Fix Knee Pain From Tight Hamstrings (5 Easy Exercises)

Address Knee Pain while Building Hamstring Strength

By Coach E

Fix Knee Pain From Tight Hamstrings (5 Easy Exercises) (1)

Simple stretches and leg curls will not solve knee pain from tight hamstrings. Instead, these 5 exercises will get you on the path to moving pain-free.

Hey, Coach E here, kinesiologist and founder of Precision Movement. I often get asked, “Can tight hamstrings cause knee pain?” Today I’m going to answer that question and explain how to loosen your hamstrings.

There are a few root causes of knee pain that people often miss, weak and tight hamstrings being one. But simple stretches and leg curls won’t address all of the ways the hamstrings might be dysfunctional.

In this article, you’ll learn five exercises to get your hamstrings working right.

Functions of the Hamstrings

Now, before we get into the reasons why, let’s talk about the basic actions of the hamstrings. There are a few that you might not have heard of before.

The first one is knee flexion. That’s just bending the knee. This is the most commonly known function of the hamstring. You probably know that one.

knee flexion

The hamstrings also control hip extension, but it’s very weak. It should not contribute to hip extension, but it does if something else is dysfunctional. The glutes should be doing the hip extension work, which is moving your leg back, behind you, but if the glutes aren’t working because you sit at work all day… the hamstrings may kick in.

Next up, we have tibial internal and external rotation. When your knee is bent, the tibia can rotate thanks to your hamstrings. The tibia is the shin bone. The outer or lateral hamstrings create external rotation, twisting the shinbone outward. The medial hamstrings take charge of internal rotation or twisting the shinbone toward your midline.

That means we can target specific sections of the hamstrings through that movement, and we’re going to do just that with one of our exercises today.

Finally, this is the one you might not have heard of before with respect to hamstring function –  posterior pelvic tilt.

You may have heard the term posterior pelvic tilt before, especially if you’re familiar with our articles and videos.

What is it? Let’s pretend I have a tail, and I tucked that tail between my legs. The hamstrings would be contributing to that movement because they insert down on the lower leg. They originate up on the pelvis.

When they contract, and my lower leg is not moving, they’ll pull the pelvis down and tuck that tail between your legs.

Posterior pelvic tilt is not often talked about or mentioned with respect to the hamstrings, and it’s an important one. We’re going to get to an exercise that will train that function specifically.

Hamstrings anatomy

Functional Anatomy of the Hamstrings

Functional anatomy means that we aren’t just looking at the basic functions of the hamstrings. We’re asking, how do the hamstrings function when we’re doing tasks of everyday life or in sports?

The first one here, the hamstrings protect your ACL (anterior cruciate ligament.) That is a very important ligament for knee stability. That ACL runs inside the knee. It prevents the tibia, the lower leg, from sliding forward on the femur. The hamstrings, because of where they run from up behind the knee to the pelvis, also prevent the lower leg from sliding forward on the femur. In anatomical terms, that’s anterior translation of the tibia on the femur.

If the hamstrings are not strong, or if they’re not able to contract at the right time, they’re not going to provide that active restraint, that active support, for the knee. Then the ACL will take more stress, and that’s when we can run into ACL tears.

Now, a lot of times, people tear their ACL – soccer players, basketball players – and they’ll think, “oh, it’s just, you know, one move that I did.”

soccer ACL tear

But, usually, it’s a result of repetitive stress on that ACL. The ACL wears out wears out over time.

The one reason why the ACL might be taking all that repetitive stress is because the hamstrings aren’t doing their job in supporting the knee and preventing that anterior translation of the tibia on the femur.

That’s an important one, especially for you athletes involved in running and cutting sports. You need good strong hamstrings that can contract when they’re supposed to.

The second function of the hamstrings is rotational knee stability.

This function, in particular, protects the meniscus. Remember, one of the basic movement functions that the hamstrings create is this tibial internal and external rotation.

If they’re working properly, they can contract, and the tibia rotates.

