We’re back with part 2 of our interview with Chris – it’s stimulated some interesting thought and conversation regarding stretching in our community and as always – we’d love to have you weigh in again… This time around we’ve asked our fellow professionals for questions regarding stretching and posed them to Chris.
This entry follows a Q & A style interview with questions asked by Nick Pereira (NP), answered by Chris Allan (CA).
NP: In your opinion, why do we (as clinicians and scientists) still advocate stretching?
CA: It’s easy and it’s what we got fed in the past. There was no clear proven reason for doing it. The research is showing specificity is key.
NP: Pre-exercise static stretching has an inhibitory effect on muscle performance, how should we prescribe stretching to patients to assist performance?
CA: I am a big advocate of mobility prior to exercise. We need to teach patients a variety of movements to perform pre-exercise. These need to include a means of increasing their heart rate, warming muscles, enhance movement patterns and mobilise muscles and joints specific to their prescribed activity. randomly stretching and inhibiting those muscle is a thing of the past.
NP: What about fascia? Is this something at influences muscle length? Or does it need to be stretched or “released” to regain muscle length?
CA: Fascia, the new buzz word, certainly has a place in treatment and pre-exercise routines. Fascia is the connective tissue surrounding all tissues in our body. It links bones, muscles, ligaments, organs etc. in a way we are barely starting to understand. So, it definitely has a role to play in our management of patients. It can shorten or lengthen in response to the tissue it surrounds. For example, in poor posture the fascia surrounding lengthened muscles will lengthen and the fascia around shortened muscles will shorten. In this way, the muscle will battle to function properly. So, strengthening the muscles or increasing the muscles flexibility will only be effective if the fascia is treated at the same time.
NP: Does hypertrophy need to be countered with stretching? Or is the transverse pressure applied by mobility and foam rolling sufficient?
CA: When a person is getting hypertrophic “gains” they may be prone to tightening up of the muscle. You don’t necessarily want this as they might need the range for their chosen activity. In this case maintaining the length of the muscle is important. I would use a mixture of rolling, massage and localized stretching of the tight tissue to maintain. Generalised stretching might compromise tissue on either side of the hypertrophied muscle so more specific soft tissue mobilization and focused stretching would be better.
NP: If too much length and too little length are both negative for muscle performance, what should clinicians look for when rehabbing or improving movement or performance.
CA: Muscles need to function at the correct ranges of joint motion. They need to be able to exert their maximum force at the best biomechanical range for the task in question. For instance, in running, the hamstring needs to be able contract effectively, eccentrically, just before full knee extension to control the foot strike. If that muscle exerts its force at an earlier range the person will develop compensatory patterns and thus predispose themselves to injury. It then needs to effectively contract concentrically just after toeing off to power the runner forward and obtain a high knee flexion for a strong swing phase. If a muscle is able to function effectively at the range needed to achieve the athletes goal then is that sufficient? Probably but there is probably a range on either side of that, that is necessary to enhance performance and prevent injury.
NP: What is the proposed physiology of lengthening via stretching? It is my understanding that there needs to be >21 days of continuous daily stretching before length changes may be observed, whether they are significant or not is another debate.
CA: Actual lengthening of muscle fiber’s has been proposed to only occur after 21 days of continuous daily stretching as you say. The lengthening effect you see after a 20 second stretch is thought to be the dampening of the stretch reflex. This reflex is protective so if you dampen it, aren’t you endangering that muscle?
NP: If muscle tone, hypertrophy, neural tension, joint ROM all influence the way we measure muscle length, surely working on all of the above may provide the ‘length’ we’re looking for?
CA: Exactly. I feel that if you work on those and also correct movement patterns i.e. ensuring good joint positioning during movement (GH centered during rotation, not shifting to far anteriorly or posteriorly) you will immediately improve range. And only after that can you try increase the length of the muscle, BUT only if its needed and most of the time it isn’t.
NP: How do we advocate a more thoughtful “out the box” thinking approach for clinicians – firstly, regarding stretching, but also regarding other clinical decisions we advocate?
CA: They need to ask what they are trying to achieve and why? If they determine that, the answers on how to treat a specific problem will probably be very different to what they were going to implement blindly. Specificity to each individual and their specific problem is key. We get taught recipes as well as clinical reasoning but choose to use the recipes instead of the clinical reasoning.
***We cannot thank Chris enough for his willingness to share his knowledge and insight with our audience. This back and forth process took place while Chris was preparing for a conference lecture in Pretoria and running his busy practice. If you’re a health care practitioner, and have the opportunity to attend one of his lectures we can HIGHLY recommend him as an educator and clinical expert.***