3 Unconventional Reasons To Stretch

Stretching is most commonly thought of as a way to increase flexibility.

What is often overlooked, is that stretching has other benefits, which are equally important to most people – especially those who feel tight, wound up and stiff as a result of a busy and stressful lifestyle.

Previously, I have discussed why flexibility is important for both fitness and ageing well. In essence, if we don’t use it (range of motion), we lose it, and stretching can help us regain lost range of motion. However, long term, our habitual activities will play a bigger role in maintaining adequate range of motion, which is why it is important to move regularly and in a variety of ways.

I have also looked at why mobility training (including stretching) doesn’t always work to improve flexibility, if you are stiff because you lack stability and control in a certain range of motion.

Because stretching doesn’t seem to do what people originally thought it did (lengthen muscles), it has been dismissed as ineffective and a waste of time by some trainers and clinicians.

This overlooks the following benefits:

Stretching Relieves Stress

This is one of my favourite reasons to stretch, particularly in the evening, when I’m winding down for bed.

Stretching stimulates the autonomic nervous system (ANS), shifting it towards the “rest and recover” parasympathetic state, and away from the “fight or flight” sympathetic state.

For most people, anything that helps them become more balanced in the ANS is a win.

Shifting towards a more parasympathetic state helps with:

  • Sleep quality
  • Recovery from exercise
  • Mental health
  • Tissue healing
  • Digestion and elimination

Whilst meditation, breathing exercises and even prayer can help reduce stress and improve ANS balance, I like to prescribe stretching for most people, because mentally it is easier to “do something”.

Focusing on the stretch, including breathing is a form of mindfulness meditation, which potential physical benefits as well.

It’s worth mentioning, that a lot of “tightness” is simply a physical stress response – it’s considered protective by the brain.

So, if nothing else, stretch, particularly in the evenings, to reduce stretch and calm both your body and your mind.

Stretching Can Help Manage Blood Sugar Levels In Diabetics

Diabetes is a growing problem in Australia and much of the world.

Type 2 diabetes (non-insulin dependent) is becoming more and more prevalent, and is primarily a lifestyle condition.

The challenge for most people with type-2 diabetes is managing blood sugar levels, particularly after meals.

There is a large amount of research that shows exercise can help manage blood sugar levels, both throughout the day and immediately after meals.

A recent study out of India looked to compare the effects of stretching and resistance exercise on post meal blood sugar levels.

What they found, was that both forms of activity reduced post meal blood sugar levels – returning them to fasting levels.

However, there was not a significant difference between the groups.

This is important, because passive stretching is easily performed at home, doesn’t require any equipment (save for maybe a stretching strap) and can be performed by people who may not easily perform other exercises (like walking or resistance exercise) due to health complications.

The Real Benefit: Improved Cellular Energy Production?

Impaired cellular energy production (mitochondrial dysfunction if you must know) is implicated in a range of conditions. Most relevant to me as an osteopath, is fibromyalgia and chronic fatigue syndrome.

If these conditions are affected by impaired cellular energy production, and stretching helps improve cellular energy production, can stretching help with these conditions?

If you’re interested in the science:

A study showed that passive stretching increases heat production and oxygen consumption in muscles. This leads to an increase in the metabolic activity in these muscles thus causing reduction in the blood glucose level due to the incorporation of glucose transporter type-4 (GLUT-4) into the stretched muscles. Stretching increases the level of nitric oxide by single passive stretch of 20%. Nitric oxide also influences the incorporation of GLUT-4 thus facilitating its activity. PSS is also known to alter the microcirculation thereby reducing tissue oxygen exchange. This resultant ischemia facilitates the translocation of GLUT-4 into the sarcolemma. Additional related studies on PSS demonstrate an increase in glycogen breakdown at the cellular level and support the effectiveness of PSS in reducing blood sugar level by stimulating the activity of protein kinase B, further improving glucose uptake by the stretched muscle cells.

What this is saying, is that stretching helps cells use glucose (sugar) and oxygen, which is aerobic metabolism. This produces energy and heat.

