Does stretching increase /decrease pain?

[emad]

Hi all:

I am cofused about stretching effect in dealing with a painful muscle (somatic), some techniques oppose the idea of using stretching to treat pain as ;
Strain Counterstrain technique
Somatic education as ( mirroring technique)


On the other side we had used stretching to treat pain for long time , even it is a great part of our experince as in sports , treating trigger point.

I have tried to search pubmed for an evidence , but no significant evidence .

I hope to know your views.
cheers :?: :?: :?:
emad

[emad]

Hi Bernard;

You are right !

Making the muscle relax is very important in our work.Thus what i understand those days ,as i am trying to read more literature in somatic education .

Bernard i think that passive stretching of the muscle may evoke more tension , pain,fear ,withdrawel reflex , protective mecxhanism , so i think it may be harmful.

On the otherside if we use hold relax(isometric) , then active stretching thus will be of great benefit.

Then what is called in somatic education active control of the muscle relaxation in a simple , slow ,gentle manner.

Yesterday , i had a consumer of knee stiffness post immobilisaTION , AFTER I APPLIED PARAFFIN , THEn ACTIVE simple gentle ex the patient said i feel great relaxation , i think my knee flexed more .

Yes i think relaxation of the muscle is extremly imporatant in our work.

[Green Hornet]

Hi folks,

This may be included in "active" stretching. I use so-called neurological stretching -- it is a functional stretching mimicking our loading (eccentric lengthening and proprioceptive activation) and exploding. The client is oscillating in a range of comfortable loading (stretching) and exploding into the opposite direction. It is stretching and re-training of using gravity, ground reaction force, and momentum. You add particular movements of arm(s) and leg(s) to induce top down and bottom up chain reaction throughout the body. Tha is the only "stretching' technique I use now -- no more isolated and passive holding of a lengthened muscle.

I am sorry that this is my emprical opinion and based on the study and teaching of Gary Gray, PT --- http://www.functionaldesign.com

[bernard]

:arrow: Hello Emad and Takao,

Emad: Actually many studies tell us that isometric exercises are not helping patients. Isometric contraction make blood stagnation. If we accept this conclusion we have to go a dynamic way of stretching?

Takao,
Thanks for the link. I must take, a bit time, to look carefully at the content. The first impress is good.

[emad]

Hi takao ;

yes , this link you applied is good , it is a form of active general stretching and mobilisation , it is good for all.

But , i think gardual beining , as gentle is important , Is noy it ?


Emad

[Green Hornet]

Emad,
Yes, gentleness is important, depending on how irritable your client's condition is. You can always tweak components of movements, such as speed, range, directions, etc.
What I like about Gary Gray's chain reaction approach is to reeducate the body in how to use physics (internal and external - ground reaction force, momentum, gravity, and mechanical and neural interaction of each body part) in the world. :lol:

[emad]

Hi Takao;

Ok thanks, those days i feel all what i done to every patient is dependant on my approach as gently as possible.
i feel as i approach more genle theoutcome will be excellent regardless of the stage of the problem.,

thanks
emad

[Green Hornet]

Emad,
I constantly think how I can get more by doing less.
Gentleness amazes me much more than technique like joint manipulation.

[emad]

Hi Takao:

Back to our main issue ,painful muscle & stretching!
EXAMPLE ; Bilateral hamstrings in a driver ;

of course we will rule out the neural involvivg using slump test ,What i usually do ,i do neural mobilis exer.

Beside to Mobilsation with Movement ( mulligan concept is concerning joint ,here i apply that to the muscle), i ask the conumer to flex the knee from prone ,while i apply muscle glide in the transverse direction.i feel thus could improve muscle fexibilty .
could regain the muscle lenght.

BUT

What i greatly concern in our discussion here ,while the hamstrings are tight , so the Quadriceps are weak in relation to the hamsatrings (muscle imbalance),
sao if we try to apply resisted /trasin the quadriceps , thus may inhibit the hamstrings ,
is thus currently ,evidenced
i hope Bernard share us his knowledge

cheers
emad

[emad]

Hi Bernard:

Muscle Imbalance,I tried to rearch a lot about that topic on the web ,but i have not found anything .

