Seated hamstring stretch

This is quite a classic stretch. I remember doing this back in the 1990’s.

Sit down,  stick one leg out straight with the sole of the other foot  facing the inside of your straight leg.

Bend forward from your hips, not your back.  Hold for 10-60 seconds, or  3,4,5, sets of 10 seconds.

Some calming rhythmic breathing is always handy. Some talk about adding meditation. I must I admit I stretch while watching TV!

As a test, it’s worth noting that whilst your hamstring ( the back of your leg) will feel tight and engaged, if you poke the top of your (straight )leg, it  (the quadriceps) will feel relaxed.

Obviously, do both sides.

There will be more hamstring stretches as we develop into the full splits.

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Flexibility, trigger points and fuzz

No modern discussion of flexibility, trigger points or pain is complete without talking about fascia.

I was introduced to fascia by Julian Baker of the Bowen technique during some guided dissection sessions back in 2012 ( which means I have dissected corpses as part of my studies).

Its the “sort of fatty stuff directly under your skin
See here

Years ago this “stuff was simply cut away by laboratory assistants so you could see the actual muscles.

It’s only now that people see this as a new communication highway for our endocrine, circulatory, or nervous systems.

Today much “tightness” is attributed to dysfunction in the fascia. Although this is far from proven it’s useful working hypothesis that makes us focus on trigger points. They are “a hyper irritable locus with a taut band of skeletal muscle, located in the muscular tissue and/or its associated fascia.”

Sometimes called knots, trigger points can be quite painful, will cause stiffness and weakness of the affected muscle, and restrict the muscle’s full range of motion.

Fascia can also stick to muscles in what Gill calls “fuzz” ( if you cannot pick the skin off your muscle, its arguably adhered and interrupting muscle function, reducing range of motion

When poking around your body, you can often find what needs attention if
1. You press on the skin, and its super painful with pressure
2. you cannot pick the skin away from the muscle. This should glide, not stick
3. You feel special tension in an area when you stretch

This is sorted by,  being bothered enough to do something about it. Practically that means a mix, but consistent mix , of gentle (and not so gentle) massage, skin rolling and pressure applied by your fingers, objects, cupping, or better still someone else.

This stuff goes under the heading of Myofascial Release.

It’s uncomfortable which is why few people use it or do it. Sort of like flexibility. You have to get used to that weird discomfort.

The problem is that medically, no one wants to be a muscle doctor. So it’s the orphan organ.

If you have enough flexibility to squat, why do you need more. Crucially, if you cannot squat well because of flexibility who cares. Most lift the weight anyway, and if they screw their back who cares!

Stretching is uncomfortable, boring, the evidence is very conflicted and many charlatans insist that flexibility is a “star gate” to spiritual well being and enlightenment. This obviously puts any right mind individual off stretching.

 

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Cupping and flexibility

The bigger your flexibility tool kit, the better your flexibility training will go. So, it was fun to come across “Effect of Cupping Therapy on Range of Motion, Pain Threshold, and Muscle Activity of the Hamstring Muscle Compared to Passive Stretching”  It’s a fascinating read.

Kim et al, set out to review the effects of cupping on flexibility. The conclusion was  that cupping therapy has a positive effect on flexibility equal to  passive stretching. Allegedly more convenient and easier to work on patients than passive stretching. Therefore, cupping therapy should be considered as another option to treat range of motion issues.

 

They tested this protocol: Cupping therapy was applied to the hamstring muscle for 5 minutes in the cupping therapy group. The passive stretching group was treated with a passive stretching for 10 seconds and repeated 9 times

 

This is the same result that Lacross, 2014 found.  Cupping therapy may induce a change in flexibility (equal to passive stretching). Maybe cupping  actually  gets into the tissues! This  depth of effect , allegedly, increases  the neurophysiological activity at the level of nociceptors, the spinal cord, and other nerves, and ultimately leads to significant relaxation (Musial et al., 2013).  Cupping has also been found to affect the body up to four inches into the tissues (Hanan and Eman, 2013).

 

So, yes to cupping. Its fairly cheap, quite safe and a good DIY thing if you make sure you are suitable for this  treatment. Bound to be good for facebook and instagram photos. Get a cheapie set for £35

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References

Lacross ZT. Treatment Outcomes of Myofascial Decompression on Hamstring Pathology. 2014.

