My personal training practice has a strong focus on corrective exercise. I see numerous imbalances when it comes to the human body. Many individuals have finally had enough of getting injured right after they have healed from the previous injury. Unfortunately many people see healing from an injury much like healing from the flu or common cold. Take it easy for bit and get back into it slowly then progress into the routine by adding intensity. The initial thoughts are to make sure you stretch more so you won’t get injured. SO what happens? Many times prudence is used, and stretching is adhered to. Weeks or months later the same injury or a slightly different injury of similar nature pops up again. On to the healing process once again. Unfortunately with injury related to exercise or sport the underlying problems are never addressed during rest and healing time unless guided by a physical therapist and even then the results can be dismal unless the PT is skilled and educated in human functionality not just rehabbing the symptom.
Here is a prime example I see numerous times. Client comes in with a history of hamstring pulls and strains. The rehabilitation process has been anti-inflammatories, some other sort of therapeutic soft tissue work, and stretching of the hamstrings and calves. They are tight that is why they are pulling right?? The injury next time looks like a pulled groin or lower back pain.. Many times I see these individual with a similar trait. They usually have over active or shortened hip flexors. These include the psoas, illiacus, rectus femoris, and TFL. When these muscles are shortened or over active the actually pull the hips forward causing an anteriorly rotated hip.
In this scenario, the hamstrings which attach to the backside of the hips are now over stretched. They are tight because they are stretched tight not shortened. As the hip flexors crank down on the front of the hips they are like the adjustments on the neck of the guitar. Keep cranking at the nobs and the strings will get tight/over stretched and eventually snap when under stress. There are a series of other problems that occur as hip flexors take over. The gluteus maximus (buttocks) become under active and can’t extend the hips as effectively since they are in a state of being chronic under-activity. So when engaging in activities such as running, jumping, squatting, or deadlifts the hamstrings in an over stretched state have to work harder to extend the hips since the glutes are inhibited by the shortened hip flexors. Now that the hamstrings are working harder in a stretched state it leaves them like the tight guitar string being strummed with in an heavy metal riff from the 80′s.
First assess the hip flexors, using the Thomas Test (see Video). This is a basic test that can show you if you the hips are over active and shortened. If this is the case there are numerous stretches and soft tissue work that can assist. Many people don’t even know how to effectively Stretch the hip flexors. Usually starting with soft tissue work with a foam roller or ball. In stretching the hip flexors make sure to keep the hips square. In my experience just passively stretching the hip flexors for 10-15 seconds won’t make a dent in an hip flexor dominance. After soft tissue work, PNF (proprioceptive neuromuscular facilitation) has been most successful in my experience. Pavel Tsatsouline has a book and DVD called Relax into Stretch which primarily focuses on this type of stretching that is a must read if you are interested in attempting this on your own. The other option is to hire a professional that is skilled in these methods. The take home message is assess first then stretch the appropriate muscles, but cranking on the hamstrings many times creates more problems in chronic hamstring pulls. After stretching the hip flexors an exercise focusing on strengthening the glutes is recommended. After loosening up the hips you may notice that contracting the glutes has an entirely new feel. You should be able to have a more powerful contraction. Strengthening the glutes is one of the key methods to ensuring long term success in preventing hamstring pulls. Now In many instances I have also seen other factors that lead to anteriorly rotated hips as locked up ankles and poor ankle mobility but that will be a blog for another day. If you suffer from these issues the strongest recommendation is to get screened by a professional that hold the FMS or CK-FMS certifications. They will be able to figure out what your weekest link may be and address it to prevent the same things from happening over and over again! Until next time..