hamstring tightness/cramping (Full Version)

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joshua5 -> hamstring tightness/cramping (May 19, 2007 10:26:00 AM)

ok, could use your opinion. haven't had any of these...

18 y.o. male, runs track. season is over.
gets cramping/tightness/pain in bilat h.strings(he uses all of these descriptors synonymously) after prolonged sitting. get's it worse after 20 min of shooting hoops. says he can do some running but the pain gets bad after he stops. likes to run 5-6 miles a day and we discussed decreasing this much activity until this episode decreases/resolves. no pain with palpation. popliteal angles are 30-40. we started stretching 4-5 times a day and this has decreased his symptoms. MMT/Arom wnl. no other numbness/tingling. doesn't experience these symp anywhere else. no other significant PMH. no meds. 5'11", 154#.

if you have seen this, what worked for you? thank you for any replies.



PTupdate.com -> Re: hamstring tightness/cramping (May 19, 2007 1:08:00 PM)

Perhaps try David Poulter's "retlouping" procedure (that's his name spelled backwards):

Have patient long sit, feet flat against the wall. While sitting up straight, 30 reps of full rotation each way, 30 sidebending each way, and 30 flexion/extension. It's a neural mobilization technique that reminds us that what we call "tight hamstrings" is really a neurodynamic limitation. Usually, one will gain more "hamstring flexibility" with one bout of retlouping than weeks of hamstring "stretches"

John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]



joshua5 -> Re: hamstring tightness/cramping (May 20, 2007 2:21:00 AM)

thanks John, i'll give it a try. anyone else?



nari -> Re: hamstring tightness/cramping (May 20, 2007 10:42:00 AM)

I would never be as violent with neurodynamics as Duffy is, but tight hams are a misnomer. It's all about the mobility and sensitivity of the nerve/s.
Overstretch a specific nerve and pain is the result, whether it is unintentional (sitting, running, standing) or through a PT's over-enthusiasm.

Nari



joshua5 -> Re: hamstring tightness/cramping (May 20, 2007 12:00:00 PM)

good to know nari, thank you. please tell me what your treatment would consist of other than h.string stretching?



PTupdate.com -> Re: hamstring tightness/cramping (May 20, 2007 12:09:00 PM)

Nari...you've GOT to be kidding me. "Violent"? Get real. I ask everybody reading this post to sit and try this benign technique and see that there are no adverse consequences. I've done it myself, taught it to many other PT's, was in a room with 35 PT's the day we learned it, and have tried it literally hundreds of times with patients...and that's just me. And guess what? No ambulances needed called, I did not need to break out my first aid kid either. Perhaps we should all wrap our patients, these fragile patients, in bubble wrap and put them in a padded room so they don't get hurt?

Duffy



FLAOrthoPT -> Re: hamstring tightness/cramping (May 20, 2007 12:47:00 PM)

I think where she is coming from, is if you did this on someone with truly irritated nerves it would send them into the hospital, but as a technique for the average athlete or person, no more harmful than yoga. I think somewhere on here I posted my neural flossing technique for hamstring/sciatic having patient supine and going into neutral/posterior tilt and passive hold hip at say 50 and have patient actively extend knee and dorsiflex foot, repeat, and creep up angle of hip to 90, and then doing it with straight leg, then passive overpressure, the whole time patient must hold posterior tilt. they may need a rest. but then you repeat a "hamstring stretch" and viola pretty good A/PROM.

yeah i don't think too many people truly have tight hamstrings as much as neural tension...

have fun

ben galin, PT, DPT, OCS



certMDT -> Re: hamstring tightness/cramping (May 20, 2007 1:01:00 PM)

Another fun technique is one advocated by Mulligan, in which the patient lies on the floor, and you perform a passive straight leg raise while maintaining long-axis traction on the leg all the way through the motion and into overpressure. This has been known to give some pretty remarkable results as well. Pretty much impossible for the patient to perform on his own, though.
Again, as Nari indicated, this would be for a very low "irritable" patient.

Charlie



ginger -> Re: hamstring tightness/cramping (May 21, 2007 12:31:00 AM)

Nari would be in a pink fit if she could be on hand to observe ballistic dural stretches Duffy, they work instantaneously to relieve what some may call neural irritation. Which, when all is said and done is a product of a central mechanism . To restore normal muscle tension behaviour to hamstrings, it is first necessary to ensure there are no focal inflammatory events taking place at the most likely of all sources of irritation, the nerve root. So no guesses what the structure(s) most likely to create focal irritation then to nerve roots may be. L5S1 facet joints . Any response to repeated hamstring misbehaviour that has not included restoring normal , non irritated , non inflamed movements to L5S1, will be time wasting to say the least.



FLAOrthoPT -> Re: hamstring tightness/cramping (May 21, 2007 6:17:00 AM)

i love this board, not being sarcastic. but I think we can do a play, we are all becoming so predictable in our answers..we have the mobilize facets for everything guy, everything is neural and be gentle lady, suck it up and go through it guy, we used to have the eruditious everything is about touch and feed forward guy, etc, etc..pretty funny, like walking into cheers, everybody not only knows your name, but they know your thoughts too!



nari -> Re: hamstring tightness/cramping (May 21, 2007 12:06:00 PM)

Ben,

Good replies. This is a predictable board, and one way to get to understand where other PTs are coming from. That's OK. Your technique is one I have used many times with good outcomes,as is the one Charlie uses.

