Breaking Down "Tight" Hamstrings

You don't all have tight hamstrings. Some of you do, and some of you don't. But mostly, you don't. Far too often do people attribute some compensation or altered movement to their "tight hamstrings". It's not the hamstring fault! The hamstrings are simply a manifestation of a faulty motor control pattern elsewhere in the body. You will have to look above the hamstrings into the pelvis and into the lumbar spine stabilization strategies and/or below into the foot and ankle complex. 

Let's evaluate the traditional motion by which practitioners deem the hamstring to be "tight". The toe-touch. Bending at the trunk and touching the hands, or if your extremely freakish, the palms to the floor indicates your hamstring tautness. Too taut, and guess what manual therapists insists you do? Stretch them. 

How 'bout no Scottie. How 'bout we assess the individual from top to bottom and figure out what exactly is wrong with their movement. Simple fundamental movements can tell us a lot about the quality of movement they are achieving day in and day out. For me, there is no better evaluation and assessment system than the SFMA. 

The Selective Functional Movement Assessment (SFMA) was created by physical therapist Gray Cook. The goal of the SFMA is to "capture the patterns of posture and function for comparison against a baseline. The SFMA is an organizational method to rank the quality of functional movements and, when sub-optimal, their provocation of symptoms" (Cook, Movement, p. 107).

Multi-Segmental Flexion (MSF)

The traditional "toe-touch" is included in Cook's system. He calls it Multi-segmental Flexion. The assessment evaluates normal flexion of the hips and the spine. Based on the photo above, you cannot definitively confirm the problem is poor hamstring mobility if he couldn't touch the floor. There are a plethora of other issues that need to be addressed before establishing "tight hamstrings" as the culprit. Perhaps it is laziness during the assessment on the part of the practitioner. Or perhaps it is just acceptance of a garbage diagnosis with an "easy fix" that they learned eons ago. 

The days of statically stretching the hamstring are over. Trust me. (Sidenote: This rant does not take into consideration PNF or PIR type stretching pre-competition. PNF affects both autogenic AND reciprocal inhibition, whereas static stretching only gets reciprocal - another blog post for another day...). 

In the SFMA system, there are "breakouts" to establish the underlyding cause of a movement dysfunction. For the Multi-segmental flexion test, there are 6 breakouts. So, let's get started... 

Single-Leg Forward Bend

The SL Forward Bend is assessed bilaterally checking for any asymmetries or pain noted during the movement. The unique component of this breakout is that it addresses how the person's movement is represented unilaterally while still in a loaded position. Still, there is no conclusively evidence that the problem is the hamstrings if they cannot achieve this movement. On to the next...

Long-sitting Toe Touch

This breakout is significant for a lot of good objective measures, and none of them have anything to do with tight hamstrings as the primary dysfunction. The goal of this breakout is to touch the toes while in an even more unloaded position (compared to standing), and having a sacral base angle of at least 80 degrees, as Gray Cook depicts in the photo above. Let's analyze the breakouts based on the potential findings of the assessment:  

Finding #1: If the individual is able to touch their toes in this position and have a sacral base angle of at least 80 degrees, then there is a weight-bearing hip stability issue, or poor motor control. 

Finding #2: If they can touch their toes but has less than 80 degrees sacral based angle, then there is a limitation in hip flexion, or hypermobile spinal flexion or BOTH. 

Finding #3: If they cannot touch their toes, but they achieve the required 80 degree sacral base angle, then there is a weight-bearing spinal stabilization dysfunction or a limitation in spinal mobility.

Finding #4: If they cannot touch their toes, and the sacral base angle is less than 80 degrees, then there is a limitation in spinal flexion or hip flexion or BOTH. 

Confused? Don't be. Let's figure out where these hamstring come back into place next. The Active and Passive Straight Leg Raise are specific for the hamstring tension. 

