Before we can understand the how to stretch the hamstrings, we need to understand how they work.
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Anatomy
Common hamstring talk:
The hamstrings are three muscles. The semimembranosus, semitendinosus, and biceps femoris, which has a long and short head. The semis are inside (medial), the biceps outside (lateral). They all start at the top of the hip behind your ass (ischial tuberosity), and connect below the knee.
Because they cross two joints, the hip and the knee, they have two actions, one at the hip; one at the knee.
They pull the hip back, hip extension:
And pull the knee back, knee flexion:
Uncommon hamstring talk:
Because the hamstrings start at the pelvis, then can exert a force there as well. The hamstrings can pull the pelvis down, posteriorly tilting it and concurrently flexing the lower back:
Never mentioned hamstring talk:
As said, the hamstrings connect below the knee, at the tibia and fibula. Not said, the hamstrings connect on the sides of these bones.
Semimembranosus connecting inside (medial) to the tibia:
Semitendinosus connecting inside (medial) to the tibia:
Biceps femoris, long and short head, connecting to the outside (lateral side) of the fibula:
Because of these attachments the hamstrings can exert a rotational force at the knee. The medial hamstrings, semimembranosus and semitendinosus, can rotate the bottom portion of the leg inward; the lateral hamstring, biceps femoris, can rotate the bottom portion of the leg outward.
Finally, the hamstrings form a connection with the gastrocnemius, the calf, which forms a connection down to the foot. Courtesy of the Anatomy Trains philosophy:
Main takeaways
From top to bottom: The hamstrings are involved in
- Lumbar flexion
- Posteriorly tilting the pelvis
- Extending the hip
- Flexing the knee
- Rotating the tibia
- And are related to ankle plantarflexion
Reversing these actions, we can potentially increase the effectiveness of stretching our hamstrings when we:
- Extend the lower back
- Anteriorly tilt the pelvis
- Flex the hip
- Extend the knee
- Rotate the tibia in either direction
- Dorsiflex the foot
Let’s start stretching those bastards.
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But are they even tight?
Assessing the hamstrings posture
The most common assessment out there people seem concerned with is an anterior pelvic tilt.
Because the hips are rotated anteriorly and the hamstrings pull the pelvis posteriorly, it’s common to assume the hamstrings are “weak / lengthened” in an anterior pelvic tilt. As we’ve gone over though, the hamstrings play a role in what happens at the hips and the knees. If we only look at the hips we’re missing half the picture.
A person who appears to have some anterior pelvic tilt:
May also appear have some knee flexion going on:
The hamstrings may appear lengthened at the hip attachment, but they are, if anything, shortened at the knee connection. Think of a rubber band, if you pull the rubber band out from one end but bring it in from the other, what happens to it? Nothing. It doesn’t get stretched.
Because muscles aren’t exactly like rubber bands, from the above photos we could deduce: The hamstrings are perhaps underactive in hip extension but overactive in knee flexion. Helping to understand why, “Strengthen the hamstrings” isn’t a solution for an anterior pelvic tilt. Or, contrary to the internet world, why “Just deadlift” does not solve everything. This is the type of person who should probably stop deadlifting for a while. (It promotes lumbar extension / anterior pelvic tilting and knee flexion.)
We need to look at the knees in a posteriorly tilted hip as well. Even though the hamstrings are tightened at the hip attachment, they may be lengthened at the knee attachment. The knees may be in hyperextension:
So again, our rubber band is being pulled from one direction but getting slacked from the other.
What the hell is going on here?
It’s all relative
When faced with these types of situations we’re forced to asked things such as the following:
- Is the amount of anterior pelvic tilt greater than the amount of knee flexion?
For instance (numbers are for example purposes), if the pelvis rotates anteriorly 5 inches (lengthening the hamstrings 5 inches), but, the knees flex 8 inches (tightening the hamstrings 8 inches), then overall, the hamstrings have been tightened 3 inches (8 – 5 = 3).
- Is the amount of posterior pelvic tilt greater than the amount of knee extension?
For instance, if there’s a posterior pelvic tilt of 5 inches, then the hamstrings are tightened 5 inches. If there’s a simultaneous 2 inches of knee extension, lengthening the hamstrings 2 inches, then the hamstrings have been (overall) tightened 3 inches (5 – 2 = 3).
