearly all the way around the femur
When those areas are worked, then massage:
- The posterior thigh, or the area containing the three hamstring muscles
Mobility in the hamstrings is critical to a comfortable running stride. Photo: iRunFar/Eszter Horanyi
Apply Pressure Perpendicular to But Not Straight Into the Bone
Most conventional massage techniques apply compressive pressure into the muscle directly at the bone. This may be useful if the muscle belly has a density (or “knot.”) But more often, whole muscle groups — bound in fascia — are stuck to adjacent muscles or the bone itself. This is a mobility concept called “muscle play.”
To free the fascial bundles and the tissue borders between them — known in the thigh as intermuscular septa — apply pressure perpendicular to the femur shaft. This is akin to a “sideways” pressure that pushes the muscle somewhat away from the bone, not into it. This will wiggle free one muscle or fascial layer from others or from the femur itself.
This can be difficult to self-apply at the quads, but using a massage ball on the lateral quad — where the ball pushes the outer quad upward, away from the femur — improves fascial mobility better than compressing the tissue directly into the femur.
Stretch Around The Hamstrings First
Finally, once those adjacent tissues are freed, stretch them. Mobilizing the hip flexors, quads, and groin (adductors) will decrease the pressure around the hamstring compartment.
Finally, Stretch the Hamstrings
Once the neighbors are freed, it is time to address the hamstrings. They should be directly massaged with a foam roller or ball, but from as many angles and directions as possible. Once freed, they will tolerate — and benefit from — direct stretching.
Watch this video for a demonstration of the fascial relationships and mobility strategies:
Conclusion
To think outside the box is often to dive deeper into the box — into the complex reality of human anatomy to understand tissue relationships and leverage that understanding into major improvements.
The thigh is yet another example of this fact. Improving hamstring health requires improving its relationships with its neighbors.
Do try this at home. Work the whole thigh, not just the nagging spots, to liberate more mobility — hopefully leading to less pain and faster running.
Call for Comments
- Do you struggle with tight hamstrings regardless of how much you try to stretch them?
- Have you tried stretching your quads to help loosen your hamstrings before? Did it work?
