Widen the Lens

By Douglas Nelson
[Table Lessons]

I always like to hear interactions, like the following remarks made at one of my seminars (it assures me the material has immediate application by the participant): 

“Wow, this is fantastic! These techniques will be so helpful for one of my clients. I have never treated the hamstring in this position.”

“Do you have a client with hamstring issues?” I asked.

“Yes, well, sort of. My client is a star high school football player, mostly because he is the fastest kid on the field. He plays offense, defense, and returns kickoffs. His mom is a client of mine and asked me to do sports massage for him just for maintenance. I discovered he has very tight hamstrings, even though they do not bother him. I have been aggressively treating his hamstrings for weeks with no real gains. His mom and I have been after him to stretch before practice and before games, but he doesn’t really like that. We are trying to convince him that if he stretches out his hamstrings, he will be even faster and less likely to be injured. He doesn’t seem convinced. In fact, he has become a bit negative toward treatment and doing his stretching. He feels as though he is now a step slower, which his mom and I think is the tightness finally catching up to him. These new approaches should help. Do you have any additional advice?”

“Yes. Stop what you are doing.”

The therapist looked at me quizzically, wondering what that statement meant.

“Seriously, I suggest that you stop aggressively treating his hamstrings with the intent of lengthening them. I also suggest that you not make him do static stretches before practice or before a game. What you are doing could be very counterproductive.”

Many times over the years, athletic trainers and I have mused about the hamstring tightness we found in athletes who have tremendous speed. We wondered if these athletes could be better with a more normal hamstring length or, conversely, do their tight hamstrings contribute to the blazing speed that makes them so valuable? (One does not experiment with elite athletes who make megabucks, but it does make for interesting conversation.)

The answer to our theoretical question came in 2009, when researchers at Nebraska Wesleyan University (NWU) explored the relationship between speed and hamstring length with the NWU track team. The results (published in the January 2009 issue of the Journal of Strength and Conditioning Research) were quite surprising. In their findings, the fastest runners generally had the tightest hamstrings. More importantly, the runners with tight hamstrings had an extremely efficient gait, as measured by the amount of oxygen used during a run. Runners with the most flexible hamstrings were slower and less efficient.

As for stretching before competition or practice, the data again isn’t very convincing. An August 2010 study of 1,400 runners by USA Track and Field found that runners who stretched (using typical static stretching) and runners who didn’t stretch had exactly the same injury rate.

“I’m stunned,” my student exclaimed. “This is in conflict with what I have been taught.”

“I understand. Nothing ruins a good theory like a few facts. Our profession, like so many others, often makes some major assumptions and teaches theory or philosophy as though it were fact. Our particular bias is that muscular tightness is the source of all pain.

“Think of it this way: how can a person in pain visit so many practitioners and get a different diagnosis from every one of them? If you see a neurologist, the diagnosis is neural in nature. If you see a physical therapist, lack of strength is the problem. A chiropractor will find the cause to be misalignment in your spine. If you see a massage therapist, the problem is due to muscular tightness. Each discipline has a bias, a lens through which the problem is seen. That bias is both our strength and an enormous blind spot. All of us need to be vigilant in questioning the assumptions we make based on that bias.”

“Should I keep treating him? What should I do now?” she asked with hesitation.

“I’d continue to treat him, not with intent of aggressively lengthening his hamstrings, but to keep them functioning at maximal capacity. Trigger points in his hamstrings will reduce strength and more importantly, increase the possible onset of fatigue, which changes the firing pattern. Hamstring fatigue increases as the season wears on, especially if he is playing so many minutes. You might plan on seeing him more as the season progresses.” 

“I will do that. You know, I just realized that before I pursue a
treatment strategy, I should be absolutely sure it is in response to the right question.” 

  Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com or email him at doug@nmtmidwest.com.