Are You Stretching Properly?

 

ASK THE PODIATRIST

 

--Dr. Jay C. Goldstein

 

Q: I was diagnosed with Achilles tendonitis five months ago and instructed to stretch diligently. I thought I was stretching adequately even before I was injured. Since then, the injured side has not improved much, and the other side is now starting to bother me, even though I’ve been doing very little running.

 

 

A: Let me begin by cautioning the reader that there are many books on stretching, and some contradict each other. I have tried to sort out the issues based upon supporting studies, but, as always, my opinion has been liberally applied.

 

I have previously covered the subject of tendonitis. One of the key components of that article includes the dirty word “rest.” Mother Nature is not fond of people who beat up tissues while She is trying to heal them.

 

People are often surprised when I tell them that it is quite possible to damage tissues by inappropriate stretching. When your body creates new fibers, which initially have no strength, they would like to be left alone until they mature. If you exert a force upon them, you are likely to damage the new fibers. That may be why the original injury is not healing as rapidly as you would prefer.

 

When you initially injure a soft tissue structure, such as a muscle, tendon, or ligament, it would be better to not stretch it. As the fibers begin to mature, you may then begin GENTLY and GRADUALLY.

 

In a previous article, I reviewed research that demonstrated the importance of stretching AFTER a structure is warm. For that reason, a good regimen would be:

 

Prior to running, walk at least ½ mile—longer would be even better. Include some uphills and downhills in order to use different muscle groups. Then begin running slowly, gradually increasing your speed. If you are about to run a race, do the slower running before the race begins. The ideal time is after you have done at least some running, when you are well warmed up. Less tissue damage occurs the warmer the muscle/tendon unit (within a physiological range).

 

 

 

WHY STRETCH?

 

The natural tendency of muscle/connective tissue (e.g., muscle, tendon, ligament, and joint capsule) is to contract (shorten), and to become stiffer. Over time, this leads to a loss of motion. If the range of motion is not adequate, you lose normal function.

 

Imagine two runners of exactly equal strength and aerobic conditioning. One runner stretches regularly; the other does not. The non-stretcher eventually loses two inches per stride because of abnormally shortened tissues, such as hamstrings. That equates to upwards of 1500 extra strides during a marathon. Guess which one will finish first.

 

As we get older (who?), connective tissue undergoes a process called cross-linking, producing a significant loss of flexibility. Maximal flexibility for males occurs at about age 10 years, and for females at about age 12 years. This loss of flexibility is one of the main causes of loss of function: feeling like you cannot perform some of the activities that you did routinely when you were younger.

 

 

BALLISTIC

 

When I was growing up, the accepted method was ballistic: apply a sudden and rapid force. There are two reasons why this method is not desirable:

  • It is more likely to produce injury.

  • It violates basic physiology.

If one OVERSTRETCHES, the tissue can be damaged (which may be why your other Achilles tendon is tender). Therefore, Mother Nature built in a protective mechanism. When you stretch a muscle, it immediately tends to contract (shorten). The faster, and the greater the tension, the more likely the reflex contraction (although if you maintain significant tension long enough, the reflex contraction will eventually give way to relaxation). Thus, ballistic produces a response that opposes what you are trying to accomplish!

 

STATIC

 

When the neurophysiologists discovered the reflex contraction of a stretched muscle, they researched ways to get around it. By stretching very slowly at low force, you partially inhibit the reflex contraction:

  • Stretch the warmed muscle slowly and gently.

  • Relax completely, but try to maintain the new length (by using a partner or a piece of furniture or a wall to do the work of holding the new position so that you can relax). Eventually, neurological signals telling the muscle to relax override the signals telling it to contract.

  • Slowly and gently a bit more.

 

Less tissue damage and greater elongation occur when a low force is steadily applied for a longer duration. In addition, the low force/longer duration method has been shown in some studies to lead to more of a long term lengthening of the tissues.

 

 

PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF)

 

Research has demonstrated a technique that, in some studies, is even better than static: PNF. It is based upon two additional elements:

  1. An actively contracted muscle will eventually receive some neurological impulses telling it to relax.

  2. When a muscle contracts, its opposition muscle is told to relax. For example, if you were running, your quadriceps (front of your thigh) would contract in order to extend (straighten) your knee. We would not want the opposite muscle group fighting the quadriceps. Therefore, your hamstrings (back of your thigh) would get a message to relax.

 

Making use of the above information results in the following sequence:

  1. Statically stretch your hamstrings.

  2. Isometrically (maintain the same length) contract your hamstrings (e.g., while laying on the ground, dig the back of your heel into the ground). One study found that no more than a three second contraction was needed.

  3. Contract the opposite muscle group (quadriceps).

  4. Relax and statically stretch your hamstrings a bit farther.

 

Different stretching routines have been devised leaving out step #2 OR step #3 above. Note that in both cases you are still taking advantage of a neurological signal to the muscle/tendon group to relax. The more relaxed the fibers, the more you will be able to stretch them.

 

 

PUT THE ICING ON THE CAKE

 

At the conclusion of your routine, apply ice while maintaining the tissues in their lengthened state. When the tissues are cooled (while in the lengthened state), they are more likely to reset to the new length.

 

Increased water content helps to keep the tissues flexible. In fact, it is speculated that one of the reasons we lose flexibility with age is because our connective tissues hold less water. Drink it.

 

Mild discomfort at the point of maximal stretching is reasonable. Pain is bad.

 

Breathing is good. Do not get into the habit of holding your breath.

 

Dr. Goldstein is Board Certified in Podiatric Surgery, Podiatric Orthopedics, and in Podiatric Medicine. He has been running for many years, although sometimes he rests.