This is part three part two of a four part blog on the therapeutic effects of exercise. See here for the introduction to the blog and here for the case for strength training. This blog contains all you need to know about stretching.
Stretching is a treatment I use with a lot of my patients. Probably not as many as I do as per strengthening or cardiovascular training but a fair few all the same.
How stretching works?
The science has proven that regular stretching does often improve range of movement. It does this through a number of mechanisms:
Firstly it causes local tissue changes. For example the connective tissue in ligaments change and the fascicles and sarcomeres in muscles change. These lead to an increased tissue length and in turn increased flexibility. Note these changes do not happen quickly and you may need regular stretches to achieve this. Be aware also that some structures cannot be changed no matter how often we stretch it. For example the IT band doesn’t even stretch under a one tonne weight so stretching isn’t going to be able to improve on that.
The second way stretching improves our range of movement is it encourages our stretch reflex systems to relax. This is the system that stops us stretching too far. It is ultimately run by our nervous system, with help from sensors such as Golgi Tendon Organs. Downregulation of this system can explain why we often see improved range of movement almost instantly after stretching. It is inconceivable that this is due to tissue changes. Simply put our body allows our joints to move further before the defence mechanism kicks in. If this happens repeatedly then the system stays downregulated and tightness reduces.
The therapeutic benefits of stretching.
Ultimately with enough time and a lot and lot of patience (and good enough joints) we could all get in that yoga pose we see on those yoghurts adverts. However, would that help prevent us getting pain and equally would it help us out of pain. The answer to that is less clear cut. The science unfortunately doesn’t support stretching in painful conditions as much as it does for strengthening.
Similar to strengthening, the traditional reasons we use stretching sits very much in the biomechanical model. The explanation we commonly use / hear include
- X is tight and it is therefore painful
- X is painful or injured and as a result has become tight
- X is tight or injured and this is causing more load on structure Y
- By stretching X we will increase the tissue length, reduce the load and things will become less painful.
On the face of it this makes sense. However it is far too simplistic. There are so many people out there where X muscle is as tight as a handbrake belt, yet don’t seem to have any pain problems. The flip side is also true, for example people with hypermobility often complain of significant pain and tightness.
Feel tight or actually tight?
In order to establish whether someone is likely to be helped by stretching it is important to see whether they are actually tight or whether they just feel tight. If it is the latter it is important to explore what might be driving this perception. Ultimately it is the nervous system at play and a whole host of factors can lead to this feeling.
Think again about the hypermobility example. Why are they feeling tight when their range of movement is likely to be rather goodd compared to the normal population?
Equally have you ever wondered why people who foam roller, get massaged the most or stretch the most, are often the ones complaining of being tight. In theory with all their efforts they should be loose, right? Sadly all this work in these types of people can actual make the perception of tightness to be worse as hypervigilance to the tight feeling can occur.
I define true tightness by decreased range of movement versus their other side or versus the general population. When patients are truly tight and their tightness appears to fit or could explain their clinical picture, then stretching should be considered.
Treating the cause of tightness.
When we consider stretching however, we also need to realise that the tightness may be being caused by something else. To address the tightness, we may need to treat the cause:
- Tightness can be caused by posture. If we spend long enough in one position then muscles and other structures can become tight. The answer here is to move more, change your position regularly, movement is medicine.
- Tightness could also be due to the way our individual skeletons are made up. Unfortunately these is often no way we can change this, so for me it is not worth dwelling on. Only concentrate efforts on things you can change.
- Sometimes tightness can be caused by the way we move. If we move in a certain way every time we move than tightness can develop. Movement retraining is important here.
- Tightness can also be caused by muscles switching on too much. We need to work out why they are switching on. Are they weak? Are they fatigued? Are they guarding? Is this guarding appropriate? Is there a lot of tension, stress ? etc etc.
Strength training instead of stretching for tightness
Although the purpose of this blog is to discuss stretching I felt it important to discuss strengthening as it can have a huge role in tightness. Getting strong can really help. If you have been stretching til the cows come home and not been getting better consider adding some strength work.
One recent study showing this looked at simple lateral raises done for 2 minutes in office workers and found their neck pain was improved much more than stretches. Other similar studies can be found in support for strength training.
Eccentric strength training (lengthening muscle as it is put under tension) has also been shown to be very effective in improving tissue length so if you are stretching regularly and your range of movement isn’t improvement consider exploring this avenue.
Summary
In summary stretching works through various changes in the tissues and the nervous system. It can be a valuable tool in managing pain however the evidence isn’t as strong as it is for strengthening. It often needs to be carefully considered. Sometimes stretching too frequently can cause increased pain and tightness through hypervigilance.
Below are my general recommendations
- For pain relief stretch only if it feels good to do so
- For improving range of movement hold your stretches for long periods. At least 30 seconds per stretch
- Stretch regularly to get true lengthening requires long periods our tissues are inherently tough.
- Consider strength training particularly eccentric strengthening- evidence suggests it can yield better results than traditional stretches alone.
- Ask are you tight or do you just feel tight? This may change your approach.
- Ask are there any factors that could contributing to your tightness? Address these alongside stretching
If you would like advice tailored to your specific condition then please get in touch and we can discuss whether stretching will be beneficial to you and if so what stretches you should be doing