Rehab & Recovery Zone!

Tight Hamstrings Causing Pain? Corrective Exercise Solutions

By Dr. Jeffrey Tucker

The very essence of working out relates to relieving and releasing the body from stress while improving flexibility and strength. If your muscles are in synch, a good workout session will center your body for the rest of the day. However, if an integral part of your musculo-skeletal system – such as your hamstrings – are overactive or tight, your workout session can be anywhere from annoying to downright damaging.

The yoga Sun Salutation is a perfect example. This pose – in which you begin by standing, feet together, arms by your sides, progressing to the prayer position, then inhaling and stretching your arms up beside your head, lengthening and arching your spine, then exhaling and bending forward, (hopefully) hinging from the hips, with your arms stretched out in front – can be potentially damaging to the lumbar spine, or lower back, if the hamstrings are not properly elongated. This is especially true once you complete the pose by placing your hands flat on the mat beside each foot, bending your knees if you have to, and try to bring your forehead to your knees. Repetitive flexion of the lumbar spine, whether during a yoga class, bending over doing the deadlift, squat, or simple bending over in the shower, or just picking up an object on the floor for the nth number of times, can cause trouble for our lower backs.

The hamstrings, which flex the knee joint and extend the hips are vital in ensuring a normal range of joint movement. Short hamstrings are common, unfortunately, and the body compensates for this restriction by increasing motion in, and pressure on, the lumbar spine.

For example, during the bending forward movement described above, a relatively stiff hamstring muscle tends to resist ideal forward bending movement, but function is maintained by excessively increasing lumbar spine flexion range, what is commonly referred to as "compensation." It is not unusual for a person with tight hamstrings to compensate with an overstraining of the lower lumbar muscles (lumbar spinalis and superficial multifidus) when bending over. Once the lumbar spine has developed abnormal compensatory motion, the stabilizing muscles and supporting structures – the ligaments – around the lumbar joints, become too flexible and lax, providing insufficient stiffness or resistance to motion. These joints are now poorly controlled by the muscles and this can cause pain in the low back region, interfering with daily activities, particularly certain yoga postures or weight lifting positions. In summary, if you repeatedly bend forward with tight hamstrings, the lumbar spine may give more easily than the hips. Excessive flexion will occur in the lumbar spine relative to the amount and timing of flexion at the hip joints. This results in compensatory lumbar flexion and potential lumbar spine instability.

However, a few simple techniques can lengthen and loosen the hamstrings and thus create more fluid movement and take the stress off the lower back. Correcting the length of the hamstring while simultaneously strengthening the lumbar region (stability exercises), is important to the body's overall well-being. The following procedures are not to be done if your low back is in an acute painful or inflammatory stage. You can do these procedures on a daily basis.

Procedure #1
Perform self myofascial release using a foam roller. Foam rolling provides muscle inhibition and joint mobilization. The technique is to use a high density foam roll, laying it across the calves and hamstrings, under the stiff hypomobile areas. Place the roll on the floor and teach your client how to lay the legs on top of the roll, knees straight, and then gently and slowly glide over the roll.

The foam roller is used as an inhibitory technique to release tension and/or decrease activity of overactive neuro-myofascial tissues in the muscle system. The foam roll provides a very good maintenance flexibility routine and is best performed before stretching as a way to mobilize the joint.

Procedure #2
The Deep Muscle Stimulator (DMS) is a hand held device that provides a useful form of soft tissue manipulation to loosen up overactive muscles. DMS provides rapid vibration and percussion allowing for contraction and relaxation of blood vessels, lymph, and tissues, changing the viscosity of the tissues. DMS is an alternative to transverse friction massage. This will have a beneficial effect in improving the nourishment and oxygen in the cells of the body part being treated. For areas of past soft-tissue injuries, such as hamstring strains, the DMS device can break down adhesions and promote absorption. When adhesions are loosened within the muscle, the muscles are lengthened and strengthened.

Additional Specific Hamstring Related Procedures

Assessment 1
Bend over and try to place fingers or palms to the floor. Measure the distance the middle fingers are from the floor. Benchmark is the ability to have palms flat on floor.

Dysfunction: Not able to touch fingers to the floor; you feel discomfort or pain in the low back; or your thoracic spine or lumbar spine are bowing with the hip hinge wide open.

Solution: Bend over, but this time think of a belt lifting the hips up and elongating the spine. Push your heels down and push your bottom up. Stretch the hamstrings with the back locked. Practice elongating the distance between the tailbone and the chin, separating the two points while hinging at the hips.

Assessment 2
Bend over and try to place fingers or palms on the floor.

Dysfunction: The thoracic spine and the hamstrings feel tight.

Solution: Practice bending over at the hip hinge with outstretched arms. Start with both arms over your head, bend over at the hips so your torso is parallel to the floor, simultaneously, maximally tightening and squeezing the butt and fists while keeping the arms outstretched. Continue bending over at the hip hinge, fists and butt as tight as you can for 8-10 seconds. Release the tension but don't come back up yet. Repeat the squeezing of the glutes and fists as tight as you can for 8-10 seconds. Practice this maneuver with your butt against a wall, getting lower and further away from the wall. Try to isolate the hamstring muscle belly and not the attachments behind the knees. Repeat this maneuver 7-10 times.

It is important to remember that a forward bend, as in the dead lift, does not require straight legs. The key is to aim for a perfect hinge from your hips no matter how straight you can press your legs. If you can touch the floor but the spine is bowing to achieve this, you leave the hip hinge open and the stress is carried in the back and knees.

To self-stretch the hamstrings without over loading the low back, use the forward lean or bow maneuver. While the back is straight (neutral spine), instruct the client to bend or 'bow' forward. The client will not have to bend over very far to feel the stretch. Ideally, the client should be able to dissociate the lumbar spine from hip flexion. Remind your client to stand using the 'short foot' or 'tripod' principles to activate the foot arches.

In clients with overactive hamstrings, it is important to check the prone and standing hip extension movement pattern. Ideally, the lumbopelvic region should maintain a neutral position as the hip actively extends approximately 10 degrees. Hip extension should be initiated and maintained by the gluteals and requires the participation of the hamstrings. However, the gluteals should dominate the movement pattern, not the hamstrings.

Summary

One possible corrective exercise program for the client with overactive hamstrings would be:

1) Foam roll over the hamstrings, especially the lateral hamstings, performed daily at home.
2) Use the Deep Muscle Stimulator, especially over the biceps femoris, each client session.
3) Perform the 90/90 active biceps femoris stretch daily at home for 10 reps. Also perform static stretching of the hamstrings using the Stretch Out Strap or the MB Stretchbands.
4) Kettlebell swings are a great whole body exercise that will help isolate and activate the gluteals and will help retrain the hamstrings for proper function.

Once your hamstrings are supple and the resulting stress and pressure is relieved from the lumbar region, the overall workout experience will be enhanced, increasing the body's strength and range of motion.



Dr. Jeffrey H. Tucker is a Diplomate of the American Chiropractic Rehabilitation Board and teaches postgraduate courses in spinal rehabilitation. He also instructs for the NASM. Dr. Tucker practices in West Los Angeles, Calif. Visit his web site at DrJeffreyTucker.com.