Body Health Blog
To stretch or not to stretch… is that really the question? Do we stretch before or after activity? Do we stretch warm or cold muscles? How far do we stretch? How long do we hold a stretch ? Like many others, I have struggled with these questions and more for years. In my quest for the answers, I came upon a very interesting practitioner. Microstretch therapist Nikos Apostolopolous has been a member of my network of alternative providers for a number of years. Nikos has been very successful at achieving results with professional athletes who had all but given in to their injuries.
So what is microstretch therapy? Let’s let Nikos explain in his own words:
The challenge of alleviating pain is integral in defining our role as practitioners. The sum total of our thoughts and practical experiences is fundamental in order to select and prescribe the best treatment for patients.
One common thread amongst my patients has always been the need to decrease inflammation and discomfort. My practical experience and research led me to believe that we need to relax the sympathetic response. If not alleviated, sympathetic mediated pain will result in physical, mental and emotional problems. We will meet with limited success if we cause pain to the body since the inherent defense mechanisms – a sympathetic response – will be stimulated to protect the body.
As practitioners we are taught to interpret the body, how each part relates to the whole in response to injury and pain. Pain and injury are not linearly related, for a person can have an injury and not experience pain, and vice versa. This variability of pain has been an enigma that has challenged practitioners and the medical profession for years. However, for our present purpose we will postulate that pain and injury are related.
Initial acute pain due to a physical injury is the epigenesis in the development of muscle shifts, a compensatory response of the body. The physical response to pain and protection of the injury is manifested in the decrease in the range of motion (ROM) of the body. Joint motion, the action of the agonist and the antagonist, and the muscles’ role in fixation and substitution, foster an appreciation of the musculoskeletal response to injury. The alteration of the above parameters due to injury results in the development of a new functional state (NFS) in which the patient resumes normal physical activities but has not re-established pre-injury ROM.
The body physically changes with every subsequent decrease in range of motion due to injury and pain. Habit is the emergent principle of form and the subsequent determinant of function. Gravitational affect on the human body is the ultimate force that determines form and function. If the force of gravity is not distributed equally on both sacroiliac joints, its potential effect on the load-bearing, protecting side can ultimately result in detrimental physical changes to that side of the body. The subluxation of the sacroiliac joint into place is the numerator in the fraction. The common denominator is the increase in flexibility of the support structures of the joint, particularly the muscles, tendons and ligaments. If these structures are tense, they will pull the joint out of place.
When prescribing stretch exercises to your patient, it is important to keep the guidelines simple. The parameters of flexibility training are intensity, duration and frequency. The chart below presents these guidelines defined by the technique of Microstretching®:
How intense should the stretch be?
30–40% of a maximum perceived stretch (a very gentle, warm feeling)
How long to hold the stretch
How often should one perform the stretch?
3 times per muscle group once per day
The intensity of the stretch is determined by the tensile strength of the muscles and tendons. The resistance to pull of 1 square inch of muscle tissue is 80 pounds per square inch while that of the tendon is 8,600–18,000 pounds per square inch (Hollinshead, 1981). If one performs a very intense stretch they are likely to cause a strain or a tear in the myo-tendon junction resulting in the subsequent development of scar tissue in the muscle at the junction.
A physiotherapy study conducted in the United States showed that a 60-second gentle stretch was far superior to either a 30-second or a 15-second stretch. In an elderly population, the 60-second passive stretch increased the ROM of the hamstring 2.4 degrees per week over a six-week period while a 30-second stretch improved 1.3 degrees and the improvement with a 15-second stretch the was 0.6 degrees (Feland et al, 2001).
In order to break a habit and re-pattern functional muscle, we need to repeat the stretch. The above study repeated the stretch 5 times per muscle group. However, in the clinic we found that 3 times per stretch was sufficient.
Another important concept to keep in mind is that in order to properly stretch the musculoskeletal system one needs to eliminate the potential of muscle contraction during a stretch. I define this as the principle of stability, balance and control (SBC®). I show my patients to stretch in a manner that prevents them from contracting the muscle group that they are trying to stretch as well as relax as much of the body as possible. Therefore, many of the stretches are done on the floor or sitting.
Below are four sample stretches that can be suggested to patients in relationship to the sacroiliac joint.
Hip Flexor Stretch (Stretch 1)
Start off with both knees on the floor shoulder-width apart. Move one leg forward while maintaining square hips and shoulder. Support your body with a stool on the hip flexor that is being stretched (in the picture, the left hip flexor). Lower yourself into the stretch with the extended leg being at a 90-degree angle. Hold the stretch for 60 seconds and then switch sides and repeat. Make sure that each stretch is repeated 3 times per side. (Figure 1)
Piriformis ITB Stretch (Stretch 2)
Start with several pillows under both knees. Bring the one leg over the other side of the other knee and place it on the pillow. If you find that you are having to strain in order to perform the stretch, place more pillows under the knee. You will need a pillow underneath your head in order to flatten out your lumbar. Gently pull the leg over and hold the stretch for 60 seconds, and then repeat on the other side. Make sure each stretch is repeated 3 times per side.
Glut-Piriformis Stretch (Stretch 3)
Place both your feet on the wall, making sure that your hip pelvis are firmly on the ground and not floating in the air. Place a pillow underneath your head to flatten out your lumbar spine. Cross one leg over the other, making sure that your ankle is past the knee joint and hold the gentle stretch for 60 seconds. Then switch legs and repeat the stretch for the other leg. Make sure each stretch is repeated 3 times per side.
Hamstring Stretch (Stretch 4)
Place one leg through a door jam and the other onto the wall, making sure you have a pillow underneath your head. Again this is to facilitate a flat lumbar. The leg up on the wall should have a bend in the knee and the stretch should be felt in the middle of the muscle belly. If there is a sensation in the hip flexor region on the straight leg on the ground, place a pillow underneath the knee to alleviate this sensation. Hold the stretch for 60 seconds and then switch sides and repeat the stretch. Remember to repeat the stretch a total of 3 times per muscle group.
In conclusion, it is very important that your patients follow the sequence of the stretches presented. They need to finish each stretch and its sets before moving to the next stretch exercise.
Hollinshead, WH, Jenkins, D B. Functional anatomy of the limbs and back. Philadelphia: WB Saunders Company, 1981.
Felund JB, Myrer JW, Shulthies SS, Fellingham GW, Measom GW. The effect of duration of stretch of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Physical Therapy 2001; 81: 1110–1117.
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