13 Tips. for Stretching Sanity. It is only natural to get up in the morning and yawn and. By Mary Ann Foster

Transcription

1 13 Tips for Stretching Sanity By Mary Ann Foster It is only natural to get up in the morning and yawn and stretch. Our feline friends do it, and so do dogs, arching their spines, extending their front paws, and even stretching their tongues and faces. Although often relegated to yoga classes and exercise routines, stretching is a natural part of many of the movements we make. Simply moving about requires that some muscles contract while others relax and some others are stretched. So why do we need to stretch? Somehow, it is difficult to imagine our ancestors going through regular stretching routines. I doubt that when Oog the caveman was awakened by a saber-toothed tiger growling in anticipation of breakfast that he paused for a stretch before sprinting to safety. Still, stretching is a great antidote to sedentary jobs. A good stretch session can work out kinks and restore range of motion, but such sessions are only beneficial if done with thought and care. Recently, I dusted off an old pictorial essay on stretching tips to share with a client. After doing yoga, she often found her muscles stiff and sore and wanted to figure out why. While watching her routine, I observed many of the common ways people incur stretch injuries. In our enthusiasm to do the right thing, we often stretch too fast with little awareness and end up feeling worse than before the stretch from a muscle pull or strain. So what is the best way to stretch? There is so much written about this wide-ranging topic that figuring out where to start can be confusing. Use Google and run a search for the word stretching, and you will get more than 9 million hits. While updating my tips, I waded through this sea of data, as well as many current texts on therapeutic stretching, and began digging for sound principles. Here are 58 MASSAGE & B ODY WO RK OCTOBER/NOVEMBER 2005

2 Somehow, it is difficult to imagine our ancestors going through regular stretching routines. OCTOBER/NOVEMBER 2005 MASSAGE & B ODY WO RK 59

3 Figure 1 Actively stretch the hamstrings by contracting the quadriceps. the results. These tips are based on the premise that understanding the logic behind stretching helps us make intelligent choices about when and where to use which kind of stretch. To this end, a narrative accompanies each tip to explore the rationale of both self-stretching and therapeutic stretching with clients. As you read seemingly conflicting approaches, keep in mind that every approach has a right time and place. Now, we begin with one popular debate: Do we stretch to warm up or warm up to stretch? Tip 1 Warm up before stretching. Popular myth would have us believe that stretching prevents injury, but in fact it is the warmup before exercising or stretching that has been shown to reduce the likelihood of injury. A good warm-up accomplishes two things: It improves muscle extensibility and loosens connective tissues, and it gets the neuromuscular circuits firing. The coordinated contraction-relaxation responses between agonist-antagonist muscles during a warm-up are a significant part of increased range of motion and injury reduction. Warm up before stretching with five minutes of brisk walking, squats, or lunges, or even a run in a stairwell. These locomotive Figure 3 Chronically contracted muscles cause compensatory stretch weakness in muscles in another area. Figure 2 Passively stretch the shoulder joint by pressing it open against the wall. activities work those large hip and thigh muscles, effectively increasing circulation and temperature while activating neuromuscular pathways. Heat makes connective tissues (joint capsules, ligaments, and fascia) more pliable. As fascial pockets around muscles become supple, muscles can extend farther, allowing for an increasing range of motion. To passively warm up before stretching, take a hot bath or a steam bath. Hot packs also work great to warm up specific muscles, for both you and your clients. Tip 2 Use dynamic stretching to warm up. Stretching can be a warm-up, but realize that the purpose of the warm-up is just that, to warm up, not to stretch. Warm up with dynamic stretching using a series of gentle swinging motions in the limbs and spine. Move at a moderate speed to increase your heart rate, gradually increasing speed as your muscles loosen. Avoid jerky, bouncy movements that go 60 MASSAGE & B ODY WO RK OCTOBER/NOVEMBER 2005

