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Re: hamstring tightness/cramping
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Re: hamstring tightness/cramping - May 22, 2007 5:07:00 PM
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PTupdate.com
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Joined: October 8, 2001
From: Pittsburgh, PA USA
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Nari..after all these years, and you have not picked up that I am sarcastic? Actually, 60 year olds do well with the technique. I think you know me well enough to know I'd never do that on a a fresh HNP patient, someone with stenotic encroachment, etc.
Since you are an Aussie, have you ever met ginger? I'd be curious to get you into his/her office and see how the CM process really works. And, while there, please snap a picture so I can get that hottie Ginger from Gillegan's Island out of my head.
Duffy
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: hamstring tightness/cramping - May 23, 2007 2:47:00 AM
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ginger
Posts: 658
Joined: February 26, 2005
From: Melbourne Victoria
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JOel,
"Another way to look at it is--If it is only neuro tightness- "
.It's not.
"then explain why he has such a hard time with activity"
.He is alive.
"are these positions loading the nerve? "
.No
"(How do we KNOW unless we see him move?)"
what would that prove?,
.Only that he had movement problems , not the root cause of those problems, unles of course you had an understanding about the nature of neurodynamics, the likely contributors to loss of norma recruitment patterns and the locations of the most likely contributors to those losses.
Taking the traction load off the sciatic nerve will not alter the precursers to altered patterns of recruitment, those will remain to bring tonic increases to muscle . wether active or not. It is just that when active , there are more indicators to the trained eye, and subjectively , to alert the observer .
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: hamstring tightness/cramping - May 23, 2007 8:08:00 AM
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RSBMPT
Posts: 17
Joined: April 24, 2007
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Joshua,
Have you checked the ligamentous stability/passive restraints at the knee joint. It is possible that the hams are spasming/cramping in response to instability, especially w/ prolonged activity.
Ryan
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Re: hamstring tightness/cramping - May 23, 2007 11:21:00 AM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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Duffy
OK! Sometimes I miss sarcasm; especially on cyberspace when one can't hear or see a person.
Ben's sarcasm leaps out into daylight, and it is quite funny at times.
Ginger lives way south of the border, quite a few hundred miles away; no I have not met him. It could be entertaining. I don't know much about Gilligan's Island, except the fact that somewhere in the introduction is a photo of an atoll where I used to live. I'm not much of a TV watcher....
A defensive pattern is often confused with a defective pattern associated with injury. Most, if not all of the reactions we see in a clinic are defensive. What does the defending? The nervous system..so it would seem logical and it is very effective, to think of it first. Muscles 'n' stuff will tend to recover if we tend to the masters of movement first.
Enough raving.
Nari
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Re: hamstring tightness/cramping - May 23, 2007 2:18:00 PM
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ginger
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From: Melbourne Victoria
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Nari and I both consider the "defensive pattern" , as she put it , to be the primary source of musculoskeletal pain and dyfunction . What drives that conclusion is of course the evidence of the effects of our interventions. Rather than pursue the possible logic of discovering pathology , which would be an attempt many times of repeating the same investigations that medical doctors may have already done . We are more interested in what we can change right now.
As I go about releasing the central nervous system from its protective tone, it becomes immediately clear , that the protective tone around spinal joints was indeed the precurser to a neural irritation . Treatment hindsight, you may say ,alerts the observer, to what had contributed to the pain and dysfunction , by having first eliminated it.
This is reliably achieved in the vast majority of musculoskeletal pain /dysfunction problems by the method I call CM. Nari acheives her results in different ways , what is very similar however , is that we both begin with a comprehensive investigation of the most likely first. Central spinal and associated neural behaviours. Not because we are nutty professors who feel the need to do what is driven by some oddball theory Ryan , but for a much more compelling reason, it works.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: hamstring tightness/cramping - May 23, 2007 5:03:00 PM
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RSBMPT
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Its not anymore oddball than that of Daniel D. Palmer, and as we all know that there has been a huge paradigm shift since then. Interestingly enough, an Australian review of low back pain indicates that patient's with true Z-joint mediated pain have to have a subjective complaint of facet/low back pain along with somatic referred pain to be considered as having a facet problem. As I have understood referred pain, it is pain that is perceived in the periphery, not tender to palpation or touch in the periphery.
I am afraid we are all just chasing the eternal question "What came first, the chicken or the egg." Would these defensive patterns have occured if there was proper dynamic lumbar control. Would there be degeneration, or irritation from biomechanical stresses. Or conversely if the defensive pattern came first, why not exercise the patient to decrease the load on the posterior elements, and prevent further injury.
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Re: hamstring tightness/cramping - May 23, 2007 9:58:00 PM
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ginger
Posts: 658
Joined: February 26, 2005
From: Melbourne Victoria
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Two points Ryan, referred events interpreted as pain, provide not just a sense of distal pain devoid of other local factors, but the full gamut of neuraly mediated changes , including sensitivity to touch , pressure , stretch, local colour changes , swelling, etc.
I can't comment on the study you drew attention to , having not seen it, though the conclusion you've mentioned holds no verisimilitude for me.
I entirely agree with your comment about the value of exercise, this is a feature of any thorough approach. were it to be the central treatment paradigm however , a great deal of time will be taken up with matters that do not produce the kind of immedaite , long term change that a skillfull hands on approach does.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: hamstring tightness/cramping - May 24, 2007 4:43:00 PM
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joshua5
Posts: 52
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jason, hip flexors aren't tight.
ryan, knee stability is fine.
ginger, what is CM?
original onset was 12/06. eval was a couple wks ago. responded well to stretching. irritation/spasms bugged him to a level of 7 after activity. now down to a 3 or 4 but still there. didn't really improve this past wk. we don't accept his insurance so we're doing this free. i don't mind at all. i just want him to get better.
not sure i understand everything you guys are talking (sounds more like arguing) about. correct me if i'm wrong, but some of you think it's a neural thing and some of you think it's a muscular thing? and another thinks it might be circular between the two? talk to me like i'm a student. thanks for all the good replies!
