Home Posts tagged "Tight Hamstrings"

Not-So-Simple Sports Medicine Solutions

Last year, in her series on common injuries in professional baseball, MLB.com writer Lindsay Berra covered the topic of hamstrings strains, and even interviewed Cressey Sports Performance - Florida co-founder Shane Rye for the piece. You can give it a read here.

This article goes into some detail on why these injuries have been so prevalent and challenging in MLB over the years:

a) the nature of baseball (stand around for a while, then have to sprint full-bore without a re-warm-up)

b) poor strength and conditioning practices (e.g., lifting too much to the exclusion of actual sprinting and mobility work)

c) muscular imbalances (e.g., poor glute recruitment, quad/hamstrings imbalances, etc)

I'd also add previous injuries as a big risk factor. Many times, it's one player who is reinjuring the same old hamstrings injury to "inflate" league-wide numbers. 

For a while, the solution was to get the hamstrings stronger relative to the quads. Then the answer was to bring an underactive synergist (gluteus maximus) up to par. And, lately everyone has jumped on board the Nordic hamstrings curl bandwagon; they apparently not only help prevent hamstrings strains, but cure cancer, acne, and hemorrhoids - and will even make girls like you. I joke, but it's actually a perfect lead-in to the next point: sports medicine doesn't have a perfect answer to the hamstrings problem in baseball.

Luckily, as with everything in life, the internet has all the solutions. Monday Morning Quarterbacks abound, and all these doctors, rehabilitation specialists, and strength and conditioning professionals really could have just gotten the billion-dollar solution they needed on Twitter.

As an example, when I linked to the aforementioned article on Twitter, one reply was particularly entertaining: 

"Simple fix already seen especially in female soccer training. With the 'best' sports med docs in pro sports crazy it hasn't been corrected."

This response couldn't be further from the truth.

First, comparing males and females is an issue in itself. Females have far more joint laxity, so they're significantly less likely to have "tight" hamstrings (for a variety of reasons) that could potentially be injured. Moreover, male athletes are stronger and more powerful than females, so there are gender-specific differences in the actual forces experienced. The faster you are, the more likely you are to pull a hammy. This is also why we see far more hamstrings strains in baseball than we do in softball even if they're both equally "far behind" in prevention strategies.

Second, soccer and baseball couldn't be more different. Soccer is continuous play for 90 minutes, and as I recall, the average midfielder covers approximately seven miles per game. Baseball games might last four hours, and a player might not cover seven miles in an entire month - and all of it is done at a high percentage of maximum speed. They stand or sit around, and then are expected to sprint full-tilt without much warning. Improving work capacity in soccer players can definitely reduce the risk of injury late in matches, but won't do much in the baseball world because they never really get fatigued; rather, they stiffen up from doing nothing.

Third, the competitive calendar is different. If you look at the Major League Soccer schedule, most clubs play 6-7 matches in June. Major League Baseball teams play this many games each week - and do so with a much more challenging travel schedule. That crazy schedule pushes out a lot of training time, and makes optimizing recovery incredibly difficult.

Fourth - and this is a very subjective, anecdotal observation - baseball players are less likely to take good care of themselves off the field. Major leaguers are far more likely to go out and crush eight beers after a game than the 16-year-old female soccer player that's been positioned atop a pedestal of sports medicine excellence. They also don't test for recreational drugs in 40-man roster players in MLB. Don't you think the guy who went on a bender the night before a doubleheader is more likely to strain his hamstrings than Susie Soccer who still lives with her parents?

I could go on and on about the differences, but I don't think that the point needs to be illustrated any further. Every sport has different physiological, biomechanical, social, and psychological factors that need to be taken into account in the injury prevention battle. Most people on social media can't possibly even come close to fathoming all these different contributing factors.

Now, I'm all for borrowing training ideas from different facets of the sports medicine industry. I've learned a ton from coaches in everything from sprinting, to tennis, to track & field, to powerlifting. Nobody has the perfect solution for your sport-specific problem, though (even though social media might tell you otherwise). Still look to to learn from these other professionals, but critically evaluating everything you come across. 

Above all else, make sure that you're still working hard to get educated in your specific sporting discipline. As an example, it's one reason why I highly recommend the American Sports Medicine Institute (ASMI) Injuries in Baseball course. This resource brings together some of the most renowned surgeons, rehabilitation specialists, and strength and conditioning professionals in the baseball world each year. And, it's on sale for $150 off (50% off) this week only. If you work with overhead athletes in any capacity, I'd encourage you to look into it. You can check it out HERE.

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Strength and Conditioning Stuff You Should Read: 6/14/16

Here's some recommended strength and conditioning reading/viewing to get your Tuesday started off on the right foot:

How Neural Tension Influences Hamstrings Flexibility - This Mike Reinold video is an excerpt from our new resource, Functional Stability Training: Optimizing Movement. It's on sale for $30 off through the end of the week.

