The Effect of Hamstring Muscle

Stretching on Standing Posture and

on Lumbar and Hip Motions During
Forward Bending

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Background and Purpose. The purpose of this study was to determine
whether stretching the hamstring muscles affects extensibility, as
indicated by straight leg raising (SLR), lumbopelvic posture, and the
relative amounts of lumbar and hip motion during forward bending.
Subjects. Thirty-nine subjects without known musculoskeletal impair-
ments of their spine or lower extremities and with tight hamstring
muscles (ie, SLR of 570") were randomly assigned to either a
stretching group or a control group. Methods. A three-dimensional
digitizer was used to measure lumbar, pelvic, and hip positions while
subjects were in a standing position and during partial and full forward
bending. Results. Straight leg raising and hip motion during late and
total forward bending were increased after stretching. No changes
occurred in standing posture or lumbar motion during forward
bending. Conclusion and Discussion. The results of this study suggest
that there is n o relationship between hamstring muscle length and
lumbopelvic posture. There was some indication, however, that stretch-
ing the hamstring muscles may affect motion during forward bending.
[Li Y, McClure PW, Pratt N. The effect of hamstring muscle stretching
on standing posture and on lumbar and hip motions during forward
bending. Phys Ther. 1996;76:836-849.1

Key Words: Hamstring muscle; Hip motion; Kinesiology/biomechanics,lower extremity; Lumbar motion;
Posture; Stretching.

Yenchen Li

Philip W McClure

Neal Pratt

I
Physical Therapy . Volume 76 . Number 8 . August 1996 1

othman and Simeone1 stated that postural or
mechanical disturbances are the most com-
mon cause of low back pain (LBP). Certain
postural".J and mobility4~hharacteristicsmay
be related to the presence or absence of LBP. Clinicians
commolnly try to correct these postural and movement
faults by prescribing therapeutic exercise. Stretching of
the hamstring muscles appears to be commonly used
and advocated."
Cailliet2 contended that alteration of the normal rela-
tionship among the alignment of the spine, the position
of the pelvis, and the length of the muscles attaching to
the spine and pelvis contributes to the development of
LBP. Kendall and McCrearyQrgued that individuals
with "flat" backs (reduced lumbar curvature) while
standing tend to have short hamstring muscles. They
presumed that short hamstring muscles rotate the pelvis
posteriorly, resulting in a concurrent reduction of lum-
bar lorclosis. They suggested stretching the short ham-
string muscles to correct the faulty alignment."(p~SHH-*89) everyday activity require trunk flexion. Forward bending
The effect of such stretching has not been evaluated.
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Toppenberg and Bullock7 examined the interrelation-
ships of spinal curves, pelvic tilt, and muscle lengths
(abdominal, erector spinae, iliopsoas, gluteal, rectus
femoris, and hamstring muscles) in asymptomatic
female subjects. Although they found no relationship
between pelvic tilt and lumbar curvature, longer abdom-
inal muscles and shorter erector spinae muscles were
associated with an increased lumbar curve. Of the lower-
extremity muscle groups studied, only the length of the
hamstring muscles was related to the lumbar curve, and
it was negatively related (ie, shorter hamstring muscles
were associated with a greater degree of lumbar lordo-
sis). Heino et a18 examined the relationships among hip
extension range of motion (ROM), standing pelvic tilt,
standing lumbar lordosis, and abdominal muscle perfor-
mance. No correlation was found among any of these
variables. FlintVound that lumbar lordosis was unre-
lated to hip and trunk flexibility.
Many of the tasks that occur during either work or
is a complex movement of combined lumbar and hip
motion. Short hamstring muscles, because of their
attachments to the posterior leg and to the ischial

Y Li, PT, is Physical Therapist, Chang Gung Memorial Hospital, Taiwan, Republic of China.
She was a student in the Departmenl of Orthopedic Surgery and Rehabilitation, Hahnemann University,
Philadelphia, PA, 19102, when this study was completed in partial fulfillment of the requirements
for her Master of Science degree.

