If you’ve ever walked into a Physical Therapy clinic, you’ve probably seen the ubiquitous hamstring stretch. Whether it’s done on one’s back while pulling the leg skyward or bending over trying to touch your toes, it’s one of the most common muscle stretches. So why is this? The reasons are a little more complicated than simply “having short hamstrings.”

The Muscle

A tight muscle is an overactive muscle; meaning it is unable to relax enough to move through its full range of motion. This may occur due to poor biomechanics or lack of movement. The hamstrings, composed of four different muscles, have a primary function to bend the knees and extend the leg backward. One factor in the prevalence of hamstring tightness is sitting. The modern world often demands long hours working at a desk, which has a few biomechanical consequences. One of them is keeping the hamstrings partially contracted for hours on end (specifically: bent at the knees). This means the hamstrings don’t move through their full normal range often enough. Another effect of sitting is that it encourages anterior pelvic tilt, meaning our pelvises tilt forward and our low backs arch. This pelvic tilt pulls on the hamstrings, preventing them from relaxing, even while standing and walking. This over-reliance on hamstrings causes people to engage their gluteals less, cyclically weakening them and leading to further dependence on the hamstrings for movement that is inefficient.

Tight Hamstrings

Tight hamstrings are often implicated in low back pain, one of the most common musculoskeletal complaint- 80% of the population will experience it at some point in their lives. It can be difficult to discern whether tight hamstrings lead to low back pain or vice versa but a good rehabilitation program will focus on both. Tight hamstrings are prone to muscle strain; they account for 29% of sports injuries involving running, jumping, and kicking, not to mention a re-injury rate of 12-31%. Hamstring flexibility has also been implicated in patellar tendinopathy, patellofemoral pain, and sacroiliac pain. Aging further exacerbates the problem as flexibility decreases due to changes such as fascial thickness and stiffness. Incorporating hamstring stretching into an everyday routine is a simple way to reduce the likelihood of injury and improve overall mobility.

There have been many studies on the best way to improve hamstring flexibility. The shortest answer is regular (i.e., daily) static stretching, wherein a muscle stretch is held to a comfortable level of tension for 30 seconds. To increase this benefit, myofascial release, such as foam rolling or soft tissue mobilization by a physical therapist, have been demonstrated to increase stretch tolerance when performed beforehand. Physical therapists also employ neuromuscular techniques, such as Contract-Relax, where a muscle can be induced to relax via neural feedback. Improvements in range of motion can be seen in as little as one week with regular stretching. It’s easy to see why this is such a PT favorite: it’s effective, it helps with a number of related conditions, and above all, it’s easy to do just about anywhere.

References

Bandy, W. D., & Irion, J. M. (1994). The Effect of Time on Static Stretch on the Flexibility of the Hamstring Muscles. Physical Therapy,74(9), 845-850. 

Freburger, J. K., Holmes, G. M., Agans, R. P., Jackman, A. M., Darter, J. D., Wallace, A. S., . . . Carey, T. S. (2009). The Rising Prevalence of Chronic Low Back Pain. Archives of Internal Medicine,169(3), 251. doi:10.1001/archinternmed.2008.543

Junker, D. H., & Stöggl, T. L. (2015). The Foam Roll as a Tool to Improve Hamstring Flexibility. Journal of Strength and Conditioning Research,29(12), 3480-3485. 

Medeiros, D. M., Cini, A., Sbruzzi, G., & Lima, C. S. (2016). Influence of static stretching on hamstring flexibility in healthy young adults: Systematic review and meta-analysis. Physiotherapy Theory and Practice,32(6), 438-445.

Mohr, A. R., Long, B. C., & Goad, C. L. (2014). Effect of Foam Rolling and Static Stretching on Passive Hip-Flexion Range of Motion. Journal of Sport Rehabilitation,23(4), 296-299. 

Wan, X., Qu, F., Garrett, W. E., Liu, H., & Yu, B. (2017). Relationships among hamstring muscle optimal length and hamstring flexibility and strength. Journal of Sport and Health Science,6(3), 275-282. 

At ProActive Physical Therapy and Sports, we see a good amount of athletes. But we also see a large number of older adults, too. The population of the older generation is growing and the importance for them to stay healthy is vital. The problem is that this population is not one that grew up in an era where exercise was as mainstream as it is today.

