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Tight Hamstrings & Calves

Muscle pain can take your breath away and can be difficult to successfully address because the real cause is often missed.  What are the hamstring and calf muscles?  What causes tight hamstring and calf muscles?  How do you loosen tight hamstrings and calf muscles?   Is there another cause of tight hamstrings and calves that is being overlooked?   What new treatment options exist?  Let’s dig in.

What Causes Tight Hamstring and Calf Muscles?

The hamstrings are a group of muscles in the upper leg.  They are located on the backside of the upper leg and are comprised of three muscles:  biceps femoris, semitendinosus, and semimembranosus.  The calf muscles are located on the backside of the lower leg and are comprised of two muscles: the gastrocnemius and soleus.  Tight hamstring and calf muscles can be painful, limiting one’s mobility.  They also make lower extremity muscles more vulnerable to injuries.  Tight hamstrings and calves can arise from different sources which include:


Medications have multiple side effects which can include muscle tightness.  Common examples include:

  • Diuretic (water pills) to treat high blood pressure and congestive heart failure.
  • Beta-blockers are used to treat high blood pressure and irregular heart rhythms
  • Statins used to treat elevated cholesterol (1)
  • Inhalers such as Proventil and Ventolin to treat various breathing conditions.

Muscle and Tendon Injury

No pain no gain is not always true.  Tears in the muscle can cause swelling, reduced blood flow, and contraction with resultant muscle tightness and pain.  Injury, inflammation, and or degeneration of a tendon can also cause muscle tightness.  Symptoms with either tendon or muscle tears are typically limited to one leg.


Running, strenuous activity and hard labor can all cause tight hamstrings and calves (2). This can lead to additional injury including muscle strain where the muscle fibers are stretched or partially torn.

Muscle Imbalance

Are you sitting at your desk, office, or in class for long periods of time?  This may be causing your hamstring and calf tightness.  Prolonged sitting tightens your hip flexors which in turn can cause your pelvis to tilt forward (3).  Anterior pelvic tilt can cause tightness in the low back which in turn can trigger tight hamstrings.  Avoid sitting for long stretches of time.  Get up and move around on an hourly basis or consider a standing desk.


Dehydration can cause depletion of essential electrolytes which are necessary for the transmission of the electrical signal from your brain to your muscles.  A  weak or intermittent electrical signal can cause hamstring tightness (4).

Poor Posture

Are you constantly looking down at your phone, tablet, laptop, or computer monitor?  Posture dramatically impacts our muscles and joints. Neutral spinal alignment is ideal where the head, chest, and pelvis stack upon one another.  In this posture, there is minimal stress on the muscles and joints. Unfortunately, news feeds, Instagram and Facebook have us all in compromised positions where our heads are forward, shoulders are rounded, the chest is collapsed and pelvis is tilted forward.  Collectively these can cause hamstring and calf tightness. Skeptical?  Next time your hamstrings are tight look in the mirror and examine the position of your head, chest, and low back.  You will be surprised!

Low Back Nerve Injury

Muscles require electrical impulses to function.  The electrical impulses tell the muscles when to contract and when to relax.  This is critical information and is conveyed by the nerves in the low back.  These nerves are called the spinal nerves.   An uninterrupted electrical signal from the brain to the leg results in a smooth and coordinated contraction of the muscle.  A weak or intermittent electrical signal, however, causes muscle dysfunction.   Over time if the electrical signal is weak or intermittent chronic muscle tightness occurs.  Persistent muscle contraction can also cause tendon injury.

What Can Cause a Weak or Intermittent Electrical Signal?

  • Low back disc bulges
  • Low back disc herniations
  • Low back disc slippage
  • Low back stenosis

But I Have No Back Pain?

Patients can have low spinal nerve irritation without having low back pain.  In fact, approximately 50% of our patients with spinal nerve irritation or dysfunction have no back pain.  Low back disc bulges or stenosis can occur with no low back pain or tension.  Often times chronic hamstring and calf tightness is the first warning sign that there is a problem. That nagging hamstring and calf tightness may an indication that there is a problem with the electrical impulses from your brain to the muscles.  In fact, it may be the first signal that you have issues in your low back that warrant attention.  To better understand the connection between spinal nerve irritation and tight hamstrings and calves please click on the video below.