10 Lessons from 10 Years of Lifting - Part 1

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Why Physical Therapists are Movement System Experts? - I thought this was an excellent article from my good friend and colleague, Eric Schoenberg. I collaborate with Eric on a weekly basis with various rehab cases and he's an outstanding therapist and even better friend.

Top Tweet of the Week:

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Top Instagram Post of the Week: (this week's come from the @CresseySportsPerformance account):

 

Another exciting 1st Year Player Draft in the books. Odds are looking pretty good that we break into triple digits in '17. #cspfamily #mlbdraft

A photo posted by Cressey Sports Performance (@cresseysportsperformance) on

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So You Want to Start Sprinting?

While sprinting has been around since the dawn of man, only in the past few years has it really taken off as true fitness trend. In other words, it was either what we did to kill our dinner in prehistoric times, or it was a modern athletic competition. Only recently have we realized that doing sprint work for our interval training is a tremendously effective way to get/stay lean, enhance mobility, improve athleticism, and prepare ourselves for the demands that life throws our way.

Heading out to sprint full-tilt when you haven’t been doing any running work in recent months is, however, analogous to signing up for calculus when you haven’t brushed up on basic math of late. The main difference is that you can’t rip your hamstrings off your pelvis doing calculus!

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Sprint work requires tremendous mobility, good tissue quality, and adequate strength to tolerate significant ground reaction forces and a wide variety of joint angles. You don’t prepare for this with your “typical” gym workouts, so before I have some specific modifications in place that you’ll want to follow. To that end, below, I’ve provided you with seven tips you can apply to ease into sprint work so that you can get the benefits of it with less of the risk.

1. Do these foam rolling drills and four mobility exercises every day for a month.

These drills are like summer reading before a tough English class. You have to do them so that you can hit the ground running (pun intended).

2. Sprint uphill first.

People often get hurt when they overstride; they’ll pull the hamstrings on the front leg. Sprinting uphill doesn’t really allow you to overstride, though, and it’s also good because you go up with each step, but don’t come down quite as much. Ground reaction forces are much lower, so this is a great option for easing into top-speed sprinting. (great studies here and here, for those interested).

While it’s more ideal to do uphill sprinting outside, it is okay to do this on a treadmill. After all, you’re just trying to lose your spare tire or be a little better in beer league softball, not go to the Olympics.

I like to see a month of 2x/week uphill sprint work before folks start testing the waters on flat terrain.

3. Don’t sprint at 100% intensity right away.

Contrary to what you may have heard, you don’t have to run at 100% intensity to derive benefits from sprint work. In fact, a lot of the most elite sprinters in the world spend a considerable amount of time running at submaximal intensities, and they are still lean and fast.

The bulk of your sprint work should be in the 70-90% of top speed range. You might work up to some stuff in the 90-100% zone as you’re fully warmed up, but living in this top 10% all the time is a recipe for injury, especially if you’re over the age of 35-40 and degenerative changes are starting to kick in.

When you first start out, sprinting is new and exciting, and it's very easy to get overzealous and push the volume and frequency side of the equation just as you would the intensity side.  Don't do it.  For most folks, twice a week is a sufficient complement to a comprehensive strength training program, and the session shouldn't last for more than 30-45 minutes - most of which will be you resting between bouts of sprinting.  If you find that they're 90-120 minute sessions, you're either doing too much volume or not working hard enough.  The speed and quality of your work will fall off pretty quickly as you fatigue, so be careful about forcing things too quickly.  Beyond just injury prevention benefits, taking it slower on the progressions side of things allows you to test out your footwear of a few weeks to make sure that they're the right shoes for you.

5. Don't sprint on pavement.

I can't think of a more unforgiving surface than pavement, especially since it means that you're more likely to get hit by a car. Unfortunately, it's also the more easy accessible surface for most people. In an ideal world, I like to see folks sprint on grass, artificial turf, or a track surface. Broken glass and hot coals would also be preferable to pavement (for the record, that was a joke, people; don't be that schmuck who goes out to try it).

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6. Don't sprint through fatigue early on.

This is a "go by feel" kind of recommendation. On one hand, you have to sprint through some fatigue to get in the volume it takes to derive the training effects you want: namely, fat loss. However, we also have to appreciate that states of fatigue drive injury rates sky-high in the athletic world. With that trend in mind, I encourage people to run conservatively in the first few months of their sprint training programs; in other words, don't allow a lot of fatigue to accumulate. Instead, take a little extra time between sprints. Then, as your sprinting mechanics and fitness improves (and you've gotten rid of the initial soreness), you can push through some fatigue.

