"It Depends".... Considerations with pain and biomechanics of injury
April 1, 2014
Less is more
July 5, 2015
Should we stretch?
September 26, 2014
Any responsible physio will set up a client with a tailored exercise plan that usually will include strengthening and stretching exercises. However, with athletes having less and less time protected for home exercises the pressure is on for a therapist to select the perfect balance of exercises that can be done in as little time as possible.
When considering bang for buck, I will always choose a functional strengthening exercise over a stretching exercise. To some this may seem obvious, to others it might raise eyebrows. The clinical rationale is detailed below.
The first can of worms point is why would be opt to stretch in the first place? More and more research grows as to the limited, if not detrimental effects of traditional (often static) stretching in athletes. This is not to say never stretch again. Rather, consider the rationale for stretching (are you trying to reduce muscle soreness vs improve performance vs reduce risk of injury etc) and then think about whether the type of stretch you are doing is clinically effective at achieving your goal. The point? A lot of the stretching we do is unlikely to be achieving what we think it is and so that time could be better spent on a more effective warm up/warm down that we can discuss in another blog entry.
So if we move away from the effectiveness of stretching exercises, to think about should we be stretching, the plot thickens. As we've discussed with pain being generated by the brain, it should come as no surprise that the central nervous system has an overarching role on muscle tone and tissue length. If we consider this point, we will realize that short/tight muscles are not an accident. The brain knows exactly what it is doing, so to blindly tug and tug on muscles to try and increase length is, firstly not going to work, and secondly not beneficial.
This tightness is almost always a protective mechanism that the brain is finely deciding upon, allowing movement to a threshold where it feels is safe. To put it simply, tight muscles are protecting and over-compensating for weak muscles. Let's take a commonly seen clinical example of tight hamstrings. The hamstrings often tighten up and are used by the body almost as the emergency brake in car, most commonly in cases where the athlete is weak in their core. This brings up two theories that I talk a lot about with my clients.
The first is stability for mobility. Whether it's in engineering or human kinematics, a lever needs a stable base to move from. i.e. without a solid and stable core, we cannot possible expect our limbs to move and function at their potential.
The second relates to Janda's cross-syndrome theory. In keeping with the above, predictable imbalances occur whereby we see specific muscle groups that are prone to tightness and specific muscle groups that are prone to weakness. Janda's Syndrome The knock on effect of seeing a lower cross syndrome (weak abdominals and glutes with tight back extensors and hip flexors) creates issues further down the chain.
This brings me to my final point in this blog, of appreciating how our body is connected. Fascia is fibrous connective tissue that binds us together. It is very rare that I see an isolated tight muscle without involvement higher up the chain. In our above example, it is unlikely our athlete with tight hamstrings will have normal pain-free range through the rest of their posterior chain. The reason I bring this last point up is that it takes us back to our original question of should we stretch a tight muscle.
My professional opinion is that of course we need to maintain functional range of movement specific to the needs of the athlete. However, without isolating the cause of the tightness and patiently instilling strength and stability before looking to lengthen, we will not achieve a happy ending of reducing soreness, improving performance or reducing injury risk etc.