The Influence of Gender and Age on

Hamstring Muscle Length in Healthy Adults

Journal of Orthopaedic & Sports Physical Therapy

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Copyright 2005 Journal of Orthopaedic & Sports Physical Therapy. All rights reserved.

James W. Youdas, PT, MS 1

David A. Krause, PT, MBA, OCS 1
John H. Hollman, PT, PhD 1
William S. Harmsen, MS 2
Edward Laskowski, MD 3

Study Design: Cross-sectional descriptive study.

Objectives: To examine the factors of gender and age, stratified by 10-year increments, on
hamstring muscle length (HML) as measured by passive straight-leg raise (PSLR) and popliteal
angle (PA).
Background: Differences in HML between men and women have not been examined for a large
group of healthy adults over a wide range of ages. The usefulness of these data is to provide some
typical values of HML for future reference.
Methods and Measures: Two hundred fourteen adults (108 women, 106 men; age range, 20-79
years) with no known history of hip or knee joint disease and no history of recent hamstring strain
participated in the study. PSLR (trunk-thigh angle) and PA (thigh-leg angle) were estimated with a
goniometer. A 2-way analysis of variance (ANOVA) was used to analyze the effects of 2
independent variables (gender and age) on 2 dependent variables (PSLR and PA). Statistical
significance was established at .05.
Results: HML differed significantly (P .001) between genders for both methods of measurement,
with females demonstrating greater flexibility than their male counterparts. The difference between
genders was 8 for PSLR and 11 for PA. HML was not influenced by age.
Conclusions: This study provides physical therapists with typical values of HML in healthy men
and women. J Orthop Sports Phys Ther 2005;35:246-252.

Key Words: flexibility, hip extensors, lower extremity, straight-leg raise

ehabilitation professionals routinely assess hamstring muscle

length (HML) in persons with injuries to the nervous or
musculoskeletal system,26 such as hamstring muscle injury,20
spinal cord injury,34 low back pain,12 or anterior knee
pain.28 Clinically, HML is commonly measured indirectly by
angular measurements of unilateral hip flexion with the knee extended
(passive straight-leg raise [PSLR]), or unilateral passive knee extension
with the hip flexed to 90 (popliteal angle [PA]).27,30
Based upon general joint range of motion data,27,30 a physical
therapist could expect HML to vary between men and women, with
women having greater HML than men. Furthermore, a clinician could
reason that HML would diminish with an increase in age. A review of
1

Assistant Professor of Physical Therapy, Mayo Clinic College of Medicine, Rochester, MN.
Statistician, Division of Biostatistics, Mayo Clinic, Rochester, MN.
3
Professor of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN.
The protocol for this study was approved by the Mayo Foundation Institutional Review Board.
Address correspondence to James W. Youdas, PT, Program in Physical Therapy, Mayo Clinic, 200 First
Street SW, Rochester, MN 55905. E-mail: youdas.james@mayo.edu
2

246

the literature does not provide direct answers to these questions

about HML, but, based on the
literature, generalizations can be
made about the effect of gender
and age on joint range of motion.
Bell and Hoshizaki5 examined the
relationship of age and gender on
range of motion of 17 joint actions
at 8 joints. The sample of 190
volunteers (124 females and 66
males) ranged in age from 18 to
88 years. The authors reported a
general decline in flexibility as age
increased, with women having a
greater range of motion than
males throughout life. Allander et
al2 reported an inverse relationship between age and range of
motion of the shoulder, hip, wrist,
and thumb in a large group of
healthy adults from Sweden and
Iceland.2 Females were found to
have significantly greater range of
motion than males, which was attributed to the fact that the men
performed more rigorous physical
work, resulting in greater joint
microtrauma, than their female
counterparts.
Table 1 summarizes previous
studies that reported HML values.
Several studies have estimated
HML with PSLR in subjects ranging in age from 18 years to more
than 80 years.11,13,15,18,19,21,29,39 Except for the study by James and
Parker,21 most investigators had

Journal of Orthopaedic & Sports Physical Therapy

Journal of Orthopaedic & Sports Physical Therapy

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Copyright 2005 Journal of Orthopaedic & Sports Physical Therapy. All rights reserved.