PW McClure, PT, OCS, is Assistant Professor, Department of Physical Therapy, Medical College
of Pennsylvania and Hahnemann University, MS 502. Broad and Vine Streets, Philadelphia, PA 19102 (USA)
(mcclurep@hal.hahnemann.edu).Address correspondence to Mr McClure.

N Pratt, F'hD. PT, is Professor, Departments of Physical Therapy and Anatomy, Medical College
of Pennsylvania and Hahnemann University, and Director, Orthopaedic Physical Therapy Program,
Medical College of Pennsylvania and Hahnemann University.

This study was approved by the Medical College of Pennsylvania and Hahnemann University
Institutional Review Board.

T h ~ snrtlcle was subrnitt~dJ u l ~5 , 1995, and wns accepted Februa~y27, 1996

Physical Therapy . Volume 76 . Number 8 . August 1996

Table 1.
Characteristics of Subiects and Results of Tests to Ascertain Group Equivalence Prior to Intervention
Control Group (n=20)
Variable X SD Range
Age (Y] 29.3 3.5 23-36
Weight (kg) 63.8 8.5 50-78.6
Height (cm) 1 66.7 7.3 149.9-1 77.8
Gender 9M, 1 1 F
LBPHX~ 6Y, 1 4 N
"Probability valut- i r ~Mar~n-WhitneyZJ rc$t.
" LBPHx=histov of lotrr back pain.
tuberosity, may limit hip flexion ROM. Several
authors"lO,llhave suggested that restricted hip motion is
coupled with excessive lumbar motion. Stretching short
hamstring muscles to increase hip flexion, therefore,
may affect lumbar motion during forward bending.
Excessive lumbar motion would increase tensile loads on
the spine and thus could result in LBP. According to
Cailliet,%hort hamstring muscles cause back pain due to
their influence on lumbopelvic rhythm during forward
bending.
Mayer and associatesI2 measured lumbar and pelvic mo-
tion during forward bending using the two-inclinometer
technique. They followed the progress of a group of
patients with chronic LBP undergoing intensive ROM
training and concluded that subjects with L.BP had less
overall flexion (65") than did subjects without LBP (122"),
with the percentage of lumbar flexion to overall flexion
decreased (63%-43%). After 3 weeks in the program, the
ranges of both lumbar and pelvic motion were increased;
the percentage of lunlbar to overall flexion increased
(43%-71%), whereas the percentage of pelvic motion
decreased (57%-29%). Unfortunately, the details of the
exercise program were not described.
Based on the studies described, standing lumbopelvic
posture has not been clearly related to muscle length.
Furthermore, there are insufficient data to determine
the effect of hamstring muscle stretching on standing
lumbar and pelvic posture or the relative amounts of
lumbar and hip motion during forward bending.
The purposes of this study were (1) to examine the
effects of stretching on hamstring muscle length, stand-
ing lumbar lordosis, standing pelvic inclination, and the
relative amount of lumbar and hip motion during trunk
forward bending and (2) to determine whether there is
a correlation between hamstring muscle length and
standing posture or between hamstring muscle length
and the relative amounts of lumbar and hip motion
during forward bending.
Stretching Group (n= 19)
X SD Range t P
28.4 5.1 22-37 .63 ,535
62.5 10.6 46.8-89.1 .40 ,688
168.7 9.4 157.5-1 87.9 - .64 ,528
8 M , 11 F ,879"
9Y, l O N ,365"
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Method
Subjects I
The subjects were 39 volunteers without known muscu-
loskeletal impairment of their spine or lower extremities
and with tight hamstring muscles on the right side. A
subject's hamstring muscles were considered tight (ie, in
a shortened position) if there was straight leg raising
(SLR) of 1 7 0 degrees.l3.l4The subjects had no current
knee, hip, or back pain and were not engaged in exercise
programs designed to strengthen or lengthen the ham-
string or low back muscles. Prior to participation, sub-
jects signed a consent form that informed them of the
nature of the study. The subjects' age, height, weight,
gender, and any history of LBP were recorded; these
characteristics are shown in Table 1.
To ensure equal distribution of hamstring muscle tight-
ness, the subjects were stratified into two groups based
on their degree of hamstring muscle tightness as mea-
sured by the SLR test (SLR between 60" and 70°, SLR less
than 60"). They then were randomly assigned to either a
control group (n=20) or a stretching group (n=19).
Both groups were measured before and after a 3-week
period.
Measurements
Measurements of lumbar and hip position were obtained
using the ~ e t r e c o m , *an electromechanical three-
dimensional digitizer. Landmarks on the lumbar spine,
pelvis, and thigh were located and marked with the
digitizing probe of the Metrecom according to the
model shown in the Figure. The Metrecom software
yields x, y, and z Cartesian coordinates of all digitized
landmarks, which are stored in a file for subsequent data
processing. From these landmarks, vectors and angles
were calculated to represent lumbar and hip positions at
rest and during partial and full forward bending accord-
ing to the model shown in the Figure.
1
'Fan) Trrhnologies Inc. 125 Techi~ologyPark, I.ake May, F1. 52746
Physical Therapy . Volume 76 . Number 8 . August 1996

