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Quite a Stretch

November 26th, 2010

Here is a guest post from Paul Ingraham, a current health science journalist and copy editor for ScienceBasedMedicine.org, and creator of the excellent website SaveYourself.ca. His website has an extensive collection of well researched ebooks and articles on a wide variety of topics related to common therapies for chronic pain and athletic performance, especially muscle pain and some common overuse injuries like IT band syndrome and plantar fasciitis. His approach is very skeptical and evidence based, and as such he does a lot of debunking, which I like. Here is his take on the alleged benefits of stretching.*

QUITE A STRETCH

Why is it that many Kenyans don’t stretch? Why was legendary coach Arthur Lydiard not a fan of stretching? Why does Galloway say, “In my experience runners who stretch are injured more often, and when they stop stretching, the injuries often go away”?

— Bob Cooper, Runner’s World Magazine.1

Stretching is a comfortable and reassuring ritual for many people — it’s simple, it feels good, and it seems to promise easy benefits. For countless more, athletes and couch potatoes alike, stretching weighs on their conscience — one more thing you are supposed to find the time to do. Can all these people be barking up the wrong tree? Sure they can! And they are.

Plentiful recent research now shows that stretching as we know it — the kind of stretching that the average person does at the gym, or even the kind of stretching that athletes do — could very well be a waste of time. Articles published in recent years, reviewing hundreds of studies, have concluded that there isn’t much evidence that stretching prevents injury or muscle soreness.2, 3 Adding significantly to the credibility of those reviews, a major year 2000 clinical study of many hundreds of soldiers showed no sign of benefit from and even some risks to stretching.4

So why are people stretching?

Why people stretch

Trainers, coaches and health care professionals are starting to insist on making recommendations based on evidence, or at least a really convincing physiological rationale … and stretching just doesn’t hold up very well under that scrutiny. When challenged, many stretching enthusiasts have a hard time explaining why they are stretching. The value of stretching has been elevated to dogma without justification. Everyone just “knows” that it’s a good thing.

When pressed for reasons, people will come up with a few predictable stretching goals. Here are the four hopeful reasons for stretching that I hear every day:

1. warming up
2. prevention of muscle soreness
3. prevention of injury
4. flexibility

And sometimes you also hear:

1. “performance enhancement” (faster sprinting, for instance)

Not one of these can be supported with evidence, or even has a persuasive rationale. Stretching for these reasons is probably a waste of your time.

Stretching research shows that stretching is not an effective warm up.

Warming up is an unclear goal with many possible meanings. The most obvious and literal — an actual increase in tissue temperature — is a reasonable goal. It’s literally true that warm muscles function better than cold ones.

However, body heat is generated by metabolic activity, particularly muscle contractions. And it’s impossible to raise your metabolic activity without working up a sweat, which can’t be achieved by stretching alone. You simply cannot “warm up” your muscles by stretching them: that’s like trying to cook a steak by pulling on it. Instead, the best way to warm up is probably to start by doing a kinder/gentler version of the activity you have in mind: e.g., walking before you run.

Metaphorically, “warming up” also refers to readiness for activity or body awareness. You are “warm” in this sense when you are neurologically responsive and coordinated: when your reflexes are sensitive and some adrenalin is pumping. Warm up for its own sake (i.e., without following it up with more intense exercise) is fairly pointless — the goal is to prevent injury and enhance performance. And those goals may be realistic. For instance, research has shown that a warm up routine focused on these goals actually might provide significant insurance against the number and severity of both traumatic and overuse-caused injuries.7

So, warm ups in this second sense might be helpful … but does stretching warm you up in this sense? No, probably not much — certainly no more than a bunch of other exercises you could do — and quite possibly not at all. The most compelling evidence that stretching doesn’t warm you up is the evidence that shows that it doesn’t prevent injury or enhance performance (discussed below). Static stretch is somewhat stimulating to tissue, but in ways that are quite different from most actual activities.

Because of all this, stretching to warm up barely even qualifies as “official” exercise dogma anymore — most professionals actually gave up on it many years ago, and it is passé even in the opinion of many joggers, weekend warriors and other amateurs. Yet there are still far too many people out there stretching before they run, trying to “warm up” almost exclusively by standing still and elongating muscles! Once again, the best way to prepare for an activity is probably to start it slowly.

Stretching research shows that stretching does not prevent delayed-onset muscle soreness (DOMS).

Another popular idea about stretching is that it prevents that insidious deep tenderness that follows a hard workout. That soreness is called “delayed onset muscle soreness,” or DOMS for short. People believe that stretching can help DOMS like its religion. This does not make it true. Unfortunately, the evidence strongly suggests that stretching is completely useless for preventing DOMS. In fact, many studies have shown that nothing short of amputation can prevent DOMS — and certainly not stretching.6, 7 Think of DOMS as a tax on exercise. As one clever commentator put it, “Only soreness can prevent soreness.”

Stretching research shows that stretching does not prevent injury.

According to the evidence, stretching probably does not prevent injury. As I mentioned above, this has been suggested by a combination of recent literature reviews and large clinical studies, some of which I have already cited. Here’s some more.

