Does your patient feel like they have "tight" hamstrings? Have you performed some STM, or a party trick like the Mulligan Traction SLR? How do you keep the rapid improvements?
The more I practice, the less I see "tight" hamstrings. Here is one of my favorite exercises that a patient can do to quickly improve their ASLR.
- Supine
- UEs overhead one hand over the other
- both ankles dorsiflexed
Cues:
- push your top hand into your bottom hand, but don't let it move (isometric resistance)
- tense your belly like someone was going to punch you or drop a heavy weight on it
- point your toes up toward your head and lift one leg up, keeping your knee straight
- push your other leg down into the table, keeping your toes pointing toward the ceiling (no hip ER)
- repeat several times on each side (they may or may not alternate), 3-4 times/day
- self audit - checking ASLR before and after, or forward bending in standing (assuming there is no posterior derangement)
- limited ASLR that improves easily with passive SLR (indicating a motor control/stability issue)
- difficulty with hip hinging
- ASLR rapid improvement with the actual exercise
Precautions:
- very painful neurodynamic dysfunction
- peripheralization of complaints that persists
If the exercise does not change the ASLR or SLR rapidly, there may be true dysfunction that requires more extensive manual work.
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