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.
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
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.
