stretching 1 By Meredith Butulis

The Internet, magazines, and media are brewing with new developments and ideas in flexibility training. What’s new? What’s old? What should you consider before designing your next stretching program?

Let’s look at how the trends hold up to science, and then empower you with the rationale to upgrade your flexibility program design.

Myth #1: Static stretching should be replaced by muscle smashing.

Fact #1

Self myofascial release (SMR) coupled with static stretching can help improve efficient movement patterns.

The Details

This past month, I’ve been traveling quite a bit, often frequenting various fitness facilities. What have I noticed? Lacrosse balls. Everywhere. People are driving them into IT Bands, hip bursae, spines, and even first ribs to “loosen up” or decrease pain before an intense workout.

As a licensed sport and orthopedic Physical Therapist, I cannot support this practice. However, SMR tools like foam rollers, runners’ sticks, and even lacrosse balls can still be an integral part of your mobility workout.

Let’s look at Davies’ Law:

Soft tissue remodels based on the stress placed upon it. So, what kind of stress is helpful?

One should generally begin with the least amount of force. Placing the release tool on tight myofascial spots then holding for 30 – 180 seconds (or until 50-80% release is felt) can effectively help normalize the nervous system signals to over-active muscles and fascia (Johnson, 2001). Remember to breathe and relax into the tension to allow for the desired release to occur.

Including SMR is important because trigger points can create pain, inefficient movement patterns, muscle imbalances, elevated stress, and injury over time (Johnson, 2001).

This technique is not limited to pre-workout. It can also be performed on non-workout days or post-workout to help improve ease of motion and blood flow to seemingly tight myofascial areas as well.

Trigger points cannot be lengthened or strengthened, so release them to get the most out of your workout!

chart 1




























Figure 1. Sources of stress and body responses. SMR can have a positive impact on all of the above (Johnson, 2001).

Since trigger points and myofascial adhesions do not allow muscles to lengthen properly, following your SMR with corrective static stretches can be helpful in restoring normal joint motion pre-workout.

If you are familiar with strength and cardiovascular training, then you’re likely familiar with the FIT principle: Frequency, Intensity, and Time. This applies to static stretching too.

Frequency:

While performing static stretches most days of the week improves range of motion, it doesn’t provide neuromuscular control. This is where dynamic flexibility warm ups come into play. Hold tight, as we will be back to discuss dynamic flexibility in just a moment.

Intensity:

Effective static stretching can be performed with less than one pound of external pressure. Muscles should be lengthened to the point of gentle tension, but not pain (Vitale). Learning to relax into the lengthening will produce much more effective results than pushing through pain. Stretching, like strengthening, can cause microtearing of muscle; like strength training, one may experience delayed onset muscle soreness after stretching. If this lasts > 24 hours, the stretching intensity should be decreased in future sessions (Vitale, 2005).

Time/Duration:

If the goal is to increase the myofascial ability to lengthen, then hold the gentle stretch for up to 4 repetitions of 30 seconds (Shrier, 2004). For older adults (65 years +) increasing the duration to 60 seconds may be beneficial (Feland, 2001).

While corrective stretching can be performed pre-workout to facilitate more optimal joint movement, most static stretching should be saved for post-workout. Pre-workout static stretches can impair muscle and neuromuscular performance for up to one hour (Fowles, 2000). If you are planning for a maximal strength or power workout, you will want to save static stretching the prime movers for post workout.

chart 2



















Figure 2. Key variables when applying corrective exercise techniques such as SMR and static stretching.

Myth #2: Stretching should focus on individual muscles.

Fact #2

Sport performance, general fitness, and injury prevention are favoring dynamic warm ups instead of isolated static stretches.

The Details

Think back to high school gym class or sport. Were you asked to find a partner, who then pushed on your legs or arms with a lot of force to try to improve your range of motion? This practice is more likely to lead to injury than actual range of motion improvements.