In 2005, Clinical Journal of Sports Medicine published a review of the scientific evidence to date, and found that the (admittedly limited) evidence “showed stretching had no effect in reducing injuries.”8 Neither poor quality nor higher quality studies reported any injury prevention effect. Regardless of whether stretching was of individual muscles or entire groups, there was no reduction in injury rates.

More experimental research has been done since. For instance, a 2008 study published in American Journal of Sports Medicine showed “no significant differences in incidence of injury” in 500 soldiers doing preventative exercises, including stretching.9

I’m never surprised by such findings, because I’ve never heard a sensible explanation for how stretching can generally prevent injury. Usually, advocates have a vague notion that “longer” muscles are less likely to get strained: even if garden-variety stretching made muscles longer (which is doubtful in itself), and even if we knew exactly what kind of stretching to do (we don’t), and even if we had the time to stretch every significant muscle group, the benefits would still be relevant to only a small fraction of common sports injuries. An ankle sprain, for instance, or a blown knee — two of the most common of all injuries — probably have nothing to do with muscle length.

Hardly anyone needs to be more flexible.

“I want to be more flexible,” people say, even when they have normal range of motion in every joint. What’s this about? Why are people so worried about being more flexible?

Most people have a normal range of motion — that’s why it’s normal! Unless you are specifically frustrated because you lack sufficient range of motion in a joint to perform a task, you probably don’t need to be more flexible.

Obviously, stretching can be effective at increasing flexibility — acrobats, gymnasts, yogis and martial artists have been doing it for centuries, sometimes achieving uncanny mobility. But these are highly motivated athletes with specific and extreme goals and stretching regimes that would intimidate the rest of us, and with good reason: they often injure themselves along the way.

Stretching probably doesn’t enhance performance (and it definitely doesn’t make you spring faster).

You don’t hear this argument for stretching as often as your hear the others. And yet it comes up, especially with athletes who play team sports. It’s a common practice to stretch when you’re off the field. The habit is probably usually rationalized as an injury prevention method, but many of those athletes will also claim that it enhances performance — that the muscles “spring back” from the stretch and make them run faster. There’s actually an entire stretching book that is largely based on this idea (The Stark Reality of Stretching: An informed approach for all activities and every sport) — but that book is conspicuously full of armchair science, and no actual evidence that the ideas are true.

Predictably, research has shown that stretching does not improve sprinting. More surprisingly, research has shown the opposite. What happens to your sprint if you stretch first? All other things being equal, the athlete who didn’t stretch is going to leave you behind!10

So … is stretching good for anything?

Probably not for the reasons or in the manner most people are stretching, no — not much good, anyway, and certainly not in a way anyone has figured out how to measure.
Notes

1. Cooper, Bob. “The Rules Revisited.” Runner’s World. September, 2009. p. 59.
2. Shrier. Clinical Journal of Sports Medicine. 1999.
3. Herbet et al. British Medical Journal. 2002.
4. Pope RP, Herbert RD, Kirwan JD, et al. A randomized trial of preexercise stretching for prevention of lower-limb injury. Medicine & Science in Sports & Exercise 2000;32:271–7.
5. Soligard et al. British Medical Journal. 2008.
6. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness : treatment strategies and performance factors. Sports Medicine 2003;33(2):145-64.
7. Weber MD, Serevedio FJ, Woodall WR. The Effects of Three Modalities on Delayed Onset Muscle Soreness. Journal of Orthopedic and Sports Physical Therapy, 20(5):236-42, 1994 November.
8. Hart. “Effect of stretching on sport injury risk: a review.” Clinical Journal of Sports Medicine. 2005.
9. Brushøj et al. American Journal of Sports Medicine. 2008.
10. Beckett et al. Medicine & Science in Sports & Exercise. 2009.

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Conversations

November 16th, 2010

Are you really brave enough to take a careful look at what kind of emotional toll your conversations are having on others? To answer this question, it could get a bit ugly. Some of us might have to don some pretty thick armor and gear up before having the courage to take a hard look at ourselves.

Most of us would like to think that our conversations are leaving an afterglow rather than an aftertaste. We want people to walk away from our conversations truly inspired. Want them leaving with a lightness of being that we helped facilitate.

I hope that is indeed the truth.

Unfortunately, that is not the case for all of us. I know sometimes I have created an aftermath. Look around you. What do you notice? What results are you and your team/family/network experiencing?

Notice:

Do people come out of their cubicles to say “hi” as you pass by; or do they scuttle deeper into the recesses hoping that they won’t be seen?
Are you surrounded by friends, family and teammates who genuinely care about you; or have you discovered that, when you look around, your friendships and relationships with coworkers have dissolved, are non-existent?
Are you on track career-wise; or have promotions, advancements, raises passed you by?
When you really are honest with yourself, do you find that you are at the center of most, if not all, of the disappointments and failures? The common denominator being you?

If we’re not thoughtful about our conversations, something could creep in and wreak havoc. Gradually, then suddenly. Unfortunately, most of us don’t wake up until we are suddenly careening off the path that would lead us to success. We tend not to notice that something bad is happening until we are staring into the void, and it may be too late to get back on course.