I will review the theory of reciprocal inhibtion ,simply when you want to contract a muscle its antagonist should be relaxed to give chance to contract the agonist .

Bernard:
this i noticed practically , when there is tight muscle , its opposite will be weak , i noticed that today in a patient with tight abductors , the adductors were very clear weak.
So the conclusion:

when there is a muscle weak , thus will not affect its surroundings , OR only here you concern the neurophysiological relation.

Your view regarding slump test , I have not undrestood !!!

Cheers
emad

[Green Hornet]

Hi, Bernard and Emad!

When I see my client in front, my brain is flooded with questions like "why? why? why?" and "So what?"

Why is it weak? If we treat weakness without knowing why, is it effective? Are there some functinal explanations for the weakness? Have you treated functional problems? Yes, it is often "not" clear at all, but I have been practicing asking myself "why?"

I think that the same thing is true for "tightness." Why is it tight? Is there any functional connection to the tightness?

These are very difficult questions to answer, but have been helping me with my clinical skills and reasoning with lots of trials and errors.

[emad]

Hi Takao:

You have mentioned a very good point regarding muscle tightness , its function
When the muscle is used in a misfunction manner , this of course lead to its tightness , and if used ( being contracted ) for long periods .

Bernard :

you are right one muscle is constrained by its opposite , yes this is completely right , but what the effect if being "constrained" for long periods of time and being misused ,or disused can not we call that "weakness".
The peoblem here is the NAMING of the muscle status , the mean concern here is there is an effective relation btween two muscles working in different direction .

What I hope Takao & Bernard your comment on the fallowing:
Every day i meet a lot of cases post-immobilisation of the elbow joint stiffness/contracture ,usually there is flexion deformity of the elbow ( the consumer can NOt extend his elbow) , in those cases is there is a relation of imbalance between elbow Flexors &extensors .

By the way i have view :
Regarding stiffness ,shortiening , contracture .
Ther are a lot of ideas about how to differenate stiffness of the joint from muscles shortening surround the joint .
I belive we can NOT seperate joint stiffness from muscle shortening which surround the joint , because all those are soft tissues liable to change , imagine there is joint limitation , thus will lead to muscle tightness .

Cheers
emad

[Green Hornet]

Emad,
We need to be able to differentiate "stiffness."
1) Stiffness due to mechanical shortening (no nervous system involved) &
2) Stiffness due to neuromuscular adaptation.

Pure mechanical tightness will benefit from stretching. BUT, how much of what we see is it? I become less and less fond of the idea of pure mechanical tightness. I don't see "tightness" that way most of the time. That is why I kind of give up on stretching exercises.
People who are getting benefits from streching are good at letting go. People who are NOT mindful can't get much from stretching, like people just counting seconds during the stretching and paying no attention to the sensation coming from the muscle.

What are we feeling in the presence of contracture, feeling of tightness, tightness through palpation? I think that we are feeling chronically stimulated muscles and other soft-tissues by the nervous system. In the face of that, we need to be successful in disengaging the vicious neuromuscualr cycle in order to unlock the tightness. It will be achieved by sensory-motor learning.

Just my opinion.

[Diane]

Takao, I completely agree with the point you made re: stretching needing to be coupled with active mental sensory appreciating and ability to let go. Years ago, that's what 'yoga' was supposed to be about; it included a third factor which was to consciously breathe throughout the whole process. I would add that a fouth factor is necessary in any form of stretching, or yoga, namely, the proper use of time: To move only at the rate the body will allow, not making it stretch further than any little area of tissue/any layer of any little area of tissue, 'can' (Patiently waiting for the body to open its own self up to the intended stretch vector.)

