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Pesky Hamstrings - Part 1

Pesky Hamstrings - Part 1 Tightness in the hamstrings can be a common symptom or finding for people with low back pain.  There are a few things that we need to look at to fully understand if indeed you have tight hamstrings.  

 

Spinal Stability

This is a term that is thrown around with other vague terms such as core stability and abdominal strengthening.  So what does spinal stability mean?  In my eyes, spinal stability is the ability of the body to resist external forces on the spine.  It is your ability to maintain a neutral spine.  A neutral spine is just what it seems, it is a spine that is not in flexion nor extension and does not vary in the frontal plane.  The biggest problem that we see is that external forces, force the spine into flexion.  I have seen some debate whether or not to train into flexion.  My current thought is that we should not for the vast major of patients/clients.  In fact out of all athletic endeavors I would have to say that sit ups or sit up like exercises are a large reason that the a lot of people come to see me.  Why is this?  According to Stuart McGill, he states that the discs in the low back only have so many flexes in them.  When we flex the spine we increase the pressure on the disc by 85%.  So considering that most of us have jobs that require us to sit in front of a computer for most of the day, we are already loading that disc quite a bit.  There is no need to further load that disc by doing sit ups. The key is to strengthen the muscles that surround the spine in an isometric manner.  Exercises such as bird dog, side plank and the like work excellent for the injured but what about the athlete without an injury?  This comes down to perfect form when performing lifts such as overhead squat, dead-lifts and Romanian dead-lifts.

This post was written by Douglas R. Krebs, DC, FACO, Cert MDT for DrKrebs.com. If it appears on another website without clear attribution, or if it is used for commercial purposes, it has been plagiarized.

Victims vs. Culprits

Patient comes in a with pain on the outside of their knee. They tell you that they consulted Dr. Google and found out that it is "IT Band Syndrome" and they have been following Dr. Googles advice and have been resting, using a foam roll and bought a brace over the last month.  They state that it starts feeling good then as soon as they run again they are in pain. You run them through a functional screen, you might even use the FMS. You notice that when they squat their knee drops inward and they round their back.

So what is going on here?  I like to describe this as a Victim and Culprit scenario.  The patient has pain on the outside of the knee.  Is the problem the outside of the knee, the Culprit?  In this instance I would say NO.  The Culprit is the weakness that is allowing the knee to fall inward.  The ITB and knee is just the Victim.  We can do all the consoling to the ITB (icing, resting, foam rolling...) but this won't fix the problem.  We must address the Culprit.

Another analogy I like to use is that of two factory workers.  We have two guys working on the line.  As the widgets come down the line one guy is doing his job.  He is taking the widgets off of the line and putting them into boxes.  The other guy is a bit slower than the first guy and he takes a lot of coffee breaks and he is constantly running to the bathroom.  So because the line never slows down the first guy (the knee) has to pick up the slack of the second guy (the hip muscles).  This happens one day, no big deal.  Then it starts happening everyday and maybe weeks and months go on.  The first guy doesn't say anything about it.  Then finally he is feed up.  He starts complaining to the boss (the brain).   This is what is happening in the ITB scenario.  So in this in case are you going to just console the first guy or are you going to address the real problem and talk to the second guy about his work ethic and fix the problem?

This is a very common thing we see with treating the musculoskeletal system.  Rarely is the source of the pain the Culprit.  It is commonly another site that is the true problem.

We must fix the problem if we want to truly have resolution of the problem.