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Why Hips Are Hurting Hamstrings

When it comes to sports injuries, the who-done-it-and-how is not always obvious, especially relating to hamstring strains. Here, alignment expert Pete Egoscue solves the mystery behind the pain.

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Pain and Anatomy Advisor
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Among athletes, professional and amateur alike, muscle sprains (stretch or tear of a ligament) and strains (a twist, pull or tear of a muscle or tendon) are among the most common injuries. This summer alone, Major League Baseball has seen a pulled hamstring epidemic with 31 players, and counting, already on the disabled list. This number is on track to surpass last year’s list of 57 players sidelined by this injury that continues to nag both the MLB and numerous other sports.

Once an athlete pulls a hamstring, he or she can be knocked out of commission for anywhere from two weeks to two months, depending on the severity of the damage. That is why many athletes go to great lengths to avoid this injury, incorporating a detailed and protracted regimen of stretching. Unfortunately, no amount of stretching will prevent this problem for one simple reason: The crux of the matter lies in the hips, not the hamstrings.

I’ve said it thousands of times, but it bears repeating: barring recent trauma, such as a car accident, the source of the pain is never the source of the problem. Hamstring pulls are really the result of a dysfunctional posture and an imbalanced body. To prevent this injury, athletes must bring proper alignment to their postures so that their bodies can work as a unit.

First, let’s cover some anatomical specifics. What is commonly referred to as the hamstring is actually three muscle groups: 1) the semitendinosus muscle and tendon, 2) the semimembranosus muscle and tendon, and 3) the biceps femoris, short and long. Those muscles run from the pelvis to the knee and are attached by the tendon to the bone. When people pull their hamstrings, it’s often in one of the muscles, however, the more severe strains that take longer to heal occur in the tendon. Regardless of whether the pull is in a muscle or a tendon, the underlying problem is the inability of the tendons and muscles of the hamstring to work in a synchronized fashion.


Related: Taking the First Steps Toward Pain-Free Living


When we break into a sprint, the muscle spindles in our hamstrings contract. In a properly aligned, fully functioning body that contraction is flawless. The tendons at the knee and hip work simultaneously to allow that muscle to correctly engage. However, if the hamstring tendons at the hip don’t work in synchronicity with those at the knee, the body, in its wisdom, puts an immediate halt to the contraction in that hamstring muscle. While the body instinctively commands that muscle to stop, the rest of you doesn’t get the memo so you continue to full-on sprint. In that split second, you may experience a pulled hamstring. (Note: I am speaking here about the most overwhelmingly common cause of hamstring pulls.)

So, you can see, the problem is not the hamstring, but rather the inability of the tendons at the hip to work in concert with the tendons at the knee and in accordance with the muscle. Pain is the body’s way of communicating to you that something is wrong. A common misconception is that you can stretch that muscle back into alignment. But the truth is, stretching or isolating it by intensely strengthening the muscles around it will not remedy the underlying issue. Yes, the hamstring will eventually feel better, but that’s the result of time allowing the body to heal itself.

Moving the hip back to the appropriate position is what will best prevent hamstring pulls. No one is more aware of this than Elliot Williams, the director of Functional Performance for the San Francisco 49ers. Elliot was recently hired by my old friend, John Lynch, the new General Manager for the 49ers. I have worked with John on his posture and fitness since he was a teenager, and because he is such a staunch supporter of postural alignment, he immediately brought on Elliot, an Egoscue Method-trained therapist, to work with the NFL team on their alignment, too. Given the prevalence of hamstring injuries among athletes, Elliot spends a great deal of time working to counter their occurrence.

“When it comes to hamstrings,” Elliot says, “the actual compensation is almost always upper-body driven. That is, if the hip isn’t in its proper place and working as it was intended, it’s something in the upper body that gives me that clue.” For instance, if a player is in the weight room, and he does a series of squats, Elliot looks at the position of his arms when he is finished.

“If those arms are spread wide and distant from their sides, as if he’d just worked his trap muscles, then I know there’s a big problem with the hips. Squats are a hip-driven exercise. But if that hip-driven exercise caused his arms to move out as if he’d just done a back-driven exercise, that means the back did actually do too much work, and that’s because the hips couldn’t. The back was compensating for a hip that’s so dysfunctional, it’s in danger of not being able to work properly for a sprint.”

The upper body is always a dead-giveaway if there’s a misalignment that could hurt the hamstrings, Elliot continues. For example, when a player sprints, his arms will move freely back and forth if the hip is properly aligned. But when the player’s hands don’t move very far from the body mid-sprint, then that’s a sign the shoulders aren’t enabling the arms to swing. In this case, the shoulders are working too hard to compensate for a hip not doing its job to allow the body to run. Sometimes, the compensation will be so extreme that the hands actually chug sideways, crossing perpendicular across the center line of the spine. That’s another sign of someone who is about to pop his hamstring.

Elliott also pays attention to the legs. “If I see someone’s stride has noticeably shortened, that’s a sign of a compromised hip.”

The bottom line: The body is a unit, and all of its many elements work in complete concert. You cannot isolate any one part from the rest. Too many people are pulling their hamstrings these days, and it’s causing untold hours of pain as well as disappointment on multiple levels. When a professional baseball player pulls his hamstring, the team loses his services for any number of weeks, perhaps diminishing the team’s chances of winning and certainly reducing the return on the owner’s investment. And when amateur athletes pull their hamstrings, they lose their ability to play that game of tennis or golf over the weekend, take that jog with their dog, or go for that moderately difficult hike with their kids.

Hamstring pulls can be prevented by aligning the body so that it is balanced and the hips are functional. Full postural alignment with a trained therapist is always best, but if that’s not immediately accessible to you, try this 15-minute exercise sequence to realign your hips so that they can help your hamstrings out when needed.


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