We are pleased to welcome Tom Willemann, Physical Therapist and Owner of Apex Orthopedic Rehabilitation in Wyckoff, New Jersey, as a guest blogger. Tom brings over 25 years of experience helping people meet their goals to remain active and independent through exercise. For additional guidance on resuming an active lifestyle following an injury, or for inquiries related to orthopedic and sports-related injuries, please feel free to reach out to him at tomw@apexorthopedicnj.com. Learn more about Tom and his clinic, and find links to his various informative social media channels, on Apex’s website: www.apexorthopedicnj.com.
Is it always helpful to stretch?
In the past, when I’ve experienced injuries playing football, running, or skiing, I have invariably been told I should have stretched or should begin stretching as part of improving my recovery. This same advice is often given as the solution for any “stiffness” or “soreness” that may arise because of too much activity or being too sedentary.
I’m not sure where this idea started, but it is a common recommendation from everybody from laypersons to medical professionals and even my ex-football coach at River Dell High School.
For many I feel that taking any action to move the area that’s injured makes them feel better and more in control. I get it!
History of stretching
From humans to animals, stretching and movement have been utilized as a preparation for movement and awakening. The Merriam-Webster dictionary refers to this phenomenon as Pandiculation in animals and humans, coming from the Latin root Pandiculari “to stretch oneself.” The act of stretching yawning and expanding the body, especially in the early waking hours, helps to transition the body from sleep to wake rhythms. It has been described as waking up the sensorimotor system.
The earliest references to stretching in humans can be found in ancient civilizations in China (2000 BC) in the practice of Chi gong or tai chi and in India (3000 BC) in yoga. Romans used it as a training method for the military. Today stretching has been used as a part of sports performance programs and in most rehabilitation settings.
What does stretching do?
Stretching involves extending muscles and soft tissues to improve flexibility, increase range of motion, and reduce muscle tension. Here’s are some things stretching does when applied to the body:
- Increases Flexibility
Muscle Lengthening: Regular stretching helps elongate muscles, increasing their length and flexibility. This makes daily movements easier and can improve performance in physical activities.
Range of Motion: Stretching increases the range of motion in the joints by allowing muscles and tendons to extend further, which can help with overall mobility.
- Improves Circulation
Blood Flow: Stretching increases blood flow to the muscles, delivering more oxygen and nutrients, which can aid in recovery and reduce muscle soreness.
Lymphatic Flow: It also helps improve lymphatic circulation, which can assist in reducing swelling and removing metabolic waste from the muscles.
- Reduces Muscle Tension and Stress
Relaxation: Stretching can help reduce muscle tightness, promoting relaxation and reducing stress. This is particularly beneficial after prolonged periods of inactivity or stress.
Stress Relief: The act of stretching can also help to reduce mental stress, as it encourages mindfulness and can trigger the release of endorphins, the body’s natural feel-good hormones.
- Prevents Injury
By improving flexibility and range of motion, stretching can help prevent injuries by preparing muscles and joints for physical activity. It can also reduce the risk of strains and sprains.
- Posture Improvement:
Regular stretching, especially targeting muscles that are commonly tight (like the hamstrings, hip flexors, and chest), can help improve posture by correcting muscle imbalances.
- Enhances Muscle Coordination
Neuromuscular Coordination: Stretching can improve the communication between the brain and muscles, enhancing muscle coordination and control. This is especially important in activities that require precise movements.
- Aids in Recovery
Post-Exercise Recovery: After exercise, stretching helps reduce muscle stiffness and soreness by promoting blood flow and muscle relaxation. It can also help in clearing out lactic acid buildup that occurs as a result of exercise in the muscles.
Why stretching is not always the solution to your injury
So when do we stretch after injury? As an old mentor of mine would always say, “It depends.” When discussing this issue with patients I give the analogy of a cut on your knuckle. If you bend it too early it will delay the healing. If you limit bending for too long it can get stiff. The key is a proper diagnosis and understanding of the injury before resting, stretching or strengthening.
