The Truth About Stretching

Recently, there has been some research that states stretching prior to exercise has lead to a reduction of muscle strength.  Of course when something this radical comes out it leads to all sorts of bandwagons, assumptions, and un-educated advice.  While this research has helped set a trend toward dynamic warm ups, it has done a big disservice to individuals participating in activities by giving them the notion that they shouldn’t be stretching. But before you toss your stretching routine it’s important to consider the details of this new research.

What the Anti-Stretching Advocates Don't Tell You

• The research was on pre-participation stretching, NOT habitual stretching or overall flexibility
• The research did not take injury prevention into consideration (which is one of the main reasons why we stretch)
• A mild acute loss of strength occurred post stretch, but the duration of this loss of strength was not studied
• There was almost no loss in muscle performance (e.g. vertical leap)

Importance of Flexibility (Muscle Length)

Achieving and maintaining flexibility is imperative for a healthy musculoskeletal system.  Muscle length (flexibility) has a major effect on your body throughout the day.  Along with connective tissue extensibility, muscle length helps dictate our movements and posture.   Not having enough flexibility can lead to compensations, poor posture, and inefficient movement.  Most of all, inadequate flexibility can lead to injuries.  In my clinical experience I have seen many patients whose injuries stem from inadequate muscle length and the cumulative stress that comes from the correlative compensations.Understanding why stretching is good for your health is a fairly simple concept.  If you use the analogy of  bungee jumping it can make this concept even clearer.  Think about it.  If you’re about to bungee jump of a bridge, would you want an extensible bungie cord that allows for high speed lengthening, tensioning, and recoil?  Or would you want a short and rigid bungee cord?Your muscles are much like bungee cords that have to quickly lengthen and negotiate tension.  Having a nice long, extensibile bungee cord will allow you to enjoy the free fall with some peace of mind and help to take up the forces when the cord reaches its limit.  Whereas jumping with a short and rigid bungee cord makes the fall even more terrifying as it puts the cord at risk for tearing and the recoil will be distributed to your body instead of the cord.

Advantages of Flexibility

As stated above, there are many possible negative effects of not having adequate flexibility.  It’s also important to keep in mind the positive effects of flexibility.  The more extensibility your muscles have, the better your ability to adapt to movement.  Increase flexibility will also lead to a decrease in resting muscle tension and improved posture.  Simply put, having more flexibility may lead to increased athletic performance, improved posture, and prevent of injuries.

Stretching for Flexibility

Increasing your flexibility doesn't happen overnight.  It takes time and persistence to really achieve a significant change in your flexibility.  This increase in flexibility is best achieved through a Habitual Stretching Program.   Stretching consistently at least 5 days a week for a several minutes a day can make a big difference and may help you prevent future injuries.  Keep in mind that it may take a few weeks before you start to really notice significant results, so stay persistent!

How to Stretch

Timing

It’s best to stretch before activity after a mild warm up.  Following this stretching with a dynamic mobility exercise would be ideal to prepare the muscles for the demands of the activity and may nullify any acute strength loss from the stretch.  But more importantly, it is absolutely necessary to stretch after activity to prevent “tightening up” and adaptive shortening of the muscles.  This post-activity stretch should be done within 10-15 minutes after exercise while your tissues are still warmed up.

Protocol

It only takes 3 minutes a day per muscle to increase your flexibility.  Stretching the right way and staying consistent is important to achieving an increase in muscle length and will ensure that you aren't wasting your time.  There are 5 simple aspects to a proper stretching program.

1. Slowly stretch the target muscle to a mild discomfort
2. Hold (don’t bounce) for at least 60 seconds (or 15-20 breathes)
3. Slowly release the stretch
4. Repeat for a total of at least 3 stretches
5. Perform this routine at least 5 days a week until the muscle no longer feels tight

Considerations

• Focus on the stretch, try not to multi-task too much
• Remember to breathe throughout the stretch
• If you're too ADD to count to 60, try to focus on 15-20 deep breathes per stretch
• Do not go past mild discomfort, if you feel a sharp pain or great discomfort stop and seek a professionals help
• If stretching prior to activity or sport, it is best to follow with some dynamic mobility exercises prior to participation
• It’s difficult to over-stretching, 3 sets of 60 seconds is a baseline, a greater duration and frequency can lead to better results
• Try to develop a routine to help habituate stretching (same time of day, same place, same order of stretches, etc.)

