Hamstring Flexibility as a Predictor of Musculoskeletal Wellbeing in University Students: A Cross Sectional Study

Abstract

Background: Sedentary academic lifestyles common in university settings, yet the specific contribution of hamstring flexibility to broader musculoskeletal health in this population has not been adequately examined. Objectives: This study aimed to measure hamstring flexibility using two clinically validated tools, establish the pint prevalence to hamstring tightness among undergraduate students, and determine whether hamstring flexibility independently predicts musculoskeletal wellbeing outcomes. Methods: A cross-sectional observational design was employed among undergraduate students affiliated to university in South India. Hamstring flexibility was evaluated using the Sit-and-Reach test (SRT) and the Active Knee Extension (AKE) test. Musculoskeletal outcomes were quantified through various validated instruments. Multiple linear regression modelling identified independent predictor of a composite Musculoskeletal Wellbeing Score (MWS). Results: Hamstring tightness was detected in 126 participants (60.0%). Female students recorded substantially higher SRT scores than males, whereas males showed greater bilateral AKE angles reflecting more pronounced tightness. All musculoskeletal outcome measures worsened in a graded manner across flexibility categories (P<0.001 to 0.003). In the regression model SRT score emerged as the strongest independent predictor (β = -0.36; p <0.001); daily sitting time and physical activity level also contributed significantly. Conclusion: Hamstring flexibility is a significant and independent predictor of musculoskeletal wellbeing in university students. The 60% prevalence of tightness in this cohort warrants structured institutional screening. Both the SRT and AKE test provide reliable, complementary assessments suitable for university health appraisals, and modifiable behavioural factors like prolonged sitting and physical inactivity should be addressed alongside flexibility training.