Physio Stretching Q&A
As a physio one of the most common topics we get asked about is stretching.
- When to stretch? Before or after?
- What to stretch?
- How long? How often?
- Active or static?
All good questions, and sadly there are not a lot of concrete answers out there. In this blog we will try to dispense with some of the myths of stretching, and provide you with a practical hit list of what you can do, and when.
Before commencing on a
stretching routine, it is important to understand what tissues you need to be stretching. A physio assessment at the Movement Centre will aim to identify the underlying contributors to any immobility. This involves assessing the range of motion for the relevant area. In this we aim to identify the specific contribution of the joints involved, the muscles that cross the joint, and the neural mobility where relevant. Other factors such as pain, balance, coordination and weakness can all contribute to a sense of tightness or immobility.
Each of these structures will benefit from a different approach to improving mobility. In this blog we will run through the approach that we take to each of these, and how they work together.
Joint stretching and mobilisation
Stiffness in structures of the joint such as the capsule or ligaments can occur after injury or prolonged immobility. Often this is an underlying issue behind problems with overall flexibility. Identification of this type of stiffness generally requires physio assessment, as it looks at what we call accessory movements. These are movements that happen at an individual joint that contribute to the movement of the joint or limb as a whole.
When your physio pushes on your joint – whether it be the vertebra in your back or your ankle – we are often assessing the amount of movement available at a specific joint.
After injury and the development of scar tissue, or if the joint hasn’t been moved much (after time spent in a moon-boot or cast), stiffness can have a dramatic effect on recovery.
Our strategy for stretching these structures usually involves joint mobilisations. These are small movements of the joint, performed repeatedly over 20-60seconds. The aim is to encourage movement in the joint in a way that doesn’t aggravate surrounding irritating structures.
Home exercises for these are joint specific, but usually involve gentle oscillating movements at the end of a range of motion.
Muscle stretching physio advice
Muscle stretching is the stretching most of us are familiar with. Under the banner of muscle stretching falls static, dynamic, ballistic, PNF and a whole host of other types of stretching.
Dynamic and ballistic stretching involve moving the muscle to the end of its range, and gently (dynamic) or more aggressively (ballistic) bouncing out of the end of the range of motion. These types of stretching are highly specialised. They can form a part of a warm-up by replicating activity based movements, such as kicking or throwing.
Static and PNF (proprioceptive neuromuscular facilitation) stretching are the kinds that most people are familiar with.
Static stretching physio advice
Static stretching involves taking the muscle to a position of tension and holding, usually from 5-60 seconds. Static stretching like this can be a lovely way to include movements throughout your day.
Examples include:
- Side bend stretching the neck – particularly when sitting at the computer for long periods.
- Pec stretching in the doorway to open up the chest .
- Bending forward with your heel up on a bench to reach for your toes to stretch the calf and hamstring.
- Standing and pulling one heel up towards your buttock to stretch through the front of the thigh.
- Reaching your arms forward and gently pulling your fingers back towards you using the opposite hand.
These are all lovely movements. They help us keep mobile, and can have a great impact on limiting the development of pain and tightness. Static stretches are especially useful to counter prolonged positions such as sitting and typing with work, or sitting in the saddle of a road bike for hours.
There are better ways to warm-up than static stretching
Static stretching is often misused as a warm-up or cool-down for sport and exercise. Ensuring movement through a full and comfortable range is important; but static stretching before exercise is not the best way to prepare for activity. Performing some light aerobic work, and dynamic movement through range is a more appropriate and beneficial way to warm-up for activity.
Static stretching physio takeaways
Where static stretching is concerned, we recommend getting physio advice on which muscles will benefit most. And from there, coming up with 2-3 easy stretches you can do throughout the day. For best benefit on muscle length, we suggest holding the position of stretch for upwards of 60 seconds. We want the stretch to be felt in muscles themselves, not in the nerves and joints associated with the movement. Performing these stretches 3-5 times throughout the day can be a nice way to break up prolonged postures, settle aches, and improve muscle range of motion for exercise.
PNF stretching physio advice
PNF stretching is all the rage right now. Stretch clinics and stretch labs seem to be popping up on every corner. PNF stretching involves a combination of partner assisted stretch and contraction positions to help stretch the muscle further than it usually permits. By making the muscle contract hard, we elicit a small post-contraction relaxation on the muscle that allows us to push the range of motion further.
PNF stretching can be a great way to improve muscle range of motion. Because it involves taking the muscle to the end of range, forceful contractions, and long stretch holds, we recommend undertaking a thorough assessment, and doing this with an experienced physio.
More importantly, while it can be effective, PNF and partner-assist and physio stretching can be hard to do. It requires an experienced and trustworthy partner, time, and positioning. For these reasons, we recommend making more regular static stretching, and regular exercise and movement through the full available range the cornerstones of your mobility routine.
Nerve stretches, glides, flossing and mobilisation
Nerve tissue is often the underlying culprit, and unintended victim of our stretching routines. Nerves, as the innervating conduit of our body can be more prone to immobility, stretch and irritation than other structures.
Often when patients say they have tight traps and shoulders, it is the nerve tissue of the neck and upper limb that is desperate for movement. Likewise with the much maligned sciatic nerve – which often gets overlooked for glute and hamstring stretching.
Understanding the role that nerve tissue plays is important. Nerve tissue can become sensitive and irritable, and create very nervey discomfort when stretched. Likewise it can result in restriction in the movement of muscles around it – to protect from further stretch and irritation.
Often an inexperienced or poorly applied stretching routine will overlook nerve tissue contributions to tightness. Prolonged stretches, dynamic stretches and mobilisations which we love for muscles and joints can be irritating for the nerve tissue.
Movements for irritated nerves
Healthy nerve tissue loves movement and gentle stretch. Acutely irritated nerve tissue usually responds to gentle movement called flossing or gliding. In these movements we stretch one end of the nerve continuum, while providing slack at the other end. Imagine tying a piece of string from your ear lobe to your finger tip, held out at your side. As the finger gets bent away, the ear must move toward it to prevent tension in the string. This is similar to some of the neural glide / flossing techniques that we use for acutely irritated nerve tissue. Similar movements can be adopted for the nerves of the lower back and legs. It can be a lovely way to settle nerve pain, and unlock neural restrictions to mobility.
Combining info from all the above, let’s break it down to some key physio stretching takeaways:
- If you have pain or tightness – see a physio for advice on the structures involved and a plan for how to improve.
- Move often, and through a full and comfortable range of motion.
- Use dynamic and ballistic (where appropriate) stretching in your warm-ups to encourage movement specific to your activity.
- Use static stretching often throughout the day to help lengthen out muscles that have been sitting still for too long in shortened positions.
- Understand that nerve tissue tension and irritation can underlie mobility issues. These often need to be addressed before muscle stretching can be progressed. And furthermore, pushing through nerve tension will often wind-up the irritation rather than improve it. So it pays to get the right advice.
- Most importantly, move your body often through a full, comfortable range of motion. Utilise exercises that work muscles and joints through a wide range of movements and stretches.
Come and see our team of physios in Randwick if you need physio stretching advice to help with pain, performance or mobility.
