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Re: When and Whom to Stretch?
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Re: When and Whom to Stretch? - May 5, 2005 2:32:00 AM
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Barrett
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Nari, you would be my guest.
Another thing about the ease with which animals stretch compared to humans-we are constantly urged to hold our feet close together when in public and not actually engaged in some sporting activity. Obviously there's no mechanical advantage to this and we know it restricts diaphragmatic excursion and increases neural tension.
To whose advantage is this posture maintained?
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Re: When and Whom to Stretch? - May 5, 2005 3:34:00 AM
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Sebastian Asselbergs
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The only times I was told to hold my feet together was as an altar boy (yes!!) during mass, and in the army at attention. It presents a visual uniformity that is pleasing and calm to the eye (supposedly), allows the focus to be on the importance of the mass celebration rather than the parts, and in the army's case, presents a mass "machine" that exudes power. The individual is, in these cases, very much of lesser importance than the whole. This makes a poor environment for natural and instinctive expression.... And to think I was a "long-haired-hippie-freak" between altar-boy and conscription army-lad.... The hippie stuff was really just as much a uniform: the walk, the hair, the smoking - all just to "belong" - to feel less insecure in the world.
Yes, it is not easy to break the bonds of external uniformity to move instinctively (you should see the faces at our Rotary meetings when I "squirm" as they call it- but now see more doing it...)
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Re: When and Whom to Stretch? - May 5, 2005 3:57:00 AM
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Diane
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There used to be (not so much anymore) huge gender inequality on that "keep the feet close together" thing. It extended to the knees, especially when sitting. As I grew up half a century ago I recall "lady" behavior compared to ordinary human behavior.
There was a certain mincing way to run, the knees pivoted around each other as if they were bolted together, and the arms pressed into the sides of the chest wall to keep the bosom still. I remember watching "ladies" run this way on the rare occasion that they had to move faster than a walk, and wondering what planet they were from.
Luckily my mother only assumed "lady" behavior when in public; I got to absorb normal human behavior, e.g., sitting with an ankle crossed over a knee, instead of a knee over a knee or knees pressed together, ankles crossed and feet over to one side... most of my formative years, learned in my body and "decided" in my social self, that normal was OK, preferable.
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Re: When and Whom to Stretch? - May 5, 2005 6:10:00 AM
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hmgross
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Great replies, and thanks Randy, I will check that out. Think of generations of young girls dreaming of being a model or Miss America, walking around with a book on top of their heads. Not what you would call a naturally assumed posture, but culturally ingrained.
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Re: When and Whom to Stretch? - May 5, 2005 9:00:00 AM
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Barrett
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So why to we continue to teach it?
To anyone else viewing this thread: Has this posture ever been correlated to pain? If you think so, please site the study. If you think stretching and strengthening will lead toward the regular use of this posture, please explain how. (I anticipate no reply. Maybe those who think so are aware of the fact that our own literature doesn't support their theory)
No doubt stretching of the appropriate tissues enhances certain aspects of performance. For choreographers, coaches and trainers this is useful to study, but how often is it an issue in typical outpatient orthopedics? Anywhere near as often as it is perscribed?
For Diane,
My own mother held herself carefully until entering the early stages of Alzheimer's. One day while watching her "play piano" on her own knees I realized that therapeutic movement might have a different face from the one I had been taught to impose upon others. This was the beginning of my study of ideomotor expression. It was also the beginning of my alienation from my colleagues. Both have done nothing but grow.
There's more about this in "The Piano Lesson" on my site and "The Forgetting" in "Barrett's Book Report" on this site.
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Barrett L. Dorko P.T.
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Re: When and Whom to Stretch? - May 5, 2005 1:28:00 PM
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nari
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Diane
A lot of women still run this way, exactly how you describe it. Keeping the feet together is a cultural thing, I am sure, and any body language text will mention this as an indication of propriety - not issuing any overtures to passing males. In the same way, men who sit with their legs apart is seen as threatening.
How did we get to this point? I don't know but body language is a fascinating study, even if most of it is silly mis/interpretation.
Barrett
Thank you.
I'm hoping to get to Canada next year - so who knows? (If Australia doesn't get half demolished by the next big shift in the Indo-Aust plate)
It is fairly well accepted here that posture and pain are not really associated, by the number of studies that have indicated this. But we are taught, culturally, that we look 'better' if we walk around looking as though we have Harringtons in our spines. I'm still trying to get across the message that if we sit or walk 'perfectly' we will get just as much discomfort from maintaining that tension as we do if we slump in front of the TV. It doesn't win me any Brownie points...
All I know is that all my life I have hated sitting still; as a child I would sit crosslegged and squirm, much to my mother's disapproval. I cannot sit through a movie at a cinema, because of the restriction of movement. I avoid chairs as much as I can and sit on the floor if it is feasible. Someone told me I had latent Tourette's!
But then i was never very good at doing as I was told...
Nari
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Re: When and Whom to Stretch? - May 6, 2005 5:48:00 AM
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Sebastian Asselbergs
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I like you more and more, nari!!
