Can I Have tips involving a pulled hamstring? (Full Version)

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Bradster -> Can I Have tips involving a pulled hamstring? (April 14, 2006 11:55:00 AM)

I pulled my hamstring about a month to a month and a half ago during rugby. I pulled it because I was recovering from my other hamstring, which I tore for my second time almost a year ago. I stretched my right hamstring so much, that I neglected my left one, and pulled it. I already rested my left leg for a month, stretched a lot after it stopped hurting when I stood, and jogged, then sprinted, and it now gets really tight whenever I run. So now, I am confused whether I should start to stretch my left hamstring now, or let it rest. If I should rest, when should I begin to stretch again? Thank You.



FLAOrthoPT -> Re: Can I Have tips involving a pulled hamstring? (April 14, 2006 12:50:00 PM)

almost no one needs to stretch their hamstrings..you may need to warm up prior to activity but lay off stretching. Functionally use is lengthened, eccentric etc, but stop passively stretching it
Love,
Ben



nari -> Re: Can I Have tips involving a pulled hamstring? (April 14, 2006 1:11:00 PM)

Stop passive stretching!!!

It is more likely to stir up the CNS and lead to possible ongoing repetitive pain.

Short hamstrings virtually do not exist except with knees immobilised in flexion for a few months.

Nari



hutch -> Re: Can I Have tips involving a pulled hamstring? (April 24, 2006 2:30:00 PM)

Nari or FLA,

Would you be able to point me towards more information towards this discussion? I'm a newly certified ATC (Well just passed the test, will graduate next week), and a DPT student next year, and I haven't been introduced to this line of thinking in my education.

Thanks.



Shill -> Re: Can I Have tips involving a pulled hamstring? (April 24, 2006 4:45:00 PM)

Hutch,
Look up a study on Hamstring Stretching by Dr Thomas Best MD PhD. While it doesnt necessarily say why, it does show that stretching can be detrimental. Its no more than a few years old, but I dont have access to my medline searches from here.

-Starsky.
I mean Steve.



Randy Dixon -> Re: Can I Have tips involving a pulled hamstring? (April 24, 2006 9:47:00 PM)

If you read the Stuart Mcgill interview referenced in "Awesome piece by Stuart Mcgill" you can read him briefly discussing this.



VagusX -> Re: Can I Have tips involving a pulled hamstring? (April 27, 2006 12:13:00 PM)

Are we talking stop passive stretching everything or just hamstrings?

Are we saying we can't stretch hamstrings to increase length?

I know that a hamstring can increase in its length by stretching it. Why wouldn't a stretched hamstring with increased length decrease pelvic stress when the hamstrings are at end range? Why wouldn't this be beneficial analogous to stretching the gastroc/soleus for plantar fascia pain?



Randy Dixon -> Re: Can I Have tips involving a pulled hamstring? (April 28, 2006 5:14:00 AM)

When you say we can stretch hamstrings to increase length, do you think that the muscle fibers themselves are actually lengthening?

Stretching is primarily a neuorological process, the problem people have with too much passive stretching is that it is possible to train the nervous system to respond incorrectly to active movement.



JLS_PT_OCS -> Re: Can I Have tips involving a pulled hamstring? (April 28, 2006 6:36:00 AM)

Couldn't have said it better than Randy did - let's think about what passive stretching does, folks - it doesn't change the length of the muscle, it reduces it's resistance to passive stretching. It is a neurological process not a physical lengthening process. It has been well-established that changing the length of soft tissue requires long periods of low-load long duration stretching. Much like burn therapists do with eschar, but nothing like the "stretching" that is done in therapy clinics and before/after sports competitions.

I think Mike Boyle summed it up pretty well: people don't pull hamstrings because they haven't stretched. They pull hamstrings because they are not prepared [for the activity they're doing].

J



Tom Reeves DPT ATC -> Re: Can I Have tips involving a pulled hamstring? (April 28, 2006 10:20:00 AM)

I never thought of it that way. Great point fellas. I will change the way I explain thing to my patients.



nari -> Re: Can I Have tips involving a pulled hamstring? (April 28, 2006 11:39:00 AM)

Vagus

If you think about it, why does gastroc/soleus stretching assist with pain in the fascia of the foot? The 'length' of the muscle/s is not a factor, it is the process of neurological lengthening; mobilising the nerve/s that settles down things.
Same thing when you feel all 'cramped' up after prolonged sitting and immobility - a stretch/movement talks to the nerves and the brain; the muscle/s respond as a result of this process. But they won't lengthen as a result of a stretch, only until the brain/PNS feels happier about things.

