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When and Whom to Stretch?
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When and Whom to Stretch? - May 2, 2005 9:12:00 AM
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Barrett
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I thought this link to an article in "The Physician and Sportsmedicine" was very useful. I got it from the "Supertraining" list.
[URL=http://www.physsportsmed.com/issues/2005/0305/shrier.htm]web page When and Whom to Stretch[/URL]
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Barrett L. Dorko P.T.
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Re: When and Whom to Stretch? - May 2, 2005 3:16:00 PM
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jma
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A very good article to have handy. It makes perfect sense.
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Re: When and Whom to Stretch? - May 2, 2005 3:51:00 PM
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Barrett
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I agree. Of special interest to me were the examples given.
I didn't see anything about the relation between stretching and pain relief. Is there one? If not, why is it often suggested?
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Barrett L. Dorko P.T.
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Re: When and Whom to Stretch? - May 2, 2005 3:56:00 PM
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jma
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Hmmm. When I think of stretching and pain relief, I think of nerve glides/flossing. Although I have not heard about the relationship between the two, I wonder if anyone can testify to this
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Re: When and Whom to Stretch? - May 2, 2005 5:59:00 PM
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Synergy
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I agree with JMA. Although stretching may not provide immediate results prior to activity, theoretically it can aid in the longitudinal excursion of nerves and may alleviate any pains.
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Re: When and Whom to Stretch? - May 2, 2005 9:22:00 PM
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nari
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,,,but one needs to be aware of the consequences of stretching ( ie static and dynamic sustained) nerves...and for that matter, interfacing tissues as well. Mobilisation is a safer word...??
nari
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Re: When and Whom to Stretch? - May 3, 2005 1:52:00 AM
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Alex Brenner PT MPT OCS
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Barrett,
I liked the vignettes as well and I too wonder why there are no studies that try to explain the relationship between stretching and pain. Perhaps there is no relationship. I am sure we all prescribe stretches for various musculoskeletal complaints everyday and don't think twice about it.
At my previous military assignment at a larger basic training post I would see many young soldiers with severe lower extremity stress fractures. In addition to rest part of my intervention would be to have them stretching, especially the gastroc-soleus muscle group. I am not sure why but to me there is something to be said about getting tissue and joints moving. It seems to modulate pain, at least in many of the responses I saw.
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Alex Brenner, PT, MPT, OCS
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Re: When and Whom to Stretch? - May 3, 2005 2:25:00 AM
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Barrett
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Alex,
Well, there's movement and then there's movement. Not all active movement is designed ideally to maintain mobility and tissue length, and choreographing movement for another carries risks any ballet dancer will be glad to tell you about.
Once we're born movement emerges naturally and efficiently, and by that I mean the movements that reduce the mechanical deformation that accumulates as we live our lives. Without question, the nervous system contains the tissue most likely to be bothered first by tension or compression and we know (or, at least should know) that ideomotor (go ahead and Google it) expression is designed to resolve that. No less an authority than Patrick Wall points out that we can be trained to withold that correction. Trying to replace instinct with choreography is what makes the connection between stretching and pain relief so tenuous. We know it can help but are often disappointed. We get neuromudulation, briefly, but no enduring correction.
When I determine that the connective tissue is the problem I'm confident that directed, accurate and prolonged stretching will help. When the restriction lies in nervous mobility or currently available length I let the patient resolve this naturally (ideomotorically).
Makes sense to me.
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: When and Whom to Stretch? - May 3, 2005 5:37:00 AM
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Lukey
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Barrett,
I've been reading up on this a bit lately and trying to understand your idea on stretching. This is where I'm up to at the moment - Can you tell me if I'm on the right track?
Acute muscle stretch results in a 2-5% change in the viscoelastic properties of the muscles and the remaining change is due to alterations in the stretch threshold via neuromodulation. Any change to the viscoelastic properties are reverted in about 1 hour. A regular stretching program has no further effects viscoelastic properties of the muscle and any increase in ROM is due to increased stretch threshold neuromodulation. There is no link between ROM and pain.
Pain results in reflex contraction of muscle in the region (or even globally) in an effort to produce an appropriate corrective response. People usually confuse the referred pain in the muscles supplied by an neurodynamically aberrant nerve and commence stretching (often upon instruction by therapist) in order to relieve the pain. This may indirectly result in a reduction in pain due to the neuromodulatory effect of the strecth (not due to increased ROM). However this effect is generally short-lived (as well as useless or even detrimental) as the originating mechanical deformation has not been addressed.
How am I going?
Luke
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Re: When and Whom to Stretch? - May 3, 2005 6:13:00 AM
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Barrett
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Luke,
I think you've described a common and biologically plausible explanation for what we see, and, unfortunately, produce in many therapy programs.
The "appropriate corrective response" is held at bay by a culture that insists on discipline and erectness in an effort to honor a Puritan ethic and ideal of beauty. At least, this is the best explanation I can come up with-and it seems to be enough.