The whole point of yoga, as I understand it, is to make stretching into a meditation, to move so consciously and so slowly and with such tuned awareness that no mistakes will be made, that each second stretches into an eon of time in which to change intent slightly or back off a little. I THINK that this development of sensory appreciation for the body IS the yoking of mind and body that yoga is supposed to be... however I think any form of slow and thoughtful and careful and perceptive exercise can be equally 'yoke-able', 'yoga-esque'...

I treat yoga instructors who have injuries! I don't see how, if they are adhering to these principles, it is possible for them to hurt themselves. I can only assume they are not learning (and therefore likely not teaching) the sensory appreciation part, the "let go" part, the breathing part, or the timing part. Certainly not the 'respect for all tissues in a given area' part, which is the part I try to impart.

So, I must conclude that any form of exercise, even yoga, done 'mindlessly', can injure the body, or at the very least not 'help' it.
Diane

[nari]

Hello all,
I finally got here after being blocked by some bug or the other.

Takao and Diane -

Exactly! I think quite strongly that stretching for X minutes Z times is a waste of time and effort, unless it is known what for and why it is being done. Often I think it is nothing more than a 'feel good' sensation, and does not change anything except our perception of how we are moving at the time. I had a discussion with a trek member last week (while we were resting on a mountain) while she was doing extreme stretches on the spot. She is keen on yoga and says she does it purely for the psychological effect..it feels good, and inspires her to keep plodding.
She lay prone, tucked on leg up under her (in the so-called 'piriformis stretch') and went into extreme lumbar extension. However, she added it was good for 'gluteus maximus' (she is not a physio) and as long as she felt it worked, I did not alter her perception by disagreeing. There is a time and a place for everything.
Elbows are notoriously difficult when it comes to stiffness - I believe it is a joint stiffness and not muscle. Functional movements seem to work best, but very slowly.


Nari

[Green Hornet]

Nari, welcome to joining us!

As far as the elbow is concerned, I used to struggle with "elbow pain," but started seeing light. Elbow could be the joint caught in the middle like the knee. The shoulder and wrist/hand function is critical, especially wrist/hand, for ideal and stressless elbow function.
How many of us perform motor activity with TOO MUCH force in the wrist and had and keeping them very stiff? Many... No wonder we see elbow problem very commonly.
When I started integrating this mindful "soft" wrist, the elbow starts getting happier.

I am sick of seeing people holding stretched muscle for a certain period of time :evil: --- I hope that more and more people realize that mechanical stretching provides less and mindful stretching does a lot. Thank you, Diane and Nari.

[emad]

Hi Diane , takao,nari &bernard ;

I think i have understood your point which is performing stretch with attention,feel,awarness , within body limits.
Thus means that elbow no more than "sensory motor amnesia"
ok , performing stretchs with attention .

Let us speak about our proprioceptive input through stretchs,mobilistion,active .I belive here in that elbow joint the joint ,muscle ,and all soft tissues are affected (lose fexiblity) .

Then to creat intelligent muscle as "Bernard" said thus through

attention
awarness
visual input .


Diane thank you for sharing us the discussion
Nari welcome to the forum

cheers
emad

[Green Hornet]

I agree that we have to go beyond just mechanistic viewpoint. We have to see living body vs. physical body. Yes, intelligence is there, it just needs to be tapped.

So many people understand that body, spirit, and mind are all connected and make us complete --> human being, but how many of us put this understanding into practice? When this concept is fully integrated, our soma may have become simple.

I read a newspaper article a few days ago where a medical school spends less time on cadaver disection and uses already-disected part for students' learning. I hope that they will learn how everything is connected even in the world of physical body.