Let’s say you plant your foot, and you’re making a cutting movement. You are controlling that with the hamstrings. That’s going to prevent the meniscus inside of the knee joint from taking excessive stress because we’ve got that active constraint. We don’t have to get into the passive tissues to stabilize or support that joint.

It’s a very, very important muscle group. It’s a very important function of that muscle group to protect the meniscus. That function also protects the ACL and PCL.

The hamstrings are much more than just knee flexors. They’re much, much more than hip they play a critical role as dynamic stabilizers protecting our meniscus and knee ligaments.

All of these functions serve to protect that knee joint and keep it healthy.

Now that you understand these functions and the background of the hamstrings, the five exercises that we go through will make more sense.

Hamstring Exercises for Knee Pain

The five exercises that we’re going to do are going to:

  • Improve strength
  • Lengthen the muscle
  • Increase range of motion
  • Improve tissue quality
  • Strengthen activation ability

Basically, we will hit all of these different functions of the hamstrings that will make sure that the hamstrings can do all of the things that it’s designed to do.

The most important thing is to get the proper technical cues and the form down.

Exercise 1: ASMR Hamstrings

The first exercise to fix your weak or tight hamstrings is Active Self-Myofascial Release (ASMR) for the hamstrings.

For this, you’ll need a massage ball or a golf ball. It needs to be something pretty hard because you need something that can really dig into the deep parts of this muscle group.

You’re going to want to work about eight to ten different spots, basically from the top all the way down the back of your thigh.

Sit on a fairly firm surface and pick your first area. When you get on that ball, it might be a little bit uncomfortable, and you may tense up a little bit. Just breathe and relax those hamstrings over the ball.

Once you’re relaxed, all you’re doing is fully extending your knee and firing those quads at the end range. Then bring it down. Do that 2-3 times on each area.

asmr hamstrings - knee pain exercise

  1. Sit with a hard ball under one spot of your hamstring
  2. Relax the hamstring over the ball, breathe
  3. Extend the leg out, firing the quads at the end range
  4. Slowly bring it down
  5. Repeat extensions 1-2 more times (2-3 total)
  6. Position the ball to a new spot, repeat extensions

Do 8-10 different areas, 2-3 extensions in each area.

Now, if you’re really tall or have super long legs, you might work more than eight areas. But work those different areas trying to get all the way from the top to the bottom of the muscle. ASMR releases any adhesions or restrictions that might be there.

This exercise is going to improve the tissue quality of your hamstrings and release any knots that might be there. If you have tight hamstrings, this allows them to lengthen properly.

Now, if you’ve got any sciatica-type problems, then one thing you can do that will allow you to get to full knee extension is point your toe. That’ll take off some of that stress and decrease the stretch on the sciatic nerve, so you can do this technique without flaring up the sciatic nerve. We want to really lengthen out that hamstring to make sure it has full extensibility and full pliability.

Exercise 2: Hamstring ERE

Once you’ve improved your tissue quality and pliability, then it’s time to lengthen and activate those muscles in length and range of motion. That’s how you’re going to build range of motion and length that lasts.

If you’re just doing static stretching, you’re pulling on the muscle, but it’s not getting stronger. Our nervous system will realize that we don’t have the strength to control the new range of motion. So… our brain is going to unconsciously think, “I don’t have strength there, that’s not a stable thing for the knee joint. I’m just going to contract things and tighten it up again to at least maintain that stability.”

Your brain would much rather have stability in a joint over length of muscle.  This is one of the reason why static stretching doesn’t work so well, no strength with the new length.  Instead we recommend the following technique, the Hamstring End-Range Expansion (ERE) technique.

We’re going to start off in the standing position. Then I’m going to talk about a variation you could do if you find this one really difficult and your quads cramp up.

For this one, you’re sticking your foot up on a stool, chair, or something stable. You want to settle your pelvis down towards the floor so it’s not hiked up, and you’re not side-bending through the spine.

Settle that pelvis down towards the floor, hang out there a little bit, and make sure your support leg is nice and straight. You want it stable and strong. Keep good posture.

