Eccentric Hamstring Strengthening

Hello

This blog post had a very organic origin. In the last few weeks I have seen/heard of too many people ‘pulling their hamstrings’ then I can recollect. In my little world, it seems to have reached epidemic proportions (not quite really, but thanks for indulging me). So let’s intervene. Now this is a big topic to tackle. For the purpose of keeping it short, we will only discuss exercises here. Before we start though I would like to make a disclaimer for my non-physio readers, please consult your physio  if you have already injured your hamstrings. These exercises may not be the best approach to your rehab goals depending upon what stage of recovery you are at. For the rest of you proactive people who have no pain and want to train for injury prevention or just try some new exercises and are tired of the same old hamstring curls etc, give these a shot.

For the most part, hamstring injuries are seen more in a ‘generally’ active, athletic population. Research seems to indicate that most of the hamstring strains occur not when the muscle is contracting (concentric) but when it is lengthening under tension (eccentric). An example during running would be when the heel of the forward leg is about to hit the ground. During this motion, the hamstring muscle is lengthening under tension.

Now logic dictates that we train this muscle similarly (eccentrically). Over the years, more and more research seems to indicate that eccentric exercises are a good option for injury prevention and hamstring  strain rehabilitation (other muscle strains too). Plus, your athlete patients will love the challenge as it breaks the monotony and are difficult to perform. So start slow and gradually progress. If it hurts, do listen to your body and stop.

 

So here goes-

  1. Hamstring walkouts –

 

 

 

2. Bilateral hamstring sliders-

 

 

 

3. Single hamstring sliders-

 

 

 

4. Eccentric hamstring on physio ball-

 

 

 

5. Eccentric hamstrings on TRX

 

 

 

 

5. Nordic Hamstring Curls- This one is modified/ scaled down to make it easier. Its a difficult movement to perform so I begin performing this by not going down on the floor completely. Start small as you develop control and strength and then work through the full range of motion.

 

 

 

Worth a try? Now work those hammies.

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)

References-

  1. Woods, C., Hawkins, R.D., Maltby, S., Hulse, M., Thomas, A. & Hodson, A. (2004) The Football Association Medical Research Programme: an audit of injuries in professional football – analysis of hamstring injuries. British Journal of Sports Medicine. Vol. 38, No. 1, pp. 36-41.
  2. Chumanov ES, Heiderscheit BC, Thelen DG. Hamstring musculotendon dynamics during stance and swing phases of high speed running. Med Sci Sports Exerc 2011;43:525

#Technique Tuesday 4- The Lunge

On this edition of #techniquetuesday we will discuss the Lunge. The lunge is a great  lower body exercise that works some of the major muscle groups of the legs- the Quads, the Hammies and the glutes. In addition to this, it also trains dynamic single leg stability and motor control and depending upon the variation you chose to perform one could also throw in half kneeling stability work and eccentric quadriceps work into the mix. All in all its a great exercise.

However, it doesn’t seem to be the most enjoyable exercise as many seem to hurt themselves while doing it. So lets try to do em right.

Avoid these common mistakes-

 

 

WATCH OUT FOR-

  • Knees going past the toes
  • Heel lifting of the floor

 

 

 

 

WATCH OUT FOR-

  • Knees going past the inner border of the foot (aka excessive valgus)

 

 

INSTEAD TRY THIS- 

 

TRY TO –

  • Shift your weight back on to your heel with the heel of the front leg flat on the ground.

 

 

 

TRY TO –

  • Keep your knees aligned over your feet

 

VARIATION-

The above lunge exercises seem to work the anterior chain with the focus on quadriceps (Don’t get me wrong, you are still working all the muscles). As a variation, to get more of my posterior chain muscles (Hamstrings, glutes) or to avoid straining sore knees/quads I like this variation-

 

Keep at it, do it right and do it often. Until next time

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)

 

 

#Technique Tuesday 3- The Plank

Welcome back,

The week ahead is long and there is much to do, its only Tuesday. So we like to keep it short and sweet on #techniquetuesday. Today we discuss the plank.  Plank is a great core exercise but often faulty techniques negates the true benefits of the exercise. In my mind, the true purpose of the plank is to engage the core to brace and protect a ‘neutral’ spine. However, I often find when performing a plank that the hold time supersedes good form. There’s a lot of excessive arching, ribs flaring out,  more than desired hip flexion, cervical extension etc all for the sake of getting that extra 30 seconds. Here are some example-

In the pictures below you will see (clockwise)-

  1. Excessive thoracic kyphosis (Rounded upper back), rib flare, excessive  cervical protraction (chin sticking out).
  2. Excessive thoracic kyphosis (Rounded upper back), excessive lumbar lordosis (arched lower back), rib flare, excessive  cervical extension (head turned up).
  3. Excessive hip flexion.