Active Straight Leg Raise

 Anytime the individual moves a portion of their body it is termed "active" and anytime the practitioner moves a portion of the patient's body is is termed "passive". During the ASLR assessment, the patient has entered into the most unloaded position, non-weight bearing position thus far in the protocol. Ideally, everyone should be able to reach 70 degrees of hip flexion, again depicted in the photo above.
This assessment is compared with the passive SLR to differentiate between hamstring tension and true hip joint mobility dysfunction. 

Passive Straight Leg Raise

Here we go.. So, you attempted the Multi-Segmental Flexion and failed to touch the floor. Testing one side at a time didn't change anything, so you moved on from the Single-Leg Forward Bend to the Long-Sitting Toe Touch. You then attempted the Long-Sitting Toe Touch and also failed to touch your toes. Now, you lay down on a table and failed to reach 70 degrees of hip flexion. If passive motion of hip flexion: 

Option 1: Increases, but is still less than 80 degrees = Then there is a core stability, hip flexion strength problem or hip mobility dysfunction.

Option 2: Increases, and is now greater than 80 degrees = Then there is a core stabilization dysfunction or a hip flexion strength problem. *This is the most common finding associated with an individual who cannot touch the floor at the initial Multi-Segmental Flexion Test.* 

Option 3: Reduces or stays the same = Possible hamstring hypertonicity (tightness). 

Finally, something that actually has to do with the hamstrings! Hoooray. It's like when there was finally a case of Lupus on House, M.D. 

In conclusion, don't be confined by dogma that never existed. Whoever created this notion about tight hamstrings must have been someone who knew how to fix them. Basically, if someone walks in who cannot touch the floor, don't assume it to be due to poor hamstring flexibility. That's like everything being a nail as long as you are holding a hammer. Think outside the box and if you have to, go against the grain of traditional thinking. 

Note: Photos taken from Gray Cook's book, Movement (2010). Here is a link to get more information regarding this amazing text. 

Prior to Exercise, Part I.

One of the strengths of popular blogs is their consistency. I apologize. I have not been very consistent in my blogging. My goal will be to narrow the space between entries with at least one large post a month, and two or three factoid/supplemental issues.

Today's topic is something I have been passionately against since discovering better alternatives in college: static stretching. Gone are the days of bending over and touching your toes, lifting a leg on a hand rail, or holding your elbow above your head for your "arms". One research article found that you lose 30% power for up to 10 minutes in the muscle that has been static stretched. If you are involved in any participation where proper muscle control is needed, you would be wise to avoid static stretching. Here's why:

We move dynamically. We simply cannot pinpoint one muscle and hope it activates properly while we perform a daily task. Whole body dynamic movements are more effective at activating the muscles you need engaged in order to avoid injury and maximize performance. 

Waste of time. 

Let's look at soccer and static stretching. Being an avid soccer fan, I find articles about anything and everything with soccer. I recently found a comparison study in which 20 male soccer players were split into 3 groups: static stretching group, dynamic stretching group, or a no stretching group. I'll skip through the hoopla of the article and show you the author's conclusion: "The results of the present study confirm that (I) static stretching is detrimental and (II) dynamic stretching is beneficial" (Chtourou, Aloui, and Souissi, 2013).

I know this is only one study, and research on static stretching has (unfortunately) varied for years now. Where I have found results is in the response to the dynamic stretches that the athletes or clients I have introduced it on. Football, track, soccer, basketball, golf, or  with a history of hamstring tears will benefit from dynamic movements. It doesn't matter the motion you need for your sports or activity, you need proper activation. I mentioned hamstring tears a moment ago: let's dig a littler further. Typically, most people have tight and lengthened hamstrings. Compared to normal tight muscles throughout the body, the hamstrings are lengthened but weaker than normal. Most tight/lengthened muscles are stronger than normal, however, the hamstring are one of the very few exceptions to the rule. Weak hamstrings are the result of our forward propulsion during walking, in which the hamstring are not utilized as much as the quadriceps. Therefore we are quadricep dominant. So, if you have a long and weak muscle what good does it do to that muscle to make it even longer? Most experts in the field of rehabilitation would say that the issue is not in the hamstring itself, so don't stretch it - strengthen it. It seems backwards to strengthen a muscle that is already lengthened.