Another example. Apparent anterior pelvic tilt with significant hip extension going on:
Even though the presence of an anterior pelvic tilt causes one to assume the hips are automatically in flexion, you can see quite a bit of hip extension going on:
And what extends the hips? The hamstrings. If the hip are in extension the hamstrings may actually be shortened, even with an anterior pelvic tilt going on. An APT is not a clear indication the hips are flexed.
Rotation at the knee
Remember, the hamstrings don’t just work in a forward and back motion. They play a role in twisting too.
This is much simpler. Look at the front of the knee and foot. Do they face the same direction? Or different directions?
Right knee (left in picture) almost straight; left clearly turned in:
You can also assess this by looking at the back of the knee. Do both hamstrings (medial and lateral) appear the same? Or is one more prominent than the other?
Often the knee will point inward and the foot outward. Meaning the femur is rotated inward and the lower leg outward.
Some people out there, whom I really respect, seem to believe this is indicative the medial hamstrings are overactive. I’m not so sure. Because the medial hamstrings connect below the knee, I’m not convinced they can exert a medial rotation above the knee at the femur. I think the adductor magnus may have a more important role as it connects to the lower femur.
As well as indicative the lateral hamstrings (biceps femoris) are working overtime, as the rotate they bottom leg outward.
At the end of the day though, this doesn’t really change our approach to loosening the hamstrings.
For now, understand:
- The hips only tell part of what the hamstrings are doing.
- The hamstrings play a role in rotation at the knee.
- Assessing the hamstrings in movement is crucial. Posture only tells us so much.
After all that, rather than trying to eye ball various alignments and rack your brain with anatomy,
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Just make the person move
Before I go over how I like to assess hamstring length, let’s go over issues with other methods.
Toe touching
The most obvious issue with toe touching is it promotes lumbar flexion.
If the lower back rounds there’s a very good chance -even if the knees are kept straight- the hamstrings are being lengthened from one end but tightened from another. Meaning we’re not really assessing their length.
During a toe touch a certain amount of lumbar flexion is expected, and what we’re really concerned with is the amount of lumbar flexion relative to hip flexion, but I find this is too hard to eye ball and just not necessary to deal with. And flexing people’s backs is rarely advised.
Moving on.
Active straight leg raise
I’m by no means an expert on the Functional Movement Screen. Forgive me if I misrepresent things.
The active straight leg raise in the functional movement screen (FMS) seems to be a popular method of assessing hamstring length. I’ve heard some repeatedly state it’s actually not a hamstring length test. Rather, it’s an assessment for the pattern of a straight leg raise test. However, in Gray Cook’s (inventor of the FMS) Movement book he states the test is “much more than a hamstring length test.” Leading me to conclude it’s, amongst other things, a hamstring length test. Plus, everyone seems to use it for hamstring length.
Here’s why I’m not big on this assessment.
1) You need to be cognizant of the hip capsule
A common movement issue at the hip is lack of posterior glide of the femoral head. Because of this the femur tends to glide too far forward (anteriorly). This will often happen during hip flexion, especially maximal hip flexion. What does the active straight leg raise attempt to do? Significantly flex the hip.
What may appear as limited hamstring flexibility may actually be the femoral head gliding forward into the pelvis. The bones may clunk together -why people with hip pain often feel pinching and catching- preventing further hip flexion.
By providing some posterior glide for the person you may suddenly find they have a greater amount of hip flexion and hamstring flexibility than originally thought.
2) The pelvis isn’t starting from a true neutral and can move quite a bit
When a person is completely supine (on their back) the lumbar is flat, which means -compared to a normal amount of lordosis- it is flexed, meaning the pelvis is posteriorly tilted, which shortens the hamstrings from the hip attachment.
When you then attempt to fully flex the hip and extend the knee, even if the person gets to 90 degrees, the hamstrings aren’t completely on stretch. Granted, if the person can’t straighten their leg with the lower back flexed they aren’t going to be able to do it with the lower back extended. (So I’m likely being a bit too picky here.)
Going right with this, you need to make sure the person doesn’t allow any greater amount of posterior tilting as the leg raises.