Subjects
We recruited 214 healthy subjects (106 men and
108 women) 20 to 79 years of age. Subjects were
stratified across 6 age groups in 10-year increments
(20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years),
each having between 24 and 43 subjects about equally
divided between men and women. Subjects were
recruited through advertisements on an institutional
intranet directory, at the institutions fitness center,
and through a local newspaper. Inclusion criteria
included (1) no current low back pain, (2) no history
of surgery to the low back, knees, or hips, (3) passive
full knee extension, (4) no known history of hip or
knee joint disease, (5) no history of recent hamstring
strain, and (6) a body mass index (BMI) of less than
30 kg/m2 to exclude obese and very obese individuals.41 This study was approved by the Mayo Foundation Institutional Review Board and each subject
signed an approved consent form. Descriptive statistics for the men and women are provided in Table 2.

Procedure
To adequately expose the low back, posterior thigh,
and knee joints, all subjects wore shorts (men) or
J Orthop Sports Phys Ther Volume 35 Number 4 April 2005

Indirect Measurements of HML

Two indirect measurements of HML (PSLR and
PA) were made by 2 experienced physical therapists.
During the measurement process, the order in which
the 2 methods were used was randomized. The right
side was always tested first.
The PSLR measurement was performed on a standard plinth with 1-cm padding, according to a
procedure described by Kendall et al.22 The subject
was positioned supine on the table with the low back
and sacrum flat against the table. If the low back did
not flatten because of shortness of the hip flexor
muscles, a pillow or towel was placed under the knees
just to the point that the low back flattened against
the table. When the low back and sacrum were flat,
examiner 1 firmly held down the thigh of the lower
extremity not being tested against the table or pillows
to limit posterior pelvic tilt. Then, examiner 1 firmly
grasped the subjects calcaneus with the opposite
hand, passively raising the lower extremity being
tested, with the knee straight and the foot relaxed.
The lower extremity was raised until firm resistance
to further hip flexion was detected and confirmed by
the subject. Examiner 2 used a 360 hand-held
universal goniometer (HHUG) (Fred Sammons Inc,
Burr Ridge, IL) to measure the angle between the
long axis of the trunk and thigh. The accuracy of this
instrument was calculated by measuring 23 known
angles generated by a computer graphics plotter. The
mean difference between the known and observed
values was 0.04 (SD, 0.2). The HHUG was masked
when making PSLR measurements. Examiner 1 recorded the measurement of hip flexion, then returned the arms of the HHUG to 0 before examiner
2 repeated the measurements. The second measurement of PSLR was made about 60 seconds after the
first measurement. The same procedure was performed for the opposite lower extremity. Examiner 2
was blinded to the values of the repeated measurements of PSLR.
Measurement of PA has been described by previous
investigators.14,25,37 The subject was positioned supine
on an examination table. The lower extremity not
being tested was positioned in hip and knee extension. Examiner 1 positioned the hip and knee of the
tested side in 90 of flexion, thus marking the
starting position for the test. With 1 hand supporting
the subjects distal thigh and the other hand cupping
the heel, examiner 1 passively extended the knee
until he felt firm resistance was elicited. At this point
examiner 2 measured the angle between the thigh
and the leg (PA), using a masked 360 HHUG. Full
knee extension would be equivalent to an angle of
180. The axis of the HHUG was positioned at the
247

REPORT

METHODS

shorts and a gown (women). Body height (m) and

mass (kg) of each subject were measured with a
standard clinical scale.

RESEARCH

small sample sizes (between 10 and 46 subjects).

