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The hamstring group are traditionally described as having their origins at the ischial tuberosity and their insertions into the linea aspera of the femur and fibula head (biceps femoris) and the medial aspect of the tibia (semimembranosus/ semitendinosus). However, according to Matt Wellden[1]there are two major flaws in thinking of the hamstrings in this way.

The true pelvic attachment of the biceps femoris has been show by both van Wingerden et al (1993)[2] and Willard (1997)[3] to be the sacrotuberous ligament – in most cases. Vleeming[4] has gone on to show that force is transduced via the biceps femoris into the sacrotuberous ligament and up into the thoracolumbar fascia. In fact, in 60% of cases, there was “hardly any connection” between the biceps femoris tendon and the ischial tuberosity at all, and in 100% of cases a caudal traction applied to the biceps was transferred into the sacrotuberous ligament. This means that, technically, the sacrotuberous ligament would actually be better termed “sacrotuberous tendon”, and means the biceps femoris attachment is to the sacrum – if not to the spinous processes of the lumbar spine – or even the lateral lip of the ipsilateral bicipital groove on the humerus (vide infra).


Biceps femoris is a hip extensor and intimately involved in gate, especially deceleration) and locomotion. “The hamstring syndrome” is a term that has been coined to describe the collective injuries which may be associated with the same biomechanical mechanism chiefly responsible for hamstring strain. Shortened hamstrings with multiple trigger points are not uncommon.

How do you treat trigger these trigger points? We’d be delighted if you want to share your own best practice.

Wallden M,

[2]Wingerden et al (1993) van Wingerden, Vleeming A, Kleinrensink, Stoeckart R, (1997). The role of the hamstrings in pelvic and spinal function in "Movement, Stability & Low Back Pain - the essential role of the pelvis", Churchill Livingstone 207-210

[3] Willard (1997)The autonomic nervous system , in Foundations for Osteopathic Medicine. Ed: Ward. Publisher: American Osteopathic Society.

[4]VleemingVleeming A, Stoeckart R, &Snijders C, (1989) The Sacrotuberous Ligament: a conceptual approach to its dynamic role in stabilising the sacro-iliac joint  Clinical Biomechanics vol 4 no 4 201-203

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