Latest / The Ask Mike Reinold Show / Is Hamstring Tightness Correlated to Low Back Pain in Young Athletes? - #AMR394

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Is Hamstring Tightness Correlated to Low Back Pain in Young Athletes? - #AMR394 · The Ask Mike Reinold Show

• 0:50
  SPEAKER_00: On this episode of the Ask My Crystal, we talk about whether or not hamstring tightness is correlated to low back pain in young athletes.
• 0:58
  SPEAKER_00: The Ask My Cry.
• 1:03
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• 1:06
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• 1:15
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• 1:23
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• 1:28
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• 1:44
  SPEAKER_00: Still getting a lot of great questions.
• 1:46
  SPEAKER_00: So, you know, anytime something comes up you want us to discuss maybe on a future episode, just head over there and uh and let us know and we'll keep answering them.
• 1:53
  SPEAKER_00: Uh let's see, who do we have today?
• 1:55
  SPEAKER_00: We have uh Lenny McCrina, Anthony Vedetto, Dave Tilley, and Brendan Gates.
• 2:00
  SPEAKER_00: Um, got a good question for us today.
• 2:02
  SPEAKER_00: Len, who are our students that will be asking the question today?
• 2:06
  SPEAKER_04: Yep, still getting to know these guys.
• 2:08
  SPEAKER_04: Um there we there seem to be some good people here.
• 2:12
  SPEAKER_04: Um we have Noah Taylor from the University of Kentucky Wildcats.
• 2:16
  SPEAKER_04: We have Emma Armstrong from Duquesne University, Yinz in Pittsburgh, and we have Carly Luca.
• 2:23
  SPEAKER_04: Kali Luca from the Northeastern University, our hometown of Boston.
• 2:28
  SPEAKER_00: Let's go, Hoskies.
• 2:30
  SPEAKER_00: I love it.
• 2:30
  SPEAKER_00: All right, who's up?
• 2:31
  SPEAKER_00: Who's up for the uh first question?
• 2:33
  SPEAKER_01: Me.
• 2:35
  SPEAKER_01: Okay.
• 2:36
  SPEAKER_01: Stephen from California asked, I have many orthosurgeons refer kids with low back pain, and almost always in their notes it mentions hamstring tightness as a reason for back pain.
• 2:47
  SPEAKER_01: In your experience and knowledge, how closely is hamstring tightness related to low back pain?
• 2:53
  SPEAKER_00: Ooh, this this is a good one, right?
• 2:55
  SPEAKER_00: I think I think Dave's gonna like this one.
• 2:57
  SPEAKER_00: Um the first two things that jump in my head.
• 3:01
  SPEAKER_00: How many of those surgeons do you think checked this kid's hamstring flexibility?
• 3:06
  SPEAKER_00: There's no way they did, right?
• 3:08
  SPEAKER_00: Um I feel like they also checked the box for ultrasound and ESTEM on the uh referral thing too.
• 3:14
  SPEAKER_00: But um uh interesting.
• 3:15
  SPEAKER_00: So I like how this is phrased on kids, though, because I actually think that's an important component to this here, and that's how we'll kind of phrase uh, I guess, this episode here.
• 3:23
  SPEAKER_00: But is hamstring tightness correlated to low back pain in children, young, younger people?
• 3:30
  SPEAKER_00: Dave, why don't you start it off?
• 3:31
  SPEAKER_00: Because I'm sure you might just start it and end it, but why don't you start it off?
• 3:35
  SPEAKER_02: Yeah, I'm gonna say kind of, because this is uh it's easy to just like say that like this equals back pain, right?
• 3:43
  SPEAKER_02: Like there's unfortunately like a lot of times in the last, I would say decade, I can only say the last decade of research I've been reaching, where like something comes up in the literature, they test a bunch of people who happen to have a stress fracture or who happen to have flexion-intolerant back pain, they test a whole bunch of stuff and they find that a good chunk of them have this.
• 3:58
  SPEAKER_02: They have core stabilization problems, they have loss of hip IR.
• 4:01
  SPEAKER_02: That was a big one for a while.
• 4:02
  SPEAKER_02: They have limited hamstring flexibility.
• 4:04
  SPEAKER_02: And in kids, I think the thing that's really important is that like kids are growing at a extra, like extraordinary rate.
• 4:11
  SPEAKER_02: Like the bones just cannot keep up, you know, relative to muscles.
• 4:15
  SPEAKER_02: So like muscles are stiff because bones are going so fast.
• 4:17
  SPEAKER_02: So you have a kid who, you know, has a whole bunch of stuff going on.
• 4:20
  SPEAKER_02: He's playing a lot of sports, he's doing zero strength and conditioning program, he's throwing, you know, with uh mechanics that look like the wacky wavy inflatable man, right?
• 4:28
  SPEAKER_02: Like he has no technical basis at all.