These studies reported a broad range of values for
HML. James and Parker21 studied 10 men and 10
women each in 4 age brackets spanning 22 years
(range, 70-92 years). Statistically significant differences in PSLR for the main effects of gender and age
were found. Women had greater HML than their
male counterparts and both men and women showed
a consistent reduction in HML with age. However,
their findings are limited to men and women between ages of 70 and 92 years.
Five studies reported HML values using PA in
healthy adults (Table 1).7,14,16,23,25 Three of the 5
studies examined men within a narrow age
range.14,16,25 Chan et al7 combined PA values of HML
for men and women, whereas Krabak et al23 studied
only 15 subjects (10 men and 5 women). The defined
end point of terminal knee extension varied among
investigators, as did HML values. None of the investigators statistically compared HML between men and
women, nor did they examine the effect of age on
HML.
The purpose of this study was to examine the
factors of gender and age on HML. We hypothesize
that there is a statistically significant effect of gender
on HML, with women demonstrating greater HML
than men. We also hypothesize that age, stratified by
10-year increments, would have a statistically significant effect for both men and women, with HML
decreasing in older age groups.

248

J Orthop Sports Phys Ther Volume 35 Number 4 April 2005

PSLR

PSLR
PSLR

14

Technique

11

HHUG

PSLR

PSLR

Girouard and
Hurley15

Raab et al29

Pendulum goniometer

PA
PA

PA

PA

PA

Link et al25
Hartig and
Henderson16
Gajdosik et al14

Chan et al7

Krabak et al23

Firm resistance to passive knee

extension

Firm resistance to passive knee

extension
Pain

Minimal resistance to knee extension

Resistance to passive knee extension

Initial point of pelvic tilt

Knee flexion or posterior pelvic

rotation

Posterior rotation of pelvis

NA
NA

Firm resistance to hip flexion

Posterior rotation of pelvis

Knee flexion

Endpoint

26-30

10

13-52
13-52

18-30

18-40

10

40

30

20-30
20s

26-30

10

61
148

26-30

65-89

50-74

85

80-84

76-79

45-55
71-75

18-40
18-37

20-25

Age (y)

10

46

31

38
80

30
20

10

Gender (n)

female
female
female
female
Female (5)

Male
Male
Male
Male
Male

and
and
and
and
(10)

(10)*
(10)
(10)
(10)

60
64
54

Female (16)
Female (17)
Male (4)
Female (6)
Male (4)
Female (6)
Male (4)
Female (6)
Male
Male
Male

69
66
62

Male (10)
Male (7)
Female (13)

139

160
167
161
171
129

31

43
46

45

53

61
81
87
68
67
74
65
75
63
69
55
57
72

78

Mean

9
9
6
9
9

6
7

13

16

14
10
16

7
10
16

6
4
7
10
NA
NA
NA
NA
NA
NA
NA
NA
11

SD

HML (deg)

Male
Male (10)
Female (10)
Male
Male (10)
Female (10)
Male (10)
Female (10)
Male (10)
Female (10)
Male (10)
Female (10)
Male (14)*

Male

Subjects

Abbreviations: HHUG, hand-held universal goniometer; HML hamstring muscle length; NA, not available; PA, degrees of knee flexion with the hip maintained at 90 of hip flexion; PA, popliteal angle formed
by the angle between the femur and tibia with hip maintained at 90 flexion (180 = full knee extension); PA, popliteal angle; PSLR, passive straight-leg raise.
* Girouard and Hurley15 studied 3 groups. Baseline measurements of HML are reported prior to therapeutic intervention.

Raab et al29 studied 3 groups. Baseline measurements of HML are reported prior to therapeutic intervention.
+
Chan et al7 studied 4 groups of 10 subjects per group (6 males and 4 females). Values of HML are baseline values obtained before a therapeutic intervention.

HHUG

Cybex dynamometer

Gravity goniometer
HHUG

PSLR

Hsieh et al18

HHUG, flexometer, tape measure

HHUG

Myrin inclinometer
Leighton flexometer

PSLR
PSLR

Flexometer, modification of Leighton

flexometer
Pendulum goniometer
HHUG

Measurement
Device

Hultman et al19
James and Parker21

Gajdosik et al
Wang et al39

Ekstrand et al

Study

TABLE 1. Summary of studies that estimated hamstring muscle length in healthy adults.

