In the clinic, I often treat athletes of impact sports as well as runners. In many impact situations, patients will strain their hamstring despite “stretching” all the time. In order to determine why this occurs, we must first understand how we move.
When we analyze movement patterns in the clinic, we can break movement dysfunctions into three main categories: (1) dysfunction at the joint level, (2) Issues with muscle length, or (3) Strength and/or sequencing of muscle firing problems. For the purpose of this article, we will use the “pulled hamstring scenario” with basketball.
Joints move in three planes of movement: Front to back, side to side, or rotation. They move in all three planes in varying amounts depending on the task at hand. Joint motion dysfunction does not always in itself cause pain, often leading to lack of knowledge that the patient is limited. In fact it is quite frequent that a patient may be limited in rotation in their spine or hip, but still move freely front to back. Our basketball player then has to compensate when he tries to rotate by working “more” in the side to side and rotation planes. This makes other joints and muscles overwork versus doing their normal job. The hamstring can then strain itself, not because it is the problem but more due to compensating for the restricted joints not doing their jobs. Stretching muscles does not fix joint restrictions, rather the best results yield from joint mobilization techniques.
Interestingly our muscles also share the three plane concept, with fibers contracting in varying amounts in all three motions. When muscle fibers are too short, they can’t produce as much force in that particular plane. The trend that we find in the clinic is that most muscular restrictions in length occur in rotation and side to side planes. Patients often stretch their hamstrings in the front to back planes, but not biasing the rotation fibers of the muscle. So the hamstring is flexible enough to work front to back, like with running, but fails when the body needs to rotate/pivot like in basketball or tennis. Stretching techniques need to tailor to the particular fiber orientation plane.
The last category is strength and sequencing of muscle contractions. If a muscle is weak and unable to handle the load placed on it, the fibers will overstretch and strain. Strength training, again in all three planes of motion, is the best way to fix this category. Again, much like shortened muscle trend, the majority of weakness are in rotation and side to side plane. Patients tend to train on machines that only work front to back, thus not addressing the underlying weakness of the muscle fibers in rotational and side to side planes. Sequencing is a complex process, but, in short, if the timing of muscles do not fire in the correct order, you will again compensate and put undue force on a muscle that is not designed to handle it. Much like an engine of a car, if the parts do not fire in the right order, the car won’t start.
So to answer the title of the article, your hamstring strain origin may be one of the outlined categories, or a combination of two or more. It is imperative to identify which ones in order to fix the underlying cause. Stretching the muscle (often in one plane only) will not lengthen the tight rotational fibers, strengthen the muscle, fix the sequencing/timing of contractions, and/or improve joint mobility of other joints that put force on the hamstring. Getting a thorough evaluation of these mechanics, even prior to injury as a preventative measure, can help ensure proper force distribution and improve muscle performance for running and impact sports.
Michael Dow MSPT and CEO/Clinical Director is founder of Amity Physical Therapy with offices in Woodbridge, Hamden and Branford. He received his degree from Sacred Heart University, and has been recognized by the U.S. Dept. of Health and Human Services for his work with the National Multiple Sclerosis Society. He treats patients of all ages, pediatrics to geriatrics, as well as local high school and college athletes. He can be reached at 203-389-4593 or visit www.amitypt.com.