This,
Often turn into this,
I’m not sure if this is something the assessment is designed to look at. It very well could be. But from how I’ve seen people use this assessment, it seems ignored.
A better way
We can take principles from the active straight leg test and then make it better. We keep the person supine, but instead of actively raising the leg, we passively pull the knee in.
This helps generate posterior glide on the femoral head, giving us a greater chance of not irritating the hip in any way. From there, we can then actively straighten the leg.
I don’t focus much on the bottom leg. The only point is I don’t keep the bottom leg completely straight, like in the active straight leg raise. Doing so encourages the knee and hip to fully extend / hyperextend. Neither of which are desirable. In the ASLR test this is part of the assessment i.e. the extension ability of the bottom leg. For this post, we’re concerned with hamstring length; not hip extension length.
I’ll comment on supporting the lower back in a minute.
What we’re looking for
During this movement we’re looking for compensations indicative of stiff hamstrings.
1) The knee
The most obvious compensation is the person can’t generate full knee extension.
2) The hips lift off the ground / the lower back rounds
The back should stay flat:
Not lift:
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Make sure to look at both legs even though only one is moving. The hamstrings can rotate the pelvis; one side may stay flat but the other lifts.
3) The person generates knee extension from hip extension
Said another way, the person’s knee travels to the ground. Rather than stay straight:
The knee extension is accompanied by hip extension.
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This is what I was talking about earlier: Hip extension and knee extension tend to go hand in hand. You can see how the hamstrings may play a role in knee extension.
4) Rotation at the knee
We want to look out for the knee turning inward.
Because the adductor magnus is also on stretch during this movement, I believe this is a sign the adductor magnus is trying to fight the stretch. (Lateral rotation of the femur would put it fully on stretch; it doesn’t like that.) Others seem to think this is the medial hamstring. Regardless, we don’t want the compensation.
If all the above is satisfactory, we can take things further getting an ever better idea what’s going on / improve the stretch.
1) Pull the toe to the stomach.
Remember that connection to the calf muscle? By dorsiflexing the ankle we can generate a greater stretch and get a better idea of the stiffness in the entire posterior leg.
2) Provide some lumbar support
By putting an arch in the lower back, which is normal and healthy,
We anteriorly tilt the hips a bit, further putting the hamstrings on stretch.
Make sure the support is under the lower back; not the hips. The hips should be touching the ground.
This is a great idea for someone with an often posteriorly tilted pelvis. We help get some of that lordosis back, while more effectively stretching the hamstrings. In someone with an anterior pelvic tilt, but hyperextended knees and hips, we could leave the pelvis alone. That way we flatten the lower back a bit (reversing the APT), but get some work into full hip flexion (reversing the hyperextension). Our assessment has turned into a nice corrective exercise.
Which is the point. The best assessments are also corrective exercises.
Let’s bring it all together in a video:
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Issues with other methods
The above certainly isn’t the only way to loosen the hamstrings. But, hopefully you can see how much there is to consider when stretching them, and I think the above method helps make matters easier. Let’s go over how other methods often miss the above factors.
Toe touching
I covered this earlier. It’s common to substitute hip flexion with lumbar flexion, lessening the effectiveness.
Frankenstein walking
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Substituting lumbar flexion for hip flexion happens in this exercise too:
It’s very hard to keep the knee straight and get any dorsiflexion.
Because of the speed of the movement it’s very hard to 1) Detect these flaws and 2) Correct them.
Walking RDL
This seems to be coached rather well regarding eliminating lumbar flexion.
However, too much knee bend is common.
To those saying you can coach a straight knee: It’s not a great idea to load a locked knee. And if our goal is 90 degrees of hip flexion with full knee extension, that’s what you’d be suggesting. You’re also assuming the person is coordinated enough to not allow that knee to go into hyperextension.
Although, I will say the first picture is pretty damn good.
Next, while the lower back may not be flexing as much, it’s often rotating.
It’s common for one leg to have stiffer hamstrings than the other, causing an asymmetrical pull on the lower back, causing a lower back prone to rotating. You can coach people to prevent this, but it’s hard. Especially if the person is stiff (the people most likely to be attempting these things). It’s very hard to know if you’re rotating without another pair of eyes (trainer / coach) as well. You could try a mirror, but looking off to the side during this is likely to cause balance issues.
