tight hamstring anterior pelvic tilt

Can Tight Hip Flexors Cause Tight Hamstrings?

I like the title of this article – Can Tight Hip Flexors Cause Tight Hamstrings?  It is sort of like a riddle, isn’t it?

I was working with a client recently that is knowledgable and understands anatomy fairly well.  He came to see me for several reasons, but high on the list was “my hamstrings are tight” followed by a poor attempt at touching their toes.  His hands were about 3 inches from the floor with his knees bent!  He added, “I don’t know why I can’t touch my toes, I have been stretching and working on my hamstrings for months!”

After spending time assessing him from head-to-toe, I shared with him that I thought his hamstrings were “tight” because his hip flexors were tight.  He thought about it for a second and then tried to call BS, stating “If my hamstrings are tight, shouldn’t my hip flexors be loose?”

My answer was “I don’t think your hamstrings are tight.”  At this point, he was about ready to leave the session, thinking I was the craziest person in the world, stating “but I can’t touch my toes?!?”


How Tight Hip Flexors Can Cause Tight Hamstrings

I bet you’ve had clients like this in the past.  They know just enough to be dangerous.  The answer to my riddle is more semantics than anything else.  Yes, hamstring tightness can limit your ability to touch your toes, but that isn’t the only cause.

We have actually done a great job understanding this concept over the last several years.  People like Gray Cook, Lee Burton, Brett Jones, and others have done wonders teaching many people that sometimes there are other reasons why you can have a limited toe-touch, specifically because of poor motor control and core stabilization.

However, hip flexor tightness can be a contributor as well, as backwards as that seems.  Again, it comes down to semantics.  I am actually talking about anterior pelvic tilt limiting your ability to touch your toes.

Here is an interesting an example.  Which hamstring is shorter in the below image?

hip flexor hamstring tightness

If you answered the left leg, you are guessing!  Without a comprehensive exam, you are just guessing.  What if his left pelvis was anterior tilted?  This would cause the proximal attachment of the hamstring to move superiorly and look just like a tight hamstring, such as in this example:

tight hamstring anterior pelvic tilt

Whenever someone appears to have tight hamstrings or can not touch their toes, I look first at pelvic alignment to see if they are in excessive anterior tilt.  Everything revolves around assessing your starting point.

As you can see in the example below, if you are starting in a large anterior pelvic tilt, then you are theoretically starting with the hamstrings long.  I used the simple math numbers of 45 degrees and 90 degrees, which is pretty excessive, but you see what I mean.  In a large anterior pelvic tilt, your normal starting position in this example would already be close to 45 degrees!

Anterior Pelvic Tilt

So, can having tight hip flexors cause tight hamstrings?  I’m not sure about that.  But I know that being in anterior pelvic tilt can limit your ability to touch your toes.  Again, it always comes down to:


Assess, Don’t Assume

This is one of my major concepts from the Functional Stability Training for the Lower Body program.  Assess alignment before you just start treating.  Resist the urge to just foam rolling, massaging, and stretching your hamstrings without truly assessing if this is the reason why you can’t touch your toes.  Sometime having tight hip flexors and an anterior pelvic tilt can limit your ability to touch your toes just as much.

14 replies
  1. Jejkka
    Jejkka says:

    Great post and what many people don’t realise. Was working on. Hamstrings for ages with no progress and tendon/knee pain after a while. Why ? Very large angle on my hips which are tilted to the anterior.

    It’s pretty much common sense.
    The tight hip flexors pull the pelvis down anterior ly. Then when you lean forward your hamstring attachment to the back of the pelvis contracts hard -: it is already taught. and can easily be overstretched causing pain and doesn’t allow muscle relaxation.

    So how to stretch my hamstrings ? First work on my hips . But the BEST way to stretch hamstrings for me is to place my leg along a tabletop. Then I slowly bend the other leg, flexing the hip then I play with the stretch and can go much further . If the leg is straight, ( the leg on the ground )the already tight hip flexor pulls the pelvis down and creates a kind of tug of war with the hamstrings which also pull on the back. Resulting in no progress.

    The more I flex at the hip on the other leg, the more I can stretch my other hamstring, with no pain.
    another tip is to place a lacrosse ball on the table where the hamstring meets the pelvis and look for tight spots. Then remove he ball and continue to stretch.

    Yours sincerely, someone with chronically tight hamstrings , but much improving condition .

  2. Christian
    Christian says:

    I would have through as soon as you raise the thigh in the hamstring Ax you are reducing distance between attachment sites of the hip flexora. Therefore their influence on saggital plane position statically wouldnt be as significant enough to alter your interpretation of the hamstring length Ax?

  3. harris
    harris says:

    hi everybody
    i want to share my problem
    i got my ACL reconstructed.
    its my 10 th days post surgery,
    i can not lift my leg straight up….
    is it because of stiches on my knee or what.
    after how much time will i be able to lift my leg straight up?
    and what exercises should i do to strenghten my leg muscles.
    need a detailed answer. thank u

  4. Dr. Caitlin McAlpine
    Dr. Caitlin McAlpine says:

    Thank you for posting this great article! My patient yesterday walked into the clinic saying the same thing…”I have been stretching my hamstrings for months” and he still has yet to see a difference. He has chronic sacroiliac joint pain and extremely hypertonic hip flexors. Now we know what to add to his rehabilitation!

  5. christian
    christian says:

    Hence why most blog’s and info on the internet paint only part of the picture if the even do that.

    The “touch your toes” Ax can provide you with valuable info that gets you closer to discovering what’s going on but again it too needs to be be taken with a grain of salt. I have a noted APT but kick ass on this test because of my exceptionally long arms.

    • Mike Reinold
      Mike Reinold says:

      Ha ha, I like it christian. I really do focus on the quality of the movement too and would look for someone like you that may be “cheating” so to say…

      I look at spine angles, sacral angles, pelvis position, and even knee bend.

  6. Kris, PT
    Kris, PT says:

    Helpful post as usual, thanks Mike.

    In our clinic we find the simple way to take the guess work out of FB observation (reach for your toes) is just to measure it. An inclinometer is an invaluable tool, do you use it or recommend it Mike?

    Here is my pathway with the inclinometer:

    1. Resting lordosis/pelvic tilt – QQS
    2. Forward bend and measure pelvic flexion – QQS
    3. Measure lumbar flexion – QQS

    QQS (quantity, quality, and symptoms)

    With all 3 data points plus the context of QQS, one can make a more reasoned analysis of gross forward bending.

    Use an inclinometer, put it on the sacrum and upper lumbar and measure the resting lordosis.

    Then ask them to forward bend and measure. The sacrum represents the pelvis and tells you how much (quantity in degrees) the pelvis moves on the hips, essentially hamstring length but in the context of the resting lordosis.

    You would look at quality (abberant patterns/substitutions) and symptoms to determine if it was not a true functional length measure or other confounding variables must be considered.

    Then put the inclinometer on at the TL junction to see how much is coming from the lumbar.

    This is a nuanced but yet valuable process in most of my examinations that involve the hips and lumbar.

    • Mike Reinold
      Mike Reinold says:

      Kris this is great. I do this as well at times and we have studied this a lot in baseball players. It is interesting to measure. It does assume pelvis symmetry, though, but still worth looking at.

  7. Nancy Bullett
    Nancy Bullett says:

    Hi Mike,
    Thanks for the article!
    Having worked with CP kids “back in the day”, I would see tight hip flexors in our non-ambulatory kids. So, in order to see how tight the hamstrings were, we would flex the hip and knee to 90, posteriorly tilting the pelvis, and then extend the knee. Quite a difference I would agree.!

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