Category Archives: Anatomy

Muscle in focus: Hamstrings

The hamstrings

I know I call this ‘muscle in focus’ but the hamstrings is really a group of muscles, three to be precise. At the back of the thigh, between the hip and the knee, semimembranosus, semitendinosus and biceps femoris all have two main actions, extension of the hip and flexion of the knee. They play a crucial role in standing up, walking, running, jumping… and are the major antagonist of the quadraceps. [1]

They are also the most injured muscles in the body.

Hamstring muscle injury is a common athletic injury, particularly for runners, running & jumping athletes like footballers, long & high jumpers, and dancers.

The most common cause of a muscle or tendon strain is overuse, which weakens the tissue fibers. Muscles and joints may also be forced to perform movements for which they are not prepared or designed, over stretching and potentially damaging the surrounding muscle or tendon. An injury can occur from a single stressful incident, or it may gradually arise after many repetitions of a motion. [2]

The word “ham” is derived from the Old English ham or hom meaning the hollow or bend of the knee, from a Germanic base where it meant “crooked”. … String refers to tendons, and thus, the hamstrings are the string-like tendons felt on either side of the back of the knee.

Injuries to the hamstring group of muscles can range from a minor strain to a major rupture. A minor or grade I tear to a hamstring will most likely heal with a small amount of physical therapy, such as massage and dry needling. A major, grade III tear or full rupture could be a major disruption to an athletes sporting career and may require surgery.

World Athletics Championships, 2017

Even someone at an Olympic level like sprinter Usain Bolt is not immune to injury, tearing his hamstring in the World Athletics Championships earlier this year.

How do they happen?

At the knee, these muscles act to slow down your leg as it swings forward very quickly during in preparation for footstrike. It’s this action that commonly leads to injuries because the muscle is trying to shorten and contract, but the knee is extending very quickly, which pulls on the hamstring and creates a tremendous amount of strain.

At the hip, these powerful muscles generate force just prior to the foot coming off of the ground as they extend the hip backwards. Injuries can occur at this point of the running cycle because these muscles are generating tremendous amounts of force to maintain, or increase, forward running velocity. [3]

What are the symptoms?

You don’t have to be an elite athlete to injure the hamstring. Over use, misuse and lack of stretching or massage can put you at risk. Even tight quadraceps can contribute to tight hamstrings.

Symptoms of a strained or torn hamstring could include sudden and severe pain during exercise, along with a snapping or popping feeling in the area, pain in the back of the thigh and lower buttock when walking, straightening the leg, or bending over; tenderness; bruising in the area. [4]

In severe cases, you can tear your hamstring from its point of origin on the ischial tuberosity (sit bones). This is called a hamstring origin avulsion. In extreme cases, an avulsion fracture will occur where the hamstring muscle tears the bone where it attaches off your pelvis. This happens after a sudden and forceful eccentric contraction of your hamstrings with your hip flexed, for example, when hurdling or performing the splits. When this occurs, it is necessary to undergo surgery in order to reattach the bones.  [5]

How is it treated?

If you feel you have strained or torn a hamstring muscle, the first thing to do is R.I.C.E.R. – Rest, Ice, Compression, Elevate and Refer, as in refer to a health care practitioner.

The risk of hamstring injury can be reduced with a regular stretching program and exercises. However, a strained or torn hamstring will need soft tissue therapy, some biomechanical assessment to find the cause of the injury, heat & ice therapy and stretching. Once the pain has eased, the muscle will benefit from gentle exercise and a strengthening program.

Static hamstring stretch

Straight leg hamstring stretch

Lying on your back, raise your leg straight up until you feel the tug of the muscle. Don’t over stretch or force the stretch. If you feel numbness in your foot, ease the stretch off a fraction until the numbness subsides.

Breathe deeply and hold the stretch for 30 seconds. Lower the leg and rest for 10 seconds. Repeat each leg 3 times.

If you need to support the leg, use a towel or belt looped around the arch of the foot.

 

To increase flexibility

Lie on the floor in a doorway or close to a corner of a wall.

Place one leg up against the wall, the other is straight on the floor and your buttock is as close as possible to the door frame or wall.

