Therapeutic Stretching Techniques & Science


There’s so much more to stretching than just extending. Chiropractic sports injury specialist, Dr. Alexander Jimenez compares, contrasts & debunks.

Stretching is now a science. A developing understanding of the physiology of stretching means sports support professionals finally have a enormous variety of methods to use with clients for training, injury prevention and rehabilitation. This report provides an summary of some of the most popular types of extending, their benefits and drawbacks, in order to help therapists and trainers pick the most important forms for their clients. I have used the description of a hamstring muscle stretch in every instance to illustrate the various techniques.

Active Stretching (Static)

Popularized in the 1980s by Bob Anderson(1), an active stretch is one in which the client performs the stretch unaided. There’s little if any motion as the controlled stretch position is maintained for approximately 30 seconds, then occasionally repeated. Inherent into the practice of yoga, physiologically this Kind of stretch has been termed ‘a form of visoelastic myofascial release'(two). Put simply, muscles and their associated fascia begin to lengthen slowly in response to a gentle and constant load.

In therapeutic terms this physiological response is a real property of fascia and muscle known as ‘creep’. The fact that the load applied is continuous and gentle is key to the efficacy of active stretching.

Many people wrongly believe that active static stretching can aid warm-ups and cool-downs, reduce DOMS, reduce injury, and enhance athletic performance. There is not much evidence to support these beliefs (3).

How To Do It

A static active hamstring stretch might be done by lying supine, clasping the hands behind an extended knee and flexing at the hip to produce the stretch. Hold the position stable for approx 30 minutes prior to releasing and optionally repeating.

Advantages

  • Client can carry out the stretch themselves in the home or after exercise to maintain joint range.
  • Gives the athlete control over their own rehab or flexibility routine.
  • Useful if the athlete doesn’t have access to a trainer or therapist.
  • Can be done nearly anywhere and in any time.
  • No equipment is necessary.
  • Is comparatively simple.
  • Strengthens agonistic muscles (see below).
  • Is known to enhance range of movement.
  • Is allegedly safe.
  • Could possibly be utilised in early-stage rehabilitation.

Disadvantages

  • Inexperienced clients may embrace an incorrect position and fail to stretch the intended muscle.
  • The athlete may not maintain the stretch place for long enough.
  • The technique demands strength in the agonistic muscles, which may be troublesome for inactive customers or those with muscle atrophy (although arguably it is also great for them — view key benefits below).
  •  It is boring.
  • Most sporting movements are ballistic in nature, so for many athletes there may be little practical bene t from raising static flexibility.

Key Benefits

  • Useful in a clinical setting where flexibility has been limited by weakness at the agonist muscles being used to bring about the stretch (as an Example, a sportsperson needing to Obtain knee extension after knee surgery or a hamstring injury where maintenance of quadriceps strength is as important as hamstring rehabilitation).
  •  Coupled with controlled breathing, it might be helpful within a comfort program.

Passive Stretching

While an athlete can do passive stretches unaided, by utilizing a piece of gear, the expression is commonly utilized to indicate that another person is needed to help bring about the stretch. This individual is often another team participant, the trainer or a therapist. No muscles are contracted as a way to bring about the stretch.

How To Do It

A passive hamstring stretch might be done lying in supine, using a towel hooked around the thigh to help to bring the hip to flexion in order to extend the hamstring muscles without deliberate contraction of quadriceps. Instead in supine, a coach uses the straight leg raise position to extend the client’s hamstring.

Advantages

  • Makes stretching less effortful, since the client relaxes into a position that makes it possible for the trainer to facilitate the stretch.
  •  When done as a member of a group action, can make stretching more enjoyable, facilitate concern for fellow staff members and enhance feelings of advancement.
  •  Is relatively easy to do.
  •  Can be performed almost anywhere.
  • No equipment is needed.

