Sports - Sports Injury

Tight psoas muscle? Here’s 3 simple and effective psoas…

by Pete Colagiuri - Sports Physiotherapist

The psoas muscle is one of the lynchpins to pelvic biomechanics, so a tight psoas muscle can be disastrous.

The Psoas muscle connects across the hip and pelvis up to the lumbar spine.

Why does a tight psoas muscle cause so much trouble?

Psoas is a key player in control and movement of the hip and lower back when it’s functioning well, or it can restrict movement and overload the spine when it’s not behaving normally.

As a tight psoas muscle shortens, it adds a sustained pull on the lower back and restricts hip extension (movement of the leg behind you).

Unfortunately the lower back tends to lose out here – the leverage of the leg just adds more pressure to the lower back and your tight psoas can quickly lead to lower back pain.

Why does a psoas muscle shorten?

A tight psoas muscle can shorten for a number of reasons. It will slowly shorten due to spending most of its time in a short position like sitting, or it can rapidly (but temporarily) shorten after strenuous exercise like fast running.

Given that our lifestyles now involve so much desk time, the first issue seems to be the culprit for most people.

In sitting, the psoas is in an extremely short position. It still gets used every time you sit forward to reach for your mouse (or coffee).

As the body is wonderfully adaptive, it alters its length to be best suited to the main role its performing.

So gradually over a number of months, the psoas will lose its length and flexibility.

How can you fix a tight psoas muscle?

The key to stretching a tight psoas muscle lies in the same adaptive process.

Just stretching for a few minutes each day isn’t enough stimulation to cause the body to adapt – it can’t offset 8+ hours of sitting.

Combining psoas stretches with muscle activation is more successful – using the muscle against resistance in a lengthened position will generate a faster and larger adaptation in length.

Adding a repetitive exercise involving lengthened positions, such as yoga or fast walking, and you have yourself the perfect remedy to a tight psoas.

What’s the best stretch for psoas?

The most effective, and simplest, stretch for a tight psoas muscle is a walking lunge. No weights or equipment required, it can be done safely by almost anyone.

Place your hands on your hips to improve balance and body awareness.

Take a long stride forward and lower your back knee towards the ground.

It’s important that you don’t lean back as you lunge.

As the psoas connects to the lower back, a forward lean as you stretch is your body’s way of letting you know that your muscle ran out of length.

Forcing your back upright will only add more pressure to it and cause back pain.

Another simple stretch is a reverse lunge.

From a standing position, take a long step backwards as you lower your hips towards the ground.

Aim to get your back leg as far back as comfortable without making your trunk tilt forwards.

Ideally the knee of your back leg should be behind your hips to maximise the stretch.

How long should you stretch for?

You’ll typically need around 2-5 minutes of stretching each day to notice an improvement in flexibility.

If you’re a stiffer body type, it may take longer to loosen up so give yourself at least 5 minutes and ease into it.

We generally advise that you continue your routine as long as you’re feeling that there’s an improvement with each repetition.

For each stretch, alternate legs on each repetition to get the best effect – otherwise your first leg will stiffen up again while you’re stretching the second leg.

What else can help a tight psoas?

Combine a daily stretching routine with a regular walk or run, ideally immediately after your stretches, and you’ll feel an improvement in muscle length with a week or two.

Just remember though, the muscle adaptation that caused the tight psoas muscle was a gradual process.

The return to normal length is just as gradual (even a bit slower according to the research).

Be patient and consistent for the best results.

3 most common reasons behind a recurrent hamstring injury

by Pete Colagiuri - Sports Physiotherapist

Recurrent hamstring injury is one of the most common issues we see in any field sport like football or hockey.

So why is the hamstring muscle so prone to repetitive injuries?

We’ll go through the 3 most common causes of recurrent hamstring injury and how to fix each one.

Reason 1: Inadequate rehab

It seems obvious – not preparing adequately for a return to sport makes you more prone to recurrent hamstring injury.

But the issue doesn’t lie in a lack of motivation or bailing early on rehab.

It’s a problem with not knowing WHEN your rehab is completed.

Is it when you’re pain-free? Back to normal strength? Back to running?

More often than not, rehab is incomplete because the hammy seemed fine so you stopped.

Solution 1: Better testing

Ensuring that your hamstring injury rehab is complete involves three aspects of testing.

1. Connective tissue testing

This assesses if the muscle has its length and bounce.

You can cover muscle length with a standardised muscle length test, like a sit and reach.

You can test connective tissue elasticity with a plyometric test, like a three hop for distance test.

