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.