Physics...Physiology...Physical Therapy

How to Keep Your Hamstrings Healthy and Happy

//  by //  Leave a Comment

Our hamstrings tend to be under appreciated. We certainly notice them when they are misbehaving, but how often do we appreciate them when they are working well? Too often, we attempt to stretch and stretch our hamstrings, but feel like we’re beating our heads into a brick wall. If you are in that category, then this week’s video will shed light on why you are likely not making progress in this area.

How do you tell if you have tight hamstrings? What are the best ways to stretch and strengthen? These are topics we get into with the video. Please pass this along to anyone you know who struggles with knee pain, hamstring tightness, or low back issues, as the information may be helpful. Enjoy and thanks for checking it out!

Hamstring tightness due to imbalance

//  by //  Leave a Comment

Tight hamstrings are a societal epidemic. Many people complain about this, especially as it affects low back pain. But what about running? Is hamstring flexibility needed for distance running? And what about those that regularly stretch their hamstrings, but still feel tight, what’s up with that? What are the underlying issues that contribute to tight hamstrings?

This brings us to Grant’s story. He is a former collegiate runner who is currently lighting up the 5k – half marathon scene. His left hamstring has been problematic for several years, mostly with the sensation of being tight, which seems to affect other areas as well. Let’s check out his running form initially. Please forgive the finger obstruction on many of the videos!

Overall, his form is pretty decent. Perhaps he’s been coached before, or perhaps he has good genes (not that a brother would be biased about that!). However, there are still improvements to be made. It’s subtle, but there is a slight wobble of his left knee and overall slowness to fully load the left leg during the landing/loading phase. This indicates that his gluts and hamstrings aren’t on the same page during the loading phase. It should be a team effort between the gluts and hamstrings, a synergy, and if it’s not perfectly graceful, this would be an example of an imbalance. Also, his hips and core generally appear rather tight and apprehensive. When considering movements of the hips and core, too much movement is not a good thing, but not enough can also be detrimental.

So, how do we tease that out. First, a single leg squat, but with a twist. Positioning his arms in these ways takes the gluts out of the picture, which places more emphasis on the quads and hamstrings. I assumed that we would see a big asymmetry with this, but his was definitely subtle. Doing squats this way helps to strengthen the quads and hamstrings in order to protect the knee when the gluts are distracted by something else (take note team sport athletes!)

Here’s a stretch for the gluts to get his hips more open.

Next, a high end hamstring strengthening activity. See my previous post on hamstring function for a more thorough dissertation. The important thing to consider is that the hamstrings need to stabilize the knee as well as help put the brakes on the upper body during the loading phase. So, here’s a way to emphasize that. He’s holding about 15 pounds, which is likely higher than most people will need!

Next, he did simple power skips to develop quickness of the load-to-push-off transition and get his arm swing more forward/backward.

Now we’re really having fun! Next he ran with the weight overhead. This places a huge load on the hips, forcing them to respond quickly to the landing phase.

But we can’t stop there, we also had him run with the weight overhead and to the side. When the weight is to the right, as in this video, it gives the left gluts an advantage and the right side a disadvantage. Essentially, this places more effort on the right hamstrings.

On the flip side, running with hands to the left places more effort on the left hamstrings. In this next video, his left knee looks more wobbly. So again, this helps confirm that imbalance between the gluts and hamstrings is an area he could improve on. Doing this as a drill helps teach the gluts and hamstrings to be comfortable working, even as the terrain or demands change.

So, after all this, here’s the new and improved Grant!

His left leg looks more stable and quick during the loading phase, which indicates that his hamstrings are working much better. His hips and core also look open and powerful which will help him use his abs and hips more efficiently. With constant attention to keeping the hamstring/glut relationship happy, this will make him more efficient and less injury prone. Great job Grant!

Rough Landing: Hip External Rotation, is it needed for runners?

//  by //  Leave a Comment

This is Jonathan, an aspiring Boston marathoner. We met for a session without any significant pain or known issues, so everything should be perfect right? Here’s a video of his run form initially.

My first observation is how his left hip behaves upon impact, as well as the increased left side bending of his upper body at foot strike on the left side compared to the right side. Upon closer assessment, we found that his left hip is limited in external rotation (turning out), as well as extension.

Now why is external rotation significant with running? The hip just flexes and extends right? At the risk of getting too geeky here, it’s worthwhile to give a brief synopsis of why rotation is needed. As Jonathan’s left leg swings forward, it is flexing with the ground as it’s frame of reference, and the right leg is extending. This creates a natural right rotation of the pelvis, again with the ground as the frame of reference. So, relative to the ground, his left hip is flexing, but relative to his pelvis, the hip is also externally rotating (abducting too, but that’s for another time!). So, to answer the question, a healthy amount of external rotation is needed to allow for a graceful loading of the hip and core, without it, he has to compensate by loading his core in an asymmetrical and inefficient way. This can be a cause of low back pain with running, but thankfully Jonathan isn’t having any issues and addressing it now, is much easier than scrambling as you get closer to race time.

So here’s what we did to get the hips moving better. A general hip flexor stretch with the upper body helping (a good one for runners and anyone stuck at a desk!)

Next, a hamstring biased hip external rotation stretch.

Thirdly, a glute biased hip external rotation stretch.

And lastly, a stability exercise to tie it all together.

So after these drills, this is what he looked like.

Not a dramatic change, but he certainly looks more graceful and symmetrical through the hips and core. With consistent performance of these drills his form should become more efficient. Keep it up and perhaps we can do a ‘Jonathan reloaded’ post as training progresses. Great job Jonathan!

As a bonus, here’s another way to get improved hip external rotation. This is my favorite way to do it, but as part of this post’s session, we used the equipment on hand as this is where he will likely be doing his stretches most consistently.

Back pain due to hip weakness

//  by //  Leave a Comment

This is Taylor, a collegiate runner. She has had back pain off and on for several months. Her Athletic Trainer has told her that she has ‘dumb butt’ syndrome. I’m not particularly a fan of the term, but it’s understandable what he was referring to. I asked her what his basis was for that statement and she mentioned lying prone on the table and raising her legs. This isn’t a bad test, but we need to know what this looks like with running and what we can do about it. Here’s video of her running initially from the side and behind.

From the side, notice the poor knee drive and landing with her knees relatively extended and moderate overstride. With landing like this, the ground reaction forces will be accentuated and not properly absorbed throughout the calves, quads, and more importantly the glutes.

From this angle you can see how her hips have to travel side to side with each stride, this indicates that it’s requiring extra effort for the glutes to tolerate each landing well. The fallout of this is how much her spine is having to rotate to accommodate for this. Any wonder where the back pain is coming from?

So here are some drills we did to get the hips working properly. Full disclosure, we also did some manual therapy for hip flexibility that isn’t shown, but complemented the movements done here.

First, hip flexor flexibility in all three planes of motion.

Next, glute activation/loading in all planes.

Lastly, a simple form drill on the treadmill to practice knee drive.

After all this, here is what she looks like from the side and behind.

Notice the improved knee drive from the side which allows for happier landing and loading through the hips. From behind you can see that she has less side to side motion in her hips and low back. In the videos she’s certainly working hard to focus on the drills we worked on. As with anything, it will become more natural as she consistently works on these things. Great job Taylor!