It might be a long bow to draw, but I think there is definitely potential for people with chronic conditions that cause low energy/high fatigue to benefit from stretching as a form of exercise that doesn’t aggravated their symptoms too much.

Stretching Can Cause Muscle Growth

Years ago I used to read a lot of strength training/body building forums. This was before social media became the force it is today, and so discussions would carry on over longer periods of time, reaching a quite a level of depth.

One interesting discussion was started by a man with the screen name DoggCrapp (real name Dante Trudel), who came up with an interesting and very effective style of training that was quite counter to the popular high volume routines that were considered standard bodybuilding approach.

I mention this, because Dante was ahead of his time in a few areas. One was the effect of stretching on muscle growth.

Here is a quote from him:

Extreme stretching can have myriad benefits if done correctly: recovery, fascia size and potential hyperplasia, which is still only theory.

What is interesting, is that more than a decade later, researchers have demonstrated that prolonged stretching can increase muscle size.

Here is an excerpt from the abstract:

This study demonstrates that stretch training is a viable modality to alter muscle architecture of the human gastrocnemius through lengthening of muscle fascicles, decreasing pennation angles, and increasing muscle thickness

Now, I wouldn’t get excited and think that stretching is all you need to grow bigger muscles.

I would suggest that this is reason enough to include stretching as part of an overall fitness program – hypertrophy is a potential benefit, even if the effect is small.

The other effect of stretching, particularly longer holds, is the potential change in muscle architecture. Chronically shortened/stiffened muscles have a lower growth potential as their cross sectional area is decreased. Additionally, a flexible muscle has a higher activation potential (muscles that are stretched first demonstrate high motor unit activation). This is why Dante focused on stretching: in addition to the potential muscle growth, he observed that the bodybuilders with the best respective muscles also had the best flexibility in those muscles.

This isn’t just value for athletes, bodybuilders or people looking to bulk up. It can be a helpful way for people in pain to load their muscles and help them grow.

For example, someone with knee pain might not tolerate compressive loading, but they find that they can stretch their thigh muscles without pain. If that person has lost muscle size and strength in the process, this could go some way to helping that.

Stretching Does Not Impair Speed And Power

One of the big arguments against stretching, especially before any form of sports of exercise, is the negative effect of stretching on power.

This has been documented in multiple studies, which have been the basis for widespread dismisal of pre-training/event stretching.

However, as with many things in the training world, there was a massive over reaction. This had lead to programming mistakes that, over the long term, lead to worse movement quality and potentially injury.

Firstly, the documented power drops were minor – nothing for the recreational athlete or gym goer to worry about.

Secondly, the effects were transient, lasting about 15 minutes. Interestingly, there are some studies that show an equal drop off in vertical jump height between groups who stretched and groups who rested. This suggests that there is more to the decrease in power than stretching – perhaps lowered nervous system activity is involved?

Thirdly, recent research suggests that stretching might not have any negative effect as once thought.

Although it’s far from conclusive, I see this as a reason to stretch – you’re unlikely to negatively impact your performance in a meaningful way, unless you’re approaching the world record in a power event.

With no negatives, there are potential positives to pre-training and event stretching.

Improved flexibility, even if transient, can be helpful.

However, going back to the first point in this post, getting into a more balanced autonomic state may help performance.

Ask any elite athletic if they prefer to be jittery and overstimulated, or calm before an event.

You’ll probably get a split of answers, but what will be common is they will want to have focus and clarity. A balanced ANS provides that.

So stretching can improve joint range of motion and balance the ANS in the short term – both desirable prior to training and competing.

Conclusions

Stretching has copped a bad rap in recent years based on the fact that it doesn’t do what we thought it did (lengthen muscles) and that it isn’t as effective at reducing injury as strength training (I have my thoughts on that below).

However, there are many reasons to stretch – including these 3.

More importantly, stretching has stood the test of time – from martial arts to yoga – flexibility training in the form of stretching has been trialled by humans for long periods and found to be beneficial.

