Ep 245 – The Hamstrings: Critically Thinking about Critical Thoughts: “The Rebel MT” with Allison Denney

0:00:00.1 Speaker 1: Become a certified manual lymphatic drainage therapist with the Academy of lymphatic studies, ACOLS. ACOLS offers a variety of courses addressing edema and lymphedema management. The popular manual lymph drainage certification and complete Lymphedema Therapy certification courses can be taken completely in person or in a hybrid format. With 150 annual course offerings all over the country, students can find the right course for them. Visit acols.com to find a class near you. That's acols.com. This episode is brought to you by rebel massage deep tissue body butter crafted because oil is too slick and lotion absorbs too fast. These organic professional grade bodywork butters give you the grip you've been looking for. The best techniques in the world can get lost without the right product to support them. Try the Get a grip version for more specific focused work, or the total meltdown version for that grip with a little extra glide made by a massage therapist for massage therapists. Head over to rebelmassage.com to get your grip today.

[music]

0:01:32.9 Allison Denney: Theoretical anecdote, I am a massage therapist. I am saved seven years into my career. I'm dedicated to the craft and practicing all the techniques I learned in school, I take continuing education courses and keep myself in the know and current with the latest research. I have a client with a grade one hamstring strain occurred four months ago, coupled with low back tension and limited hip range of motion. I understand the issue and I feel confident with my approach. But the client is not getting better. As a matter of fact, they walk away feeling worse. I then begin to doubt myself. Am I good enough? Did I learn the wrong approach? Did I not understand what I was taught? Am I doing this all wrong? Should I quit? No, just no. Here's the thing. We can do all of this incredible work on ourselves so that we are more present on our knowledge so that we understand more on our techniques so that we can do more, but if the other party involved is not showing up, and they are not doing their own work, it can all fall flat. Hitting your head against a brick wall then ain't gonna hurt that brick wall. That's for sure.

0:02:48.0 AD: So what is the answer? I hear you asking. Self-care. Yep, I said it, self-care. Not focusing more on them, focusing more on you. Self-care, the endlessly opined topic of all seasons, there are reserves of commentary on the subject, videos, podcasts, articles, some of which I have even written myself. It is a proven hot ticket item. But we are, I want to highlight, the royalty of self-care. We teach it, we preach it. We understand the benefits of it on existential levels. So how can my own self-care help a client who is not making any progress? I hear you ponder. I admit it seems a bit backwards, maybe, but not so much. I am talking about the kind of self-care that keeps a career going. That gives body workers a long life in this otherwise typically short affair. Granted, that is the point of all self-care. But I'm focused on a branch of the basics that goes beyond the usual suspects. I'm talking about critically thinking about what self-care means. I know, I know, critical thinking, another hot topic clickbait term, just hear me out.

0:04:10.9 AD: Critical thinking is defined as the objective analysis and evaluation of an issue in order to form a judgment. But what is that judgment we are hoping for is no judgment. Or what is the opinion we are seeking to change is from not liking a thing to liking a thing. Allow me to explain. Opinions are abundant, and it is ultimately impossible to not have one. But the fault in the system comes when we finally shift those opinions from outward to inward, only to find that those thoughts are predominantly negative. We look at ourselves and we don't like it. The internal conversation is full of doubt and disgust. The opinion we find is a big old thumbs down. Stretching and Epsom salt aside the most critical kind of self-care, is the ability to know how to critically think, it is entirely too easy to waltz through this extraordinary life we are in and believe that everyone else has it all figured out. That we are the only ones who can't seem to do it. The truth is, the hustle it takes to keep growing and thriving uses an exorbitant amount of energy. But man, if we don't dig deep to find it, that's when the real trouble starts.

0:05:26.3 AD: Our relationship to ourselves is a lot like the hamstrings, actually, a deeper look at where they are and what they do reveals an unhealthy dialogue amongst the bellies of this upper leg beast. They are in a self-involved relationship with each other, quite literally joined at the hip, they spend a lot of time complaining to each other and about each other. I didn't say it was an ideal relationship, but it is one that most of us are familiar with. The different parts of who we are can feel like multiple internal dialogues, and it's not always a pleasant conversation to listen to. They also have a habit of taking cues from each other. If one is tight, the others start to tighten up. If one is strained, the others feel the strain. If one is damaged, well, the others play the victim. Maybe that needs to be the case within a muscle group. They are dovetailed together after all, and they need to be in hyper communication in order to carry out their respective tasks. But as we take a closer look at hamstring anatomy, remember that we are smarter than a human muscle. The faults of the part do not have to also be the faults of the whole. Stay with me here. Originating at the ischial tuberosity of the pelvis, the hamstrings cascade down the posterior thigh, divide about two thirds of the way down and take hold on some bony landmarks on either side of the knee.

0:06:51.8 AD: They are typically thought of as having three parts, the long head of the biceps femoris on the lateral side, and the semitendinosis and the semimembranosis, lovingly referred to as the semi sisters on the medial side. The insertion of the semi sisters is more specifically the medial aspect of the proximal part of the tibia for the tendinosis sister, and the medial condyle of the tibia for the membranosis sister. So basically, they both cross over the knee joint and find connection with the upper inside aspect of your shin bone. On the lateral side, the long head of the biceps femoris veers laterally to insert onto the head of the fibula, or the little bump just below the knee on the outside of the lower leg. But wait, there is more, a fourth segment of the hamstrings. That's right, there's a short head of the biceps femoris. I guess when there's a noted longer portion, you got to figure it there's a counterpart, this one enters a bit late to the game than its cohorts, originating inferior to the rest of the crew at the lateral lip of the linea aspera and the lateral Supracondylar line of the femur, otherwise known as the upper portion of the back of the thigh bone, it meets up with the long head of the biceps femoris to insert at the lateral knee.