Note that the 3 hop test also tests aspects like strength so the result isn’t purely based on elasticity.

2. Muscle strength testing

You can compare it to your unaffected side but remember that the other side has been out of action as well.

For this assessment, it depends on your equipment.

There are fancy machines that can isolate hamstrings but for most, a simple single leg barbell deadlift does the job nicely.

You’re looking to lift the same weight on both sides, with good technique for each rep.

You should be able to complete around 90% of the reps as the unaffected side over three sets.

3. Technique testing

This assesses your muscle firing patterns and coordination for any sport-specific movement that loads the hamstrings.

This might include running, jumping and kicking a ball.

This testing is to ensure that the brain is controlling the hamstring muscles effectively and not putting it at risk by being over-protective.

You’ll need another set of eyes to watch you throughout each movement, preferably someone trained in techniques like a coach (remember that a great player probably only knows their own technique and may not be a great assessor).

Perform the different techniques at game intensity (after a warm up).

You should also perform them while fatigued as that’s your riskiest time in the game.

So warm up and go through the individual techniques.

Then conduct some high intensity fitness training followed immediately by the same techniques.

Your observer is looking for altered muscle patterns, both fresh and then while fatigued.

Reason 2: It’s not a hamstrings tear

Another big reason behind recurrent hamstring injury is that it’s not actually a hamstring injury.

Seems odd but there are a number of other injuries that behave exactly like a hammy tear.

There are also a number of secondary injuries that can co-exist with a hammy tear – basically you get two injuries at the same time and the more subtle secondary injury is missed.

Most of the injuries in this category involve nerves.

You can have an irritated Sciatic nerve alongside a regular hamstring strain.

You can have a primary Sciatic nerve tension issue that behaves exactly like a hamstring tear – it’s even sore to push on!

Then there’s lower back referral. This can be due to a nerve irritation or even referred pain without nerve involvement.

Lastly there’s a few vascular (blood vessel) conditions that can cause recurrent hamstring injury symptoms but these are quite rare.

Solution 2: Confirm the diagnosis

This might be done with a second opinion or with imaging like MRI.

I wouldn’t recommend ultrasound as it lacks the detail we need to exclude some of the conditions associated with recurrent hamstring injury such as nerve issues.

MRI can be expensive but it’ll save you plenty in the long run.

Reason 3: Biomechanical issues with your technique

There are a number of biomechanical reasons why hamstring injuries occur.

It might be a longer stride length or poor pelvic control during jumping.

If that’s the case, the hamstrings are always vulnerable and recurrent hamstring injury will follow.

With each injury to the hammy, the technique issue may worsen due to strength, length or inhibition issues.

This sets up a cycle of recurrent hamstring injury that drives you nuts!

Solution 3: Technique assessment and modification

For this solution, you’ll need one, or ideally two, sets of eyes on you.

Select experienced and trained coaches rather than good players – coaches are trained in technique, players only know their own technique and they’ve never seen it from an observer’s perspective.

Start by assessing the technique that matches your injury scenarios.

If you always get injured jumping for a ball, look at your technique for that.

If it’s sprint starts, look at a variety of start positions and directions.

Then reassess each technique with fatigue – just smash out a hard 10min of cardio then re-test.

For each technique, you’re looking for errors that make you more prone to recurrent hamstring injury.

If you find those errors, design exercises and/or drills to fix them.

If you don’t find anything obvious, you can still modify technique to reduce hamstring loading.

KT tape for Achilles pain

by Pete Colagiuri - Sports Physiotherapist

Is KT tape for Achilles pain useful, or just a marketing trick?

If it’s useful, how do you apply KT Tape for Achilles pain?

Our Physiotherapy team share all their tips and tricks for using dynamic tape to help Achilles pain.

(If you’re looking for KT tape for calf pain, check out this post).

Firstly, what is KT tape?

KT tape is one brand of dynamic tape, a stretchy elastic tape designed to stick to skin.

The tape provides feedback to the brain on whether the joint or muscle is stretching.

That can be useful is the normal mechanism of feedback, from ligaments and muscles, is disrupted by an injury.

The tape doesn’t provide restriction to movement like rigid strapping tape.

So the unique qualities of dynamic tape could be best summed up as “movement feedback without restriction“.

Is KT tape for Achilles pain useful?

KT tape for Achilles pain can be hit and miss, although it’s more of a miss for most people.

This is because the tape only provides feedback on movement – it doesn’t actually support the Achilles tendon.

So KT tape for Achilles pain can be useful in cases when people aren’t aware of the level of stretch in the Achilles tendon during exercise.