Disadvantages

  • Unless gear is used, a stretching partner is necessary.
  • There’s a danger of the athlete being overstretched by an inexperienced partner.
  • The athlete must trust their partner.

Key Benefits

  • Passive spouse stretching is a great option when flexibility is limited by the elasticity of this muscle/s to be stretched.
  • Also useful therapeutically when the agonist is too weak to result in a successful active stretch.

Active (Ballistic) Stretching

The stretched muscles serve as a kind of spring to assist the athlete bounce repeatedly and rhythmically in and out of the stretch place, in effect producing several tiny moves. Muscles are not allowed to stay in the extended position even for a few seconds. Instead, the athlete uses momentum to stretch into and beyond their end of scope position with the intent of raising range of movement (ROM) with subsequent movements.

The degree to which ROM is expected to improve with each stretch is not given in research, nor is there a recommended number or variety of stretches required for every targeted muscle (contrast this with AIS below).

Ballistic stretching can significantly raise tendon elasticity(4), a more useful finnding given that tendon elasticity seems crucial to the discharge of stored energy employed in several sports.

Nick Grantham(5) has previously pointed out the similarities between ballistic stretching and the more recent variant of dynamic stretching where controlled leg and arm movements are used to help take the limb into the constraints of the associated joint variety. He notes that in the latter circumstance, movements are gentle and controlled, whereas in ballistic stretching they are forceful and less controlled.

Plyometrics is another form of ballistic training. It utilizes the elastic recoil of this muscle-tendon unit following a surprising stretch of the muscle to enhance muscle strength and is thus helpful in explosive sports. As an instance, after a leap, the muscle-tendon device of the ankle plantar flexors is stretched as the plantar flexors (gastrocnemius and soleus) are eccentrically contracting to help slow the entire body once the feet hit the ground and the ankle begins to dorsi flex. As Sean Fyfe describes(6): ‘…this stretch-upon-impact can lead to the muscle building larger elastic force in response to the stretch.’

From a security point of view, ballistic stretching is controversial on the grounds that it does not permit sufficient time for tissue adaptation and carries a relatively high risk of harm if poorly implemented. A sudden stretch may stimulate the stretch re ex, muscles contract, muscle strain increases and cells become more challenging to stretch, beating the object of the activity. However, advocates of plyometric training argue that, properly regulated, it plays an important part in late stage rehabilitation, as plyometric movements (running, jumping and throwing) occur widely in sport (6).

How To Do It

A ballistic hamstring stretch may be done standing, bent in the trunk. With straight legs. Make small bounces up and down, trying to touch your toes (this also affects spinal extensors, not just hamstrings).

Advantages

  • Reportedly useful for sports with a ballistic component, such as kick boxing.
  • Helps build lively versatility, so can be used to increase training specificity.
  • Performed after static stretching, it seems to contribute to greater flexibility.
  • Clients may do it in your home or following exercise.
  • Gives an athlete management over their own flexibility routine.
  • Might be done almost anytime, anyplace.
  • Does not need any equipment.
  • Is relatively easy.

Disadvantages

  • Critics think the ballistic movement is more likely to damage muscles, since there isn’t sufficient time for creep to occur in soft tissues.
  • Can’t be used in early-stage rehab.
  • The sudden stretch stimulates the stretch re ex, increasing muscle tone and making it harder to extend the muscle.
  • Shouldn’t therefore be relied on in order to attain developmental flexibility or permanent lengthening of cells, as fast/high-force extending tends to increase muscular stiffness.
  • If tissues are stretched too quickly in 1 movement, they may tear, leading to soreness and limited ROM.
  • Because of a scarcity of investigation (ethically it is hard to test potentially damaging kinds of stretching), it is not clear what effect ballistic stretching has on range of motion.