Current evidence supports dynamic mobility as part of the warm up sequence (Weerapong et al., 2004). This implies that all the major joints should be moved through gradually increasing ranges, speeds, and planes. This shifts our thinking away from individual muscles and broadens the view to myofascial systems working together throughout the body.

Sometimes we think to organize dynamic warm ups in planes of motion:

  • Sagittal: Forward/backward motions
  • Frontal: Sideways motions
  • Transverse: Rotational motions

This provides a good start, but we are missing part of the plan.

What about Fryette’s Third Principle?

When motion is introduced in one plane it reduces motion in the other two planes (Greenman, n.d.). Quite simply, we are going to need to include a variety of movement combinations. This simple idea becomes complex as you realize there are an infinite number of possible movement combinations. However, there’s a solution to organizing these functional movements.

The Solution:

Wolf builds from Myer’s work with the suggestion of five flexibility highways: anterior, posterior, lateral, anterior X, and posterior X. The key is to work on the extensibility of the grouping instead of focusing on isolation.

Posterior:

  • Key muscles/structures: Plantar fascia, calf, hamstrings, gluteus maximus, thoracolumbar fascia, latissimus dorsi, paraspinals, sub occipitals
  • Example: Pilates scissor (Level: Advanced)













  • Other examples: Inchworms, yoga forward bends, sit and reach, child’s pose

Anterior:

  • Key muscles: Anterior tibialis, quadriceps, hip flexor complex, abdominals, pectoralis major and minor, anterior delts, and anterior neck musculature.
  • Example: Yoga upward facing dog (Level: Intermediate-Advanced)










  • Other examples: Pilates prone press up, standing back bend, gymnastics bridge

Lateral:

  • Key muscles/structures: peroneals, ilioibial band, tensor fascia latae, gluteus medius, obliques, lateral neck muscles
  • Example: Side plank overhead reach (Level: Intermediate-Advanced)










  • Other examples: various forms of sidebends, Pilates side mermaid

Anterior X:

  • Key muscles:
    • One side: hip flexor complex, adductors, abdominals
    • Opposite side: Pectorals, anterior deltoids, anterior neck
  • Example: Function-Specific Stretch. Level: Intermediate-Advanced










  • Other examples: Lateral lunge with overhead reach, front lunge with overhead reach, scorpions (face down), Pilates snake and twist, diagonal lift pattern

Posterior X:

  • Key muscles:
    • One side: plantar fascia, calf, hamstrings, gluteus maximus, thracolumbar fascia
    • Opposite side: latissimus dorsi, posterior deltoids, posterior neck, sub occipitals
  • Example: Yoga bound chair variation (Level: Intermediate)













  • Other examples: Windmill, lawn mowers, Pilates saw, diagonal chop pattern, yoga triangle

While these sample stretches appear static, remember to keep moving as you gradually increase the range and speed of the motions, as well as ensuring good motor control during your dynamic warm up. These same flexibility highways can be utilized with static stretch parameters post workout if desired. In selecting movement, remember to scale combinations and positions to your specific goals and abilities.

Myth #3: Stretching improves body composition.

Fact #3

Currently evidence to show that stretching alone would improve body composition is lacking. Including stretching as part of a well-rounded fitness plan can help reduce stress, and this can help with hormonal regulation. Hormonal regulation is a critical component in optimizing body composition and physique.

The Details

It is easy to find headlines with claims that stretching leads to weight loss or maximizes muscle gains. Where’s the scientific evidence to support these direct conclusions?

Here’s what we know: A dedicated flexibility program may help decrease psychological stress (Smith et al., 2007), as well as physical stress of inefficient movement patterns (Vitale, 2005). Stress impacts the hormonal system in a way that can make it difficult to lose unwanted pounds (Ranibar & Reetu, 2011).

Stress management is a critical component of successful weight loss programs.  Evidence to support the integration of stretching based yoga, Pilates, and other mind-body programs into weight loss methods continues to evolve.


























Figure 3. Unfavorable hormonal changes with prolonged stress that impact body composition and risk for metabolic diseases (Ranabir & Reetu, 2011). Stretching can be a part of a more comprehensive stress management program, which could improve hormonal balance.

