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Picture

Hamstring Tightness or Neural Tension: How can you tell?

11/14/2013

5 Comments

 
Picture
We are all guilty at one time or another of prescribing a hamstring stretch prematurely. You saw a patient bend forward to touch their toes and they abruptly stop short. This must be their hamstrings stopping their motion! Well unfortunately it is not that simple anymore. Modern literature tells us the reason they cannot touch their toes may be due to an array of possibilities: tight posterior chain muscles, adverse neural tensioning, or poor stability/motor control of the core musculature just to name a few. For the sake of this post we want to address hamstring tightness vs. adverse neural tension. 

To begin this conversation, let's take that same patient above and place him/her in long sitting to reduce the effects of spinal loading. Now, postural demands are less than that in standing. We can focus specifically on muscle tightness vs. neural tension. The patient leans forward to touch their toes, but again nothing changes. We are no closer to finding our solution than we were in standing. Now, we bring the patient into supine, and the therapist performs a passive straight leg raise (PSLR). The patient cannot raise beyond 60 degrees of hip flexion. We still do not know, but we are getting close to the answer. Is it muscle tightness that is stopping this patient at 60 degrees or is the act of passively straightening the leg causing strain on the neural tissues. To answer this question, simply palpate the ASIS as you perform the PSLR. If you notice that hip flexion stops prior to movement at the ASIS, the answer is Neural Tension. If the ASIS begins to move prior to resistance, then hamstring tightness is the answer. 

Since the hamstrings attach to the Ischial Tuberosity, the body will naturally begin to posterior pelvic tilt once all the available range is taken up in the hamstring muscles. This posterior pelvic tilt will cause movement at the ASIS, letting you know the hamstring muscles have reached their end range. If no movement was noted at the ASIS, you can shift your hypothesis towards adverse neural tension. An additional component you can consider is the use of cervical flexion/extension to change the tension of the nerves and thus potentially alter SLR ROM.

Just like any examination test, it is important to cluster your findings with other tests and measures. For example, if you suspect adverse neural tension, perform a SLUMP test as well. Additionally, always check side to side symmetry. 

5 Comments
Ben Pianese link
11/18/2013 07:45:57 am

Hi James,

You are sound very knowledgeable with a good understanding of body mechanics . The words and phrases you used to describe the movements of the hamstring muscles is very empowering. Thank you for sharing your experience with us we never stop learning.

In my experience I can help release people release neural tension from their hamstring sometime in only few minutes. I use the Emmett Technique. You can learn more about my therapy by watching Ross Emmett video on my site. Ben

Reply
Robert
11/21/2013 12:02:22 am

Just to clarify, do you palpate the ASIS on the same or opposite side of the PSLR?
-Robert

Reply
Jim Heafner
12/1/2013 12:01:46 am

I have tried doing both, but prefer to palpate the ASIS on the ipsilateral side. Since the hamstrings on that ipsilateral side attach to that innominate, I believe it gives a more accurate result. Unfortunately the movement can be very subtle.

Reply
Michelle
12/5/2013 12:41:47 am

Thanks for the post.
Can you also differentiate hamstring involvement from sciatic nerve irritation by sensitizing the SLR test with hip IR & hip abduction?

Reply
Alfred
8/5/2015 02:43:51 am

You are most likely biasing one hamstring over the other with this modification, so it may give you some good information as to which hamstring is tight. It shouldn't change the sciatic nerve itself much.

Reply



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    • Cervical Spine >
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      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
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      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
    • HEP >
      • Neck and Shoulder >
        • Supine Chin Tuck
        • Supine DNF with Towel Assist
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        • Seated Cervical Retraction Repeated
        • Seated Cervical Retraction with Extension Repeated
        • Seated Cervical Retraction with Sidebend Repeated
        • Seated Cervical Retraction with Rotation Repeated
        • Standing Wall Shrugs at 90 Degrees Flex
        • Seated Thoracic Whips
        • Standing Ballistic Shoulder Extensions
        • Standing Repeated Shoulder Extension with Squat
        • Standing Repetead Shoulder Horiz. Abd. with Ext. CKC
        • Seated with Arms on Pillows Cervical AROM (Flex/Ext/Rot/SB)
        • Seated with Arms on Pillows Shrugs
        • Seated with Arms on Pillows Shrug with Scapular Retraction
        • Supine Shoulder IR with GH Centralization
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        • Holding Dumbbell at 180 Degrees Flexion for Time
        • Cat Camel
        • Prone T's
        • Prone Y's
        • Quad Chin Tuck w/ Shoulder Flexion
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        • Repeated Lumbar Sideglides
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        • Repeated Standing Lumbar Flexion
        • Repeated Prone Press-Ups
        • Repeated Supine DKC
        • Slump Sciatic Nerve Glides
        • Birddog Progression
      • Hip and Knee >
        • Clamshells with Progressions
        • Fire Hydrants with Progressions
        • Donkey Kicks
        • Bridge Variations
        • Repeated Hip Flexion
        • Squats
        • Seated Repeated Knee Extensions
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        • Heel Slides
        • CKC DF with Tibial IR
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        • Forefoot Adduction
        • Gastroc Stretch
        • Repeated PF
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