Hamstring strains, anatomy and nerve tension: two real stories

This is session number 69 of the Performance Place Sports Care Podcast. Yay! Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey everyone, it's Dr. Sebastian Gonzales again, Performance Place Sports Care Podcast right here. Now, if you didn't hear the last intro, the last one was about my friend who was, he's half Canadian and half Pakistani, and he just started dropping A's in here. You know, he'd go to Canada, and he would kind of bring back all these terms and lingo that he had heard over there, and A is obviously one of them.

So yeah, last podcast, I had Abra, which is a combination of Canadian plus surfer lingo. This one was a combination of, yay, it was yes and a question, eh, right? So anyways, first off, I guess I should let everyone know that I'm trying to be a lot harder with this stuff. I don't have any prejudice against different ethnicities or cultures. I think they're great because they are different than mine. But anyways, so I have friends of all different cultures and types, so I, yeah, I'm not bashing on Canadians, I promise, okay? So this month, this podcast, actually we're going to go over some stories from people who have hamstring conditions, as well as we're going to go over a little anatomy.

And the reason why I wanted to bring this up for at least the patients or the people dealing with hamstring injuries is I want them to realize that there's no point in reinventing the wheel, okay? So these people have had the conditions that you probably have. Or at least, obviously, you need to get diagnosed and see someone, but you might have a lot of questions of, is this normal? Like, how long did it take this person? What did they do for rehab? What worked? What didn't? How did they feel? How did they feel mentally? Were they defeated? Did they're, were they able to complete their workouts?

Were their friends still around for them, you know? Did they have to get new friends? Like, these are all things that I think patients with hamstring conditions, they get frustrated. It's a very frustrating condition. As you're going to hear next week with, Nate Helming is going to come on and talk about that from the runner's experience, or the run experience. So this is why you should stay tuned as a patient. Stay tuned as a doc. I think that you're going to get a couple things out of this, okay? And number one is I want you to be able to clear and approve this podcast and all my podcasts. Because I want you, this is what I really, really want.

I want you to share them with your patients, okay? And the reason for this is because I believe in scratching my own itch. I have patients all the time ask me, let's just say with a hamstring, it's like, how long will this take? You know, like, what should I stay away from? Can I go running? You know, can I do boot camp? These are things that, like, I believe could be roughly answered in a format like this. And I don't think we have time to have this conversation with every single person. And it might sound like I'm being a jerk, but honestly, it's more of helping more people with a little less reinventing the wheel or doing the same thing over and over again.

So, I prefer just to improve on our system here. So, if you have not seen this already, docs, PTs, trainers, okay? If you're still using all your old beaten up netters and skeletons and Merrick charts and things like that, and people still keep coming back and asking you the same questions over and over you get every day, I'm trying to mitigate all this stuff. And so, what I'm trying to put together this year in combination with a bunch of YouTube videos, a bunch of images, and a bunch of podcasts. By the way, I'm doing YouTube videos every day. If you don't know my podcast, boy, that is, just type my name up or performance place on YouTube, you'll find it, okay?

We're doing this every day. So, what I'm attempting to do is build a really, really good patient education platform for the modern sports medicine patient education, okay? So, we're going to do the eyes and ears as attacking the senses, all right? For the eyes, obviously, we have YouTube videos as well as the images or posters, which are anatomy-based, so the updated stuff, right? Netters is amazing, and skeletons are amazing, but realistically, I think we can update all the stuff that we have because those are what taught us. They didn't teach, they're not intended to teach patients. I mean, we spend hours and hours and hours learning that stuff.

So, there's going to be a ton of posters. By the way, go on to ptsportscare.com slash shop, and you can get them all there, the web-based version, for free, okay? You'll see that there'll be an email flying, and that's mainly just so I can get you to get them in a timely manner because I can't manage everybody's right there. So, if you want my help in patient education, because that's what I'm trying to do here with the podcast, you can share them with your people individually, or what I'm doing for all the people who do buy posters, and it doesn't matter if you buy one, it doesn't matter if you buy a small one, a big one, a vinyl print, it doesn't matter, okay?

I'm going to send over a Google Doc of all of the podcasts categorized into conditions, all right? So, if you have someone with a hamstring condition like today, these are the four podcasts you should listen to, and by the way, here's a correlated one on trunk stabilization, and here's another one on how to improve running gait, right? These are things that they might want, so I'd rather your office staff or you as the doc send them to your patients so they can better understand what you're trying to do with them. Does that make sense, everybody? Good. All right. So, no guest or expert today. It's just going to be people with stories, and I want to express extreme gratitude to everybody for sharing and listening to this podcast.

It's been over a year now, and I've heard so many good stories, people emailing me and contacting me and letting me know what they think, and I really hope to. I mean, I have a couple friends, actually, a couple colleagues that I think they should start podcasts. They're amazing individuals, they have great information, but sometimes it takes a little bit of, you know, pushing. So, if you are someone who has a story or has stuff they've got to share, stuff they should share, and you want to make an impact in the world, I think a podcast is a great way to do it. It's much easier than YouTube videos, which that was my original passion with patient education, and I still do like it, but, I mean, shoot, I'm unshaving right now, and I'm wearing a dirty old hat, which is, it works, because you can't see me, right?

