Stretching: What’s all the fuss about?
In our last blog we discussed what we do with you during your treatment time, now I want to discuss, in part, what we want you to do for yourselves away from the clinic, and most importantly why!
More often than not, after your first session with us, you will be sent away with a few exercises to be getting on with and initially this home exercise programme (HEP) will consist of some stretches. Stretching is a form of physical exercise whereby a muscle is deliberately elongated to principally improve its’ elasticity and tone. It is suggested that stretching can enhance athletic performance, aid in the prevention of injuries as well as assist in musculoskeletal injury rehabilitation; the latter being our primary focus. There are several forms of stretching including dynamic, ballistic and proprioceptive neuromuscular facilitation (PNF) stretching. However, for the purpose of this blog, we will be focussing on static stretching.
An improvement in muscular flexibility will help to reduce pain and tension
To statically stretch a muscle, is to place it at its’ greatest possible length and hold it there for a period of time. Our main aim with performing static stretches is to increase the muscles’ flexibility. Flexibility has been defined as “the ability of a muscle to lengthen (Zachazewski., 1989), allowing one joint (or more than one joint in a series) to move through a range of motion (ROM).” If a muscle has poor flexibility, its’ capacity to deform is reduced leading to a decrease in ROM of the joint/s in which it surrounds. An improvement in muscular flexibility will help to reduce pain and tension but it will also promote more efficient movement patterns and functionality (Law et al., 2009) therefore helping to correct the causative factors that lead to injury in the first place.
In short we aim to lengthen muscles that are short or overactive and strengthen muscles that are weak / underactive. This aids and re-balances normal function around joints and so treats the underlying cause of your injury and pain and not just your symptoms!
So we want you to stretch but for how long should you hold that stretch and how many times should they be performed?
Stretch a minimum of three times a day
Here at City Rehab, we generally advise you to stretch a minimum of three times a day whilst holding the stretch for at least 30 seconds; of course these are only guidelines but we find that this minimum, gains the most beneficial results. Duration of stretches varies amongst researchers but studies have shown that a stretch sustained for at least 30 seconds increases a muscles’ flexibility and the ROM of the surrounding joint/s greater than that of a stretch held for less than this time period. It is thought that before the 30 second marker, the receptors in the muscle only oppose the stretch, i.e. they do not like the fact that they are being stretched so signals are sent to tell the muscle to contract and shorten, which is the opposite of what we are trying to achieve. After 30 seconds, it is believed that the receptors switch off which then allows the muscle to relax and lengthen.
Stretch at regular intervals throughout a day
Frequency of stretching again is not clear cut amongst advocates and some studies suggest that there is no difference between performing one stretch per day and performing three stretches a day (Bandy et al., 1997). However, research is sparse when it comes to examining the longevity of gains in muscle flexibility through the use of static stretching, whether performed once a day or more; thus a clear conclusion cannot be drawn. Nevertheless, some hypothesise that continued stretching regimens are essential to maintain ROM gains (Feland et al., 2001), therefore surely stretching at regular intervals throughout a day will have much more positive effects regarding a muscles’ length and flexibility than just repeating the exercise once a day.
Stretches are a good starting point to get your rehabilitation underway
As clinicians at City Rehab we highly value the use of stretching as part of a rehabilitation programme, hence why we put so much emphasis on its’ importance. Stretches are a good starting point to get your rehabilitation underway; as we’ve discussed they improve a muscles elasticity, which in turn increases joint ROM helping to reduce pain and stiffness and also promoting improved function. Of course we understand that stretching alone isn’t going to rid you of your injury for good but coupled with other rehabilitative components, such as strengthening exercises (which will be covered in our next blog), we can certainly make a difference to your active life, and not just for the short term.
References
Bandy, W.D., Irion, J.M. &Briggler, M (1997) The Effect of Time and Frequency of Static Stretching on Flexibility of the Hamstring Muscles. Physical Therapy, 77, 1090-1096.
Feland, J.B., Myrer, J.W., Schulthies, S.S., Fellingham, G.W. &Measom, G.W (2001) The Effect of Duration of Stretching of the Hamstring Muscle Group for Increasing Range of Motion in People Aged 65 Years or Older. Physical Therapy, 81, 1110-1117.
Law, R.Y.W., Harvey, L.A., Nicholas, M.K., Tonkin, L., De Sousa, M. &Finniss, D.G (2009) Stretch Exercises Increase Tolerance to Stretch in Patients with Chronic Musculoskeletal Pain: A Randomised Controlled Trial. Physical Therapy, 89, 1016-1026.
Zachazewski, J.E (1989) Improving Flexibility. In: Physical Therapy. Scully, R.M. & Barnes, M.R (Eds), 1st Edition, Philadelphia, Lippincott, 152-153.