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Re: When and Whom to Stretch? - May 6, 2005 6:20:00 AM
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Diane
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About the original article, I wonder about the mechanisms, i.e., why daily and ongoing stretching produces better function and occasional stretching doesn't. Seems to me the probable answer lies not in lengthened muscles or increased joint range. Rather I think the improvement lies in microtissue, like the nervi nervorum, vasa nervorum, vasa vasorum and nervi vasorum, their health, and the possibility that daily and not too strong stretching stimulates the body to lay in adequate lengths/amounts of these vital nutrient and impulse suppliers. Once built, their increased functionality would be easy to maintain by the same means. Could this be why yoga (along with other contemplative movement practices) is a feelgood activity that has persisted for millenia?
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Re: When and Whom to Stretch? - May 6, 2005 7:23:00 AM
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JLS_PT_OCS
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As an Ortho/Sports guy who prescribes stretching exercises every day (and having been accused of Cartesian thinking to boot), I have some reasons why I give these exercises out and wanted some feedback.
I struggle a lot with this "stretching" concept.
I do think that, like Barrett mentions and the article suggests, that there are some people who might require or benefit from stretching and some that don't.
I think the most frequent reason I use it is that I am attempting to improve the kinematics/ biomechanics of a patient's body, after having thought, through exam, that this was a factor in their pain.
For example, in patients with shoulder pain or "impingement" syndrome who have limited horizontal adduction, I use posterior capsule stretching. I know the morphology of the posterior capsule (it's thin connective tissue) and that given our theories about shoulder biomechanics, having capsular tightness might contribute to abnormal mechanics. In this case, I'm talking about the theorized anterior and superior migration of the humeral head in response to posterior and inferior capsule tightness.
So that's my rationale for using it in that case, by example.
What do you guys think of that?
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: When and Whom to Stretch? - May 6, 2005 8:05:00 AM
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Shill
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Jason,
I think its good. I think its the best weve got, so lets do it. Makes sense to me.
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Re: When and Whom to Stretch? - May 6, 2005 10:38:00 AM
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Barrett
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Jason,
I agree. This is a thoughtful approach based upon your understanding of the properties of the materials you're trying to change with a reasonable and specific force. You can easily defend your technique and you're sticking with commonly applied conservative management. You haven't reverted to an "it works" philosophy of care, and I'm not certain you could find the literature to back such a claim. I might be wrong about that.
Would you agree that all this is harder to find when we talk about treatment of the lumbar spine?
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: When and Whom to Stretch? - May 6, 2005 1:13:00 PM
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nari
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Jason
Your rationale is one that is accepted widely, and seems to have validity.
But I have to agree with Diane - the target tissue remains, for me, what we are doing to/with the neural stuff.
Re the shoulder - have a bit of a glance at the nerves around the structure. Suprascapular, etc etc. Anything one does to the shoulder area with the idea of changing the capsule's physiology has to include nerve mobilisation by default. The effect or outcome remains the same - but is the capsule the target as far as the brain is concerned?
neuronut.. ;)
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Re: When and Whom to Stretch? - May 6, 2005 3:33:00 PM
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jma
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There are receptors in that area as well and they too should be affected by default as well.
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Re: When and Whom to Stretch? - May 9, 2005 4:33:00 AM
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JLS_PT_OCS
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Barrett-
Yes, I agree, I think that such a rationale is much harder to propose in the lumbar spine, kind of why I chickened out on the question and picked deliberately an easy scenario. :)
I think there is some evidence to support the targeting of the posterior capsule in shoulder treatment, though I'm not sure about that. I am happy for now using a biomechanical model to substantiate this aspect of my treatment, which is combined with interventions that have more firm support, from an evidence point of view (mobilization, cuff and periscapular strengthening).
Nari-
I guess the capsule is never the target for the brain, I suppose the nerves always are. But I feel that many times the repeated pain our patients are experiencing (ie nerves are reporting) comes from a biomechanical problem that can be addressed quite well by "targeting" other tissues. That is, improve the mechanics of the shoulder to reduce the repeated mechanical deformation of tissue, including nerves, during motion and activities. So I guess all structures other than nerves are always sort of intermediate targets, in that way, since the only thing we are concerned about, pain-wise, is the neural tissue.
JMA brings up the fact that there are receptors in non-neural tissue which can be affected, this is a good point, and I'm sure that's part of what we are accomplishing.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: When and Whom to Stretch? - May 9, 2005 5:50:00 AM
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Diane
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Jason, JMA, to "get to the capsule" you are still having to go through skin and other soft tissue including nerve plexuses, vascular plexuses etc.
Just making the point that nothing exists or can be treated in isolation from anything else. All that other stuff on the way to the "capsule" is bound to have its own opinion about/reaction to what you are doing.
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Re: When and Whom to Stretch? - May 9, 2005 10:01:00 AM
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JLS_PT_OCS
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I think that's a good point, and perhaps I should be describing the MOTION, and not the target tissue when I describe this "stretch" or maybe I should call it "self-mobilization"?
I think we recognize that nothing can be treated in isolation but we have to have a rationale for why we are prescribing certain activities for patients, and sometimes that involves joint biomechanics as well as neural tissue.
Sometimes that rationale is not only neuromodulation, but another goal that helps us achieve that.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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