I hope I don't start doing these ever in actual video format. Maybe I will one day. So, anyways, I think if you're struggling with that, or if you're scared, like, your first podcasts are going to be terrible. Your first videos are going to be terrible. Mine were, and you should look back on, if you're looking at, look at YouTube. Go back to the very first video, the earliest video that I had, and it's me standing. I was actually, I had this terrible lighting. I was by a, I was at my kitchen table, and you can see this creamy colored background, and it's terrible. I feel like I was just rambling, kind of how I am now, and you've got to be very direct.

You've got to be very quick with people on YouTube, because you lose their attention. You lose their audience retention, like, because it's under 15 seconds, sometimes you lose half of them. So, at least on podcasts, like, you're probably flying on a plane or walking your dog right now, and you just, you're okay with hearing this right now. But anyways, it was really bad. It was really, really bad. The lighting was terrible, and my first podcast, actually, I did it from my iPhone on a headpiece driving in a car to a clinic. And it was mainly because I was, I forget my first podcast topic actually was, but I remember I would go back and forth, and I would have, I'm like, I saw a great patient today, or here's what I learned today.

And they were really, really short, and the audio was bad, and you can, there was one point I had to stop because, like, someone almost hit me. But, yeah, so anyways, if you have a passion for that, and if you want my assistance, go ahead and just ask me. I have no problem sharing videos of how my mixer's set up, which mixers I bought, what kind of technology you need, which you can probably do it under. I mean, you buy, I mean, you really do it on your computer. It doesn't cost that much at all. So, if you have that passion, go ahead and share it with people. So, here we go into the hamstring topic.

Sorry for the long-winded one this morning, but here we go into it. Okay, so here's anonymous caller number one with a hamstring problem. What's up? Hey, so I always injure my right hamstring every single time I play sports. What do you play? Tennis. Okay, tennis. So, just to reiterate, I'm going to have you on as well as another caller who I want to make sure that all the listeners hear what a hamstring condition kind of feels like, at least to some people, so they can kind of resonate, is this something that's happening to me, you know? Yeah, exactly. So, with tennis, how long have you been having hamstring things?

So, it's more than one. Yeah, so hamstring things started happening after I graduated college and graduate school and just started getting old. Started getting old. How old are you? 29. So, you started having it at like 25? 23. So, what happened the first time, anyways? So, the first time I was sprinting, so I was changing directions quickly. So, what ended up happening was I made a good shot, thought I had it, and then he made a better shot back, and I had to change directions, go make a 180 turn, and really push up to get there because I'm that terrible person who will sacrifice my body for the point.

So, did you win that game? Not even close. I didn't even get near the ball, but I got a nice injury out of it, too. That's good. Wait, so when you stopped and turned, was it the leg that you were stopping on and turning away from, or was it the other one? It was actually the other one. It was, so I was running to my left, I stopped and turned, pushed off my, tried to do a real hard push off my right leg to pull myself in the opposite direction, and it just felt like a pulling, like a, all of a sudden, like a sharp pull in the back, right behind my knee. Okay, so it was more of like a knee-based one rather than like up at the butt cheek or mid-belly.

Yeah, definitely closer to the knee than the butt. Okay. Did you have any experience any, like, did you have any tingling in the feet or like back pain or any that stuff at the time, or? No tingling in the feet, but back pain definitely started happening after a couple, after a couple days. Okay. In weeks. Were you, I'm guessing, did you bruise? Or was it bruising on your? No bruising, no. Just real tight, and the problem is if there's no bruising, you can't physically see it when you go to the doctor and they look, they look at you and they're like, well, looks fine to me, here's, tries taking some ibuprofen, but the thing is, taking ibuprofen doesn't get me back on the court, it just gets the pain to go away.

Yeah. And then I know if I get back on the court after the pain is gone, I'm still going to be injured. Yeah. Did, how long did it take you to actually start playing again? Uh, so I rested it for about three months. After that, so after those three months it took you to get back, then, is there, actually, what did it, you said three months of resting it, and then you eventually started to play, how long? Sorry, I had a timer go off on my phone here, so I don't know if you heard it. Found a problem? Yeah, so how long did it take you to play one more time? Uh, I think we got three months before I was, before I felt ready to play, and it, by feeling ready, it was just, hey, I'm going to try playing with some friends again.

Okay. Did you try anything for, like, did you, did you try to rehab it at all, or, or do any, um, any stretches or, or treatments or anything with it? Yeah, I did, like, a hamstring stretch before playing and after playing, and that's about it. Okay. Was there, was there anything that you remember, or a couple activities that, uh, you can recall that, that hurt every single time you did it after you, at least the first week after you had the strain? Sprinting. In a straight line, to the side, forward, backward. Sprinting, it just feels like when I'm pushing off, like, my hamstring feels loose.

Okay. Loose. Can you, can you explain that? I haven't heard that, actually. It's hard, it's hard to, it's a hard, it's a weird way to describe it, I know, because usually everyone says it's tight, but it feels loose. Like, when I push off, I feel like it's not like a crisp pushing off, like, it's just some sort of, like, sluggish, all right, here we go, push. Huh. I, I, I'll be honest with you, I haven't, I haven't heard that description either, but this, this is actually, this is a good reason why I'm more, we're doing the interview here, um, because everyone's going to feel things a little different way, right?

