Sports Injuries

The body is a connected whole and more than just separate parts and regions. When back pain presents, it might not be the back muscles or spine but could be tense, tight hips, and hamstrings causing low back pain. How it happens, how to stretch and loosen up, and target these areas could help alleviate the pain.

The Hips and Hamstrings

When the hip flexors and hamstrings become tense, the tightness can alter the pelvic alignment. This affects spinal alignment leading to discomfort and low back pain. The hip flexors are a group of muscles around the front of the hips, and they activate when moving the leg and knee upward. The hamstrings are the muscles in the back of the thighs that allow for flexion of the knees and hip extension. Muscle tightness in the hips and/or hip joint stiffness can also contribute to low back pain. Not being able to rotate, flex, or extend the hip forward or backward can affect:

• Walking
• Running
• Swinging
• Twisting movements
• This increases mechanical strain on the lower back.

Hamstring tightness can be a side effect of:

• Low back pain
• Pelvic positioning
• Muscle guarding
• Weakness
• All can contribute to the hamstrings feeling tight.

Tense Hips and Hamstrings

The factors creating this tightness can come from:

• A sedentary lifestyle
• Little to no physical activity
• Sitting too long with no stretching or movement.
• Injury
• Intense workout

Losing the ability to function through the entire length of motion can also indicate muscle weakness and a lack of joint movement where the joint around the muscle becomes stiff. This can be caused by:

• A lack of movement
• Arthritis
• Age-related changes

Stretching and Treatment

Stretching exercises can be the first line of treatment. It is recommended to start with gentle stretches targeting these areas. What works best for the individual is the stretch they are comfortable repeating enough to make a difference. Warming up the muscles first will generate the best results. An easy place to begin is a gentle forward fold stretch.

• Stand up straight, or sit with the legs extended out in front.
• Then, reach with the fingers toward the toes. Don’t worry if you can’t reach them.
• Don’t bounce.
• Hold the position for a few seconds.
• Repeat five to 10 times.

For the hip flexors, stretches include:

• High lunge
• Low lunge
• Warrior 1 pose

If the stretching does not bring relief, it is recommended to progress to a personalized treatment and stretching program with a chiropractor or physical therapist. Chiropractic and physical therapy can relieve the problems without medication, injections, or surgery and provide lifelong techniques for maintaining optimal flexibility, mobility, and strength. The hands-on treatment loosens and relieves the tense tightness, reinforcing the flexibility and range of motion. Treatment includes:

• Joint mobilization to the hips and spine.
• Soft tissue mobilization.
• A personalized strengthening program with stretches and exercises that target the specific muscles.
• Health coaching.
• Anti-inflammatory diet recommendations.

Body Composition

Monounsaturated Fats

Monounsaturated fat is considered healthy fat. This type of fat makes up a significant component of the Mediterranean diet. Studies have shown monounsaturated fats like extra-virgin olive oil can help prevent adverse events related to cardiovascular disease. A meta-analysis evaluating diets high in monounsaturated fats indicated a significant reduction in:

• Triglycerides
• Bodyweight
• Systolic blood pressure in individuals with type II diabetes.
• A significant increase in HDL or good cholesterol.

Another study showed the protective effects of monounsaturated fatty acids reduced the risk factors associated with metabolic syndrome and cardiovascular disease. Monounsaturated fats can have a positive impact on overall health. Monounsaturated fat sources include:

• Olive, peanut, and canola oil
• Avocados
• Almonds
• Pecans
• Hazelnuts
• Sesame and pumpkin seeds

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Estruch, Ramón et al. “Retraction and Republication: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90.” The New England journal of medicine vol. 378,25 (2018): 2441-2442. doi:10.1056/NEJMc1806491

Gillingham, Leah G et al. “Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors.” Lipids vol. 46,3 (2011): 209-28. doi:10.1007/s11745-010-3524-y

American College of Physicians. (February 2017) “American College of Physicians issues guideline for treating non-radicular low back pain” https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain

MedlinePlus. (2019) Hip flexor strain – aftercare https://medlineplus.gov/ency/patientinstructions/000682.htm

NCBI. (2021) Hamstring Injury https://www.ncbi.nlm.nih.gov/books/NBK558936/

Why is it that all of our patients seem to have “tight” and “overactive” upper trapezius.

A deep ache and constant tightness in the upper trapezius is a common complaint amongst most people and as well as leading to direct discomfort in the muscle, it may also contribute to headaches and neck pain.

But does everyone have tight upper trapezius or is it perhaps a secondary symptom of a larger underlying problem.Upper trapezius tightness and overactivity definitely does exist. We tend to see this a lot in heavy lifters such as weightlifters, powerlifters and cross fitters who have these big jacked up upper traps due to the huge amounts of pulling and pressing movements they do in the execution of their particular lifts.

The upper trapezius primarily works as an upward rotator of the scapular in the last phase of shoulder elevation and abduction, it assists the levator scap to elevate the scapular (but the scapular needs to be already in some upward rotation), it supports the weight of the arm and scapular as our arm is holding something (like heavy groceries or 200kg on the deadlift bar) and it also laterally flexes the neck and works to stabilise the neck when large forces are imposed on the head and neck. All of these movements are involved in most of the powerlifting/Olympic lifts/ Cross Fit moves seen by these athletes.