Extend the elevated leg and pull your toe own as much as possible until you feel a stretch behind your thigh.

Hold the stretch for between 10 and 30 seconds.

Active Stretch

If you’re a particularly flexible person, but still have tight hamstrings, you could benefit from an active stretch.

Lie face up with a theraband around the arch of the foot to be stretched. Bend this knee. Hold the stretch theraband in one hand, arm straight. Stabilize the thigh with the other hand.

Exhale, straighten the knee while lifting up on the theraband, until extended.

Lower the leg and repeat 5 times. Finish with a static stretch.

Foam rolling

Place a foam roller on the floor and sit on the floor supporting yourself with your hands.

Place the back of one thigh over the foam roller and the other leg on the floor for support. Support your core and have proper low back posture during the exercise.

Stretching; the when, what and how.

When should I stretch ?

In the first 24-72 hours of injury the best treatment is R.I.C.E.R. (rest, ice, compression, elevation, and referral). At this stage, stretching is not advised. It’s best to rest the injured area and apply ice for 10 minutes of every hour until the swelling goes down.

Head to the emergency department if you think you may have a bone fracture or to your health physician for further investigation.

After the initial 72 hours, with clearance from your health physician, you can start some rehabilitation techniques over the next 10-24 days.

Over the period of 2 to 5 weeks you should aim to regain your flexibility, strength, power, muscular endurance, balance and co-ordination.

Long term, once you have recovered from your injury, it’s time to regain fitness, strengthen the injured area and improve flexibility.

When we talk about injury, this doesn’t always mean a serious injury. It could be anything from also waking up with a stiff neck or straining a muscle while picking something up to tearing a muscle during sport or exercise.

What types of stretches are there?

Static Stretching

Static stretching is used to stretch muscles while the body is at rest. It is composed of various techniques that gradually lengthen a muscle to an elongated position (before the point of discomfort) and hold that position for 30 seconds.

Passive Stretching

Passive stretching is a form of static stretching in which an external force exerts upon the limb to move it into the new position. This is in contrast to active stretching. Passive stretching resistance is normally achieved through the force of gravity on the limb or on the body weighing down on it.

Active Stretching

Active stretching eliminates force and its adverse effects from stretching procedures. Active stretching stimulates and prepares muscles for use during exercise. … Agonist refers to actively contracting muscle or muscles while their opposing muscles are termed antagonists.

PNF Stretching

Proprioceptive Neuromuscular Facilitation (PNF) is a more advanced form of flexibility training that involves both the stretching and contraction of the muscle group being targeted. PNF stretching is a very effective for rehabilitation.

Dynamic Stretching
Dynamic stretching is a form of stretching beneficial in sports utilizing momentum from form, and the momentum from static-active stretching strength, in an effort to propel the muscle into an extended range of motion not exceeding one’s static-passive stretching ability.

When should i use these stretches?

Static and passive stretching should be used in the early days after injuring.

PNF stretching can be used in the later weeks as the muscles are beginning to regain their strength. This type of stretch is often performed with a physical therapist.

Dynamic and active stretches should only be used when the muscles are healed and are strengthening. They should never be forced and always a controlled action.

What techniques do i use to stretch?

  • Focus on the muscles that are sore;
  • Ease into the stretch, do not over stretch or force the muscle into position or into pain;
  • Hold the stretch for 20-30 seconds;
  • Breathe! Oxygen helps the muscle release;
  • Stretch both sides. The other side is likely to be carrying the work of the sore muscle.

Stay tuned!

In the coming weeks I will be adding some fact sheets on stretching routines for each of the major muscles groups, such as the calves, quadriceps and hamstrings, lower back, neck and shoulders, rotator cuff, and forearms.

 

The Benefits of Breast Massage

Breast massage is a useful tool in maintaining the health of your breasts. According to the Texas Institute of Functional Medicines, breast massage is the act of slowly kneading and stroking the breasts, using varying amounts of mild to moderate pressure in gentle lifting and compressive movements. You can perform breast massage on yourself or with the help of a partner or trusted qualified practitioner.