Yeah, exactly. Okay. Um, so what's your experience with, actually, what was your, what was your next time that you irritated it? And it was, it was at the exact same spot or a different spot? The next time I irritated it ended up being a little bit higher up my hamstring, more towards the middle. And it was sort of the same thing. I was backpedaling and trying to get to something that I should have given up on. I feel like I can insert joke here. Um, okay, so then, did that, that one didn't bruise either, I'm guessing. Backpedaling's not, didn't seem like a lot, you know? No, never bruising. I guess when you were looking for people, you asked for a hamstring injury.

I just keep getting injured. It's not like some drastic torn hamstring or anything crazy. It's just my hamstring. Yeah. It hurts. Yeah, no, I, I, I get it. I get it. Cause, cause I had one too. And actually, so this month we're doing hamstring injuries. And so one of the podcasts I did, uh, just before this was my story with it. And like, I felt a pop. I was running. Um, I, I actually didn't notice a bruise until about a week later. Someone pointed it out to me. Um, I decided to get a massage with it and there was a little bit of a bruise really high kind of up into the groin area. And that was all I noticed.

But I mean, I couldn't, I couldn't play for three months either, you know? Um, so yeah, it sucks. Cause I mean, you get out of work, all you want to do is play some tennis. I, I never really think that, but I can, I can see where you think that. How long have you played tennis? I started in high school. Okay. Do you still, you still play tennis, Alan? Not too much. I moved on to other sports. Is it, is it because of the frustration of the hamstring or because you just don't have a drive for tennis anymore? I don't have the drive for tennis at this point. Okay. I heard people go to pickleball. Never played it.

Really? Don't even know what it is. It's a, you should look it up. It's, it's a huge thing with, um, I don't want to say, I don't want to say, I want to say the geriatric population because they narrow the court of tennis. It looks like you're playing, uh, in the inner squares, I think. It reminds me of a combination of like badminton and tennis. I thought that was called short court. I don't, I don't know. This is, I, I wish you had already heard about it so we can have the discussion between both of them because I don't even know. I, but I, I know that people lose their mind about it out here in California.

So with, then what, what, what kind of stuff are you onto right now then? Uh, volleyball and just general running, jogging. You don't have any problems jogging then? No, no problems jogging. Okay. And so just to reiterate for people then, is it, is it, do you still feel that if you were to sprint right now, do you feel like you would have a strain possibly or? Yeah. Over the course of the years, I figured out how to warm up a little bit better. Uh huh. So now I have to, uh, now, now when I warm up better, it doesn't bother me as much, but at the same time, I don't play as hard as I used to. Okay.

What, uh, why did you decide to not play as hard? I guess I just was sick of getting injured. Okay. So if then, if you, if you were to not be able to, if you were to eradicate the possibility of having an injury, at least drop the rate of it, would you play tennis again or would you increase your? Okay. Wow. I know what sport you're into right now. You still there? Yeah, I'm still here. Oh man. I think you're into windsurfing. Windsurfing? No, it's just windy here. Is that what that was? Yeah. Oh, cool. Um, all right. Well, uh, anything you want to add else to your hamstring story? Uh, no, I'm looking forward to hear the rest of the podcast.

I'll learn more about it. Okay, cool. Well, thanks a lot. All right. Thanks. And now a word from our sponsor, Health IQ. Did you know that higher levels of physical activity like running is actually associated with reducing risk of seven, seven different types of cancer. And it's actually around 20% roughly. This is a big drop. Health IQ knows this and they know that you're an overall healthy person. So why not pay less for life insurance? Contact them and take their lifestyle quiz to see if you qualify for special rates on life insurance. Health IQ is an insurance company that helps health conscious people like runners, cyclists, weightlifters, and vegetarians get lower rates on their life insurance.

To see if you qualify, get a free quote today at healthiq.com slash performance or mention the promo code performance when you talk to a health IQ agent. Now back to the show. Hello? Hey. Hi. How's it going? Fine. Sorry, I missed the other call. I was trying to hang up for one call and it didn't go through. No worries. Then I lost you by the time I got to your call. No worries. I thought I would just try again because, yeah, why not? So how's it, what's new? What's new? Um, what is new? Nothing. Same old stuff. Well, did that, did that hamstring thing ever come back or? It does, um, on occasion.

Actually, it's, you know, a little sore now type, but nothing like it was. It doesn't impede my running at all. So, I just, you know, try to remember to step up on, say, the rolling and stuff like that when it starts coming around. But, no, not like it did. Okay. See, this would be your perfect one for this, this interview. Okay, good. Okay, well, so then, what do you, like, what do you remember about it? Or, actually, first, where, where do you feel it? Where did you feel it? And has it changed? No. It's right at this insertion, so real deep, you know, so, you know, um, real high on the hamstring at the, you know, lower, like, under the glutes.

