NULL

Hamstrings – Pain & Trigger Points

The hamstrings are located at the back of your thighs and can trigger pain in your thighs, knees and calves.

These pains often are caused by tensions, shortened muscles and trigger points.

However, it’s possible to free yourself from these muscular problems with a self-massage.

Once you have relieved your muscles of tensions and trigger points, the pain usually disappears, too.

Does this sound too good to be true? Maybe, but it’s reality! Every day thousands of people massage themselves to relax, feel better and relieve pain – because it works.

On this page you will learn everything you need to know about self-massages and much more.

  • Where exactly do the muscles cause pain?
  • What ailments can occur besides the pain?
  • Where are the muscles located?
  • What functions do these muscles provide?
  • Why are these muscles tense, shortened or carrying trigger points?
  • How can I feel these muscles?
  • How can I massage these muscles?

I will answer these questions now!

1. Pain Patterns & Symptoms

The hamstrings consist of three muscles:

  • Biceps femoris
  • Semimembranosus
  • Semitendinosus

Don’t let these names scare you!

It doesn’t matter if you can pronounce or remember them. It is important that you know which problems they cause and how to relieve them. And you’ll understand that, I promise!

In the next chapters, I will show you what pain the individual muscles may cause.

1.1 Pain patterns and trigger points of the semitendinosus and the semimembranosus

Tensions and/or shortenings in these two muscles often result in local pain in the posterior thighs.

Trigger points in these muscles can cause additional pain in the buttocks, the hollow of the knee, along the posterior portion of the thigh and on the medial side of the calf.

The pain in the hollow of the knee is often perceived as “sharp”.

1.2 Pain patterns & trigger points of the biceps femoris

The biceps femoris can also trigger pain in the posterior portion of the thigh if it is shortened and/or tense.

The pain triggered by trigger points in the biceps femoris mainly radiates to the hollow of the knee and is often described as deep-seated or as deep pain.

From the hollow of the knee, the pain can also extend to the outer/lateral side of the calf, especially if the trigger points are “very strong”.

1.3 Symptoms of trigger points and shortening of the hamstrings

In addition to the pain described above, symptoms often occur during certain activities and in the anterior portion of the thigh. In each of the examples, the muscles are either tensed, stretched or put under pressure.

  • Walking or jogging
  • Sitting
  • Pain in the anterior thigh
  • Pain when bending down

1.3.1 Pain while walking or jogging

With each step, your hamstrings control the “forward swing” of the leg and support the extension of the hip when pushing off the ground.

In the first example the muscle is lengthened, in the second it is contracted and shortened.

Trigger points can hinder this lengthening and shortening of the muscle and lead to pain – your brain believes that there is danger because the muscle can no longer be used as usual. Pain arises.

The pain during strain is often so intense that the affected person limps in order to relieve the leg. A compensation mechanism that can lead to further problems and should be avoided. That’s why it´s good to loosen your muscles!

1.3.2. Pain in the hamstring whilst sitting position

During sitting, your hamstrings are put under pressure. If there are trigger points in the muscles, this can cause pain. In this case in the ischium and the posterior part of the thigh.

1.3.3 Pain in the anterior portion of the thigh

Most muscles in the anterior thigh act as antagonists to the hamstrings. This means, that they perform opposite movements.

Your hamstrings flex your knees and extend your hips (more about that in the chapter Function). If they are tense or shortened, they can no longer be extended easily.

This will permanently put more stress on the muscles on the anterior side of the thighs (they extend your knee and flex your hip), as they have to work against the contraction of the hamstrings.

If you do not understand this relation, then simply continue reading and do not worry.

The message is: If you have pain in the front of your thighs, you should also look at the muscles on the back of your thighs.

1.3.4 Pain when bending over

When bending over, you flex the hips and stretch/extend your hamstrings. If there are trigger points or if they are shortened, your nervous system allows this stretching “reluctantly”.

As a result, you perceive pain when you bend over, especially if you do this with your knees stretched. Usually, affected persons quickly discover how to avoid this, namely by flexing the knees.

If you flex your knees while bending down, the muscles on the back of your thighs will be less stretched and there will be less or no pain.

Of course, this does not mean that the problems are gone! You just found a “smart” compensation.

2. Attachment Points

In simple terms, these muscles run down from the ischium to both sides of your lower legs.

2.1 Origin & insertion of the biceps femoris

The biceps femoris consists, as its name implies, of two muscle heads, one long and one short head.

The long head runs from the ischium to the fibula. The short head runs from your thigh bone to the fibula.

  • Origin: Tuber ischiadicum & Linea aspera of the femur
  • Insertion: Caput fibulae/head of fibula
  • Innervation: Nervus tibialis & Nervus peronaeus communis

2.2 Origin & insertion of the semimembranosus and the semitendinosus

These two muscles run from the ischium to the medial side of the tibia.

  • Origin: Tuber ischiadicum
  • Approach: Pes anserinus of the tibia
  • Innervation: Nervus tibialis

Spots with high probability of trigger point presence are marked with an X.