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We measured HML on both right and left sides

using the PSLR and PA methods in all 214 individuals. Paired t tests were conducted after all the data
were collected and revealed that HML did not differ
significantly between sides. For PSLR the mean (SD)
difference between sides was 0.5 4.5 (P = .09); for
PA, it was 0.1 5.4 (P = .83). Therefore, we
collapsed the data across sides and used as data
points for each subject the mean value calculated for
PSLR and PA.
Descriptive statistics on age, height, body mass, and
body mass index (BMI) were calculated for both men
(n = 106) and women (n = 108). To analyze
differences in HML, we conducted a separate 6 2
two-way analysis of variance (ANOVA) for PSLR and
PA. The independent variables were age stratified on

RESULTS
Descriptive statistics are provided for men and
women for each measure of HML (Table 3). For
PSLR, the ANOVA revealed a significant gender
effect (F1,202 = 46.5, P .001). Neither age nor the
gender-by-age interaction effect were significant. For
PA, the ANOVA revealed a significant gender effect
(F1,202 = 63.8, P .001), whereas there was no statistically significant age or age-by-gender interaction effect. The PSLR angle in men (mean, 68.5 6.8)
was less than that in women (mean, 76.3 9.5). PA
in men (mean, 141.4 8.1) was also less than that
in women (mean, 152.0 10.6).

DISCUSSION
We were able to support our hypothesis that there
is a statistically significant effect of gender on HML,
with women having more HML than their male
counterparts for both dependent measures examined
in this study. Men have approximately 8 less PSLR
than women, and 11 less PA than women. However,
we were not able to support our hypothesis that HML
decreases with aging.
Gajdosik et al14 reported that PSLR is the clinical
test most often used to assess HML. According to
Kendall et al,22 the resulting angle between the
longitudinal axes of the trunk and thigh should be
about 80 for HML to be considered normal. However, Kendall et al22 appear to have based this HML
estimate on clinical observations rather than original
data gathered from a cohort of healthy persons.
Additionally, Kendall et al22 assume that the 80 value
should be identical for both men and women. According to our data, the mean value of PSLR for
women (76.3 9.5) was closer to 80 than the value
of PSLR for men (68.5 6.8). For females, we
compared our values of HML with those of Wang et

TABLE 2. Descriptive statistics for men and women. Values are mean SD.
Men
Age
Group
(y)
20-29
39-39
40-49
50-59
60-69
70-79

n
20
20
19
16
21
10

Age (y)
23.7
35.4
44.5
53.8
64.9
73.4

1.9
3.1
2.6
2.6
2.7
2.5

Height (m)
1.82
1.77
1.81
1.78
1.75
1.75

.06
.05
.06
.05
.08
.08

Women

Mass (kg)
79.5
81.1
83.8
81.1
78.5
80.0

8.3
6.2
9.4
9.9
10.2
6.1

BMI
(kg/m2)
24.0
25.8
25.3
25.5
25.3
26.0

2.0
2.1
2.2
2.2
2.5
2.7

n
23
15
20
17
19
14

Age (y)
23.9
35.2
45.0
55.0
65.1
75.1

1.0
3.4
2.9
2.6
3.1
3.1

Height (m)
1.66
1.68
1.64
1.64
1.62
1.63

.06
.05
.07
.07
.05
.05

Mass (kg)
62.8
66.6
61.8
66.2
63.7
60.4

7.4
9.4
8.5
8.7
8.7
7.5

BMI
(kg/m2)
22.8
23.6
22.9
24.6
24.2
22.8

2.5
3.0
3.0
3.3
3.1
3.3

Abbreviation: BMI, body mass index (kg/m2).

J Orthop Sports Phys Ther Volume 35 Number 4 April 2005

249

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Data Analysis

6 levels of 10-year increments (20-29, 30-39, 40-49,

50-59, 60-69, 70-79 years of age) and gender was
stratified on 2 levels (men and women). Statistical
significance was established with .05.

