Physiotherapy and Stretching

The limitations in flexibility which people exhibit are of interest to a large group of professions from medicine to physiotherapy, osteopathy and chiropractic. Yoga and other eastern traditions have employed stretching techniques called asanas for thousands of years although this was not their primary purpose. The eastern martial arts, such as karate, judo and taekwondo, also emphasise flexibility in the performance of these comprehensive martial ways of living. Flexibility is not precisely defined but in anatomical terms it mostly refers to the ability of joints to go through a particular range of motion.

Ballistic versus Static Stretching

Stretching, when you get down to details, has a lot of controversial and uncertain matters which are unresolved. The pros and cons of static and ballistic stretching is one discussion point. Static stretching is overwhelmingly more common but most activities and sports have a large dynamic component so ballistic stretching may reflect more accurately the actual physical challenges. Ballistic stretching can be more interesting and reduce the boredom associated with static regimes.

Ballistic stretching does have severe possible negative characteristics which can limit their usefulness. Rapid elongation of a muscle and the accompanying connective tissues means the tissues do not have the time they need to adapt by more permanent lengthening as using longer periods of low force stretching has been shown to be more effective. Muscles which are stretched quickly can react by reflexly contracting to prevent injury, limiting elongation. If the movement develops much momentum this can cause forces which overwhelm the tissues’ tolerances.

Static Stretching

Static stretching occurs when a stretch position is held for a defined period of time at least once, but it could be more times. The stretch should be performed in a controlled manner, without any movement or speed of movement. Static stretching has been researched and shown to be effective in changing the ranges of movement of joints. Static stretches are easier and more convenient to perform, require less energy and may result in less muscle soreness, but many of these things have not been proven.

Joint ranges of motion are altered by stretching but there are usually some ballistic parts of most activities and sports. The benefits of stretching have been variously reported as:

Warm up is enhanced by stretching. As stretching does not increase the temperature of contractile structures this seems not to be the case.

Cool down is enhanced by stretching. The mechanism of cooling down is to facilitate the diversion of blood from the exercising muscles back into the circulation. Passive stretches cannot achieve this.

Delayed onset muscle soreness (DOMS) is relieved by stretching. This idea has not been supported by any evidence.

Athletic performance is enhanced by stretching. Evidence does not support this idea either and dynamic flexibility may approach performance more closely.

Stretching helps to prevent injury. While lack of flexibility can be associated with increased injuries, stretching has not been connected with a reduction in this risk. Recent research has indicated that stretching before exercise might actually increase the chances of injury rather than reduce them.

There is a different classification of movement and stretching in physiotherapy and this involves the ideas of active and passive, accessory and physiological aspects. Moving a joint independently a patient is said to be doing an active movement. If the joint is moved by a physiotherapist instead then this movement is termed passive. Stretching can be active or passive or a combination in some cases.

Physiological stretching can be active where the patient lifts their arm up with one set of muscles, stretching the joint and the opposing set of muscles. If the joint will not go through the full range expected it is possible it is stiffness, weakness or pain which is limiting the joint. By checking the passive physiological range a physiotherapist can determine which one of these problems is troubling the joint. If the movement is full when the joint is stretched passively and there is not much pain then weakness must be the presenting problem.

About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Edinburgh. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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