Working in the healthcare field, and more specifically the world of sports medicine, we often hear the complaint of “my hamstrings are tight”. Stretching hamstrings goes hand in hand with taping ankles and filling water bottles for Athletic Trainers according to spectators of our profession. Countless minutes and hours in the span of our career are spent stretching the hamstrings of our patients whether it be before competition or as a part of the treatment regimen. What if I were to tell you that more often than not, our patients do not have structurally tight hamstrings?
Often times, perceived tightness in the posterior chain is a stability/motor control dysfunction (SMCD) and not a tissue extensibility dysfunction (TED).
Don’t get me wrong; the person who drives to work every day, sits at their desk for eight hours, drives home, and returns to the couch until going to bed very well could have shortened and therefore tight hamstrings. But what about the majority who have common complaints of not being able to touch their toes for years due to “tight hamstrings”? Don’t let your patient fool you, this may not be a tissue extensibility issue at all! We’ve been taught and instructed to stretch hamstrings as a daily regimen since our introductory classes in undergrad. It’s more than likely countless minutes and hours have been wasted on something that truly has not helped our clientele.
One of our body’s basic functions is to prevent us from falling through proprioception, stability, and motor control. Normally we generate this stability through rhythmic muscle contractions from our toes, feet, ankles, knees, hips, and core (and yes the rest of our torso and upper body but that is for another post). But what if each muscle doesn’t fire in the appropriate manner that it was originally meant to? In this case does the system simply fail and next thing you know you’re on your rear end? Luckily no. Our bodies are great at adapting and finding ‘detours’ to still get the job done. Unfortunately, these detours often lead to dysfunction that can in turn lead to shear forces and injury.
In the case of the toe touch (multi-segmental flexion), often times a person lacks the ability to utilize the deep core stabilizers (DCS) and instead use other means to resist the body from falling over. One such scenario, is when subconsciously a person utilizes the ground to draw stability from instead of the DCS. Once this initial act occurs, a domino effect occurs in the posterior chain. First the intrinsic muscles of the foot grab tight to the ground to gain stability, followed by the plantar flexors of the ankle which are hardwired to the intrinsic flexors of the foot. Due to the premature activation of these muscles to make up for the lack of activation in the DCS, a posterior weight shift occurs which begins to offset stability. As the body begins to fall back what prime mover takes over to regain control of the body? The hamstrings. This is why the average person will complain of “hamstring tightness”. Muscles normally responsible for simply relaxing and elongating (posterior chain) are instead contracting and becoming toned to make up for the inability of the DCS to properly fire and stabilize the body. This is only one example of how sequential firing can put on the brakes for movement.
The explanation above is all well and good, but how do we fix it. We can stretch the hamstrings for days but we now know that a patient with a SMCD will not benefit from this. Let’s first discuss how to differentiate between someone with a SMCD and a TED. Begin by having the patient or yourself attempt a simple toe touch, feet together with a slight bend in the knees. Suppose the brakes are hit about halfway down the lower leg, now let’s have this person sit in a long-sit position (legs extended straight ahead with an upright torso) and attempt to touch their toes. Often times that same person who couldn’t touch their toes a few seconds before can now miraculously touch them. How is this possible? It’s the exact same motion isn’t it? The answer is yes, but in the long-sit position we have now taken gravity out of the equation. This person no longer has to stabilize themselves from falling backwards. So it’s obvious that this person does not have a TED, but a SMCD. Now the person that can neither touch their toes in the standing nor long-sit position does indeed suffer from a TED, which could potentially be remedied with posterior chain stretching and stick work.
So how do we fix the person with the stability/motor control dysfunction? Or more specifically, how do we teach them to facilitate the deep core stabilizers and inhibit the posterior chain in order to reach the toes? There are a few methods but for this blog post I will outline the technique that I have had success with myself. The guys at Functional Movement Systems developed a Toe Touch Progression where differing foot positions and an added adductor squeeze helps the patient achieve a successful toe touch in as few as one treatment. The different foot positions throws the body’s equilibrium off and forces it to adjust while the adductor squeeze facilitates the hip adductors which are actually hardwired to the anterior deep core stabilizers. Listed below is a link to the functional movement systems website where they instruct you through video how to perform this corrective strategy.
Now with the means to create a differential diagnosis between a stability/motor control dysfunction and a tissue extensibility dysfunction and correct it I hope you are able to better serve your patients and save yourself some time. Please continue to follow our blog for more information on similar topics including the Active Straight Leg Raise Progression.
As always, please ask the opinion of your physician prior to attempting any strategies outlined in our blog.
Functional Movement Systems Toe Touch Progression- http://www.functionalmovement.com/exercises/toe_touch_progression