Welcome to the blog post that will help YOU understand your body better.
My name is Grayson Starbuck, and I am a Doctor of Physical Therapy. Why am I qualified to tell you this?… I have been there and done that. Am I the smartest person in the world? … probably yes …but maybe not. Anyway, I am one of the people that believe YOU should know how to treat yourself. My goal is to help you treat yourself before you get bad advice from somebody that does not know what they are doing or wants to have you rely on them instead of being self-sufficient. Yes – this might sound controversial. Yes – this might annoy some people. I don’t care! I feel like it’s the right thing.
This blog post is going to be one of many blog posts that I am verbally writing on the road. I had to make a last-minute trip to Kansas City, and I thought that the best way to pass the time would be to talk to myself in a car…With no one around…don’t judge me.
Anyway, here we go: This blog post is going to be centered on hamstring tightness
But is it truly hamstring tightness?
That is the question! “Hamstring tightness” may be something else. Treating hamstring tightness might cause, what is actually your pain, to worsen. Unfortunately, I remember doing hamstring stretches for about every sport I was involved in growing up.
“What kind of hamstring stretches, Grayson?” WELL. The scretch where you sit on the ground, you have your feet together and you lean forward to touch your toes. Additionally, the stretch where your feet are apart in the shape of a V and you lean your body, twisting it slightly, to touch one foot for a moment or two… or ten… or 30! (If your coach hated you). Then, you change feet and reach towards the other side.
Now I am embarrassed to say that I remember being one of the most inflexible people growing up in sports. I was so inflexible, I decided to not play sports in high school eventually, due to my embarrassment of hamstring tightness… Well, that is not actually true. I stopped playing basketball because I could not do left-handed lay-up and I stopped playing football because I was somewhat of a softie. I quit playing baseball because, well, I wasn’t good at it. Although I was borderline starting my junior and senior year, I still didn’t really enjoy it anymore. (That’s a tangent that my friends from high school will enjoy reading). All that matters now: I am employed and I’m here talking to you. I went to school. I’m a doctor in physical therapy. Now I that I am qualified, you may know my high school secrets.
(I want to remind you that I am writing this with my voice, and I am relying 100% on my brain power to remember structures, location, etc.)
Three main parts of the hamstring: the biceps femoris (short and long heads), the semitendinosus and the semimembranosus. The hamstring is also joined by a structure called the sciatic nerve. This nerve travels from the lower lumbar spine from L4 to S3, which is the 4th vertebral level of the lumbar region down to the 3rd level, which is arguably not even a level because of the fusion of the sacrum.
Let’s talk about the sciatic nerve first. It begins its nervy-structure at a point of the spine where people are notoriously hypermobile (when a joint is very mobile, more so than typical). When people are hypermobile, two things commonly happen, they compensate, or they develop a chronic injury. Now, when we hear the words chronic injury, typically we think it is something that involves a disease, like Parkinson’s or muscular dystrophy. However, I define chronic injury as an issue that has developed over time. Cumulative microtrauma is another term I also use a lot in the clinic. This occurs when you have something small or subtle, and possibly not painful in the moment, then accumulates and creates a bigger issue. Examples are sitting, walking, or standing incorrectly.
Even a movement that is a little bit off kilter or out of alignment can cause chronic injuries, secondary to cumulative microtrauma. The sciatic nerve is one structure that is often missed because it can be irritated through movements that expose or create a hyper mobile joint and irritate the structure that is designed to cushion the hypermobile segment(s). From the L4 to the S1 region, it’s very common to see joint issues that deteriorate the discs or cause growth/hypertrophy of tissues that can impede the nerve ability or space.
Keep in mind people, I am literally driving down the road saying these things. So, if you are very impressed, be even more impressed. If you’re not impressed, be less not impressed, and give me a break here. I am currently weaving in and out of traffic while telling you these things, because you need to know. I am a therapist that will risk his life to tell you about hamstring tightness…which makes me the most generous person in the world…or reckless and stupid. We’ll go with the former.
Hamstring tightness and sciatic nerve tightness can be differentiated based on one simple movement: If you have pain in the back of your leg that is only present during certain movements, a simple trick can help you diagnose sciatic nerve pain vs hamstring pain.
I want to emphasize that I’m merely educating you about this and not telling you to do it yourself. (This is how I avoid getting sued by people that take advantage of nice physical therapists like me).
Don’t do this. (Don’t)
I have the patient stand and lean down until they feel their hamstring tighten. Also, I will note the amount of flection they have in their lumbar spine (which is the amount of bend when leaning forward). I might measure the angle of their hip joint or I might see how far they bring their hands down. Following, the patient is to lay on their back on the table and I will keep both of their legs straight (as they were when standing) and I will bring their legs upward, as if I were folding them in half. Pretty much recreating the same position, except for now, they are lying flat on their back and gravity is not contributing to spine pressure.
This makes my point. When they are lying on their back, there is no pressure on their spine (or at least a significant decrease in pressure). If the patient can bring their head closer to their feet when they are on their back, this typically concludes the location of pain is from their spine or sciatic nerves.
Why is this exactly?
When somebody is standing in a position where their spine is stacked and the head is above their hips, the disc in the spine is going to have more pressure. Leaning forward with pressure on their spine causes the disc to behave much like a jelly donut. If you put pressure on the front side of a jelly donut, the donut’s outer shell will have a compromised integrity and jelly will shoot out in the opposite direction. Your back will share a similar experience. When pressure is placed in the front side of your disc, if there is this bulge or herniation, and the nucleus pulposus (gelatinous central portion of the intervertebral disk) pushes either into the outer layer of the disc (annulus fibrosis), extruding material through a torn disc into the nerve.
Now some of you might be thinking to yourself, “Oh no! I’ve been doing a hamstring stretch that might’ve been putting pressure on my disc!” – Well, if this is you and you haven’t created any sort of permanent numbness, weakness, or stiffness down the leg, you’re probably okay. But what you were doing was probably causing your issue to worsen instead of bringing relief.
Hamstring, tightness is always hamstring tightness. On your back, on your side, on your head, wherever you are, hamstring tightness is always going to be the same. For disc issues or sciatic nerve issues, stiffening varies based on how you are positioning yourself. If the issue you are experiencing does not go away on its own, it could be a complex injury.
The good news: knowing the source sooner will make it cheaper to fix down the road. Kinito physical therapy gives people simple movements called nerve glides, reeducation for posture, and the relief of stiff joints (that cause other joints to overcompensate). Our goal is to make hypermobile joints more stable and to make hypomobile joints (stiffer joints) more mobile to allow every joint do its part. Imbalances in the system, will cause manipulable tissues (like discs) to change or even break down to accommodate bones that cannot change or breakdown. This can lead to collapsing of important structures – an entirely different animal.
To learn more about fixing nerve pain or hamstring tightness. Please reach out to us. We are happy to help you work through your problem over the phone, giving you some easy ways to approach the issue and to certainly help you rule out anything serious. If you want help beyond that, we are glad to provide opportunities to resolve your issue without injections or surgery.
Thank you so much for reading. I’m excited to be a part of this journey with you!
Good look out there, we will see you soon!