November 4, 2010

Of hips and hamstrings

Stretching hamstrings is a hot topic of conversation around my house. I have a 13 year old son who can’t touch his toes and I’m a yogi who knows that I could use more flexibility in my hamstrings. And most of my clients with Cerebral Palsy (CP) have hamstrings elongation as an ongoing part of their home programme. However, the traditional stretch of flexing the hip to 90 and trying to straighten the knee usually results in an active holding response in my clients and I don’t believe I am getting any meaningful range in the muscle when this happens. Now a recent study also sheds some light on what happens during hamstring stretching in children with CP. In the July/August Journal of Pediatric Orthopedics, Cheng et al studied a group of children with spastic Cerebral Palsy who underwent typical stretching of the hamstrings. The sample size was small however the results indicate that passive stretching of the hamstrings in hip flexion followed by knee extension resulted in dynamic posterior displacement of the femoral head. In children whose hips may already be dysplastic, this is probably not something Physical Therapists want to be promoting in a daily programme. So I would suggest the following; a kinder, gentler approach to hamstrings stretching. Extend the knee first and allow your client to experience knee extension. Then gently and slowly move the hip into flexion. When you encounter resistance, wait and, if the resistance softens, then move further into range. If not, hold the elongation for 60 to 90 seconds. My clients relax with this elongation and parents and caregivers learn it easily and integrate it into home and school daily programming. My hope is I’m putting less stress on the joints and the muscle. And I’ll keep watching the literature to see if anyone else can shed more light on the best way to stretch hamstrings.