Nari



Tom Reeves DPT ATC -> Re: Can I Have tips involving a pulled hamstring? (April 29, 2006 5:03:00 PM)

One way or another, the soleus has to lengthen in order to allow the ankle to dorsiflex and prevent excessive dorsiflexion at the mid-tarsal joint. Whether we are treating the nerve or the musculo-tendinous comples lengthening has to happen. Effective "stretching" has always been (to my knowledge) done slowly and for prolonged periods. Perhaps what Nari and Jason are saying, is simply a matter of semantics. I mean, if your hamstrings restrict hip flexion prematurely requiring trunk flexion and causing back pain, or responding early to stretch and contracting in a lengthened position causing a "hamstring strain" what does it matter whether you are changing the neuromodulation of the spindles etc . . . or lengthening the connective tissue?

I am not saying that the neuro explanation is flawed, I think it makes much more sense than the connective tissue thing, but it really just supports what has been done in the past in the name of connective tissue lengthening. Perhaps it was an inaccurate description, but the results were the same.



nari -> Re: Can I Have tips involving a pulled hamstring? (April 30, 2006 12:11:00 AM)

Tom

The results may well be the same, but *if* it is based on an incorrect premise, I think that matters.
It is the 'why' something works which is important for professional integrity.

Nari



Tom Reeves DPT ATC -> Re: Can I Have tips involving a pulled hamstring? (April 30, 2006 5:31:00 AM)

Agreed



PTupdate.com -> Re: Can I Have tips involving a pulled hamstring? (April 30, 2006 5:00:00 PM)

Like Jason indictes...it's more neurlogical than simple "muscle elongating"

Try this unique trick, called RETLOUPING. Where'd the name come from? It's POULTER spelled backwards, one of the original McKenzie founders and David Butler peer David Poulter:

Measure your hams in any way you choose...sit and reach, stand and bend, etc. Then, long sit with feet flat against the wall. Turn your head right and left 30x, tilt right and left 30x, and flex/extend 30x. Now re-test. Tons of ROM gains? More than you ever get with typical "hamstring stretching"??

Even David Butler told me he's not sure what happens. But, it appears to be neural mobilization. I will admit, however, that regardless what happens, it can be debated as to whether it helps or hinders body mechanics. I'll be the first to admit that my "tight hamstrings" cause me a ton of back pain when performing tasks where I bend with straight knees. "Stretching" these takes away the strain and the pain.

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



drbuddy -> Re: Can I Have tips involving a pulled hamstring? (April 30, 2006 6:21:00 PM)

So, what is the best way to increase ROM/lengthen the hamstrings? How about the hip flexors? I have many patients with restricted hip range of motion. Right now I am just using post isometric relaxation stretching to help improve the ROM.

Any suggestions?



nari -> Re: Can I Have tips involving a pulled hamstring? (April 30, 2006 11:52:00 PM)

If it's 'tight' hams, mobilise the sciatic nerve as per Butler, Shacklock...watch the pelvic tilting and discourage it. (actively or passively)

If it's tight hip flexors..mobilise the femoral while keeping the pelvis lightly controlled. The patient can do all of these things for themselves
.
None of it must be forced. Think nerve ( ie, sensitive) and not tough old CT and muscle.
No more than a few reps at a time, say three or four. PKB (or AKB) is a good way to mobilise the femoral.


Nari



rwillcott -> Re: Can I Have tips involving a pulled hamstring? (May 1, 2006 6:28:00 AM)

Nari,

Could you please go into more detail regarding the mobilizations of the sciatic nerve you prescribe. I've used the technique with the patient sitting at the edge of the bed acitvely moving in and out of the Slump position. I know you've mentioned before that you prefer to have the patient perform the technique themselves before you place your hands on them.

If a specific branch is involved do you have the patient actively move their foot/leg into the appropriate biased postion?

How many repetitions do you recommend?

Thanks,

Rob



scpt -> Re: Can I Have tips involving a pulled hamstring? (May 1, 2006 4:21:00 PM)

A muscle will not lengthen to stretching????? What happens to your elbow when placed in a cast for six weeks. You lose sarcomeres and your muscles shorten. The reverse happens with stretching. The correct question is how long do you have to stretch to increase sarcomeres and clinically do we ever experience this?

Jim



JLS_PT_OCS -> Re: Can I Have tips involving a pulled hamstring? (May 2, 2006 5:03:00 AM)

Jim-
Does the reverse happen with stretching?
Does stretching for 30-45 seconds several times a day add sarcomeres? Does it change the actual length of the soft tissue?
If you've any proof of this, I'd love to see it.

To my knowledge, the only way to really lengthen (that is, cause the addition of tissue to a structure) is low-load, long duration stretching. This sort of thing has been demonstrated with splinting in the management of joint contractures and burn eschar. But this is clearly different from muscle stretching several times per day.
So the answer to you question is - we have to stretch a LONG time to add tissue. I'd have to look to give you a good idea on time frames, but we are talking prolonged positioning for hours at a time, days and weeks long. Not simple muscle stretching.

J



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