Best Practices

There is much debate in the fitness world about stretching. The popular consensus appears to be that consistent daily stretching for ten to fifteen minutes is important for increased flexibility, which improves joint mobility for daily function.  The most current prescription for casual exercisers is:  a light cardio warm-up and dynamic stretching prior to a workout, static stretching after a workout.  Based on their own personal experience, people generally have their firm beliefs about how much stretching is required to obtain the benefits of flexibility – some require more than others, and others do not stretch at all.  (Full disclosure: I am the latter.)  If athletic performance rather than flexibility is your goal, your attitude toward stretching may be completely different, and different still depending on whether your sport demands power or range of motion.  Regardless of where you fall in the stretching spectrum, there are situations in which your personal stretching routine is appropriate and there are situations in which stretching is actually detrimental to your body’s healing.  Our bodies send us signals to let us know which situation we are experiencing, and it’s important to be able to interpret those signals properly to give our bodies the response they need.  I will explain both scenarios.

 

When we have used our muscles more than we are accustomed to doing, our muscles can experience soreness.  This can happen deliberately, like from increasing weight load at the gym, or inadvertently, like when performing a different type of activity than we normally do (shoveling snow after a big storm, for example).  The feeling of soreness often accompanies the body’s response to microscopic tears in the muscle created by the increased force of the contraction.  (Soreness is not, contrary to popular belief, due to lactic acid build-up, which clears the body a few hours after a workout).  We experience swelling and inflammation because nutrients and fluids flow to the muscle site in order to repair these micro-tears, and this tear-and-repair process is actually how the muscle grows and becomes stronger.  An interesting side note about soreness is that muscles tend to become more sore during eccentric contractions than concentric contractions.  Concentric, or “positive”, contraction is when a muscle generates force as it shortens.  This typically happens as the muscle works against gravity: the load is most often traveling up (think of lifting a heavy grocery bag onto your shoulder).  The “negative” or down phase involves an eccentric contraction, in which the muscle produces force as it lengthens while resisting a load.  The load is traveling down more slowly than gravity alone would take it down (think of lowering that same grocery bag onto the table slowly so as not to break the contents).  For example, runners performing hill workouts report more soreness in the quadriceps muscles in the front of the thighs (which contract eccentrically while running downhill) than the glutes (which contract concentrically while running uphill).  In a scenario such as this, or any in which you experience muscle soreness, stretching is appropriate.  It may not eliminate your soreness, but it could help move some of the fluid out of the area and decrease the swelling.*

However, in some situations the sensation you experience is more than just soreness.  If you are experiencing pain, you might have over-stretched the muscle. As counterintuitive as it may seem, stretching out the muscles in which you experience pain in this case is not the best course of action.  As these muscles are already over-stretched, stretching them MORE is not helpful.  With over-stretched muscles, there are two things you can do that work much better than stretching:  massage and exercise.  What’s right for you depends on whether you have an acute injury or a chronically elongated muscle.  An example of an acute injury would be performing a vigorous kick in kickboxing and over-stretching the hamstring or hamstring tendon on the back of your thigh.  For an injury such as this one, rest is probably the best idea.  There are multiple massage modalities which can help you, as well, including active and positional release therapy.   Positional release will be the topic covered in my next blog post.  It yields amazing results and can be done by yourself at home.

 

Chronically over-stretched muscles also respond to massage, but they tend to respond even better to massage coupled with exercise.  A very common example of discomfort due to a chronically overstretched muscle would be a constant nagging pain in the shoulders and in between the shoulder blades, after a long day (or days) slouched over the computer desk.  A simplified version of what is happening is this:  when you spend many hours with your arms in front of you, you are continually contracting your chest muscles.  Due to reciprocal inhibition, opposing muscles perform the opposite actions.  This means that if a muscle is shortening, the opposing muscle must lengthen.  The contracting muscles, in this case the pectoralis muscles, are perpetually shortening so they are sending constant signals to their opposing muscles, the trapezius and rhomboids, to lengthen.  If these muscles are continually receiving signals to relax, eventually they stop activating and they become very weak.  This is where exercise comes in.  By exercising those muscles you can strengthen them and stimulate them to activate.  In this example, pull-aparts with a band, seated rows and wall angels are all helpful exercises to perform. **

To summarize, stretching can be beneficial.  Stretching muscles can lead to increased flexibility in their corresponding joints, which can aid in pain-free movement in everyday life.  Stretching, however, is not universally advisable and there are situations in which it can even be harmful.

