Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Witty, Pask & Buckingham Chartered Physiotherapists 56 Billing Road, Northampton, NN1 5DB Tel / Fax: 01604 601641 Email: [email protected] www.WPBPhysio.co.uk • Twitter.com/WPBPhysio • Facebook.com/WPBPhysiotherapy Witty, Pask & Buckingham, in conjunction with Northamptonshire Sport Is your sport just a pain in the bum? The spot between the top of the hamstring and the bottom of the buttock can make it so.... The spot at the top of the hamstring where the buttock ends can be the site of much pain. Or is it tightness? It is often difficult to tie down what it is and thus it is difficult to know how to treat it. There are several common options: • Tear or strain of the hamstring • Tendinopathy of the hamstring • Gluteal strain – not common • • Nerve irritation Sacro iliac joint dysfunction The self-managed way to assess for a strain of the hamstring or glut is to stress the muscle and see if it hurts. If there is pain on stretching the hamstring or gluts especially sharp pain, there is likely to be some tissue damage. Testing and stretching Glut stretch Glut bridge Hamstring stretch Complete the glut and hamstring stretches and test your pain level. If you then have further pain when contracting the hamstring or glut, as shown in the glut bridge and hamstring contractions, especially sharp pain, then it is likely that you have a tear in the tissue. This needs to be rested and treated with easy stretching and massage, and you should only begin to load the muscle once the above tests are clear. This can take five to 10 days. There is usually a sudden onset, say during sport, but not always. Tendinopathy of the hamstring is more difficult to assess yourself. There is rarely pain on the tests described above but there is a tender spot just down from the bone that you sit on. The tendon feels thicker and stringier than the other side. The history is of a gradual onset of pain and is often associated with pelvic dysfunctions as described later. The presentation is of more of a dull ache and stiffness in the hamstring when running which warms up a bit but generally is just there! All of the above are associated with Sciatic nerve irritation. The Sciatic nerve passes through the gluts and into the leg at the top of Hamstring contraction Produced in conjunction with TimKeayDesign.com and SteveWalshMedia.co.uk Witty, Pask & Buckingham Chartered Physiotherapists 56 Billing Road, Northampton, NN1 5DB Tel / Fax: 01604 601641 Email: [email protected] www.WPBPhysio.co.uk • Twitter.com/WPBPhysio • Facebook.com/WPBPhysiotherapy the hamstring. Issues in this area have the effect of upsetting the nerve and causing protective tightness. This can last longer than the actual strain or inflammation because nerves are slow to settle down. There are ways to specifically test nerves but all are difficult on yourself. However using simple lower back and nerve stretches as shown will help in the mobilisation of the nerve. By putting yourself in the position below with a straight leg and doing small movements with the foot – pulling the foot up and down - 20 repetitions for three sets, four times a day will help to mobilise the nerve. Muscle tear To treat a fresh tear of the muscle requires four to six days of rest and the previously painful tests need to be pain-free. Once this has settled then you can start to mobilise the sore areas with a ball or roller as shown. Try to do a couple of minutes twice a day but not too hard as it is repairing tissue and you just want to mobilise it not break it. In an older, more chronic problem which is comfortable to perform the tests on but sore to touch and to run, then a more aggressive approach is required. These need a lot of mobilisation of the stiff and grotty tissue. These need around two minutes, four times a day, every other day and hard! Further, the hamstring needs to be strengthened with a combination of work in the gym and at home. The simple hamstring machines are a good place to start as they provide basic concentric and eccentric loading of the tissue and therefore strengthening. You need to work it hard though and five sets of eight reps at a weight that is fatigued at eight reps is the normal protocol. Other things to do are bridging with your foot on a gym ball and slowly straighten and bend the knee – single legged, three sets of 15 reps is fine. Chronic issues The final note here is that many of these chronic issues have a pelvic or Sacro iliac joint dysfunction at their core. It is worth trying to mobilise this yourself by using the Push exercise on the right. Grip your knee and press as hard as possible into your hands. The object is to try to straighten the hip not the knee. Repeat 10 lots of five-second presses hourly through the day. The deep glut muscles also always become very tight and using a ball as shown to work into the muscle is helpful. 2 minutes a few times a day. However if the tightness does not settle then it is time to seek help from a Sport Physio with good experience in running issues. This set of problems is complex and experience is helpful! Mark Buckingham is director of Witty, Pask & Buckingham Chartered Physiotherapists, based on Billing Road, Northampton. Call 01604 601641 for an appointment or visit www.WPBphysio.co.uk Produced in conjunction with TimKeayDesign.com and SteveWalshMedia.co.uk