Tuesday, June 20, 2017

Why Stretching Something That Hurts Isn’t Always The Answer

It seems like when something hurts the most common advice you get is to stretch it.

At face value, this makes sense. When something feels stiff and sore, it’s easy to assume that short muscles are to blame, and the obvious solution would be to try to lengthen them through stretching.

However, research is finding that the underlying causes of pain are more complicated than short muscles, and stretching isn’t necessarily the best option for tight hamstrings or a sore neck.

What are can cause pain and tightness?

While there has been a lot of debate around this topic, it’s currently thought that pain is a signal from the brain warning of a perceived threat of instability or weakness around a joint that may or may not correlate with actual damage to the tissues. A great resource with more information on this topic is the book Explain Pain by David Butler and Lorimer Moseley.

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When this signal goes out, the brain tells the nervous system to tense the muscles around the joint to protect you from going into a range of motion you can’t support.

Understanding this, it then makes sense why tightness and pain are poor predictors of what the problem is.

Pain could stem from restriction in the connective tissue after trauma, an unstable joint that your brain is trying to protect, or a muscle that’s functionally short from overuse.

For instance, many of people experience tight IT bands and hip flexors, especially after a challenging workout. In this case, the IT band and hip flexors often feel tight, and that could be because deeper smaller muscles around hips, which are also known as hip stabilizers, are weak.

In this scenario, the IT band and hip flexors are overworking, because they’re having to do their job along with the job of the hip stabilizers. This is turn tells the nervous system that the hip is unstable, which can result in hip discomfort and pain. Since the IT band and hip flexors are compensating for weak muscles or instability, stretching them wouldn’t address the underlying problem.

So, while stretching isn’t inherently a bad option, it may not always be the best option, especially if the pain is due to instability. Stretching might feel good in the moment, but long term it could make you feel worse, because the pulling would signal further instability to the nervous system, which would tell the brain to create even more stiffness and in turn, discomfort.

What happens when we stretch?

Studies are suggesting that while stretching does improve range of motion, it’s not because muscles are getting longer.

Researchers from Graz University in Austria tested ankle mobility after a six-week program focused on static stretching of the calf muscles. They found that while mobility improved, there were no structural changes to the muscles and tendons around the ankle.1 It’s believed that the increased range of motion or tolerance to stretch was a response of the nervous system as a result of stimulation of the nerve endings in the muscles and connective tissue.

What to do about joint stiffness and pain

First, if something has been bothering you for more than a week or two, even after rest, it’s best to consult a physical therapist who can evaluate you and create a comprehensive treatment plan if needed. Getting help in the early stages of an injury makes for a quicker and less complicated recovery.

Sometimes massage can help, but because a massage therapist can’t diagnose you, it is better to start with the physical therapist who will be able to tell you if massage will be beneficial, especially if you’ve been experiencing pain for a prolonged period of time.

Strategies to address minor stiffness or discomfort

As previously mentioned, instability is among the more common causes of stiffness and pain, so one of the best things you can do is strengthen your stabilizers.

If you’re not familiar with the term, your stabilizers are the smaller postural muscles responsible for holding your joints in good alignment. They work with your big “mover” muscles to create efficient movement.

To return to the above example about hip stability, when you lunge, the gluteus maximus and quadriceps are among the big movers that create the physical movement. However, for you to perform that lunge without compressing your joints, you will also need to engage the gluteus medius, deep lateral rotators, and deep core to stabilize the pelvis and lower back.

Since stabilizers are postural muscles, they ideally remain gently engaged for long periods of time, even during sedentary periods like sitting. As a result, they’re best targeted by performing exercises in sets of higher repetitions with lighter loads.

Instability and pain are also associated with a lack of movement in certain areas, so mobility drills can be effective for improving range of motion and decrease pain.

Mobility drills can be thought of as a more dynamic means of stretching, because they help you explore fuller ranges of motion and decrease stiffness. It’s believed that much like stability work and stretching, they improve range of motion because of how they stimulate the nervous system.

However, because mobility drills are gentle and don’t involve holding a posture at end range the way you would with static stretching, they’re less likely to irritate something that hurts due to instability.

For functional, pain-free movement, both stability and mobility are needed, so these exercises pair well together. Molly Galbraith’s article on dynamic warm-ups demonstrate a great way to combine stability and mobility work.

Researchers from the Rush University Medical Center found that an increase in proprioception or body awareness and quadriceps strength correlated with a decrease in knee pain in people with knee osteoarthritis.2

This suggests that strength training in conjunction with stability and mobility work can also reduce instability and the corresponding discomfort. Before using heavier loads be mindful that you aren’t loading an already irritated joint and that you’ve mastered the form and have good mobility.

When should you stretch?

When it comes to static stretching, the jury is still out on the best application, but if done thoughtfully and with good alignment, it can be a good way to explore new ranges of motion, enhance mobility, and calm the nervous system.

However, if you’re hypermobile, have a known instability, injury or trauma, or you’ve recently had surgery, it is best to avoid stretching the affected areas unless your doctor or physical therapist has recommended it.

Coaches’ Corner

How do you know if your client should stretch an area that hurts? We all have clients who come in with the occasional ache or pain, so it can be tricky to know when stretching will be beneficial or if you should suggest that your client sees a medical professional before working with you.

As fitness professionals, it’s out of our scope of practice to diagnose or treat pain.

The first thing we should always ask a client who comes in with pain is if they’ve been to their doctor or physical therapist for it. If they say yes, the next step is to find out if they were given a diagnosis and what they’ve been cleared to do, because stretching can be beneficial for some injuries, but not for others. For example, if a client is hypermobile, stretching isn’t recommended.

If a client hasn’t been to the doctor, but they’re otherwise moving well, you may be able to have them stretch avoiding the painful area or movements that cause pain for that session. If they continue to have pain after a week, even after rest, it is wise to refer them to a medical professional for evaluation, so they can get the best treatment possible and the most out of their training sessions.

If the pain resolves within a day or two with rest and a client is able to return to their normal activities, then light to moderate stretching is mostly likely okay, as long as it doesn’t create a recurrence of pain or discomfort.

 

References 

  1. Konrad A., Tilp M. Increased range of motion after static stretching is not due to changes in muscle and tendon structures. Clinical Biomechanics. June 2014; 29(6): 636–642.
    http://www.clinbiomech.com/article/S0268-0033(14)00098-9/fulltext
  2. Shakoor B, Furmanov S, Nelson DE, Li Y, Block JA. Pain and its relationship with muscle strength and proprioception in knee OA: results of an 8-week home exercise pilot study. J Musculoskeletal Neuronal Interact, Jan-Mar 2008; 8(1): 35-42. http://billnordt.com/EXERCISEINTERVENTIONPROGRAMS/Painanditsrelationship.pdf

 


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