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Hamstring Tightness and Low Back Pain

Fairly often I have a patient that states “I stretch all day long and I still feel tight.” The obvious solution for many seems to search stretches for the affected body part and keep working. Muscles become tight for a reason. Every muscle in the body crosses at least one joint. The muscles function to create movement and provide stability across the joint(s). Chronic hypertonicity of musculature is likely as sign of an underlying pathology oversimplified as a “tight muscle.”

I have a patient that is an avid golfer. He vented about how he now gives himself an extra hour before golf to stretch to prevent back pain. Prior to playing, he works on stretching his hamstrings which are chronically tight and stretching his lower back prior to every round. The golfer was becoming increasingly frustrated because he increased the amount of time devoted to stretching and the pain was becoming more frequent. Upon examination, we saw his hamstrings were tight even at rest and his lumbar spine (low back) had become unstable. Two things are apparent- the pre-golf stretching routine is failing at accomplishing lengthening his hamstrings and he is likely making his low back pain worse by overworking his lower back.

Focus on the hamstring specifically for the above example The hamstrings are a dominant knee flexor (bending the knee) and assist in hip extension (thigh moving backward). The golfer was constantly attempting to stretch his hamstrings by bending at the waist, reaching for his toes, and rotating to each side. The hamstrings control and limit hip flexion therefore bending forward at the waist will not increase hamstring flexibility (try stretching a muscle as it is contracting). If the hamstrings do not have enough length to allow bending at the waist, the athlete may compensate by flexing the lumbar spine to provide a false sense of motion at the hips. This action repeated over time increases flexibility at the lumbar spine, creates poor compensation patterns, and increases risk for injury to the lower back.

In the example, the golfer didn't necessarily need more stretches to work on his flexibility; he needed to address his dysfunction influencing both his pain and limited range of motion. Athlete specific mobility exercises and strengthening muscles surrounding unstable joints increase quality of movement. Better movement patterns create a more durable athlete.

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