When an athlete is injured one of the first things they ask me is “What stretches can I do” as if the reason they were injured was due to a lack of flexibility. The last 20 years of sports medicine research has dispelled the myth that stretching prevents injury but that does not mean that stretching may not HELP you once you are injured. Notice, they are not the same thing. For amateurs who might read “Google research” the snippets they are exposed to seem to intimate that stretching will not help….this is because in the medical research it has been shown to not be a factor in PREVENTING injury and may in face decrease performance in some instances. However, when you suffer a muscle, tendon, ligament or joint injury it is common to have a secondary reaction known as “muscle splinting”. Muscle splinting is your bodies normal reaction to injury whereby it neurologically causes muscle spasm, shortening and hypertonicity of the involved and surrounding muscles to protect and inhibit you from damaging yourself further.
There are different forms of stretching that can be helpful. Most people are familiar with static stretching. This is the type of stretching where you lengthen the muscle and hold yourself in a fixed position for a period of time. Ballistic stretching is the type where the muscle is stretched and there is rapid, forceful movement. There is also controlled dynamic stretching. Dynamic stretching stretches a muscle gently while the joint is taken through a full or partial range of motion. For the purposes of this article we will focus on Static stretching as that is the most commonly performed and prescribed stretching.
The problem with stretching is not necessarily the stretching itself but the variables involved with stretching. For example; how long do you have to hold a stretch for it to be effective? How many times per day do you have to do the stretch in order for it to be effective? At what point am I not stretching intensely enough? At what point am I over-stretching and causing more damage? These are all important variables that need to be addressed if you are going to stretch effectively for your injury. We will categorize these variables into;
- Too much – Can I stretch too much. Of course you can. Anything can be done in excess. How do you know how much to stretch? I would have to defer to 3 variables here. Research, my experience and personal research and common sense. If you are stretching to the point of pain you are over-stretching and most likely tearing tendon or ligament fibers. Pain is your body’s way of telling you that damage is occurring. Stretching into a painful range is damaging to the body and would explain why I have seen so many patients over the years that get hurt doing Yoga. A proper static stretch stretches the muscle, the tendon slightly but does not apply stretch to the joint and ligament. Stretching the joint and ligament will result in short term pain and long term joint instability. In spite of what you may have been taught, learned or think having excessive range of motion confers no additional health benefits upon you but does leave you with lifelong disability and unstable joints.
- Tool little – Can I stretch tool little? Of course you can. For example, common sense would dictate that if you stretch for your injury for 2 seconds once a day that you would be wasting your time. I have found that when I direct patients to stretch on the hour and hold each stretch for 30 seconds the result has been a thousand times better than if I direct them to stretch 2-3 times daily and give no instruction for exactly how long to hold each stretch. The protocol of stretching on the hour is loosely based on stretching research studies, my experience and common sense. I know that almost no one is going to stretch every hour but I also know that if I instruct someone to they will stretch far more than the 1-2x they would have otherwise. I also know that if I tell someone to hold the stretch for 30 seconds that they will probably hold it for about 20 seconds…..a far better cry than the patients and runners I observe stretching for about 2.5 seconds before a run!!
- The wrong kind – What is the wrong kind of stretching you ask? Improper form comes to mind. If you are performing a stretch with improper form you may be causing more injury and at best you are not being efficient and allowing the stretching to have its maximum therapeutic effect. I have rarely met a patient who is doing a stretch with correct form. For that matter I have rarely met a doctor or physical therapist who understands muscle mechanics and how to properly isolate a muscle during a stretch. I can usually “clean up” a patients stretching technique quickly and patients will instantly say, “Wow…now I feel it”.
Please realize that not all injuries and conditions will respond to stretching and some may even be worse for it. A good example of this would be an Medial Collateral Ligament Tear in the knee. The Medial Collateral Ligament or MCL purpose is to prevent excessive internal rotation at your knee joint. Tearing of the MCL results in Quadriceps muscle splinting in your body’s effort to protect the joint and long term instability to your knee joint as the MCL’s primary job as a ligament is to provide stability and prevent excessive range of motion. Another common injury that stretching would not be inappropriate for would be a heel spur. Heel spur syndrome can mimic plantar fasciitis and while plantar fasciitis will respond well to proper stretching a heel spur will often be aggravated by the exact same stretches!
In the next article we will tackle the rehabilitation principle of massage, self-massage, foam rolling, sticking and more. In the meantime if you are going to stretch make sure to not do too much, too little or the wrong kind!