Right here we go!
For those who know me from the RICE thread hi again. For those that don't, welcome to hopefully another interesting and intriguing thread.
For reference to the following input, go to RICE: yes or No in Sports Physio forum.
Now, as we were saying...Stretching is one of the subjects where there is controversy as far as when and how long it should be done.
I would like to put another spin on the common advice for stretching (yeah what's new I hear you saying! ). I would like to look at stretching from a myofascial point of view, something I have been working with for the past 15 years. It really makes one think differently about body function and in particular, stretching.
Canuck wrote a great piece in the RICE thread ("In terms of optimising..."), and I admit I would have agreed whole-heartedly with this until I learnt more about fascia and connective tissues in general. Fascia is one of the understudied tissues and most ignored tissues in the body, yet without it we are dead. Sounds harsh but true. It covers the heart (pericardium), brain & spinal cord (dura), organs, muscles,nerves, blood vessels etc. etc. It gives us shape, supports us and controls movement. It forms the meshwork around our skeleton, the bones acting like tent poles kept in place by the fascia (tent canvas).
But most importantly for this discussion they cover the muscles to form the Myofascial unit. Basically, the myofascial unit (MU) is made up of the muscle (mainly elastic) and the fascia (mainly inelastic). The muscle is attached to the fascia via millions of microfibrals, thus making it a close knit unit. Now the elastic vs inelastic properties are the important factors here.
Imagine this unit being stretched. The fascial sheath forms the tendons at both ends of the MU together with small connections from the muscle and its micro fascial internal layers. If stretched, the end point of the stretch (first 'feeling' of stretch) will be reached when the inelastic fascia reaches its limit. The muscle inside is practically dragged along by the fascial sheath. So in essence we are not stretching muscle we are stretching fascia. Therefore reactions in muscle and their nerve supply is dependent on the integrity of the fascial sheath of the muscle.
On the other hand muscle contraction drags the fascial sheath along with it and as it is ade up of criss-cross fibres, it can alter shape and adapt to the shape of the muscle it contains...it does not contract.
If our flexibility was governed by muscle (elastic) we would have absolutely no control over movement, somewhat like a puppet on a string...and I am not talking about politicians! So our movement, our power, our control of dynamics is governed by fascia.
Looking at te studies described by Canuck, I can only assume that these were done with the idea that stretching had to do with muscles, not fascia. One thing we need to remember is that being inelastic stretching can only maintain the flexibility of fascia in the short term, and will not necessarily lead to increased ROM even after 10 weeks. Another factor is that excessive exercise leads to thickening of fascia and thus tightening, and thus loss of ROM, so testing weight lifters was probably not a good idea in the first place, especially if they had not been involved in any regular stretching programme before.
One of the main questions is how long to stretch. There is conflicting around on this subject but all involve a certain amount of time, be it 3 X 20 secs stretch or 1 X 30 secs stretch etc. Unfortunately it is much like modern medicine thinking that one drug is good for all . We are all individuals and all need our own time to stretch depending on the feedback from the body. Even both side of our bodies may need different time to stretch as we are not very symmetrical in design and use. Like the animals I discussed before, I am sure they cannot count, and yet there seems to be a trigger built in that says, 'OK you can stop stretching now', and this will vary depending on how long they have been resting. Interestingly, they always start with stretching the spine...it contains the nervous system responsible for blood flow rate, and other physical functions of the limbs, so get the engine up and running and everything can follow.
"Stretching was performed at various intensities..." indicates that there may have been cases of over stretching which is quite easy, as any time you go beyond the very first sign/feel of stretch, you have gone too far. Stretching should only go as far as the fascia will allow, and fascia as with other connective tissues contain over 75% of the sensory nerve supply, so the feeling of stretch is a warning sign to say don't go any further. The fascia just needs to be stretched to its limit and allowed to settle in that position. So once that point has been reached, wait let it settle and once the feeling of stretch eases, that is it. One a day has been shown to maintain flexibility of fascia.
Stretching allows for the necessary space for muscle to work in at their maximum, allows for good flow of blood, and allows for full ROM of joints and other structures.
If fascia becomes tight it constricts the muscle inside, and this will lead to a degree of weakness of the muscle. The majority of muscle weakness we see in patients is actually due to tight fascia, not lack of exercise. It is hard to believe that top sportsmen and women have weak muscles (cause of injury) from a lack of exercise, so why do we often use exercise to strengthen muscles that are weak from overuse in the first place? Exercise to treat injury caused by exercise??
I hope this is becoming clearer, as it is a different way of looking at function, from a myofascial model and not a muscular model, but I think I can summarise my personal ideas as follows:
1. Stretching is directly for fascia not muscle
2. Stretch slowly until first sign of stretch is felt, WAIT and HOLD until the feeling of stretch eases (that is how long you should stretch for...let your body tell you)
3. Strength depends on flexibility, not the other way around
4. Where there is stiffness there will be weakness, and vice versa
5. Stretch first, then warm up, then activate!
As they say of good physicists, they lay down an hypothesis and say, 'shoot holes in it if you can'. If they can't, he is onto something good, if they can, he goes back to his study and continues. Bad physicists or should I say scientists, take their hypothesis and publish it without peer review...quite common these days! This is what this forum is all about, so shoot this down if you can!
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