One interesting finding I have discovered while working with children with spasticity, particularly spastic diplegia is that if I apply low intensity FES to the hamstrings, ant. tibialis or triceps surae I find that I can achieve greater passive and active range for a period of time. In over 15 years of practice as a pediatric PT, I realize I frequently was convinced I had achieved end range and soft tissue limitations, when I believe now I only reached the limit of my comfort stretching against hypertonicity. The intensities are well within the comfort of most children and may be incorporated with weight bearing, active movement, or passive stretching. Typically 30-50Hz, 100-200microsecond pulse width and less than 15-20mAmps. Administered with ramp up of 1-2sec, on time of 5-8sec, ramp down of 1-2sec, off time of 3-5 sec.

Obviously reducing hamstring tone is critical for appropriate range of the knee and hip passively and actively and contributes significantly to crouched patterns of gait. Using FES to manage provides greater insights into muscle imbalance, tone, soft tissue limitations and potential clinical approaches for neuromuscular re-ed. That said, I prefer to evaluate with temporary and rapidly reversable noninvasive functional methods before discussing any longer term management from chemo denervation to surgery.

dear Lisa,

I am so sorry, I was not specific enough. I meant the hamstrings of the normal developing infant.

Of course, in children with any type of hypertonicity, it is a different story all together.

I was referring to studies such as:

VALIDITY OF SIT-AND-REACH WITH PLANTAR FLEXION TEST IN CHILDREN AGED 10-12 YEARS Mayorga-Vega D, Merino-Marban R, García-Romero JC

or others on the subject of testing sit and reach.

Sorry for the misunderstanding and thank you for drawing my attention to this. I have changed my question accordingly.

Its very difficult to do so.

Hi...usually there are 3 main clinical tests could judge about hamstring flexibility.

1- Popliteal angle test (Hip 90, Knee 90 to full ext. with considering ext of untested limb.

2- hamstring shift test. full bilateral hip flexion, knees flexion . then, ext knee through full range.

3- Dandy angle. hip 45, knee is 90 to full ext. knee

Hallo Javier,

You state that the sit and reach test can be useful for children but WHY is my question. What is your reasoning behing this?

Ehab, Thank you for your answer..... would you tell me your reason behind wanting to test the hamstrings length?.

I want to try to understand why colleagues think this is so important in the daily clinic.

Esther, hamstring is more critical for disabled children however my opinion for normal children it has impact on pelvic and spinal alignment. currently we are conducting work to examine effect of hamstring shortening on efficiency of core stability.

for your question about SRT, go for this paper:

Assessment of Hamstring Muscle Length in School-aged Children Using the Sit-and-Reach Test and the Inclinometer Measure of Hip Joint Angle

PHYS THER. 1996; 76:850-855.

Suzy L Cornbleet and Nancy B Woolsey

I dont know about infants but Hamstrings tightness is very important in children with or without spasticity. As a podiarist all my cases esp at the age 10-14yrs old, with symptomatic AT, Severs, Knee pains, growing pains, shin splints related with the tight Hamstrings. The best test is the First Catch test that shows te real tightness of the HS. So it is very important for every day clinic. why when we put orthotics that relax the semitendinosus bkz of the hyperpronation all the symtoms dissapears, why when we give stretching exercises the same?? (Answer to Esther)

I have seen that hamstrings flexibility is quite important in children as i have observed that children with hamstrings tightness are most likely to develop back pain and generalised pain in lower limbs owing to change in pelvic alignment. Not only that i see children with hamstring tightness are more prone to falls as it affects the balance.

Thank you everyone for sharing your ideas with me.

I am aware of the differences in flexibility in children in general. We have our hypermobile and our hypomobile children in the normal population.

Shortend hamstrings and backpain are two symptoms we see in the clinic. I am not aware of any research into this combination (cause-effect) and if there is, please let me know.

I am very aware that it isonly one muscle in a whole functional chain. I think we always need to look at the whole and not only at the part.....