7. Generally speaking, sprint before your lower body strength training work, not after.

People often ask me when the best point in one's training split is to sprint.  As a general rule of thumb, I prefer to have people sprint before they do their lower body strength training sessions.  We might have athletes that will combine the two into one session (sprinting first, of course), but most fitness oriented sprinters would sprint the day or two prior to a lower body session.  A training schedule I like to use for many athletes and non-athletes alike is:

Mo: Lower Body Strength Training (with athletes, we may do some sprint work before this as well)
Tu: Upper Body Strength Training
We: Sprint Work
Th: Lower Body Strength Training
Fr: Upper Body Strength Training
Sa: Sprint Work
Su: Off

In this case, the intensive lower body work is consolidated into three 24-36-hour blocks (Mo, We-Th, Sa).

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Conversely, I've also met lifters who like to sprint at 70-80% effort the day after a lower body strength training session, as they feel like it helps with promoting recovery.

Closing Thoughts

As you can tell, while there are definitely some tried and true strategies for avoiding injury when you undertake a sprinting program, there are also some areas that are open to a bit of interpretation.  The value of incorporating sprinting into one's program is undeniable, though, so I'd encourage you to test the waters to see how it fits in with your strength and conditioning programs.  At the very least, it'll give you some variety and help get you outdoors for some fresh air.

If you're looking for ideas on how to incorporate sprinting in a comprehensive strength and conditioning program, I'd encourage you to check out my latest resource, The High Performance Handbook

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Strength and Conditioning Stuff You Should Read: 3/12/13

Here's this week's list of recommended strength and conditioning reading:

Some Thoughts on Crossfit - I thought Patrick Ward did an excellent job writing up this post, which features a review of a recent study performed on the efficacy of Crossfit.

Elite Training Mentorship - In this month's update, I contributed an in-service on evaluating and managing "tight hamstrings" as well as a few articles and exercise demonstrations. Vaughn Bethell and Tyler English also contributed some excellent stuff, so check it out!

Unilateral Work: Don't Forget the Upper Body - I wrote this blog post over at Men's Health almost two years ago, but was reminded of it during a conversation I had with an athlete this week.  It seems like as good a time as any to bring it back to life!

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15 Static Stretching Mistakes

One of the most debated topics in the strength and conditioning world in recent years has been whether or not static stretching is necessary and, if so, when it should be implemented.  While I don't think everyone needs it, and that there are certainly are times when it is a bad idea to utilize, I'm still of the mindset that it can have some solid benefits when implemented properly. 

Unfortunately, like all training initiatives, some people do it all wrong. To that end, I wanted to devote today's article to covering the top 15 static stretching mistakes I encounter.

Mistake #1: Stretching through extreme laxity.

This is the most important and prevalent one of all, so it comes first.  When I see someone doing this, this is pretty much how I feel:

We're all have a different amount of congenital laxity.  Basically, this refers to how much "give" our ligaments have.  Some folks have naturally stiff joints, and others have very loose joints.  This excessively joint laxity is obviously much higher in females and younger populations, but, as Leon Chaitow and Judith DeLany discuss in Clinical Applications of Neuromuscular Techniques: Volume 1, it is also much higher in folks of African, Asian, and Arab origin.

When you take someone who is really lax and implement aggressive static stretching, it's on par with having someone with a headache bang his/her head against a wall.  It makes things worse.

This is a tricky thing to understand, though, because many of these "loose" individuals will comment on how they feel "tight."  Usually that tightness is just them laying down trigger points as a way for the body to create stability in areas where they are chronically unstable.  They'd be better off working on stability training to get back to efficient movement.

I think yoga has a tremendous amount of applications and we borrow from the discipline all the time, but I think this is where many modern yoga classes fall short; they have everyone in the class go to the same end-range on certain exercises. Folks with serious joint laxity should not only contraindicate certain yoga poses, but also modify others so that they're training stability short of the true end-range of their joints. Unfortunately, most of the people you'll see in yoga classes are hypermobile women; you see, they like to do the things they're good at doing, not necessarily what they need to do.

How do you know if you're lax, though? I like to use the Beighton hypermobility scale to assess for both generalized congenital laxity and specific laxity at a joint. The screen consists of five tests (four of which are unilateral), and is scored out of 9:

1. Elbow hyperextension > 10° (left and right sides)
2. Knee hyperextension > 10° (left and right sides)
3. Flex the thumb to contact with the forearm (left and right sides)
4. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
5. Place both palms flat on the floor without flexing the knees

Beighton_Score

One of the biggest problems I see in today's strength and conditioning world is that we assume all "big, strong" athletes are tight and need aggressive stretching.  As an example, take a look at this high Beighton score in a 6-3, 240-pound athlete.  We do very little static stretching with him - and absolutely none in the upper body.

If someone is really lax, nix the static stretching and instead spend more time on stabilization work.  If they still feel like they need to "loosen up," tell them to do some extra foam rolling.  They'll transiently reduce some of the stiffness they're feeling, but they won't be working through harmful end-range joint range-of-motion in the process.