• 4:30
  SPEAKER_02: And then he gets back pain.
• 4:31
  SPEAKER_02: And then they test a bunch of stuff and they're like, oh, he like, you know, he has tight hamstrings that must have caused his back pain, right?
• 4:37
  SPEAKER_02: If that kid had had, I don't know, like a total arc that was 20 degrees more than average or less than average, they've just like, okay, well, this caused his back pain, right?
• 4:44
  SPEAKER_02: Like there's a lot of things that go in there.
• 4:46
  SPEAKER_02: But that being said, I think if you look at it from a point of view of like relative instability and or like maybe something's moving more or taking more stress to make up for another thing, that tends to be something with flexion intolerant back pain that might make sense, right?
• 4:59
  SPEAKER_02: So you take a kid who um is growing a lot, he develops, let's just call it limited hip mobility, right?
• 5:04
  SPEAKER_02: His hamstrings are stiff, his quads get really stiff too as well.
• 5:07
  SPEAKER_02: And it's hard for him to hinge well and not have some rounding in his back or or have a high flexion angle of his trunk, maybe when he's running, or maybe when he's sprinting, or maybe when he's starting a gym program, right?
• 5:17
  SPEAKER_02: So they're connected, I would say, but correlated is tough because like the hamstrings didn't cause his back pain.
• 5:22
  SPEAKER_02: It was like his hips weren't moving for many reasons because he's growing and he's getting stiff or he's playing a lot, he's maybe not as strong, and he has some issues with his back.
• 5:30
  SPEAKER_02: The other thing I'll say on the other side, and this is the last point, is I actually remember hearing this from Eric Cressy in 2023 when I was taking a seminar or 2013.
• 5:38
  SPEAKER_02: Um, he was saying that like he sees a lot of people who have overextended postures because they're baseball players, they sprint a lot, they're whatever, and that if you start to have back pain, your brain might try to react and pull you into a posterior pelvic tilt, and you're yanking on your hamstrings all the time.
• 5:52
  SPEAKER_02: So maybe there's something there too as well with extension-based pack pain that it's more of a secondary protective thing.
• 5:57
  SPEAKER_02: But, you know, again, those are I just gave like five context situation that hamstring equals back pain.
• 6:03
  SPEAKER_00: Yeah, and I think they're all good.
• 6:05
  SPEAKER_00: I uh one of the first ones you harped on, I think, which was really good too, is that we we're specifically talking about children here.
• 6:10
  SPEAKER_00: So when you talk about children, you talk about bone growth and you talk about then muscle adaptation to bone growth.
• 6:16
  SPEAKER_00: You know, there's you know, I think a lot of kids when they're going through girl sparts, you could argue has hamstring tightness, right?
• 6:22
  SPEAKER_00: Or a flexibility issue.
• 6:24
  SPEAKER_00: You just you see it all the time.
• 6:25
  SPEAKER_00: And then they come in with low back pain and like, well, they must be correlated.
• 6:28
  SPEAKER_00: Um, let me ask you a question, Dave, or anybody else, but like, is there a chance it's the flip, right?
• 6:33
  SPEAKER_00: Does back pain cause hamstring tightness?
• 6:37
  SPEAKER_00: Yeah, we everybody wants to say hamstring tightness, tightness causes back pain.
• 6:41
  SPEAKER_00: Could it be the opposite?
• 6:42
  SPEAKER_02: I I think in that extension-based example, it makes you know mechanical sense.
• 6:46
  SPEAKER_02: Whereas if somebody has a stress reaction or a facet syndrome or something like this, um, and they're very overextended, the hamstrings being extra stiff could be a protective, like, you know, response to try to get them out of raging anterior pelvic tilt.
• 6:58
  SPEAKER_02: That's I I think I I do see that amount, but I don't see that kid when he's healthy before he got back pain.
• 7:03
  SPEAKER_02: Rarely exactly.
• 7:04
  SPEAKER_02: I I see that kid who walks in for an avow.
• 7:06
  SPEAKER_00: Right.
• 7:07
  SPEAKER_00: And theoretically, before he started, you know, swinging off a T at max effort all winter, he also was tight.
• 7:15
  SPEAKER_00: Oh hanging fruit.
• 7:16
  SPEAKER_00: Right.
• 7:17
  SPEAKER_00: Yeah, exactly.
• 7:18
  SPEAKER_00: Um, all right, I like that.
• 7:20
  SPEAKER_00: Anybody else want to jump in?
• 7:21
  SPEAKER_00: I mean, I get some other thoughts here too, but I got some I guess a thought or two, but a lot to unpack.
• 7:26
  SPEAKER_04: You know, why why is a kid with like non-specific low back pain going to a surgeon?
• 7:30
  SPEAKER_00: Um say he's friends of the family.