[rolf]

Hi!
Cant see the problem with streching increased muscular tension(latent or active muscular triggrepoints).Have done this for years on acute or chroick pain patients ,often with very good results.I often learn my patients to do their own streching on specific triggerpoints or a specific muscle(levator scapulae).Together
with the streching i often use dry needeling.The best results regarding streching is in increased muscular tone due to increased physical muscular tension in different types of sports activities.
The streching is not so effective on emotional increased tension,but dry needeling inits self can make the tension dissapear.At the same time we have to try to understand WHY its become as tens at it is.
RIN :wink:

[bernard]

Welcome Rolf on SomaSimple Board,

I deleted your second post which was identical to the first one. We are pleased to see that Europe (Norway in your case) is sharing its experience. As you said, stretching is less efficient on emotional tightness and in our stressed societies I believe that component is increased each day to a new peak?

[emad]

Hi Rolf and welcome to the Forum:

since a year i was using stretching to eliminate /supress/ trigger points and particularly eccentric muscle energy technique MET.

But those days i am so new to use /apply/implement somatics to my work ,yesterday i had a consumer with alot of trigger points surrounding his shoulder , postive yergson test , passively free from pain ,all these since 2 months , in the past i used to apply ultrasound to those trigger ponits then stretching and glenhumeral physiological mobilsation ,

this time i added asking the consumer to control the tension of the muscles ,to relax his muscle power .

The issue was greatly different in the outcome , the second session/setting/visit all had improved 60%. This is really effective and as miracullous .to ask the conumer to be in active ,to take active role to control his tension , NOT just being passive partener through drug,intake and physio methods /or trigger point therap[y.


Rolf:
I am going to tell you pesonal experinece with thus active control of relaxtation , i wake up with just pain above my left iliac crest , there was limiting flexion .
I deceded to feel /experince /live what is that realxation they all speak about those days ,which i have read a lot about it .
Really i felt i can relax voulntary my painful region , i felt at the time pain is like melting , my paiful region is like alive a part i am in contact/touch with.

I can say honestly , there is like messages i can send to my painful area to relax ,to peace my paiful area .

Cheers
emad

[Diane]

There is an article about stretching on this website...
http://www.somatics.de/

I like to visit here; I've found Robert Schleip an informative source for uncovering reasons why body work, well, ..... works.
There are articles here regarding fascia (which must be one of the most understudied tissues in the body), the nervous system, somatics and all the various contributors to the field, all sorts of interesting articles for visitors be they practiioners or non-practitioners.
Cheers,
Diane

[emad]

Hi Bernard &Diane :

excellent link .
emad

[BB]

Hello all,
May be tough to insert my first post in such an already well discussed topic...but I'll try.
I think there are several reasons why stretching is such a controversy, mostly because people have seen it work and others have seen it not work or worse, have seen it increase pain. How could these different experiences exist? I think the "why" is the most important question. Why is the stretch being applied? Is the stretch is being applied because of a subjective report of "tension"? Tension can exist because of shortness, or holding patterns, resulting in various tissue responses (eg. trigger points, spasming, etc.) but it can also result from overstrain of an OVER stretched muscle. A common example is stretching the upper trap of a person with depressed scapula where the trap is too long already. The likely short tissues are actually the scapular depressors, but the pain is occuring in the overstretched trap. Stretching this persons trap only exagerates the problem.
I think that stretching can be beneficial when applied to tissues that really are short, BUT studies show that the effects of a passive stretch do not last long. Active stretching is preferable because of the motor learning or patient experience that occurs. More importantly though, when proper motion is used the tight tissue will be stretched functionally as the person moves. In the case of the depressed scapula, if they are taught to improve the elevation of the scapula as they elevate the arm, then the depressors will be stretched actively and fuctionally. Also, the patient will likely feel less pain and therefore learn a pattern to decrease their pain.

I think that this process can also be facilitated by a passive stretch. Even though the effect is short lived, we can educate to stretch throughout the day in addition to moving correctly. The short term gain in length allows the movement pattern to occur more easily and overtime become lasting.

Sorry for the long post.
Cory

[Green Hornet]

Let's welcome Cory.
He is a spy ---- just kidding. I think that I know him personally.