Once you feel like you’re in good alignment with the knee being straight, you’re going to contract the quads and contract the hip flexors and just lift the foot off whatever it is you’re on. Keep trying to get deeper into that range. Keep the leg straight and really contract the hip flexors and quads for 10-15 seconds. Breathe naturally, maintain good posture, and then slowly place it down on the stool.

Next, you’re going to contract the hamstrings. How we’re going to push the heel into the stool, but also think of flexing the knee. Bend the knee like you’re trying to drag that stool toward yourself. Fire those hamstrings up again, and hold for 10-15 seconds. Try to gradually ramp up and ramp down the contractions that we’re doing here so you don’t surprise your muscles.

Breathe naturally, and maintain your form and your posture. We’re going to end with another lift-off. Your support leg is straight, good alignment, good posture, contract the quads and hip flexors. Lift the heel off as high as you can and keep trying to get higher and higher, even though you’re not moving. That’s going to massively activate those muscles. Hold for 10 -15 seconds. Then you can slowly lower down to the ground and relax.

That’s one cycle of the hamstring ERE technique.

Supine Hamstring ERE - exercise for knee pain from tight hamstrings

  1. Extend your leg out (knee straight) so your heel is on the stool
  2. Lift your foot off the stool using your quads and hip flexors
  3. Hold for 10-15 seconds
  4. Lower your heel back to the stool
  5. Pull the heel into the stool, flexing the knee like you’re pulling the stool
  6. Hold for 10-15 seconds
  7. Relax
  8. Lift the foot off the stool again
  9. Hold for 10-15 seconds
  10. Return your foot to the ground

That’s one cycle.

Do 2-4 cycles per side, holding each activation for 10-15 seconds.

What we’re doing here is we’re strengthening the muscles that bring it into this range of motion that lengthens the hamstrings. We’re strengthening the hamstrings at that end range of motion. We’re getting strength in both of those muscle groups that bring it into and out of that hip flex position where the hamstrings are the longest.

That’s how we’re going to build range of motion that lasts.

Now, if you find that really difficult, what you can do is use a door frame at home. You’re just lying on the ground with your foot up on the door frame as opposed to on the stool.

supine hamstring ere - variation

You do the same technique. This is just a little bit easier because you’re not fighting gravity as much.

Exercise 3: Marching Hip Bridge

The third exercise is the March Hip Bridge.

The reason why we’re doing the Marching Hip Bridge is to strengthen the glutes and get the glutes activated so that the hamstrings don’t feel like they need to compensate for weak glutes.

Like I said in the beginning, the hamstrings contribute to the movement of hip extension, but they’re very weak. But if the glutes aren’t working properly, your brain will try to get some other muscle group to contribute.

The hamstrings are next in line. This means they’re going to do this job of hip extension, but they’re not well suited to it. It’s going to cause them to quickly get overworked, just like you do if you did a thousand bicep curls in a workout. The next day, you’re going to be sore, but if you do that relentlessly every day, then the hamstrings are chronically becoming overworked. Then they become really tight.

By getting the glutes working, we can indirectly influence the length and the tone of the hamstrings.

For this technique, you could do a standard hip bridge, but I’m going to show you the marching version.

Now, whenever I’m on the ground, I like to train good posture, so get those shoulders back and chest out in good alignment. The more that we can train good alignment, the easier it will be for it to stick. Even if we’re not training the shoulders, we can work this good postural alignment.

Feet are flat on the ground, and I like to get the active arch going, so do the short and skinny foot. (That’s using the muscles in your foot to pull the metatarsals back toward your heel and together toward each other.) From here, the next activation is of the deep pelvic floor muscles. So if you can imagine you’re peeing and you’re stopping your pee mid-stream, those are the pelvic floor muscles.

Next you contract the glutes. Then you lift up to the point where you’re not hyper-extending your spine. You’re in a natural lumbar spine, and you’ve got the glutes working.

standard hip bridge - exercise for tight hamstrings

  1. Lay on the floor with good posture, knees bent
  2. Activate active arch in the feet
  3. Activate pelvic floor muscles
  4. Contract glutes
  5. Lift your hips straight up
  6. Soft landing

We’re not prioritizing the hamstrings for this exercise. What we want to make sure is the hamstrings aren’t overworking. We’ve got good glute activation.