• 7:36
  SPEAKER_00: We'll see.
• 7:37
  SPEAKER_04: I'm gonna say that, but then you know, it's just like how did how did he determine that these hamstrings were tight?
• 7:42
  SPEAKER_04: Just like a you know, 90-90 leg raise, he just like forced the kid's leg into flexion.
• 7:48
  SPEAKER_04: Oh, yeah, a little tight.
• 7:49
  SPEAKER_04: Because it's an easy thing to find.
• 7:51
  SPEAKER_04: Um, but I do agree completely with Dave that it's you know what caused it and what what's it is is it the cause or is it the the result?
• 7:59
  SPEAKER_04: Um I know um you know most kids, like Dave said, are growing, they're just their bodies are in shock.
• 8:04
  SPEAKER_04: So uh you gotta convince the parents oftentimes that, yeah, the hamstrings could be playing a role here, because that's gonna be the question.
• 8:10
  SPEAKER_04: The parents be like, well, we have tight hamstrings, we've got to stretch his hamstrings out or her hamstrings out.
• 8:15
  SPEAKER_04: And you're gonna have to figure out a way to um address that because that's probably hamstring, quad, uh glute strengthening looks.
• 8:24
  SPEAKER_04: Um what put them in that position is an overuse thing.
• 8:26
  SPEAKER_04: Is there a spongy that we're missing?
• 8:28
  SPEAKER_04: Um is there some kind of issue with um you know overuse is the volume issue.
• 8:34
  SPEAKER_04: So um, yeah, I'm gonna stop there and I'll let anybody else take over.
• 8:37
  SPEAKER_00: Uh Brendan, what do you think?
• 8:39
  SPEAKER_00: I know obviously you work with a lot of different athletes and a lot of different settings and stuff, but what's your experience been with this?
• 8:45
  SPEAKER_03: Well, I was just gonna say the other box that always gets checked right next to the tight hamstring box is usually the weak core box.
• 8:52
  SPEAKER_03: Um, and I think going off of what Dave said and uh his experience with Creske's seminar, if we're in like a super extended position, just like the position of like producing power for like a lot of athletes.
• 9:03
  SPEAKER_03: If we're kind of stuck in that anterior pelvic tilt and uh you know, like we have our hamstrings really lengthened, maybe we have tight hamstrings, but also you know, like like a lot of kids have tight hamstrings with low back pain.
• 9:15
  SPEAKER_03: I think often as kids are learning how to play sports and learning how to move their bodies, like core control can be something that gets you know the boxes checked for a reason.
• 9:22
  SPEAKER_03: Um so I wonder if it's you know a mix of like we said, kind of all the above, if the weak core correlates to tighter hamstrings, tighter hamstrings can correlate to a decrease in core control, especially if we're playing like rotational sports, like baseball across anything where we're producing power in a rotational aspect.
• 9:40
  SPEAKER_03: Um I wonder if those are some things that are worth looking at for most people, and it seems to be.
• 9:45
  SPEAKER_03: And then uh the topic of just volumes, right?
• 9:48
  SPEAKER_03: Like if these kids are just playing so many sports and their bodies like uh capacity for these movements are just exceeded, um, you're likely gonna find a lot of these things to get checked on those boxes, but I think it's hard to say that it's just tight hamstrings.
• 10:01
  SPEAKER_03: I think we hopefully hammered home the point that it's it's quite a bit of different things that kind of all tie into each other.
• 10:07
  SPEAKER_00: Yeah, makes sense.
• 10:08
  SPEAKER_00: And you you you bring up almost like the concept of like relative stiffness to what in my mind, right?
• 10:12
  SPEAKER_00: Like the you know, the hamstring is relatively stiffer than the than the lumbar spine, for example, and just how those things interact.
• 10:19
  SPEAKER_00: Um, yeah, I mean, uh this is definitely a a broader topic, right?
• 10:24
  SPEAKER_00: When somebody comes in with non-specific low back pain, it's usually not one thing, it's gonna be a combination of things.
• 10:29
  SPEAKER_00: That's why, yes, you need to do a structural exam to look at the low back.
• 10:33
  SPEAKER_00: Did you find anything structurally wrong?
• 10:34
  SPEAKER_00: But two is you also have to look at some of those uh other findings, right?
• 10:39
  SPEAKER_00: So we call it like that checklist of suboptimal things that you might find because then they start adding up, right?
• 10:44
  SPEAKER_00: You might say, like, oh, you know, he has really poor, you know, core control, he has tight hips, he has uh, you know, tight hamstrings, weak core, whatever, whatever.
• 10:52
  SPEAKER_00: These things start to add up and they go together.
• 10:54
  SPEAKER_00: It's hard to say it's one thing when when you know it's it's that deep.
• 10:58
  SPEAKER_00: Uh what one other question I have, I guess, before we move on here is uh, and I'll go to Dave for this one just because Dave's the athletic low back pain guy.