4 stretching to or beyond end range. This type of motion can trigger the protective contractions that cause some stretch injuries. Stop when your muscles tire because once fatigued, muscles lose elasticity. Five to 10 minutes of dynamic stretching constitutes an adequate warm-up for most activities. Tip 3 Avoid quick, bouncing ballistic stretches. Runners who bend over and do a few quick strong bounces to stretch their hamstrings are doing just the opposite: They are actually tightening the hamstrings. Anytime we put a muscle on a quick, strong stretch, the stretch reflex triggers a protective contraction that prevents passive lengthening and subsequent tearing. (There is no worse feeling than limping with a torn muscle from a self-inflicted stretch injury.) Some clinicians argue that ballistic stretches are no more dangerous than the ballistic movements we do in sports. Yet, stretch injuries sustained during sport are likely the result of quick, uncontrolled movements. Why practice something that might cause injury? Tip 5 Increase the effectiveness of stretching by contracting the target muscle first. When a client is unable to relax a tight muscle so that you can stretch it, using a facilitated stretch to trigger a relaxation response can do the trick. A simple facilitated stretch uses a muscle energy technique known as contract-relax. First you have the client contract the target muscle (often against your resistance), then relax it. After the contraction stops, a strong relaxation response follows that lasts for about 30 seconds. It is during this short window of opportunity that you can lengthen the muscle and move a joint to its next motion barrier. You can also use contract-relax to increase the effectiveness of self-stretching. Do this by actively contracting the target muscle before you stretch it. Make sure to pause after the contraction to give the muscle time to relax; then, stretch it. Tip 4 Hold a stretch for at least 30 seconds, longer if you can. Stretching has both neurological and mechanical effects on muscles and connective tissue. A stretch needs to be held long enough for muscles to relax so that they can be passively lengthened. As you hold a stretch, consciously relax the tight muscle and feel the myofascial tissues around it elongate. Once the muscle fully relaxes, the connective tissues can begin to stretch. Connective tissue, like molasses, has viscous properties that need ample time to flow and move. Stretching fascia and all types of connective tissues is time dependent: It occurs slowly under constant force applied over time (this is the definition of creep). When stretching thick or dehydrated fascia, you may need to hold the stretch for yourself or your client many minutes to achieve this mechanical effect. When using myofascial release, apply at least 90 seconds of sustained pressure to the tissues to give fascia, with its thixotropic properties, plenty of time to change from a gel to sol. However, be careful not to hold a stretch too long and stretch past end of range of motion because muscle fibers can do only two things: contract and relax. Once relaxed, they can be elongated only to their anatomical length. Stretch past that length and the muscle will tear. Figure 4A Contract the abdominal muscles to stabilize the lower back during back bends. Figure 4B Without the work of the abdominal muscles, the lower back is less stable and bends. OCTOBER/NOVEMBER 2005 MASSAGE & B ODY WO RK 61

5 Tip 6 Use active stretching to increase flexibility. It is widely thought that stretching increases flexibility, but it is easy to mistake passive range of joint motion during static stretching with flexibility. True flexibility is the ability to control motion through the full anatomical range of motion. A football punter may appear to be flexible because he can bend over and hold his nose to his knees. With true flexibility, he should be able to stand and bring his extended knee to his nose using his own muscular control. Without this flexibility, he is susceptible to an injury common to punters when the powerful quadricep femoris muscles contract to flex the hip and extend the knee to kick the ball, the hamstrings fail to relax and therefore tear. Static stretching makes a punter susceptible to stretch injury because he does not stretch the way he moves. In contrast, active stretching, where you contract the muscle opposite to the one being stretched, facilitates coordinated contract-relax responses in agonist/antagonist pairs. The idea is to train Stretching after an injury has a similar effect to deep stripping strokes used in bodywork. the agonist to relax while the antagonist contracts. By practicing active stretching, the punter trains his hamstrings to relax as his quadriceps contract, thereby patterning himself for functional movement during punting. To self-stretch active, contract the antagonist to the muscle you are stretching. You can even use the contraction as the stretching force. For example, lie on your back and raise your leg to stretch your hamstring (see Figure 1). To make a therapeutic stretch on your client active, have your client actively contract the antagonist while you stretch the agonist. 64 Figure 5A Keep both sit bones on the ground to square the trunk during a rotational stretch. Figure 5B Hiking one hip puts torsion stresses in the waist and laterally bends the spine. Figure 6A Counter-rotate the head with the pelvis to take a diagonal stretch through the entire spine. Figure 6B Without the counter-rotation of the head, the neck is not included in the stretch. M A S S A G E & B O DY WO R K O C T O B E R / N O V E M B E R

