[Real life case study below]
I want to introduce you to Pete* (not his real name).
Now Pete came in to see me complaining of tight hamstrings. He plays basketball several times per week, and has had a couple of ‘twinges’ in the hamstrings over the last 12 months. He was feeling very fragile in his hamstrings, worried they were ‘going to go’ when he played sport. In his words: “They are just tight all the time. I keep stretching them and stretching them and they never seem to get any better.”
Perhaps you can relate to this?
“I have to stretch for at least half an hour before basketball, and I can hardly touch my knees, let alone my toes”.
Pete had been stretching, massaging, foam roller-ing for months with little improvements to show for it. He’d seen a massage therapist to work on his hamstrings, but it wasn’t helping.
Here’s a picture of Pete trying to touch his toes:
As you can see, he’s looking pretty stiff (and rather unhappy).
So you are thinking there’s obviously something wrong with his hamstrings, right? A flexibility issue that needs working on? Well I did some further assessment and I found this:
So you can see from these photos that Pete has pretty close to 90 degrees straight leg raise. This is pretty good for a middle aged male, so clearly hamstring flexibility really wasn’t his problem. There was also no pain in his hamstrings on palpation (to touch), and he had good strength in both hamstrings as well.
Pete had been working on his hamstring flexibility for months! He wasn’t too happy to hear it wasn’t helping him at all. (Not that being more flexible is a bad thing. I mean there are a lot of people out there who would be very jealous of Pete’s flexibility).
So What Was Causing Pete’s Tightness?
“Tightness” in muscles is actually a pretty ambiguous term, and not very useful as a diagnosis. A lot of people will report tightness (how many of you “carry tension in their shoulder” for example?) but it’s really just a symptom.
Tightness can be caused by a lot of different things, including:
- Overworked muscles
- Weak muscles
- neurodynamic restrictions
- Fascial restrictions
- Referred pain
Often, tight muscles are NOT short muscles. (I repeat: tight muscles are not short muscles!). The feeling of tightness in a muscle and the flexibility of that muscle are not the same thing.
Tight muscles are often overworked or weak muscles. Sometimes tight feeling muscles are already over stretched. OR the sensation of tightness is actually due to something else entirely.
In Pete’s case, however, it wasn’t weak or overworked muscle tissue at all. After a thorough assessment, we found that the source of Pete’s ongoing hamstring tightness was actually his low back. If you look at the first picture again, you’ll see his low back is still very straight. He was struggling to bend at the low back, and was experiencing a lot of referred pain into the hamstrings from his back.
Pain and stiffness in the low back was driving the tight feelings in his hamstrings. The low back issue was also causing his loss of mobility.
After months of hamstring stretching, all to no avail, one session of individualised physiotherapy treatment to address his specific limitations in the lumbar spine, and Pete could get his fingers down to his ankles with no hamstring pain. He’s still got some work to do (as months of issues don’t just magically disappear in one day) but he’ll be well on his way to a pain free basketball season.
There are a few important lessons to learn from Pete’s case:
- If you’re not getting better by doing the same things you keep doing, maybe you need to try something else (or seek expert help).
- Accurate diagnosis is the key to a full recovery. If you don’t identify the actual underlying cause of the problem, you will never get a perfect solution.
- Just because it feels tight, doesn’t mean it’s short. AND it doesn’t mean that stretching is the solution. (Stretching is very good for addressing muscle flexibility issues, however).
I’m sure there are lots of people out there just like Pete. People who have been struggling with “tightness” and have tried stretching, or massaging, but it’s just not helping. Maybe they haven’t worked out what the actual problem is yet. Unfortunately stretching and massaging the ‘tightness’ might only be addressing the symptoms. If you don’t identify and treat the underlying cause, you’re not going to be able to get better.
If you need some help getting to the bottom of your tightness issues, why don’t you get in touch?
A few people have asked how “Pete” is going with his physiotherapy management. Well below is a picture of his mobility when I reviewed him again. He’s still got some work to do to make lasting long term changes, but I think you’ll agree he’s well on his way.
Julian is a Director and Senior Physiotherapist at South Perth Physiotherapy. He has spent over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 35,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors, to thousands of everyday people with all manner of issues. He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries.