Recently, I have seen a number of clients presenting with a common complaint – tight hamstrings. Sometimes in my job, it is not straight forward to find the cause of my client’s pain. In this post I will use one of these clients (Claire*) as a case study to demonstrate my methods, and how a dysfunction in one area of the body can have a knock on effect elsewhere.
Claire came to see me at my clinic in EP Gym, Banbury one rainy tuesday morning. During her consultation Claire didn’t mention any previous injury to the hamstrings, though she had felt the tightness for years. She did note that she sometimes sits for a few hours at a time whilst working (which can be linked to hamstring tightness) and that she was increasing her mileage towards a marathon. However, she was following a sensible training plan and there was nothing that majorly flagged to me as a cause for her perceived tension.
Claire’s pelvis sat in a neutral position, suggesting that her hamstrings are normal length. I tested Claire’s I tested Claire’s passive knee extension with hip flexion, which appeared normal too. True “tight hamstrings” would usually restrict range of motion in this test. This suggested that her hamstrings were not actually shortened. One thing I try to remember as a soft tissue therapist is that “I have tight [insert muscle]” is a client’s perception of how their body feels rather than an accurate reflection of the quality of said muscle. This is one reason why the time I spend doing consultations and assessments is an important part of your treatment.
I tested her muscle firing pattern to see if her hamstrings were overworking (leaving them prone to overuse injuries). Although there was scope for improvement, her glutes were actually firing pretty well and working well with her hamstrings. Despite all of this, when I palpated the hamstrings there was no give in them. They were hardened and adhesed – not how a happy normal length normal tension muscle feels!
Tight Hamstrings – Villains or Victims?
I asked Claire to show me a video of her running. Claire has a tendency towards a forward head posture, which is when the head pokes forward. When I watched her running I noticed that this was exacerbated. An average human head weighs 5kg. For every extra inch the head protrudes forwards, it is thought it’s weight increases by a further 4.5kg. As if training for a marathon wasn’t already hard enough!
Claire’s forward head posture had altered her centre of gravity. You may have read my post on biotensegrity, which explores how muscles work like the guy ropes of a tent to hold our posture in place. In my opinion, this was a large contributing factor to Claire’s perception of tightness in the hamstrings – they were constantly switched on in an attempt to counteract gravity and stop her from falling on her face!
Following this theory, I used general massage techniques to warm and loosen the muscles around Claire’s neck and chest. I used neuromuscular techniques and soft tissue release in this area to help restore normal muscle length and tension. I noticed Claire had a tendency to take shallow breaths into her chest, which can overwork the neck and chest muscles. We worked on diaphragmatic breathing and I gave her homework to practice this before bed. I used some neuromuscular techniques in the hamstrings and calves to help to improve the quality of muscle, and the limited range of motion in the ankles.
Claire was already doing some strengthening and conditioning work as part of her marathon training. As part of her remedial exercise, I asked Claire to lay off the press ups for the time being. Instead we incorporated some upper back and eccentric hamstring strengthening exercises and some deep core stability work. Claire has really been enjoying her sessions with me and is starting to see some improvement, despite fairly minimal work at the site of her niggles!
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