Physio Table: When Is A Tight Hamstring Not A Tight Hamstring?

 

Clinical assessment of muscle tightness must follow a logical order particularly when a problem sounds tricky. In the clinic I see at least two people a week who tell me that they have tight hamstrings and no matter how much they stretch they cannot quite get the stretch they are looking for. The next logical step would be to see how they stretch. More often than not they have a poor Straight Leg Raise but toe touch seems to be within normal limits. So you have two active range of movement tests that check the same thing give you two different results. My next step would be to check the neural slide with a slump which proves to be normal so then I would look at passive hamstring length. Turns out the hamstring length is just fine.

So why is a tight hamstring not tight?

This is when I check the pelvis for any excessive rotation and the sacroiliac joint. More often than not there is a slight difference in the pelvis in which one side is tilted slightly more anterior than the other.

Anterior Pelvic Tilt
Anterior Pelvic Tilt

In the image we see that short hip flexors in front cause the pelvis to tilt forward. This puts a stretch on the hamstring. At the same time the hamstring is weakened by being pulled into a stretched position thus altering the length-tension relationship for optimal use. When the patient then tries to stretch or kick the leg it becomes like stretching an already stretched elastic band. The only outcome from repeated kicking or stretching will be a hamstring strain. 2

Stretching a stretched hamstring results in less range due to protective mechanism in hamstrings.

How can I prevent hamstring issues in the future?

There are three key concepts in preventing hamstring issues in the future; a) open up the anterior chain, b) myofascial release of glutes and hamstrings and c) strengthen the posterior chain.

A) Open the Anterior Chain If you consider how much time is spent sitting day to day you can appreciate how shortened your hip flexors, adductors and abdominals have become. Chances are you are sitting down while reading this. Just check yourself for a minute. How hunched am I? Where are my hips in relation to my knees? Am I hunched over? To counteract this shortened anterior chain, spend some time stretching your adductors, hip flexors and abdominals.

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Hipflexor, prone quad and upper borders of the adductors being stretched.

B) Myofascial release of glutes and hamstrings Just as it says on the tin. Break  out the foam roller, hockey ball or other release tool of your choosing and go to work on the glutes and hamstrings. As with all myofascial release work, avoid bones and if you get pins and needles or other neural signs immediately stop.

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C) Strengthen the posterior chain

8 images

Deadlift, Glute-Ham raise, KB swing or any other strengthening exercise that hits the glutes and upper hamstrings. Programme as you would initially to get strong then build strength endurance and make it sport specific at that stage.

Summary

If you have a hamstring issue or you have an athlete/client/patient with a hamstring issue you can be reasonably confident that if you open the anterior chain, release the posterior chain then strengthen that posterior chain you will improve that hamstring issue. Posterior chain strength appears to be a great challenge to all S&C coaches and Personal Trainers as athletes/clients/patients do not always see the benefit of strengthening muscles that they cannot see! If you have any doubts while working with an injured athlete/client/patient,  always remember; “When in doubt refer out”!

Anthony

References

Arnason, A., Andersen, T.E., Holme, I., Engebretsen, L.,  Bahr, R. (2007) Prevention of hamstring strains in elite soccer: an intervention study Scandinavian  Journal of  Medicine and Science in Sports 18(1):40-8

Brooks ,J.H.M.,  Fuller,C.W.,  Kemp, S.P.T., and Reddin,D.B.  (2006) Incidence, Risk, and Prevention of Hamstring Muscle Injuries in Professional Rugby Union American Journal Sports Medicine vol. 34 no. 8 1297-1306

Petersen, J. and  Hölmich, P. (2005) Evidence based prevention of hamstring injuries in sport British Journal of Sports Medicine 39:319-323

Malliaropoulos, N., Papalexandris, S., Papalada, A., and Papacostas, E. (2004) The Role of Stretching in Rehabilitation of Hamstring Injuries: 80 Athletes Follow-Up American College of Sports Medicine 756-759

Anthony Raleigh is a chartered physiotherapist with a background in exercise physiology and currently completing a Masters in Sports and Exercise Medicine. Anthony has worked with a wide client base from recreational runners to elite athletes.  Anthony’s main interests are in knee pain, gluteal strengthening, thoracic spine issues and small group coaching. Anthony is based between Naas, Co. Kildare and Shannon, Co. Clare. Anthony can be contacted via Twitter @anthonyraleigh

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