If you find your hamstrings are working too much, just think of extending your knee like you’re sliding your feet away from you. Activate the quads a little bit, and that can help to shut off the hamstrings. You still maintain the pelvic floor and the glutes. Keep the glutes on. Keep the pelvic floor on as you go down, and then relax everything once you’re on the ground.

That’s just the basic hip bridge.

Now the Marching Hip Bridge has the same start. So feet, pelvic floor, glutes. I’ve got a natural lumbar curve here under my low back. I could fit my hand under my low back just barely, and then I lift up, maintaining that natural lumbar curve, making sure my glutes are working, and my hamstrings are as quiet as possible. Then marching is just lifting one leg up slowly, soft landing. Lift the other leg up slowly, soft landing. Keep the glutes on, the pelvic floor on, all the way to the ground. Once you’re on the ground, gradually ramp down the muscle contractions.

marching hip bridge exercise

  1. Lay on the floor with good posture, knees bent
  2. Activate active arch in the feet
  3. Activate pelvic floor muscles
  4. Contract glutes
  5. Lift your hips straight up
  6. Lift one foot straight off the floor, soft landing
  7. Lift the other foot straight off the floor, soft landing
  8. Lower your hips back to the ground

Do 2-3 sets of 5-8 reps.

That’s the marching hip bridge. If you find that really difficult, just stick with the basic hip bridge. But if you’re okay with the basic hip bridge, this allows us to get a little more strength required to hold up on one foot.

The Marching Hip Bridge is a great exercise to get those glutes fired up and stronger so that the hamstrings can relax for that hip extension movement.

The first three exercises really worked on hamstring activation, ensuring tissue quality and making sure that we have the full length of the hamstring. As you improve, they’ll become less taught and won’t restrict your movement. You’ll avoid unnecessary tension, stress, and force to the knees.

Exercise 4: Seated Tibial Rotation

The fourth exercise to solve knee pain from tight hamstrings is the Seated Tibial Rotation. This works the rotational function of the hamstrings at the knee joint. This is important for maintaining rotational stability at the knee to protect the meniscus and the ligaments like the ACL and PCL.

For this technique, you sit on something stable, knees are approximately 90 degrees, and I’m going to lift my heels just off the ground. I’ll push both heels out like I’m pivoting on the ball of my foot. I’m trying to really push both heels out, and I’m thinking of medial hamstrings.

Pushing your heels out creates the movement of tibial internal rotation. The medial hamstrings, the inside hamstrings, are the ones contributing more to this.

Then, after about 5 seconds, rotate the heels in towards each other. Now you’re thinking lateral hamstrings. Try to get deeper into this range, keeping your heels just off the ground, like you could slide a piece of paper underneath them. That’s it. Hold for 5 seconds. Then back to internal tibial rotation, trying to get deeper into the range. That’s important.

Seated Tibial Rotation

  1. Sit with your knees at a 90-degree angle
  2. Slightly lift your heels
  3. Push both heels out
  4. Hold for 5 seconds
  5. Push both heels in
  6. Hold for 5 seconds
  7. Return to neutral

Do 2-3 sets of 4-6 reps with 5-second holds on internal and external rotation.

Don’t just get there and then relax. Try to get deeper into that range. Force those heels out more. Activate the hamstrings more.

Now, if you don’t feel your hamstrings on this one, a little tip is to think of dragging the floor toward you like you’re trying to flex your knees. Bend your knees more. That’ll fire up those hamstrings. You might be able to feel them. Prod them a little bit to make sure they’re on, and then switch direction.

The knees should stay in place. They’re not going closer or farther apart.

Go back and forth, focusing on those cues, and you’re going to work that tibial rotation function of the hamstrings to maintain rotational stability at the knee.

Exercise 5: Jefferson Curl

The fifth and final exercise we’re covering today is called the Jefferson Curl.