And so deep that I think, um, as I recall, it, some people would say piriformis, and some people would say, no, it's not that, so it was right, you know, that general area, but it was real deep, where it was hard to get to. Mm-hmm. What, uh, and it hasn't changed, right? It's, it's still kind of similar. No. And when, when it gets really bad, like, when I came and saw you, it was bad enough, it was traveling down my leg, and I think occasionally, even into my lower leg, but it would, it would definitely travel down my hamstring. Um, and I think, uh, yeah, it would go, sometimes, like, down my leg, and then it would, um, like, rotate onto the left side of the calf, almost, when it was really bad.

So it was going all the way down. Okay. So actually, you're, you're actually going to be awesome for this, because, um. Okay. I love being awesome. Well, I never told you anything differently, so, um. The, so, uh, the, the reason I thought it'd be, actually, that you're, I, I'd forgotten it was like this, because it was years and years ago, but the reason why, actually, you're going to be good is because, actually, hamstring conditions are a little bit different, or they, they go very closely to nerve-related conditions, like sciatica, or like, um, we call it discogenic pain, but. Okay. And that was the other thing, people, they could never tell, sciatica was another one that no one ever knew of, was it sciatica, was it piriformis, whatever, so.

Yeah. That would explain why. Well, so, down into the calf, that's actually a sign of neural tension, so there's a nerve-related component with it. Oh, okay. Whether you have both or just one is a whole different story, but, um, so, with that being said then, since this is educational for everybody, can you say what things would bother it? Um, uh, well, running. Well, I, I say running, it impeded my running, but I found when I stopped running, it didn't make it any better. But it bothered my running, and then the big one is sitting. Okay. Um, whether for, you know, long periods on drives, but even, I can remember, like, going to restaurants, and you're sitting, if it's a hard seat at all, I was always shifting, because I couldn't sit for any length of time, so that would be the biggest.

Um, occasionally, bending down to pick something up, but that wasn't near as bad. It was more the sitting that was the problem. Okay. So, it didn't matter how long you're sitting. It was, the firmness of the seat seemed to matter? Yeah, the harder the seat, like if it was wood seats, that was really bad. And then, I think on driving, you know, of course, that's cushioned, but then that would be a length, if it were a long drive, then it would bother me. So, yeah, definitely the hardness of the seat made it, um, to where you didn't want to sit at all, then. Okay. So, you remember so much more stuff that, uh, I, I don't know if those questions helped us in the other day.

They did, because it got me thinking about it. You know, and actually, I didn't remember the radiating down my leg until you just asked that question, and I'd forgotten about that. Yeah. But, I know when I went to see you, it was 2012. What I don't know is how early in the year I went to see you. Um, um. And you might have that. I don't recall. I, I, I, I'm kind of blindly going through. I, I didn't look at any, any, anything from the past. I just know that. Okay. You had it kind of around the cheek, which I thought would be a good one. Yeah. Um. Yeah. So, how long did you have it? Well, I, and that's, I think prior to seeing you, I, I, it had been several years.

I mean, it could have been, could have been off and on for like maybe five years, it seems like. It was a long time and it just was varying degrees of, um, of debility, you know, how much it hurt and stuff. And then I think I was, I was picking up my running. And so, of course it was getting a little worse, but, um, it was off and on for quite a, and I tried a lot of different kinds of treatments. Okay. So just, just so everyone knows, cause you're running a couple of times, can you, can you describe, uh, what caliber of running or what speed or what distance? Just so. Oh, well, let's see. But, um, I mean, I do marathons and I was training for a marathon when I came to see you.

Um, so I was probably doing, uh, 50 miles a week roughly. And I was training for Boston in 2013 and I did Boston that year, I think, uh, just under three 40. So that gives you, that's like an eight 20 pace or something like that. Eight 25. I may be remembering wrong, but it's right in there. I know that runners are really good at dividing like that. I used to be better, but now that I have it Garmin, I'm not as good as I used to be at dividing. So, so during that time, like I, I thought I would go a little bit into the, the, the psychological portion of it. Was it when you first got it, did you feel like, Hey, this is going to go in its own or was it really freaky?

And that's something I was saying. That's, I think where it was the most frustrating is because it felt like it wasn't that big a deal. It just feels like, Oh, I'm a little bit tight. I need to stretch it out. And I think where the frustration was, was nothing was helping. So I think that was, and I, and I like to run and I wanted to be able to still try to run. I mean, I used to be quite a bit faster than that. And I just wanted to try to be competitive again. So it was more frustrating than anything because it did seem like it should have been an easy fix. So it affected your, it didn't affect your running completely, but it affected your pace.

Yes. And it would affect my, yeah, it affected because when it was bad enough, it would hurt the whole time I'm running. In fact, I do remember it was bad enough at one point. I think I remember, like I'd wear water belts because, you know, hydration belts. And it seems like I was going numb even in my butt cheek area. And it was, you know, because the carrying the water belt must have been right on where it wanted to, it was, you know, pressing on something. But if you're going on a long run and you're going numb on one side or you've got pain, yeah, if it's not affecting your pace, it's got to be affecting your, um, uh, your efficiency because if that's all I'm thinking about, so that kind of stuff.