Variation

A version of active/ballistic stretching known as busy isolated stretch (AIS) involves stretching one isolated muscle at a time by repeatedly hammering the opposite muscle for only 2 seconds, up to ten times. For each contract/relax, the resistant stage is surpassed by 1-4°. Alter (3), in his literature review of AIS, found 10 almost equal variants on this kind of extending, each using a different title, and differing only on the matter of this 2-second protocol.

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AIS (also referred to as the Mattes Method after its developer, Aaron L Mattes) seems to differ in ballistic stretching in 2 ways: it’s formulaic in its protocol, and in ballistic stretching the stretch isn’t held but simply ‘bounced’ out of.

PNF Stretching

Developed in the 1940s as a physical therapy to help rehabilitate victims of migraines, there are many forms of proprioceptive neuromuscular facilitation (PNF), all of which use effective muscle contractions.
Probably the most recognizable is the ‘single airplane’ PNF technique, where an athlete’s muscle is accepted several times to a stage of immunity and the athlete restricts the muscle isometrically (often using a coaching partner or therapist as resistance), even before the muscle is then stretched either actively by the client or passively from the spouse. One of the most exhaustive and well-known books on the topic is by McAtee and Charland (7).

The Way To Do It

To carry out a PNF hamstring stretch, in supine the hamstrings are taken into mild stretch. The athlete then isometrically contracts the hamstrings, while the partner provides resistance. There’s no consensus on how long to maintain or how powerfully to contract the stretching muscle. Generally PNF contractions are more powerful than those used in MET (see below). Following an agreed period, eg, 6 to ten seconds, the athlete relaxes the hamstrings and the muscle is actively or passively eased to a lengthened position, where the stretch is replicated.

Advantages

• More pleasurable and less boring than straightforward static stretching.

• Improves range of motion.

• Advocates claim many other benefits including improved strength, improved joint stability, improved co-ordination, improved endurance, improved blood circulation.

Disadvantages

  • Normally requires a partner.
  • Since there are many variants, athlete and spouse / therapist / trainer have to be clear about which protocol they are using.
  • There could be more stress in the muscle being stretched than happens in active stretching, raising the potential danger of this technique.
  • Done incorrectly, may cause harm, eg, from over- extending by a zealous partner.
  • May not be suitable for hypertensive clients, since there’s a possibility of the valsalva phenomenon occurring during isometric contraction (customer holds their breath after deep motivation, increasing systolic pressure).
    Key Benefits
  • Good for highly motivated people and to aid team- building, in which staff members are encouraged to stretch each other.
  • Specific forms may be useful therapeutically where active movement isn’t feasible because of pain or weakness, or ROM severely restricted.

Variation

PNF can also involve spiral diagonal patterns of motion, on the premise that muscles have a tendency to spiral around bones; this form of stretch intends to maximize natural motion patterns.

MET Stretching

Muscle energy technique (MET) originated from the late 1950s/early 1960s as an osteopathic technique, by the work of individuals like TJ Ruddy and Fred Mitchell Snr. The main differences between MET and PNF lie inside their roots, coming as they do from two distinct disciplines. This gives rise to different terminology, which can be widespread anyhow within the subject of extending — helping to add to the confusion.

In technical terms, the force of contraction exerted by a client utilizing MET is reduced in contrast to PNF. The use of submaximal contractions has been shown to be equally as beneficial since maximal contractions at enhancing hamstring flexibility in areas not able to reach 70° of hip flexion, and might therefore be safer in early-stage rehabilitation of cartilage and muscle injuries(8).

There are many variations and applications of MET(two). At its simplest, the therapist requires a client’s muscle into a point of mild tension, in which the customer contracts it isometrically (up to 20 percent of their force), whereas the therapist provides resistance.

The muscle can be lengthened either following regeneration, when the client relaxes (called post-isometric relaxation extending, PIR); or during contraction (an isolytic contraction, where the muscle is having to contract eccentrically). In this second kind of MET, rather than fitting the force of the client’s contraction, the therapist accomplishes it, raising ROM in the associated joint, thereby stretching the contracting muscle.