Mistake #2. Substituting knee hyperextension for hip flexion in hamstrings stretches.

This comment piggybacks a little bit on mistake #1, as lax individuals (who probably shouldn't be stretching their hamstrings, anyway) are the most likely to have problems with this.  Because the hamstrings are two-joint muscles (knee and hip), folks will often allow the knee to "give" extra because they are subconsciously trying to avoid an uncomfortable stretch at the hip - or they simply aren't paying attention.  These are the same folks who have terrible hip hinges on toe touch tests, yet can touch their toes without a problem; they just go to knee hyperextension to make it happen.  As an example, this particular athlete scores really high on the Beighton hypermobility score, and he can actually put his palms flat on the floor with little to no posterior weight shift (the wall blocks him). 

How does he do it? Knee hyperextension. 

We'd much rather get a good hip hinge without resorting to excessive joint range of motion at the knee. You get good at what you train, so if you're always doing your static stretching in a bad position, you're going to be more likely to wind up in knee hyperextension on the field - and that's where ACL injuries occur.

Mistake #3: Not creating stiffness at adjacent joints.

In a previous post, I talked about why stiffness can be a good thing, in spite of the negative connotation of the word.  Stiffness is a crucial part of keeping us healthy and enhancing athleticism.  "Good" stiffness allows us to overpower "bad" stiffness that's occurring in the wrong places, and it helps to transfer force as part of the kinetic chain.  Static stretching can either be an opportunity to foster good stiffness or develop bad habits.

You see, we static stretch to transiently reduce stiffness (or true tissue shortness).  However, if we don't stabilize (stiffen up) adjacent joints, it defeats the purpose. Let me give you an example.

Let's say that I want to stretch my hamstrings in the supine position with not just a neutral position (center), but also a bias toward internal rotation/adduction (left) and external rotation/abduction (right).


 



 

 

Now, let's see what happens to these stretches if one doesn't engage the lateral core to prevent the pelvis from rolling toward the direction of the stretch on the ones that go out to the sides.

Mistake #4: Irritating the medial aspect of the knee with 90/90 hip stretches.

Most folks are familiar with doing 90/90 hip stretches or cradle walks as a way to improve hip external rotation in a position of hip flexion.  This is the position I commonly see people using at the point of maximal stretch:

The problem is that many folks crank excessively on the medial aspect of the knee by rotating the tibia (lower leg) instead of the femur (upper leg).  This actually parallels what happens during a McMurray's Test for medial meniscus pathology:

It's a pretty safe bet that static stretching into a position that replicates a provocative test is never a good idea - and it's one reason we use 90/90 stretches very sparingly.  If you are going to use this stretch, however, I recommend that individuals grab the quadriceps on the stretching side to ensure that the majority of the pull into external rotation and flexion comes from the femur and not the tibia.  The opposite hand is simply there to support the weight of the lower leg.

Mistake #5: Substituting valgus stress at the knee for hip adduction/internal rotation stretching.

It's really important than folks have adequate hip internal rotation, as a loss of hip internal rotation has been correlated with low back pain, and it can certainly predispose individuals to hip and knee issues as well. The knee-to-knee stretch is a popular approach for maintaining and improving hip internal rotation, and it's also my chosen method for demonstrating how incomplete my goatee was at the time of this picture.  

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As you can see from the picture, this position can also impose some valgus stress at the knees if it isn't coached/cued properly.  So, instead of thinking of letting the knees fall in, I tell athletes to actively internally rotate the femurs (upper leg).  The stretch should occur at the hips, not the knees.

In folks with a history of medial knee issues, we won't use this static stretch.  Rather, we'll use a kneeling glute stretch, which still gets a bit of stretch into adduction, which will still stretch several of the hip external rotators indirectly.

Lastly, keep in mind that the knee-to-knee isn't a stretch most females will ever have to utilize because of their tendency toward a knock-knee posture (wider hips = greater Q-angle) at rest.

Mistake #6: Not monitoring neutral spine during hip stretching.

This point really works hand-in-hand with #3 from above, which talked about establishing stiffness at adjacent joints.  Certainly, maintaining neutral spine falls under the category of "good stiffness," but because it's such a common mistake, it deserves attention of its own.  When the hip flexes, you shouldn't go through lumbar flexion. For this split-stance kneeling adductor stretch, notice the correct on the left and the incorrect on the right:

And, when it extends, you shouldn't go through lumbar extension.  Again, the correct is on the left, and incorrect (hyperextended) is on the right:

Mistake #7: Not monitoring neutral spine during standing stretches.

Again, this is another point that piggybacks off of establishing good stiffness, but I see a lot of people doing upper extremity stretches - overhead triceps, lats, pecs - in terrible spine posture.  Perhaps the best example is the overhead triceps stretch with the lumbar spine in hyperextension, plus forward head posture further up.

Mistake #8: Stretching your lower back.