Yeah. I'm sure, like, so it just kind of weighed on your mind and it was just... Yes, yeah. Okay. Yeah. And I didn't like, yeah, you know, you're constantly moving and trying to... Or sitting. If I can't sit at a dinner table for long periods of time, that's not good either. Your husband never told you to sit still. Stop moving around so much. No, you know, and that's why I know that the not running didn't help. His was more than just, quote, don't run. His was... But I... It didn't matter. If I didn't run, it still hurt. Yeah. Did... But I'm sure running... I'm sure running exasperated it, and it's probably...

But it didn't seem like that was... Yeah. So as far as how I felt, it was more frustrating than anything. Yeah. And I'm sure it affected my running. I mean, I know we went pretty, uh, intense on treatment towards the end because I was, um, running Boston and... And that's why I know it was 2012. I was running Boston in 2013, and I was concerned about not being able... That it would stop me from being able to do the race. So, you know, I'm sure it impeded my running. To some degree. Mm-hmm. Um, can you... What's your... What's your age range? Just so everyone can kind of get a picture of... Oh, well, I just turned 60.

Did you really... That was a big one. Congrats for making... So when I was seeing you... So that's, um... What did we say? 2012? Uh-huh. Um... Hang on. I can turn that off. Um... Yeah. So I was 55, right? Am I doing that right? I... I don't... That's pretty bad if I can't... I was in the 54, 55 range when I was doing it. But I'm still running. Okay. At 60. So five years later, so, you know, it must have helped. And I had... Like I said, I have it a little bit right now. But, um, I'm probably not doing some of the stuff I know I should be doing. So when you first had it, I imagine that, like, if I was that age range and I had that, someone's...

And you started talking about it, someone's going to say, well, you're maybe just getting old. Oh. Um... Hmm. Did anyone... No one ever did that to you? And the other thing is, I happen to know that... That is true. You do just say that. But, I mean, I knew that I have other friends in that age range or close to it, and they're running pain-free, and it bothered me not to be able to run pain-free. But I knew they could, so I'm thinking I should be able to run pain-free. So I guess, as opposed to just dismissing it and giving up running, is that maybe what... Well, that's sort of like what my husband's point was, just give up running.

But, um... Yes, I think some people would say that, but most of my friends are runners. So I didn't hear that as much. Yeah. Um... They're runners that are younger than me, most of them. Yeah, I don't... I don't think anyone really ever wants to hear that. I heard it one time, too, when I was, like, 29. I'm like, this is the exact wrong thing to say right now, this whole point in time. Yeah, yeah. And it's... But what I was going to say is, the other thing is, I know that hamstring injuries, it's really common as people age. I don't know what, um... Physically why that is, but it's really common that people have hamstring issues.

Mm-hmm. Yeah, I honestly think a lot of that is from... I mean, there's a tissue repair process, which is important, but also, too, like, I mean, I think sprinting is a healthy thing, or running at quicker cadence, but it's... Mm-hmm. It's... I don't... A lot of people don't do the work during the week to prepare for that, you know? It's not something you can just get up and just do it when you haven't been doing it for months. Yeah. Okay. Yeah. That makes sense. Um... So... And that's actually one of the things you... You had given me... I don't know if you recall, you had given me, uh... Warm-up exercises to do, and I was really good about those during that time.

Like, I can remember doing it in the hotel room before Boston and all of that, and those helped a lot. So that's sort of like the same thing. It's warming up those muscles so that you could do those... That's faster pace or whatever. Mm-hmm. Yeah. And be more diligent about that. Well, I'm glad it worked. I'm glad it worked out. Yeah. Although you got a little thing there still, so I might give you some advice after I turn the recording off, but... Okay. What advice would you give other people or runners that are having hamstring conditions? The cross-training, I think, is really critical. Um...

I was doing it some, but not as diligently, so that you get a stronger core. And you stress having a stronger core, and I think I did some weight sessions with you to try to work on that. So I think cross-training and rolling on my own... I mean, definitely, you're going to a doctor who can do all this stuff, but if you roll on your own, the rolling, I think, is really good. And you had me doing that, too, because I remember you suggesting... Different... Like, you know, sometimes I was just rolling on the hamstring, and you were like, you know, also do the hip flexor and stuff like that, because it's all attached.

So I would say the cross-training and the rolling. So now we've heard those really awesome stories of people's real accounts of hamstrings. You kind of get an idea of how different they can be, how different people describe them. Overall, it's... I mean, I think they're really, really frustrating conditions, and they don't have to be. They do not have to be. But I know that... And I've probably said this before, but when I have an injury, I sit and sulk about it for probably a good two weeks, sometimes, sometimes three. And in this case, my hamstring condition, it was probably about a month or so, you know.

I eventually did the right thing, but it took a little time to get my wits about me and so on. So now on to the boring part, and I don't want you to tune out, because there are some juicy tidbits in here. I think they're important, but I think we should go over some of the rough terminology surrounding the hamstring, because we have a couple hamstrings. They cross multiple joints. They're very dynamic, and the reason why I want you guys to at least know some of this terminology is because when you read things on the internet or you see videos, you're going to wonder, what the heck are these words?