Musial F, Spohn D, Rolke R. Naturopathic reflex therapies for the treatment of chronic back and neck pain-Part 1: neurobiological foundations. Forsch Komplementmed. 2013;20(3):219-24.

Hanan S, Eman S. Cupping therapy (Al-Hijama): It’s impact on persistent non-specific lower back pain and client disability. Life Sci J. 2013;10:631-42.

The Sitting Groin Stretch

A great starting stretch, as, in simple terms, all you have to do is to plonk yourself down on the floor (bed, bench, loo) put the soles of your feet together, grab them, and lean forward from the hips.

Groin stretch andrewstemler.com

Simply, pull your elbows to the floor, or lean form the hips to build the stretch which you’ll feel on the inside of your upper legs.

You’ll find that once you have held a stretch, it starts to ease off as the body gets used to it. This could be an opportunity to improve the stretch by pulling or maybe pushing your knees to the floor, or leaning further forward from your hips.

If you train in a leisure centre, you’ll be told to do this for 10 seconds. However, the modern evidence is that stretches need to be held (or accumulated) for up to 2 minutes and beyond. Start off gently and build time time in the stretch sensibly.

We will show you lots of variations to this stretch.

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Alfredson and eccentric drops.

I refer to this  “genius” so often, that I thought I should post up this reference here.

Alfredson H Pietila T Jonsson P Lorentzon R. Heavy‐load eccentric calf muscle training for the treatment of chronic achilles tendinosisAm J Sports Med. 1998;26(3):360‐366. [PubMed[Google Scholar]

This is a report that has changed the lives of so many people, it’s ridiculous. It’s basically stretching a tendon through its eccentric phase, under load.

Here is a much younger me trying it out, back in the days when I was sufferer!

For those who want to dig further into this issue, check out this useful review.

So you hold a stretch for 2 minutes!! Or must you?

In this blog Ive been diving in and out of various flexibility regimes and training ideas. One of the developing themes has been “hold that stretch for 2 minutes”.

However, one of the exciting regimes Im looking at, is by Paul Zaichik. He discusses a different approach that is outlined in his blog post “Most Effective Stretching Modality: Alternating Contracting Target Leverage” (click here) . The basic summary that he offers is this:  “it involves alternating the directions of the stretch adding a muscular contraction in between”

Check this video out

Hmm, food for thought!

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Is stretching enough to fix pain?

Ever since I became a fitness instructor back in 1997, I was assured by every trainer and every therapist I met that pain can simply be stretched away.

In practice, results are far more mixed. Whether people are doing the wrong stretch, for the wrong time, or lying ,  if you are honest, stretching often isn’t a long term solution for pain.

I wrote about this in my “backaholic”  blog where I quoted some of the observations made by Stuart McGill And Boo Schexnayder

Soft tissue injuries result from excessive tension, so excessive tension in the rehabilitation situation is counterproductive…stretching of …chronically tight tissue is counterproductive. It may give an initial sensation of relief because the muscle spindles have been deadened, but this practice…weakens the tissue further because of the weakened proprioceptive response.” Boo Schexnayder

stop trying to Stretch and mobilise! Let tissues settle and regain their proprioceptive abilities so they tell the truth” Stuart McGill

Its important to recognise that stretching has an analgesic effect , but it seems to be attributed to switching receptors off in the muscle. ( I suppose its like I’ve cured your  headache by switching off the fire alarm, but I haven’ checked that there isn’t a fire!!).

Do bear in mind that pain has many causes. I have clients with bad backs, caused by rubbish abusive employers, I have clients who use their backs appallingly,  and are so tight their posture is disgusting, who have never had a minutes worth of pain.\

Nevertheless  stretching  has enough of an  albeit , muddled,  pedigree to justify its inclusion in pain treating especially if better protocols can be designed.

In the therapy world, the chances are we know everything, it’s probably a matter of nailing the sequencing to get optimal results.

We know for example not to train static stretching before sprint practice.  “in strict terms of performance, it seems harmful to include static stretching in the warm-up protocol of collegiate male sprinters in distances up to 100 m”. (ref)

So what do we have to do to make stretching work as a pain relieving protocol? Because just to say ” stretching is magic” doesnt cut it :

If you read “Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial”. (Ref)  they found that “When used for the short-term treatment of plantar heel pain, a two-week stretching program provides no statistically significant benefit in ‘first-step’ pain, foot pain, foot function or general foot health compared to not stretching.”

