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.
Your recommendation makes sense I will keep it mind from now on. A friend of mine did her master's thesis on hamstring lengthening …longstoryshort….she concluded stretching at the knee than the hip was more effective.
I have also tried joint mobs to stretch the posterior hip capsule.
Thanks Barbara. I do use joint mobs too but not often. I would love to read your friend’s master’s thesis if she publishes it!
That article really changed my thinking, too, Shelley. I have been trying to do some gentle elongation by putting the hip into more abduction, as well. At the end of the article, there was mention of that. I also am finding that the sidelying position tends to be much more fun and distracting for children.
“However, on the basis of the results, the hamstrings stretching method in the authors’ hospital was changed to stretching by passive knee extension with hip in abduction and relative extension position in those hips with higher migration index. In patient with progressive crouching or flexion contracture of the knee with hip subluxation, we would consider changing the modality of treatment.”
Source: Chang, CH, Chen, YY, Wang, CJ, Lee, ZL, Kao, HK, Kuo, KN, Dynamic Displacement of the Femoral Head by Hamstring Stretching in Children With Cerebral Palsy, J Pediatr Orthop 2010;30:475–478.
I really admire your blog. I don’t have one; I am just not that great of a writer.
Thanks, I find side lying useful with some of my clients too. The challenge for me is the stability in this position and my ability to control the position of the pelvis. Sometimes I wish for another set of hands!