Hamstring pain, tightness, and strains are some of the most common symptoms I see in the clinic, and this makes sense given their crucial responsibility of controlling deceleration of the leg in running gait. One of the assessment pieces I use when I see a patient is forward bending - how well the athlete can flex through the lumbar spine and general posterior chain mobility. My instruction for this is “Bend forward AS IF you are going to touch your toes”, a modification I made early in my career to avoid dad jokes related to tight hamstrings - although if you know me you know I appreciate a good dad joke.
A typical response to a tight or painful muscle is the desire to stretch it, or sometimes my patients and clients will proclaim that they “need to go to yoga”.
But is stretching best in these scenarios? We’ve covered this on the blog before with Strengthen to Lengthen and this review of a study that compared stretching to strength training to increase flexibility. Our focus in this article will be on the hamstrings specifically, however these principles apply to other areas of the body.
A major complicating factor of the hamstring muscle group is how closely it is intertwined with the Sciatic Nerve - the biggest nerve in the body. Nerves are the sensors and messengers of the body - they relay information back to the brain so that our brain can make decisions on how to move. The nervous system is influenced by all kinds of factors that have nothing to do with actual muscle length - including (but not limited to) overall stress, mental/emotional factors, pain, and recent postures. I wrote a blog about this concept of neural tension previously, and I was blown away with the response it got. I got emails, calls, patients coming to see me specifically in the clinic - so this is an aspect of injury rehabilitation that is clearly missing in the grand scheme of things! All of this is to say, we want to screen out if the tightness of our hamstrings is from actual muscle length deficits or neural tension.
To do this, sit on a chair or surface with your legs dangling off the ground. Bring your knees together, place your hands behind your back, tuck your chin to your chest and slump forward. Then, straighten one leg. Most people will feel some tightness in the back of the thigh in this position. Keep your leg extended, and lift your head up to look up at the ceiling without losing the slump position of the rest of your body. Note how the sensation changed in your leg. Did it get better, worse, or stay the same? Repeat on the other side. The interpretation of this test can be quite complicated, but in general, if the tightness improves or even disappears with lifting the head, this is considered "positive" for neural tension. This is because we were able to manipulate the "tightness" of your hamstring, without changing the length of the hamstring - just by changing your spinal posture.
Now, just because you have a positive slump doesn't mean that you can't apply the "load to lengthen" principle to your hamstrings, but it does mean that you should also address your neural tension, which is a topic for another blog.
The exercises I like to use to help with lengthening the hamstrings are various versions of hip hinging: deadlifts, single leg deadlifts, and good mornings. When we complete these exercises, we want to make sure that our rib cage and pelvis are stacked, pelvis is in a neutral position (neither anterior nor posteriorly tilted), and that we utilize our glutes and hamstrings as much as possible. It's okay to "feel" your low back with these, but we also want to make sure that you notice the other muscle groups working as well. These can take a lot of practice, so I would highly suggest asking a PT or other exercise professional to help you with form.
I hope you feel encouraged to spend more time strengthening and loading your hamstrings instead of stretching them after reading this. Again, stretching isn't necessarily "bad", but based on what we know now, strengthening is better!
Keep going, You've got this!
Dr. Kacy Seynders, PT, DPT