Friday, April 6, 2012

Not Just In Your Hamstrings

Think it's just in your patient's/ athlete's hamstrings when they've hurt it, well, think again.

We've been seeing many hamstring injuries in our 2 clinics especially now when the school sports competitions are ongoing. Here's a post for all physiotherapists treating hamstring injuries (and patients/ athletes who are keen to know) to consider.

You've all seen a typical hamstring injury. You've assessed your patient and diagnosed it as a low grade hamstring strain and have managed it with soft tissue and manual techniques, (or even a Kinesio taping application) followed by a thorough stretching & strengthening program. Some physiotherapists will no doubt use EPA modalities like ice, interferential currents etc while some may include neuromuscular control rehab.

Frustratingly, your patient/ athlete does not improve. Or worse still, they suffer an injury recurrence while returning to their sport.

Fret not, there may be a missing piece to that puzzle, at least that's what the research papers seem to be saying anyway.

A randomized controlled study published last year (Szelzak et al, 2011) suggests that lumbar (or back) mobilizations may be useful in the management of hamstring strains. Their study had a control group, a group which received passive straight leg raise (SLR) stretches from a therapist while the last group received lumbar mobilizations of the spine.

Their results were most interesting to say the least. The last group (lumbar mobilization) had the only statistically significant response, improving SLR by 8.5 degrees while the other 2 groups did not improve significantly.

I personally have found that patients/ athletes who are nursing a hamstring injury will often present with a positive slump (or adverse neurodynamics) compared with the uninjured side. An older study (Turl and George, 1998) suggested that this can influence hamstring muscle activity and biomechanics in the pelvis. They suggested that treating the neural componenent would be key in the treatment of hamstring injuries. Since lumbar mobilizations can affect neurodynamics, this may be the missing link to treating your patient's hamstring strain.

So, all patients/ athletes nursing a hamstring strain reading this, please get whoever is treating you to check your neurodynamics and your lumbar spine (back) too. Better still, come to one of our clinics and we'll use an evidenced-based approach to treat your hamstring injury so you can return to you sport quickly.


Szelzak AM et al (2011). The Immediate Effect Of Unilateral Lumbar Z-joint Mobilisation On Posterior Chain Neurodynamics: A Randomised Controlled Study. Manual Therapy 16(6): 609-613.

Turl SE & George K (1998). Adverse Neural Tension: A Factor In Repetitive Hamstring Strain? JOSPT 27: 16-21.

*Picture of Aized by Azreen Noor

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