Think the culture isn't enough to alter behavior detrimental to our health? Given what we know now about the immediate effects of stretching prior to performance, can you imagine the rituals of stretching before a high school football game or track meet disappearing in response to this knowledge?
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: When and Whom to Stretch? - May 3, 2005 6:14:00 PM
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ericm
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Barrett, you'd be surprised. The running club I train with has dropped stretching as part of the warmup during their workouts. This change happened about 2 years ago. Although as the article makes clear, it probably would not make any difference for this group of 'athletes' anyways.
eric
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Re: When and Whom to Stretch? - May 3, 2005 8:01:00 PM
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nari
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Stretching may or may not be of significant value, but people feel better after a stretch or two, and certainly after a yoga session.
Why?
I suspect it assists with the brain's decision-making process as to the importance of the stretch. People feel it may be a good sort of 'pain', or a pleasant sensation. Done frequently and carefully (ie not dozens of reps) it may be as good an antinociceptive as anything else.
So if no stretches are done, it may not matter in the painfree person....but dynamic stretches seem to help the persistent pain person.
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Re: When and Whom to Stretch? - May 3, 2005 11:41:00 PM
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Randy Dixon
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Barrett,
Is the supertraining site still working? I haven't gotten anything for a month and when I went there was no activity posted.
One thing I didn't notice on the paper is that stretching can be used as a diagnostic. I wrote a paper on injury prevention in Judo, one of the recommendations I had was to perform a quick, systematic stretch of all the joints at the beginning of exercise. Not as a warmup or to gain flexibility but simply as an assessment of problem areas.
I had some research showing that the neuromodulating effects of dynamic stretching last for about 24 hrs. Dynamic stretching bordering on ballistic performed in the morning will increase available range and that range will remain more or less availaile throughout the day.
There wasn't much evidence for injury prevention from regular stretching, but in Judo there was considerable performance enhancement and I believe that that in itself has some protective effect.
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Re: When and Whom to Stretch? - May 4, 2005 2:14:00 AM
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Barrett
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Randy,
No doubt stretching would be required for special activities. I can sit on a plane for hours without pain or any evident stress on my neural tissue signified by tingling or numbness, but three minutes in a kyak is, for me, torture. Only prolonged stretching would make this possible for me. An instructor concerned with my comfort would tell me to go home and stretch for a couple of months before I got in the kyak. I should also probably learn how to swim.
Supertraining appears sporadically. Mel's passing hurt it but someone's still sending it out.
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: When and Whom to Stretch? - May 4, 2005 6:26:00 AM
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hmgross
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I think this came up in another post before, but any ideas on why dogs stretch? I thought about it this morning watching my little dog after he woke up. Some days he stretches out the front legs, butt in the air. Other days he leans forward and stretches out a hind leg. Of course he was never taught this, but I am sure it feels good, or he would not do it. Just curious, but maybe it is along the same line as "why do we yawn"--Any thoughts?
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Holly Gross PT
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Re: When and Whom to Stretch? - May 4, 2005 9:43:00 AM
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Barrett
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Dogs move instinctively in an effort to resolve their own mechanical deformation, and unless they are posing for a specific reason (to threaten or display submission, to look a certain way while in the show ring, to beg for food) this will emerge appropriately. They aren't domesticated sufficiently to eliminate this.
We are.
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: When and Whom to Stretch? - May 5, 2005 12:11:00 AM
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Randy Dixon
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Holly,
I once asked Barrett about this, the fancier term for it is "pandiculation". I thought it might be something along the lines of Barrett's theories. Anyway if you google pandiculation you might find something of interest.
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Re: When and Whom to Stretch? - May 5, 2005 12:21:00 AM
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nari
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Cats and dogs particularly enjoy a good momentary stretch or two. We might as well, but it is a heck of a lot easier on four legs - more instinctive and useful. Some dogs will stretch to the point of clonus initiation, whereas if we do a prolonged plantarflexion stretch - cramp.
As Barrett says, dogs will do what dogs do, if not under the master's thumb. Most of us don't. We tend to do what is right, or what someone has told us to do...and then proceed to perfect it consciously.
Nari
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Re: When and Whom to Stretch? - May 5, 2005 1:04:00 AM
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Barrett
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Nari,
I agree that there may be greater ease with movement while on all fours, but I doubt the instinct to do this is stronger-just less restricted by other quadripeds.
Here's a quote from the legendary psychologist Stanley Milgram, the most innovative theorist and experimenter regarding the human response to authority: "It may be that we are puppets-puppets controlled by the strings of society. But at least we are puppets with perception, with awareness. And perhaps our awareness is the first step to our liberation."
Why not make your patients aware of what they instinctively want to do? Of course, you should explore that within yourself first.
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: When and Whom to Stretch? - May 5, 2005 2:07:00 AM
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nari
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Barrett
I have not explored that aspect within myself - could get me into all sorts of interesting confusions. I don't have a handle on the topic yet, but I think I am getting closer.
If the USA wasn't so far away, I'd book into one of your courses...
Nari
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