Whilst some will always want double-blind randomised controlled trials to justify everything they do, with stretching, the risk is low, the cost is negligible (maybe a mat and a strap) and the potential returns are high. To me, it’s a no brainer that stretching is at least worth trying.

If you want to implement stretching into your daily routine, subscribe to my mailing list below and I’ll send you a copy of my 40 page eBook ‘Active Stretching’. This covers the theory and practice of stretching in simple terms, with colour photographs and descriptions of how to stretch each muscle group.

 

 

Nick Efthimiou Osteopath

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

 

References

Stretching increases heart rate variability in healthy athletes complaining about limited muscular flexibility

Acute Effects of Stretching Exercise on the Heart Rate Variability in Subjects With Low Flexibility Levels

Acute Changes in Autonomic Nerve Activity during Passive Static Stretching

The Effect of Neural Stretching Technique on Sympathetic Outflow to the Lower Limbs

Effects of stretching on menopausal and depressive symptoms in middle-aged women: a randomized controlled trial

Immediate effect of passive static stretching versus resistance exercises on postprandial blood sugar levels in type 2 diabetes mellitus: a randomized clinical trial

Effects of passive static stretching on blood glucose levels in patients with type 2 diabetes mellitus

Twenty minutes of passive stretching lowers glucose levels in an at-risk population: an experimental study.

Stretch training induces unequal adaptation in muscle fascicles and thickness in medial and lateral gastrocnemii.

Time course of changes in vertical-jumping ability after static stretching.

The effect of static, ballistic, and proprioceptive neuromuscular facilitation stretching on vertical jump performance.

STATIC STRETCHING DOES NOT REDUCE VARIABILITY, JUMP AND SPEED PERFORMANCE

Achilles Tendinopathy? Treat The Whole For Better Results

Statue of the Achilles, wounded by an arrow through his heel – Achillion Palace, Corfu island, Greece

The Achilles tendon is one of the coolest tendons in the body.

While many body parts are named in Latin or Ancient Greek, the Achilles tendon draws its name directly from Greek mythology.

For those who don’t know the story:

Achilles was a hero in Greek mythology and one of the main characters that participated in the Trojan War. He was also the protagonist of Homer’s epic, the Iliad. 

When Achilles was born, his mother wanted to make him immortal and thus, dipped him in the river Styx. However, she did not realise that his heel, by which she held him, was not touched by the waters, and so that was the only part of his body that remained mortal. (1)

Achilles was then struck down in battle by an arrow through his heel, or more accurately, his tendon, hence we name it the Achilles tendon.

The Achilles Tendon Is Strong

The job of a tendon is to transmit the force developed by a muscle to the bone to which it attaches. The Achilles tendon is one of the thickest and strongest in the body, and allows us to walk, run and jump efficiently. It’s almost like having our own springs in our legs. In fact, when we run, the Achilles tendon deals with forces up to 12.5 times our body weight – for me, currently weighing around 87 kg, that is 1087.5 kg!

But It Still Gets Injured

One of the most common forms of injury to the Achilles tendon is to develop an “overuse tendinopathy”.

An overuse tendinopathy, or more accurately, an overload tendinopathy, occurs when the loading on the tendon causes an increased rate of tissue breakdown, beyond which the body can keep up with. This results in inflammation, swelling and pain localised to the tendon.

Side note: all tissues in the body are in a constant state of breakdown and building, it’s when the rate of breakdown is increased beyond the body’s repair capacity, or the body’s repair capacity is impaired, that we see problems.

We Don’t Know Exactly Why

Researchers haven’t been able to isolate a single variable that causes Achilles tendinopathy (surprising eh?), but the following are implicated:

  • Running (recreationally and competitively)
  • Participation in other sports like track and field, racquet sports, volleyball and soccer
  • Use of certain antibiotics (fluoriquines)
  • Biomechanical issues at the feet
  • Age, gender, height and weight
  • Injury history, like previous ankle sprains

What we don’t know, is exactly what happens that makes the tendon painful.