Well check out Effectiveness of Myofascial Trigger Point Manual Therapy Combined With a Self-Stretching Protocol for the Management of Plantar Heel Pain”

This  2011 study combined trigger point therapy with stretching and concluded “that the addition of TrP manual therapies to a self-stretching protocol is superior to the sole application of self-stretching in the treatment of individuals with plantar heel pain at short term“. 

So its really worth thinking about combining trigger point therapy with stretching.

If you want to get an inexpensive handle on trigger points, buy this book

Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief (A New Harbinger Self-Help Workbook)

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If you are near the east end of london, you can book a PT session with me and ill show you how (andrew@andrewstemler.com)

So, for now, my conclusion is that, when applying stretching for pain relief,  it’s sensible to consider combining Trigger points with stretching. I’ll talk about the re education of tissues, rest period, elsewhere. This I think is also the view of Joe Hippensteel from Ultimate Human Performance. The UHP  stretch based method has recently shot to fame as it was popularised by  David Goggins in his book Can’t Hurt Me: Master Your Mind and Defy the Odds 

 

It’s still important to  say that every year dancers, gymnasts athletes and physical enthusiasts get flexible by using a mix of the work of  Zaichik,  Kurz and others.  That you can improve your range of motion  isn’t really up for debate.

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How long to hold a stretch?

If you are a standard athlete  or anyone who hangs around at the gym you’ll know how long to stretch for. Its a 10-20 second hold of the stretch in your warm up, and maybe you go mad in the  after workout stretch and go for those 30 to 40 seconds hold.

The only problem is , you are wrong!!!

As I’ve already explained, in the first few weeks of a stretching regime, any increase in the range of motion is due to an improvement in Stretch Tolerance. This gives you a transient increase in range of motion, and you’ll probably feel a bit looser. If you use stretching as part of a pain reduction programme, these short stretches will help build your confidence. But, no actual  physical improvement in your muscle extensibility ( you’ve pushed open a rusty door and you are getting used to the grinding and  stretching noise the hinges make)

Holds For 2 Minutes PLUS

Well, now we enter the real world of  full on, proper, big boy stretching, and this comes with spooky therapy words like  “tensegrity” and “mechanotransduction” and the “Thixotropic Effect”, which states the longer a tissue is under load, the more adaptable it will become.   This all leads to the rule of thumb that says if we want to make physical changes to your muscles you need to apply  force to the tissues for around two minutes or more.

This two minute mark is determined as the average time  it takes a cells to recognise the stresses being placed on it.  The longer and more regular the stress, the more the body   goes. “we better adapt to this” .

Dr. Andreo Spina frequently states, “Force is the language of cells.” 

Keep in mind that stretching one time for two minutes will not create a permanent change.  It takes a lot of repeated stimulus over a long period of time to create actual changes to tissues.  This follows the Thixotropic Effect, which states the longer a tissue is under load, the more adaptable it will become.

To put this all in context, jumping straight to 2 minute stretching is a silly idea.  Use that first month to build up. I started with sets: 3 sets of 10 seconds, then 20 seconds, then a week later 30 seconds. We know that first period is building up tolerance, so, “just build up tolerance”

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The first 30 days of stretching!

It’s about time that you began to understand the secrets behind effective stretching. The secrets begin with understanding what the process is.

The first part of the process, in the first 30 days, is that improvements in  your range of motion in the joint occur because you tolerate the discomfort more (aka Stretch Tolerance) NOT, because you have lengthened the muscle.

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Reference

Law et al, 2009. Stretch exercises increase tolerance to stretch in patients with chronic musculoskeletal pain: a randomized controlled trial.   Find here

 

 

Flexibility Standards

Do you need to be more flexible?  How flexible are you? What are your flexibility targets? It’s interesting ploughing through the flexibility literature looking for effective and reliable flexibility standards.

These  following two photos are from the  Men’s Gymnastics Coaching Manual and they give an “interesting” guide as to the possible  levels of flexibility that would be gymnasts may need. Im not sure to what extent it should guide normal people, but, it’s an interesting, if depressing, place to start answering the question of ” how flexible” do you need to be.

Tom Kurz suggests this reference chart in his famous book  Stretching Scientifically: A Guide to Flexibility Training

IMG_2607

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