Now, the lateral hamstrings are generally known to most people by the terms called the... God, it's escaping me right now. The biceps femoris. There's a long head, and there's a short head. Whenever you hear long and short, long means two joint, short means one. So the short head just goes past the knee. That's it. The long head goes up into the sit bone, which is actually the pelvis, in case y'all didn't know. The medial hamstrings are... They have a little bit more complicated names, but for the most part, just if we know them as the medial hamstrings, we're not going to lose that on a lot. They're called the semitendinosus and the semimembranosus.

Now, these ones on the inner side or the medial side are... They're also two joint muscles, so they can also have a possibility, or they actually move the hip as well. And they're also affected dramatically by the pelvis, the hip, and the torso. Okay? The short head muscles really don't have a lot of injuries. They can, but it's much more rare. These two joint muscles, they're really, really dynamic. Okay? And what I mean by that is they can do a lot, and they're really exciting muscles, and they really allow us to do a lot of exciting and fun things. A lot of times when you hear of someone straining something, it's usually the two joint muscle in question.

Quad strains are a lot of times they're a two joint muscle in the front, called the rectus and morris, so a lot of times they're not the actual single joint part of the quad that you're probably thinking about. Now, to really consider the association with the hip, I want you to be seated for this demonstration. If you're driving a car, you can't do it. But if you're walking along, just get on a park bench, tail fighter to take a little break right there. And I want you to sit there, put both your feet on the ground, drill three points of contact in, or another way to think of it is just have your complete foot grounded on the ground.

You're going to have to slide off the end of the bench to actually do this. Now, I want you doing something called perching. I want your sit bones on the very edge of the seat. Now, we're going to take the hands, actually it'll be harder to do if you have a dog in your hand, but I want you to take your hands and put them on the sides of your hips and kind of push your pelvis forward or quote unquote sticking your butt out, and then do the opposite. And you're going to rock back and forth here a little bit, and you're going to feel your sit bones move in relationship to the contact on the bench.

Now, this is a technique we use for actually finding a comfortable seated position in case some of you having back pain. This affects the stacking of the spine above it, but also too, it affects the nerve roots coming out. So, first off, if you're having any issues, you probably want to stop or just make sure you find a comfortable position. But when it comes to the hamstring attachments, I want you to feel how the actual sit bones move. Now, this is where the hamstrings attach at the top end. So, the reason why we're doing this demonstration is because, say the hamstrings are supposed to be three feet in length.

Now, they have this optimal range of contraction. We call this the length-tension relationship. They want to be three feet. They have the most contraction potential at three feet. They're the strongest at three feet. But now, you rock the pelvis back. You have the butt sticking out. The sit bone comes back a little bit. And now, you're asking it to be three feet and one inch. It might not seem like a lot, but it's actually a pretty dramatic change when it comes to function. So, a lot of times people say that things feel tight, but they're not actually tight in their normal position. So, let me say that one more time.

You are supposed to have the hamstring at, say, three feet, but you're asking it to do more length than it's supposed to. So, that's one reason why they could possibly be doing more work and possibly being strained. Second thing is we have to consider is the possibility that this is not a hamstring condition at all. And I'm sure that there's a lot of people out there that think that stretching the hamstring will increase its length because it feels tight, but realistically, we have to consider the possibility that this is a nerve root condition or what we call neural tension. Now, something I usually have people demonstrate with this is I have them seated and I have them kick their leg out.

This is actually an orthopedics test. But you kick the leg out and you see if their hamstring, quote-unquote, tightens. If it tightens, that's fine. Now, let's do some tests to actually see if it's correlated to a nerve root or if it's actually the muscle itself. Now, when doing tests like this, I usually explain that there's... When we put a load upon the hamstring and the hamstring tightens or strains or becomes painful, by all means, like this is... That's a possibility of a hamstring strain. But if I had you move something else or we affected something else, let's just say your finger, and the hamstring all of a sudden increases its symptoms or tightness, then that's not the hamstring at all because the hamstring doesn't attach there.

We just talked about the attachment points. It goes below the knee, up to the hip, or up to the sit bones, the pelvis. That's it. Okay? That is the first thing to consider with this. So, with this test, or these tests, when we're tensioning the nerve, you kick the hamstring out, you lock it, and you draw the toe towards the head. Don't move anything else. Does this increase the tightness? Well, it's okay if it increases the tightness in your calf, but if it's into your quote-unquote hamstring, then it's not really your hamstring. It's neural tension. Next thing is, if you look up to the sky, with that same position, everything else, if you look up to the sky, and this decreases the sensations, then, again, we're affecting something so far away from the hamstring, from a structural standpoint, that there's no possibility of it being the hamstring, almost next to zero.

Sure, you're allowed to have multiple things. I don't discount that you can have a hamstring strain plus neural tension. You can have all that stuff. But, realistically, when we're looking at the testing and the assessment, if you can affect the person's feeling of tightness of that quote-unquote hamstring with foot movement, or head movement, or even postural changes, or load changes to the spine, then we're not working with a hamstring. We should be working at, probably, spinal stiffness. And this is different for every single person. It's really dependent upon the assessment and what is needed.

But a lot of times, people can affect this or improve this just by improving their posture or how they move throughout the day. Now, I've had people in my office, actually, before. We do this obstacle course, actually. And a lot of them don't like it because I snap my fingers. And for some reason, snapping fingers doesn't work for people. So, but I started off, actually, well, there was this one lady the first time that I started. She likes to speak during her, talk to me during her rehab. And I have no problem with that. I like talking to her. She's a cool lady. But I needed her to stop at certain points or correct something.