There may be times when a qualified manual therapist might want to do some mobilizations on your lower back. The rest of you really shouldn't be stretching your spine out. Stretch your hips, and mobilize your thoracic spine (upper back), where it's much safer for you to move. Focus on building up some core stability.

Mistake #9: Stretching your calves – and then wearing high heels the rest of the day.

There's nothing wrong with the "stretching your calves" part; it's the high heels part that makes me want to bang my head against the wall. Talk about a dog chasing its tail!

Mistake #10: Stretching a throwing shoulder into extension and/or external rotation (and creating valgus stress at the elbow in the process).

I devoted an entire video to this topic last week in my baseball-specific newsletter:

Mistake #11: Stretching through pain or neurological symptoms.

I honestly can't think of a single reason why anyone should ever stretch oneself through pain. Sure, there may be times when physical therapists may push a post-operative joint through some uncomfortable ranges of motion, but that's a trained professional making a educated decision.  You stretching yourself through pain is just throwing a bunch of s**t on the wall to see what sticks.  Don't do it.

Sometimes, an indirect approach is better.  As an example, there is research demonstrating that core stability exercises can transiently and chronically improve hip internal rotation - even without stretching the joint.  If you're hurting while stretching, see a qualified medical professional to help you devise a plan to work around the issue while reducing your symptoms.

On the topic of neurological symptoms, as an example, intervertebral disc issues with radicular symptoms into the legs may be exacerbated by stretching the hamstrings.  Similar issues can come about if folks with thoracic outlet syndrome perform aggressive upper body stretching. If nerves aren't gliding the way that they need to be, the last thing you want to do is yank on them.

Mistake #12: Not tightening the glutes during hip flexor stretches.

I've written previously at length about how anterior (front) hip irritation is often caused the head of the femur (ball) gliding forward in the acetabulum (socket) during hip extension.  This femoral anterior glide syndrome (described in detail here), was originally introduced by physical therapist Shirley Sahrmann.  Effectively, the hamstrings have a "gross" hip extension pull - meaning that they don't have a whole lot of control over the head of the femur.  Therefore, we need to have great gluteus maximus contribution to hip extension, as the glute max posteriorly pulls the femoral head back during hip extension so that the anterior hip capsule doesn't get irritated.

What we don't consider, however, is that if we stretch a hip into hip extension (osteokinematics), we also need that glute contribution to control the glide (arthrokinematics) of the femoral head.  This is a definite parallel to what I described earlier with respect to stretching a throwing shoulder into extension or external rotation; you don't just want to do it carelessly. As such, whenever you stretch the hip into extension, make sure that you tighten up the glute:

Mistake #13: Stretching into a bony block.

There are a lot of things that may limit range of motion at a joint.  It could be muscular shortness/stiffness, capsular tightness, muscular bulk, swelling, or guarding due to injury.  In many cases, though, it simply has to do with the congruency of the bones (or lack thereof) at a joint.

In the case of a "fresh" bone spur or loose body at the posterior aspect of the elbow, aggressively stretching into extension could easily provoke symptoms.  Conversely, I've seen some elbows with flexion contractures that are a combination of bony blocks and subsequent tissue shortening and capsular tightening that can be stretched until the cows come home with no problem. 

Each case is unique - but at the end of the day, remember that you're better off being too tight than too loose.  In other words, if you're unsure about something, don't stretch it.

Beyond just reactive changes like bone spurs and loose bodies, we also have folks who simply have different congenital or acquired bone structures.  Many individuals have retroverted (externally rotated) or anteverted (internally rotated) femoral carrying angles.  Those in retroversion will lack hip internal rotation no matter how much you stretch them, and those in anteversion aren't going to be gaining external rotation no matter what you do.  Trying to power through these bony blocks will likely create hip discomfort as well.

We also see retroversion as an adaptation in throwing shoulders, where bones "warp" to allow for more lay-back during the extreme cocking phase of throwing.  This is why most throwers will have significantly less internal rotation on the throwing shoulder than on the non-throwing shoulder in-spite of the fact that they have symmetrical total motion (IR + ER) from side to side; they simply shift their arc.

Before you stretch, you better find out if it's bone or soft tissue that is limiting you at end-range.  If it's bone, you're better off leaving things alone.

Mistake #14: Putting the band behind your head during hamstrings stretching.

This one drives me bonkers.  It screams "I know stretching isn't hard to do, but I'm still too lazy to put any semblance of effort into doing it correctly."  Why create forward head posture and neck stress when stretching the hamstrings?

Mistake #15: Not monitoring your breathing.

Nowadays, I'd say that we do just as much "positional breathing drills" as we do actual stretches. The more I learn (particularly from the Postural Restoration Institute school of thought), the more I realize that breathing in specific positions can have a dramatic effect on reducing tissue stiffness. For instance, here is one that many of our right-handed pitchers do. 