Perfect form - except for the neck. She should be looking down and retracted with a neutral cervical spine

The hamstring are not the issue. The dysfunction is in the posture and positioning that the body employs for hours and hours throughout the day. Vladimir Janda described this postural dysfunction as "Lower Crossed Syndrome." He found that when hamstrings are weak, so to are the muscles controlling the abdominal cylinder, specifically the rectus abdominus muscle. On the other end of the spectrum is the quadriceps and the erector spinae. These muscles are tight and often laced with trigger points.

Strengthen glutes, hamstrings and abdominals.

Next Up: 
For my next post, I will be addressing the alternative to a static stretch. Stay tuned folks!

References 

Baechle, Thomas R., and Roger W. Earle. Essentials of Strength Training and Conditioning.

Champaign, IL: Human Kinetics, 2008. Print.

Beck, Randy W. Functional Neurology for Practitioners of Manual Therapy. Edinburgh:

Churchill Livingstone, 2008. Print.

Hyde, Thomas E., and Marianne S. Gengenbach. Conservative Management of Sports Injuries.

Sudbury, MA: Jones and Bartlett, 2007. Print.

Kisner, Carolyn, and Colby, Lynn Allen. Therapeutic Exercise: Foundations and Techniques.

Philadelphia: F.A. Davis, 2012. Print.

Weight training for Osteoporosis

The other day when I was at work a patient asked me if there is anything she should do for her “osteopenia”. Besides being intrigued by her knowledge in radiological terminology, I was caught by surprise.  After taking a split second to think it through, I hollered back, “Lift heavy things.” She didn’t like that idea because she has postmenopausal osteoporosis, which makes lifting a more challenging experience. Research states that 33% of women will experience this condition at some point in their lifetime.

Here’s why: After 35 years of age, bone mass decreases owing to the reduction of the cells responsible for generating new bone. The process continues to deplete cortical bone (outer aspect of the bone) at a rate of 1% per year until 20-40% has been lost by the age of 65. Trabecular bone (inner aspect of bone) depletes even faster, at a rate of 2% per year. At menopause, the average rate of bone depleted accelerates to 6% of bone density. Osteoporosis is the reduction in bone quantity, NOT the quality.

In their book, Healing Moves, Carol and Mitchell Krucoff, MD state, "Physical impact and weight-bearing exercise stimulates bone formation. Just as a muscle gets stronger and bigger the more you use it, a bone becomes stronger and denser when you regularly place demands upon it” (p. 144).  This idea of bone following the stress placed upon it is not new. In the 19^th Century, Julius Wolff postulated the exact biomechanics mentioned by Krucoff. His work eventually became so popular and accurate that it was inevitably dubbed, "Wolff's Law". 

Treatment Options for Osteoporosis

1.Bisphophonates, such as Fosamax, improve the bone density by increasing the quantity of the bone, but drastically reduce the quality of the bone. This leads to pathological fractures, commonly in the femoral neck of the hip. This is one of those scenarios where you wonder if the fall broke their hip, or the broken hip caused the fall…

2. Calcium supplements simply just aren’t enough anymore. Contrary to popular belief, calcium is not the end-all-be-all to prevent osteoporosis. Nutritional biochemist Dr. Neil Orenstein believes that “no amount of calcium supplementation will prevent osteoporosis” (Keeton, page 120). Oh, and that goes for milk, too. No amount of milk will prevent osteoporosis. (Have you even stopped to think about who benefits the most from cow's milk?? It's baby cows...not people, but that's a post for another day.) 

