My client has a recurring problem with his hamstring/gluteus. He is a weekend warrior who is very active in softball and football. A year ago, he tore his hamstring badly, causing extensive bruising. About three months ago, he had sciatica problems. Now he has severely pulled his gluteus. He says he has been stretching before he plays, but he still keeps having these problems. We have been working on strengthening his hamstrings and lower back as this is obviously a weak spot. What stretches and strengthening exercises do you suggest?
From the looks of it, I can tell you right now that the hamstring is not the problem, and I would bet the glutes aren’t either. I would consider this client to be in a delicate state as what you do with him can shift him for better or for much worse. Softball and football require a very high level of athleticism. The musculoskeletal system has to be at a “race car” level of conditioning. This means you have to be proficient in gross chained movements in all planes of movement and have a highly developed neuromuscular system.
There is a common catch phrase in the fitness industry: “the site of the problem is rarely the origin of it.” Remember the body works as a unit. If there is a weak link in the chain, the rest of the links have to pick up the slack, which is exactly what is going on with your client. Let’s look at some of the factors about the musculoskeletal systems' functioning and behavior to help you approach this properly.
- Muscles behave in protective manners whenever there is instability, particularly at the joint level by tightening or becoming facilitated. This is like a “picking up the slack” principle (i.e., an unstable shoulder will create facilitated tension in the biceps to keep it together). So understand that muscles act like the Calvary if there is instability.
- There are mechanoreceptors in joints that allow muscle work to perform at varying degrees, provided stability is present. They provide information to the brain about what is going on every millisecond when it comes to movement. The less stability there is, the less your brain will allow the particular muscle group to perform because it deems it too risky and can cause pain or injury. The more stability there is, the more recruitment of muscle your brain will allow because the “coast is clear,” so to speak. This is why it’s important to never train through pain.
- Pain is the most powerful re-programmer known to man. The body uses pain as a tool to ensure safety and survival. Your body can and will completely realign its musculoskeletal system from something as simple as a bunion to any kind of trauma in order to avoid exacerbation of it. Pain will cause inhibition, reciprocal inhibition and the shutting down of certain tissues. For instance, a Cesarean section will completely shut down the abdominal wall. This alteration and inhibition will change the length-tension relationships of the musculoskeletal system in the body.
- Length-tension relationships are important to assess and understand. Long muscles tend to be weak and lack mechanical advantage and stability. Short muscles tend to be workaholics or facilitated and can risk overloading from contraction and/or referred pain to another site close by.
Understanding these factors can shed some light on what’s going on with your client. You mention that the hamstring has been torn before and stretching hasn’t helped. Using what we know about the musculoskeletal system, the hamstring seems to be facilitated and behaving in a protective manner because of a root problem that has yet to be determined. The stretching is not working because the root of the problem hasn’t been solved. Most people generally have tight hamstrings, so they were probably already somewhat facilitated before he tore it. Once the hamstring had to stiffen more to provide stability for the root problem, overload of contraction on an already tightly wound up muscle would cause it to rip. It probably happened during a game. At this point, massage or neuromuscular therapy would be good to help heal the hamstring. There is probably old scar tissue, trigger points and even some pain inhibition that can shut it down, which is also a clue to why the glutes are now acting up.
As you can see, we are moving up in the chain. The glutes now are acting in the same pattern as the hamstrings. Once the hamstring tore, it most likely shut down, decreasing stability so naturally the glute has to "pick up the slack." However, it sounds as if there is some double duty going on with the glutes. The hamstrings may be shut down and weakened from the tear, so they can’t handle the job of stabilization they were already doing for the root problem, so the glutes now have to stabilize the root and the bad hamstring on top of it. That’s a recipe for a tear as well.
So continuing up the chain, you mentioned there is currently some sciatica-type pathology. The best thing to do would be to assess the lumbar vertebrae and sacroiliac joint (focus on L4, 5 and S1). This could be the root of the problem, which can be throwing everything else off. There is probably some type of pathology and instability going on in the lumbo-pelvic hip complex. There could be one or more herniated discs, nerve compression, some old injury and/or an inactive abdominal wall.
Everything in the body emanates from the core, and it is or should be the primary generator for movement. The limbs or extremities are merely expressions of the core that are like the finishing touches. You will find most of your problems in the area from the neck to the pelvis. It looks as if the root of the problem is in the lumber spine or sacroiliac region. You have to be a good detective to get to the source. I would ask your client if he had any old injury or back issues in the past that may tip you off to the etiology.
I’m afraid there is not much I can offer you in the way of stretching and exercises because I don’t know exactly what’s going on. It may not be a good idea to do a particular stretch or exercise because it could make your client worse. You can quite easily herniate a disc or tear another muscle group with a particular exercise. This is why program design is essential to learn about as well as advanced training of the musculoskeletal system because you just can't throw exercises at a client without knowing what’s going on. In the meantime, you should read the articles The Inner Unit and The Outer Unit by Paul Chek. Until you find out what’s going on, you can get some mileage out of this to make sure your client has a fully functioning abdominal wall, which will be critical going forward.
Also, you should find a good physical therapist, chiropractor or orthopedic specialist to help your client. These people will be your best friends right now. Your client needs to be muscle tested and checked for spinal pathologies such as herniation, disc bulging, etc. Assessing the length and tension of the entire musculoskeletal system, focusing on the hamstrings and glutes, can lead you in the right direction for stretching and strengthening exercises. Only then can you effectively be part of the solution to getting your client rehabilitated.