The left femur is internally rotated and adducted, the left rib flare is "tucked," right thoracic rotation is encouraged, the lumbar spine is flat, and the right shoulder blade is fully upwardly rotated with a bit of upper trap activation. We cue the athlete to inhale through the nose without allowing the rib cage to "fly up," and then encourage him to exhale fully, allowing the ribs to "come down."

We stretch to reduce tone, not increase it - and most athletes are in a constant state of inhalation, which corresponds to a big anterior pelvic tilt and lordotic curve. 

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When the rib cage flies up like this, we lose our Zone of Apposition (ZOA), a term the PRI folks have coined to describe the region into which our diaphragm must expand to function.

Zone-of-Apposition-300x220

In this extended posture, rather than effectively use their diaphragm, athletes will overuse supplemental respiratory muscles like lats, sternocleidomastoid, scalenes, and pec minor - and these are all areas where we're always trying to reduce tone.

Teaching athletes how to control their breathing during stretching - and paying particular attention to fully exhaling on each breath - goes a long way to help reduce sympathetic nervous system stimulation, get rid of unwanted tone in the wrong places, effective favorable changes to posture, and make the most of the stretches you're prescribing.  I think the folks in the yoga and Pilates worlds have done a good job of drawing attention to the importance of breathing, and we should appreciate that with respect to how static stretching and dynamic flexibility drills are implemented.

Conclusion

There are really only 15 mistakes that were right on the tip of my tongue - to the tune of 2,800 words!  To reiterate, I have a lot of clients/athletes who do absolutely no static stretching, but that's not to say that it can't be of benefit to a good chunk of the population.  Just remember that each body is unique, so no two static stretching programs should be alike in terms of exercise selection and coaching cues. 

If you benefited from this article, please share it via Facebook or Twitter, as this is a very misunderstood topic in the world of health and human performance.  Thanks for your support!

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The Best of 2012: Strength and Conditioning Articles

With 2012 winding down, I’ll be dedicating this week to the best content of the year, based on traffic volume at EricCressey.com. I’ll kick it off today with my most popular articles from the past year.

1. 5 Reasons You Have Tight Hamstrings - This article received about 24,000 more views than the next most popular post of the year.  I guess a lot of people have tight hamstrings!

2. Are Pull-ups THAT Essential? - People love controversy, and when you call into question the risk/reward of one of the most sacred strength training exercises of all time, that's exactly what you get! 

3. The Superset Survival Guide - This article, which featured my "Top 10 Supersets," got a ton of Facebook shares and Retweets.

4. Everything You Need to Know About the Front Squat - This article was published less than a month ago, but already shot up to the top five, which isn't easy to do!

5. 6 Tips for Adjusting to Exercise in the Morning - Early morning exercise might not be your cup of tea, but with some of these tips, it very well could be in 2013!

This wraps up my top 5 posts of 2012, but I’ll be back soon with more “Best of” highlights from 2012. Next up, I’ll list my top videos of the year.

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5 Reasons You Have Tight Hamstrings

There might not be a more obnoxious and stubborn athletic injury than the hamstrings strain.  When it is really bad, it can bother you when you're simply walking or sitting on it.  Then, when a hamstrings strain finally feels like it's getting better, you build up to near your top speed with sprinting - and it starts barking at you again.  In other words, a pulled hamstrings is like a crazy, unpredictable mother-in-law; just when you think you've finally won her over, she brings you back down to Earth and reminds you how much more she liked your wife's old boyfriend.

However, not all hamstrings pain cases are true strains; more commonly, they present as a feeling of "tight hamstrings."  If one is going to effective prevent this discomfort, rehabilitate it, or train around it, it's important to realize what is causing the hamstrings tightness in the first place.  Here are five reasons:

1. Protective Tension of the Hamstrings

This is readily apparent in someone who has a crazy anterior pelvic tilt, which puts a big stretch on the hamstrings, which posteriorly tilt the pelvis.  When someone is extremely anteriorly tilted, the hamstrings are constantly "on" to prevent someone from ending up with extension-based back pain, such as spondylolysis (vertebral fractures), spondylolisthesis (vertebral "slippage"), and lumbar erector tightness/strains.  This is a problem most commonly seen in females (greater anterior pelvic tilt than men) and athletes:

APT-250x300

Doing a lot of longer duration static stretching for the hamstrings in this population usually isn't a great idea, as you run the risk of making someone more unstable - particularly in the case of females, who have less rigid ligamentous restraints (more congenital laxity) to protect them.  To that end, our approach with these folks is to use the warm-ups to foam roll the area, then do some hamstrings mobilizations to transiently reduce stiffness in the hamstrings.

After this reduction in stiffness, we work to build stability in synergists to the hamstrings in posterior pelvic tilt.  In other words, there's a heavy emphasis on glute activation and anterior core recruitment both with a strength training program and postural reeducation for the other 23 hours of the day.

