Several times a week we are asked at The Thrive Clinic by patients and GPs what is the difference between and Exercise physiologist and a physiotherapist? Below is a great explanation for GPs, health specialists and patients with easy to follow examples of different servicing situations. To get the best outcomes, improvements and prognosis for patients its important that they understand how to manage their own illnesses and injuries and appreciate that they have choices and options as to how they approach their rehabilitation or condition to ensure the best results.
MYTHS, FACTS AND RESEARCH BASED FINDINGS ON STRETCHING
Mindlessly we fall into an immediate process of stretching before we start our workouts or exercise. But have we ever actually stopped to think if we could be doing more with that time? What does it actually do for our bodies? How does it help us get more out of our bodies and our exercise?
Exercise Physiologist Katie Stewart from The Exercise Therapist answers the questions we often may think about but never ask.
What happens to our muscles when we stretch? How does it make them ‘relax’ or become more limber?
Stretching increases the distance between the hard tissue origin and insertion points by elongating the relating soft tissue, being muscles and connective tissue (tendons and fascia). The impact of the change in length of the muscle tissue and the associated connective tissue including fascia and tendons improves joint ROM. This improvement in ROM allows our joints to move freely without pre-existing passive muscle tension. Feeling limber essentially defines ones ability to manipulate joints unencumbered by restrictive soft tissue.
Regular movement and elongation/contraction of any living tissue also promotes circulation, neural activity, cell turnover and metabolic activity.
How does stretching improve flexibility?
Flexibility is defined by the malleability of all joint related soft tissue including the capsuloligamentous structures around the hard tissue. The degree of malleability determines joint ROM. Regular stretching ensures the soft and connective tissue is nourished and has a responsive elastic nature allowing joints improved alignment and geometry. This is imperative for maintaining healthy posture. We all know the power of good posture - It can make a gorgeous size 14 figure look like a size 10.
Flexibility is therefor a critical modality for physical health and wellbeing. In fact given that there is a direct correlation between a reduction in movement/exercise and physical degeneration - Flexibility is the most powerful anti aging tool you could use!
Is stretching essential for all kinds of exercise (weights, running, cycling, HIIT etc.)? Is it more essential to certain other kinds?
Bottom line no. Is it preferable for most? – yes. Stretching has been proven to reduce power output and performance. So the conversation should be directed more around the whys of stretching to determine how and what’s best.
There are two main reasons why we stretch:
The first is to restore healthy ROM to joints and associated soft tissue prior to exercise or movement. This has been traditionally referred to as a pre exercise warm up.
The second is to challenge and explore improved ROM with the objective of optimizing joint alignment and geometry. This is the predominant focus of gymnastics, yoga and dance flexibility practice.
Both are key to long term physical health & wellbeing.
So if your looking to prepare the body and joints for movement then you need to be looking at an ideal PRIMING sequence for the activity you’re going to be doing. PRIMERS are a combination of activities that increase ROM, heat, circulation, neural activity (alpha and gamma innervation) and muscular responsiveness. They provoke the optimum muscular landscape and recruitment order for the task. This reduces your risk of injury and ensures the best quality of work for the muscles resulting in the greatest possible adaptations.
‘PRIMING WELL ENSURES YOU ENJOY THE GREATEST POSSIBLE PHYSICAL ADAPTATIONS NO MATTER WHAT YOUR TRAINING MODALITIY’
For example, if you where about to do a boxing class. You would want to restore healthy ROM to the shoulder and mid thoracic spine. This could be achieved by foam rolling or static stretching. You would also want to provoke heat and enhanced contractility to the muscles fibers in the latts, trunk and gluts to ensure your power output was optimized. This could be achieved with dynamic and or pre-contraction stretching such as PNF (proprioceptive neuromuscular facilitation).
Finally you would want to ensure the elbow and wrist joints are responsive, warm and engaged. Again dynamic & any type of pre-contractive stretching (most effective I find is PFS or post facilitation stretch. This involves a maximal contraction at mid range with a rapid movement to maximal length followed by a 15 sec static stretch.
So for me as a practicing clinical exercise physiologist with over 15 years experience as a personal trainer, the focus is on PRIMING my clients for movement not stretching or warming them up per say.
What are the possible benefits/ risks of stretching before exercise?
Static stretching has been proven to decrease power and performance if done immediately prior to exercise. This ‘stretch induced strength loss’ can have an impact on runners or activities that involve jumping such as basketball. So I would avoid any static stretches (traditional old school stretches) prior to competition in athletics, football, basketball or netball. Your better off with a combination of dynamic and pre-contraction stretching for these sports. But if you doing a gym workout there’s no great reason to avoid them.
As discussed above the benefits of pre activity stretching is going to be found mostly in enhanced/improved joint ROM. Greater ROM means the muscles have much better access to sound biomechanical contraction.
If you focus less on the warm up and more on PRIMING your body for the specific exercise you are about to engage in then you cant go wrong.
What are the possible benefits/ risks of stretching after exercise?
Stretching of any style be it static, dynamic or Pre-contractive post activity have the capacity to improve long term flexibility and therefor possibly improve long term performance. Most definitely it will ensure healthier joints and better posture.
Make sure you dedicate time to exploring and challenging your flexibility after your sessions with some dynamic and or pre-contraction stretches and or engage in some yoga.
Can stretching reduce the risk of injury? Or prevent or mediate the onset of muscle soreness post exercise?
Contrary to popular belief there is no evidence to prove that pre or post stretching reduces DOMS (delayed onset muscle soreness) nor has it been substationally proven to prevent the risk of injury during exercise.
Interestingly enough, a study completed in 2004 by Thacker et al. concluded that a combination of pre-exercise resistance activities, body conditioning and warm up show much better promise for injury prevention. This has lead to the altered direction away from traditional stretching towards Priming in many professional sports and with many individual athletes.
Can you help me define the different kinds of stretching: ballistic, dynamic, PNF, isometric, passive, active and static. Are there more types of stretching we should know about?
The easiest way to categorize the many different types of Stretching is to split them up into three basic groups. Static, dynamic and pre-contraction. Under these three umbrellas fall the many styles. Passive stretches are defined by no muscle contraction. Active involve muscular contraction to assist the stretch and or/movement to add momentum. Those that stimulate alpha and gamma innervation are pre-contractive by definition. That’s PNF, CR, HR, CRAC, PIR, PFS, MET.
Are different stretching techniques (of the above) applicable to different exercises? If so, how do you know which one you should use?
Think about what your doing. Be mindful about how your body moves and what’s required of the different muscles throughout the session. You want to prepare them as well as you can to improve/restore healthy ROM and biomechanics, improve muscle contractility, improve flexibility, increase heat and circulation. These are all factors required for most domestic exercise sessions in the gym. Address any tightness and joint restriction with foam rolling and or any stretches. Then you want to ‘fire up’ and stimulate the main agonists and antagonists that are going to be used with any pre-contraction style of stretching.
Are there specific stretches applicable to different exercises?
Yes! There is an ideal priming sequence for every single sport, exercise and movement modality. Look out for follow up blogs, videos and articles on your favourite sport and exercise at www.theexercisetherapist.com.
Are there any benefits to stretching daily, regardless of if or how you are exercising? If so, what are these benefits?
Dedicated daily practice directed to improving your flexibility will not only keep you younger for longer, it will keep your taller & healthier for longer. It will reduce your risk of posture related chronic diseases and injury developing such as frozen shoulder, lower back pain and cervical kyphosis (stooping of the head and neck). So yes a good mindful priming session a day just may keep the doctor away!
Author Katie Stewart BHMS AEP ESSAM
© The Exercise Therapist 2015