Dear list:
When discussing "stretching" I think the term needs better
definition. Let's look at 3 different ways to "stretch" the hamstring.
1. If you lie on your back, flex your hip at 90 degrees, stabilize your
thigh and then actively extent your need, your are "stretching" your
hamstring--it would be better described as a stretch of an opposing muscle
with the contraction of the antagonistic muscle.
2. With one leg up on a "rail" lean forward emphasizing a anterior pelvic
tilt and stretch the hamstring (no muscle contraction)--a typical stretch
in ballet.
3. Us a weight on the ankle. In the standing position, do a hamstring
curl against resistance working all the way through the full range of
motion. You are contracting the sarcomeres, but, at the same time, your
are applying a stretch to the serial elastic components of the muscle.
Looking at that, I may have my anatomy wrong, but your are stretching the
connective tissue that holds the sarcomeres together.
I have found that working muscles through full range of motion against
resistance, as described in 3 is as good if not better than the stretching
in example "1" and "2". Not that 1 and 2 are necessarily "bad" in any
way. So, when you take a very active crowd of army recruits with their
exercise regimes, are they not in fact doing plenty of "stretching" as
described in 3. I would content that this piece of research does not apply
to "weekend warriors" or to factory workers or warehouse workers,
especially when they are not in good physical condition, only work the same
muscles repeatedly, have a pre-existing injury, or are not 18-24 years old
(the age I imagine these army recruits to be). So, while the research may
be true for this population, I think the age of the sample is in question
when you try to apply this to a different age group, but also the wide
range of "stretching" that is inherent in their everyday activities--much
different than folks I treat.
Herb Silver, PT
At 02:22 PM 10/15/00 +0000, you wrote:
>Actually Henry, everything I have read so far says exactly the
>opposite: that there are many proposed benefits for stretching before
>exercise, however not all have been substantiated (in particular the
>relationship between stretching and injury prevention).
>
>Although it seems to make sense, there doesn't seem to be conclusive
>evidence around stating that stretching decreases the chance of having
>an injury. Maybe you have stumbled across a couple of articles that
>have been hidden from me (my class-mates, and my exercise physiology
>lecturer).
>
>To me it seems unethical (and impractical) to hold a RCT to
>investigate the relationship. Unethical because the study would
>essentially involve making some subjects stretch with their warm-up,
>and others not, with the belief that half of them will come out with
>an injury? How exactly are you going to phrase your consent form to
>get people to agree??
>
>And impractical as it is a commonly-held belief in the community that
>stretching is effective for injury prevention. If you gathered
>subjects for the trial and instructed half not to stretch, yet be just
>as involved as those who did... they'll have the preconception that
>they may incur an injury, and will only gradually involve themselves
>in whatever activity you set. How would you control that??
>
>
>** Very interesting, and very much against everything we have known
>about stretching before exercise. Is the paper published on the
>internet, and if not, where can I get hold of this paper. However, I
>have a few questions:
>
>** Is there any further research that will backup this claim the
>pre-exercises stretching is not beneficial for injury prevention?? Was
>the study specific in saying which muscles they stretched, how they
>stretched them, whether they stretched for a certain time frame, and
>whether they stretched after their exercises?? it seems to me that
>1538 people is a large sample, and would be difficult to control these
>factors, which are as important in injury prevention as simply doing
>stretches.
>
> >Henry***
> >
> >>From: "Linda K" <[log in to unmask]>
> >>Reply-To: [log in to unmask]
> >>To: <[log in to unmask]>
> >>Subject: pre-exercise stretching
> >>Date: Thu, 12 Oct 2000 22:03:39 +0100
> >>
> >>in 1996 Pope R et al (proceedings of the 1996 National Physiotherapy
> >>Congress p193 - A RCT to determine whether pre-exercise stretching
>prevents
> >>injury ) did an RCT with 1538 male Australian army recruits and
>showed that
> >>there were no benenfits of pre-exercise stretching in preventing
>injury
> >>(presumably this would also apply to the weight lifters and mm in
>the
> >>lumbopelvic region). Injury was more closely correlated with
>aerobic
> >>fitness.
> >>Linda K
> >>
> >>----- Original Message -----
> >>From: "Henry Tsao" <[log in to unmask]>
> >>To: <[log in to unmask]>
> >>Sent: 09 October 2000 21:48
> >>Subject: Re: TA & Stabilisation?
