#9 FItness Focus: Lateral Leg Release (December 2013)

The Problem
Give the following technique a try if you suffer from persistent or recurrent lateral (outer) leg pain at the hip, along the thigh, at the knee, in the lower leg, at the ankle, or all of the above like I did. I had a combination of muscle spasms in the buttock muscles; a burning sensation the length of the ITB (illiotibial band) on the outer thigh; vague stiffness around the side of my knee; tenderness in the peroneus longus muscle adjacent to the soleus in the calf; and discomfort around the outer ankle bone. Icing, massage, and stretching took the edge off of the discomfort and pain, but none of these remedies solved the string of nagging problems I experienced.

Studying an anatomy app for inspiration to banish this distress reminded me that the lateral hamstring of the thigh, the biceps femoris, and one of the lateral muscles of the calf, the peroneus longus, both attach to the head of the fibula (below the knee), the smaller of the 2 bones in the lower leg. Looking at the anatomy suggested that my pattern of distress from my hip to my ankle (and low back) could all be caused by a tug-of-war between these 2 lateral muscles that together reach from the hip to the ankle. An online search for "biceps femoris stretch" brought up 3 YouTube videos all describing the same non-stretch stretch. The searing sensation in my currently irritated right buttock when I performed the active stretch (versus the usual passive stretch) confirmed I was on to something, especially since the same maneuver was a non-event for the left side of my body.

The Active Biceps Femoris Stretch
Search online for "biceps femoris stretch" and take a look at the "Active Biceps Femoris Stretch" by Brent Brookbush on YouTube and a couple of others for a visual of how to create the release http://www.youtube.com/watch?v=PMiJ_7D15mA. My description below includes several details that have helped me maximize the benefit of this active stretch.
..Lie on your back on the floor, preferably with your shoes off and both legs straight on the floor.
..Lift your right leg up so that you have a 90° bend at the hip and some bend in the right knee.
..Adjust your right foot into a "standing foot" position with at least a 90° bend at the ankle, keeping the big toe and little toe the same distance from the knee to maintain an even pull on the knee joint.
..Internally rotate the entire right leg by twisting the leg at the hip so the knee points inward and then restore the standing foot position that is likely beginning to 'sickle.'
..You can hold the right leg with the left hand if you choose, placing the hand on the outer knee tendons of the thigh near the knee, or use a yoga belt on your foot if you have one.
..Straighten the right knee; begin pulling the right foot towards your left shoulder; strongly contract the quadriceps, those big muscles on the front of the thigh; and hold for a count of 3-5 seconds. (I hold 5 seconds.)
..Bend the right knee enough to release the tension for a brief rest, then repeat 8-15 times per leg.
..Remember to breath and note where you feel the most sensation and how similar the sensation location is between the 2 legs after repeating the release with the left leg.

Here's a look at the stretch from a different angle.
The presenter of the most descriptive video, Brent, neglects to mention during the demo that the key to this release is in the strong quadriceps contraction, something your body will likely resist doing. This strong contraction of the quads is pivotal however, because it is what forces the hamstrings to stretch through the principle of reciprocal inhibition, something he mentioned during the intro.

This use of brief, active stretching is an interesting strategy because as Brent said, the goal isn't to stretch the biceps femoris but instead to tone down the neuromuscular overactivity of it. The hamstrings and the glutes (major buttock muscles) are both involved in hip extension, which is when the thigh moves back like when walking or running. The glutes however are supposed to be the primary movers of the thigh bone during hip extension, with the hamstrings being helpers.

Along the way in some of us, the hamstrings become 'synergistically dominant' and the roles of the 2 muscles get reversed. When that happens, the hamstrings do too much of the work of hip extension, making them neuromuscularly overactive and making them feel tight. Achieving more neuromuscular control over the hamstrings through the use of this active stretch allows the glutes to resume doing their job with less involvement from the hamstrings, which in turn diminishes the hurtful pulling on the entire length of the leg and sometimes the low back.

On the Road to Recovery
Being weary of the buttock muscle discomfort that disrupted my sleep and had haunted me for a month, I performed 3 sets of 15 reps of the described action 3 times that first day (morning, afternoon, and evening) on my irritated right side and fewer reps on the left leg. I could tell by the end of the day that I was on the road to recovery. Over the course of the next 3 days, the nagging distress in my buttock, knee, and calf were greatly diminished and after that, I reduced my effort to 3 sets of 15 reps once a day. After several weeks of daily use of this active stretch, my lateral leg and hip issues were almost history, though I kept doing the exercise every day to lock-in the new pattern. I anticipated that this release would be a part of my regular stretching routine, though perhaps not used every day.

My first big hike was about a week after I began doing this active biceps femoris stretch and I was startled to feel how sore my glutes were on both my right and left sides after the hike. That soreness was highly suggestive that I had indeed been experiencing synergistic dominance of the hamstrings--the glutes were sore because they were now doing their job--a job that they hadn't been doing fully. That glute soreness recurred with each hike on steep terrain for weeks after beginning the stretch, which signaled that those snoozing muscles were still developing the strength they needed to match the capability of my other leg muscles.

It seemed highly probable that the various episodes of pain and disability that I'd experienced at various times over the last 2 years in both legs were triggered by the over-activity of the biceps femoris muscles. I'm suspicious that resuming a modest running program is what set them off and now wonder if the persistent ITB pain common in many runners might be due to this issue with the biceps femoris and not the ITB as is commonly believed. When Bill used the foam roller on his ITB's after about 3 weeks of doing this hamstring release he declared "They are the best they've ever been." He too has decided that this release needs to be a permanent part of his fitness routine.

Want to Know More?
An online search for "synergistic dominance hamstrings" will expand on this topic as it relates to the biceps femoris. Searching "gluteal amnesia" may also be useful to you. I stumbling upon the topic 1 year ago and discovered that it was a huge issue for Bill. His glutes were very weak on both sides and remedial work immediately gave him more power on the trail though it took months of corrective work to get them where they needed to be. Correcting gluteal amnesia is considered by some as the starting point for dealing with knee problems. It seems that the glutes readily turn over their job to the piriformis in the buttocks in the case of gluteal amnesia and to the hamstrings in the case of synergistic dominance by the hamstrings. Could the glutes be the original "lazy butts?"