6 stretching Tip 7 Stretch connective tissues and joint capsules with static stretching. Now that we have discussed why not to use static stretching, here is a reason to use it. Stretching affects many tissues and layers. The key to successful stretching is to target the chronically short and inflexible tissues. Static stretching involves relaxing into a position and holding there. It effectively accesses deeper tissue layers because it removes active restraints to joint motion (muscles). As the muscles relax, the passive restraints (fascia, ligaments, and joint capsules) slowly stretch. Scar tissue in connective tissues and around a joint capsule restricts normal range of motion. To use static stretching on a joint capsule, first relax the associated muscles, then put the joint in a position of stretch using your own body weight or an external force. For example, you could lean on the joint, lever it open while pressing against a wall, or have someone push it open (see Figure 2). Use passive stretch with your client by first having her consciously relax muscles around the joint that you are about to stretch. Next, isolate the motion of that joint by stabilizing the bone on one side of the joint while moving the bone on the other side to end of range. Then, stretch the joint at end range by applying a slow, gentle rhythmic force. A warning: Joint pain does not indicate the joint should be stretched. Long-term joint pain not caused by disease may be a symptom of instability. Stretching unstable joints exacerbates the problem. By knowing what normal joint range is or by comparing bilaterally, you can determine whether a joint is unstable or has a restricted range of motion. Although information about normal joint range is generally not part of massage training, it is accessible in many references. Tip 8 Stretch muscles selectively.target short muscles for stretching.avoid stretching muscles with stretch weaknesses. A chronically tight muscle puts long-term tension on its antagonist, holding it in a stretch beyond its normal resting length. The antagonist responds like overstretched fabric; over time its sliding filaments are pulled apart, which weakens the muscle because it has fewer myosin crossbridges to pull in the actin filaments (see Figure 3). Although these poor muscles have put in the good fight resisting the pull of the agonist, they eventually become taut, ropy, and thin. They tend to ache and hurt, tempting us to want to stretch them for Figure 7A Keep the shoulders down. Figure 7B Avoid hiking the shoulders. relief. Clients often request deep massage on muscles suffering from stretch weaknesses. Although stretching creates a temporary analgesic effect (a big reason for static stretching), in the long run it exacerbates stretch weaknesses. Better to stretch the chronically tight muscle on the other side of the joint, then learn to actively contract and control muscles with stretch weaknesses. Tip 9 Stretch after soft-tissue injuries to assist recovery. A look at the research on stretching reveals a surprising volume of conflicting medical opinions about the actual benefits of stretching for injury recovery. Stretching itself does not induce healing, but stretching sore muscles affected by delayed onset muscle soreness increases endorphin production and stimulates the gate theory response, creating an analgesic effect. It feels good, and you feel better, but recovery time is not significantly reduced. However, pain relief does trigger the relaxation of protective spasms, which in turn restores local circulation and allows healing. Scar tissue fibers stack in random, thick, crosshatched piles. Like stiff patches over torn fabric, they OCTOBER/NOVEMBER 2005 MASSAGE & B ODY WO RK 65

7 stretching Figure 8A Reach into a stretch. Be mindful of body position. lack elasticity and restrict motion. Stretching after an injury has a similar effect to deep stripping strokes used in bodywork. It puts directional pulls on collagen fibers in scar tissue, causing parallel fibers to line up along lines of tension and randomly oriented fibers to be absorbed. The parallel arrangement of the fibers results in more pliable scar tissue. Stretch regularly and slowly after an injury to promote connective tissue suppleness. Stretching and deep-tissue massage both stimulate the fibroblasts in connective tissue to produce ground substance, reducing the number of cross-links between the collagen fibers and increasing the fascia s capacity to absorb water. All of these effects help to keep the new scar extensible. during a back bend. While bending backward beyond my range of flexibility, I pinched the synovial lining of a facet joint in my upper thoracic spine. The pain was sharp and piercing, followed by protective muscle spasms. It took months to heal. Sharp pain woke me up whenever I moved while sleeping, as though I had just rolled over on a sharp nail. The injury eventually healed with regular heat applications, neck stabilization exercises, and deep tissue work coupled with cross-fiber friction on the joint capsule. Another time, a partner pulled me into a back bend before I had time to contract my lumbar stabilizers. I felt that same sharp pinch in the lumbar spine. The piercing pain of these two injuries seared into my memory the importance of spinal stabilization before extension stretches. The lesson: Make sure to contract the deep abdominal muscles and the multifidus muscles along the spine before going into hyperextension or rotational stretches (see Figures 4A B). And avoid stretching in positions that take the knees or elbows into hyperextension. Figure 8B Avoid awkward, static positions. Not reaching into the stretch. Connective tissue, like molasses, has viscous properties that need ample time to flow and move. Tip 10 Contract stabilizer muscles while stretching to avoid injuring joints vulnerable to hyperextension, such as elbows, knees, and facet joints in the spine. Most people understand how important it is to contract the abdominal muscles before picking up something heavy to avoid injuring the lower back. The same goes for stretching. I learned this lesson the hard way Tip 11 Avoid stretching in a range that induces pain. Although you may feel some discomfort while stretching, avoid stretching to the point of pain. Many people who feel pain in a certain range of motion keep stretching in that range to see if the pain is still there. Little do they realize that each time they stretch into their pain, 66 MASSAGE & B ODY WO RK OCTOBER/NOVEMBER 2005