So, I said, look, if I see the knee cave in, I'm going to snap. Okay? And what I want you to know is every time I snap, we can keep talking, but you better correct that. So, what I'm asking of people here is that we're looking to see if they are changing posture and this is affecting the tightness of the hamstring, then I will have them go through random tasks throughout the office, quote-unquote obstacle course. So, I might have them pick up a kettlebell and move it. I might have them get down on the ground, roll on their back, crawl over to the corner, pick up something light sometimes because sometimes heavyweights actually gets them to get their form right, but picking up a lighter weight, all of a sudden, they disrespect it.

Okay? You have to respect the movement. So, as I go through this, I basically see them around or have poor posture and their symptoms come back and I snap my fingers. I'm like, is your hamstring tight? Yeah, it is. Okay, well, stop right there. Reverse a little bit. Let's do that a little bit better. What's a better way to do this so you don't lose posture? And they sit there and think about it. So, they might, rather than crawling onto their hands, they might sit up tall and then go into a lunging position. This seems to work for them. So, but there's many, many different things that people do this on.

We call them pain triggers or they sensitize the nerve root. And I know I'm getting a little bit away from hamstring stuff, but the reason why I'm speaking about this today with you guys is because it is extremely, extremely common for people to come in with completely normal hip range of motion, completely normal hip function, completely normal hamstring range, and say their hamstrings feel tight. And then they demonstrate and they say, it's worse when I sit down. It's worse when I look down. It's worse when I'm sitting in my car. These are things that indicate that they're going in the wrong direction with their care, that they need to improve their assessment.

First, number one, and second is they need to clean up what they're doing throughout the day. Third, we need to implement more of a spinal stiffness program rather than just a hamstring stretching one. Now, going back to the hamstring, let's talk about actually if there is a strain there or a structural problem, by the way. Actually, first, I should talk about structure and functional problem. I did a whole podcast on this in the past. I will link to it. It's about categorization of muscle strains, and this was as of a consensus statement they had back in 2012. But basically, it took the breakdown of a functional versus structural injury, and it kind of goes along the same example I was talking about with the neural tension.

Basically, and this is how I explain it to patients when they come in, and they say, well, when I go like this, it hurts, or what's a better example? Okay, so actually, recently, I cut my finger. I was brewing beer. I sliced my finger with glass, and honestly, I'm thinking if I should ever make beer ever again, because it's kind of traumatizing for me. I didn't want to go in the garage, actually, for a little bit of time. But when I sliced my finger, there is nothing I could possibly do, movement, position, load, any of that stuff to make that area feel better. That's what we call a structural injury.

The structure has been compromised. There's a tear. There's a fray. And that is the exact pain generator. Now, what I tell patients when they come in, I say, if I stabbed you in the quad right now with my pen, is there anything I can do right now that would make this feel better? And they say, no. Right? It's going to hurt. Now, if I have a move, let's just say we're talking about hamstring stuff, if I have them lunge, and their hamstring hurts, and then we position their torso in a better position so the sit bone is in a better position, so the attachment is in a better position, and the hamstring no longer hurts with this movement, then we're looking at not a structure anymore.

We're looking at a function. If we can manipulate how that thing feels within only a couple minutes, then we're looking at a functional problem, not a structural one. Functional problems are a lot easier to address, but they take a lot more time. Structural problems, though, like they do happen. Structural problems typically occur at what we call the musculotendinous junction, and I'll back up a little bit here just so you understand the parts of a muscle or tendon complex. So, number one, muscles and tendons are the same thing, roughly. We categorize them as something different, but realistically, they are the same unit, okay?

A muscle is like what you would eat in a steak. It goes down and attaches to a tendon, or it becomes a tendon. The tendon attaches to the bone and moves the bone, or in relationship, moves the joint or your body. Now, this area where the muscle transitions into the tendon is called the musculotendinous junction, and it is an extremely dynamic, exciting, cool section of the entire unit, but because of that, it's almost like you have a Ferrari. Like, it's really exciting and cool and stuff, and all of a sudden, it breaks down. Actually, well, I guess I can't validate that, but I hear this about Ferraris and Porsches for some reason.

You have a sports car, and all of a sudden, it breaks down. It's in the shop all the time, but I don't know about that. Yeah, let's just say that's true. You get a high-end sports car right there with the musculotendinous junction, and it has a higher probability of breaking down, but it's exciting. So, which one do you want? You got to have some trade-off there, because these are the areas that you use a ton when you jump, run, play sports, especially, I don't want to say athletic sports, but quick sports, all right? Jogging is not as—the slower the movement, the slower the speed, the less of change of direction, the less these areas are actually utilized, and that's why a lot of times you'll hear people, they'll say, well, I was changing direction.

I was slowing down. I was landing. These are quick impulses. They just—impulse hits the area, and it can just damage the area into a structure injury. Now, let's back up a little bit here. Was that person just unlucky? I don't think so. I think there's signs that show that we could prevent these, and if you listen to the podcast coming up where I have with Dr. Colby Kondos, we're talking about a simple test called the star excursion test, which can, I think, believe it was 80 to 83% predict lower extremity injuries, non-traumatic, on D1 athletes. So, I mean, there's things we can see. We can see if the torso has stabilization.