One of the most important factors when establishing a rehabilitation plan is the date of onset of the injury or when the patient first experienced pain. Healing times for different tissues can vary from weeks to months or even years.
The following are basic tissue healing time frames for recovery:
|
Tissue Types: |
Range of time of healing: |
| Muscle | Grade I: 2-4 Weeks Grade II: 8-16 Weeks Grade III: 9-12 Months |
| Tendon | Acute: 2-6 weeks Sub-acute: 2-4 Months Chronic: 3-9 Months Surgical repair/Tear or rupture: 4-12 months |
| Bone | 6-12 weeks |
| Ligaments | Grade I: 2-8 weeks Grade II:2-6 Months Grade III: 6-12 month |
| Cartilage | 9-24 months |
| Nerve | Regrowth rate: 3-4 mm/day |
Here are a few factors to consider when deciding to stretch an injured structure.
Type of Injury: Different injuries have different rehabilitation protocols. For example, after a muscle strain, gentle stretching might be beneficial, but for a fracture or a torn ligament, the focus might be on protecting the injured area and gradually restoring strength.
Stage of Healing: Early in the healing process, the focus is often on rest and immobilization. As healing progresses, gentle stretching and range-of-motion exercises might be introduced to prevent stiffness and restore function.
Medical Advice: It's crucial to follow the guidance of a healthcare professional. They can provide personalized recommendations based on your injury's specifics and overall health.
Understanding Stretching Role in Recovery
If stretching is recommended, it should be done gently and within pain-free ranges. Overstretching or aggressive stretching can potentially worsen the injury or cause additional strain.
In cases of chronic injuries typically greater than 8 to 12 weeks most times stretching is appropriate and part of the complete treatment plan. Oftentimes, I meet patients who have been stretching injuries over months and even years without significant improvement in how they move or feel. In those cases stretching could be having a negative impact on the recovery. Strengthening - even though there is still pain in the region - may be the solution to stabilize and create greater resilience even with an older neck or knee injury.
It has been shown that when properly timed, stretching can improve the injured tissues, whether it be muscle, tendon, ligament or bone. More importantly, delays in strengthening can cause a great deal of atrophy of the musculature, decreased ability for the tendons and ligaments to take load and decreases in bone density.
A Quick Guide to Stretching After an Injury
For effective stretching, the goal should be to stretch daily or at least 3-4 times per week. Focus on major muscle groups or the injured region, holding each stretch starting at 1-2 seconds eventually building up to 30-60 seconds.
When you first start your stretching program you will perform each stretch 15-30 reps at 1-2 second holds. As your tolerance improves you reduce the repetitions to 3-6 reps for 30-60 second holds.
Stretch gently, feeling a mild pull without pain. After each stretching session you should not experience increased pain or discomfort lasting longer than 5 minutes. Stretching should never be forced or painful. After stretching, you should feel a sense of increased flexibility and relaxation, not discomfort. It’s normal to feel a slight warm sensation as the muscles lengthen, but avoid bouncing or jerking movements.
In summary, while stretching can be an important part of rehabilitation for some injuries, it’s not universally necessary and should be tailored to the individual case. Always consult with a healthcare provider to determine the most appropriate approach for your situation.
If you want a personalized stretching assessment and plan after a recent injury please contact our office!
To contact Tom Willemann, Owner and Physical Therapist from Apex Orthopedic Rehabilitation, please visit the clinic’s web site at www.apexorthopedicnj.com, call the clinic at 201-251-2422, or email the clinic at info@apexorthopedicnj.com.
Medical Disclaimer: The information provided by Tom Willemann from Apex Orthopedic Rehabilitation in Wyckoff, New Jersey is for informational purposes only and is not intended as a substitute for advice from your physician or other healthcare professional. You should not use this information for the diagnosis or specific treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise, or supplemental program, before taking any medication, or suspect you might have a health problem. You should not stop taking any medication and/or should not discontinue any prescribed treatment or exercise without first consulting your physician. The opinions expressed by Tom Willemann from Apex Orthopedic Rehabilitation are of the author and the author alone.