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Re: hamstring tightness/cramping - May 24, 2007 5:06:00 PM
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ginger
Posts: 658
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From: Melbourne Victoria
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Josh, you can read a number of posts I have written on the Continuous Mobilisation method ( CM ) of spinal facet joint treatment here in the manual therapy section , along with other posts on ballistic dural stretching and various treatment specifics on other matters. Take a look there when you can . Essentially it is clear, that when attention is paid to the neural irritation produced when facet hypomobility occurrs ( common ), and inflammatory events follow and include adjacent neural structures ( the nerve root ),that altered sensations and behaviours affect distal structures. All without there being pathology as such , or damage . These behaviours , relate of course to the specific nerve root associated with dermatomes and myotomes as usually understood, and are easily charted .
Hamstring tightness , and with it a disposition to remain at higher tonic loads when fatigued, stressed and under performance pressures, raises the prospect of damage. Even where no focal damage occurs, tenderness, altered patterns of recruitment and poor flexibility will be a common feature of a hamstring group , irritated at L5S1.
The ideal way to release hamstrings from these chronic and often seen altered behaviours , is to release L5S1, in particular, from protective responses leading to irritations at the nerve root.
CM is the ideal method in my view. Works every time with skillfull hands and persistance, with immediate normalisation able to be effected to hamstring tenderness, tone and behaviour usually within one treatment, Thus offering not just an immediate sense of positive change for the patient , but also a positive indicator for the prospect of further improvements to other lower limb performance.
cheers
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: hamstring tightness/cramping - May 24, 2007 5:47:00 PM
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RSBMPT
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Joined: April 24, 2007
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Josh,
There remain numerous possibilities for the hamstring tightness from circulatory issues to nutrition. Also to be included are lumbar disc herniation or spondylolisthesis. Kudos on the pro bono work, it is always great to see the keeping the patients best interest at heart in lieu of the almight dollar.
Ryan
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Re: hamstring tightness/cramping - May 25, 2007 11:21:00 AM
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nari
Posts: 1568
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From: Australia
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Josh, just keep in mind that it is quite possible to have tight hamstrings (according to the book) and be fully functional and painfree. Depends on the level of adaptiveness (sic) of the nervous system and various other things.
18 yo males are legendary for "short" hamstrings but only some will develop problems. Try a sitting slump and add neck flex/ext with knee flex/ext - that should tell you one way or the other whether it's neural or "muscle".
Nari
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Re: hamstring tightness/cramping - May 25, 2007 11:58:00 AM
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Chocco
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Joined: September 5, 2006
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Getting back to the original question, I love using the mulligan snags with SLR in sidelying. Most times you'll need 2 people, but I have had great success with it.
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Re: hamstring tightness/cramping - May 29, 2007 3:39:00 PM
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joshua5
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how does one do a "Mulligan snag" for this?
nutrition and circ aren't a problem on a gross level. on a finer level - who knows what's going on in there.
will try and read more on the CM method but extra time is difficult to find (2 very young ones, wife, and volunteer work). if someone has a CM post or article that is readily linked, i would greatly greatly appreciate it!
thanks again to all that have replied!
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Re: hamstring tightness/cramping - May 31, 2007 1:39:00 PM
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Chocco
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Its a two man mobilzation with the patient in sidelying with the side you want to mobilize on top. One man would provide a downward (geotrophic)glide to the spinous process while the other person supports the leg as the patient kicks their leg ( keeping knee straight) gently until meetin resistence. Then return to starting posistion and repeat.
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Re: hamstring tightness/cramping - May 31, 2007 1:51:00 PM
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Chocco
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Its probably actually a smwm
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Re: hamstring tightness/cramping - June 3, 2007 12:30:00 PM
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joshua5
Posts: 52
Joined: April 19, 2004
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ok, new info...
discomfort is down but not resolved.
popliteal angles are better i.e. 17 and 7 prom. originally 30-40 bilat.
haven't done ginger's miracle mob as i don't want to push on facets without proper training (especially after that post about cervical mob causing a CVA!).
i've redone his BLE MMT and his hip flexors are weak i.e. 4
most of my patients are over 65 so i find i don't do much mobilization or get too aggresive with anything. so why am i helping this kid? - he's part of our community and it's free i.e. no payment. would love to go to a course but our SNF/AL/IL pays for con't ed but most of the ortho courses are over the budget. feel like my bag of tricks is more of a change purse. this will definitely be a discussion with my clinical coordinator.
hamstring cramping and weak hip flexors sure sound neuro to me. thanks for all the replis. some good info but unfortunately, it all comes back to me. i need to get into a course or two to increase my skills.
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Re: hamstring tightness/cramping - June 4, 2007 12:48:00 AM
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ginger
Posts: 658
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From: Melbourne Victoria
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Josh ,CM and other cervical mobs won't cause CVA's , you are confusing manipulations with mobs , two very different things.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: hamstring tightness/cramping - June 7, 2007 1:16:00 PM
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joshua5
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i was just commenting that i'm manipulatively timid. i understand the difference. pt. stated today he's 90% better and no longer feels he needs to stretch pre/post activity. encouraged him to stretch anyway. pop angles are 0 bilat with the ankle at neutral. thanks for all the help!
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