Each spring, many frustrated clients arrive at the clinic with tight and painful hamstrings.  Despite their best efforts to stretch, massage, or roll them into submission, they have made no progress.  For some it only made things worse, causing sudden attacks of pain and cramps in the hamstrings, low back and even the calves.

Common wisdom tells us that to relieve tightness in a muscle, just stretch it.  It’s true that in many cases, a tight muscle is just a tight muscle, and stretching can help in recovery and relief.   However, when we’ve tried an approach that doesn’t seem to be helping, it often ends up that the pain is not where the problem is.

Getting to the source of the problem

When stretching doesn’t help it is usually because we are treating the symptom, not the problem.  From the clinical perspective, we refer to hamstring tightness as a compensation strategy.  The tightness is your body’s way of supporting other muscles, as well as changing posture and movement.  However, tightness also comes with changes in the way that deeper muscles work, creating an imbalance in the muscles that coordinate to maintain stability and mobility.  And this is not good.

Many leading clinicians believe that compensation strategies arise from a strain, sustained posture or repetitive movement that created physical pain at some point in one’s past.  When hamstrings compensate and tighten up, they stop your pelvis from naturally tilting forward.  This increases the effort needed to walk, run, climb and step, and can also flatten or round your low back.  These changes put more stress on the low back and leg muscles which can add up and get worse over time.

This discovery has led to the use of the phrase –  “using high load strategy for a low load task”.  This means that you are using additional muscular effort for normal daily activities that should be relatively effortless.  Some clients describe these compensatory strategies as a sensation of heaviness in the legs, muscles that fatigue quickly, or of a feeling as if you are “driving with the parking brake on.”

How to get better

Depending on the cause, rest and anti-inflammatory drugs often help temporarily relieve symptoms, but often do not help in the long run.  Even when the pain subsides, muscles may not automatically reset themselves and return to normal,1 increasing the risk that the lingering imbalance could resurface as a bigger problem in the future.  Research2 suggests this may explain why so many people suffer recurrences of the same problem after their initial injury.

The key to getting better is to first identify and then retrain those deeper muscles whose response has been decreased by pain.  This is done with slow, specific movements that focus on your ability to control the activity of the deeper muscles.  This treatment approach proceeds from easier, non-functional movements, to dynamic, functional, movements so that muscles progressively rebalance their activity to share the load efficiently.  Rushing ahead with strength training too early will not let us retrain a “low load strategy for a “low load task”, since over-active, tight muscles would reinforce a “high load strategy” for all movements.

Identifying the affected muscles requires a thorough evaluation by a qualified musculoskeletal health professional.  Fortunately, our treatment for such a complex problem often won’t even ask you to break a sweat.  At the Orthopaedic Therapy Clinic, we routinely prescribe only 3 or 4 simple exercises that can be done in under 12 minutes and requires no equipment.   These exercises improve the deeper muscles’ contribution to joint stability so that over-active muscles don’t have to compensate for this loss.  Tightness and stiffness naturally recede as muscles work more efficiently in the balance between movement and stability.

I hope this short article has helped clarify that not all muscle stiffness is created equal.  If you suffer from unrelenting hamstring tightness, it could be a sign of more serious issues that should be addressed before larger injuries possibly occur.  If you would like more information on this subject, or to book an appointment, please call us at 416-925-4687 or email me at jgray@orthophysio.com

This information is for educational purposes only and does not constitute medical advice for any condition.  Reasonable and appropriate care should always be performed by a qualified health professional after a comprehensive evaluation to identify treatment goals.

References:

  1. Hides JA, Richardson CA, Jull GA. (1996).  Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.  Spine, Dec 1;21(23):2763-9.
  2. Comerford, M & Mottram, S (2012). Kinetic Control: The management of uncontrolled movement.  Churchill Livingstone.