RESEARCH

patients lateral femoral epicondyle. The fixed arm

was positioned along the long axis of the femur on a
straight line between the greater trochanter and
lateral femoral epicondyle, whereas the moving arm
was aligned with the line between the fibular head
and the lateral malleolus. Examiner 1 recorded the
value of knee flexion indicated on the unmasked side
of the HHUG. Before the HHUG was used by
examiner 2 to repeat the measurements, the arms
were returned to the 0 position. The second measurement of PA was made about 60 seconds after the
first measurement. The procedure was the same for
the opposite lower extremity. Examiner 2 was blinded
to the values of the repeated measurements of PA.
The 2 HML measurements were repeated on the
first 43 subjects. Intratester reliability was determined
for each of the measures using the intraclass correlation coefficient (ICC3,1) described by Shrout and
Fleiss.33 For PSLR, ICC3,1 was 0.98 for the right side
and 0.98 for the left. For PA, ICC3,1 was 0.97 for the
right side and 0.98 for the left side. On the basis of
these data, we considered our measurements to be
consistent. Therefore, we chose not to make repeated
measurements of HML for the remaining 171 subjects.

TABLE 3. Hamstring muscle length for men and women.

Gender/Age
Group (y)
Men
20-29
39-39
40-49
50-59
60-69
70-79
All
Women
20-29
30-39
40-49
50-59
60-69
70-79
All

PSLR-R (deg)

PSLR-L (deg)

Average
PSLR (deg)

20
20
19
16
21
10
106

69.9
67.5
67.6
65.7
70.7
64.0
68.0

5.6
6.2
7.8
8.0
6.3
7.5
7

68.9
70.1
67.9
67.5
71.3
66.8
69.0

5.0
5.2
10.3
6.5
7.0
11.1
7.5

69.4
68.7
67.8
66.6
71.0
65.4
68.5

4.7
5.4
8.6
7.0
6.4
8.9
6.8

141.7
143.0
140.2
141.6
141.9
137.8
141.3

8.5
6.5
10.0
9.5
8.9
9.5
8.7

142.8
142.6
141.5
140.1
142.0
138.4
141.5

7.4
6.2
10.1
8.8
7.4
10.8
8.2

142.3
142.8
140.8
140.8
141.9
138.1
141.4

7.7
6.0
9.8
8.8
7.7
9.9
8.1

23
15
20
17
19
14
108

78.9
76.6
75.7
76.7
75.5
72.9
76.3

11.7
8.5
7.2
9.1
10.9
10.0
9.7

77.4
76.3
77.2
76.5
75.0
74.8
76.3

11.8
10.0
9.2
8.8
9.5
9.8
9.8

78.2
76.5
76.4
76.6
75.2
73.8
76.3

11.6
8.9
8.1
8.8
9.9
9.7
9.5

154.9
152.7
150.6
152.1
152.7
148.5
152.1

12.5
10.9
8.5
12.8
11.1
11.3
11.2

154.7
151.1
149.9
152.9
152.6
148.9
151.9

12.2
9.4
9.7
13.0
10.9
9.5
10.9

154.8
151.9
150.2
152.5
152.7
148.7
152.0

12.0
9.8
8.4
12.6
10.5
10.0
10.6

PA-R (deg)

PA-L (deg)

Average
PA (deg)

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Abbreviations: Average PA, data collapsed across right and left sides; Average PSLR, data collapsed across right and left sides; PA-L, popliteal
angle, left; PA-R, popliteal angle, right; PSLR-L, passive straight-leg raise left; PSLR-R, passive straight-leg raise right.

