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Hamstring tightness is a very common and complex condition. Causes are either due to neural or myofascial tightness. Environmental factors such as a desk job may be the cause, or intrinsic postural faults can compound both neural tightness and myofascial loading. Piriformis syndrome, ITB friction syndrome and poor rotational control of the lower limb all need to be considered when addressing this issue. Custom orthotics can control pronation and reduce anterior pelvic tilt thus releasing the pressure on the hamstrings.