20th April 2015
We've all seen clients demonstrate limited ROM in a straight leg raise and had them say to us "I know, I've got tight Hamstrings. I haven't touched my toes in years!". Often we see clients with a ROM of 45 degrees or less and here them say how they've tried to stretch but never see improvements. So why is this?
The first feel
When testing the straight leg hamstring ROM, and finding a large limit to the range, you'll want to determine how this end range feels. There are two main sensations - soft and firm. A soft end range indicates that there is potential for quick improvement as high tone or fascial binding give a springy sensation. In this case, when the client has not benefitted from stretching, it is likely that synergistic or antagonistic muscles need addressing. Improvements in ROM can improve in mere seconds, especially if inhibition of the Glute Max is indicated.
Firm end feels are more of a challenge though. Unless significant boney abnormalities exist, a 45 degree ROM in the straight leg raise is unlikely be limited by the joint. Therefore we need to look at other soft tissues to decide what the limiting factor is.
Asking the client where they feel the stretch is a great clue, as most will say that the stretch is behind the knee or in the calf, rather than in the belly of the Hamstrings. This stretch is also a bit more 'zingy' than a muscle stretch. Plantar flexing the foot usually releases the stretch whilst dorsi flexion significantly increases it. You've now ascertained that the nerves are restricted and are indicated rather than the hamstrings.
Further tests can be made to work out where and why the nerves are restricted and manual mobilisation of the nerves can help to improve their overall mobility.
From a Home Care perspective 'Flossing' has been proven to be a successful strategy.
Whilst a little complex to learn initially, flossing helps to glide the nerve from head to toe, with slight adjustments in technique for targeting the Tibial, Peroneal and Sural devisions (see our members area for how to perform these tweaks).
This exercise works well in the initial stages but often we find that the pelvis has lost its ability to rotate anteriorly in this type of patient and traditional nerve flossing exercises do little to change this.
Functional Nerve Flossing
That’s why we developed the Functional Nerve Floss. In just a few reps you can watch a client struggle the reach their knees in a toe touch assessment to seeing them gain a whole hand’s distance below their knees. This is because the nerves have been mobilised, whilst the nervous system learnt to tilt the pelvis forwards as they flex at the hip.
This is why we call this a Functional Nerve Floss - we get to teach functional patterns and improve soft tissue mobility.
To perform the floss, stand straight then flex forward at the hips (not the spine) and hold onto something like a chair that can support you in this position. Keep flexing at the hip until you feel the sensation of stretching nerves down your legs. From here, rock back on your heel, raising the toes, which increases the stretch. As the stretch sensation increases allow your pelvis to posteriorly tilt to feed slack back into the nerves and allowing them to be drawn towards the feet.
Next, drop your feet whilst you tilt the pelvis as far forwards as you can. This is the more intense phase of the movement, so go gently. By doing this we now drag the nerves back up the legs.
Repeat 8-10 times then rest, repeating only one set 3-5 times during the day.
In limited ranges of straight leg hip flexion, you should assess what the end feel sensation gives you. If firm, and a stretch anywhere distal to the hamstrings, you should test the ankle to see if the sensation intensifies and/or relieves. If so, nerves are usually indicated.
Functional flossing of the nerves allows us to access the movement pattern, as well as the nerve mobility, and free up the pelvis. This will have repercussions in all movements for the patient, particularly in allowing them to sit in a more neutral position rather than tilted back onto their sacrum.
Give it a try and let us know how you get on.