3. Maximal strength training (MST) on postmenopausal women (according to the research) seems to be the most effective at laying down new bone formation. An October 2013 issue of the Journal of Strength and Conditioning Research found that postmenopausal women had an average of 5% bone mineral content increase after a 12-week maximal strength training program. The best part of the research article is that the participants were told only to squat. Within three months the training group also showed increases in their 1 repetition maximum (1RM) by an average of 154 pounds (Mosti, Kaehler, et al.).

The best exercises are weight bearing ones, such as squatting or lunging, but could also be started off with walking. Any stress placed on bone will stimulate new bone formation, which is crucial for osteoporotic bones. It is also important to seek advice on the program that fits you. Hire a personal trainer or group instructor to write you a program. It is important to lift properly, so maybe hire a certified trainer a few days a week until you get the form down. Remember, the benefits of maximal weight training is in the amount you are lifting. You need to be lifting your max!

4. Dr. Joseph Mercola suggests coupling Vitamin D3 with Vitamin K2 to help protect your bones. Mercola is well known for his stances on exercise and nutrition and makes no exception for osteoporosis. He firmly believes in a balanced lifestyle with weight bearing exercise and a diet rich in fresh, raw whole foods.

Conclusion

If you want the benefits, you have to put in the work. Avoiding exercise that can potential help your bone density will lead to postural changes and weak, frail bones. It is important to stay active with weight bearing exercises, with the squat being of utmost importance. 

 References

Keeton, K. “Bone density sharply enhanced by weight training, even in the elderly.”

            August 2005. Natural News Online

             http://www.naturalnews.com/010528_bone_density_mineral.html#ixzz2nlFdo5e  d

Firooznia H, Golimbu C, Rafi M, et al.: Rate of spinal trabecular bone loss in normal

            perimenopausal women: CT measurement. Radiology 161:735, 1986.

Mosti, MP, N. Kaehler, AK Stunes, and Syversen U. "Maximal Strength Training in

            Postmenopausal Women with Osteoporosis or Osteopenia." National Center for

            Biotechnology Information. U.S. National Library of Medicine, n.d. Web.04 Dec.

            2013.

Howe Et Al. "Exercise for Preventing and Treating Osteoporosis in Postmenopausal

            Women." National Center for Biotechnology Information. U.S. National Library

            of Medicine, n.d. 4 Dec. 2013.

Mercola, Joseph. “The Key Vitamin to Use with Vitamin D to Help Reduce

            Osteoporosis by 25 Percent.” Mercola.com

            http://articles.mercola.com/sites/articles/archive/2012/05/16/vitamins-d-and-k2-

            reduce-osteoporosis.aspx

Nasal Congestion: How to Get Rid of it Quicker

Part of being a 24 hour athlete is staying healthy. I mean, what good are you if your unable to play, work, or spend quality time with your family if you're sidelined? Don't get me wrong, there are a plethora of reasons to knock someone down for a day or two but today's topic is about a supplementation garnered to assist in getting you back to 100%.

A few weeks ago, I was assisting in a construction job in an older building. All sorts of allergens clogged up my eyes, nose, and mouth. It also didn't help that I wasn't sleeping as much as usual (lowering my immune system even further) and I wasn't eating as strictly as I would have liked. I mean, when your working/working out you get to eat whatever you want right?...Well, I got sick within hours. I feel my throat drying up the longer I was working and eventually I had to stop and call it a day.

I contacted my respected pharmacology professor and opened up some textbooks for guidance. I landed on two supplements that immediately affected my symptoms. I started taking 500mg of Bromelain and 500mg of N-Acetylcysteine (NAC for short) each day until my symptoms subsided (which was within hours of taking my first installment, but I continued for a few more days just to be sure).

Let's start with Bromelain. This is a potent anti-inflammatory botanical. This is not a drug. Bromelain is found throughout all parts of pineapple, with the stem carrying the highest concentration. Bromelain acts to inhibit a number of biochemical pathways that all lead to inflammatory molecules thereby reducing the amount of blood flow to an infected area: my sinuses. If left alone, the worst case scenario would be a secondary bacterial infection in my sinuses requiring some antibiotic (which would then destroy my gut flora). So, let's try to avoid that.