But what about Sally the secretary who seems to always have a tight upper trap but does not have the same imposed loads as a heavy lifter. Maybe the upper trap is compensating for something or it is trying to protect something. Below are a few reasons why someone may have tight feeling upper traps but in fact have weak traps that are just simply trying too hard.

 A TRUE SCAPULAR ELEVATION IN POSTURE WITH A BUNCHED UPPER TRAP IN SPASM

A Patient could be trying to hide or protect something and what they may be trying to protect is a cervical nerve root injury of a brachial plexus injury.Injury to the nerve bundle will feel worse when it is placed on stretch as the traction of the arm will tug on the nerves and may create nerve pain ad radiculopathy. One way we can alleviate the pain is to contract the upper trap to lift the scapular and release some of the traction. This is a common finding in research that looks at how the upper traps fire during an upper limb tension test for the nerves. As the nerve is manually stretched in the test, the upper trap picks up its activity to perhaps protect the nerve and take some stretch away. This happens in healthy people as well as injured persons.

So someone with a nerve root problem may in fact increase the upper trap to protect. This has been studied for decades and I have included a reference of a recent study on this exact phenomenon(1).

THE UPPER TRAPEZIUS CAN COMPENSATE FOR WEAK UPWARD ROTATORS SUCH AS SERRATUS ANTERIOR

The upper trap should only really come in to shoulder elevation movements in the last phase of movement when the arm is approaching a vertical position. It does this to elevate the scapular and clear the acromion process away from the head of the humerus. If it comes in too early and is active too early, then perhaps it is compensating for weakness in other upward rotators such as the serratus anterior.

THE UPPER TRAP COULD BE HAVING A TUG-OF-WAR WITH THE PEC MINOR

The pec minor is a downward rotator of the scapular. As the arm is being lifted and the scapular is upwardly rotating, the pec minor needs to relax. If the pec minor is overly tight and hypertonic, it will try and pull the scapular back down again. So the upper trap along with the serratus anterior will have their work cut out to try and fight this downward drag. Again this is a compensation.

So before you go ahead and deep tissue massage a patient’s “tight” upper trap or dry needle the muscle to relieve the tone, have a think about WHY the muscle is so active. You may get better results treating the neck for a nerve root irritation, or strengthening the serratus anterior or maybe loosening the pec minor instead.

 
1. Matthews et al (2012) Upper Trapezius Activation during Upper Limb Neural Tension Test-1 in Karate Players. Ibnosina Journal of Medicine and Biomedical Sciences. 173-178.

This piece comes straight from The Sports Injury Doctor. Sign up on the right to receive advice and information like this straight to your inbox.

Science chiropractor, Dr. Alexander Jimenez investigates the methods described in treating a tight calf muscle.

Assess The Calf Complex

In the calf complex, the medial sural nerve descends between the two gastrocnemius heads and also at mid-calf level combines with a branch of the peroneal nerve to form the sural nerve(1,2). As we get older, the body's connective tissue gets less pliable. Nerves are naturally surrounded by connective tissues -- sometimes they even run through connective tissues, so with aging the nerves can get trapped, trapped or tethered to surrounding muscle or fascia(3).

This can manifest as a feeling of tightness deep in the calf muscle that never changes, no matter how much the customer stretches the muscles.

Action! Evaluate The Calf

The perfect method to appraise the calf is to palpate the muscle in a relaxed position (see Fig 1. below). Begin with your patient's unaffected calf; palpate (feel) deeply between the gastroc heads supporting the knee and work down the calf into the Achilles tendon. This will give you a sensation of the deep neuro myofascial tissue enclosing the tibial nerve, and what 'normal' feels like in this patient. Beware: it's generally quite uncomfortable to do so because of the sensitive neural structures.

Then feel the affected calf in the exact same way. If there is a difference in the deep center section (eg tightness, pain, lumpiness) and if, when you press, then it replicates their usual 'pain' or 'tightness', it might indicate a nerve tethering problem that needs hands-on intervention.

Assess the nerves of the lower limb by using the slump test (see Fig 2, below) or the straight leg raise test to cross-check your client's neural system and compare sides.

Treat The Neural Calf Complex

Once you've found something asymmetrical, you can treat the problem.

Warning: this therapy could be painful, but in my experience you need to treat very firmly to get results. Warn your patient.

Action! -- Friction The Deep Structures

In the exact same position (see Fig 3, below), ensure finger tips are together and palpating right on the tight, painful area. With firm pressure, friction across the line of the nerve with your finger tips going into the left with both hands and then to the right (firm treatment is essential).

Repeat this along the length of the tibial nerve down the area where the patient has identified a difference in the feel compared to the other side. After you have loosened the neuro-myo-fascial constructions, get your client to walk or jog to see how it feels.

Action! Educate Your Client To Self-Treat

Sitting with knees bent, they should use their thumbs to palpate; ensure they can replicate the sensation you produced with your treatment. This way, your active patient can make chronically tight and painful calves a thing of the past.

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