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

Aging, Fitness and Flexibility

van Damme Volvo Splits

Two of the biggest physical issues we face as we age are:

  1. Loss of strength and power (1,2)
  2. Loss of mobility and flexibility (3)

For most people, exercise is a means to improve and maintain their health and well-being (including aesthetic goals).

So it makes absolute sense to focus on preventing or minimising the loss of these physical qualities as much as possible, in order to maximise health and well-being for as long as possible.

One of the best things about the rise in popularity of Crossfit and functional training is the emphasis on explosive movements to develop power.

However, despite this increased popularity, it is still rare to see people in gyms, fitness groups and sports clubs (martial artists and dancers excepted) doing any dedicated and meaningful flexibility work (a couple of quick toe touches before a workout don’t count).

I think this stems from a few different reasons:

  • Flexibility work is hard to monetise (there is no equipment to sell for example, outside of maybe a mat and a strap).
  • Stretching well takes time – people have been sold on 30 minute fitness, which is great, I love short sessions, but not at the expense of what you need.
  • Most people don’t know how to stretch well, so they don’t feel any lasting benefits from doing it and give up.
  • Misinterpretation of the research surround stretching, especially around pre-exercise stretching and force production which has seen a preference for dynamic mobility over more traditional flexibility work.

Use It Or Lose It

Almost everyone will agree that “prevention is better than cure”, and this is especially true with flexibility training.

Like every physical quality, flexibility exists on a “use it or lose it basis”, so if you live a modern life like I do (lots of sitting, very little physically taxing work outside of exercise), then it is very easy to lose.

To combat this, it is essential to work on your flexibility pro-actively.

Optimal Vs Reality

Understanding what is optimal for physical health and fitness, and what can be realistically achieved by someone for whom fitness is a small component of their life is quite important.

For the person who exercises because they have to in order to maintain their health, but they don’t necessarily derive any pleasure from it, the minimal effective dose for flexibility is all that is needed.

This person can regain flexibility by stretching (4), can then maintain it with almost any activity that requires range of motion – for example, a gym based exercise program or tai chi practice.

Additionally, if they make an effort to squat, bend, reach and generally move more in day to day life, then maintenance is that much easier.

Fitness Enthusiasts

For people who spend a lot of time and energy into improving their physical fitness, a specific focus on stretching will be beneficial.

This can take place as part of the warm up, cool down or separate session, as there a pros and cons to each.

For the fitness enthusiast, recreational or even professional athlete, a prime focus on flexibility and it’s associated qualities – motor control and joint stability – is even more important, due to the high loads placed on the body consistently from training and competition.

I believe that stretching is the only physical quality that in relation to it’s training, the saying ‘more is better applies. – physical preparation coach Ian King, whom I have mentioned on this blog previously. (5)

Again, this is a contentious area, as most research doesn’t show a cause-effect relationship when it comes to stretching and injury prevention, but there are many contributing factors, of which flexibility is just one.

Conclusions

You don’t need to turn yourself into Jean Claude van Damme (pictured above at age 53 in a Volvo commercial), but you do need enough flexibility to reach up overhead comfortably, bend down without strain and essentially move without restriction doing the things you do in your day to day life.

If you don’t lead a physically active life, then it is more important to increase your activity – even if you don’t exercise – than worry about specific stretching.

Once you are active, a focus on stretching can really complement whatever it is you are doing.

 

This post is a re-worked version of my May 2016 newsletter. You can sign up below to receive all future editions, plus my upcoming (and FREE) guide to stretching.

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) Strength and muscle loss with aging process

(2) Age associated loss of upper extremity strength and power

(3) Flexibility of older adults and the influence of physical activity

(4) Purely my opinion, eccentric exercises can also be very helpful.

(5) King, I., Legacy – Ian King’s training innovations, King Sports International

4 Major Exercise Programming Mistakes

Woman stretching hamstrings.

He who represents himself has a fool for a client. – Abraham Lincoln

In many cases, it could be also said that the person who writes his own training program has a fool for a trainer.

The reason, in both cases, is the difficulty of being objective in deciding your own needs.

It’s only natural to gravitate towards what we like and what we are good at (often one and the same), which means when we write our own exercise programs, we often neglect what we need.

In fact, if you coach yourself, chances are you are making (or have done so in the past) at least one of the following common exercise programming mistakes.

Now, if you are experienced enough, with the accompanying knowledge, you can write yourself good programs, but I would always argue, that these will generally be inferior to a program written for you by a coach with equivalent or greater knowledge and experience than you.