Duffy, sarcasm does not become you. If you are dealing with rough'n'tough athletes, I would possibly agree. The nervous system deserves better and more discreet handling if there is moderate pain. I doubt if your system would benefit a 60 year old person who is scared of PTs.

Ginger, I may well have a pink fit at your ballisticisms - but that would not be the first time.

In short, if we treat the nervous system kindly and with persistence, it will be more effective in terms of the patient's responses and outcomes.
No bubblewrap required. There is a difference between wimps and aggressors.

Cheers

Nari



allenbr4 -> Re: hamstring tightness/cramping (May 21, 2007 3:51:00 PM)

Are the movements of the "Retlouping" procedure in the cervical spine or trunk? A previous post seemed to indicate cervical movements.

If it is trunk movements, what degree of flexion and extension should it be?

Thanks!



ginger -> Re: hamstring tightness/cramping (May 21, 2007 4:09:00 PM)

So happy to be a source of amusement for you Ben. If by having become predictable I have entered your consciousness as a source of reliable , if unsurprising, commonsense, I feel I have done well.



jlharris -> Re: hamstring tightness/cramping (May 21, 2007 5:04:00 PM)

How about this??

Maybe the hamstrings aren't tight, but the iliopsoas is holding increased tone, puling the pelvic inonomate forward causing functional shortening of the hamstring. So, if that were the case (which, IMO, is there in many runners and Hamstring stretching seems to have no effect) using the bodies reciprocal inhibition can help. I see it as the dark matter or MET.

Lay the pt in supine with hips and knees at 90 degrees and feet on wall. Have pt move pelvis into post pelvic tilt by activating the ipsilateral hamstring (or left is bilateral. Why? You gotta start some where, lol) only. Hold ~5 seconds (or 2 breath cycles) and relax. Perform 5 reps.

In summary, fix hip flexor excess tone to get improved hamstring length.



joelkphysio -> Re: hamstring tightness/cramping (May 21, 2007 6:25:00 PM)

This shocks me that when the hamstrings are "tight", people instantly assume its true hamstring shortness, or rather neurodynamically involved.
While I agree this can be(and often is)the case, and no point did joshua5 mention anything about the hamstrings strength (in inner outter ranges), and more specifically eccentric strength. Ive found more often than not that in a case of a hamstring strain (without neuro involvement (ie negative slump) that the range (SLR) will invariable increase as you increase the strength of the hamstring (especially true as the athlete strengthens the hamstring in the outter ranges). This can be done by doing a supine hip extension on a cable mchine. (remembering that the hamstring is a two joint muscle and must perform hip ext, and knee flexion, and all the variants of the combined movements).
If you want to check out the eccentric hamstrings get you patient to do prone flutter kicks (from the knee down) with some degree of force and amplitude (this position completely rules out neurodynamic tightness) and see if they cramp up...weakness? perhaps.

Jason I definitely agree with you, often finding the pelvic alignment is often involved...

Im not saying that any of the posts are wrong, but based on the info, can we really jump to the neuro based answer (whether or not you treat it with joint mobs or dural mobs (i prefer mulligan tech my self)is obviously a bone of contention in this forum...=)

Im obviously biased at the sports side of things, but ruling out neuro, I would go the strength route...

J



Sebastian Asselbergs -> Re: hamstring tightness/cramping (May 22, 2007 12:56:00 AM)

Joel - there is an absence of recorded injury here. Why would you assume injury then? And how would that jive with the history of this patient? And why would you strengthen? Have you established weakness first?
It is much much more reasonable to assume BILATERAL hamstrings "tightness" being a defensive pattern - especially in the present case history - than a BILATERAL hamstrings injury....



ginger -> Re: hamstring tightness/cramping (May 22, 2007 1:32:00 AM)

No position rules out neurodynamic tightness Joel.



FLAOrthoPT -> Re: hamstring tightness/cramping (May 22, 2007 3:07:00 AM)

look at it this way, if your patient was given anasthesia do you think you could get 20 more degrees on the SLR, if so, it couldn't be actual shortening or weakness of the muscle...all about type 2 nerve fibers...



joelkphysio -> Re: hamstring tightness/cramping (May 22, 2007 6:08:00 AM)

sebastian, I realize there was an absence of recorded injury here (I wasnt suggesting it was a Hstring strain or tear, or assumed either), however this patient notes that the pain is worse with activity. the MMT position is ONE position that the hamstring works in, and is by no means a functional evaluation of the strength capability of the hamstring. All I was suggesting is that while I fully agree that the neurodynamic tightness is a possibility (often is the case and I find works well with traction SLR or bent knee raise stretches), so is the the functional strength of the hamstring (whether based on inner/outter range or type of load-eccentric).

Another way to look at it is--If it is only neuro tightness- then explain why he has such a hard time with activity--are these positions loading the nerve? (How do we KNOW unless we see him move?)

Sebastian-Is it possible to have BILATERAL weakness with no nerve involvement?

Ginger- Let me rephrase....The position takes the traction load off of the sciatic nerve (as opposed to the SLR position increasing it)

please understand I am not trying to refute what you have been saying, just suggesting another possible option.



nari -> Re: hamstring tightness/cramping (May 22, 2007 10:38:00 AM)

Why shouldn't activity load the nerve/s if it is "only neuro tightness"? Especially when it is known that weakness and pain are not related. Work to "strengthen muscle" is probably successful as it reduces the load on the nerve/s.

We have been down this path a zillion times, for sure. Depends on the focus one takes; muscle focus can be one way to improve things, but there are others.

Nari



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