TIGHT HAMSTRINGS. Can you be born with it? Nicole Feder-Perone. 31 January Course Year 2016/2017. Bahrain

Transcription

1 TIGHT HAMSTRINGS Can you be born with it? Nicole Feder-Perone 31 January 2018 Course Year 2016/2017 Bahrain

2 SUMMARY The hamstring muscles attach to the pelvis, thigh, and lower leg. We usually think of their action as a group of knee flexors - bringing your heel closer to the back of the thigh. We commonly neglect to pay attention to their other action, which is to posteriorly tilt the pelvis flattening out the lower back and tucking the pelvis under. When the hamstrings are weak or tight, movements are restricted and our posture is thrown out of alignment with a potential risk of developing back pain.

3 Problems in the lower back can put pressure on the sciatic nerve which runs down the legs and can cause muscles to tighten. Sadly, most people sit on their sacrum instead of their ischial tuberosity (sit bones), which means we are sitting in a posteriorly tilted pelvis all day. The lumbar discs, sacroiliac ligaments and hamstrings greatly dislike this. Sitting means that the hamstrings are constantly contracted. It is therefore impossible to elongate our hamstrings when only stretching them for a few minutes per day or worse a few times per week while contracting them for eight to fifteen hours a day. Even when our workday ends, we go home and often sit on our sacrum on the couch.

4 TABLE OF CONTENTS SUMMARY... II ANATOMICAL DESCRIPTION... 1 CASE STUDY... 4 PILATES PROGRAM... 6 CONCLUSION BIBLIOGRAPHY... 17

5 ANATOMICAL DESCRIPTION The hamstring muscles consist of three posterior upper leg muscles which are working together as a group. They are the Semitendinosus, Semimembranosus and Biceps femoris. Their primary actions are to flex the knee and extend the hip/thigh. They all arise from the ischial tuberosity, posterior to the hip bone and insert on the bones of the lower leg. The Semitendinosus is posterior to the Semimembranosus. Both are located medially and insert on the tibia, medially (inwardly) rotating the knee. The Biceps femoris is located laterally and assists in lateral (outward) hip rotation.

6 Image 1 from the back of the leg

7 The hamstrings cross and act on both hip and knee (polyarticular muscles). They also act in extension of the pelvis. The hamstring together with the gluteus maximus and adductor magnus make up the hip extensors. Hip extensors and hamstrings act on the hip joint and thereby play an important role in everyday movements such as unstacking the dishwasher, putting shoes on and picking up objects from the ground. Both the hip flexors and the quadriceps work closely with the hamstrings. It is therefore important to find proper balance between all muscle groups to ensure optimum movement. Image

8 CASE STUDY Justine is a 28-year-old office manager who sits for approximately 8 hours a day. She likes being active and has trialed and tried different forms of exercise. About a year ago she tried yoga and her instructor noted that Justine found it impossible to sit upright on the floor whilst at the same time straightening her legs. The instructor laughed at this and remarked that it was highly uncommon and strange for a female of her age to be unable to do so. Justine subsequently undertook some research and found out that Pilates was a way to strengthen and stretch muscles at the same time. She wanted to try it out to see if her limited range of motion could be improved. Justine s short term goal was to be able to perform daily activities such as standing up from seated, bending down and tying shoe laces with more ease. 4

9 Her long-term goal was to maintain the increased flexibility achieved and beyond that, to get a full range of motion or as close to full range of motion as possible. In our first meeting, I asked Justine to demonstrate a roll down for assessment of her posture and alignment. Her fingertips barely came to her knees whilst her legs were straight. I asked her to bend the knees to see if this would improve her range of motion. Based on what I saw, I could understand her discomfort as she could only just marginally bring her fingertips further down with bent knees. When observing Justine from the side it showed that she had a good posture; apart from her shoulders being slightly rounded and her head a little forward due to her desk bound job. 5

10 PILATES PROGRAM Justine has an excellent mind-body connection and is keen to learn more about her body. She enjoys working with concentration and precision. This I had already learned from the group mat classes she attended with me for the past 6 months. The Pilates program was designed keeping in mind the increased hamstring flexibility goal set but also introducing BASI Equipment using the BASI Block System to create diversity and added challenge from the Mat group workouts she enjoyed. Justine decided to continue with her weekly Mat group class and add an additional hour of equipment training per week. 6