At the end of the training session, with the male athletes, we may do some shorter duration hamstrings stretching just to "dissipate" a little eccentric stress.  I like ten seconds in each of these three positions:


 

 

 

 

 

The thing to remember is that while you can do everything right with these athletes in training, what they do with their posture during the rest of their lives is of paramount importance.  If they continue to stand around in anterior tilt and don't help the new stiffness they've developed "stick," they'll continue to over-rely on their already tight hamstrings.

2. Neural Tension

Just because you feel hamstrings tightness doesn't mean that the hamstrings are actually the source of the problem.  In fact, it's not uncommon at all for those with lumbar disc issues to present with radicular pain, tightness, or numbness/tingling into the legs - especially the hamstrings.  The symptoms may also come from nerve entrapment (most commonly the sciatic nerve) on soft tissue structures further down the chain.  Just aggressively stretching the hamstrings can actually make these symptoms worse, so it's important to see a medical professional to rule out causes further up with the appropriate clinical exams, such as the slump test.

3. Truly Tight Hamstrings

In order for hamstrings to really be short, one would have to spend a lot of time with the knee flexed and hip extended - so just imagine the position you're in at the top of a standing leg curl.  That's a hard pose to hold for an extended period of time, much less do so on a regular basis.

That said, some folks do get somewhat close to that on a daily basis in the sitting position, and are therefore the most likely to really have "tight hamstrings." They have to be in posterior pelvic tilt and knee flexion for a considerable chunk of the day - and even then, it's still pretty tough to be truly short, as they are still in hip flexion.

These folks usually can't distinguish hip flexion from lumbar flexion, so if you do a standing hip flexion assessment, rather than maintain the neutral spine we see in this photo, they'll go into lumbar flexion (butt will "tuck under").

The same trend will usually be noticeable with any kind of squat unless they have a tremendous amount of core stiffness to overcome the posterior hip stiffness that's present.  If you test these folks on an straight leg raise, it isn't pretty, as the pelvis is already posteriorly tilted.  In a pelvis that starts in "neutral" on a straight leg raise, roughly the first 1/3 of movement that you see comes from posterior tilt of the pelvis before the femur ever starts to flex on the acetabulum of the pelvis.  These folks are usually already posteriorly tilt, so that 1/3 is already used up; you're really only measuring hip flexion and not hip flexion PLUS posterior pelvic tilt.  And, as you can imagine, if someone is truly short in the hamstrings, that straight leg raise isn't going to be pretty. Obviously, these folks usually have a terrible toe touch pattern as well.

This should also educate you on why you can't treat all hamstrings strains the same.  In the protective tension example earlier, we needed to work to regain stability to hold a position of a bit more posterior pelvic tilt.  We'd cue glute activation, and use exercises that draw folks back into posterior tilt (e.g., reverse crunches).  If you have someone has a pulled hamstrings because they are truly short from already being in posterior pelvic tilt, though, some of these cues and exercises would be contraindicated. You'd be feeding the dysfunction.

While manual therapy and stretching for the posterior hip is valuable, again, it must be followed by stabilization work at adjacent joints with the pelvis in a neutral position.  These folks can benefit from training hip flexion above 90 degrees as well, as it educates them on how to flex the hip without rounding the lumbar spine.  This is one reason why I think a lot of the chop and lift exercises we've learned from Gray Cook are so fantastic; they teach us anti-rotation and anti-extension stability in various positions of hip flexion while the pelvis is in neutral.  They make changes "stick" better.

4. Previous Hamstrings Strain

Not to be overlooked in this discussion is the simple fact that the single-best predictor of hamstrings strains is a previous hamstrings injury.  One you have an injury, that area may never be the same from a tissue density standpoint - whether it's the surrounding fascia or the muscle or tendon itself.  A previous injury can leave athletes feeling "tight" in the region, so regular manual therapy can certainly help in this regard.

Anecdotally, the athletes with the long-term problems seem to be the ones with the pulls up on the gluteal fold, right where the hamstrings tendons attach to the ischial tuberosity.  The area gets "gunked up"in a lot of athletes as it is because of all the tissues coming together and exerting force in a small area, but it's especially problematic in those who have a previous injury in the region.  Perhaps more problematic, though, is the fact that we sit on our proximal hamstrings attachments - and that isn't exactly good for blood flow and tissue regeneration.

Semimembranosus_muscle-2 

I haven't seen any research on it, but I have a feeling that if you looked at this region in a lot athletes with ultrasound (similar to this study with patellar tendons), you'd find a ton of people walking around with substantial degenerative changes that could be diagnosed as tendinosis even though they haven't actually hit a symptomatic threshold.  My guess is that it's even worse in the posterior hip region because a) we sit on it, b) the ischial tuberosity is a more "congested" area than the anterior knee), and c) the study I noted above used 14-18 year-old athletes, and degenerative problems will get worse as one gets older (meaning this study likely undercut the true prevalence across the entire population).

