The Sciatic Nerve Is Often The Source Of Your Chronic Posterior Thigh Pain, Not Your Hamstrings.
It is alarming how often people are encouraged to stretch their hamstrings in response to an insidious onset of posterior thigh and buttock pain, often coupled with a nagging low back problem. 90% of the time the problem is not the hamstrings at all, but rather the sciatic nerve. So if you have pain in the back of your leg and it wasn’t in the course of coming up lame after a sudden sprint, consider performing the following simple test before stretching your hamstrings:
Sit in a slouched position, head looking down to your lap. If this is pain-free, proceed to the next step. Dorsiflex the ankle on the side you are testing. Then, slowly extend your knee, stopping at the point where you first feel any symptoms, (stretch, pull, pain, tingling, etc). Next, while still holding this leg position, extend only your cervical spine. If this alleviates your symptoms, you are most likely dealing with an irritated sciatic nerve rather than your hamstrings. Why? Your hamstrings don’t connect to your head, so changing the cervical position shouldn’t influence the symptoms if the hamstrings are the source of the problem. Rather, the tension upon the sciatic nerve is alleviated with cervical extension as the dura of the spinal chord is connected with that of the sciatic nerve. So if your “chronic hamstring strain” isn’t healing, and your slump test is positive, you should stop stretching your hamstrings, and seek some professional advice.
Learn To Posteriorly Tilt Your Scapula.
Poor control of the scapula is the root of most shoulder problems, as most informed conditioning and rehab experts will attest to. In fact, and anteriorly tilted scapula is the most common postural impairment found in those with shoulder pain. Posteriorly tilting the scapula removes a common mechanism of impinging the rotator cuff against the subacromial arch when elevating the arm. Furthermore, it helps to position the scapula to facilitate optimal length tension of the scapula and humeral musculature. So merely “pulling the shoulders back” doesn’t do the trick.
To improve activation of the scapula posterior tilt, lay supine on a firm surface, and attempt to bring the posterior aspect of the acromion to the table. If this is very difficult for you, you will likely require some activation work for your lower traps and stretching of your pec minor.
Stretch Your Psoas And Your Rectus Femoris Separately.
Although it is common to hear recommendations to stretch your hip flexors, two major hip flexors, the psoas and the rectus femoris, should be stretched separately. Why? Because they have separate origins and insertions. To stretch the psoas, ensure a neutral or slight forward lumbar flexion, lumbar contra-lateral side bend, and hip extension. This can be done in standing or half kneeling. These motions can be quite tricky, so be sure to have a qualified coach or PT teach you. For the rectus femoris, posteriorly rotate the pelvis, flex the knee to about 120 degrees while placing the foot upon a stationary surface, and extend the hip. With both stretches, the most common mistake is to hyperextend the lumbar spine, which will reduce the effectiveness of the stretch and could contribute to back problems.
Train Hip Rotation Versus Lumbar Rotation
Most tasks that involve powerful whole body rotation, such as swinging, throwing, and kicking, mostly involve hip rotation versus lumbar rotation, at least when they are performed by skilled athletes. Emphasizing hip rotation makes sense from an anatomical perspective too. The hips are very stable joints, with a network of dense musculature designed to perform rotation. The lumbar spine is relatively more fragile, and in fact, the annulus of the disc begins to experience failure at only 4% elongation, which usually occurs at only 4 degrees of rotation at each segment! Clearly, our training should reflect these biomechanical factors.
Use Deloading To Stimulate Recovery
When we fracture a foot, it is well known that taking load of the bone for a limited time will facilitate healing. We should use the same logic regarding injuries to our weight bearing joints to various degrees. Vertical deloading through band or bar hangs are an example of removing loading upon the spine. This is often a welcomed break from the excessive loading we impose upon our spine through maximal strength workouts. The degree to which we perform our deloading should be proportionate to the degree to which we load our spine, be it chronic loading (sitting at our desk) or acute loading (heavy dead lifts), and proportionate to the severity of the symptoms (e.g. manual traction for acute back pain). Deloading can also be done with lower body exercises such as lunging when bodyweight is enough to irritate a flared up knee. Try taking a strong band suspend it from a rack, and loop it under your arms. The stronger the band, the more the deload. This will allow you the benefits of facilitating the desired motor pattern and full joint excursion without reproducing the painful irritation of the joint.
Perform Balance Activities With Your Eyes Closed.
Balance is simply maintaining your center of mass within your base of support and is facilitated by many different sensory and motor qualities. Proprioception is a component of balance that is very important to athletes and fitness enthusiasts, as the training of it can reduce the incidence of some injuries injuries, and the loss of it is the by-product of any joint injury. This is well researched with ankle injuries in particular. When performing single leg exercises, closing your eyes reduces the contribution of visual input towards the task of maintaining your center of mass over your base of support. Therefore, you must almost exclusively rely on feedback form the joints, and as a result improve your proprioception.
Try The Modified 1-Leg Squat To Assess Leg Strength Discrepancies
Strength discrepancies amongst the legs is very common, and often the cause of injury and decreased performance. A very simple technique to identify a unilateral strength deficit is as follows: perform a one leg squat or modified Bulgarian squat (non-stance leg moving backward). At the bottom of the movement, when the stance leg is at least 90 degrees and toes of the trail leg are in contact with the ground, lift the toes of the trail leg off the ground before ascending exclusively on the stance leg. Any strength discrepancy will be obvious based on the perceived difficulty from one leg to the other or the presence of compensation patterns.
Address Your Lumbar Stability And Position Sense Before Overloading.
Far too common is the failure to adequately master position sense and stability prior to overloading a joint. Doing so will lead to injury through structural damage and decreased performance through muscle inhibition. You cannot build the second floor before solidifying the foundation of a building. You cannot throw a punch with a limp wrist. Accordingly, you should not lift heavy before you can demonstrate proper joint position and stability.
Look To Your Daily Life As The Root Of Joint Injuries.
The more we learn about joint injuries, the more we learn that damage is more likely the consequence of repeated micro trauma, versus a one-time, acute macro-trauma. Joints respond very well to frequent, intermittent, and gradual loading, as opposed to infrequent, sustained, or sudden loading. Joints receive their nutrition from the passive diffusion of nutrients in the synovial fluid, facilitated by movement and intermittent loading. Prolonged sitting and standing can often rob the joints of the stimulus required for optimal health. When our minds are occupied, it is amazing how we can find ourselves enduring prolonged and awkward postures. Even worse, we may not feel the adverse affects of this in the short term, thus we don’t have an impetus to modify them. This is usually because many structures, such as disc, meniscus, and joints are aneural is areas, and often do not relay noxious stimuli until a higher degree of damage occurs. Clinical experience and research shows that countless joint conditions, including OA, shoulder impingement, low back, and neck pain are all correlated with prolonged sitting or repeated bending and twisting. It’s obvious to focus on technique, program design, corrective exercise, and nutrition for optimal performance. However, neglecting to address movement patterns and postures with daily tasks can subvert much of your hard work and often contribute to injury.
Perform Thoracic Mobilization Before Exercise, Not After.
There always seems to be controversy regarding when stretching should be performed to maximize function. Fortunately, the answer is clear regarding joint mobilization: perform exercise aimed solely at enhancing normal joint arthrokinematics prior to exercise. Studies have demonstrated that mobilization of the thoracic spine enhances voluntary force capacity of the lower trapezius, which is a muscle group that plays a pivotal role in ensuring optimal scapulo-humeral mechanics. The foam roll has been used very successfully as a self-mobilization device for the thoracic spine, and will be a key exercise in the beginning of your routine.