11 Warm up As several fundamental and intermediate mat exercises assist in releasing tight hamstrings and/or strengthening them I made sure to include them in the Mat group classes Justine attended as well as add them to the Warm up for the Equipment classes. We would typically start with a roll down with bent knees followed by stretching of the hamstrings prior to starting the work out. I showed Justine how to stretch the hamstrings supine, one leg at a time with the Thera band. After the stretch, we would move on to Pelvic curl and Shoulder bridge prep focusing on activating her hamstrings. I alternated between fundamental and intermediate Warm up due to Justine s existing mat experience and would often add some of the following exercises with modifications: Spine Twist, Saw, Spine stretch, Side kicks (supporting leg bend in 90-degree angle on floor), Roll up (with bend legs). Saw and Spine twist to focus on the co-contraction of back extensors and transvers abdominis in order to open up her chest to counter act her desk bound computer posture. For the seated exercises, I would modify Justine s position from straight legs to bend legs or alternatively would let her sit on a yoga block so that she could focus fully on the co-contraction work of the upper body. I added Spine stretch and Roll up to work on her spinal flexibility particularly focusing on her lumbar spine to make her feel more supple when bending forward, for example to tie her laces. 7

12 Justine had never tried Equipment classes before and was slightly weary to move outside her mat comfort zone. That combined with her minimal range of hamstring motion showed that we needed to take it slowly. The exercise plan was therefore broken down into three sets of 10 classes for progression with different equipment types. We started the first 10 sessions on the Reformer. Then progressed to the Cadillac and finally moved on to a combination of Cadillac and Wunda chair. I found out quickly that I had to limit the number of exercises to one per BASI block to get through all blocks. Also, Justine preferred to continue practicing an exercise until she felt comfortable with its execution rather than working on new exercises in each class. Usually this would mean that we would introduce new exercises only after approximately 3 classes depending on the complexity of the exercise. I concentrated introducing fundamental and only some intermediate exercises due to Justine having no previous equipment experience. All exercises were focused on helping her improve not only her hamstring range of motion but also strengthening and stretching the surrounding muscles of hip and knee joint as well as working with more focus on transvers abdominis and back extensor co-contraction. 8

13 Program Class 1-10 Class Class 21+ Preparation for Class Warm Up Reformer Cadillac Wunda Chair Roll Down with bent knee, Hamstring stretch with Thera band Mat: Alternating between fundamental and intermediate warm up Foot Work On Reformer On Cadillac On Wunda chair Hundred prep Warm up series Standing pike modified w bent knees Abdominal Work Hip Work Spinal Articulation Stretches Full Body Integration Arm Work Leg Work Lateral Flexion/Rotation Back Extension Cool Down Later: Hundred, Coordination, Abdominal leg in strap series (yellow spring) Supine leg series Later: Extended frog, Extended frog revers Bottom lift Later: Bottom lift w/extension (focus on Roll up with RUBar initially with bend then straight legs) Supine leg series Later: Supine single leg series Pelvic Curl - holding PTBar or putting RUBar under knees Later: Tower prep Later: Standing pike reverse w bent knees Step barrel: Supine leg series Pelvic Curl Later: Jackknife modified w bent legs Reformer: Standing lunge stretch of hamstrings with Thera band or magic circle on Cadillac Later: Standing lunge, Side split Round and Flat back Later: Stomach Massage series Arm supine series Later: Arm sitting series modified sitting on block Hamstring curl (initially without springs) Kneeling cat stretch Later: Thigh stretch w RUBar Arm Standing Series Squats Cadillac: Kneeling cat stretch, Thigh stretch continued Later: Sitting forward modified w bent knee Shrugs, Triceps press sit Leg Press Standing Later: Hip Opener, Hamstring curl Mermaid Step barrel: Side lift Side Stretch Breaststroke prep Step barrel: Swan Swan on floor prep Later: Pulling strap 1 Roll down to visualize improvement of hamstring flexibility before and after class 9

14 Footwork The footwork progression chosen helped Justine to get a feel for pelvic lumbar stabilization on the Reformer first by using glutes and hamstrings rather than quadriceps and knees. This was important before moving her on to the more challenging footwork on the Cadillac which focuses heavily on the lengthening of the back of the legs. This was when the real challenged showed. I had to modify by letting Justine face towards the tower and by using 1 blue spring only. Her hamstring inflexibility would not allow her the normal set up or a higher spring setting as she was unable to keep the sacrum anchored to the mat while bending and extending her legs. Footwork on the Wunda chair was introduced last as the co-contraction of abdominals and back extensors for trunk stabilization is the most challenging of the footwork repertoire. Justine felt that the Cadillac foot work was the most valuable for her in terms of achieving her goal while at the same time enjoying the exercise. The Wunda chair foot work was the one she did not enjoy and found extremely hard to perform. Abdominal Work I modified the Standing pike and Standing pike reverse on the Wunda chair and let Justine bent her legs so that Justine would feel her abdominals working rather than concentrating on her hamstrings. I added the Standing pike reverse for more in depth work with Justine back extensors as she found it 10