3. Hamstrings – Function

Your hamstrings provide extension of the hip (excluding the short head of the bicep) and flexion of the knee.

They also act as rotators of your hips. The biceps slightly contributes to an external rotation and the semimembranosus and semitendinosus to an internal rotation at the hip.

In everyday life, these muscles support many movements without you being aware of it.

1

Extension at the hip

2

Flexion of the knee

3

External rotation of the hip

4

Internal rotation of the hip

4. Hamstrings – Trigger Point Activation

Trigger points in the hamstrings usually get activated when you constantly shorten, actively overload, or injure them

In the following, some examples:

4.1 Active overload

Active overloads occur mainly in sports, when …

  • too much stress is put on the muscles, beyond their current performance.
  • Stress on the muscles is increased too quickly.
  • the pauses between activities are too short.
  • no compensatory activities, such as stretching and massage, take place

A few examples

Ball sports: Almost all ball sports involve running and quick changes of direction. The upper body is often tilted forward. This is when your hamstrings work at their maximum.

Cycling: When cycling, your hamstrings are very active and contribute about 30% of the force when pedaling down – this is the phase where extension of the hip happens.

When cycling with click pedals, your hamstrings are active when you pull the pedals, too. This is why in this case they work permanently.

This is no problem as long as you give them enough time to adjust.

Martial arts: In martial arts, kicks with the legs are performed, often very high. The knee is stretched with almost every kick and the hip is either flexed or extended.

This means the muscles on the back of the thigh must be able to lengthen quickly. Especially when cold or tired, your nervous system is not always able to control these highly complex movements.

That’s why the nervous system may interpret these fast movements as a danger and, as a result, reflexively contracts the hamstrings.

This can lead to the activation of trigger points.

Further examples of how you can overload your hamstrings:

  • Deadlifts (weight training exercise)
  • Leg Press
  • Leg Curls
  • Skateboarding

Permanent shortening

All sitting positions lead to a flexion at the knees. This means the muscle fibers of your hamstrings are approached. What is more, your body weight puts additional strain on the muscles.

In the long run, this can lead to tensions and trigger points.

What helps? Take frequent breaks and avoid long periods of sitting. Also, stretch, especially if you are forced to sit for a long time because of your work.

5. Palpation

In this chapter you will learn to feel these muscles. First as a whole and then, in a second step, individually.

5.1 Palpation of the muscles as a whole

1

Put one leg slightly forward and place it with the heel on the ground.

2

Press your heel into the ground and exert pressure in backward direction, but without moving your heel.

3

Now place one hand on your ischium and feel the hamstrings that run down ...

4

... to the posterior side of your thigh.

5

Also feel the two prevailing tendons of these muscles on the lateral …

6

... and medial side of the knee.

5.2 Palpation of the biceps femoris

1

Lie on your back and bend one leg.

Use your thumb and index finger to grasp the tendon on the lateral side of your knee.

2

Flex and extend this knee several times. Try to feel how the tendon moves between your fingers.

3

Now reach a little higher and feel the tendon merging into the muscle. Try to feel the muscle as far upwards as possible.

5.3 Palpation of the semimembranosus and the semitendinosus

In this chapter you will palpate the semimembranosus and semitendinosus together. It is not easy to distinguish these two muscles if you are not experienced at palpating.

Since, in this case, it is not so important to make this distinction, just try to feel their muscle heads.

1

Lie on your back and flex the leg.

Use your thumb and index finger to grasp the string on the medial side of your knee.

2

Flex and extend this knee several times. Try to feel how the tendon moves between your fingers.

3

Now reach a little higher and feel how the tendon merges into the muscles. Try to feel them as far upwards as possible.

6. Self-massage of the Hamstrings

You can massage these muscles with your fingers, a massage ball, the Body Back Buddy or a foam roller.

As a massage technique you can apply any of the techniques presented on this website. These are …

  • Ischemic compression
  • Precise massage strokes
  • Pressure-motion technique

On this page, I show you a very simple massage with a foam roller and a massage ball.

6.1 Self-massage with a fascia roll

The massage with a foam roller is a simple method for massaging the hamstrings.

It is particularly suitable for general muscle relaxation or when your tensions are so severe that a precise massage would hurt too much.

  • Sit on the floor and place a foam roller under your thigh.
  • Support yourself off the ground with your hands and then roll back and forth slowly.
  • This way, search for tensions in the hamstrings.
  • Once you find one, slowly roll across it a couple of times.

6.2 Self-massage with a ball on the ischium

Here you will treat the area where the tendons of the muscles attach at the bone. Trigger points in this area often lead to pain in the sacroiliac joint and to pain when bending down with stretched knees.

  • Sit on a chair and place a massage ball under your thighs, in the area directly in front of your ischium.
  • Shift some weight on the ball and roll your thigh over it.
  • Search for tensions and treat them with some of these movements.

Thank you very much for your visit.

References

  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. The Lower Extremities. Baltimore, MD: Williams & Wilkins, 1993. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print