Summary:

Overall, the scientific data and trends are moving toward:

  1. Combined techniques specifically timed pre- and post-workout to maximize performance and minimize injury risk.


  2. Multi-planar controlled mobility through increasing ranges of motion, speeds, and combinations of patterns.


  3. A more holistic view of the body, where flexibility program design can be part of other goals like weight loss, physique, functional training, and sport.
























Figure 4. Timing of mixed flexibility methods relative to strength, cardiovascular, or skill based workouts.

References:

Feland, J.B., et al. (2001). The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Phys Ther. 85(5): 1110-17.

Fowles, J. R., Sale, D.G., MacDougall, J.D. (2000). Reduced strength after passive stretch of the human plantar flexors. J Appl Physiol. 89:1179-88.

Greenman, P.E. Principles of Manual Medicine. Baltimore: Williams and Wilkins; 1989:58-60

Johnson, G.  (2001). Soft Tissue Mobilization. In: Orthopedic Physical Therapy, 3rd Ed. Donatelli and Wooden (Eds). Churchill Livingstone: Philadelphia. Chapter 27.

Myers, T. (2009). Anatomy Trains. Churchill Livingstone: Philadelphia.

Ranibar, S. and Reetu, K. (2011). Stress and hormones. Indian Journal of Endocrinology and Metabolism. 15(1): 18-22. Retrieved from PubMed Central https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079864/

Shrier, I. (2004). Does stretching improve performance? A systematic and critical review of the literature. Clin J Sport Med. 14(5): 267-273.

Smith, C., Hancock, H., Blake-Mortimer, J., Eckert, K. (2007). A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complimentary Therapies in Medicine. 15(2): 77-83.

Teisala, T., Mutikainen, S., Tolvanen, A., Rottensteiner, M., Leskinen, T., Kaprio, J., Kolehmainen, M., Rusko, H., Kujala, U. (2014). Associations of physical activity, fitness, and body composition with heart rate variability–based indicators of stress and recovery on workdays: a cross-sectional study. Journal of Occupational Medicine and Toxicology. 9(16). Retrieved from BioMed Central Open Access: https://occup-med.biomedcentral.com/articles/10.1186/1745-6673-9-16

Vitale, A. (2005). Stretching. In: Principles of Manual Sports Medicine. Karageanes, S (Ed). Philadelphia: Lippincott. Chapter 12.

Weerapong, P., Hume, P., Kolt, G. (2004). Stretching: mechanisms and benefits for sport performance and injury prevention. Physical Therapy Reviews. 9(4).

Wolf, C. (2016). Stretching. PTA Global. Retrieved from: http://staticcontent.fitpro.com/ptaglobalus/lectures/241/index.html on 29 November 2016.

Photo credit: Lucas, S. (2016). Steve Lucas Photography. Eden Prairie, MN. USA.


Meredith Butulis Meredith Butulis blends a background in Sports/Orthopedic Physical Therapy, Personal Training, Pilates Training, Performing, and Post-Secondary Education Curriculum Design & Instruction.

Most importantly Meredith is a life-long learner and is grateful for the opportunities to observe and exchange ideas with the world. She’s worked in the industry since 1998, and is currently a Sports/Orthopedic/Dance Physical Therapist at Twin Cities Orthopedics in Minnesota (www.TCOMN.com). In her free time, she can be found dancing, performing, and writing a free blog to help dancers with health, wellness, and fitness (www.DancePT.org).

Degrees: Doctor of Physical Therapy, Master’s in Physical Therapy, Master’s in Business Administration, Bachelor’s in Health Studies, minors in Psychology and Dance.

Certifications: Orthopedic Certified Specialist (ABPTS), Certified Integrated Manual Therapist (GLS), Health Fitness Specialist (ACSM), Comprehensive Pilates (BB), Certified Personal Trainer (NASM), Performance Enhancement Specialist (NASM), Corrective Exercise Specialist (CES).