Next up is NAC. Depending on its chemical form, it could be prescribed from a physician or it could be purchased over the counter at local nutrition stores. The form that I purchased was the supplement form, not the pharmaceutical. Besides a lengthy list of beneficial mechanisms, including promoting healthy liver function and inhibiting viral replication of the Influenza A virus, the primary use for NAC  is for it's mucolytic functions. Muco = mucus... Lytic = Breaks down. Got it. So, I have nasal congestion and I keep sneezing and I can't breathe when I sleep. Take Bromelain to reduce inflammation, and NAC to break up the mucous so I can breathe. Within a hours of taking both 500mg of NAC and Bromelain, I could breathe. Most people reach for an anti-histmine in the medicine cabinet when they feel "stuffed up".Taking an anti-histamines, such as Benedryl, on the other hand, thickens mucus and therefore exasperates acute sinusitis! I don't know how many times I have made that mistake. If you are seriously struggling to sleep, then take the anti-histamine for its sedative effects, but as soon as you wake up take NAC + Bromelain and drink a lot of water.

Both supplements can be purchased at a local grocery stores or nutrition shop. For 100 capsules, the price is reasonable at only $15 apiece. The effects of getting rid of the congestion and allergens is priceless if you desire to get healthy quicker. Both are safe and both are natural. Enjoy.

Godiyal, S. "Health Benefits of Bromelain: An Anti-inflammatory Enzyme." http://www.naturalnews.com/039123_Bromelain_anti-inflammatory_enzyme.html#

Norek, D. "N-acetylcysteine for Detoxification, cognitive proteection and more." http://www.naturalnews.com/041542_n-acetyl_cysteine_detoxification_cognitive_protection.html

Rushworth, G. and Morgan, I. "Existing and potential therpeutic uses for N-acetycysteine: The need for concversion to intracellular glutathione for antioxidant effects." Journal of Pharmacologic Therapy. 27 September 2013. Web: http://www.ncbi.nlm.nih.gov/pubmed/24080471

The Mentality for Success

Over and over again I (unfortunately) experience an individual who sets themselves up for failure. They are the ones who always cancel appointments or are constantly arriving late. We all know people like this in our own circles, but rarely do they succeed at anything other than pure annoyance. Consistency is the only common denominator between a person who achieves their goal and those who fade away. The most consistent individuals have an attitude for success. They make a conscious effort at their goal with each and every decision they make throughout the day whether it be in the fitness center, on the trail, or in the kitchen.

If you have a scheduled appointment at 8am the following day, what on earth are you doing out at a midnight showing of Iron Man 3? Trust me, I'm all for the fun and excitement of the cinema. However, you need to be realistic, and if you know you are planning on going to a midnight event, reschedule your appointment for a later time. Worst case scenario is that you go to Iron Man 3, are in bed by 3am, up at 7:58am, in the McDonald's drive-thru at 8:07am, and arrive for your 8am appointment at 8:15am and give everyone in the office attitude because you didn't get enough sleep. Make a priority list, and if that means cutting out social activities to focus your energy and efforts on your goals then so be it. I'm willing to guess that you will regret missing a workout/training/rehab session more than if you missed a movie that will come out on DVD soon anyways. And if you are the type that look forward to skipping sessions, your days are numbered. You won't succeed in the long run with an attitude like that. 

Here are some tips that can help you focus your energy on your workout/training protocol in a consistent manner. 

1.) Don't be afraid to tell others "No." Be nice about it, but you can tell people no in a way that won't upset them. If you have had a scheduled training session at 5pm, and your phone rings as you are on your way out the door, be honest and tell the person on the other line, "Oh, you know what, I'm sorry that you're out of flour for your gluten-laced cookies, but I have a scheduled meet time that I'm heading to. Can I swing by the store on my way home and grab them for you?" Nine times out of ten they will understand. 