WATCH OUT FOR THESE COMMON MISTAKES!

 

Try this instead-

 

unnamed (4)

Remember, the spine is not perfectly straight so a little ‘natural’ arching is acceptable. A cue I often use is to gently pull the front rib cage down towards the feet, I’m not a big fan of the cue ‘drawing the belly button towards the spine’ because it interferes with normal diaphragmatic  breathing (which is important for proper core engagement).

If the plank off the feet/toes is hard, regress it to ‘off the knees’ like this-

 

Do it right and do it often. Until next time

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)

Speed and Agility Drills

As I have mentioned before many times, my masters in exercise science was just what I needed after completing my bachelors in physiotherapy. To over simplify it, It gave me an insight into exercise selection, administration and prescription which was only brushed in my bachelors of physiotherapy program. I believe this was for good reason, the bachelors degree in physiotherapy is focused on rehabilitation. Not as much on improving performance or training otherwise healthy adults. It brushes over it, but not thoroughly enough in my humble opinion. No wonder physios in countries like the US and Canada often go through this path of exercise science/ Kinesiology before entering physio school. I went the other way, but the bottom line is, there was a lot to learn and it is fascinating.

One of the facets of training which I was fairly unfamiliar with was training for speed and agility. Before we proceed, this is what the NSCA describes in its book ‘The essentials of strength training and conditioning’ speed and agility in terms of training-

Speed- the skills and abilities needed to achieve high movement velocities.*

Agility- the skills and abilities needed to explosively change movement velocities or modes.*

Most athletes need these attribute, the ability to get from point A to point B fast, this could be chasing a football/soccer ball, a run up for a fast bowler, sprinting to the finish line etc. Also, the ability to accelerate, change directions, decelerate etc. like in tennis or basketball. The ability to produce force fast in a certain direction would still require baseline/foundation strength. But we must also train for that quick first step in a sprint or that quick change in direction which must be practiced with drills. Just lifting heavy things might not help with that. These drills reinforce the ‘brain-to-muscle’ connection that we often talk about that is learnt with repetition.

One of the common drills I often saw being used by strength coaches as a warm-up or on a low training volume day is ladder drills. Here is a video of one of my colleague performing some basic (not simple) drills on the ladder. She has a track and field background in high school and collage and has practiced these drill many times over the years.  Enjoy-

  1. Forward sprint
  2. Forward sprint (Variation)-
  3.  Lateral In and out’s-

    4. Icky Shuffle-

    5. Cross behind forward-

 

I also use some of these drills in our senior population. After all, what is one of the major reasons for falls in seniors with balance issues? I think its one of them is the inability to contract muscles fast enough to prevent a fall. An example would be if they have one of their legs caught in the cable/carpet at home, its the inability to put the other leg forward to prevent a fall. Why not train them to move faster or to be able to maneuver around objects at home with ease. It can also be a great multi-planer cardio-vascular exercise for them. But of course at their own pace, keeping their medical history in mind and keeping these drills simple. There are many more drills and exercises which I will discuss in later blogs. What are some of the drills that you like? Feel free to share.

Until next time

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)

 

 

# Technique Tuesday 2- The Pushup

On #techniquetuesday part duex, we discuss pushups.
In the 1st video you see some of the common mistakes when performing a pushup. Elbows are not close to the body but flaring out, not going deep enough and not going down and coming up as a whole but instead bending and arching from the back which might be indicative of weakness or improper engagement of the core.


2nd video shows corrections for the above along with finding a proper neutral starting position for the pushup

 

image1.jpeg

 
If you are unable to perform a push-up with proper form, regress by doing it off a bench, table or mats as demonstrated in the 3rd video.

 


4th video is another regression of the pushup off the wall. 


Do it right and do it often. Until next time

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)

#TechniqueTuesday 1- Quad & Hip Flexors Stretch

The intention of #techniquetuesday is to highlight mistakes and demonstrate corrections for common exercises that I see often. For the very first one, we will discuss everyone’s favourite, the quadriceps stretch and the hip flexor stretch. Here goes-

Do it right and do it often.

