When should you stretch, for how long and what kind of stretching should you do?

Stretch when your muscles are warm, so that you don’t strain your muscles. Don’t stretch prior to starting your activity unless your body is warm and your sport requires a certain degree of flexibility. Stretching prior to exercise has been shown to decrease force and power. The general recommendation for stretching duration is 20-30 seconds.

A short bout of stretching will: decrease the amount of strength available to the muscle, cause no change in muscle length and decrease discomfort in the muscle.

Regular stretching has been shown to improve the power and speed of muscle contraction. Regular stretching will cause stretch hypertrophy, which means your muscle tissue increases in length, and increases joint flexibility. With irregular stretching, the muscle goes back to its previous length.

Two types of common stretching techniques are static, where you hold the stretch, and ballistic, where you bounce while you stretch.

Ballistic stretching causes the muscle being stretched to be in a state of contraction during the stretch. This means the muscle being stretched is stiffer, and this will have more effect on the tendon, which is what attaches the muscle to bone. Ballistic stretching increases tendon elasticity. A contracted muscle cannot relax and this style of stretching will cause injury if you’re not warmed up.

Static stretching is slow and controlled. It may allow your muscles to relax during the stretch.

The question you need to ask yourself while you are stretching is what part of the body you trying to stretch? How many joints does the muscle cross? What sport are you doing? Do you need that muscle to be long or short? Target a small area and protect the areas around it that may not need to be stretched. There is no blanket prescription for stretching. It varies between sport, person, joints, etc.
There has not been a lot of research on stretching. From athletes involved in sports that need lots of flexibility like gymnastics, it has been found that regular, long-term stretches, held for long periods of time and repetition of these stretches has increased flexibility.
For adults to see a difference in flexibility, it will take up to three months of regular stretching. Children gain flexibility easily.
Stretching the wrong way can lead to injury or overstretching of areas that should be protected.

US machines send sound waves through the tissues and causes molecules in the tissues to oscillate in the area of treatment. When on a thermal setting, this will cause heating of the tissues; an athermal setting is pulsed, the machine is only on a certain percentage of the time. This will increase the activity of the cells without heating them, which will help in tissue healing.

Thermal US is usually for chronic conditions and pain management. Athermal US is usually for tissue healing. Some of the conditions treated with thermal US include: complex regional pain syndrome, chronic inflammation, adhesions, tendonitis, and contractures. With thermal US treatment, you should only feel slight heating of the tissues and the sound head moving over the area of injury. Conditions treated with athermal ultrasound include: sprains, strains, overuse injuries, trauma, and surgical scars. With athermal US treatment, you should only feel the sound head moving over the tissues.

It is important that you know how to lift properly so that you don’t injure your back. To do this, you will need to use your abdominal and back muscles and your legs.

Step 1: Preparation
• Make sure that the area where you are lifting and moving the object to is clear of obstacles. It seems obvious but you may try to save time by leaving a shoe or bag in the way.
• How heavy is the object you are lifting? Is it a bag of books or a full laundry basket full of wet clothes? Depending on your strength, you may need to get help from someone else.

Step 2: Body preparation
• Make sure your feet are shoulder width apart and you have both feet flat on the ground.
• Keep the object close to you when you lift it and keep it at waist level

Step 3: Activate you core muscles (Stomach and back muscles)
• The core muscles act as a girdle to protect your back.
• Keep them engaged throughout the lift.
• Remember to keep breathing. Don’t hold your breath.

Step 4: Bend at the hips and knees
• Don’t bend down at the waist because this puts a lot of stress on the low back.
• Kneel down, resting one knee on the ground or do a squat with your knees apart.
• You always want to keep your back straight during the lift.
• Keep the object close to your body as you prepare to lift it.

Step 5: Lift
• Keep the object close to your body as you lift it and use your leg muscles to stand up.
• The leg muscles are stronger than your back muscles, so they are better muscles to use to perform the lift.

Step 6: Putting the object down
• When you are ready to put the object down, don’t lead with your shoulders. You want to avoid twisting at the hips to put your item down. Instead, use your feet to change directions to turn in a small circle so that your body is facing where the object needs to go.
• Keep your shoulders over your hips.
• Use your leg muscles to place the object down. Slowly lower into a squat to place it down. Don’t bend from the hips to put it down.

To summarize:
• Avoid carrying heavy objects long distances. If the object is too heavy for you to lift by yourself, get help from another person. If no one is around, push it to where you want it to go.
• Avoid twisting and bending at the waist.
• Keep your core muscles strong.
• Don’t forget to breathe.
• Use your leg muscles to perform the lift and not your back muscles.

Cold (medically known as cryotherapy):

Used to control inflammation, pain, and edema (swelling) and to reduce spasticity (muscle spasm). Cold causes immediate constriction of blood vessels that supply the skin; this effect lasts as long as the cold is applied, as long as it is limited to less than 15 minutes. If the cold application is longer than 15 minutes, then vasodilation (increase in circulation) may occur, which will increase swelling. Cold should be applied every 2-3 hours post injury for 2-3 days.

Cold has powerful neuromuscular effects: it decreases the speed of nerve conduction, elevates pain threshold and decrease muscle spasm – all of which are helpful to combat pain immediately post injury. Cold therapy also decreases the amount of tone in the muscle, which can help with stretching the muscle.

Cold therapy can be used to control acute inflammation (24-72 hours post-injury) and thereby accelerate recovery from injury or trauma. Decreasing tissue temperature slows the rate of the chemical reactions that occur after injury. This lowers the amount of oxygen the area needs, and reduces the risk of further injury to the area from lack of oxygen to the tissues.

After an acute injury, there is an imbalance between oxygen demand and supply in the injured area from the damaged blood vessels. When there is not enough oxygen for the tissue, secondary tissue injury can occur from inadequate oxygenation of the tissues.

Cold can reduce muscle strength, can limit how much your joint can move and delays tissue repair.

Heat

Used to control pain and decrease muscle tone. Heat will increase swelling, cell metabolism (how hard your cells work), joint mobility and how much your muscles can stretch. Heat causes dilation of the blood vessels to the skin making the skin appear red. Heat will make it easier to stretch your muscles because it decreases muscle tone, the thickness of the body fluids and the resistance of the collagen tissue to stretch.

Heat will decrease the healing time by increasing the amount of oxygen available to the tissues and increase the rate of work of the healing cells. After acute injuries, the application of heat is not advised because it increases swelling, metabolic rate and oxygen demand to the tissues, increasing the risk of getting a second injury from not enough oxygen reaching the tissues. Heat can be used for chronic inflammation (after 4-6 weeks) to help increase blood flow to the area and promote healing.

Heat decreases muscle spasm and works by the same physiological mechanism as cold.

Heat should be applied for 15 minutes. Heat should be used for: pain control, muscle spasms, scar management, on injuries that are no longer acute, and for joint stiffness. Cold should be used on acute injuries, to control pain and for muscle spasms. Do not use heat or cold before balance or strengthening training.

Our physiotherapists, Jeff and Tanya, will both be contributing to the
blog’s content. In the future, we plan to cover some subjects that
commonly raise questions from our patients. The following topics will
include: when to use hot and/or cold, understanding medical
acupuncture, stretching, how to keep good posture and proper lifting
techniques.

If you have any topics you’d like us to address in the future please
e-mail us at: familyphysiotherapy@gmail.com

Happy learning!

Jeff and Tanya Kestenberg