 

*Massage helps reduce DOMS (Delayed Onset Muscle Soreness) and a number of studies prove it. In two similarly designed studies where all subjects lifted weights but only half received massages two hours after working out, subjects who received massages reported less muscle soreness than the subjects who did not. In a longer-term study in 2005 in which soreness and swelling were measured, all subjects lifted weights, but only half of them received massages 30 minutes after exercise and then one, two, three, four, seven, 10, and 14 days post-exercise. The subjects who received massages reported 30% less soreness than subjects who were not massaged, and importantly, swelling in the muscle was reduced only in the subjects who received massage. It may be that the pressure of the massage strokes moved fluid out of the muscle and reduced the swelling that causes DOMS. Whatever the mechanism of action, massage after a workout (sometimes lots of it) was effective in reducing DOMS in these studies.  (MedicineNet.com)

**”Regaining Healthy Posture”, Michelle Burns, BSRN, BSAltMed, LMT

The human body works best when in constant gentle motion.  It is a fluid system of muscles, bones and nerves that interact dynamically, and, miraculously, the more we engage this system, the better it functions.  The body did not evolve to be in one stationary position for a prolonged period of time.  The anatomy of the posterior chain is not well-suited for sitting at desks and car seats for as much time as the modern lifestyle demands.  Likewise, our shoulder joints and upper back muscles were not designed to type on a computer or text on a cellular device for multiple hours each day.   The body is, however, extremely adaptive and will re-pattern itself on both muscular and neurological levels to sync with our daily activity.  The bad news is that when we offer the body very little activity, it will respond with stiffening into the position of most use.  The muscles that are overstretched will be in constant pain, while the muscles that are continually contracted will lose their range of motion, along with the associated joints.  The good news is that, since the body and brain are adaptive, we can reprogram these pain and stiffness patterns with small adjustments in our daily lives.

 

Sitting has been labeled the new smoking. Bio-mechanist Katy Bowman, says that while this labeling may sell standing desks, it largely misses the point.*  The problem is not necessarily sitting but a lack of movement.  Standing in the same place for a long time will produce a different set of aches and pains, but the negative effects on the body are similar.  During my years as a restaurant manager, I moved around the restaurant for ten hours at a time, and I always felt very agile. Every once in a while, there would be a particularly busy night during which I would have to stand at the host desk all night to control the flow, instead of moving around from table to table.  Waking up the next day after those nights, my body felt very stiff, with both my feet and my back scolding me for my lack of motion the night before.  Simply standing up for your whole work day can be just as detrimental as sitting.  Bowman explains that the body will adapt to any type of repetitive positioning, so it’s best to avoid staying in a single position for indefinite periods of time.  Adaptable workstations are the best, but many people do not have access to these.  Her advice:  move around.  Take small breaks during the workday to get up and walk even if it’s just for three minutes at a time.  If you stand, use those breaks for movement.  Vary your positions, whether sitting or standing (better if you can do both during your day), so you are never in the same position for an extended period of time.  One of Bowman’s main concerns with our current level of inactivity is that the body adapts not only on a musculoskeletal level, but at the cellular level as well.  Lack of movement changes blood flow and arterial geometry, which can cause coronary artery calcification.  This is an early marker of heart disease, making the case for increased movement that much more compelling.

It’s also important to keep the brain awake during periods of inactivity. Anat Baniel says “It’s the wakefulness of the brain that determines, to a great extent, the level of activity of the muscles, and, thus, our health and well-being.”**  In other words, during prolonged sitting or standing, the parts of the body we are not using largely disappear from the brain’s activity map and the brain “goes to sleep”.  The key, again, is to try to keep the entire body active when possible with constant gentle motion, so the entire body is being mapped to the brain.  One easy way to accomplish this is to sit in chairs that encourage movement.  Chair seats that are slanted backward, for example, immobilize the posterior chain, cause slouching and prohibit small movements while sitting.  For periods of prolonged standing, you can keep the mind-body connection dynamic by activating your muscles and keeping your joints in proper alignment.  Your joints should stack up one over the other and all muscles should be lightly engaged.

Those of us who log an hour or two of exercise in the morning are not immune to the negative effects of inactivity, if we are sedentary for the rest of the day.  So-called “active couch potatoes” experience the same degenerative outcomes of multiple hours without motion, regardless of how hard they hit the CrossFit in the morning.  Taking the time and incentive to take the stairs, perform gentle stretches at the desk, and to be mindful to stand dynamically when in the grocery line can benefit everyone.  With just a few small tweaks to our daily routines, we can ensure that our bodies stay as supple and agile as possible for the benefit of our greater health.