Until then

Pursue Excellence

Abhijit Minhas

(BPT,MS,CMP,FMT)

My thought process on improving hamstrings flexibility

To say that I wanted to write a blog post on hamstring flexibility would be incorrect. In fact, this is a issue I avoid like the plague. Why? I’ll tell you. I have pretty tight hamstrings. And since I make all the videos on this blog myself with my friends and not just throw in some you tube video of someone else doing these exercises, I’m nervous to look bad. And my hamstring flexibility makes me look bad, at least in my head. But then again, there’s also frustration. The frustration of doing repeated static stretching and not really getting much outta it. Not to forget, I have tried to be aggressive thinking if I yank on that muscle, maybe it will finally give. What it has often given me is pain instead of flexibility,  and soreness. I’m sure many of you will agree with me, that for the subset of people who are on level 0 on path to becoming a yogi, this process is discouraging. So we avoid it. I can’t argue with the fact that if we keep up this torture, we might get better, but I know many people who have not made significant strides with this approach, myself included.

The reason I wrote this blog is because I had a few of my readers respond to my previous blog post reporting that one of the major reasons they were unable to hip hinge was due to those disobedient, stubborn hamstrings that were preventing people from hip hinging. So essentially this blog came from a need to hinge better. It would be great if one could touch their toes but that’s not up in the front on the priority list. The point is to hinge from your hips to learn correct lifting form so you don’t throw your back out.

If you have been part of my writing journey so far, you know that I don’t like interventions that are too painful. After all, a lot of ‘hands on’ intervention that we do is desensitizing the nervous system. Why cause deliberate discomfort (with good intentions of course) to ‘release things’ only to set the warning alarms off on the CNS. I’m not saying this is the only way, I’m saying its an easier, non/less threatening option. Hence I tread the path of lesser resistance.

So without much more blabber, here are some lesser threatening, novel approaches to improving hamstring flexibility. I like to wrap the mobility band on the hamstrings and do my neural glides, SLR’s, some hold relax etc. I will let you be the judge, practice these strategies and retest your hinge,dead lift, possibly toe touch etc.

Here’s the first one-

 

image1

Here’s another strategy-

Right side-

image2

Left-image3

Worth a try?

Pursue excellence

Abhijit Minhas PT

(BPT, MS, CMP, FMT)

Hips Don’t Lie- The Hip Hinge

Greetings

I know I know, the title is a cliché but I couldn’t help myself. Dealing with patients with low back pain is our bread and butter as physios. Not that we don’t see other stuff in the office but all of us have seen more clients with low back pain then we can count. For all you physio student that are readers of this blog and have not yet treated patients you still know what lies ahead of you; a lot of sore, achy backs.

For some time now I have introspected on how we treat low back pain and have come to the realization that we are fairly good at treating various causes for low back pain when our patients come see us in the office. We often  measure our outcome depending upon how low could we bring the pain down on the pain scale and get our patients back to their ADL’s. However, an aspect we often unintentionally neglect is keeping people pain free and out of our offices. In other words training our patients in lifestyle modifications and on how they should move better. Not all of us though, I have had the pleasure of meeting and working with some physios that hammer the above two points well. For them the whole spectrum of treatment for a person suffering from low back pain does not end at manual therapy/modalities etc to relieve pain and then strengthen back/core etc. This is just half the job done. These physios take multiple visits just to teach lifestyle and behavior modification strategies so their clients stay pain free and learn to move well. We all can learn something from this. This blog post is on one such example. Lets dive right in.

Let me paint a clinical picture we often see- Patient comes in with low back pain, no H/O trauma, pain from repeated bending forward or lifting etc, pain has a gradual onset, no major red flags etc etc. Fairly common scenario. We dig into our tool kits and do a great job in getting the person almost or completely pain free and then prescribe strengthening exercises. We spend a few visits in this. Finally, when its time for discharge, we go over the do’s and don’ts, show them how to maybe lifting things of the floor or bending forward correctly etc and then its goodbye. I have done this in the past and have had lengthy debates with other physio friends about how this seems to be a norm. What we ought to do instead is to spend more time/visits to show them how to bend forward correctly/lift correctly so they can protect their backs.

Enter one of the most underutilized movement pattern that everyone must be able to perform- THE HIP HINGE.

The hip hinge is an excellent movement pattern to disassociate the hip from the rest of the back/torso, an good position to lift  heavy things off the floor without stressing the lower back and its associated discs which would otherwise put us at an increase risk of injury (refer to the work of one of the best back research and rehab specialist Stuart McGill to learn more), a great movement to train some of the strongest muscles of the body- the glutes, hamstrings, a very important athletic movement to produce explosive power for movements  like jumping, sprinting etc (the glutes muscle is stretched and in a good position to produce great force for athletic performance). The list is quite long. Hence its imperative that we not only master it ourselves, but make sure our patients can execute it well and most importantly, that they utilize this in their day-to-day lives. That only means one thing- practice.

