When I first began my career in physical therapy (PT), I wanted the opportunity to be able to make a significant difference in someone’s life.  I envisioned myself working in an outpatient clinic and helping patients get back to doing something they loved. Maybe it was the runner with the sprained ankle or the baseball pitcher with a torn rotator cuff.  

The epiphyseal plate aka “growth plate” is the area of new bone growth near the ends of the long bones in children/adolescents.  Long bones include: the femur (thigh), the tibia and fibula (shin), the radius and ulna (forearm), and the bones of the hands and feet.  There is typically one growth plate at each end of a long bone. As your child ages and grows, the growth plates harden and become solid bone.  Once this process is complete, the growth plate is closed and no additional growth occurs. Growth plates usually close near the end of puberty (13-15 years for girls and 15-17 years for boys) [1].  

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. 

Blood Flow Restriction (BFR) training uses a pressurized cuff to apply external pressure on an extremity, which maintains arterial inflow but occluded venous outflow. Doing this produces a systemic response comparative to heavy weight training. In short, the goal is to enable users to make greater strength gains while lifting lighter loads, thereby reducing the overall stress placed on the limb. Users usually work at 20-30% 1RM or 15-20 min at 40% VO2max.

Sinding Larsen-Johansson Syndrome (SLJS) is classified as a repetitive overuse injury leading to juvenile osteochondrosis and traction apophysitis.^1,2 SLJS typically occurs in the adolescent population between the ages of 10-14 and may occur during a growth spurt.^1,2 This syndrome can be diagnosed with radiographic imaging showing fragmentation of the patellar pole (distal/bottom of the patella).¹ One may also experience swelling, pain and tenderness, at the distal pole of the patella leading to functional limitations.¹ If gone untreated, this acute injury can become chronic which causes calcification at the distal pole of the patella and possible life-time impairments. It is important to make an appointment with your Physician to rule out other possible diagnosis such as Osgood-Schlatters Disease (OSD), Jumpers knee syndrome, Bursitis, Iliotibial Band syndrome, and patellofemoral pain syndrome to name a few.¹

Low back pain is an extremely common condition that affects individuals worldwide.  It is estimated that 80% of the population will experience a significant bout of low back pain at some time during the life span, and approximately 25% of adults in the United States will likely have had one entire day of low back pain in the last three months.  Low back pain is the most common disorder managed in outpatient physical therapy, accounting for 50% of all referrals. A common question asked by patients with low back pain is, “do I need an X-ray or MRI of my low back?”

A common concern of patients coming to outpatient physical therapy is whether the condition they are receiving treatment for will require surgery.  Patients presenting with lateral hip pain, or pain located at the outer portion of the hip, are often concerned whether arthritis is causing their pain, and worry that they may require a total hip replacement.  The good news is that lateral hip pain is usually not a result of arthritis, but more likely a condition involving the soft tissues of the lateral hip.

There are many different types of headaches the most common being migraines, tension headaches and cluster headaches. In physical therapy we tend to address tension headaches, which usually start at the base of the skull and wrap around to the side of the temples. Tight neck muscles, poor neck mobility, and bad posture can lead to tension type headaches.  Forward head posture puts increased tension on the neck muscles and adds to stress on the spine that can lead to headaches. Sitting at the computer, reading or driving for long periods of time can lead to forward head posture. Daily stress is also a contributing factor because it can cause increased tension throughout the neck muscles. 

Our sense of balance comes from three different systems working together:

1.  The vestibular system (inner ear) gives us feedback on our head position and movements.

2.  The visual system allows us to see where we are in relation to our environment.

3.  The proprioceptors, which are located in our muscles, tendons, and joints, give us feedback on where our body is in space.  

We all know we benefit from exercising, aerobic activity, strength training, balance and stretching.  Regular exercise also helps improve bone density, which prevents fractures; improves balance which makes falls less likely. But if walking, or going to the gym has lost its appeal, there are still a variety of ways to achieve your regular exercise.  For example, joining a team is fun, allows you to meet new friends and work toward a common goal. For example, Your local recreation center or YMCA will offer adult leagues for several sports. And with rules for older age groups such as no running or jumping for basketball, it minimizes injuries but is still a good workout. Here is San Diego, we can also find leagues for more social sports such as dodgeball, kickball, and bowling.