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Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
November, 2009, Vol. 9, Issue 11
An Alternative Approach to Stretching
By Whitney Lowe, LMT
Clinicians, athletes and rehabilitation specialists advocate stretching as a means for injury prevention and treatment. The primary purpose of any stretching technique is to enhance pliability and flexibility in the soft tissues. It is also routinely incorporated with massage in the treatment of pain and injury conditions. There are many different stretching techniques, which all fall into one of three primary categories: static, ballistic or active-assisted stretching.
Static stretching is the most common. In static stretching, you bring the target muscle into a lengthened position and hold it there until you have achieved the desired stretch. The ideal length of time to hold a static stretch is debated in the literature and the results appear inconclusive. Somewhere around 15 to 20 seconds is a common time frame that achieves good clinical results.
Ballistic stretching is used most commonly in the athletic environment. During a ballistic stretch, you bob or bounce into a stretch to encourage tissue elongation in the muscle. Ballistic stretching works by using the momentum of the moving limb to extend past the initial limitation of range of motion. Many people oppose the use of ballistic stretching because the rapid elongation of muscle tissue in the bouncing motion can activate the stretch reflex, which would be counterproductive to stretching.
In active-assisted stretching, the client actively engages a specific muscle contraction prior to, or during, the stretching procedure. There is a variety of active-assisted techniques and they go by different names such as PNF, muscle-energy technique, active isolated stretching or facilitated stretching. There are slight variations in each of these methods, but they are all based on the neurological principles of post-isometric relaxation (PIR) and reciprocal inhibition. Experiments that compare active-assisted methods with static or ballistic stretching show the greatest range of motion gains with active-assisted methods.
Immediately following an isometric contraction, there is an increased degree of relaxation in that same muscle. This immediate reduction in neurological activity is called the post-isometric relaxation (PIR). The methods of active-assisted stretching use the window of reduced neurological activity during the PIR to engage a stretch of the target muscle after it has isometrically contracted. Stretching during the PIR is more effective than stretching without the prior isometric contraction.
The other neurological principle that is of important in active-assisted stretching methods is reciprocal inhibition. When an agonist (target) muscle contracts, there is a neurological inhibition of its antagonist (opposite) muscle. The reduction in neurological activity in the antagonist muscle is called reciprocal inhibition. Because reciprocal inhibition decreases neurological activity in muscles opposite the ones being contracted, it is helpful to use during stretching procedures. Stretching of the target muscle is enhanced when its opposite muscle is contracted at the same time (Fig. 1).
The various techniques of active-assisted stretching advocate different lengths of time to hold the isometric contraction prior to stretch. Initial research has indicated that a relatively short period of nonmaximal isometric contraction (about 3 seconds) seems most effective for holding the contraction prior to stretch.1 These methods also vary in the length of time that the stretch is held. A study investigating active-assisted stretching compared stretch duration times of 3 seconds and 30 seconds and found no significant difference in the outcomes between the two time periods.2 More research is needed to determine the ideal stretching method(s). It may turn out that the optimum stretching method depends on the situation in which it is being used.
Effective Stretching Procedures
Each of the stretching procedures mentioned above must take into account the biomechanical and neurological properties of the myofascial unit. Therefore, all stretching procedures engage two primary components: the physical stretch of muscle and connective tissue (mechanical effects) as well as the reduction in neurological resistance to stretch (neuromuscular effects).
Fascia is interwoven throughout muscles in an extensive network. It has viscous properties that respond better to slow, sustained tensile loads and resist rapid elongation.3 The process of connective tissue gradually lengthening when a sustained stretch is applied to it is called creep. The extensive fascial network running through all muscles suggests greater benefit for longer-duration stretching methods to take advantage of connective-tissue creep.
The neurological resistance to stretch is primarily governed by a specialized proprioceptor called the muscle spindle. It is responsive to both the rate of muscle stretching and the amount of stretch in the tissue. If the muscle is stretched too fast or too far, the muscle spindle sends signals to the central nervous system and an immediate muscle contraction is engaged to prevent overstretching. This immediate muscle contraction is called the myotatic (or stretch) reflex. Stretching procedures attempt to minimize any recruitment of the stretch reflex.
An Alternative Method
Manual-therapy practitioners have been excited by recent research studies enhancing our understanding of the physiological properties of fascia. We have recently learned that fascia contains contractile cells and is capable of releasing its contraction and further elongating when a prolonged tensile load is applied to it.4 Armed with this new understanding, we can use the physiological properties of fascia to enhance stretching procedures. Combining active-assisted stretching methods with fascial-elongation methods would address both the neuromuscular and connective-tissue components of the stretching process.
Consider hamstring stretching as an example of how this works. Engage the hamstrings in a short 3-second nonmaximal contraction. Release the contraction and bring the hamstrings into a stretched position (Fig. 2). Have the individual attempt to further stretch the hamstrings by attempting to flex the hip as far as possible (as they did in Fig. 1). This movement engages the reciprocal inhibition process and encourages further lengthening. While this position is held, apply a myofascial-stretch technique (with the hand or back side of the fist) to the hamstrings and hold it for about 30 to 60 seconds. Holding the myofascial stretch encourages relaxation of the fascial contractile cells and enhances connective tissue creep.
Both the neuromuscular and connective-tissue components of the stretch are emphasized by combining these myofascial and active-assisted stretching techniques. I have found this stretching method helpful with a number of chronically tight muscles. In the future, it will be valuable to perform comparative studies with this and other stretching techniques to find out which ones are most effective under various clinical circumstances.
Click here for more information about Whitney Lowe, LMT.
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