Dear Hamstrung,

As much as I value manual skill, it is not a panacea. Unresponsive hamstrings can result from many causes, including habitual movement patterns, posture, or an irritable sciatic nerve caused by spinal issues or piriformis syndrome. In addition to your manual skills, you can be of great help by teaching clients a consistent program of stretching to be performed many times a day to retrain stretch receptors and prevent a rebound from stretching too intensely only once a day. (Many clients report that Active Isolated Stretching is tremendously helpful.) Don’t forget there is a great difference between short and tight muscles and long and tight muscles, and you need to approach them differently (Massage & Bodywork, “The Long and Short of It,” May/June 2012, page 29). 

Although this may not be the case with your clients, I’d like to bring some attention to my personal crusade for the Rodney (“I don’t get no respect”) Dangerfield of the hamstring muscles. I’m surprised how many excellent therapists work the origin, insertions, and belly of the three hamstrings that originate from the ischial tuberosity, but ignore the very important, but often forgotten, fourth hamstring—the short head of the biceps femoris (SHBF). This muscle is frequently the missing link for me in restoring hamstring balance, especially for athletes or clients with knee dysfunction who often express surprise that nobody has isolated that muscle before.

Although it does join the tendon of the biceps femoris, the SHBF is the one hamstring that does not cross the hip joint, so it flexes the knee independently of hip flexion or extension. If only this muscle had been given a different name, rather than being relegated to secondary status, it might get more attention. Consider how the soleus is analogous in joining the Achilles tendon with the gastrocnemius and how important that muscle is as it plantar flexes the foot independently from the position of the knee. Notice the very different angle of contraction of the SHBF from the other hamstrings (Image 1, page 31). Asking for active flexion of the client’s knee will give you a feel for the muscle’s contraction and the direction of its fibers. Dysfunction of the SHBF can be a significant factor in causing rotational problems with the knee joint and should always be addressed. 

Even if one does great work with the other hamstrings, if the SHBF is tight or irritable, it will communicate to its fellow agonists to contract before allowing the knee to come to full extension—contributing to their tightness. An irritable SHBF can also send inhibitory impulses to the quadriceps as the knee approaches full extension.

The good news is there are no tricks to working this muscle aside from knowing your anatomy so you can work with precision in your intention. Just work the SHBF like you would any tight muscle. Prone and side-lying positions (Images 2 and 3) allow for the easiest access and for variations in knee flexion to either put the muscle in a stretch or shorten and soften the muscle if it is irritable. Because you need to sink through superficial tissue, use fingers or knuckles for precision rather than broad forearm or fist work. 

Adding this muscle to your skill set should prove helpful for many situations, ranging from general hamstring tightness to rotational strain on the knee. 

  Art Riggs teaches at the San Francisco School of Massage and is the author of the textbook Deep Tissue Massage: A Visual Guide to Techniques (North Atlantic Books, 2007), which has been translated into seven languages, and the seven-volume DVD series Deep Tissue Massage and Myofascial Release: A Video Guide to Techniques. Visit his website at www.deeptissuemassagemanual.com.

 

The prone position allows easy access to the short head of the biceps femoris; if you need to soften the hamstrings, bolster the ankle. Use anchoring and stretching strokes if you feel adhesions or thickening, and use facilitated lengthening strokes in a distal direction to coax the muscle into relaxing.