 

 

*”Standing Pretty”, What Doctors Don’t Tell You, February 2017

**”Dynamic Sitting”, What Doctors Don’t Tell You, February 2017

 

Many people suffer from chronic pain – either from repetitive use injuries, postural distortions, or other pathological states.  One very simple thing we can do in order to alleviate some of this discomfort is to pay more attention to our body positioning while we sleep.

 

A good night’s sleep allows your body to rest and recuperate from the day’s stresses.  Your muscles need this time of total relaxation in order to rejuvenate themselves.   However, although you may lie down to rest, your muscles may not necessarily be relaxed.  Sleeping in compromised or uncomfortable positions can cause your muscles to contract all night, which will result in waking up achy or tired.  Not fully supporting your proper alignment can also cause your muscles to do unnecessary work while they are supposed to be resting.  You can easily alter your sleep position in order to make your sleeping hours the most effective for your body.

 

Sleeping on your back:

This appears to be therapists’ favorite sleeping position.  If you like to sleep on your back, it’s important to support the natural curvature of your spine.  Your cervical spine at the back of your neck naturally curves inward from the bottom of your skull to your shoulder area, and this curve needs to be supported.  A good rule of thumb is:  your ears should line up with your shoulders.  Often people sleep with pillows that allow for too much support in the head area, causing the head to be flexed slightly forward all night, which overstretches the muscles at the back of the neck.  A cervical pillow, which is slightly thicker in the neck area than the head area, is perfect for cradling the head in optimal alignment.  If you prefer not to sleep with a pillow, a small towel rolled up and placed under the neck area works very well.

 

The second area of inward curvature in the spine is at the lower back.  Sleeping on your back can cause the lumbar spine to arch upward too much, so sleeping with a small pillow under the knees can help balance this and bring the low back into a more natural curve.  The pillow under the knees also allows your hip flexors to completely relax, which takes pressure off of the pelvis.  If supporting your legs then causes your lower back to press too far down into the bed, a very small towel folded up and placed under your lower back should get you into just the right position.  It might take a few tries to get the towel and pillow height just perfect, but it’s worth taking the time to get it right.  You want to imagine the best bodily alignment you could achieve while standing up and support this posture while lying down.

Bad for your body:

Good for your body:

 

Sleeping on your side:

This position is the most helpful for people who suffer from sleep apnea or snoring.  Like back-sleepers, side-sleepers will need to support the spine, starting with the cervical vertebrae and muscles.  A cervical pillow will work nicely here.  In this position a towel rolled up under the neck is generally not enough support, because the head needs to be slightly raised off of the bed so the neck is straight.  Again, the ears should line up with the shoulders and the head should be straight.  In order to avoid your shoulders collapsing into your chest (we spend too much time during the day with those shoulders rolled forward anyway!), you can hug a large pillow with the top arm in front of your chest.

The lower back and hips need to be properly placed as well.  The goal is to maintain your spine in a neutral position, by slightly bending and curling your legs forward while avoiding an overly fetal position.  A pillow in between your legs from your knees to your ankles will support your top leg in proper hip alignment.  For women with smaller waists, you may need to put a small folded towel under your waist to keep your side from collapsing down into the bed.  Any space in between your body and the bed could be filled by a folded towel or a pillow in order to make those muscles completely relaxed. However, if that sounds like too much work – the neck and the knees is a great start.

Sleeping on your stomach:

Most therapists agree that this position is not desirable for sleeping and should be avoided.  The main reason to avoid stomach-sleeping is that the head must be turned to the left or right, which is not good alignment for the cervical spine or for relaxing the muscles of the neck, as they find themselves in rotation all night.  Lying down on your stomach also arches your back into a swayback, which compresses the vertebrae in your lower back.  If you must lie down on your stomach, putting a very small folded towel under your stomach to open up your lumbar spine helps, but it does not help the bigger problem of the cervical spine rotation.  In addition, stomach-sleepers compress their internal organs by putting too much weight on the front of the torso.  One trick to stop yourself from rolling over onto your stomach is to place two large pillows on either side of you while sleeping on your back.  The hope is that they will deter you from rolling over.

 

This may sound like a lot of work, but it only takes a few weeks to condition yourself to sleep in a more restful position.  Supporting your muscles and bones during the night is one of the most important things you can do for your body.  This simple thing will help your body to maintain proper movement patterns and to alleviate chronic pain.