There are times when we have to deliver messages that your partner will be less than thrilled to receive. It is absolutely essential that we have those conversations as well as the easy, fun ones. The way we deliver the message is crucial.

There is a difference between being thoughtful and being careful. Careful conversations can be absolutely failed conversations because they often postpone what needs to be said. We tiptoe around the real issues and they never, ever go away. And, believe you me, avoiding a conversation leaves a very definite negative wake!

A thoughtful conversation is intentional. It’s one where I have spent some time analyzing what the issue is, why it’s important, how I would like to resolve it, what my part has been, etc. — all my own perspective, of course. A thoughtful conversation includes space where I can learn from my partner what their perspective is, because I know that resolution is rooted in understanding.

During a thoughtful conversation, I am aware of what kind of wake I am leaving because it is important. It lingers. My intention is resolution, not dissolution. And if I find myself veering off–course, I will course–correct.

Our individual wakes are larger than we know, and no comment is trivial. So, ask yourself, who should I speak with to clean up anything that’s messy or off in some way? How do I leave people at the end of a conversation? Take responsibility for your emotional wake. You will notice a change in how you are received.

-Jennifer Brewer

You don’t hesitate to buy the best equipment – but how do you support your most important piece of equipment, your body? Sports equipment constantly evolves. Not only does it get more expensive, it gets faster, more accurate and more fun. How has your body evolved, or has it devolved?

If you are an athlete or just someone who enjoys his or her, body you know that things happen. You over train, you injure it, you wear it out. More hard work is not giving you the results you want; it is wearing you out more.

If you are like most, you’ve tried the orthodics, massages, chiropractic adjustments, physical therapy and may be even surgery. Reluctantly you may attribute it to aging – it is not aging. It is the accumulation of stress from life and use.

Beyond the pain, you are getting scared that you may never get your game back.

It is possible to rebuild your body, to have it match your equipment. As I tell my clients, going through a series of Rolfing sessions is like renovating a house. At first, you may think there is only one problem, but as you get into it you realize to go beyond fixing the immediate complaint, you need to rebuild the entire body.

I am going to immediately address the presenting compliant. Usually within three sessions, the complaint that brings you in is improved or resolved. Yet, like house renovation, you see more that you want changed. You start thinking if I feel this good after three sessions, how would I feel after the basic 10 series of sessions.

My goal

I want to get you well so you don’t need me or any other treatments. That said, clients do come back for tune-ups or advance work. They rarely return for the same reasons that brought them to me initially. The elite athletes will come every few months to keep their edge and release that next layer. Most of us don’t push our bodies as much as these women and men so follow-up work is more icing on the cake.

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Thoughts on Research

November 9th, 2010

I have always enjoyed reading research, especially when it supports an idea or belief of mine! Research is the hot discussion topic these days in the Rolfing® community. The problems with research have been well documented. There is a belief that science and research are self correcting and this is how some folks justify a bogus or flawed study.

This past weekend I had the opportunity to talk with some research friends of mine at the University of Washington. It was really interesting and got me thinking….here are some of my thoughts on what I learned:

In all scientific arguments of the modern day, epistemology (the study of truth) can be written as:

TRUTH=BELIEF+EMPIRICAL EVIDENCE.

The meat of the work is twofold:
1) How much empirical evidence is necessary to complete the equation? This differs greatly among people. For some religions, empirical evidence might be scant to non-existent. Science-minded folk often have higher bar for how much empirical evidence is required to justify something. The problem is that in almost all cases you NEVER have enough evidence to fully explain something. It is also very easy to fall into the trap of only finding evidence that supports what you believe.

2) Say 100+ years ago, the meaning of subjectivity and objectivity were reversed (great book by Dalston called Objectivity). Experts with subjective opinions (aka wise men) were the keepers of truth. Then came technology (photography, computers, etc) which effectively gave objectivity the podium. Stated another way, if you can measure something without human intervention, it must be closer to truth. A related point, if you have an explanation for something at a lower level of analysis (e.g. gene expression < genes < neurotransmitter levels < muscle tone < diet) then it should have greater explanatory power. While objective measures are fine, and reductionistic science is helpful at giving fuller explanation to conditions (albeit each level doesn't quite overlap with the next), they rarely (if ever) can put humpty dumpty together again. A further point is that intentional or unintentional human tinkering often colludes study results (e.g. the first study published on a new drug always has greater efficacy than all subsequent studies), making it never quite clear just what was "measured". Perhaps this logic can be illustrated as follows: You are fishing. You begin to reel in a huge fish, only to have it get away. To understand what kind of fish it was, you perform a written survey asking people around what they have caught recently. You also do a sampling of the lake (with fishing nets) to evaluate the current species present. Then you do a sonar sampling, followed by detailed assessment of water from areas where fish breed. This provides a full accounting of past/present/future populations in the lake, allowing you to get very close to understanding the likelihood of what type of fish/size you might have had on your line. You publish this result to much fanfare and all stated results are true, scientifically justified, and rigorous. But there was one problem. It was only a tire. Over-n-out.

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