The problem with programming mistakes is that they compound over time (more on that later), and the risks they pose are not insignificant.

Risks of Poor Exercise Programming

Before I go on to describe some of the most common exercise programming mistakes I see, I want to outline the risks involved with making these mistakes:

  • Injury. This is far and away the biggest risk of poor programming. In my opinion, if you exercise for health, you should never get injured as a result of your exercise program. I understand that for competitive athletes, a certain amount of risk is assumed in order to push the limits of performance, and I also understand that on any given day, shit happens, so a random injury might occur. But often, what seems random, is not, and if you look at past workouts, there were modifiable factors that contributed to the injury. The other injury consideration is joint degeneration.
  • Negative postural changes. Posture is complex – it has psychological and emotional components to complement the physical components that are commonly talked about. One of the influences on posture are the activities and tasks we expose ourselves to on a regular basis. With poor exercising programming, you can develop poor postural habits.
  • Suboptimal progress. To be honest, the risk of getting injured is enough of a reason to ensure good exercise programming. However, even if you are a throw caution to the wind type, good programming will ensure you make the best possible progress towards your goals, whatever they may be.

The Most Common Exercise Programming Mistakes People Make

These 4 mistakes are not listed in any particular order, and I would say, based on experience only, that the majority of people who have poor (or no) programming when it comes to their exercise make more than one of these mistakes, if not all!

1. Improper or lack of warm up

There’s a popular quote in trainer circles:

If you don’t have time to warm up, you don’t have time to work out.

Unfortunately, like many things, the quote is more popular than the practice.

Too many people make the mistake of not warming up properly before exercising, or, even worse, not warming up at all.

Excuses range from “it’s boring” to “I don’t have time” and god knows what else.

Like many things, there is a disconnect between what most people do and what those who are succesful do.

For example: professional sports clubs, with million dollar athletes, have staff dedicated to optimising warm ups in order to maximise training and game performance and minimise injury risk.

The bottom line is, warming up is important.

During a warm up, there are 3 main goals:

  • Psychological preparation – a transition period from what you were doing, to what you are going to do.
  • Physical preparation – increase body temperature, address physical qualities like mobility and muscle activation
  • Skill practice to prime the nervous system for the upcoming task

If you don’t warm up properly (or at all), you decrease your subsequent performance and increase your risk of injury. A lose-lose situation.

2. Lack of Flexibility Work

Time magnifies errors in training. – Ian King

Ian King has been a physical preparation coach for more than 30 years, and is often outspoken about many topics. However, his opinion is based upon experiencing of producing real world results with both athletes and coaches over many years, so his opinion counts.

One of the biggest topics he is vocal about, is flexibility training.

I like static stretching. I know, I know…current trends in sport science have found favor in other methods, like dynamic stretching. But, in my opinion, it’s all part of a circle that’s slowly turning. Static stretching was the big hit in the ’80s, and I suggest that it will be again. – Ian King

Not only does Ian promote the less popular static stretching, he also promotes stretching before a workout.

Now, I’m not going to regurgitate his reasons for doing so – you can read the article for yourself – but the biggest take home was that if you are performing activities that stiffen your connective tissue (just about everything involving muscular contraction), then you should be performing activities that decrease this stiffness as well.

To counter the points above, people will cite research that demonstrates decreases in power and force production immediately after stretching (lasting up to 15 minutes).

To paraphrase Ian again, if you did a study that measured strength immediately after a weight training workout, you would see a decrease in strength, and the researchers would conclude, based on that data, that weight training makes you weaker.

The solution lies in watching how top level athletes have prepared for many years, which is generally a variation of the following sequence:

  1. 3-5 minutes of general warm up to elevate body temperature
  2. Static stretching
  3. Dynamic/specific warm up
  4. Workout
  5. Go home

The added bonus of this: after your workout, when you are tired, you don’t have to do anything else, except maybe walk around a bit to cool down and start recovering.

3. Ignoring structural balance

Structural balance is a term I first read about in the writings of Charles Poliquin, another highly experienced strength coach.

Whilst we know that posture is poorly correlated to pain, we also know that the body will adapt to repetitive activities.

Thus, if all you do is run, then your body will adapt to running, which is both good and bad.

Good, because your performance will increase, bad, because you need to do more than run in your life.

