In the first part of my blog entries about pain, I wrote about pain and how much is too much versus how much is to be expected. Basically, laying out the guidelines to figure out if the pain you are experiencing is “normal” or if it requires treatment.
This part is about myofascial pain and stretching.
Stretching does Not Help Prevent Injuries:
The best way to avoid myofascial and/or musculoskeletal pain is to no injure yourself. At my Portland Brazilian jiu jitsu gym, Straight Blast Gym, I find many people stretching for various reasons and in various ways. Static stretching, dynamic stretching and even stretching with a buddy occurs in gyms everywhere. Why?
Often, when asked, people respond by stating that it keeps them from getting injured. Well, there is little to know research evidence that suggests this is the case; in fact, there is quite a bit of evidence suggesting that stretching (depending on the type of stretching), can actually pre-dispose you to GETTING INJURED.
Rather than writing a very opinionated post about stretching, I decided to grab some convincing research evidence to back my claims:
Effect of stretching on sport injury risk: a review: This review paper surveyed research from 1966 to 2002 and found no statistically-significant link between stretching and a reduction of injury risk.
Stretching before exercise does not reduce the risk of local muscle injury: a critical review of the clinical and basic science literature: This study (another literature review) did a more comprehensive search and still found no link between stretching and decreased injury risk.
A randomized trial of preexercise stretching for prevention of lower-limb injury: This was a very well-designed study that found no reduction of injury in study participants who performed a pre-exercise stretching routine.
There are so many research papers on this topic, none seem to clearly link stretching to decreased injury.
Stretching to Reduce Pain:
Another reason people often cite when asked why they stretch is because it reduces pain for them before and after exercise or activity. Well, this may be true is they are performing active “stretches” or what I like to call self-mobilizations (more on this in a bit, it has to do with joint motion, not muscle length), it probably has no real effect on pain at all.
Again, the evidence for this is overwhelming, I have picked out a few studies to illustrate my point:
Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review; this study showed no significant decrease in soreness with stretching before or after exercise.
The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise: This study also showed stretching has no effect on pain when performed before an activity.
Stretching to prevent or reduce muscle soreness after exercise: And yet another one that showed no reduction in soreness in those who stretched before and/or after activity.
Warm-up, Not Stretching:
OK, so many people stretch as part of a warm-up. The evidence is clear about stretching; skip it, but DO perform a warm up. Here is some evidence showing that warming up can help prevent injury although it probably still does not prevent soreness or pain.
Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial: Although the original premise that warming up would prevent lower extremity injuries was not proven; warming up does seem to reduce the risk of severe injuries and overall injuries.
Compliance with a comprehensive warm-up programme to prevent injuries in youth football: Here’s another study that showed a reduced risk of injury when young athletes perform a warm-up.
Again, skip the stretching but perform a warm-up; I’ll touch on my warm-up recommendation at the end.
Stretching and Trigger Points:
I have even heard that massage therapists, trainers and other health care providers are telling their clients/patients that stretching reduces the risk of developing myofascial trigger points. There really is no evidence for this idea; I think the idea came from (erroneously) the Travell and Simons trigger point books. I further believe it came from this part of the books; Simons et al. Myofascial Pain and Dysfunction, pp127–135.
Travell and Simons’ well-documented “spray and stretch” method seems to be promoting stretching for the treatment and eradication of myofascial trigger points. The point of the vapocoolant spray is to “distract” the nervous system from the pain of stretching a muscle that is both dysfunctional and painful because it is riddled with trigger points. These book go on to further suggest (possibly true) that myofascial trigger points have both small patches of hypercontracted muscle fibers (trigger points) and long stretches of fibers that are overextended. Without the spray, muscles in this predicament may contract defensively if stretched. Interestingly, Travell and Simons do not recommend stretching trigger points without the spray.
Stretching and Pain (Soreness):
So, does stretching help to reduce soreness from activity and exercise? No.
I have seen many patients with myofascial pain, trigger points and other musculoskeletal pain syndromes; stretching is rarely something I recommend. Here is some evidence supporting my stance on the matter; at the end of this post, I will write about my recommendations for warming up and self mobilizations:
Stretching to prevent or reduce muscle soreness after exercise: Stretching does not reduce muscle soreness after exercise…. sorry.