FuIl Forward Bending
Figure.
Model used to describe forward bending. L-1 =first lumbar vertebra, S-2=second sacral vertebra (calculated as the midpoint between two digitized
points on the sacrum], ASIS=anterior superior iliac spine.
Prior to digitization, the spinous processes of the first
lumbar vertebra ( L l ) and second sacral segment (S2),
the right anterior superior iliac spine (MIS), the right
greater trochanter, and the right lateral femoral epicon-
dyle were identified through palpation and marked with
adhesive markers. The examiner (YL) located the spi-
nous process of S 2 by palpating the posterior superior
iliac spines and moving her thumbs medially to the
midline of the subject's sacrum. The examiner then
located the L 1 spinous process by palpating and moving
her thumbs superiorly six levels above the subject's S 2
spinous process.
A plastic marking apparatus with a point at each sup-
porting base was made to improve digitization of the S 2
and L-1 spinous processes. First, this plastic apparatus
was placed along the subject's spine and centered exactly
over th.e L 1 vertebra. Both upper and lower points of
the plastic apparatus, which represented points 2.54 cm
(1 in) above and below L-1, respectively, were then
Physical Therapy . Volume 76 . Number 8 . August 1996
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Partial Forward Bending
digitized and used to form a vector that was tangent to
the lumbar curve at L-1. This same procedure was used
for S2. The plastic apparatus was centered over the $2
vertebra, and points above and below $2 were used to
form a vector that was tangent to the curve at $2
(Figure). The points obtained by digitizing the greater
trochanter and lateral femoral epicondyle were used to
form a vector representing the thigh. In the resting
standing position, the ASIS was digitized and a vector
was calculated between $2 and the ASIS. Subsequently,
three angles were obtained by a computer program that
calculates the angle between two vectors using these
coordinates. The lumbar angle was formed by the vector
at L-1 and the vector at S-2. The hip angle was formed by
the vector at S 2 and the vector representing the thigh,
and the pelvic inclination was the angle formed by the
vector from S-2 to the MIS with respect to the horizon-
tal. All angles were based on the sagittal-plane projec-
tions of the relevant vectors.
 Hamstring muscle length was characterized using two
methods. First, the SLR method described by Ekstrand et
all5 was used. With the subject positioned supine on a
table, an inclinometer was placed on the leg 5 cm below
the inferior border of the patella in line with the tibia.
The examiner placed one hand under the calcaneus of
the tested leg while palpating and maintaining the knee
joint in extension with the other hand. The examiner
then moved the leg vertically until the subject first felt a
stretching sensation in the posterior thigh area. At this
point, the inclinometer value was read. The SLR test was
repeated two more times. These three measurements
were averaged, and the resulting mean SLR angle was
used to reflect the hamstring muscle length.
Hamstring muscle length also was characterized using
the active-knee-extension (AKE) test described by
Gajdosik and Lusin.'G The subject was positioned supine
with the posterior thigh held firmly against a vertical
board that was attached to the table so that the thigh was
stabilized at a 90-degree angle with the trunk. This hip
position was maintained while an inclinometer was
placed on the leg 5 cm below the inferior border of the
patella in line with the tibia. The subject then slowly and
actively extended the leg while maintaining the thigh
against the vertical board. The lower extremity not being
tested was maintained flat on the table. The range of
restricted extension in the knee joint was measured by
reading the inclinometer (ie, total knee extension was
recorded as 0"). The AKE test was repeated two more
times, and these three measurements were averaged.
The resulting mean AKE angle was used to reflect
hamstring muscle length.
Procedure
Once each subject had read and signed the informed
consent statement, measurements of hamstring muscle
length were performed as described. Subjects were
instructed to stretch their hamstring muscles five times,
holding each stretch for 10 seconds as a warm-up prior
to measurement of hamstring muscle length. Stretching
was performed with the subjects positioned supine by
actively extending the knee with the hip flexed. The SLR
measurement method was used first, followed by the
AKE method.
Next, subjects were asked to remove their shoes and
