Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.

Recently, I came across a new concept called Stretch Labs. A Stretch lab is a practitioner assisted-stretch studio to help you achieve better flexibility. I thought this was a great idea until I went further down the rabbit trail to find out stretching was actually a controversial topic in the fitness and health industry. 

That’s how this Note got started. I called a dear friend/colleague, Ernie Dickson, to come by and chat with me about the benefits and controversies surrounding STRETCHING. How should we approach it? No question, you can do more harm than good, if you don’t do it right! But what is right? I had so many questions. 

Let’s dive in. 

Note: Ernie is a veteran Physical Therapist (36 years experience), trained at Northwestern (one of the top PT schools in the country), who has a like minded, common sense approach to healing: find the root cause!  


The Upside Of Stretching 


If you look at the Mayo Clinic guidelines, here’s how they talk about stretching: 

  • Improves performance and physical activities 
  • Decreases your risk of injuries
  • Helps joints move through a full range of motion
  • Increases muscle blood flow
  • Enables your muscles to work more efficiently

I love stretching. The main reason I like to stretch is because it makes me feel good. As you get older, your muscles get stiff. For me, stretching helps prevent stiffness. I, also, think it helps my posture. Stretching stimulates the parasympathetic nervous system, which we need to relax. 

Note: The parasympathetic nervous system is what keeps your heart rate going when you’re sleeping, helps you digest your food, etc. 


Potential Downside Of Stretching 


A lot of the experts think that stretching (a)weakens the muscles, (b)doesn’t prevent injury, and (c)actually worsens performance. They say that when you stretch before an athletic activity, you’re weakening that muscle, which may decrease performance (compared to if you didn’t stretch, and/or depending on how you stretched). 


Types Of Stretching 


In general, there are three types of stretching: 

  1. Static stretching. Example: when you bend over, touch your toes, and hold.
  2. Dynamic stretching. Example: moving your muscle through a range of motion. You will see a lot of athletes do this type of stretching. Ballistic stretching is a particular type of dynamic stretch where you are overloading, or overdoing it. Example: jumping really high (which can be dangerous for some). 
  3. PNF (Proprioceptive Neuromuscular Facilitation). Example: gently stretching a muscle to its end range, then doing an isometric contraction of that muscle in the opposite direction, followed by relaxation and being able to increase the stretch further in a safe manner. PNF helps you safely stretch the muscle further in the range, than you could with traditional dynamic and static stretching. 


Myths About Stretching 


Ernie and I discussed several myths surrounding stretching. 

  1. The belief that stretching prevents muscle soreness
  2. The idea that flexibility is the same as mobility

Note: The truth is: stretching may increase muscle soreness. If you’re anything like me, you’ve probably heard, “never stretch a cold muscle”. So what should we do? How should we look at it? What do you do after a workout to improve flexibility and decrease tightness?


Ernie’s Philosophy On Stretching 


Ernie’s overall philosophy on stretching is that it’s important, but it should be approached on a case by case basis. Things like lifestyle, diet, and lack of exercise can all contribute to tight muscles and a loss of range of motion. 

He talked a lot about the fact that we are creatures of habit. “We do the same activities day in and day out. As we age, certain muscle groups tend to tighten up, which leads to loss of range of motion, which can lead to joint issues, as well as some pain. It’s important to look at how you spend the majority of your day. Most of us are more sedentary than we were years ago. If you look at a computer all day, you’re forward bending and hunched over all day. And when you go home, you immediately sit on the couch. So, look at your patterns. Remember, If you don’t use it, you lose it.” 

Note: Over time we start to lose mobility. Stretching is good, but it’s just one component. Flexibility, strength, and joint mobility all contribute to your overall flexibility. 


Ernie’s Take On The Different Types of Stretching


Dynamic stretching is great because it allows you to warm the muscle up, but that only gets you so far. Sometimes, static stretching is best for targeting specific muscles. Note: Be careful with static stretching. We tend to like to “feel” something, so we go to the point of pain, and it’s too much. Gently stretch. Don’t get in the pain zone.

Active stretches are when you’re moving the muscles. A great example of this is the quad stretch (when the patient is actively flexing and extending the knee while warming up). An active assist stretch is when you use an assistive device to help you gently stretch, applying a bit more pressure to increase the range of motion.

PNF (Proprioceptive Neuromuscular Facilitation) is a type of stretching technique that utilizes the muscle spindle, which lies within the nerve fibers of the muscle and is sensitive to muscle stretch. The muscle spindle, when stretched, sends an impulse to the spinal cord, in turn causing a contraction of that muscle. The importance of a long static stretch is you don’t quickly stretch the muscle spindle, therefore you don’t have that impulse to contract the muscle and shorten it back up. With PNF stretching, the muscle is passively stretched in the available range, with the patient performing an isometric contraction, followed by relaxation (which allows the muscle to be stretched further than it normally would be). This isometric contraction also helps inhibit the antagonist muscle, which allows the muscle to relax and go a little further than normal. PNF is often used in stretching programs, and when combined with strength training, gives the best results. It’s best to work with someone who is trained and can help guide you through these PNF techniques.

Note: Ernie suggests using a combination of all of the techniques listed above, modifying them as needed to best fit the patient’s specific needs. 


Find The Why 


Why are you so tight? Figure out the WHY!

  • If certain muscles are weak, then you could be tight in other muscles, as well due to overcompensation (which could also be part of the cause). 
  • If somebody has chronic muscle tightness, often the antagonist muscle can be part of the cause (due to the imbalance between the two). 
  • It’s important to always look at the overall picture. 

Remember that muscles affect joints, and joints affect muscles. Note: It may also be a biomechanical issue. 


Final Thoughts 


The main thing that bothers me about aging is joint stiffness (the feeling that the motion of a joint is limited or difficult). That bothers me more than anything. At my age, when I tweak something, it takes longer to heal. I love Ernie’s approach. 

I’m a big believer in stretching. I think you need all three forms of stretching. Ernie pointed out at the end of our conversation that your stretching program has to be “doable”. The key is actually doing it! How TRUE!  

Think about stretching and how you can build it into your daily routine. And don’t forget the WHY. I.e., The first step (before you stretch) might be to figure out why you’re stiff in the first place!   

Till next week.