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This is part 2 of a 2 part series. Catch up on part 1.

A good dynamic warm up will get you ready for whatever sporting event you are going to do that day by targeting the tissues involved in that event. For example, if you are to go for a run, you would want to primarily warm up the calves, quads, glutes, and hamstrings. A dynamic warm up will not be the same for golf as it will be to go out for a run but they may contain some of the same components. The broad routine for a dynamic warm up should include soft tissue preparation, a general warm up and a specific warm up.

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This is part 1 of a 2 part series.

Do professional athletes warm up prior to their games and events? Absolutely, and you should too. Warming up prior to any workout or athletic event is essential for many reasons. A good warm up will increase blood flow to active muscles, improve muscle function by increasing strength and power as well as improving reaction time. Continue Reading »

Every single person has some kind of muscle imbalance. A muscle imbalance is where one muscle is weak and the antagonist or opposite muscle is tight. These imbalances are one of the most common impairments that we as physical therapists see during evaluations. They often the result of habitual movements such as only working out certain muscle groups or doing repetitive motions, such as running, without cross training.

One primary cause of muscle imbalances is poor posture. People are working longer hours, staring at their computer screens for hours and hours. This causes muscle imbalances which can lead to neck pain. One of the most common types of muscle imbalances in the neck and shoulders is called “upper crossed syndrome.” This is where you have inhibited or weakness in the deep neck flexors in the front and rhomboids/lower traps in the back in combination with tightness of the upper traps/levator scapula and pectorals.

It is common to see these patients with a forward head posture and rounded back as seen in the above illustration.

In order to address these muscle imbalances, it is important to take quick, frequent rest breaks at your computer to relieve the tension in the tight muscles and engage the weak muscles. There are two simple exercises that you can perform at your desk during these 30 second breaks. The first is a scapular retraction where your pull your shoulders blades together and pinch back and down. The other is a chin tuck where you gently draw your chin back and slightly down towards your spine and chest. You can progress these exercises with holds and repetitions.

As always, if you ever have any questions regarding your unique condition or simple questions regarding these exercises, please come in to ask one of our therapists in Carlsbad, Vista, or 4S Ranch.

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Is your golf swing hurting you?

One common phenomenon that can lead to these compensations is called Lower Crossed Syndrome. It was first established by a Czech physician named Vladimir Janda. He noticed that over time, people developed the same muscle imbalances that caused poor posture and movement mechanics.

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Swinging a golf club requires an immense amount of flexibility and strength. Our muscles must have the proper length and firing pattern to allow it to move in the correct planes at the precise time. Our spinal, hip, knee, ankle, shoulder, elbow, and wrist joints have to allow the proper amount of mobility and to obtain those ranges of motion in the golf swing. When one joint or muscle is tight or weak, the body naturally compensates, which puts extra stress on these overused joints or muscles. Overtime, this can result in degenerative or arthritic changes in the joints and/or muscle strains or tears. You can prevent these compensations from happening by simply getting a golf evaluation. Call us at ProActive if you have any questions about what an evaluation encompasses.

The game of golf has grown from a niche sport to one that all ages, shapes, and sizes of people play all over the world. Here in Southern California, we have hundreds of golf courses for thousands of golfers and a lot of these golfers are playing in pain. I am a Titleist Performance Institute (TPI) Certified Professional and one of my goals is to get those golfers swinging pain-free and enjoying their time more out on the course. If you have an injury or pain when playing golf, don’t continue playing through the pain.

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As a physical therapist, one of the most important things that we can do for our patients is to educate them. Informing our patients on why they are in pain or are not able to run is an essential aspect of rehab. After determining the impairments and the cause of pain, your ProActive Physical Therapy and Sports Medicine PT will come up with ways to Continue Reading »

(This is part 2. If you haven’t already, you can ready part 1.)

The two most important muscles in the human body that protect the spine are the transverse abdominis and the multifidus muscle. The multifidus is a small but powerful muscle in the back that lines the spine as it attaches to adjacent vertebrae. Its main functions are to stabilize the spinal segments while it rotates and extends the back.

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