With this exercise you’re also saying working on lumbar extension is ok for everyone with stiff hamstrings. Go back to the pelvic alignment section if needed, but I’ve gone over extensively how lumbar extension is not always desirable when loosening the hamstrings. Especially loaded lumbar extension. (Gravity is resistance.) Not to mention excessive lumbar extension is the most common cause of lower back pain. And this is one aspect of the exercise you can’t eliminate. You’re going to extend the spine, and you’re going to load it through extension, AND challenge the person’s balance.
The irony of this exercise is the people who can do it properly probably don’t need to do it for the purpose of improving their hamstring flexibility. Maintaining? Alright, maybe. I suppose my overarching point with this exercise is if you have stiff hamstrings you probably can’t do this exercise well enough. You have to improve your hamstring stiffness through other means first.
Downward dog / Yoga push-up
I actually like this exercise and use it quite a bit. However, I often advocate doing it with the assistance of a mirror. Because the motion is slow, and the feedback of the mirror (or someone watching), it can be done well. For some though, they’re simply too stiff and it doesn’t work. Similar to the RDL notes above.
You can see someone rotating here:
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Here’s me talking to someone as they go through this. You can see the same issues we’ve been talking about with the lower back, knees and feet.
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Foam rolling
Same shit, different day.
Along with a bunch of other issues beyond the scope of this post.
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If this was helpful, consider buying me a few beers-
Or maybe you’d like an extra pair of eyes to help catch something like above.
Chris
July 29, 2013
Brian, what do you think of using a band (looped around the foot) for the bent-knee stretch you outlined in the video? Same, but different?
reddyb
July 29, 2013
Hey Chris,
I just about always prefer an active stretch over a passive one. The active stretch normally will accomplish some things a passive one won’t.
For example, in the preferred stretch I outlined above, people will often get some work in the quadricep from the knee extension. I didn’t go into this in the article, but you’ll see some people who’s quadriceps actually aren’t working ideally. They’ll use hip extension to generate knee extension. I go over this a bit in this post: http://b-reddy.org/2012/09/03/my-visit-to-the-washington-university-in-st-louis-physical-therapy-program/
Using a lunge as an example. Video here: http://www.youtube.com/watch?v=pS–BT_B5UM
This goes with the example I used above where the knee, rather than stay straight, travels towards the ground.
With a band / passive stretch it’s unlikely you’d 1) Notice a flaw like this and 2) Be able to work on it.
It’s not using the band is bad or anything, I just think you can get more bang for your buck through other means.
Hope that makes sense.
Chris
July 29, 2013
Thanks for your detailed reply. I should’ve clarified what I meant… I was talking about the band method used at the beginning of the following video example:
reddyb
July 29, 2013
In that instance the quadriceps are getting some knee extension work, but the band is generating the dorsiflexion.
Also, if curious, you can see the posterior tilting of the pelvis. While that guy is definitely flexible, he’s generating a ton of lumbar flexion during what’s supposed to be a hamstring stretch. (This of course isn’t the band’s fault.)
The band could definitely work, I’m just partial to not using it.
Tangent: When you’re working with people (you’re a trainer / coach / whatever), and you’re implementing corrective exercises, the less equipment you can use, the better. Especially for new people. If you have a new client and they don’t have a band, they’re less likely to do the exercise. I know, many will think “IT’S JUST A BAND! YOU COULD EVEN USE SOMETHING ELSE! PEOPLE ARE SO LAZY!”
But, the less work a person has to do in order to an exercise, the better. Essentially, the easier it is for a person to do at home on their own, the better.
Ming Wei
August 8, 2013
Hi, I stumbled upon your site and wish to know how to correct my condition. I have this condition where my right knee would point inward if I try to point my right feet forward. Hmm my bad for not able to understand your post, what are some assessments to see what condition I have and how to correct it If you know about my condition. Really annoyed by this for some time. Thanks!
reddyb
August 8, 2013
Read these: http://b-reddy.org/category/posture-assessment/
Bloss
August 26, 2013
Do you know much about neural tension and tingling pain in calf with hamstring stretch plus dorsiflexion?
reddyb
August 27, 2013
Hey Bloss,
I’m versed in neural tension, but not well versed. Primarily because the reasoning behind using it hasn’t proven persuasive for me. So, I know about it, have read plenty about it, but haven’t practiced it.