Wealso  know from various research, that relative strength imbalances can lead to injury, so the implication is clear: balance your training to reduce injury risk.

This means:

  • Exercising a variety of physical qualities – strength, power, endurance, flexibility etc.
  • Performing a variety of activities.
  • Moving across different planes of motion and different “levels” (ground, standing, kneeling etc).
  • Balancing stresses across joints as best as possible.
  • Allowing for periods of higher intensity/lower volume and lower intensity/high volume.

4. “Too Much”

This is not a specific claim, but rather, an observation that most people, once they cross the line from casual exerciser to exercise enthusiast simply do “too much”.

Whether it is too much strength work and not enough flexibility and endurance work, or too much exercise and not enough rest and recovery.

I’m a massive proponent of doing something everyday if possible, but that doesn’t mean smashing yourself every day.

In my experience, this simply stems from being overly emotional about the outcomes attached to exercise.

You are not your fitness.

If you have an overly emotional attachment to certain outcomes associated with your fitness, I’d suggest you do some deep contemplation to find more balance in your life.

Conclusions

It might seem that I keep repeating myself when I talk about training: warm up, manage your volume/intensity, work on all physical qualities, prioritise rest and recovery etc etc.

That’s because:

  1. This is what the vast majority of people need to do, but don’t
  2. Training isn’t as complicated as the internet makes it out to be.

What is complicated, is you as a person (we all are), and so a good coach helps you recognise where you are, what you need and what you don’t. In fact, many of the benefits of a coach are not that you have the best program (it doesn’t exist), but rather adherence, consistency and progression, regardless of the means.

To avoid making exercise programming mistakes, it’s best to enlist help. There are options to suit all needs and budgets, ranging from free programs online all the way to individualised coaching (both online and in person).

Whatever your scenario, even for a short time it’s worthwhile investing in coaching of some form, in order to learn skills that will stay with you for life.

 

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) Australian Institute of Sport – The Warm Up and Cool Down

(2) Ian King Blog

(3) Ian King – The Lazy Man’s Guide to Stretching

(4) Charles Poliquin Blog

Why Mobility Exercises Don’t Work, And What To Do Instead

Man with great mobility doing yoga with laptop

You don’t wake up one day suddenly stiff, it only feels like that.

Mobility, like most skills, exists on a “use it or lose” basis.

Unfortunately, for most of us adults, our daily lives don’t incorporate much “using it”, so we end up “losing it”.

The best way to maintain mobility if your life doesn’t have you climbing trees and crawling around on a daily basis is through exercise, but, if you have already lost a large amount of mobility, then you’ll have to work specifically to regain it, exercise alone is often not enough.

If you ask google “how to increase mobility”, the top 5 results say roughly the same thing: stretch, foam roll, perform dynamic “joint mobility” and “activation” exercises.

These are valid, but incomplete strategies.

The reason being, lack of mobility is usually not a true range of motion issue – I could lie you down on a treatment table and passively move your joints through a much greater range of motion than you can demonstrate – but rather, a stability issue.

Instability is perceived as a threat by the central nervous system, so protectively, it shuts down range of motion so you can’t cause yourself any harm.

Thus, the underlying cause of limited mobility is neurological.

So, in order to improve mobility in the real world, you must go deeper than foam rolling and targeted stretching/joint exercises and “release the brakes”.

If you don’t, you will just end up spinning your wheels, because when improperly applied, mobility exercises don’t work.

This is because you can’t force the body to do anything, it will resist in an effort to maintain equilibrium.

Now, there are definitely cases where there are physical changes to soft tissues and joint structures that limit mobility, but, outside of diseases and trauma, these physical changes usually occur as a result of the limited mobility caused by the nervous system (use or lose it principle).

So, if you have lost mobility over time, how do you get it back? There are many ways, this is the process I’ve found effective and use with my patients:

Osteopathic Manual Therapy

Being an osteopath, I like to start with manual therapy, but not for the reasons you might think.

Manual therapy doesn’t change tissue length, nor does it “put you back into place” or “re-align” you.

What manual can do, and in the hands of a skilled practitioner, does very well, is provide the body with a chance to change.

Movement, or motor output, is the result of complex co-ordination that takes place in the brain, based in part, on sensory information provided by the peripheral nervous system.

Nociception, the transmission of “danger” signals to the brain and spinal cord from nerves located throughout the body can inhibit motor output.

Nociception is related to, but not the same as, pain. You probably know that if something hurts, it usually doesn’t work well. This can also happen when that something doesn’t necessarily hurt, but the nerves are hyper-active anyway.