As with any massage, its primary purpose is to rid your body of the harmful toxins that interfere with your health; however, there are many cosmetic and therapeutic benefits to breast massage as well.

Breast massage can;

  • help clear congestion, oedema or lymphedema;
  • help reduce breast pain;
  • help reduce the discomforts of pregnancy, breastfeeding and weaning;
  • help improve general drainage problems;
  • reduce menstrual congestion;
  • ease tenderness and congestion related to benign conditions;
  • reduce scarring from recent surgery;
  • ease pain and improve perception of breast trauma;
  • ease discomforts related to cancer treatments*
  • integrate post-surgical changes;
  • educate in self examination and self massage.

Breast massage can be useful in maintaining the shape of your breasts and preventing sagging. According to the Ayurvedic Cure website, massaging your breasts stimulates circulation, which is necessary for keeping your breast tissue healthy. Massage also helps break up benign cysts, strengthens the muscle tissue of the chest and builds resiliency in the ligaments. With breast massage, your breasts will be firmer and less likely to sag.

Massage is contraindicated when lactational mastitis, post surgical infection, current active infection for any reason, any undiagnosed lump, any abscess or any forceful technique on implant related contracture.

Men suffer from breast conditions too, including cancer. While incidence is low, prognosis is often poor because of late diagnosis.

Self Breast Massage

You should never consent to breast massage if you cannot, for whatever reason clarify your wishes and comfort boundaries, if the therapist cannot establish professional neutrality, or if you and therapist cannot establish open communication.

*when treating clients with breast cancer, the therapist must have a body of knowledge about cancer, cancer therapies and implications for massage treatment planning

References

  1. Curtis, D., ‘Breast Massage’, 1999, Canada
  2. Ernst, M., ‘The Benefits of Breast Massage’, viewed 20 January 2016, <http://www.livestrong.com/article/134213-the-benefits-breast-massage/>
  3. http://www.thetorontobreasthealthclinic.com

Muscle in review: Pectoralis Major

I’ve decided to do a series of reviews on some of the major and minor muscles in the body. Some of them might be obvious to you, in where they are and what they do but some may get forgotten about and neglected. Hopefully you’ll learn something new about your body and how to look after it.

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Pectoralis Major

Pectoralis Major

More commonly known as one of the ‘pecs’, pectoralis major is the largest muscle in the rotator cuff group, at the front of the chest. Generally speaking it attaches from the sternum and collar bone, to the top of the humerous.

It’s main job is to help raise and lower your upper arm, it also helps rotate the head of the shoulder. A common pectoralis major exercise is the chest press or push ups.

Chest press

 

 

When there are trigger points in the pectoralis major, pain and tension will occur in the local chest area and may refer down the inside of the arm into the inside of the forearm and hand.

Trigger points

 

The main symptoms may feel like pain in the front of the chest, front of the shoulder, hypersensitive nipples or breast pain, pain inside the elbow; rapid/fluttery/irregular  heartbeat/heart attack-like pain*, wrist & palm pain; other symptoms may include pain in the back of the fingers or inside of the arm.

Tension in the pectoralis major can also cause obstruction to the bracial plexus, the major network of nerve controlling the functions of the arm. When obstruction of this nerve occurs, patients may experience numbness, tingling and weakness in the lower extremities of the arm, especially in or starting from the thumb.

Brachial plexus

When treating pectoralis I generally use manual techniques, such as myofascial release through compression or slow deep tissue massage from the sternum, below the clavical and into the attachment below biceps at the top of the arm. Pausing to compress at any active trigger points until they release.

If you are doing stretches to look after your neck and shoulders, don’t forget to also stretch your pectorials. The most convenient way to stretch them is to lean into a doorway, holding either door jam (or one side at a time).

Pectoralis major stretch

Or on a foam roller/rolled up towel;

Foam roller stretch

Lying vertically on a foam roller with your buttocks and head supported, bring your arms to 90 degrees with your hands facing the ceiling. Gently rest your arms on the ground and hold the stretch for at least 60 seconds.

 

 

If the stretch is too much, place towels or pillows under your hands so that the stretch is more comfortable.

*Please ensure if you ever feel chest pain or heart attack symptoms to immediately seek emergency medical care