Tight Hamstrings or Poor Motor Control ?

heavysideCase Studies

A patient presented to our clinic that has been suffering from chronic right-sided hamstring injuries for the last 2 years. He is a footballer who had missed half of the last season and the beginning of this season due to his persistent hamstring pain. He has had ongoing episodes of his symptoms over the last 2 years and has sought physiotherapy treatment, which had not fixed the issue.  Besides his hamstring issue, his history includes a herniated disc and a right ankle injury.

We began our physical assessment with the Functional Movement Screen™ (FMS™), where he scored 14/21. We then continued with biomechanical testing (SFMA), which revealed that his hamstring strength and range of movement was greater than expected and had no limitations. Through his ankle, knee, hip and back there were no major restrictions in movement. Although he has suffered a back injury, he still had great spinal flexibility and there appeared to be no obvious contributing factor to his hamstring issues. The assessment did however show a significant restriction to his lower back stability, causing his hamstrings to become extremely tight. This was diagnosed as a lumbar spine motor control problem.

This video shows the difference between his squat pattern before (left) and after (right) we fixed his motor control problem. His movement patterns were disrupted due to weakness in the lower back. The significance of this is that the muscles in his back, although he has full range-of-movement, do not know how or when to switch on in order to achieve this movement. As a result rather than recruiting the appropriate muscles to move his low back, he was over recruiting his hamstrings. This presented as the chronic tightness and pain he felt as he tried to perform this movement. The instability at his ankle was the result of his ankle stabilizers not switching on, which was influencing his glute activation higher up the chain. This also contributed to his over recruitment of his hamstrings.

A common treatment he had received previously was massage and dry needling through his glutes and hamstrings to try and relax the muscle and promote tissue healing. Some temporary relief was achieved but his problem was still ongoing. Looking at his presentation, some local dry needling or massage to his hamstrings may have helped to relax the muscles, but was not correcting the cause of his issue. Looking further at how his body moves functionally we were able to pick up on the cause of his dysfunction and begin to work on correcting the cause.

The main treatment for this patient was exercise, specifically motor control exercises for his lumbar spine, which aim to retrain the muscle function in order to achieve movement. This patient attended 4 treatment sessions over two weeks with a focus on retraining his movement and stabilizing his hip and ankle in movements important during his day-to-day and athletic pursuits. This patient was able to finish every game of the season without his hamstrings limiting his movement. He did not require treatment to his hamstrings for the remainder of the season and was moving without pain. This gives a great example of the importance to screen the entire body and understand motor control with movement.