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Hamstring stretching help
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Hamstring stretching help - July 1, 2008 1:47:05 PM
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andgh
Posts: 3
Joined: March 13, 2008
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Hi, I am new to this board, but am finding it very helpful and informative. I have a patient who is 13 year old girl who just underwent a spinal fusion L4-S1 for Grd 4 spondy. We saw her pre-op for several months. Her hamstring length is about 125 deg bilat. With passive stretching, it is very hard to stabilize her pelvis. We are trying straight leg raise stretching, 90/90 stretching, foot on stool stretching, and several other traditional HS stretches. Any thoughts on ways to get this girl's hamstrings stretched while providing pelvic stabilization? Thanks in advance for any input.
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RE: Hamstring stretching help - July 1, 2008 4:20:19 PM
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buckeye
Posts: 175
Joined: May 24, 2007
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Quick answer -
Find out how soon the patient can do gentle small range anterior and posterior pelvic tilts then use them for proprioceptive reeducation for her to learn neutral spine. Once learned, use a hand initially and maybe later a towel under lumbar spine (patient in supine) to help maintain neutral stabilization for the exercise. Consider doing more of neural mobilization rather than prolonged stretch as early part of program. It is possible 'tight hamstrings' in a 13 year old girl may have a neural component rather than just muscle tightness.
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RE: Hamstring stretching help - July 1, 2008 5:26:28 PM
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rwillcott
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From: Canada
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Agree with buckeye. Have you checked Slump Test?
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RE: Hamstring stretching help - July 1, 2008 7:35:51 PM
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andgh
Posts: 3
Joined: March 13, 2008
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I said "just" had the fusion, but it was about 6-8 weeks ago and we are cleared for strengthening and things. We do have her trying to maintain a small tilt to stabilize while we stretch, but she has a hard time with it. I might try the towel roll. The neural mobilization is a really good thought. We have not checked slump test that I know if, but I did not do the eval (she is public aid and in Illinois you have to have at least 3 practice owners to have more than 1 person public aid certified to see the patients--and I am not). Thanks for the ideas.
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RE: Hamstring stretching help - July 2, 2008 9:13:47 AM
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PTupdate.com
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Joined: October 8, 2001
From: Pittsburgh, PA USA
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As the others note, this may be more a case or neural "immobility" versus a true muscular tightness. And, it may not be something that can really be stretched out or lengthened. I am sure those who have been practicing a while have seen enough cases of a young person (such as in this case) with horribly "tight hamstrings" and a history of back problems to rival a 45 year old coal miner.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Hamstring stretching help - July 2, 2008 11:01:39 AM
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Shill
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From: Madison WI USA
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There is no longer the capability of doing a pelvic tilt when L4 through S1 is fused. One can only now "tilt" from L3-L4 and up. She is going to need to learn how to use her paraspinals to keep from levering into flexion at L3/4 alone, as this could develop adjacent segment dysfunction.
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RE: Hamstring stretching help - July 7, 2008 11:56:58 AM
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buckeye
Posts: 175
Joined: May 24, 2007
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Shill - agree with the misnomer about 'pelvic' tilt. I think the teaching part will still be about the same from a patient's perspective. Agree with the notion of trunk stabilization to prevent problems at higher lumbar levels.
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RE: Hamstring stretching help - July 8, 2008 9:02:55 AM
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gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
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I used to use this with children years ago. Haven't used it in many years, but I wonder if you could use it in some way while stretching?
www.nadachair.com
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RE: Hamstring stretching help - July 9, 2008 12:45:24 PM
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cclem2000
Posts: 21
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Question:
Why are you sretching her hamstrings?
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RE: Hamstring stretching help - July 9, 2008 1:21:09 PM
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andgh
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Joined: March 13, 2008
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We are stretching her hamstrings because they are so tight that they affect her gait and functional mobility. When she gets into positions that lengthen the hams, she substitutes with trunk movements--especially not a good thing now that she has a fusion and only 13 (or just turned 14?) years old. Plus, surgeon wanted it done.
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RE: Hamstring stretching help - August 5, 2008 3:56:52 PM
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jddufault
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Joined: July 31, 2007
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I also use biofeedback/blood pressure cuff under the Lspine to ensure that there is no spinal flexion, especially after a fusion. While stretching the hamstring, I also have the patient PF/DF to get a gentle neural glide as well.
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