Re-Thinking Stretching

Last month, we had the privilege of hosting Functional Range Release course for the Lower Extremity here at Perfect Stride.  As usual, it was a great seminar with a lot of takeaways.  The FR system always leaves us with great knowledge that makes an immediate impact on how we treat and help patients recover from injury.

Typically after a seminar we would write a course review that discusses our thoughts and experiences.  We already wrote that review last December when we hosted the FRR Spine course (click here to read more).

Rather, we will discuss an important FRR concept that we use at the clinic on a daily basis, which has come full circle for us again this time around.  That concept is proper stretching, and how you can use it to create long-lasting changes to your connective tissue and mobility. 

When it comes to mobility work and stretching, your goals should dictate what you do.  These goals direct your prescription of the type of mobility work and how long you should hold your stretches for.

Dynamic Warm-ups

The overall purpose is to prepare the body for the demands of the upcoming workout, in particular to increase temperature-dependent physiological responses.  This is done by performing movements specific to a sport or movement pattern (Hendrick, 2012).

At our clinic, this type of stretching is used with our personal training clients.  We create a dynamic warm-up that will ready the client/athlete for exercise.  This helps us not only increase tissue temperature and activate necessary muscle groups needed for performance, but that a dynamic-based warm-up prior to physical activity may improve performance while providing increased resistance to muscle injury (Hendrick, 2012).

Holds For Less then 2 Minutes

When it comes to holding stretches for any amount of time, we must understand the effects of the stimulus we are providing.  A study by Currier and Nelson in 1992 has shown that both much longer amounts of time and significantly more force are required for permanent deformation of dense connective tissues.  What this means is that for any cell in the body to even care about a stimulus that is being placed on it, the imposed stimulus  needs to be greater then two minutes.  If you didn't want to hold stretches for that long, a study by Robert Shleip in 2008 supported the notion that it takes roughly 2,000lbs of force to deform dense connective tissue 1%.  Good luck producing a literal ton of force onto someones hips.  

Based on those above studies, this must do the trick. 

Based on those above studies, this must do the trick. 

Of course that leads to the question, "why is it that after stretching for 10-30 seconds I not only feel "looser", but I have improved range of motion." 

This may be true, but ask yourself this.  How long does this last?  Or, does stretching every day actually "fix" the problem?  

What we do know about short duration stretching is that it effects the nervous system.  Studies suggest that increases in muscle extensibility observed immediately after stretching and after short-term (3- to 8-week) stretching programs are due to an alteration of sensation only and not to an increase in muscle length (Robert Schleip, 2003).  

This type of stretching is designed to give a transient increase in range of motion, as well as help decrease your perception of tightness in areas.  We use this at the clinic to help people break the cycle of pain associated with a movement, to decrease fear avoidance with movement, or once some one has developed sufficient ROM at a particular joint. 

Holds For 2 Minutes +

Studies done at the cellular level, particularly on tensegrity and mechanotransduction, suggests that if we want to make actual physiological changes to tissue we need to be applying forces to our tissues for around two minutes or more.  

This two minute mark is determined as the average time cells begin to recognize the stresses being placed on a tissue.  So spending longer duration time in a particular position can help teach tissues to reorganize themselves, making long lasting changes over time.  As Dr. Andreo Spina frequently states, "Force is the language of cells." 

Keep in mind that stretching one time for two minutes will not create a permanent change.  It takes a lot of repeated stimulus over a long period of time to create actual changes to tissues.  This follows the Thixotropic Effect, which states the longer a tissue is under load, the more adaptable it will become.  

This is our bread and butter when we are looking to help patients create long-lasting changes to injured tissue. By giving tissue long duration inputs every-day, over time we can create resilient, flexible tissue that will become more capable of accepting and creating force (particularly at end ranges of motion), allowing you to return to the things you want to do and stay there. 

Remember, the why in what you do is everything.  Random assortments of mobility drills, with random time periods because Joe Schmoe told you to do so is not good enough.  Understand the physiology, know your goals and you will be able to help yourself, your clients and your patients reach their goals. 

Until Next Time, Happy Rehabbing!