stand comfortably with their feet about shoulder width
apart. Each subject stood on a piece of paper taped to
floor in the middle of the Metrecom measuring field. To
ensure that all measurements were taken in the same
position, the outline of the subject's feet was drawn and
the subject was asked to stand in the tracings for each
subsequent measurement. To facilitate digitization,
adhesive markers were placed on L-1, S2, the ASIS, the
right greater trochanter, and the right lateral femoral
epicondyle. The superior border of each patella also was
marked because subjects used this landmark during the
test of partial forward bending.
Anatomic landmarks were then digitized as described
with the subjects resting in a standing position. To
determine the amount of lumbar and hip motion during
the early and late phases of trunk flexion, the subjects
were instructed to bend forward slowly into partial and
full forward-bending positions. The partial forward-
bending position was defined by the point at which the
subjects' fingertips reached the top of patella. The
subjects were instructed to "bend forward as far as you
can while keeping your knees straight" to achieve the full
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forward-bending position. Subjects were asked to hold
the partial and full forward-bending positions while the
landmarks were digitized. Subjects were permitted to
move back into an upright position between the partial
and full forward-bending positions. Digitization took
about 10 seconds in each position.
Ecirly fonuard bendingwas defined as the interval between
the resting standing position and the partial forward-
bending position. Latefornard bendingwas defined as the
interval between the partial forward-bending position
and the fully forward-bent position. Totalfonuard bending
was defined as the interval between the resting standing
position and the fully forward-bent position.
When the subjects were in a partial or full foward-
bending position, the same points were digitized as in
the neutral standing position, except that the ASIS was
not digitized in the partial or full forward-bending
positions. Changes in position between standing and
partial forward bending represented motion during
early forward bending. Changes in position between
partial and full forward bending represented motion
during late forward bending. Changes in angle between
standing and full forward bending represented motion
during total forward bending. All measurements were
taken by the same investigator (YL).
To decrease the error associated with each Metrecon1
measurement, the entire measurement procedure was
repeated by the same investigator in both pretest and
posttest sessions. For each session, the average of two
measurements was computed and used as the value for
that session. The intersession reliability of all measure-
ments was evaluated by comparing the average value
from the pretest session with the average value from the
posttest session for subjects in the control group. Twenty
paired measurements, therefore, were used to deter-
mine intersession reliability over a 3-week period. Intra-
class correlation coefficients (ICC[3,k]), as described by
Shrout and Fleiss," were used to examine reliability for
each measurement.
Physical Therapy . Volume 76 . Number 8 . August 1996
The intt:rsession reliability values (ICCs) are presented
in Table 2. The intersession ICCs for the SLR and AKE
tests were .99. The ICCs for the measures of lumbar and
hip postures and motions using the Metrecom ranged
from .79 to .95.
Stretching Regimen
The stretching group stretched daily for 3 weeks. Each
subject was instructed in the stretching technique imme-
diately following the pretest measurements and also was
given written instructions. The regimen consisted of
slow, static stretching for 15 seconds, followed by a
15-second rest, 10 times daily. The subject was instructed
to lie supine between a doorway with hips positioned
while keeping the knee extended and the other lower
extremity flat on the floor. To increase the stretch, the
subject was instructed to slide the buttocks closer to the
doorframe or to lift the limb away from the door frame.
The subject was encouraged to stretch to a sensation of
mild discomfort in an effort to achieve maximal stretch-
ing. After stretching was completed with one limb, the
contralateral limb was stretched. Each subject main-
tained a daily log to document compliance.
Data Analysis
The equivalence of the stretching and control groups
prior to the study was checked by conducting indepen-
dent t tests on age, weight, and height and by conducting