If one were to feel any type of pain during a stretch like you’re describing, they’re either doing the stretch wrong or simply trying to go too far too soon.
PT advantage
April 17, 2014
Hey Bloss,
That tingling sensation is caused by excessive tension along the sciatic nerve. Your essentially performing a neural tension test in that position. Look up sciatic neural flossing exercises for a treatment exercise. Cheers!
reddyb
April 17, 2014
If by position you’re referring to the stretch outlined in this post, I just want to note that while it’s similar to a neural tension test, it’s not quite there. Because the head is kept on the ground and there is a lumbar support, that changes things. (Neural tension test involves flexing the entire spine.) Also, because the back and spine is purposely kept stabile, that also changes things. Going with a neural floss, where you’re purposely flexing the spine, is something I haven’t been able to get on board with.
Fred
September 24, 2013
Is it important that the leg be fully straightened? Even when my arms are straight, barely grabbing onto my leg, I can’t fully straighten my leg. Should I just straighten it as much as possible, and then dorsiflex the ankle? Or wrap a towel or something around my leg to ‘lengthen’ my arms.
reddyb
September 24, 2013
Hey Fred,
The intention to get the leg straight is what’s important. If you can’t get your leg straight, then this is a good exercise to work on that. The people who can get their leg fully straight are the people least likely to benefit from something like this.
I typically don’t worry about dorsiflexing the foot much until the hamstring flexibility, the ability to straighten the leg, improves first.
Hope that makes sense.
Den
October 22, 2013
I get a lot of pain/ tightness in my hamstrings when I am standing all day, at tradeshows and that type of thing. Also suffer from ITBS. This stretch really does seem to work, and I can fully extend so assume that means I need to work on it. Great advice. let me go and look at the ITBS page.
reddyb
October 22, 2013
Thanks Den. Glad to hear you found it useful.
Martin C. Kviteberg
March 12, 2014
What exercises and stretches would you recommend to correct the APT-, knee flexion- and hip extension-posture? (guy in the first pictures)
reddyb
March 17, 2014
Hey Martin,
I believe you mean the guy in the black briefs? Just want to clarify, he is in APT, knee flexion, and hip flexion.
This is one, low level, example:
You want to perform a fair amount of movements where the person doesn’t compensate. In someone like him, it’s typical to do something like move their legs with too much lower back movement. Where, say they bend their knee, they’ll also tend to extend their back. So, you want them to move their legs without extending their back. There are some exercises aimed around these principles here: http://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
Martin C. Kviteberg
March 20, 2014
Great, thx!
Is that the same reason his center-line is so far back?
reddyb
March 21, 2014
He has a little bit of a forward lean going on at his whole body. Likely indicative of what he does during the day. That is, in some capacity, he probably leans forward a decent amount during the day. You see this with taller people a fair amount. Because everything in their environment tends to be below them, they’re always leaning forward / looking down to compensate. Therefore, when you look at them in stance, they’re leaning forward.
Martin C. Kviteberg
April 26, 2014
Tight lats also?
reddyb
April 28, 2014
Not necessarily. It’s more of what the person does on a regular basis opposed to one or two muscle groups being tight. If the forward lean is what you’re referencing, you first want to start with correcting the forward lean.
That said, tight / stiff lats are so common it probably wouldn’t hurt to work on that too.
Martin C. Kviteberg
June 4, 2014
Is it correct to assume that he’s counteracting the forward lean by flexing the knees and shifting the pelvis forward in his walk and stance, and as a result of this externally rotating the femurs and tightening the TFL?
Also, what muscles would you focus on strengthening to correct the forward lean?
reddyb
June 6, 2014
-Eh, maybe. His lean isn’t that pronounced. But external rotation of the femur does not work the TFL.
-I would tell the person to not lean forward.
Martin C. Kviteberg
October 5, 2014
Hi again!