Because the body functions as a whole, when one area isn’t moving properly as a result of this increased nociception, then there is a chain reaction throughout the rest of the body.

By using manual therapy, we can inhibit nociception, change motor output and affect a change throughout the rest of the body – often decreasing pain and increasing mobility.

Often manual therapy alone is enough, especially if the issue is relatively new or minor, and new, dysfunctional patterns have not had time to become ingrained. If the problem has been around longer, or is not responding to manual therapy alone, we can move to the next step.

Restore Reflexive Stability

Reflexive stability is the term physiologists give to the near instantaneous adjustments that take place when we move.

This allows us to move safely and effectively, and usually efficiently.

With disuse and pain, this response is dulled, and one of the results is an increase in stiffness, which is designed to protect us in the absence of true stability.

To restore this, you have to go back to fundamental movement patterns, progressing to the next only when you have reached mastery each position/stage.

As mentioned earlier, most stiffness is the result of instability, rather than a true range of motion issue. With this in mind, regaining lost reflexive stability is an effective way to improve mobility by addressing the underlying cause.

Reflexive stability exercises are by nature, whole body movements, performed in progressively more challenging positions/postures.

For the vast majority of people, a combination of manual therapy and reflexive stability exercises will improve most mobility deficits.

For an example of reflexive stability in action, try this simple test:

Perform a squat, noting your depth and the amount of tension involved in achieving it.

Now, get down on your hands and knees and perform 60 seconds of quadruped rocking (below):

After 60 seconds, get up and retest your squat.

If you notice an improvement, then you just witnessed the benefits of reflexive stability. If it was the same for you, then either you don’t have a deficit, or your deficit is elsewhere.

Maintaining Reflexive Stability

After you have gone through the progressions, moving from ground based to upright, the easiest way to maintain your reflexive stability and build your health is by walking properly and walking regularly.

Walking is largely reflexive – a lot of the control occurs at a spinal, not brain level – which means that once you have restored your reflexes, maintaining them simply requires using them.

Now, any old shuffle won’t do, what you want in order to reap the benefits, is to walk with a contra-lateral arm swing, looking up. Ambling down the street with your phone in your hand and your eyes on your phone isn’t going to help you, it’s only going to re-inforce the issues the caused you stiffness in the first place.

For most people, especially those of you who don’t exercise, these two steps alone are enough to restore the mobility you need to go about your daily living.

If you are exercising and/or you want to take things even further, then we can add a few more steps.

Active Stretching and Functional Movement

If you have addressed potential issues with manual therapy and general (reflexive) stability work, but you’re still not getting the specific mobility improvements you want, it is time to begin more targeted work.

One form of targeted mobility work I like to use is “active stretching”.

Active stretching is probably just another name for PNF (Proprioceptive Neuromuscular Facilitation) stretching, but it’s simpler for my patients to understand, so I prefer that.

Active stretching is where you are stretching a muscle group whilst simultaneously activating opposing or synergistic muscle groups – essentially adding stability to the newly explored range of motion.

I’ve found this to be far more effective than passive static stretching, and it really helps people “get” what a joint position is supposed to feel like.

If you then use this increased joint range of motion in more demanding, functional tasks, then you “teach” the body that this range is okay to use, because you are adding strength/stability to a previously weak/unstable position.

This results in an increase in mobility.

In the following example I shared on Instagram, I’m using an active hip flexor stretch, followed by an isolated glute activation exercise before reinforcing the new pattern under load with a barbell squat:

If the problem was at the ankle instead/as well as at the hips, another sequence might involve an active calf stretch (demonstrated below), followed by a dynamic mobilisation of the ankle joint before squatting.

Again, these exercises are not only addressing range/length of a joint/tissue, but improving stability, which, as we discussed, is often the real driver of joint mobility.

The functional exercise then reinforces the pattern, and once repeated enough times, in correct fashion, it is usually enough on its own to maintain the improvements in mobility.

Whilst I demonstrated the example with a barbell squat, this isn’t necessary, you might simply perform a full squat position, as millions of people around the world do on a daily basis, in order to maintain mobility.

As always, the execution will depend on your needs and wants, but the underlying principles remain the same.

An Aside On Exercise Technique

In the examples above, the active stretching is then reinforced by the high demands imposed by the squat.

However, if you are squatting with poor form, then you are undoing the effects of the active stretching.