MET is gentle and may be used without the stretching component. The very low-level contractions involved in the procedure may be helpful in early stage rehabilitation, to help grow or maintain muscle strength when tissues are in the initial stages of repair.

How To Do It

To carry out a MET hamstring stretch in supine, the client actively exes the hip to its maximum with knee bends, then extends the knee until they reach a point of mild stretch/restriction (therapists can refer to this as the ‘point of glancing’ or ‘ first barrier’). The therapist maintains that this position while the athlete tries to ex the knee by contracting the hamstrings, using up to 20 percent of their force, making an isometric contraction resisted by the therapist for 7-10 minutes. The client relaxes and on exhalation, the therapist gently extends the knee to the new barrier position. This place is held for 10-30 minutes and the procedure repeated.

Advantages

  • Stretches soft and muscle tissue.
  • Strengthens muscle.
  • Relaxes muscle.
  • Helps regain correct muscle functioning.
  • Enhances local circulation.
  • Helps to de-activate trigger points.
  • Contrary to PNF, among the goals of MET is combined mobilization.
  • Advocates claim there are no contraindications.

Disadvantages

  • There are many distinct kinds of the technique and coaching is needed to understand how and when to utilize them.

Key Benefits

MET is used to deal with many patterns of muscle dysfunction. Chaitow (2) explains in detail the use of eight variants on the basic MET technique and when they might be implemented.

Soft Tissue Release Stretching

Utilized by physiotherapists, this entails ‘locking’ a passively shortened muscle close to, or on its own origin prior to stretching the muscle. By forming a false source, the stretch could be applied specifically to areas of brotic tissue.

Advantages

  • Stress and stretch are believed to ease a lengthening of soft tissues and an increase in range of motion (9).
  • Certain stretches may be performed either actively or passively.
  • Comparatively easy to use.
  • Performed knowingly, the only equipment needed is a tennis ball.
  • Can readily be incorporated into a massage series, so can be helpful where massage is indicated as part of a rehab or care program.
  • Helps de-activate activate points.

Disadvantages

  • Therapists will need to learn the method, which can take many forms.
  • Cannot be used on all customers (eg, people who bruise easily and have fragile skin).
  • May result in soreness, very similar to DOMS.

Key Benefits

  • Useful where a client can’t take a joint through a full range because of injury, or with hypermobile clients where starting a stretch at the end point may not be desirable.
  • Valuable for targeting areas of fibrotic tissue in muscles which might otherwise not be stretched with gross active stretching.

Conclusion

This summary isn’t meant to be comprehensive — there is not any space here, for example, to cover techniques like tractioning, neural mobilization and non-traditional kinds of extending. All kinds of stretching can be utilized within a sports-specific endurance regular; it’s all up to this support professional to comprehend the repertoire available to help optimize the benefits to their client.

References
1. Anderson B (1981) Stretching.
2. Chaitow L (2001) Muscle Energy Techniques. Churchill Livingstone.
3. Talter, Michael J (2004) Science of Flexibility. Human Kinetics.
4. Witvrouw E, Mahieu N, Roosen P and McNair P (2007) The role of stretching in tendon injuries, Br J Sports Med 41: 224-226.
5. Grantham, Nick (2008) Dynamic flexibility, Sports Injury Bulletin 77, March.
6. Fyfe S (2007) Why you should put plyometric into rehab, Sports Injury Bulletin 71 July/Aug.
7. McAtee E and J Charland (1999) Facilitated Stretching. Human Kinetics.
8. Feland JB and Marin HN (2004) Effect of submaximal contraction intensity in contract-relax proprioceptive neuromuscular facilitation stretching, Br J Sports Med 38 e18.
9. Sanderson M (2002) Soft Tissue Release.

Dr. Alexander Jimenez ♛
Chiropractor💡 Author • Researcher • Clinician @ PUSH-as-Rx® 915-850-0900 📞
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