We Don’t Even Know Why They Get Better

With Achilles tendinopathy, we will often see symptoms that correlate with structural changes early on in the clinical history, but as the condition progresses and goes on for longer, this correlation becomes weaker and weaker.

In fact, in many cases, it has been shown that diminished or even absent pain is accompanied by little to no structural change to the tendon!

We Do Know What NOT To Do

You’d think that simple rest would therefore be best for an Achilles tendinopathy, however, that’s not the case. Too much rest and we lose conditioning of the tissues, and thus our capacity is reduced, leading to recurrence, only this time it takes less and less loading to aggravate.

We also know that taking anti-inflammatory drugs is not the best approach either. Firstly, there isn’t strong evidence to suggest inflammation is the primary cause of pain. Secondly, anti-inflammatory drugs have side effects. Thirdly, anti-inflammatory drugs can impair healing.

Stretching tendons also gets a bad rap, though I’m not sure why this is a blanket no. Some tendon injuries respond to being stretched (it’s simply a form of load), while others do not. You’ll see why below.

We Also Know What Works

In the physiotherapy world, where much of the research on tendinopathies is done, load management strategies combined with targeted exercises are currently the treatment with the best supporting evidence.

The actual type and dosing of the exercises has not been fully established, though we do know that you can push the loading higher than you would expect, even if it is painful.

You can use different types of exercises:

  • Eccentric where you load the lengthening portion of movement
  • Isometric: where you load the tendon without lengthening or shortening it
  • Concentric/Eccentric: where you load the tendon in a full range of motion (lengthening and shortening)

To my knowledge, the best approach has not been established in research, and in my experience, different people respond better to different approaches.

This might have something to do with some recent research that suggests there are different types of tendinopathy: compressive, shear and friction, and tensile.

As the names suggest, these imply that the tendinopathy occurs as a result of different types of tendon loading, which makes sense to me. It also makes sense that if there are different aggravating loads, the exercises which have the most benefit will also differ.

The evidence suggests avoid those loading mechanisms which are aggravating (load management), whilst stimulating the tendon with loads that don’t aggravate it.

For most people, isometrics are a good, neutral, place to start.

You can do these in a variety of ways, but one of the most accessible is to sit with your thighs under a table and feet on a block, then press your thighs into the table by raising your heels. You want to be about 70% of your maximum contraction, at least to begin with. Hold that contraction for up to 45 seconds (though I will often break it down to 3×15 second holds per set). Over time you can increase the intensity of the contraction and then progress to dynamic loading.

Sometimes exercises will hurt while you do them. That’s okay. As long as your pain doesn’t spike, or get really bad afterwards, you are stressing the tissues in a positive way.

Hands On Treatment?

This is something I learnt from my colleague, osteopath Cameron Kealy who runs Recharge Osteopathy in Melbourne, along with teaching at Victoria University.

There aren’t any studies (to my knowledge on this), just clinical observations.

Cameron will treat Achilles tendinopathy with a localised technique. He will grasp the tendon and find a position where tension is relieved and hold it – often for 5-10 mins – waiting for a tissue texture change. He will then check and treat the pelvis and upper neck. Another osteopath, Walter McKone, has also suggested the key to relieving Achilles tendinopathy is optimising blood flow by treating the pelvis.

Success leaves clues, even when there aren’t studies.

Now, we know that manual therapy doesn’t change the structure of tissues.

What is happening is likely an effect of working with the sensory nerves around the tendon.

But if a person’s pain decreases, allowing them to load again and return to activity, I’m all for it.

This Makes It Work Even Better!


At the moment, one thing that all this focus on localised exercise for tendinopathy is doing, is forgetting that the injured and painful tendon is part of the body, which is considered a whole.

After all, the blood that supplies our tendons also supplies everything else.

The nervous system that perceives the tendon also perceives everything else.

The nutrients delivered to the tendon are, you guessed it, also the nutrients delivered to everything else.

Once we have labelled the tendinopathy, the more important thing to do is to look at the health of the person.