Good form is easy to spot – it is controlled, stable and smooth. Whilst everyone has different body shapes and sizes, thus the execution of movements will look different, the ability to perform controlled movement should be universal.

It’s also important to understand that if you skip straight to exercise, without addressing the stability issues first, then your body will simply “survive” the exercise by using whatever movement pattern is strongest, optimal or not.

Once you have addressed these issues, using optimal exercise technique reduces the need for continuing mobility work – once you’ve got it, maintaining it is easy – this is why in countries where people continue to squat throughout their life, mobility deficits are less common.

Maintaining Mobility

Maintaining mobility is relatively simple: use what you have got.

If you are coming to this article with restrictions, then it is still simple: regain what you’ve lost, then use it to keep it.

If you go to all the effort and expense of getting treatment and performing the work to regain mobility, only to continue with the lifestyle that got you needing treatment in the first place, then chances are, you’ll end up back where you started, given a long enough time frame.

Because we don’t have many (any) physical demands to survive anymore, we have to deliberately perform tasks that challenge us physically, including our range of motion.

This goes against human nature, which is to conserve as much of our energy as possible – it’s wired into our brains to do this – so, what I recommend is to build mobility maintaining activities into your day.

Examples of mobility maintaining activities are:

  • Walking properly (as discussed earlier) instead of driving short distances
  • Sitting on the floor to watch TV instead of on a couch
  • Squatting instead of bending to pick things up from the ground

Whilst these activities are not going to prepare you for a Cirque de Soleil audition, they will help with your activities of daily living (ADL) and your quality of life.

Beyond this, exercise, particularly full range of motion strength training, in all its forms, is the best way to maintain, and even improve mobility.

Conclusions

Mobility exercises need to be used in context. If you use them when you have an underlying stability issue, either at the stiff segment or elsewhere in the body, they will not be effective.

Used in a sensible, principle based approach, like the one I outlined above, they can play a valuable role in regaining mobility.

Once you have restored lost mobility, it’s much easier to maintain. This can be done by incorporating activities into your day that require you to use extra mobility.

Walking is one of the best general exercises, if you do it well, and can help maintain good health, including mobility.

For more focused efforts, full range of motion strength training is probably the best way to maintain and even improve joint mobility, once you are moving correctly.
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

Nociception and motor function

Cutaneous afferent regulation of motor control

Feed forward control and movement stability

Physiological basis of functional joint stability

Training the Core

Lower motor function, Lederman, E., The Science and Practice of Manual Therapy, pp 99-100

Exercise For Low Back Pain

Fit girl lift weights at fitness gym center. Deadlift workout.

Any article about exercise for pain needs to cover one important fact before it goes on:

The body will tend towards self-correction/health/resolution, if, and that’s a big if, the right conditions are present.

The biggest challenge facing an osteopath, or any other therapist, is finding, or more likely, stumbling upon, the right conditions for the individual seeking help.

Whilst there are general guidelines to abide by, every one of us has a unique set of experiences, thus different stories, explanations, treatment techniques and movements are required to facilitate a recovery; not to mention all the environmental factors that come into play.

This article intends to discuss the general principles that should underpin your actions when exercising for/with low back pain.

Where Most Back Pain Exercise Programs “Go Wrong”

Most back pain exercises or exercise programs are based on the notion that pain is the result of specific factors, and that these factors can be specifically identified and then specifically addressed.

There are a variety of factors that can contribute to low back pain, but aside from a history of previous episodes of low back pain, nothing drastically stands out as being identifiable. (1)

As an aside, this perhaps points the finger at us, therapists and rehab professionals, who are not doing a good enough job in the first place (on a population, not individual level).

It is also highly important for sufferers of low back pain to understand, as many people decide to cease treatment/rehab as soon as their pain is gone, rather than concluding the full course of treatment and restoring “lost” function.

Unfortunately, it is very difficult to specifically assess and as a result, address them with targeted exercises.

So knowing that specific factors may be hard to identify and treat, it seems more important to build resilience with a complete mobility, strength and conditioning program.

Take home point number 1: exercise programs for low back pain should not attempt to be specific, but rather improve all physical qualities.

There Are No ‘Good’ And ‘Bad’ Exercises

Another misconception surrounding exercise for low back pain is the concept of ‘good’ and ‘bad’ exercises.

Generally, if you are reading a fitness article, the concept of “neutral spine” is mentioned quite a lot. Lifting should always take place with a neutral spine, regardless.

