If Stretching is Out, What is In?

Dr. Stewart McGill, possibly the most regarded expert of spine biomechanics, and professor at the University of Waterloo in Canada, has stated that “static stretching deadens the muscle from a neural perspective – diminishing the stretch reflex and reducing peak strength and power.“ He goes on to state that active warm-ups actually facilitate muscle contraction, and have a positive effect on muscle function. This line of thinking isn’t shocking to anyone who has followed studies published in the Journal of Strength and Conditioning Research, the Journal of Orthopedic and Sports Physical Therapy, Strength and Conditioning Journal, The New England Journal of Medicine, just to name a few, over the past 20 years. Those studies have shown stretching to decrease vertical jump eight, increase 40 yard dash time, decreased single leg stance stability, and have no benefit on decreasing injury rate. One study done by the US military showed that recruits who entered boot camp with the most flexibility for the most likely to get injured and not finished boot camp.

The question is, what should someone do with this information? First, it helps to understand what muscle is, what it does, and why it gets “tight.“

  • Muscle is a contractile tissue.
  • When it contracts, it either stabilizes a joint or causes motion at a joint.
  • When muscles provide stability (like the muscles in your neck or as you read this), there should be equal contraction on all sides of the joint. When muscle contracts to cause motion (like bending your elbow to put food in your mouth), one group of muscles contract concentrically as the opposing muscles contract eccentrically. Notice, none of the muscles RELAX. If the muscle on either side relaxed, or misfired, joint mechanics would suffer, performance would decrease, an injury (acute or chronic) could also occur.
  • Muscles get “tight“ when they don’t to give/receive a normal input with the nervous system. Nerves regulate muscle tension. If a muscle is in a shortened position, and doesn’t have normal regulation from nerve, it will contract and get “tight.“ Things like fatigue, swelling, dehydration, malnutrition, and stretching can cause the nerve/muscle relationship to be impaired.

Second, stop stretching, and know what to do instead.

  • Isometrics help to engage muscle and “reset“ the nervous system input. When you watch a dog or cat wake up and “stretch“, they’re actually doing isometrics to get their muscles firing. Isometrics are easy to do, just think of flexing muscle that feel weak or tight, just like when you wake up.
  • Use an active/dynamic warm-up prior to exercise. This could include a light jog, high knees, lunges, skips, push-ups, crunches, band or dumbbell work, etc. Anything that involves movement in and out of different positions would fall into this category.
  • What about post workout cool downs? Just re-do your warm-up routine.

The take-home message here is that movements that engage muscle will increase range of motion, maximize athletic ability and decrease the risk of injury. This is a much better option than increasing range of motion by forcing muscles to relax, become weak and no longer function normally. So, get moving and leave stretching behind.

Five Reasons Why Yoga is a Great Idea.

At least once a week we have a patient ask if yoga would be a good idea to help reinforce what we do with The One80 System. They always seem surprised when we would say, “you bet!“ Most people think that yoga is synonymous with stretching, and since we recommend patients avoid stretching, yoga must also be a no-no. It is important to understand that stretching is forcing a muscle to passively lengthen. On the other hand, yoga (we are talking more specifically about flow or power practices like Vinyasa, Hotha, Asthanga and Bikram) is great because it;

  1. requires muscles to contract globally – in order to stabilize the upper extremities during warrior pose, the trunk and lower extremity musculature has to be facilitated. This makes yoga a great total body functional workout.
  2. is a multi joint exercises done in weight-bearing anytime you can load and unload multiple joints simultaneously, you are reinforcing functional patterns.
  3. requires a-planer motion – moving through more than one plane at a time, with emphasis on the transverse plane, will help decrease future injury.
  4. requires the student to get in and out of end range of motion positions – this increases range of motion, builds strength and maximizes stability (review our blog post on MoStreBility), while decreasing flexibility. That means function is increased and the risk of injury is diminished.
  5. they are portable – at One80 we like prescribing home programs that can easily be done with minimal equipment, space and time involved. Yoga is great because you can do short versions of your practice while on vacation, during business trips, or on off days at home as a recovery work out.

As with any type of exercise, the effectiveness of your yoga practice will depend on your studio, instructor and motor control. With The One80 System, we can help you maximize the your stability, proprioception, strength and biomechanics. If you need advice on where to go to find a great studio and instructor, we can probably help with that too.