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slightly in front of the doorframe. The subject raised one the nonparametric Mann-Whitney tests on gender and
lower extremity and rested it against the doorframe history of LBP.

A multivariate analysis of variance (MANOVA) was used

Table 2.
Intersession Reliability Values (n=20) to examine group differences for dependent variables.
The MANOVA was used because the dependent vari-
L

Measurement ICCa(3,k) ables may be correlated. In addition, the use of one test
of significance for all dependent variables in multivariate
SLR~ angle .99 analysis, rather than multiple separate tests for each
AKEc angle .99
dependent variable in univariate analysis ( F tests), can
Standing lumbar angle .92
Standing pelvic inclination .91 decrease the probability of a Type I error. Therefore,
Early lurrlbar motion .85 Hotelling's T ~ which
, is a multivariate extension of
Early hip motion .88 Student's t test, was used for comparison of the two
Late lumbar motion .79 groups. Subsequently, F tests were used to compare
Late hip motion .85
group means for each dependent variable in follow-up
Total lurnbar motion .92
Total hip motion .95 analysis. The acceptable Type I error was set at PS.05.
Pearson product-moment correlation coefficients also
IC(:=intraclass correlation coefficient.
"
were used to show the association between hamstring
" SLR=straight leg raise.
' AKE=active knee extension. muscle length and all other dependent variables.

Table 3.
Descriptive! Values and F-Test Results for Hamstring Muscle Length and Lumbar and Pelvic Angle in a Standing Position

Control Group (n=20) Stretching Group (n= 19)

Variable X SD Range X SD Range F P

SLRo angle (")

Prestretching 61 6 50 to 69 59 7 43 to 69
Poststretching 61 6 51 to70 68 6 59 to 78 14.28 <.OOlb
AKEc angle (")
Prestretching 38 11 20 to 53 40 13 15 to 65
Poststrekhing 38 11 20 to 52 28 12 1 1 to 47 7.95 .008b
Standing lumbar angled
Prestretching -14.0 6.1 -26 to -4 -15.4 8.8 -28 to 4
Poststretching - 14.7 5.3 -24 to -6 - 16.0 6.1 -26 to -4 0.53 .47
Standing pelvic inclinatione
Prestretching -3.2 8.3 -17to8 -3.1 10.0 -19 to 13
Poststrekhing -2.4 8.8 -18to9 -5.6 9.7 -20 to 10 1.15 .29
" SLK=srraight leg raise.
I' E.05
' AKE=active knee extension.
"Negat~veraIues represent extension (lordosis).
"Negative values represent anterior inrlinatio~~.

Physical Therapy . Volume 76 . Number 8 . August 1996

Table 4.
Descriptive Values and F-Test Results for Lumbar and Hip Motion During Forward Bending

Control Group (n=20) Stretching Group (n= 19)

Variable X SD Range X SD Range F P

Early phase
Lumbar motion
Prestretching
Poststretching
Hip motion
Prestretching
Poststretching
Lumbar/hip ratio
Prestretching
Poststretching

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Late phase
Lumbar motion
Prestretching
Poststretching
Hip motion
Prestretching
Poststretching
Lumbar/hip ratio
Prestretching
Poststretching
Overall
Lumbar motion
Prestretching
Poststretching
Hip motion
Prestretching
Poststretching
lumbar/hip ratio
Prestretching
Poststretching