Cuing

Wrong cuing– Before we proceed, lets talk about what we have been doing incorrect for a while. When we ask our patients to bend forward and lift something off the floor we often say thing like ‘keep your back straight and bend from the knees’ or bend your knees and lift the object of the floor’. There are a few things wrong with this- first this que sounds like a squat and as we all know a squat is one of the most complex movements. Not everybody will be able to perform it well. Secondly, there is no mention of the hips. Moreover, if our patients lack ankle dorsiflexion or/and have knee pain, good luck with having them do this. What ends up happening is that they go back to their default lifting pattern and sooner or later they will be back to see you.

Here’s an example of bad lifting form-

Bad form

The squat-

Enter The Hip Hinge-

I’m pretty sure your tired of reading so scroll down for a video on how to hip hinge.

The hinge-

Now go out there and lift heavy things, the right way.

Pursue excellence

Abhijit Minhas PT

(BPT, MS, CMP, FMT)

Drive your woes away

Ladies and gentlemen

Got a long drive ahead of you that you are dreading? Feel stiff and achy sitting all day. Below I present to you some simple exercises, stretches and strategies that you should try and incorporate if you know you would be behind the wheel for a few hours. Make them a non negotiable part of your drive (safety permitting) and more likely than not, your body will thank you for it.

Here you go-

1. While driving

(Disclaimer- do not take your hands of the wheel for more then 2-3 seconds and never both together, driving safety comes first. Do not let these exercises distract you from the primary activity of driving, I do these often and they are like second nature to me. Only perform them if you feel comfortable to do so safely depending upon your traffic conditions. Practice them at home or work first and then incorporate them carefully while driving. If you still feel unforgettable, avoid this and try the strategies in step two).

2. Take breaks often and move

Try holding the stretches in the above videos for about 30 seconds and repeat 2-3 times. For neck, wrist, back exercises that are not stretches, try about 10 repetitions. Although you ‘might’ feel some discomfort due to staying in one place for some a few hours, none of these exercises should cause pain. If they progressively increase pain and/or discomfort every time you do it, STOP. DO WHAT YOU CAN.

Always remember, the body is not meant to sit in one position all day and ‘motion is lotion’ for your body. Consult your physio if you have pre existing conditions as some of these exercises might not be right for you.

Pursue excellence

Abhijit Minhas PT

(BPT, MS, CMP, FMT)

Navicular Drop Test

Greetings

This is going to be a short one. As indicated before on my social media, this one is on the feet. Foot examination is a big part of my assessment with patients presenting with lower extremity pain and often back pain. Of the many dysfunctions of the feet that could cause pain anywhere along the lower extremity, a pronated foot often steals the lime light. While there are definitely problems that can be associated with  excessively pronated feet and has been well established in the literature, I must point out that the word ‘excessive’ is important here. When I first started looking at the body  not just as individual parts but as a unit together, the idea of regional interdependence was a game changer.

However, I was quick to jump on the bandwagon of blaming pronation for everything- shin splints, tibial stress fractures, ACL injuries, hip issues, global warming, oil crises (a bit too much, I know. Just my attempt to keep this as light reading). Remember that pronation is a regular part of the gait cycle during the suspension phase and also is a normal physiogical movement of the body. It is really the ‘excessive’ pronation and medial arch collapse that we should be worried about without demonizing foot pronation.

Apart from generally eyeballing movements for foot positioning during different movements like running, walking, squatting etc I like the Navicular drop test to assess ‘over pronation’/ medial arch collapse. Here’s a video of how I perform it.

 

If the difference between the two points is >10mm then the test is considered positive.

I’m keen to read  your thought on this subject. Do you often use this test? Any other tests you like to use in your assessment? Would you like that featured on this blog? Feel free to share your thoughts.

For those of you who are wondering what an excessively pronated foot has got to do with other lower leg problems (not you of course, you know this all to well), its might be useful to understand how problems at the feet might cause problems upstream at other joints, its called ‘regional interdependence’ and this is just one example. Understanding this is paramount. More on this in the next blog. Until next time

Pursue excellence

Abhijit Minhas PT

(BPT, MS, CMP, FMT)

Reference-

  1. Vinicombe A, Raspovic A, Menz HB. reliability of navicular displacement measurement as a clinical indicator of foot posture. J Am Podiat Med Assn 2001;91:262-8\
  2.  Flynn, Timothy. User’s Guide to the Musculoskeletal Examination. Evidence in Motion, 2008. Print.