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In my last newsletter I wrote about mobility and stability, and more specifically addressed the concept of stretching. Is stretching a good idea? When is it beneficial? When can it do more harm than good? Is stretching the best way to improve range of motion (ROM) and function?
Since writing the newsletter I have received lots of feedback and have fielded lots of questions. While the piece caused some of you to re-think when and why you "stretch", there were others who literally thought I was telling them to never stretch. The message was not "never stretch", but rather my intent was to both educate readers about the difference between neural tension and short muscles and explain how a muscle - or group of muscles - will not lengthen appropriately when adhesions and/or antagonist inhibition is present. At the very least I wanted to get readers thinking about what they are investing their time in when it comes to training, injury prevention, and injury resolution.
Lets clear a couple of things up. My point on neural tension used the hamstring as an example. Oftentimes when someone has "tight" hamstrings, they or their therapist / trainer tries to stretch the muscle or "stretch away" the pain. Pain cannot be "stretched away." Many times when provocative testing is performed, it is revealed that the pain and tension are being driven by neural tension. When considering the concept of soft tissue adhesions, the following experiment may help. Take a rubber band and tie a knot in the middle of it. Next, stretch the rubber band from both ends and observe what happens to the knot. Yes, it gets tighter! Now continue to pull and stretch the band. The knot continues to get tighter and tighter, unless it has already broken. Eventually, it will break. If you go to the point of the rubber band snapping, the important thing to realize is that it did not break in the knot. It either snapped above or below the knot because this is where the stress is directed to. Our muscles will behave in exactly the same way. The cause is oftentimes removed from the sympton. It is that simple. Whether one is dealing with adhesions / scar tissue or neural tension or both, if you don't "untie the knot" or free up the nerve effectively, static stretching is not going to do you any good, and again, may even be harmful.
Again, I will be the first to acknowledge that one component of injury prevention and optimal performance is optimal mobility. In fact, I often suggest different stretches and mobility drills to patients. It may be an active isolated form of stretching on one side of the body, a mobility drill, an EQI (eccentric quasi-isometric), or some good old foam rolling. The suggestions are given, however, with purpose and are appropriate for the individual. My main point here is that flexibility training goes far beyond common methods of stretching. Sources of movement impairments can be tissue-related, neurological, or strength-related.
As stated earlier, mobility is a big part of performance, injury prevention, and injury resolution. Most of us know this. But most of us are less sure how much is needed, where it is needed, how it is best developed, and how a newfound ROM is most effectively used. Consider this: how does a therapist or trainer passively stretching my hamstrings to 90 degrees of hip flexion relate to me actively achieving hip flexion ROM? With assistance a high passive ROM can often be achieved, but will the body still provide that same ROM at higher speeds and in loaded environments? More importantly, will the body possess the ability to actively stabilize through this newfound ROM? The fact is, a joint that has lost some passive stiffness requires more muscular contraction to maintain stiffness. Yes, there is often a price to pay for stretching passive tissue in terms of joint stability and risk of injury. Ask yourself one more question: Which flexibility / mobility do you need most in sports and competition - static or dynamic?
Efforts should be made both in training and injury rehabilitation towards facilitation of the neuromuscular system as a whole rather than dampening with stretching. Evidence has shown that static stretches can decrease subsequent coordination and proprioception in joints and muscles (McGill). The body works most efficiently when we are able to move the right joints with the right muscles at the right times with the right amount of force. When training myself and working with others I favor active / dynamic mobility and flexibility over passive forms. Research clearly demonstrates active flexibility correlates with performance more strongly than passive forms of flexibility.
Lastly, I have told many people in my office and have written it before. Yes, mobility is a requirement....for certain parts of the body. Remember, we should all be investing small portions of our training time enhancing mobility of our ankles, hips, shoulders, and thoracic spine. Notice the low back is NOT included in this list. Of course special considerations may be applicable for certain athletes and the demands of their sport, but for the most part, stretching the tissue of the low back is best avoided. In fact, there is documented negative correlation with more flexibility in the back and higher subsequent back troubles. That goes for both flexion (lumbar disk) and extension (facet jamming) movements of the low back and all of the other lumbar torque or twisting maneuvers out there. Movements typically seen in gyms (ie., scorpions, supermans, windshield wipers, Iron Cross / spinal twists, etc...) contradict the biomechanics of the lumbar spine. "Rotation of the lumbar spine is more dangerous than beneficial and rotation of the pelvis and lower extremities to one side while the trunk remains stable or is rotated to the other side is particularly dangerous" (Sahrmann). Further, from Mel Siff, "the combination of lateral bending and rotation constitutes one of the most dangerous maneuvers for the lumbar spine" (Siff). I have completely eliminated any exercises that drive spinal rotation from the bottom up. Instead, when working with patients (and myself) efforts are directed towards driving rotation from the top (thoracic spine) down. This spares the lumbar spine and emphasizes the thoracic spine which is ultimately better designed for mobility.
It is imperative that we choose our exercises and those we prescribe to others wisely as it is clear that dysfunction can be created just by moving the spine in a non-functional manner - regardless of load.
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