al39 and Raab et al,29 because a HHUG was used to

measure PSLR in all 3 studies. Wang et al39 reported
a mean HML value of 87 7, which is greater than
our value, whereas Raab et al29 reported mean values
(60-64, with SDs ranging from 10-16) that were
less than ours. For men, our value of PSLR compared
favorably with the value reported by Girouard and
Hurley15 (66-72, with SDs ranging from 7-11),
who also used a HHUG.
We compared our data for HML, using PA, to that
of others16,23 who also used an HHUG. Hartig and
Henderson16 reported a mean PA value for men of
46 7 (or 134 if using 180 for full knee
extension), which is about 7 less than our values
(141 8). Using the PA procedure, Krabak et al23
reported a mean ( SD) HML for men of 129 9
and 139 7 for women. Both of these values are
considerably less than ours. We used the same end
point as Krabak et al23 for determining HML. Perhaps the differences between the 2 studies can be
attributed to differences in sample sizes. Based on
our data, average HML for men is about 141 of
passive knee extension with the hip at 90 hip
flexion, whereas for women this value is 152. Studies 3,8,9,10,13,40 investigating various hamstringstretching protocols have used limited HML (defined
as a PA less than 160) as an inclusion criterion.
Based on our data, it could be argued that there is a
difference in what should be considered tight hamstrings in men as compared to women.
When comparing men and women of the same
age, it is apparent from our data and others21,23,39
that women statistically have greater HML than men.
Nevertheless, this is not the case for all measurements
of joint motion or muscle length. Walker et al38
examined the active mobility of the extremities in 60
older subjects (30 men and 30 women), whose ages
250

ranged from 60 to 84 years. Twenty-eight (13 upper

and 15 lower extremity) movements were measured
with a universal goniometer. Of the 28 movements,
14 were statistically found to be different between the
men and women. Of the 9 upper extremity movements that demonstrated a statistical difference,
women had greater motion than men in 8 of the
movements. Of the 5 lower extremity movements that
were significantly different, women had greater motion than men in 3 of the movements. Therefore, it
appears that the effects of gender on joint range of
motion and muscle length are joint and motion
specific.
Aging is commonly associated with a reduction in
joint range of motion.2,4,5,21,24 However, the literature
fails to provide conclusive evidence that this relationship always exists and that the reduction is both
statistically and clinically significant. Roach and
Miles32 reported a 3-to-5 decrease in mean active
hip and knee motion between young subjects (25-39
years of age) and the oldest age group (60-74 years of
age). With the exception of hip extension, these
decreases represented less than 15% of the available
arc of motion. Similarly, our data did not demonstrate a statistically significant loss of HML with
advancing age.
It has been purported17 that the decrease in joint
range of motion and muscle flexibility with aging may
be due to the age associated molecular cross-linking
in collagen molecules that can potentially alter the
mechanical characteristics of collagen at the cellular
level. Moreover, the loss of joint range of motion or
muscle flexibility is likely multifactorial and also
influenced by a generalized decline in activity level as
persons age. Perhaps we would have found a statistically significant age effect and loss of HML with
aging if our subjects had been less physically active.
J Orthop Sports Phys Ther Volume 35 Number 4 April 2005

The majority of our subjects were recruited from our

institutions fitness center so their physical activity
level may not have been representative of the average
American adult.
Mean values of HML for both men and women
(Table 3) illustrate that there were no systematic
side-to-side differences in HML. Our data agree with
that of others1,6,31,35,36 who reported little difference
between the range of motion or muscle flexibility of
the right and left extremities.

CONCLUSION
The PSLR angle in men (68.5 6.8) was significantly less (P.001) than that in women (76.3
9.8). Likewise, the PA value in men (141.4 8.1)
was significantly less (P .001) than that in women
(152 10.6). No difference in HML was found
across age groups. These data provide physical therapists with typical values of HML for men and women
over a span of 60 years.

J Orthop Sports Phys Ther Volume 35 Number 4 April 2005

251

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REPORT

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variations in the normal range of joint motion. Clin
Orthop Relat Res. 1988;229-231.
2. Allander E, Bjornsson OJ, Olafsson O, Sigfusson N,
Thorsteinsson J. Normal range of joint movements in
shoulder, hip, wrist and thumb with special reference to
side: a comparison between two populations. Int J
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1. Richard W Bohannon. 2005. June 2005 Letter to the Editor-in-Chief. Journal of Orthopaedic & Sports Physical Therapy 35:6, 388-388.
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