Results the ratio of lumbar to hip motion during early forward

The descriptive characteristics of the subjects in each
group are shown in Table 1. There were no differences
between the two groups in age, weight, height, gender,
or history of LBP.
Results of the MANOVA (Hotelling's M h for group dif-
ferences showed a difference between groups following
the stretching program (P<.05). Thus, in follow-up
analysis, univariate F tests were used to compare group
means for poststretching variables. Table 3 shows the
descriptive values and Ftest results for SLR and lumbar
and pelvic angles in a standing position. There was an
increase of 9 degrees in SLR angle and a decrease of 12
degrees in AKE angle, both reflecting increased ham-
string muscle length after stretching. No change
occurred in lumbar lordosis and pelvic inclination in a
resting position. The data relating to lumbar and hip
motion during forward bending are shown in Table 4.
There was no change in lumbar and hip motions, or in
bending. During late forward bending, group differ-
ences were found only in the amount of hip motion
(P<.05). There was an increase of 5.1 degrees in hip
motion during late forward bending in the stretching
group. The stretching group also had an increase of 8
degrees in hip motion for total forward bending
(P< .05).
Because not all subjects in the stretching group demon-
strated increases in hamstring muscle length, we decided
to do a post hoc analysis on those subjects with increases
in AKE angle greater than 10 degrees (11/19). Paired
t tests were performed to compare pretest and posttest
values in these 11 subjects. A paired t test showed that
there was no change in standing posture after stretching.
There was an increase of 3.9 degrees (P=.026) in hip
motion during early forward bending. The mean
decrease of 2.9 degrees in early lumbar motion after the
stretching period was not a significant difference. There