Bottom Line

While there may be a temporarily decrease muscle strength immediately after stretching, there is no evidence that it significantly decreases performance.  Most importantly these studies do not focus on injury prevention, which should be the main concern when discussing a stretching program.  Increasing your flexibility through a habitual stretching program is a main component of achieving and sustaining good musculoskeletal health.  Whether you’re a desk jockey or a high performance athlete, increasing your flexibility can lead to an improvement in your quality of life.

Dig Deeper

http://chrisjohnsonpt.com/are-you-stretching-your-hamstrings-properly/http://www.mikereinold.com/2010/06/best-postural-stretch.html

References

McHugh MP and Cosgrave CH.  Review: To stretch or not to stretch: the role of stretching in injury prevention and performance.  Scand J Med Sci Sports 2010: 20: 169-181 --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

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How To Pick Your Kicks (Part 3 of 3)

Assessing your static and dynamic foot type can be difficult, but it seems simple when compared to the complexity and confusion associated with selecting the right shoes for your feet.This post will be focused on shoe selection and how to use information from the parts 1 & 2 to help you choose the right shoes.

Shoe Selection

Basic selection starts with finding which “group” your feet belong to.  Using the previous 2 posts you can attempt to classify your foot type as either a supinator, neutral, or pronator.  Within each category there is a continuum from minimal, moderate, to severe.  Each different foot type is going to have a corresponding shoe type.

Shoe Characteristics

Shoe companies have come a long way since the one-size-fits-all flat soled shoe.  While Converse still has a place in punk-rock bands and hipsters, it is fairly conclusive that these type of flats are not the best for athletic activities.  Today there is a plethora of shoes available to accommodate just about every possible foot types.  Walking into a shoe store can be confusing with all the different companies and characteristics.  But to attempt to keep it simple, just look at 2 characteristics: pronation control and features.

Pronation Control

This is the most important characteristic to consider when choosing footwear.  You want enough support to prevent any ankle instability or over-pronation, but not too much support to where it limits your normal foot motion.  The midsole of the shoe is usually the predictor of how much support/control the shoe provides.Pronation control ranges from minimal (neutral foot types) to maximal (severe pronators) support

• Neutral shoes are for neutral foot types that have no over-pronating tendencies
• Support shoes helps maintain a neutral position of the foot during dynamic activities and prevent mild-mod over-pronating
• Motion control shoes will have a more aggressive support against severe over-pronating or severe ankle instability

Features

This is where the shoe companies often times try to separate themselves with the "latest technologies and innovations".  Regardless of what the shoe companies are selling, the function of the features is always the same.  It comes down to how much and what type of cushioning system the shoe has.  The trade off here is that the more cushioning a shoe has, the heavier it is.  Therefore, it is important to find the right amount of cushioning for your comfort and support, but not too much to where you care carrying unnecessary weight.Like pronation control, features can be considered on a continuum from minimal to maximal cushioning/features

• Minimal feature/cushioned shoes will usually be lighter and are best for athletes who don't need shock support and are not big heel strikers
• Maximal feature/cushioned shoes will usually be heavier and are best for athletes who require a great deal of shock support, have a strong heel strike and/or are over-supinators

Foot Type and Possible Shoe Type

This table will hopefully provide an idea of what shoe type might be best for you.  Each individual has a unique foot type and therefore simply categorizing yourself into a 1 of 3 category is not always the answer.  It all comes down to the proper fit, support, and comfort.  Hopefully this table will give you a place to begin your search. 

Considerations

Shoes are Made for Specific Athletic Activities

◊ Running shoes give anterior-posterior (sagittal) support

◊ Cross-Training shoes give more medial-lateral (coronal) support

◊ Always consider which event you are performing as you will need a shoe that can meet the specific demands of that activity

Where to Buy

◊ There are many specialty running stores and shoe stores that have a knowledgeable staff that can help you (please don't waste your time and money by going to the mall or a corporate chain store)

◊ If you have any injuries or pain it is best to be evaluated and fitted by a trained professional

◊ It helps to bring in your old shoes so that they can be assessed for the wear and tear

Wear Them in First

Wear your shoes in slowly.  Try wearing them around some before going for a long run in a brand new shoe.   This can possibly prevent some pain with the change in footwear.