0:08:12.2 AD: Still with me? Okay, technically speaking, the short head of the biceps femoris is not a hamstring, but is instead considered a muscle in the posterior compartment of the thigh. The other muscles taking up space in this compartment are the actual hamstring muscles. And the only differentiation lies where their origins originate. But they live in the same covering of deep fascia in the posterior upper leg. And so for me, they are all hamstrings. Side note, you might be familiar with the story of how the hamstrings got their name, from the way a butcher would display a pig in a window. But you might not know that the word ham actually derives from the Old English ham or hom, originally denoting the back of the knee. Both the long head and the short head of the biceps femoris are situated around that popliteal region. So it seems a bit odd to me to leave a portion of a muscle out of a group just because it doesn't share the same grasp on the pelvis. Humans do odd things though, so I can't spend too much energy on this one.

0:09:16.6 AD: What I can hone in on is that when we recognize where the hamstrings are, and we begin to analyze what they do, how they communicate to each other, and dare I say it lack the ability to critically think about themselves, we can glean deeper truths about how to work in this area, and of course, deeper truths about ourselves. Collectively, they all influence the knee since they all cross over the knee. The semi sisters both flex the knee and medially rotate the flex knee and the femoris brothers, that's right, if there are sisters here, can't there also be brothers? Both flex the knee and laterally rotate the flex knee. Makes sense considering where they fall on either side of the knee, yes. And with three of the four of these muscles crossing the hip, they play a major role in extending the hip, or the action or like does when we pull it back and wind up for a big kick of whatever ball we are trying to get into whatever goal we are trying to get it into. With all of this in consideration, our approach to the hamstrings most commonly involves some combination of passive or active range of motion of the hip and/or knee to shorten, lengthen or engage the stringy group so that you can address the issue they're in.

0:10:31.8 AD: But before I offer specifics on some handy approaches to the hamstrings, allow me to draw some conclusions from the nature of relationships and the deeper aspects of self-care. The hamstrings, just like the various parts of who we are, need to be taught first and foremost, how to love and respect each other, and themselves. Each of these parts of the whole can easily climb on the wagon of becoming overbearing, contentious, agitating, or tense. Or they can slip down the slope of becoming enabling, under spoken, passive, or weak. We know enough to know that when we pull any of this stuff within ourselves, it can be disastrous, destructive behavior creates unstable beings. We do it though, don't we? We blame ourselves for not, "fixing a client." We talk harshly to ourselves when our techniques aren't working. We doubt ourselves when the outside world doesn't match what we think to be true. It's no different for the bellies of the hamstrings. We don't want them to turn on each other, as much as we should not be turning on ourselves.

0:11:42.0 AD: Try this. With your client prone, loosen up the back of the thigh and slowly sink into the fascia that divides the hamstring siblings. With a thumb or fingers or a knuckle holding steady into this septum, use your other hand to lift the ankle up off the table so that the knee is flexed. Gently allow the ankle to drop passively medially towards the opposite leg, and then laterally away from the midline. After repeating this a couple of times, release the pressure from the hamstrings and shake the lower legs so that the hamstrings loosen up a bit more, then do it again. Only this time, as the ankle drops immediately grab the lower leg firmly and create a rotation in both directions of the flexed knee. Do the same thing as you let the lower leg drop back out laterally. The range of motion here is minimal, maybe five or 10 degrees. But the goal is to bring a little awareness to those attachment sites at either side of the knee, and therefore into the relationship of the semi sisters, and the femoris brothers.

0:12:46.9 AD: With a sustained pressure into where they divide, they become less dependent on each other and perhaps a little healthier in and among themselves. This is clearly a passive technique. But I'm not stopping you from making this an active one. If you feel like your client is ready to engage, have them create the actions I just described. Perhaps even throw in some resistance against each movement, the flexion of the knee, the internal and external rotation of the hip, and then the medial and lateral rotation of the flexed knee. You can even go one step farther and throw in an AET or a PNF or another group of letters that will shake things up a bit. What you do is up to you. The bottom line is that you bring awareness into the separate elements that make up the hamstrings. And you do this with confidence and certainty in your own self. Because modeling positive behavior is the best way to teach it, the hamstrings, they'll catch on eventually.

0:13:45.2 AD: And here we are the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you want to get any of your words into my ears, or more accurately into my brain via my eyeballs from a computer screen, drop me a line at rebelmt@abmp.com. That's R-E-B-E-L-M-T@abmp.com. I always want to hear your questions, comments, suggestions or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on like homemade organic products for your practice, cool links to continuing education classes thoughts I have typed up and posted here in there, and other rebel massage dabblings.

0:14:37.3 S1: Members are loving ABMP five-minute muscles and ABMP pocket pathology, two quick reference web apps included with ABMP membership. ABMP five-minute muscles delivers muscle specific palpation and technique videos plus origins, insertions and actions for the 83 muscles most commonly addressed by bodyworkers. ABMP pocket pathology created in conjunction with Ruth Werner puts key information for nearly 200 Common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today. ABMP members log in at abmp.com and look for the links in the featured benefits section of your member homepage. Not a member? Learn about these exciting member benefits at abmp.com/more.