8 Figure 9A Reach with the top of the head to keep the spine long. Figure 9B Failing to keep the spine long and supporting the head causes the neck to hinge and break. they are irritating the pain-causing tissues. Just because an area hurts does not mean it is tight and needs to be stretched. Pain could be the result of damaged nerves, discs, joints, or other soft tissues. Chronic pain is often the result of hypermobile areas that a person is unable to stabilize while moving. These are areas in need of stability training, not stretching. If you feel pain while stretching, stabilize around the joint, then reach and elongate the area being stretched to traction the joint. If this fails to relieve the pain, avoid that stretch until the area heals. The same is true for pain when stretching clients. Put light traction on the limb or part of the client s spine you are stretching to decompress the joints. Also, tingling sensations while stretching are a warning sign: Peripheral nerves must elongate or slide relative to the adjacent tissues. Nerves can be compressed or entrapped, causing abnormal tingling response. Neural mobilization (a manual therapy technique), massage, or deeptissue techniques can work to relieve pain and tingling. Tip 12 Stretch with good form. Myofascia is akin to a well-fitted suit covering your body. The shape and fit of your suit depends on the form with which you move into each stretch. To stretch with good form, maintain symmetry and balance in your skeletal structure. The shape of your stretch should Figure 10 Begin cervical flexion at the top, curling the neck like a sea horse to stretch the posterior cervical spine. pull your myofascial fabric evenly over your bony frame. For example, when doing a seated stretch, keep both sit bones on the ground because hiking one hip places an uneven torque in the waist muscles (see Figures 5A B). When doing a rotational stretch in the spine, turn your head in the opposite direction of your lower body to rotate your entire spine. By turning the head opposite to the tail, you twist the tissues between each vertebral segment with even tension (see Figures 6A B). Lastly, when bending forward to stretch the spinal muscles, keep your shoulders wide and on your sides to avoid narrowing and bunching the myofascial fabric around your neck (see Figures 7A B). Tip 13 Reach into the stretch. Rather than placing your body in a position of static stretch, reach into a dynamic stretch. Go slowly. Keep the stretch going as though there is no endpoint, no place to get to. Keep lengthening your body into the stretch. Reaching decompresses joints and allows the stretch to sequence from one end of the body to the other (see Figures 8A B). Reaching into a stretch also improves the continuity of the stretch along a kinetic chain of myofascia between the core and periphery. Continue to reach into the stretch long enough to allow the tissues to relax and elongate. As you reach, sense your limbs and spine extending and growing longer. When bending backward, as in the cobra pose of 68 MASSAGE & B ODY WO RK OCTOBER/NOVEMBER 2005

9 stretching yoga, reach and elongate the entire spine to avoid bending and breaking in the middle of your neck (see Figures 9A B). The upper cervical spine (suboccipital area) can be difficult to stretch. To get a deep flexion stretch along this area of the spine, stand tall and lengthen the curves of your spine, especially your neck. Reach the top of your head up toward the ceiling and over as you curl your neck and head like a sea horse. Begin curling at the first cervical vertebra, at an axis of motion behind the ears. Slowly roll down, one vertebra at a time while continuing to reach through the top of your head to elongate your neck (see Figure 10). Let your head hang, and reach with the top of your head toward the floor to stretch the back of your neck (see Figures 11 A B). Breathe in to lengthen the entire spine, then breathe out and sink deeper into the stretch on each exhalation. Conclusion These tips are designed to help you think your way through effective stretching and to tailor your routine to individual needs. Here s a review of the major points. Make your tissues more supple and responsive to stretch with a pre-stretch warm-up, using hot packs or a hot bath, or doing 5 to 10 minutes of vigorous exercise. Hold a stretch until you feel your muscles completely relax and elongate and your connective tissues lengthen. Prevent pulls and strains by avoiding ballistic stretching, stretching past normal range, and, most importantly, stretching in ways that cause pain. Make sure to contract stabilizing muscles before moving into a position of stretch to prevent injury. Although stretching affects many tissues, different approaches target different tissues. Passive stretches work best for lengthening short or scarred connective tissues, active stretches for lengthening tight muscles. Contract a muscle before a stretch to take advantage of the relaxation response. Contract the antagonist to activate inhibitory reflexes that will help the muscles that are being stretched relax. Move gracefully through each stretch, reaching into a dynamic stretch on the inhalation, sinking more deeply into the stretch on the exhalation. Finally, remember that stretching does more than elongate tight tissues. By actively lengthening target muscles while intentionally contracting opposing muscles and consciously relaxing others, stretching trains our muscles to work in functional and coordinated patterns. As with any sport, stretching should be approached with attention to good form, optimal alignment, and ease and efficiency of motion. These qualities not only improve the effectiveness of stretching, but they also cultivate an agile, yet selfassured posture. As a massage or bodywork practitioner, this can only enhance your clients confidence in you. M&B Figure 11A Let the head hang to stretch the entire spine. Figure 11B By holding the head up, this model shortens and tightens the neck. Mary Ann Foster has been a massage therapist and movement educator for 24 years. She teaches movement classes at the Boulder College of Massage Therapy. Contact her at info@somaticpatterning.com. OCTOBER/NOVEMBER 2005 MASSAGE & B ODY WO RK 69