When to buy new shoes?

General acceptable range is between 300-500 miles

Summary

Hopefully this 3 post series provides some information and understanding to the confusing world of footwear.  As mentioned above, there are many factors to consider when choosing which shoes are right for you.  Even if these posts do not lead you to the perfect shoe, I hope that it will at least prevent you from running in the wrong shoe.Part 1 - Static Foot AssessmentPart 2 - Dynamic Foot Assessment

Dig Deeper

www.runnersworld.comwww.runnerswarehouse.comhttp://www.wilkpt.com/Articles/Singles/buyingtherightshoe.htmlhttp://chrisjohnsonpt.com/defective-running-shoes-as-a-contributing-factor-in-running-injuries/

Update 2015

While this blog post series may provide some helpful knowledge, it should be known that static foot posture and selecting shoes based off of this foot type is not the best option.  For more information please read this article on pathomechanics and refer to the GaitGuys for the most up to date information on shoes, feet, and gait.

How To Pick Your Kicks (Part 2 or 3)

In the last post we discussed how to assess your foot type in static positions.  Knowing your static foot type gives you a good place to start, but you really want to be choosing your footwear based on the dynamic support it can provide for your athletic activities. However, for a true dynamic assessment you should seek the help of a trained individual.Hopefully this post will give you some useful information to help you understand more about your possible dynamic foot type.

Assess Your Foot Type

3 Foot Types

Remember this is a CONTINUUM and an oversimplification.

• Supinators (pes cavus, high arching feet)
• Neutral
• Pronators (pes planus, flat feet)

3 Ways to Assess Your Dynamic Foot Type

1. Balance on 1 Foot (Barefoot) - Try to balance for 30sec-1min to allow the possible instability to display itself.  Placing a camera behind to view the heel and subsequent movement will provide the best assessment
2. Check Your Kicks - Look at the soles of your old shoes (supinators wear on the outside toes, pronators wear more on the inside toes)
3. Film Yourself Running on a Treadmill - Of course a 30 sec clip of a quick jog won't provide the most accurate assessment of how your running gait, but may show some possible tendencies.  A proper gait analysis involving the whole body from various positions would be required to truly assess for foot type and preferred footwear.

Results

Pronator

◊ If your foot has the tendency to “roll in” ( inner ankle goes towards the ground)

◊ Heel is angled outward (rear foot eversion, calcaneovalgus)

Chris Johnson has a great post and video of someone who dynamically pronates ("runner's wobble").http://chrisjohnsonpt.com/the-wobbly-runner-and-recurrent-injury/

Neutral

◊ If your foot has minimal movement and stays in neutral position

◊ Heel is angled vertically

Supinator

◊ If your foot has the tendency to “arch up” (outer ankle goes towards the ground)

◊ Heel is angled inward (rear foot inversion, calcaneovarus)

Example of Gait Analysis at the Foot/Ankle

This picture shoes an oversimplification of what a video analysis of running gait may show at the foot and ankle. 

Now What...

Having an idea of your static and dynamic foot type will give you a better idea of what type of shoe is best for you.  Again, it's best to get a professionals opinion, especially if you are experiencing injuries or pain.  But hopefully these last 2 posts will provide some information to help you understand your foot type.The next post will deal with the types of shoes available and how they correlate with foot type.Part 1 - Static Assessment of Foot TypePart 3 - Shoe Selection

Update 2015

While this blog post series may provide some helpful knowledge, it should be known that static foot posture and selecting shoes based off of this foot type is not the best option.  For more information please read this article on pathomechanics and refer to the GaitGuys for the most up to date information on shoes, feet, and gait.

How To Pick Your Kicks (Part 1 of 3)

Shoe shopping can be a very complicated and confusing process.  Choosing the proper shoe can ensure injury protection and provide proper distribution of forces.  Whereas choosing the wrong shoe can lead to injuries and under performance.  To add to this problem, there are many stores out there with self-proclaimed “professionals” giving out the wrong advice.This post will hopefully clear up some of these concepts and begin to lead you in the right direction in choosing your next shoe.