This exercise works the hamstrings in the closed chain fashion where our feet are stuck to the ground. They’re not moving, and our upper body is moving around the stable lower body. It’s going to work the posterior pelvic tilt function of the hamstrings.

Now, if you have low back pain, specifically the type where sitting really bothers your back, or you tweaked it just bending over to pick up something light off of the floor, then you’ll want to avoid all this flexion of the lumbar spine.

If you do have low back pain, instead of flexing the spine and doing the Jefferson Curl, you can do a simple hip hinge.

hip hinge exercise - variation for low back pain

For this, I would recommend you bend your knees, keep the spine neutral, and you’re just hinging at the hips, lengthening the hamstrings, and same thing. Think of using the hamstrings to pull you up in addition to the glutes. Repeat hanging over, lengthening the hamstrings, standing back up, contracting the hamstrings.

Here you’re just maintaining neutral lumbar spine, which is going to protect the low back and the discs that might be affected by whatever it is that you do in your life that tweaks your back.

This exercise is really beneficial for helping you to increase your kinesthetic awareness when the hamstrings are contracting and their influence on the position of the pelvis.

Start off with your feet about shoulder-width apart. Stand nice and tall. What you’re doing is you’re bringing your chin to your chest and then flexing your spine segment by segment. We’re keeping our knees straight the whole time. So segment by segment. Then I’m going down, and this is where my pelvis is tilting anteriorly. Imagine your tail going towards your back.

I go as far as I can go with straight knees. Then I’m coming up thinking of the hamstrings, contracting, pulling the pelvis posteriorly (tail between the legs). First, pulling it under to a neutral position and then coming up segment by segment, stacking the spine nicely in good alignment. Ending in really good posture and alignment.

Jefferson Curl hamstrings exercise

  1. Stand tall, feet shoulder width apart
  2. Bring your chin to your chest
  3. Roll your spine down segment by segment
  4. Roll down as far as you can with straight knees
  5. Contract your hamstrings to pull yourself up vertebrae by vertebrae
  6. End in good posture and alignment

Do 2-4 sets of 3-5 reps.

Solving Knee Pain From Tight Hamstrings for Good

Those are five exercises to help you fix weak and tight hamstrings that could be contributing to painful knees.

exercises for knee pain from tight hamstrings - routine summary

Do this routine 2-3 times a week for 5 weeks, and I bet you’ll find your hamstrings are stronger or longer, and your knees might feel a little bit better.

If you want a really easy way to follow these exercises, I suggest you get our ROM Coach app, which is a free download.

You can go into the library and search for “hamstrings,” and you’ll find the Tight Hamstring I and Tight Hamstring II routines. All you have to do is add it to your calendar and schedule the days that you want to do it. You’ll get notifications, and as you work through the routines, the sets and the reps will be progressed to ensure that your body continues to adapt. That way, you don’t hit a plateau, and you won’t get stagnant.

Download the ROM Coach app. It’s available for Apple iPhones and on Google Play.

Now we have another article if you want to supercharge your start to stronger, longer hamstrings. Try “How to Stretch Tight Hamstrings for Lasting Effects” next.

Again, get the ROM Coach app. This is something that is going to be your companion for the rest of your life if you want to keep moving pain-free.

I’ve been in and out of rehab for over a decade for “IT band syndrome” “piriformis syndrome” fractured forearm, bilateral cubital tunnel syndrome, and twisted ankles.

They said I also had weak glutes and tight hamstrings which I now understand is sooo true but why couldn’t they teach how to do the exercises correctly? Insane.

Was doing a million glute bridges and everything else but no improvement. I just got it when I started with ROM coach. The exercises are unlike any I’ve ever had in therapy and a main reason it works is because the number of reps is doable and I don’t quit because I can’t do them all or because I hurt myself. And it’s usually hard to stay motivated but you’ve really put a doable program together.

I’ve been telling everyone I know. It took almost 5 months of pretty much daily work for right glute issue, right rotary cuff issue and left brachial tendinitis thing and my balance seems better due to the footwork.

It’s not all perfect but I can feel the improvement and I’m slowly starting back running without pain. Thank you so much!!!

– Alex

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.