Thursday Thoughts: More on "Tight" Hamstrings - Poll | Modern Manual Therapy Blog

Thursday Thoughts: More on "Tight" Hamstrings - Poll



Just google tight hamstrings, and you'll see all kinds of routines, treatments, that it is the #6 running injury, etc...

You regular readers will know that very few have "tight" hamstrings (or adaptively shortened anything for that matter). It's all in the perception and whether or not the individual and their movement patterns know how to access their available mobility.

before "I have never been able to touch my toes"

after "Wow, so that's what the floor feels like"


Why did you choose the answer you did and what's the rationale? Chime in below or on the facebook page!

Keeping it Eclectic...
 

15 comments:

  1. Dr. E,
    Always an interesting point of discussion with pts (and PTs) I'm hoping that practice of stretching "tight' hamstrings and stretching in genera,l for that matter, is slowly working its way out of regular PT practice.


    My choice for treatment is based on my evaluation and will obviously vary from pt to pt and situation to situation. If it's a tone issue, often the pt will need to be able to access some relative "core" stability before they are able to move better. Sometimes the restriction may be due to unresolved neural/dural tension issues maintaining the hamstring tone so neural mobilization and manual therapy to joint and soft tissue interfaces is appropriate. I see a lot of mobility restrictions in the lumbar spine with pts with "tight" hamstrings to joint mobilization is often effective in those situations. And sometimes, it's just good old-fashioned movement since the pt may not have accessed that range in a long time, just getting stress to the muscles and collagen and improving the fluid dynamics within the muscle will help increase it's relative mobility along with teaching the pt proper movement patterns. Often, they don't know how to perform a posterior pelvic tilt and so are unknowingly already putting excessive tension when they bend forward.


    So all in all, my favorite answer....it depends!

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  2. I feel that a lot of people are tight in the psoas therefore in too much of an anterior pelvic tilt which is putting the hamstring on stretch to begin with, but also the sciatic nerve I feel is entrapped on lots of people. When I would stretch I use to only feel it in my gastroc and behind the knee. When I started doing neurodynamic stretching of the nerve I increased fast and so did patients and family that had the same problem. So I would do both of those rarely do I think it is the hamstring tone.

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  3. Right, both strategies have their time and place, I find clinically that rarely is it a hamstring problem.

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  4. Indeed it does depend, and actually I think you wrote this before the poll was live, as the post went live without the embedded poll. I just want to make sure people look at other reasons why someone cannot toe touch rather than always focusing on the poor hamstrings.

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  5. I think its important to differentiate between a muscles PHYSICAL length, and its PHYSIOLOGICAL length. You cannot increase the first without a sustained stretch of at least 20 mins. The second is tone-dependent, meaning any method of detonisation will reduce muscle guarding with lengthening. Massage, post-contraction, reciprocal inhibition... even the jacobson technique (hands off).

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  6. How about looking to the suboccipitals?

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  7. Yes, that is an important distinction. Clinically, most people do not present with physical length as in adaptively shortened hamstrings.

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  8. i'm gonna go with "none of the above" since you just posted a week ago about coaching pelvic tilt control in order to magically alter floor-touchability

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  9. That actually helped him touch the floor in the end, but what really got him close was the pain free psoas inhibition.

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  10. Assuming that these results were rapid I would think some motor control training ie: pelvic floor training, breathing, hip hinging, active toe touch with stabilization progression, foot and ankle work. Just my 2 cents :)

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  11. I'm a student of neurokinetic therapy (NKT), and at our last tutorial session, we touched on the connection between tight hamstrings and tight suboccipitals. Our teacher posted an interesting study that looked at methods of release and the effect on the hamstring, which I'm pasting below.

    http://www.ncbi.nlm.nih.gov/m/pubmed/25642072/

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  12. I could see that from a neurodynamic perspective, would have the effect of a slider by enabling the head to get into less of a protracted position.

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  13. Any of those are great strategies, it just didn't take that much!

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  14. I often find a lot of people misinterpret a tethered lower limb nerve for "tight" hamstrings

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