We can see if the hip has proper movement. We can see if the ball and sockets are functioning well. And then we can see if the muscles crossing them have a higher risk as well. They're a little bit harder to see if you don't have a keen eye for it or if you're not looking. Let me say that. But it does mean they can't be found. Now, you're probably wondering, which one do I have? A function injury, a structure injury, a neural tension, a hamstring injury. I didn't say all this to confuse you. I think with a good healthcare provider, a sports doc, a good physical therapist, or even a trainer, although they're not supposed to diagnose things, they can watch you move and kind of see and they can see what is occurring with your body that will kind of lead you into the information that you need to make the correct call or to have the correct diagnosis.

Now, oftentimes, honestly, if we know the pathway that created it or we see the signs or what I call the elephant in the room, does it really matter what it is? Unless it's a surgical correction or if it's going to require some other type of intervention that I can't do in here anyways, that is not movement-based, that's not postural-based, that's not treatment manual therapy-based, if it's none of those, then I need to look and we need to have that MRI, we need to investigate the possibility that it is something more severe, but realistically, if the elephant's in the room, let's just deal with the elephant and how do you eat an elephant?

One bite at a time, right? It takes time. It's a process. It's not going to happen overnight. So, I know a lot of people are looking for quick fixes out there. There is no quick fixes, or at least I think there shouldn't be. There are things that will decrease pain, but there is no quick fixes. By the way, if you're looking for written content that I have on this, I have a whole article on hip pathologies, especially for distance athletes and baseball players, go on to p2sportscare.com. You'll see the patient area or the article area, and it's all in there. Just click on the person, their highlighted areas.

If you're looking for videos on this, I do have a bunch of videos coming out this month on hamstring conditions. And I dare to say, I mean, I'm pretty sure that every single day this month, every single day is going to have a video correlated to either hamstring assessment, hamstring diagnosis, hamstring rehab, hamstring treatment, or things surrounding that idea. Okay? Because you're going to see one, which is coming out, I think, at the end of the month. It's going to be about intra-abdominal pressure or how to stabilize the torso for hamstring conditions. And some of you might look at this and say, this is BS.

Why is breathing going to affect my hamstring? Well, it's going to affect it for the same reason I just said before. It changes the attachment point, which it changes the strain on the muscle. Or if you have neural tension, then it can affect the neural tension. So we're going to do things that are surrounding this concept this month. And for the entire year, every single day, unless I get lazy, I'm pretty sure I'm going to make it. I want you to root me out of this or send me ideas of things that you want to hear about because I feel like probably into April, I'm going to lose my train of thought and think things have already been done.

So send me some ideas of things that you want me to do videos on. Some suggestions I had before already was when I get to the shoulder month, someone asked me to show them how to put a jacket on without having shoulder pain because they had shoulder pain when they put their jacket on. And so I want you to go on to those articles, listen to the podcast correlated, watch the videos correlated, and become extremely educated about neural tension versus hamstring pain. Very, very different. Function versus structure, neural tension versus hamstring. All right, everyone. Those were anonymous stories of hamstring people.

So there's no way to contact them. Don't even try. Don't try to track them down. Yeah, if you've listened to that, I love the beautiful anonymous podcast. It's funny. Apparently, people try to track those people down. They're like, yeah, I know who they are. I'm like, don't even try. Don't even bother. It's anonymous. That's why they're sharing. So if you're looking for the show notes on this podcast, go to p2sportscare.com slash podcast slash pound or hashtag whatever age group you are. Put in the session number there. And since you're looking at your phone to see what session number is this, well, and while you're on there, why don't you just do a review too?

Scroll all the way down. Look at all those stars. You'll see the actual change from white to blue, I think, on iTunes now, the current update. And just put a little line in there. Just tell me what you think, how you felt when you listened to this podcast. Do you think I can improve on anything? I want to hear about all that stuff. I do want to make this podcast for you guys so you guys can learn and feel better about your injury after you hear it. All right. It's not meant to confuse you by any way. So lastly, if you are a doc, a PT, a trainer, a chiro, an MD, an ortho, and so on, if you want this stuff to put out to your patients, the images, the podcasts, and so on, just go on to p2sportscare.com slash shop, and there'll be a fly-in right there.

If you don't see it, it's because you've been on there recently and you didn't fill it out, so I think it only pops up every five days or so. Just go on there and say, hey, here's my email. I want all this stuff. Can you get it all to me? And I'll say, yeah, yeah. By the way, if you do email that back, I will answer every email that comes through. All right. Although it's an automated drip to get you the content, I do get emails back from there, and I do answer them. Okay. Lastly, this is the last. All right. Remember that golden rule. Okay. Treat others how you want to be treated. Be good to each other.

Think about, I think the world can do with a little bit more empathy. How do your actions affect other people, and how do the things that you say affect other people? All right. So I prefer to think it's what you, it's not what you take, it's what you leave. So if you leave people in a better place than what you found them, you're doing a good job. Peace. I'll talk to you soon.