How Do You Loosen Tight Calves and Hamstrings?

Treatment Depends Upon the Cause of the Tightness:

  • In many cases, rest after strenuous exercise and work will relieve the tightness.
  • Medications may be causing your hamstring and calve tightness but should not be discontinued without consultation with your physician.
  • Stretching and physical therapy should always be the initial treatment of choice.
  • Muscle imbalance and poor posture can often be addressed with physical therapy.
  • Hydration is key as properly functioning muscles require adequate hydration.

If you still have hamstring and calf tightness despite addressing the issues listed above you may have an irritated spinal nerve.  In fact, your chronically tight hamstring may be a warning sign that you have a problem in your low back that requires attention.  If ignored, like most things in life, it most likely will get worse and the number of injuries will increase.  Remember when your brakes squeaked and they could have been fixed for a nominal price but you opted to ignore them?  You ended up spending serious money on the replacement of the rotators, calipers, and brakes.

A New Treatment for Irritated Spinal Nerves

Precise injections of PRP around the irritated nerve and low back injury can relieve chronically tight hamstrings and calves.  PRP has many growth factors that can increase the blood flow and decrease the inflammation around nerves and injured lumbar discs. Steroid injections should be avoided due to their toxic side effects (5).  To learn more about the treatment options for low back and spinal nerve irritation  please click on the video below:

At the Centeno-Schultz Clinic, we have extensive experience in the treatment of tight hamstrings and calves with both PRP and bone marrow concentrate.  All injections are performed by a fellowship-trained physician using ultrasound or x-ray, or both.  For patients who want to stay at the top of their game, we have a Pro-Active program. This program provides practical advice on understanding the early warning signs such as chronically tight hamstrings and actions to maintain peak performance. To download this free book please click here.

Do Tight Calves Cause Knee pain?

Yes.  The hamstrings play an important role in maintaining proper knee function and health.  If the hamstring fails to function properly due to chronic tightness or if the hamstring decreases in size in comparison to the quadriceps, knee cartilage and the meniscus is at risk for swelling, degeneration, and injury. (6)

Related: Biceps Femoris Tendonitis stem cell treatment

In Conclusion

Tight hamstrings and calves are common and can arise from many sources.  Stretching is not always the best solution as it may only provide temporary relief and does not address the underlying problem.  Identifying and treating the underlying problem is best.  Chronically tight hamstrings may feel like a leg problem but is usually a warning sign that there is a back problem.  Ignoring the issue may lead to more severe injuries.  Precise injections of PRP around irritated low back nerves are an effective treatment option for tight hamstrings and calves which have not responded to conservative therapy.

1.Stroes ES, Thompson PD, Corsini A, et al. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J. 2015;36(17):1012-22.DOI: 10.1093/eurheartj/ehv043.

2.Decoster LC, Scanlon RL, Horn KD, Cleland J. Standing and Supine Hamstring Stretching Are Equally Effective. J Athl Train. 2004;39(4):330-4.

3.Takaki S Ms Pt, Kaneoka K PhD Md, Okubo Y PhD Pt, et al. Analysis of muscle activity during active pelvic tilting in sagittal planePhys Ther Res. 2016;19(1):50–57. Published 2016 Nov 29. doi:10.1298/ptr.e9900.

4.Freckleton GPizzari T. Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis

5.Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic ReviewOrthop J Sports Med. 2015;3(5):2325967115581163. Published 2015 Apr 27. doi:10.1177/2325967115581163.

6.Kumar D, Subburaj K, Lin W, et al. Quadriceps and hamstrings morphology is related to walking mechanics and knee cartilage MRI relaxation times in young adults. J Orthop Sports Phys Ther. 2013;43(12):881-90.DOI: 10.2519/jospt.2013.4486.

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