“I have tight hamstrings”.

“I used to be able to touch my toes”.

“I want to have better hamstring flexibility”

Have you ever said these terms?

As a Physical Therapist, I hear these phrases every day from patients. Often, these comments are usually ignored by typical physical therapist as many aren’t concerned with flexibility. However, flexibility plans a vital role in movement and movement quality. Flexibility is defined as:

“the ability to move a single or series of joints through an unrestricted pain-free range of motion (ROM), with PatriceWymoreToeTouchROM as the degrees of freedom around a particular joint”.

As physical therapist, shouldn’t we be concerned with pain-free range of motion? Personally, range of motion testing is the first criteria I look at. If a person can’t move pain-free through a range of motion, I doubt they have a high quality of life and are able to perform the activities they desire (whether sport, work, or play).

Many assume muscles restrict their muscles restrict their flexibility, when many other tissues influence flexibility:

  • Fascial Tissue: Fascia is a connective tissue which surrounds every nerve, blood vessel and muscle fibre in the human body resulting in the connection of bones, muscles and organs which form large networks throughout the body.
  • Vascular Tissue: Veins and arteries slide and glide throughout the body and poor vascular mobility may reduce flexibility.
  • Neural Tissue: Nerves often send signals during range of motion, sometimes limiting flexibility.

Based on the tensegrity principle, previous studies have highlighted the presence of continuity and connectivity between fascia or muscle that may be anatomically distant from each other. For example, issues related to the plantar fascia may be associated with tight hamstrings and even lumbar lordosis (low back arching).

Self myofascial releases (SMR), works under the same principles as myofascial release and has been adapted to allow regular and frequent applications, without a therapist’s intervention.

To demonstrate the effects of SMR and the connective tissue in the body, Myers (2014) suggests rolling a tennis or golf ball under the foot for 3 minutes. After performing this test, Myers suggests flexibility of the common toe touch or sit-and-reach test improves.

Recently, this theory was researched as thirty-three participants underwent this test.

Specifically, “[p]articipants were instructed to roll a tennis ball on the sole of each foot from behind the metatarsal heads to the heel concentrating on the medial arch for 2 min. Participants were instructed to apply as much pressure as they could, pushing into discomfort but not pain, as greater pressures have shown to have better benefits on flexibility.”

Overall, the intervention group improved their sit-and-reach performance by 2.5 centimeters. This pilot study didn’t answer how exactly range of motion was improved, but did find an immediate clinical benefit of bilateral SMR on the plantar aspect of the foot on increased flexibility and ROM of the hamstrings and lumbar spine. The ability to increase flexibility and ROM proximally (lower limb, lumbar spine) by focusing on a distal anatomical region (plantar aspect of the foot) may have implications for future clinical practice and the management of numerous dysfunctions.

Once again, flexibility is complex. As the rehabilitation and sports performance world unlocks the answers to these complex questions, remember, be curious, question common principles, and learn about your body, as we still don’t know why a lot of things happen!

Don’t believe rolling your feet will improve your toe touch, TRY IT!

References:John Headshot 2

  1. Grieve R, Goodwin F, Alfaki M, Bourton AJ, Jeffries C, Scott H. The immediate effect of bilateral self myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility: A pilot randomised controlled trial. J Bodyw Mov Ther. 2015 Jul;19(3):544-52. doi: 10.1016/j.jbmt.2014.12.004. Epub 2014 Dec 18.

Written by Dr. John Mullen, DPT, CSCS. Dr. John is the owner of COR, a physical therapist, and strength coach. He has helped resolve pain and improve performance with Olympic medalists and consults with numerous sports teams.