3 Foot Types

Keep in mind that this is a CONTINUUM and that each individual has a unique static and dynamic foot type.  This is a simplification to help people categorize themselves into selecting proper footwear.  It is always best to seek help from a professional when selecting the proper footwear for your activities.

• Supinators (pes cavus, high arching feet)
• Neutral
• Pronators (pes planus, flat feet)

Assess Your Foot Type

3 Ways to Assess Static Foot Type

Be sure to stand with both feet pointed forward and try to distribute weight equally during assessment

1. Stand in front of a mirror - look at space under arches and inner ankle position (stand at 10 o'clock and 2 o'clock to the mirror to change the angle to get different views of the inside of your arch)
2. Take a picture of both feet at foot level - from behind (heels) and from the front (toes)
3. Wet Test - wet feet and stand on cardboard or paper bag, then look at foot print

Results:

Supinators

◊ Increased space under the longitudinal arch (middle of foot is far off the ground)

◊ Greater curvature on the inside of the foot print

Neutral

◊ No exaggerated flattening or arching of midfoot

Pronators

◊ Decreased space under longitudinal arch (middle of foot is close to ground)

◊ Lesser curvature on the inside of the foot print

Now What...

Unfortunately most of us buy athletic shoes for athletic events and a static assessment doesn't always translate well for the dynamic demands of sports and activities.  However, having an idea of your static foot type will provide a good base knowledge for what type shoe your feet may need.Part 2 - Dynamic Foot AssessmentPart 3 - Shoe Selection

Update 2015

While this blog post series may provide some helpful knowledge, it should be known that static foot posture and selecting shoes based off of this foot type is not the best option.  For more information please read this article on pathomechanics and refer to the GaitGuys for the most up to date information on shoes, feet, and gait.

The Best Posterior Chain Stretch

Inflexibility of the hamstring muscle is often a prominent kink in most people's posterior kinetic chain.  It's the reason why we have to sit down to tie our shoes, can't sit up-right with our legs straight out in front of us, and the reason why most of us would be very pathetic at martial arts.  Having a tight hamstring is a major concern as it can lead to increased risk of injury, decrease athletic performance, and cause pain and symptoms both proximally and distally (low back pain, achilles pain, etc.).A possible cause of this common impairment could be that the majority of the population spends a substantial amount of their time in the seated position (jobs, communting, watching tv, reading this post, etc.).  This seated position puts the hamstring in a shortened position.  The body responds and adapts to this habitually shortened position by decreasing the hamstring muscle length.To further complicate the problem, hamstring tightness is not just a result of muscle tightness.  Fascia and neural tension are a major component of posterior leg tightness.  So how can we address all of these aspects of hamstring tightness without spending 30 minutes of stretching a night?

90-90 Active Hamstring Stretch

This stretch will hit the entire posterior kinetic chain from your plantar fascia to your low back.  It also works all 3 aspects of hamstring tightness (muscle, fascia, neural tension).

How to Perform

1. Start on your back and grab the back of your thigh with both hands
2. Your thigh should be at 90° throughout the entire stretch
3. Slowly use your quadriceps to kick your leg up while flexing your foot towards you at the same time
4. Pause for a second when you reach your limit
5. Slowly relax your foot and drop your lower leg back to the starting position
6. Repeat for 3 sets of 10-15 reps

http://www.youtube.com/watch?v=s4wgP4wjeDc

Other Considerations:

• If you are very tight and not getting much motion at all, start off with your other knee bent (in hooklying) instead of straight
• Try not to flex your neck and upper back up during the stretch, use a pillow to support your head if you need to
• Best time to stretch is within 15 minutes after working out while your body is still warm
• 3 sets of 10 a day is not a limit - adjust to what your mobility needs are

Of course there are many other considerations when addressing hamstring tightness (posture, ergonomics, muscle weakness, compensations, etc.).  But I hope this article will at least give you a new way to stretch your hamstring and posterior kinetic chain.  Just taking a few minutes a day for this exercise can help improve your hamstring flexibility and possibly decrease your risk for injuries. --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

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