I
842 . Li et al Physical Therapy . Volume 76 . Number 8 . August 1996 j
was an increase of 9.7 degrees in hip motion during late
forward bending after stretching (P<.001) and a 13.5-
degree increase in hip motion during total forward
bending (P<.001). There were n o differences found in
lumbar motion during the late phase of forward
bending.
The results of the Pearson product-moment correlations
of hamstring muscle length (AKE test) with standing
posture and lumbar and hip motions during forward
bending; are presented in Table 5. The correlations
between AKE test results and standing lumbar angle and
pelvic angle were not significant. A number of correla-
tions between AKE test results and measured motions
during fbrward bending emerged. The AKE test results
were correlated with lumbar motion and the ratio of
lumbar to hip motion during late forward bending. That
is, as hainstring muscle length increased, lumbar motion
and the: ratio of lumbar to hip motion during late
forward bending decreased. In addition, significant cor-
relations of AKE test results with hip motion and the
ratio of' lumbar to hip motion during total forward
bending; existed (F- .55 and .50, respectively). As ham-
string m.uscle length increased, as indicated by the AKE
test, hip motion increased and the ratio of lumbar to hip
motion decreased during total forward bending.
Discussion
Effect of Hamstring Muscle Stretching on Hamstring
Muscle length and Standing Posture
Both the SLR and AKE tests were used to assess ham-
string rr~usclelength before and after a stretching pro-
gram. ELoth measures showed that hamstring muscle
lengthening occurred in the stretching group. We chose
to use both methods because we were unsure which
method would be most sensitive. Although both tests
indicated changes, we preferred the AKE test because
motion at the lumbar spine and pelvis is less likely to
influence measurement of the knee angle measured
during the AKE test.
The F tests indicated that there was no difference
between standing lumbar lordosis and pelvic inclination
in the c'ontrol and stretching groups. This finding does
not support the theory that short hamstring muscles
cause posterior pelvic inclination and a concomitant
reduction in the lumbar l o r d o ~ i s . ~
The data from this study d o not support a direct
relationship between hamstring muscle length and
standing lumbar and pelvic posture, and the data agree
with other research findings of no correlation between
postural alignment and muscle length.8.g Furthermore,
Toppenberg and Bullock7 found that hamstring muscle
length was negatively related to the lumbar curve. The
.
Physical Therapy . Volume 76 Number 8 . August 1996
Table 5.
Correlation of Hamstring Muscle Length (in Active-Knee-Extension Test)
With Standing Posture and Lumbar and Hip Motions During Forward
Bending
Variable Pearron r
Standing lumbar angle
Standing pelvic inclination
Early lumbar motion
Early hip motion
Early lumbar/hip ratio
Late lumbar motion
Late hip motion
Late lumbar/hip ratio
Total lumbar motion
Total hip motion
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Total lumbar/hip ratio
same relationship was noted in our study, but it was not
significant. These data d o not support Kendall and
McCreary's%ssumption that individuals with flat backs
o r reduced lumbar curves in a standing position tend to
have short hamstring muscles. It is possible that if we had
included subjects with longer hamstring muscles (SLR
>70°), and thus had a broader range of hamstring
lengths in our sample, we may have found a relationship
between hamstring muscle length and lumbar curve. We
believe, however, that if hamstring muscle length is
related to standing lumbar posture, the stretching group
would have shown a change in standing lumbar posture.
We are not aware of data that demonstrate a strong
relationship between hamstring muscle length and lum-
bar posture in a standing position.
The degree to which the hamstring muscles act on the
pelvis probably depends on the knee and hip angles and
the inherent muscle length. Even short hamstring mus-
cles may be placed on slack when standing with the hips
in a neutral position and the knees in extension; in this
position, a change in hamstring muscle length may cause
no change in pelvic or lumbar posture. Therefore, this
slack position may be the reason lengthened hamstring
muscles caused no changes in standing posture. Another
reason may be that posture is dependent on multiple
factors (eg, muscle length, lumbosacral angles, postural
awareness, motor programming) and will not change
significantly with a change in any one variable. In any
case, these data suggest that lengthening the hamstring
muscles will not change standing postural alignment.
Effect of Hamstring Muscle Stretching on Lumbar and Hip
Motion During Forward Bending
Stretching the hamstring muscles resulted in greater hip
motion but did not cause less lumbar motion during
forward bending. In the 11 subjects in the stretching
group who had an increase in hamstring muscle flexibil-
Li et al . 843
 ity of greater than 10 degrees, hip motion during early
forward bending increased significantly after stretching.
Because subjects were instructed to achieve the same
partial forward-bending position, the total range of early
forward bending should be the same at both the pre-
stretching and poststretching sessions. Greater hip
motion, therefore, should be coupled with less lumbar
motion during early forward bending. Lumbar motion
was reduced in the same 11 subjects, even though the
amount was not significant. Lumbar motion during total
forward bending also decreased in these same 11 sub-
jects, although again the amount was not significant.
One possible explanation for the lack of significance was
sample size. These data, therefore, neither confirm nor
disprove the idea that an increase in the amount of hip
flexion during forward bending results in a decrease of
lumbar motion; these data do, however, indicate a trend.
A follow-up study, with either more subjects o r greater
increases in hamstring muscle flexibility, is warranted.
In this study, shorter hamstring muscle length was
correlated with an increase in the ratio of lumbar to hip
flexion during both late and total forward bending. That
is, shorter hamstring muscle length is associated with
greater relative lumbar motion during late forward
bending.
Hamstring muscle length, however, was not correlated
with total lumbar motion during full forward bending.
This finding is consistent with those of other studies in