An active and mindful process is an important in any exercise and movement therapy. It will be short-circuited to change the neurological conditioning vs. passive mindless stretching. I would put mind and awareness into whatever I do vs. simply keep stretching throughout the day. If I can keep stretching throughout the day with mindful awareness, that would be the best.

Cory, you are right on that there are different types of so-called tension. And it is much easier to indentify which type of tension our client has by zooming out. See a tension pattern in the body vs. zooming into an isolated tension.
Tension does not exist in isolation!

Talk to you alll soon.

[Rolf-Inge]

Hi all!
As tako writes,"see atension pattern in the body"is for me afundamental question.As i have witten before its almost impossible to stretch muscles
which have increased theirtension due to due to emotional stress.
just at the moment i am treating a woman with incrased muscular tension in her left side of the body ,with most of her pain inIS area.The most tens musles is the QLumborum(second iliopsos,glut med ,adductors etc)
"Normal "joint function in the lumbar area ,hip and is joint.Zooming in i tried to deactivate possible active triggerpoints in QL but cant find any area whichgives me the tradisional twich respons .
Zoomimg out gives me a clu why the tension in her left side is increased.
She have had these problems 2,5 year since she gave birth to twins.,which make her day at home like hell as she tells me.They are everywhere,and gives her no pease in mind.She arent able to take care of her self ,both physicly and emotionally,just careing others.
It seems to me that her"basic ground tension"is increased due to her new way of living,and her" body" is calling for help,by giving her this pain.
she understands the connection betwenn her anger,anxiety,etc and her general increased tensio and pain but she arent able to reduse it at the moment.The kids take all of her energyand she hasnt got any left to take care of her self.
I think we have to educate some of our patient that sometimes life is hard and its a part of living.The pain is there to tell you something and you have stop and listen to it.Iit isent dangerous .It can just be a "normal "respons to the way you are living at the moment.
I have stoped treating her back but no tries to educate her in the connection body-mind,mind -body.Well see what comes out of it.
rin :wink:

[BB]

Hello again,
I completely agree with you (takoa and bernard) about active vs. passive stretching. I should have clarified that I was trying to state why some may have a positive response, although definately an even more positive response would occur with an active application.

Bernard- I am curious about your statement of further shortening a short tissue. Are you speaking of a strain-counterstrain type situation, or maybe you accentuate the dysfunction to demonstrate to the patient how it contributes to their pain? Could you clarify.

Green Hornet- What is your approach to scanning for tension patterns ? Do you assess based on movement or through palpation or other?

And by the way, Takoa is the one you need to watch out for...not I!
Cory

[BB]

Thanks for the explanation bernard.
It seems that a muscle that is shortened to protect from injury, even if input or feedback is decreased, is getting told to shorten. Therefore, wouldn't shortening it further only increase the imbalanced message it is recieving? Or, maybe do you use a contraction to effectively say "this is where I want you to relax"?
Cory

[Green Hornet]

Cory,
you wrote (asked):

maybe do you use a contraction to effectively say "this is where I want you to relax"?

I think my answer is yes.

Shortening can send a message to the brain, saying that "This is what you (the brain) is doing to me (a muscle)." If the brain gets a info of too much contraction, it can reset its resting state and let the excessive tension go. You need not only to contract it more on purpose but also to relax it gradually and mindfully. That is a way to change (immediately) the neuromuscular tone.

It is based on our neurophysiology = the function of neuromuscular system/motor system and it is beyond the mechanical approach.

[BB]

Takoa and Bernard,
Thanks for your clarifications! I think that shortening in that way is a great way to make the pt. more aware.
I tend to think of normalizing input. I simplify my thinking often times by saying to myself, the body wants to move and feel normally, it just doesn't remember how....how can I best remind it? Movement is usually the easiest way to "remind" the body because it gives the body sooo much input. And one of the nicest things about what we do is that we get to see the various ways the body tells us "yes, that's right" or "no, you're on the wrong course." That movement is the most important part of stretching, I think is the important theme here. To bring about effective change, you must affect movement.

Cory