Warm-up and Self-Mobilizations:
The common thread here is that static stretching does not decrease activity-related pain. What does? Well, a good warm up and some mobility exercises. Here are areas of your body that really need optimal movement and mobility:
- Thoracic spine
If you tend to have joints that are mobile or hypermobile…. you don’t need to worry about mobilizations and PLEASE DON’T STRETCH. How do you know which of these areas you need to focus on? Well, if you have a history of low back or knee pain; you should focus on your thoracic spine (upper back), hips and ankles. If you’ve had a lot of shoulder injuries or neck pain, focus on your thoracic spine, shoulder and hips. Stay tuned to my new website:
In the months to come, I will be posting both free and paid lessons on this topic and more.
Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
As a Chiropractor and educator in Portland, Oregon, I see patients with pain of all types and intensities; I also lecture on myofascial pain and mechanical pain (low back, shoulder, neck, etc.). A subject that recently came up with both my students, interns and colleagues is, how much pain is OK?
Can you answer this? How about your medical doctor, naturopath, chiropractor, physical therapist? I was playing devil’s advocate with some interns in my teaching shift at NCNM and I asked them,
“Should we be treating every little ache and pain our patients have and if so, is this teaching them to be hypersensitive?”
In addition, what impact does this have on their pain coping mechanisms, both internal and external? I believe it gives the message that any and all pain is bad and makes patients much more likely to overuse pain medications. There has been some speculation amongst researchers and clinicians (doctors and therapists) alike that we are conditioning ourselves to be in pain. By taking pain medication and other remedies every time we feel, even the slightest pain, we may be conditioning our nervous system to SENSE PAIN ALL THE TIME.
Now most know that in my Portland chiropractic, nutrition, myofascial therapies and functional movement clinic, Optimum Function, I often treat patients to improve function instead of treating pain. The simple fact is, we have to help patients with their pain because often, that is why they are coming in; the unanswered question is, how much is OK?
I have been training in Brazilian Jiu Jitsu (BJJ) in Portland at Straight Blast Gym for almost a year now and recently, been training harder . We have some fighters going to the worlds at the end of this month and our competition team has been going at it in practice. This past Friday, my back just couldn’t take the pace and today, it’s hard for me to move around, in fact, writing this is painful as sitting seems to be the offending position. Is this OK? Well, in my opinion, it is…. let me explain.
I overdid it, I kept playing in people’s guards and they kept trying to break down my posture, the is the game of BJJ. I should have known better, my back has been feeling tired after practices for 2 weeks, I should have modified my game. Now I am in pain, I didn’t damage anything, just some minor strains and sprains but in an area that is fairly crucial to functional movement and one that is affected by just about any position I put myself in. I have no doubt, that in 2-3 days, I will be back to 100%
Why am I writing this? Because I am planning on doing a more in-depth article series on the topic and will use this information to help educate my patients and students on this topic so we don’t over focus on normal, physiologically-beneficial pain.
Stay Tuned…. feel free to leave a comment, maybe I’ll use it in the articles to come on this topic.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Well, I just finished another site www.OptimumHealthEducation.com
Optimum Health Education is your source for Health, nutrition and functional fitness online classes and resources. In the near future, I will be posting classes about vitamins and minerals, nutrition for MMA and other sports, daily mobility exercises, daily stability exercises, healthy eating and more. All classes will be college-level presentations; what this means is that I will be presenting them in the same quality as I do in the college and university classes that I teach. Anyone will be able to take these classes, no matter what your current educational level is; the only requirement is that you have a passion and desire to learn more about health, nutrition and functional fitness
Are you a health care provider? If so, Optimum Health Education will be for you too! May of 2012, I will be launching a class about internet marketing for health care providers. For more information, click here: Blog Post || Optimum Health Education; Internet Marketing ClassYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
OK, for the last 12 years, I have been learning and applying fascial techniques, myofascial release, Fascial Manipulation©, trigger point dry needling, chiropractic adjusting and mobilization, instrument-assisted soft tissue techniques (like Graston© therapy) and more in unique ways to restore movement, stability and dynamic physical health.
This year (2012), I am dedicating my clinical practice to further develop a system to use these myofascial techniques and more and will work on developing a curriculum to teach this system so no matter what fascial technique you use, you can use them more efficiently and effectively. I have decided to call it Fascial-Applied Soft-Tissue TherapySM or F.A.S.T. TherapySM.
In fact, I am in the process of developing an adjunct tool to be utilized for various fascial therapies. I have been developing this tool for a while and it is going to blow the doors off of everything else out there….. stay tuned for F.A.S.T. TherapySM and the F.A.S.T. Therapy ToolSMYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Having just finished the final course to become certified in Fascial Manipulation©, I figured I’d post a web page about it on my site Optimum Function: Portland Chiropractic and Nutrition.
I am VERY excited about this technique, please click on the following to go directly to the page I have devoted to Fascial Manipulation : Portland Fascial ManipulationYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health