2.) Plan meals accordingly. If you frequently experience gastrointestinal discomfort, you aren't alone. Remember that it takes as little as 30 minutes but as much as 2 hours for the average stomach to clear the previous meal/snack. So, you might want to chow down on the fatty foods and fibrous vegetables after your session. GI discomfort can be the cause of many complaints that often get labeled a "cramp", so keep an eye out on your own eating patterns and look to make any necessary changes. Oh, and probably not a great idea to chug a venti caramel macchiato minutes before exercise. Don't think I need to go any further on that one.   

3.) Get small projects out of the way. You shouldn't be worried about the rest of your day while you at your training session. You should be worried about your training session when you are at your training session. Any known tasks that are on a time restriction can be completed after your working, especially if you're running late. 

4.) Get enough sleep. 8 hours are the general recommendation, but few actually accomplish this feat. Sleep is a crucial aspect of the recovery process as it increases protein synthesis and human growth hormone for maximal muscle recovery. In contrast, not getting enough sleep puts the body into a pro-inflammatory state. 

The Abdominal Crunch Myth

In honor of tonight's The Office series finale, I thought I'd share a bit of a tangent inspired by one of my favorite characters on television, Dwight Schrute. Today's message: Don't be an idiot. 

Only a few things get me more agitated than watching people in the fitness center perform abdominal crunches. You will NEVER get a six-pack or a flat stomach from doing crunches. Never. Period.

The reason is quite simple, but unfortunately never really talked about - there is no such thing a spot reduction. You cannot target an area and find a specific exercise to reduce the amount of fat in that area. You cannot perform crunches until you "feel the burn" and assume you are trimming down the beer belly. One source claims it takes 5,000 crunches to burn... 1 pound of fat. That poor soul who had to endure 5,000 reps! I could go on for an hour about why they are a terrible choice for a core strength exercise, but I will just highlight the main points. 

The intervertebral disc in the low back (lumbar) region is very susceptable to injury during improper mechanics of movements. Anytime you are in an upright position, heck even when you are sleeping at night, there is a given amount of pressure on these discs. In severe situations where too much pressure is placed on the disc, an injury can occur. Every time you bend over to touch your toes you increase the amount of pressure on your discs in the lumbar spine. And, any time you couple flexion with any rotation, you are begging to blow out a disc. Isn't a crunch the same movement? One text suggests that any flexion in the lumbar spine along with hip flexion puts 4 times the amount of pressure on the disc than our normal body weight when laying down. That means a 175lb individual will put 700 pounds of pressure on his lumbar disc during an abdominal crunch. That's a good enough reason for me to never do another crunch in my life. Well, unless I feel like blowing out a disc and skipping school for a week.

The above photo depicts the amount of pressure on the disc in a variety of movements or postures. Note that this source found only 225% in lumbar flexion solely, and only 275% lumbar flexion with hip flexion...Still, that's a little too much for my liking. 

Long story short, your discs are fantastic entities that (like everything if stressed too much) can deteriorate. Proper biomechanics and common sense can provide you with better results and less injuries. 

Some alternatives to crunches are planks, pikes, ab wheel rollouts, pallof presses, isometric theraband holds, any exercise on a TrX strap, and dozens more that are safer and more effective for you to achieve your goals. The biggest difference between these exercises and the abdominal crunch is that the crunch utilizes the rectus abdominis muscle only, whereas the other exercises mentioned utilize multiple muscles around the core in order to properly contract the abdominal musculature as a unit and perform proper biomechanics. 

TrX Atomic Pushup.

Sources
Neumann, Donald Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. Mosby Elsevier, 2010.
Andersson, Ortengren, and Nachemson. Intradiscal pressure, intra-abdominal pressure and myoelectric back muscle activity related to posture and loading. Journal of Clinical Orthopedic Medicine.