In fact, this is the premise of osteopathy: find the health within the person, and remove the barriers to that health being expressed.

After all, it isn’t lack of exercises that cause a tendinopathy, it is lack of capacity. Exercise can increase physical capacity, no doubt about it.

However, lack of capacity can be cause by sub-optimal physiological function, and not just poor load tolerance. For example, impaired blood flow.

And, as I have discussed before, it is often easier and more efficient to “remove the handbrakes” to performance/health, than it is trying to force adaptations.

Enter The ANS

The autonomic nervous system (ANS) regulates physiological function in our bodies.

It is controlled by lower brain centres – that means we don’t have direct conscious control over it. This is a good thing, as regulating all the systems in our body is a lot of work.

Having a balanced ANS is important for health. When the ANS is over or understimulated, so that it skews towards one state too much, health is affected.

This is where it gets really interesting.

The School Of Physiotherapy at The University of Otago has been doing some interesting research (and research that should be done by osteopathic schools, but that’s another issue altogether) on the effects of manual therapy and the ANS.

Recently, one of their PhD students looked at whether spinal manipulation, delivered to the thoracic spine (which is where many important ANS centres are located) would have any effect on recovery from Achilles tendinopathy.

First, they did a review on the effects of manipulation and the ANS. That is, they looked at all the research on the topic to see if manipulation affected ANS function in any way. They found a positive relationship.

Then, to look at whether this would affect recovery from Achilles tendinopathy, the researchers created two groups: a control, which received usual care for Achilles tendinopathy (read: exercises) and the intervention group, which received usual care plus spinal manipulation.

The group receiving the spinal manipulation made better improvements in both pain and function compared to the usual care group.

Whilst only a pilot study, this is promising. It suggests that improving whole body, or rather whole person, health and function, is the most optimal way to treat Achilles tendinopathy.

Future studies will need to look at whether this was a specific effect of spinal manipulation, or a general effect of manual therapy, however, my gut feeling is that the researchers are onto something.

Don’t Forget The One Percenters

Finally, when we are really seeking above average results, we can add the extras, which can help take things from good to great.

These extras wouldn’t be classed as treatment on their own, but they enhance what you are doing already.

In my opinion, these extras are what should define private healthcare. This is what you are paying for. Not just “usual care”, which is offered by the public health system, but exceptional care, with exceptional results to match.

Some of these “one percenters” can include:

  • A tailored, not generic exercise plan
  • Specific nutritional strategies, including supplementation advice
  • Behavioural and mindset coaching (we know that mindset is an important factor in recovery from injury)

These are not specific to Achilles tendinopathy, but they can definitely play a role in addition to the treatments mentioned above.

Conclusions

If you are suffering from Achilles tendinopathy, the two most important things you can do to manage/treat it are:

  1. Load management: avoiding/reducing aggravating movements initially
  2. Build capacity: use loading/exercise strategies to build capacity in the tissue and inhibit pain

However, while these strategies would give you the majority of benefits, if you are looking to optimise your recovery, then there are more options available.

I’ve outlined some of these options, which you give you a clue as to how you can really enhance your recovery from an Achilles tendinopathy injury.

As with everything, it comes down to you.

The two big questions any osteopath worth their salt should ask are: what do you want, and what can you do to achieve it?

Some interventions are not realistic because of cost, availability or other reasons. Whatever your situation, your treatment approach should be optimised for you.

That means treatment for Achilles tendinopathy should have a whole person focus, and not just a tendon focus.

Nick Efthimiou Osteopath

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

 

References

(1) Achilles

(2) Throw Away The Anti-Inflammatories & Start Loading Your Damaged Tendons

(3) Infographic – Tendinopathy – Thou shalt load. But how? With Dr Ebonie Rio

(4) Exploring the changes in pain, function and sympathetic activity when a thoracic spine manipulation is used as an adjunct to the treatemnt of Achilles tendinopathy

Further Reading

Why Achilles Tendon Problems Don’t Heal

Recharge Osteopathic Clinic