> >>
> >>
> >> > Dr Siff and others,
> >> >
> >> > I was talking to friend who worked at the olympics as a
>Physiotherapist
> >>down
> >> > in Sydney in the last 2 weeks, and briefly touched upon the issue
>of low
> >> > prevalance of back pain in weightlifters. He offered me a
>different
> >> > alternative on why back pain was limited in weightlifters:
> >> >
> >> > 1. They stretched their muscles always before they compete, hence
>they
> >>have
> >> > length and strength in their muscles. This means that the TrA and
> >>multifidus
> >> > muscles will not be inhibited and can be used to stabilize the
>lumbar
> >>spine.
> >> > This is in contrast to a worker who does not stretch at all
>before heavy
> >> > lifting, tightens muscles in the lumbopelvic region, which in
>turn
> >>inhibits
> >> > the TrA and Multifidus muscles and hence are more prone to injury
>as a
> >> > result of reduced lumbar stability.
> >> >
> >> > 2. Most sport people will have physiotherapy, chiropractic and
>other
> >>therapy
> >> > intervention during their training (I know for a fact that
>Maurice
> >>Green,
> >> > the 100M champion has both Physiotherapy and chiropractors work
>on him
> >>4-5
> >> > times a week. These will not only free up their joints, but also
>help
> >> > stretch their muscles. It is like having treatment regularly -
>hence
> >> > reducing the prevalence of back pain.
> >> >
> >> > 3. The diet that sports people are on usually is very beneficial
>for
> >> > healing. Diet is a big part of the human body. Therefore, even if
>they
> >>have
> >> > an injury, they will heal a lot faster than compared to the
>average
> >>worker
> >> > who strains their back.
> >> >
> >> > 4. Psychologically, it is known that if you are under a lot of
>stress,
> >>such
> >> > as the stress of work, your muscles will tighten. Most sportman
>(and I
> >>mean
> >> > most) are motivated and so focused in what they do that their
>normal
> >>pain
> >> > threshold would be high, especially in weightlifters. They need
>to block
> >>out
> >> > the aches and pains in their muscle and simply focus on what they
>are
> >>doing.
> >> > I know as a soccer player I have had times where I would play a
>game and
> >>be
> >> > so focused in the game, not realizing that my legs were bleeding
>from a
> >> > previous tackle until I slow down.
> >> >
> >> > We both agree that there is a lot of factors involved, and we can
>not
> >>simply
> >> > pinpoint a single factor on why weightlifters and most sport
>people
> >>don't
> >> > have back pain. However, it does show us that other factors such
>as
> >> > nutrition and psychology play a big part in the overall
>presentation of
> >>the
> >> > human being.
> >> >
> >> > To answer some of the questions posed by Dr Siff:
> >> >
> >> > >5. Are TrA methods definitely superior to most other methods of
> >>addressing
> >> > >back pain?
> >> > ***Definitely not, TrA, like any other Physiotherapy method, is
>always
> >>used
> >> > in conjunction with other Physiotherapy techniques, and it is
>always
> >> > difficult to say which methods are the best simply because every
>patient
> >>is
> >> > different. This is probably why Physiotherapy has lacked so much
> >>evidence,
> >> > because research is not easy to do, since we do not use a single
> >>technique
> >> > in our treatment(eg, it took Physiotherapists down in Sydney 6
>months to
> >> > examine the effectiveness of AP glides on the AC joint in the
>shoulder).
> >> >
> >> >
> >> > >6. How does one non-invasively check for TrA 'miseducation' or
> >>'laziness'
> >> > >during full ranges of dynamic or ballistic 'functional' movement
>(such
> >>as
> >> > >running, lifting and jumping)?
> >> > ***This is still to be shown, but the TrA theory offers us a way
>of
> >>thinking
> >> > and an explanation to what is happening in the lumbar spine. With
> >> > advancements in technology, I am sure they will soon be able to
>check
> >> > non-invasively TrA activation during functional movements.
> >> >
> >> > >7. Why do some cases of back pain, even among those with
>apparently
> >>'weak'
> >> > >or 'lazy' TrA muscles, spontaneously resolve themselves without
> >>repeatedly
> >> > >recurring?
> >> > ***Is there any research on the percentage of back pain patients
>who
> >>resolve
> >> > spontaneously and NEVER get back pain again. It would have to be
>a very
> >> > extensive longitudinal study to show this, and would be a very
> >>interesting
> >> > topic of discussion.
> >> >
> >> > Henry***
> >> >
> >> >
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> >> >
> >>
> >
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