15 sometimes hard to feel her back extensors in other back extension exercises. The Warm up series on the Cadillac supported our efforts for concentrated work on spinal articulation to increase her flexibility in the lumbar region while strengthening the core. Hip work The Supine leg series on both Reformer and Cadillac was challenging especially when extending the leg/s towards the ceiling. We had to modify to bent leg/s. It was very beneficial to work on Justine s pelvic lumbar stability as she could really feel her hamstrings kicking in. This is why at the end of each series I gave her a little extra stretch with one leg at a time in the strap. It was however the step barrel that proved to be a great success. It really motivated Justine seeing her legs fully extended in the starting positions of each of the exercises. I kept the movement of the legs to a minimum in each exercise as when increasing the range her legs had to bend. Spinal Articulation (Leg work) Bottom lift (w/extension), Pelvic curls and Hamstring curls (from Leg work block) where greatly felt often accompanied with cramping when trying to strengthen the hamstrings. The Tower prep was a real challenge for Justine s tight hamstrings as the movement requires good hamstring control 11

16 throughout the exercise. Especially the starting position was highly challenging. Stretches As for the stretch block, I mainly used the Thera band for stretching as even the magic circle proved challenging. I introduced standing lunge for diversity but felt that Justine could work better into the stretch when working supine using the Thera band. Interestingly she did very well on the Side split mastering it with one red spring. Her legs had to be slightly bent in the abducted split position. Full Body Integration I choose Round and Flat back to work on Justine s trunk and shoulder stabilization taking away the focus from the hamstrings which would have been more evident in Up stretch 1/Elephant. It also allowed me to work on Justine s hip and knee extensor control and strength as the opposing muscle groups. Later I introduced the Stomach massage series. Justine really enjoyed practicing the dynamic movement. Cat stretch kneeling provided a great shoulder stretch with more articulation work and the Thigh stretch w/ru Bar worked the other opposing muscle group of the quadriceps. 12

17 Arm Work The Arms supine series was chosen to work on Justine s scapular stabilization. Through this series, she learned how to activate her latissimus dorsi in order to improve her posture when sitting in front of the computer for most of her day. The Arms sitting series was clearly a challenge which I had to modify by letting her sit on a yoga block or letting her bend her knees. Leg Work I chose Hamstring curls on both Reformer and Wunda Chair, as well as Squats and Leg press standing. These exercises work the Quadriceps/Hip Extensor as well as the Hamstrings to encourage a balanced strengthening of all muscles groups involved. The Hamstring curl on the Reformer had to be modified initially and was performed without springs. I later introduced unilateral work, each leg at a time on a light spring (yellow). The leg press standing spring setting had to be light as Justine had difficulties stabilizing because of the added balance challenge of the exercise. Lateral flexion and rotation Mermaid on the Reformer continued the work on Justine s scapular stabilization while mobilizing the spine. During the second 10 weeks, I chose to move her onto the Step barrel for the Side lift as I felt it was more valuable 13

18 to work her obliques while one leg was bent. She greatly enjoyed the Side stretch on the Wunda chair. Back extension Breast stroke prep and Pulling strap 1 on the Reformer, Swan prep on the Step barrel (to keep the flow from the Side lift) and finally Swan on floor on the Wunda chair were chosen. We would focus on lengthening the back of the legs throughout the performance of each repetition of those exercises. We finished each class with a roll down concentrating on elongating the back of the legs and trying to keep the hips over the heels as Justine s muscles were warm and most receptive for stretching. This also showed her a small increase in flexibility after each class for motivational purposes. As homework, I encouraged Justine to stretch her hamstrings with the Thera band on a daily basis. 14

19 CONCLUSION The causes of tight hamstring muscles are varied. Genetics is one reason. One can be born with naturally short hamstrings whereas some people are naturally supple. In general women and children are more supple than men. The normal range of hip flexion is measured when lying flat on your back and raising a straight leg off the floor towards the ceiling. The hamstrings are sufficiently flexible if the leg can be lifted in the region of degrees. Anything less than 80 degrees is considered tight 3. Justine s program turned out to be a success. Most importantly she feels a release in her hamstrings after each session both during the class and the day after but also because she feels more aligned. She has become more aware

20 of her posture both when standing and sitting during her working day. She enjoys using the BASI block system on the equipment not only for working her hamstring but because it makes her feel better from head to toe. Justine is really motivated to continue to work on her hamstring and spinal flexibility. She is nowhere near to be able to touch her toes as of yet and still needs to sit elevated to achieve straight legs and a straight back simultaneously. She has however integrated what she has learned into her everyday life and continues to stretch daily. This is why she has been able to maintain the increase in flexibility. 16

21 BIBLIOGRAPHY Isacowitz, Rael: The Comprehensive Course Study Guide & Workbooks Isacowitz/Clippinger. Pilates Anatomy Isacowitz, Rael: Pilates. Illinois. Human Kinetics Calais-Germain, Blandine: Anatomy of Movement, revised edition, 1999 Foot notes: 1 lab. Image 1 from website: 2 Aid my muscle. Image 2 from website: 3 How do you assess tight hamstrings - 90/90-degree straight leg raise 17