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Botulinum Toxin-A: exercises hamstring muscles fact sheet

Botulinum Toxin-A: exercises following injection into hamstring muscles

About the hamstring muscle

The big group of muscles and tendons in the back of the thigh are called the hamstrings. They attach to your sitting bone and insert below your knee. The hamstrings cross the back of the hip joint on their way to the knee. They help to extend the hip, pulling it backwards. They also bend the knees, a motion called knee flexion.

If your child’s hamstrings are tight, they will affect both your child’s knees and their hips as the muscles cross these joints. It can result in a tilt backwards of the pelvis, often seen by a rounded spine in sitting or standing. Tightness can also prevent the knee from straightening fully.

Hamstring muscles are a common muscle to be injected with Botulinum Toxin-A and the following exercises will help to maximise the effect from the injections.


Why stretching is important

Your child may have shortened hamstring muscles because of spasticity, limited movement or long-term muscle tightness. Spasticity is caused by the brain sending too many messages to the muscles telling it to tighten. Tight hamstring and calf muscles make it difficult to place the foot flat on the floor without bending the knee. It can result in toe-walking, walking or sitting with bent knees, poor curved posture, leg and foot discomfort and fatigue.

Maintaining the length of the hamstring is important to enable a good even gait pattern and upright sitting posture.

How to stretch

As the hamstring muscle crosses both the hip and the knee, your child’s knee needs to be straight and their hip and pelvis controlled in a neutral position in order to hold an effective stretch. Any position when the knee is straight and you lean forwards or sit up straight will stretch the hamstrings. Leg wraps can hold the knee straight and a wedge under your child’s bottom or sitting up against a wall prevents their back from becoming too curved and loosening off the stretch.

Formal exercises

Long sit

Sit your child on a wedge with your child’s back against the wall or with someone behind to ensure the back is straight. Aim to be in this position for at least 30 minutes. It can easily be done watching TV or playing a game on the floor. For an added stretch you can widen the legs and feel a stretch on the inside of the thighs as well. Put the pieces of the game/puzzle/book in between the legs to make it more interesting. If your child wears AFOs, they can hold onto the straps to increase the stretch

Lying doorway stretch

To stretch your child’s hamstrings in lying, lie on your back in a doorway. Place the leg to be stretched on the wall with knee slightly bent and your child’s bottom as close to the wall as possible. Keep the other leg that stays on the ground straight. Straighten the knee that is up on the wall until stretch is felt in back of thigh. Hold for 30 seconds. Relax and repeat 3-10 times.

Leg wraps

Leg wraps are often used after Botulinum Toxin-A injections. The muscle is relaxed and this provides a good opportunity to stretch it. The duration of the effects of Botulinum Toxin-A is increased by doing other treatments at the same time, such as serial casting, AFOs, night splints and physiotherapy. Your therapist will specifically look at the hamstring length and walking pattern to evaluate whether leg wraps may help.

Sleeping with leg wraps on at night or wearing leg wraps when using a standing frame will give the hamstrings
a prolonged stretch and is particularly important in order to maintain muscle length in non-mobile children with cerebral palsy. They should be wrapped firmly around the thigh and leg with the knee cap positioned in the hole that is cut out.

Preventing crouch

Crouch occurs in a child who stands and walks with feet flat but with very bent knees and hips. Several factors contribute to this, along with hamstring tightness and spasticity and weak calf muscles. It often occurs during growth spurts and may result in becoming tired when walking as the gait pattern is not effective.

Maintaining hamstring length through stretches and wearing leg bands is important in being able to walk with an upright posture as well as doing exercises to strengthen the quadriceps muscles (front thigh muscles) which help
to straighten your knees while walking.

General activities to assist stretching

There are some general, every-day activities you can encourage your child to do which include: swimming, sit to stand, squatting, walking up hills or driveways, walking backwards and heel stomping.

Contact us

Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Resource No: FS193. Developed by the Queensland Paediatric Rehabilitation Service, Children’s Health Queensland. Updated: August 2015. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.