• 11:06
  SPEAKER_00: At least we, you know, we have a course on on online for that.
• 11:09
  SPEAKER_00: But um, for for Dave, uh, does hamstring tightness correlate to any specific pathology more?
• 11:16
  SPEAKER_00: So let's say, for example, it's not non-specific low back pain, maybe it's a spongy.
• 11:21
  SPEAKER_00: Like our hamstring strains prognostic, I mean not strains, uh tightness prognostic of um like sponies or anything like that, like a real type of structural deformity?
• 11:31
  SPEAKER_02: Yeah, um, I'm gonna go with no.
• 11:33
  SPEAKER_02: You know, I'm in the literature, like I actually just did a huge lit review when we were making the course last year.
• 11:38
  SPEAKER_02: And there are definitely some studies that show, like, again, more people in this cohort had tight hamstrings and they also had back pain.
• 11:45
  SPEAKER_02: That's why they're in the study.
• 11:46
  SPEAKER_02: But I don't think you can you can say like tight hamstring equals, you know, flexion and tong back pain, uh, multifid eye spasm, disc herniation, sciatica, whatever.
• 11:56
  SPEAKER_02: Um, I think again, the only like connection that you find is that people who are young have limited hip mobility if they play a lot of sports and they don't take care of themselves.
• 12:05
  SPEAKER_02: And or I've had kids who like are literally at our gym stretching and doing soft tissue work every day, and they still like grow, you know, two inches when they're on a summer camp and they come back.
• 12:13
  SPEAKER_02: I have a kid today who literally has recurring groin strength.
• 12:16
  SPEAKER_02: He's a hockey goalie because every time he, you know, gets a little bit like uh stronger, he then gets a lot taller and his legs grow a lot, and then now he's doing three full splits on the ice.
• 12:26
  SPEAKER_02: And it's like kind of makes sense why your groin might be sore, but if his back is sore, I'm not saying that stiff groin equals back pain, right?
• 12:32
  SPEAKER_02: It's just that he's growing, his hips are stiff, and he's doing a ton of sports.
• 12:36
  SPEAKER_02: He just wants to play and be those kids.
• 12:37
  SPEAKER_02: And his interest in strength conditioning and 15 to 20 minutes of soft tissue work in addition to his warm-up is not really high right now.
• 12:43
  SPEAKER_02: He wants he wants to play hockey and play Fortnite.
• 12:45
  SPEAKER_02: That's what he cares about.
• 12:47
  SPEAKER_00: Yeah, you know, that that's the part that stinks about this for me, too, is like you go through a growth spurt, you have these issues, you know, you work really hard to get over it, and then you go through another gross spurt and you have more issues.
• 12:57
  SPEAKER_00: It's it's really that 13, 14-year-old, right, where it's that is just the worst age for these like overuse type injuries and growth-related injuries, these types of things.
• 13:07
  SPEAKER_00: So, um, so yeah, I mean, I guess I'll just end with one other thing.
• 13:10
  SPEAKER_00: Lenny mentioned it, you know, briefly.
• 13:12
  SPEAKER_00: Um, you can't not work on the hamstring tightness, right?
• 13:16
  SPEAKER_00: Because the physician said it, they probably said it to the person.
• 13:19
  SPEAKER_00: They probably told the kid to do it at home, that type of thing.
• 13:21
  SPEAKER_00: So I think what we do is we educate how that's part of the process, and it's just like one component of the process.
• 13:27
  SPEAKER_00: And we probably have to put it all together.
• 13:28
  SPEAKER_00: If all you did was work on your hamstring flexibility, you probably aren't going to get better.
• 13:33
  SPEAKER_00: Uh, but if you add that as part of a comprehensive, you know, program that looks at everything three-dimensionally, I think you'll probably do a lot better, as Lenny mentioned.
• 13:41
  SPEAKER_00: So uh anyway, uh, great question.
• 13:43
  SPEAKER_00: Um, I like ones like that there too, because I like I like when the PTs come and they say, like, I'm seeing a lot of this from physicians.
• 13:49
  SPEAKER_00: I think that's good because that could be some trends.
• 13:51
  SPEAKER_00: It could be their area, could be just trends uh from the physicians in general.
• 13:55
  SPEAKER_00: But I think that's that's a great one here.
• 13:56
  SPEAKER_00: So uh assess, don't assume, right?
• 13:58
  SPEAKER_00: That's something we always say, but it's always deeper than that.
• 14:01
  SPEAKER_00: So, Steven from California, thanks so much for submitting that.
• 14:04
  SPEAKER_00: If you have a question like that, again, head to microrund.com, click on that podcast link, and be sure to subscribe so you get updates on our future episodes.
• 14:11
  SPEAKER_00: Thanks so much.