Stretching has been an ever present component of my routine for just about as long as I can remember. It has played a role in my flexibility for dancing, sports, and yoga. And it has been a critical part of my own personal physical therapy treatment and ongoing maintenance following an episode of severe low back pain and leg weakness related to disc herniation. This occurred when I was barely 20 years old and at the time completely confused me. I didn’t think I’d had any injury at all, but just seemed to wake up one day with pain and so much difficulty moving my body.
In retrospect and with education, I eventually recognized two things that contributed to my initial back problem: 1) I had been spending very long hours sitting (likely hunched) at a computer working on a term paper or lab report with a deadline; and 2) My instinct was to just “stretch it out,” and I definitely stretched wrong!!
When a joint ends up with limited range of motion, regular stretching can help gradually improve then maintain flexibility for better motion.
Taking stretching into consideration is something we all need to do because we don’t live perfectly balanced lives. We may spend a lot of time in a particular position such as sitting or looking down, or repeating particular motions, depending on our vocation or recreational activities. This ends up putting certain muscles in shortened positions and over time results in decreased range of motion of the joints those muscles cross. Each of our joints needs to be able to move freely through an adequate range of motion in order to do what we need to do without injury. For example, prolonged sitting can result in tight hip flexors at the front of the hips and tight hamstrings at the back of the knees and thighs. Over time, these tight muscles impact the normal muscle balance needed for proper upright posture, pelvic alignment and biomechanics when standing and walking.
When a joint ends up with limited range of motion, regular stretching can help gradually improve then maintain flexibility for better motion. So how does this work? How does stretching result in improved range of motion over time? The answer, it turns out, is not that simple or fully understood scientifically. Proposed theories include mechanical changes that result in structural lengthening of muscle and connective tissue. A newer sensory theory suggests that with regular stretching, our sensation (what we feel when we stretch) actually changes and allows increased tolerance to stretch. This allows our muscles to lengthen further and increase joint range of motion.
As a physical therapist, my guidelines for how to stretch are informed by these various theories and by the properties of the individual tissues (including muscle fibers, fascia, tendons and even nerves) on which tension is placed during stretching. In addition, each person’s unique body structure and unique daily activity requirements will affect how best to stretch.
Some general tips (things I find myself saying a lot!) for good stretching practice:
- Warm muscles are easier to stretch and more resistant to injury, so warm up with 5 to 10 minutes of light activity before stretching.
- Pay attention to proper alignment and stabilization so that each stretch is targeted to the tight muscle tendon unit and not being transferred to other areas that may be already hypermobile; we don’t want to stretch joints that are hypermobile.
- Don’t bounce in a stretch; this can cause tissue injury. It is best to gently move into a stretch to the point where you start to feel it and then hold for about 30 seconds.
- If using a piece of equipment or strap to help with this kind of stretching, make sure it is unyielding. I find that sometimes people try to hold stretches with the resistive bands that we use for strengthening exercises. In this case, the stretch is less effective and harder to hold because the tension causes the band itself to stretch out.
Finally, back to the back problem that I had when I was younger. It’s important to be cautious when considering stretching around an acute injury. This is obvious if there has been some trauma and you have a broken bone, sprain or torn muscle. It’s less obvious if you have woken up with severe pain in your neck or back seemingly out of nowhere. In both cases, it is not the time to start working on flexibility by static stretching, since holding a stretch across a compromised structure can disrupt the initial healing process.
When I initially began physical therapy for my back problem years ago, stretching was an important part of my rehab. In particular, my hamstrings and hip flexors were tight at the time. This was toward the end of the semester in the tennis off season, and much of my time was spent sitting in classes and working at computers. In addition to stretching, it was important that I learn how to use my core to stabilize my spine. Over the years since then, my activity patterns have changed and I feel lucky that I rarely spend prolonged periods sitting now. However, I am finding that, as I settle into my postpartum body and get a little older, I have new stretching needs. I now notice that it actually makes a difference when I warm up, and my old stand by stretches are not necessarily the ones I need most. It is a reminder that when a new pain occurs, however similar to past problems, it should be evaluated in the context of one’s current daily routine.
~ Elizabeth Maynard PT, DPT