Very simply, an athlete with a previous hamstrings strain needs to stay on top of quality manual therapy on the area, and be cognizant of maintaining mobility and stability in the right places.  They have less wiggle room with which to work.

5. Acute Hamstrings Strain or Tendinosis

Of course, the fifth reason you hamstrings might be tight is because you might actually have a hamstrings injury!  It could be an actual hamstrings strain, or just a tendinosis (overuse issue where tissue loading exceeds tissue tolerance for loading).  There is no one perfect recommendation in this regard, as a tendinosis or grade 1 hamstrings strain is going to be much more tolerable than a grade 3 hamstrings strain where you have bruising all along the back of your thigh.  

In terms of maintaining a training effect with the less serious ones, here are a few suggestions:

a. When you are ready to deadlift, use trap bar deadlifts instead of conventional or sumo deadlift variations.  I explain a bit more about how the positioning of the center of gravity makes this more hamstrings friendly HERE.

b. Shorten up your stride on single-leg exercises.  This makes the movement slightly more quad dominant, but allows you to still get the benefits of controlling the frontal and transverse planes with appropriate glute and adductor recruitment at the hip.

c. Go with step-up and reverse sled dragging variations.  Eliminating the eccentric component can take a considerably amount of stress off the hamstrings, and both these exercises get the job done well.

d. If you're going to squat, start with front squats at the beginning, and reintegrate back squat and box squat variations later on, as they will be more hamstrings intensive.

e. Understand anatomy.  If you are in hip flexion and knee extension, you're going to really be stretching the hamstrings and likely irritating them in the process.  Select exercises that don't hit these painful end-ranges, and then gradually reintroduce more dramatic ranges of motion as the issues subside.

f. Do hill sprints before you do regular sprints.  Your stride is going to be a bit shorter with hill sprints, and that'll take a considerable amount of stress off the hamstrings at heel strike (pretty good research on uphill vs. downhill sprinting HERE, for those who are interested).  Just don't go out and run as hard as you can the first time out; propulsive forces are still quite high.

Of course, this just speaks to how to train around a pulled hamstrings; there is really a lot more to look at if you want to really understand why they occur and how to prevent or address them.  In my eyes, this post was necessarily "geeky," as it is important that we don't dumb down complex injuries to "just stretch it out."  This recommendation is analogous to a doctor just telling someone to take some NSAIDs for regular headaches; it doesn't get to the root of the problem, and it may actually make things worse.

For more information, I'd encourage you to check out the Functional Stability Training series. The entire package - and the individual components - are on sale for 20% off through tomorrow (Sunday) at midnight. The discount is automatically applied at checkout at www.FunctionalStability.com.

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The Who-What-When-Where-Why of Flexibility Training

I got this question the other day and thought I'd share my response: Q: When significant improvements in flexibility are either desired or needed, do you have any general suggestions with regard to what method(s) and type of schedule set-up (frequency, duration of session, etc.) would help accomplish this in the most timely and efficient manner possible? A: As always, my answer would be "it depends."  And, more specifically, it depends on whether you are talking about short or stiff tissue. If a tissue is legitimately short - meaning that it has lost sarcomeres due to chronic immobilization - longer duration holds are ideal.  Bill Hartman and Mike Robertson go into great detail in covering this in the Indianapolis Performance Enhancement DVD Set, as I noted HERE.

ifast-dvd-cover

If you are dealing with someone with capsular issues (outside the scope of practice of the personal trainers and strength coaches out there, in most cases), then you might just leave them alone with 15 minutes of low-load passive stretching (e.g., theraband wrapped around a DB to hold the shoulder in external rotation after a period in a sling).  Going back to our "loss of sarcomeres" scenario, if you're dealing with something more muscular-only issues, the least you'll want is five 30s holds throughout the day, in my experience.  Or, if feeling bold, you can have people set up for 3x5min holds or 1x15min hold.  In both cases, total duration over the course of the day is likely more important than duration per stretch. If it's stiff, in order to get it to relax, you likely need to train an adjacent tissue that acts as a synergist.  A good example would be strengthening the lower traps to take the stress off chronically overused upper traps and the stiff neck that follows.  Or, we have activating the glutes to take the stress off the lumbar erectors and/or hamstrings and adductor magnus.  Here is a great blog post from Bill Hartman that closely illustrates the point that you don't necessarily have to stretch a muscle to reduce its stiffness. Of course, you can never go wrong with integrating a good dynamic warm-up program prior to exercise, as this option challenges both range-of-motion and stability to provide a comprehensive training effect in a matter of minutes. So, in the end, it's different strokes for different folks - at different times, with different issues.  Keep an eye out for an upcoming project from Bill, Mike, and I that really delves into this in great detail.  It'll be the most comprehensive resource out there for self-assessment and corrective exercise.
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