If you are reading a rehab article, limits might be imposed on external loading, as in, any lifting above 10 kg is bad, and must be avoided.

Or you might read a medical article which mentions you should simply avoid things that hurt.

All of these comments have a place, and are neither right or wrong without any context to define them.

A ‘good’ exercise is one that you can do safely, is suitable for your current ability, is able to be gradually progressed and fits in with your needs and wants (aka your goals).

Take home point number 2: blanket statements and absolutes do more harm than good. There are times when a moderate approach doesn’t work and more extreme action needs to be taken, but it is rarely either or. Exercise selection is based on your needs and wants, not an arbitrary definition of good and bad.

Self-Limiting Movements

This is a concept that was popularised by American physical therapist Gray Cook, in his book Movement.

Self limiting movements/exercises are those that have an inbuilt “coaching mechanism”, meaning doing them forces you to increase your awareness with movement, and often times with these type of movements you can only perform them correctly, or not at all.

Utilising self limiting movements as part of an exercise program for low back pain allows you to safely challenge your body and brain, leading to improvements, without the risk of overdoing it.

There are many different examples of self-limiting exercises. The specifics are not as important as being able to move with increased awareness and a low risk. This is a big focus of our exercise programming for low back pain, especially in the early stages.

Take home point number 3: a good exercise program will provide both a challenge and the option to “fail safely” – thus reducing the fear associated with facing more demanding movement challenges.

Our Approach To Programming

There is no one way to program exercise for low back pain. As long as the programming is underpinned by sound principles, and not “technique based”, then it should be sufficient.

We strive for more than sufficient, we strive for optimal.

As such, over the years our approach to exercise programming for low back pain has been refined to what it currently is. Chances are, in another 5 years it will be further refined, but the vast majority will be consistent, as it is all principle based.

First, we consider the body as a whole. We don’t only do “low back” or “core” exercises, but rather we devise a total body program. This is the underpinning principle of osteopathy, and is also applicable to exercise programming.

Second, we ensure that of physical qualities are developed in the right sequence.

If we start with osteopathic manual treatment in the consultation room, we then progress to mobility and flexibility exercises.

These will usually start on the ground, as this provides the most stable environment, thus is the least threatening.

Considering pain occurs when there is a perception of threat by the brain (if you haven’t already, have a read of Pain Basics), this is one of the best ways to regain movement and avoid inefficient compensation patterns taking over.

From there you are looking to build “motor control” – this is simply the ability to control movement well.

We can call this stability, but that implies static positions and discounts the movement component. This is actually achieved simultaneously with improving movement/mobility/flexibility.

We can consider mobility as “end range strength”, and we are simply progressively challenging you so that both qualities improve.

Once you have achieved adequate movement and control (adequate is based on your individual needs), if you want and/or need, we would add load. This might be in the form of external resistance, increased leverage challenge or even changing the tempo.

Only when you are moving competently under load do we add a conditioning component – that is, more volume of work. This is the challenge of fatigue to your new found movement abilities, and if done correctly, is the difference between breaking down when the going gets tough and being able to withstand (almost) anything.

Take home point number 4: whole body, principle based programming that utilises appropriate methods of progression yield the best long term outcomes (based on clinical experience and research) (2) for sufferers of low back pain.

Conclusions

There is a well worn quote:

Methods are many, principles are few. Methods always change but principles never do.

This served as inspiration for this post – there is no point showing you how to do an exercise with no context as to whether it is appropriate for you or not.

Rather, it is important to have an understanding of why you are doing something – even if you only care about the “what”.

This understanding means you will not chop and change based on the latest article in your newsfeed.

It means you will take the time to get things right, knowing that making progress is all the matters, even if it is “slow”.

It also means that you have a better chance at a good outcome and are less likely to become a statistic of low back pain recurrence.

Reducing the article to four sentences, we would end up with something like this:

  1. Do something you enjoy doing, that has intrinsic reward – there are no “good” or “bad” exercises.
  2. Ensure you take a “whole body” approach to exercise. Don’t simply focus on “low back exercises”.
  3. Start slowly, progress gradually.
  4. Vary the stimulus over time, but not too much or too often (or you won’t elicit adaptations).

 

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) Incidence and risk factors for low back pain: http://www.ncbi.nlm.nih.gov/pubmed/24462537

(2) Resistance training and low back pain in active males: http://www.ncbi.nlm.nih.gov/pubmed/20093971