which low degrees of correlation between hamstring
muscle length and spinal motion during forward flexion
were f o ~ n d . ~ J ~
Even though some of the subjects (15/39 o r 38.5%) had
experienced LBP before the study, most subjects (24/39
or 61.5%) had no history of LBP. As a result, application
of these data to patients with LBP should be limited. We
compared the pretest data for hamstring muscle length,
standing posture, and forward bending motion variables
between subjects with and without a history of LBP.
Subjects with a history of LBP had slightly tighter ham-
string muscles, but there was no evidence that either
standing posture o r forward bending differed between
subjects in these two categories. We believed that sub-
jects without LBP were appropriate for the questions
posed in this study because most authors claim that
hamstring muscle tightness is a factor associated with
posture and abnormal motion regardless of whether a
history of LBP or current LBP exists.2~6
Our results agree with those of some other studies.
Biering-SorensenlRfound diminished hamstring muscle
flexibility as a residual sign of low back problems. Day et
allYfound there was no difference in lumbar lordosis
and pelvic inclination between subjects with and without
low back dysfunction in a relaxed standing posture.
Thus, attempts to alter standing lumbar and pelvic
posture for individuals with a history of LBP are ques-
tionable. Results of studies addressing the relationship
between spinal mobility and a history of back pain have
been varied. Some r e s e a r c h e r ~ ~have
~ J ~reported
~~~ a
general decrease in spinal mobility associated with a
history of back problems, whereas Howes and Isdale"
have reported increased spinal mobility. Our study
showed that a histo~yof back pain had n o effect on
spinal flexion ROM. The number of subjects with a past
history of LBP (n=15), however, was limited in our
study. In recent work, we compared subjects with and
without a history of LBP and did not find differences
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between these &o groups in the amount of lumbar o r
hip motion during forward bending."
!
Further research could be directed toward studying
subjects who have chronic LBP. Studying greater num-
bers of subjects who demonstrate a more dramatic
increase in hamstring muscle flexibility after a stretching
program also may reinforce and clarify our findings. O u r
method involved essentially static measurements. Future
studies, utilizing continuous sampling techniques for
dynamic movement, also may provide greater insight
into the effects of a stretching program.
Conclusions
This study has provided information basic to the under-
standing of the normal relationships between hamstring
muscle length, standing posture, and motions during
forward bending. This information can act as a guide to
clinicians when designing treatment programs.
The data gathered in this study suggest that a 3-week
program of hamstring muscle stretching (1) will not
alter standing lumbar and pelvic postures, (2) will pro-
duce greater forward bending as a result of increased
motion at the hips, and ( 3 ) may alter the pattern of
lumbar and hip motion during forward bending.
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Followini: are two invited commentaries on "The Effect of
Hamstring Muscle Stretching on Standing Posture and on
Lumbar and Hip Motions During Forward Bending."
Li and colleagues are to be commended on their interest-
ing article examining the relationships among hamstring
muscle length, standing pelvic alignment, and motion at
the lumbar spine and hip during forward bending. These
relationships, their effect on function, and changes result-
ing from exercises are critical to substantiating the role of
physical therapy in treatment. My questions and comments
about this study pertain to the methodology and the
suggested implications of the findings.
One pui-pose of this study was to examine an assumption
attributed to Kendall that short hamstring muscles will
cause posterior pelvic tilt and a flat-back standing align-
ment. Although the investigators classified their sample
by using; the straight-leg-raising (SLR) test advocated by
Kendall., they failed to adhere to the guidelines she
advocates for accuracy. She emphasizes the importance
of using. a hard table, making sure the lumbar spine is
flat, accommodating for any hip flexor shortness, and
holding the contralateral thigh down, while performing
the SLR..'(P~'~~-'") The methods described by Li et a1
did not address any of these important criteria for
accurate testing. Kendall also recommends that the SLR be
taken to the point of resistance and a feeling of slight
discomfort. Failure to stabilize the contralateral lower
extremity to prohibit pelvic and lumbar motion and failure
Physical Tlierapy . Volume 76 . Number 8 . August 1996
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- -
22 Esola MA, McClure PW, Fitzgerald GK, Siegler S. Analysis of lumbar
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to stretch to the point of resistance raise further questions
about accurate assessment of hamstring muscle length.
Certainly, the reliability reported by the investigators is
impressive, but the issue is accuracy not reliability.
I was interested that Li and colleagues used the measure-
ments from the SLR to group subjects but did not use
this same measure for correlational analysis. The second
measure of active knee extension (AKE) was used for
analysis, which the investigators explained by the state-
ment, " ... we preferred the AKE test because motion at
the lumbar spine and pelvis is less likely to influence
measurement of the knee angle measured during the
AKE test." Such a statement suggests that the SLR was
influenced by motion at these segments. If this is the
case, then the AKE should have been used to classify the
subjects or a correlation between the SLR and AKE
measurements would have established their relationship.
I am confused by the values in Table 4. The lumbar/hip
ratios for early and late phases d o not seem accurate
when the means for the separate values are calculated,
although those for total motion are correct based on the
mean calculations.
The lack of correlation between hamstring muscle
length and standing alignment measurements is not
surprising. Such a correlation implies a vely precise
relationship between the length of the hamstring mus-
cles and the angles of the pelvis and the spine. Such a
Sahrmann . 845