Hello, welcome to the Balanced Body podcast.
I'm Lindy Royer, physical therapist, founder of Pac-Medus Pilates and Physical Therapy
in Lone Tree, Colorado, and Balanced Body faculty.
I'm with my friend Krista, who's going to be helping us demonstrate balancing the ham
strings.
This is a really critical piece of knee rehabilitation, and one of the things that gets neglected
quite often is the fact that we focus on strengthening the ham strings, but don't
look at the issue of whether we're strengthening more of the medial side of the ham strings
or more of the lateral.
Clearly, we want the ham strings to be in balance because the ham strings are partially
responsible not only for knee flexion and hip extension, but also for tibial rotation.
So just as a review, ham strings start at the issue of tuberosity, and we have one part
of the ham strings that go laterally down to the fibula head with a little slip into
the tibia, and then we have medial ham strings going down to the medial side of the tibia.
So we're going to look particularly now at the rotation of the tibia as it relates to
hamstring control.
So keeping in mind that we have ham strings going medially and laterally, the medial ham
strings are going to be responsible for tibial rotation in that direction, and the lateral
ham strings are going to be responsible for tibial rotation laterally.
So I'm going to have Christa bend her left knee, and I'm supporting her tibia in this
position.
We want to make sure that her pelvis is balanced.
So Christa, can you just let the left side of your pelvis drop, and then let the left
side of your pelvis lift?
So you'll notice as she does that, she's also creating some hip hiking on the right side.
We want to bring her pelvis into a position where the pelvis is balanced on top of the
right femur without her loading into that hip or hiking it up.
Now we're going to allow the left femur to hang, and I'm supporting the weight of her
tibia in this position.
Christa's in her beautifully aligned spine and pelvic position here with her weight
through her right leg.
And Christa, can you imagine the medial side of your ham strings shortening in order to
rotate the tibia medially?
Good.
And then can you imagine and pull up on the lateral side of your ham strings to create
lateral rotation?
Good.
And we're just going to rotate the tibia medially and laterally.
Some things to watch out for here, one of the things that you will see is if the lateral
ham strings are not firing correctly, you're going to see more of an abducted position.
So Christa, as you do that, can you just take your knee out to the side?
So that's what you're going to see.
This is the abductors taking over because of weakness in the lateral ham strings.
So bring your leg back down.
So we want to see a nicely aligned leg.
You could imagine the femur just hanging directly down from the pelvis.
And let's just go back to medial rotation and lateral rotation.
The other thing that you might see is some compensations going on in the foot and the
ankle.
So what we want to see is nice clear tibial rotation being directed directly from the
medial and the lateral ham strings.
Now we're going to take a look at this on the reformer using the infinity foot bar as
our modality.
Here we are with the infinity bar set in the high position and we have one yellow spring.
This is clearly going to be a less stable position for the carriage.
So Christa is going to be very careful as she mounts the reformer.
She's going to place her pelvis closer to the center of the reformer and then she's
going to go down onto one side, rolling over into supine, placing the feet on the bar and
then sliding down so that her head can be supported.
One of the advantages of being able to take the shoulder rests off the carriage is that
Christa can now find a position where her head is supported, her pelvis is also supported,
but she doesn't have to deal with the shoulder rests potentially coming up and hitting her
in the back of the legs.
Christa, can you put the back of your heel on the bar?
We have her a little bit open at the knees so she's at a greater than 90 degree angle
here in knee flexion and in hip flexion.
We're going to make sure that she's aligned in her ideal neutral position.
Head is resting, shoulders are open, arms are long, pelvis is in its ideal neutral position
also.
We just took a look at rotation of the tibia.
So what I'm going to ask Christa to do now that she understands that movement, she's
going to medially rotate both of her tibia bones and then we're going to ask her to do
a little bit of knee and hip flexion.
So Christa maintaining that rotation and I'm just monitoring and reminding her that that
is medial hamstring.
Take a breath in to prepare and as you exhale can you pull yourself toward the bar, maintaining
that rotation of the tibia and then inhale as you send the carriage back out, beautiful.
Notice that we're limiting her rotation so can you do about three more of those.
We're going to limit the range of motion until she has gained control and coordination of
this movement.
Then what we may do is move the foot bar more toward the risers giving her more range of
motion and also giving her more resistance as a challenge.
And then we're going to laterally rotate the tibia.
So notice here that she is maintaining the femurs parallel.
The rotation is actually coming from the tibia not from the hips.
Christa can you just show the difference between rotation of the hips.
So here we have external rotation of the hip.
What we're doing is maintaining the hip in a neutral position and just rotating the tibia.
So from here she's going to externally rotate, take a breath in to prepare and as you exhale
bend at the knees, bend at the hips pulling the carriage in.
So that's more of a challenge for Christa which gives us some information about the
fact that she's probably not accessing lateral hamstrings quite as much as she has been medial
hamstrings.
This is a really important component of knee rehabilitation and hip rehabilitation because
we want to look at balancing the forces not just in generic knee flexion but really looking
at the control of the tibia via hamstrings whether that's medially or laterally.
Once we've established this, so Christa can you come now back into a neutral position.
Now we can go ahead and do more of a balanced knee flexion so take a breath in to prepare
as you exhale pull under and what I'm going to be reminding Christa of is that activation
of the lateral hamstring because for her this is part of the rehabilitation process that
we would want to emphasize since she is more medial hamstring dominant.
So as she now goes into her regular hamstring strengthening we're going to be more aware
of using lateral hamstrings.
A couple of other options here we could also go into some single leg so Christa can you
float your right leg up and now she's going to activate just left hamstring.
This is a great way then to look at balance between the two sides so as you exhale pull
in we're just going to do two more of those.
You can also add if we wanted to some choreography for the right leg so we can add a little bit
of reaching for the right leg bring that leg back in and one more time and bringing the
leg back in and lower this foot down.
So there you have some options for balancing the hamstrings particularly important with
knee rehabilitation especially as it pertains to control of the tibia in rotation.
Thank you very much for watching.
