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Hamstring Muscle Tightness in CP Children
Hamstring tightness is very common in spastic CP, especially in children with diplegia and quadriplegia.
The hamstrings run from the pelvis to the back of the knee and help with bending the knee and extending the hip.
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Why Hamstring Tightness Happens in CP
• Spasticity (increased muscle tone) in the hamstrings
• Weakness in opposing muscles like quadriceps and hip flexors
• Poor posture -crouched gait
• Prolonged sitting or W-sitting
• Lack of stretching and mobility
This tightness can cause:
• Knees staying bent while standingor walking
• Difficulty walking with straight legs
• Toe-walking or crouched posture
• Back pain
• Limited flexibility
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Signs of Hamstring Tightness
• Difficulty straightening the knee
• Child walks with bent knees
• Pelvis tilts backward
• Strain while sitting on the floor with legs stretched
• Limited SLR (Straight Leg Raise)
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Effective Exercises for Hamstring Tightness (CP)
1. Supine Hamstring Stretch
• Child lies on back
• Lift one leg up, keeping knee straight
• Hold for 20–30 seconds, repeat 3 times
• Gentle and slow — avoid bouncing
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2. Seated Long-Sitting Stretch
• Child sits with legs straight forward
• Encourage them to reach towards toes
• Support at knees to keep them extended
• Hold 20–30 seconds
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3. Wall Stretch (Passive Stretching)
• Child lies near a wall
• Legs go up against the wall
• Knees remain straight
• Hold for 1–2 minutes
Very effective for severe tightness.
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4. Standing Hamstring Stretch
• Place foot on a small stool
• Keep knee straight
• Lean forward from the hip
• Hold 20–30 seconds
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5. Towel -Strap Stretch
• Use a towel around foot
• Pull leg upward gently with knee extended
• Useful for toddlers and low trunk control kids
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Strengthening Exercises (To balance the tightness)
1. Quadriceps Strengthening
Because weak quads worsen hamstring tightness.
• Sit-to-stand
• Wall sits
• Supported squats
2. Gluteal Strengthening
• Bridges
• Hip extension kicks
• Standing hip exercises
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Functional Activities
• Cycling -Tricycle use
• Scooter board activities
• Climbing (soft play -stairs)
These help naturally stretch the hamstrings.
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Avoid
❌ W-sitting
❌ Long sitting with bent knees
❌ Sudden, forceful stretches
❌ Unsupported walking on crouched posture
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When to Seek Additional Support
• Severe tightness not improving
• Knees do not fully straighten
• Significant gait deviation
• Child experiences pain
Physiotherapy and occupational therapy can provide:
• Serial casting
• Taping
• Weight-bearing exercises
• Stretching protocol
• Gait training
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