This group are often the ones who can train well but get Achilles pain afterwards.

The tape can provide a reminder to not overstretch the tendon in the absence of pain.

For most people though, the pain is a great reminder to not push it too far so the tape wouldn’t help.

Other people with more severe and sensitive cases of Achilles tendinopathy actually need physical support of the Achilles.

This reduces the loads the Achilles is exposed to and can only be achieved with rigid tape, a brace or heel wedges.

How should you apply KT tape for Achilles pain?

When you apply any dynamic tape, remember that its job is to provide stretch feedback to the brain.

With that in mind, it has to be quite firm and noticeably tight in the target position.

Set up position

With KT tape for Achilles pain, you’ll need to know that the tendon is under pressure as soon as the foot moves past 90 degrees (standing position).

So it’s best applied with the foot in a plantarflexed (slightly pointed) position.

Tape application

You then apply the tape with only a mild pressure from 2″/5cm under the heel and up the Achilles tendon around 8-10″/20-25cm.

The next tape has the same pressure but runs slightly diagonally from one side of the previous tape’s start point to the other side of its end point.

That tape should cross the other tape near the base of the Achilles.

The slightly offset position is to maximise the tape’s contact with the skin (rather than having it pull on the other tape).

The 3rd tape is the mirror image of the 2nd tape, running diagonally in the opposite direction to maximise skin contact.

Now is the time to test the tape tension (try saying that quickly…)

The tape should noticeably tighten up as the foot moves past 90 degrees.

If not, remove and reapply the tape to refine the tension.

If it works as planned, move on to the most important step – anchor the tape.

Anchoring the tape

Any dynamic tape under tension tends to lift off the skin.

The anchor holds it in place to stop it lifting off and to help maintain its tension.

For this step, rigid strapping tape works best.

The anchor tape runs at right angles (perpendicular) to the dynamic tape.

Anchor the dynamic tape under the heel, just above the Achilles and at the top of the tape.

Don’t anchor across the painful part of the tendon as it hates compression from a firm anchor.

Another runner with hamstring tendinopathy on MRI…

by Pete Colagiuri - Sports Physiotherapist

It feels like every report from an MRI of the hip, pelvis or upper thigh seems to come back with “Oh BTW, there’s a mild reaction in the proximal (upper) Hamstring tendon.”

So is a proximal Hamstring tendinopathy normal, is it a common injury or does it occur with other injuries?

How accurate is MRI for diagnosing Hamstring tendinopathy?

MRI is great for picking up small reactions, inflammatory responses and fluid.

It’s not as accurate in detecting structural change but it’s still fairly good.

So if your MRI finds a Hamstrings tendinopathy, it’s very likely that you have evidence of that condition.

If it doesn’t show up on the scan, there’s a possibility that you have a very low grade tendinopathy but the chance if it missing a moderate to severe tendinopathy is very unlikely.

How common are Hamstring tendinopathies?

This one is much harder to quantify. There’s no research specifically looking at the incidence of hamstring tendinopathy in people without symptoms.

Clinically we see around one third of MRIs of the hip, pelvis and thigh come back with an incidental finding of hamstring tendinopathy.

Keep in mind that these athletes have pain in and around the area and they’re likely to be moving differently, which can cause overload in tendons.

Does a Hamstring tendinopathy always cause pain?

Of the hamstring tendinopathies that show up on MRI, less than half are symptomatic.

When we perform our clinical tests for hamstrings loading, they have no pain or weakness.

So despite the MRI finding, it seems to be pain-free and functioning normally.

There are two common hypotheses on why hamstring tendinopathies are commonly seen in scans for other injuries.

One hypothesis is that the tendon will naturally react in any athlete participating in a running sport, and that MRI is so sensitive that it detects these normal reactions.

Another hypothesis is that any alteration to biomechanics, such as an asymmetrical running gait or a limp, will cause overload in adjacent structures and may cause the hamstring tendon to react.

What are the best exercises for treating a Hamstring tendinopathy?

If you’ve got a hamstring tendinopathy on MRI but you don’t have symptoms, it’s not necessary to start rehab for te MRI finding.

That’s not to say that you won’t benefit from hamstrings strength work – everyone will benefit from being stronger.

It’s just not essential to address an injury that’s not causing any symptoms.

If you are experiencing symptoms, or if you wanted to bulletproof your hamstrings, here are the best options for exercises.

Eccentric exercises

This type of exercises involves the muscle slowly lengthening under tension and it’s great for tendon health.

In this category, the single leg deadlift is king. It’s simple and very effective.