How is the progress in terms of correcting his posture? Is there any stretches/exercises that have been particularly effective? I have a similar posture myself..
reddyb
October 7, 2014
He’s doing well. I’d take a look at all the exercise and ADL recommendations I went over previously.
Mary
May 18, 2014
I tried your hamstring stretch and experienced almost immediate relief of my right SI joint pain. Great, finally a stretch that helps! Two days later, I did the same stretch and had burning, tingling and a numb feeling from my lower back, buttocks and down the back of both legs to my feet. It remains after a week. I’m not sure what to do.
reddyb
May 20, 2014
Hey Mary,
If you get pain during the stretch:
1) Check your form. Really, really make sure the lower back / hips aren’t moving.
2) Be careful how far you push the stretch, especially with a sciatic history. You want to tow the line between getting a stretch and going into pain.
Because you felt good after the first time but had issues the second, 1) and 2) are what I’d look at first. Often, one does something, feels better, then do it with less focus (form isn’t as good, push things too much) and pain arises. That said,
3) The stretch may be too much for you at this point. Oddly, I’ve found people to sometimes have issues with this one, no matter what, but be ok with a seated version:
Of course, this all assumes you did nothing else to flare something up. That this stretch was all you did on these two occasions. That is, other factors could be important too.
Kevin Gibbs
August 4, 2016
Hi Brad.
I’m assuming this will sort out both hamstring inflexibility in knee extension as well as hamstring inflexibility in the hips? But as a test, how do I differentiate between which is tight? Is it simply by checking out do they have lock-knees (therefore the problem would be in the hips) or not (whereby the problem would be in the knees). Also, I feel this more in my calves than anywhere in my hams BUT I have lock-knees. What’s up with that? Thanks.
p.s. about that thing I was to send you – well, I got a finn to look at it and therefore I didn’t have to translate the whole 16 pages. Sorry about that!
reddyb
August 7, 2016
Hey Kevin,
In the leg kick exercise the hip(s) are flexed and the knee(s) extends. So the hamstrings are being stretched from the hip and knee connection.
I believe you’re asking something like would the knee not fully extend with the hip extended, or would the hip not fully flex with the knee flexed. That wouldn’t be testing the hamstring flexibility then.
Hyperextended knees in standing are not a guarantee about hamstring stiffness. You need to assess them specifically. (More about this here: https://b-reddy.org/2013/07/21/looking-at-pelvic-tilts-the-hips-only-tell-you-part-of-the-story-an-anterior-pelvic-tilt-doesnt-mean-your-hips-are-flexed/ )
If you wait until the top of exercise to dorsiflex the ankle, then you will feel this in the hamstring *if* you have stiffness there. If you aren’t stiff there, then dorsiflex the ankles, then feel stretching in the calves, then you have some stiffness in the calves.
Kevin Gibbs
August 8, 2016
Hi and thanks for your reply.
this is interesting… I shall have to look into that article of yours indeed! Only thing I will ask here still before I read that article is… if my calves are tight and calves are flexors of the knee, how can they be tight without flexing the knees? (in case of hyperextended knees). Thanks again.
reddyb
August 9, 2016
Calves connect to the knee and ankle. They dorsiflex the ankle. In knee hyperextension, the ankles are plantarflexed.
Some images here: https://b-reddy.org/2013/02/20/another-example-of-a-postural-evaluation/
Kevin Gibbs
August 9, 2016
Love this info in your head! thanks so much.
reddyb
August 11, 2016
You’re welcome :).
Sam Johnson
September 11, 2016
Hi reddyb – Just discovered your website while looking for info about hip pain/stretching.. very interesting. This post is also interesting, however, your demo for downward dog is a bit wrong. The person should not have their legs together, they should be hips width apart. Bringing the legs so close together would most likely make someone lean to one side. It’s a basic yoga pose and not something difficult. (Even for people not very flexible, usually its poor arm strength that beginners struggle with at first.) At least I didn’t think people could get it so wrong until I saw this post!
reddyb
September 13, 2016
Hey Sam,
-Curious to hear the rationale between why feet together vs feet ~6 inches apart causes leaning to become most likely.
-Not sure what you’re getting at with difficulty. Not difficult in what way? You mention poor arm strength. If someone has poor arm strength, then the exercise would / could be difficult, no?