5 Reasons Why Dry Needling is… Something We Don’t Use at One80.

Many patients who are new to The One80 System have tried trigger point dry needling treatments with little to no success. Others ask why we don’t offer it. Here are 5 reasons that address both situations.

1. Experts don’t know what trigger point dry needling (TDN) treats.

PTs and chiropractors that use TDN claim to be treating “trigger points.” A common definition for a trigger point is, “a hard and/or tender part of a muscle where the fibers are balled together causing local or referred pain.” This is actually different than a “tight muscle” where the length of the muscle belly is shortened. The problem is, although the theory behind trigger points has existed since the 80’s, not even the “experts” have been able to tell exactly what they are, what causes them, or if they really exist. If they don’t exist, or if we can’t find or clearly define them, how and why are people sticking needles in them?

2. Nobody agrees on what it does.

Speculation runs rampant on what actually happens when needles are stuck into muscles. Hypotheses suggest that needling techniques; stimulate fibers, may activate inhibitory interneurons, causes opioid mediated pain suppression, activate inhibitory systems to block noxious stimulus, disperse the excessive ACh in the tissue to relax muscle fibers, enhances the release of ACh from nerve terminals, cause micro-trauma and bleeding/inflammation to help promote healing, results in increased ACh receptors at the neuromuscular junction, releases various chemicals at the motor end plate… Does that sound like a treatment strategy or a guessing game?

3. Research has shown little to no efficacy.

Although a Google search will uncover plenty of case studies and testimonials claiming miraculous results with TDN, published studies differ. A systematic review of the literature with meta-analysis published in Physiotherapy in 2017 concluded that, “There is very low evidence to support the use of TDN in the shoulder region for treating patients with upper extremity pain or dysfunction.”

4. Let’s pretend we knew trigger points existed, knew how to find them, knew exactly what they were, knew what caused them, and we also could prove at the physiological level that TDN decrease pain and cause muscles to relax… would masking pain and forcing muscle relaxation be good?

Remember, at One80 we NEVER mask pain (that is what tells us there is a problem somewhere) and we NEVER force muscles to relax (because muscle can’t function normally when forced to relax). So, even if TDN did what clinicians claim it does, it would not address or reverse the root cause of your problem.

5. If the entire TDN thing is bogus, why does every PT clinic other than One80 do it? It all comes down to the equation TDN = $$$. Here is a line from a blog written by a clinician who works for one of the biggest providers in the TDN continuing education realm. “…while there is a paucity of evidence, TDN probably works in some instances-likely more to “meaning effect” and placebo than anything else, which of course is fine…” That’s right, even the experts in the TDN world know its nothing more than placebo. But, if PTs want to shell out thousands of dollars to learn it, and referring physicians want patients to get it, and patients will pay for it, does it really matter that patients don’t know any better? We think it does, and that’s why we don’t offer it.

Learn more about The One80 System, why it works, and how it is different, and earn FREE CEUs at http://promo.theone80system.com/videoseries

Taping Away the Pain, A Sticky Issue

Therapeutic tape has a long history in the world of physical therapy. In the 80’s and 90’s it was more commonly called McConnell tape. This tape was popular in the treatment of painful joints that were deemed weak and unstable, mostly knees and shoulders. The downfall of McConnell tape was two fold. First, it was proven bogus by many studies that showed that bones (patellas, scapulas, vertebra, etc.) could not be moved or held in place by tape. Second, and somehow more significant, it was uncomfortable, ugly and lacked a catchy name.

Fast forward to the marketing savvy 21st century, and tape is back! But, this time, its biggest limiting factors have been remedied. Now tape is colorful, comfortable and has cool names like “kinesio tape”, “rock tape” and “spider tape”. Along with the new look, the new tape now claims to improve performance, decrease swelling, remove lymph, reduce injury, and even re-educate nerves. As for any clinical proof for the old and new claims, that remains to be seen. But, who needs that when Olympic and professional athletes use it?

So what does tape really do and why to physical therapists, athletic trainers, chiropractors, physicians and coaches deem it so useful? To answer the first question, tape, especially when applied in a manor that wrinkles or pulls on skin, stimulates proprioceptors. These microscopic mechanisms include Merkel’s disks, Meissner’s corpuscles, Pacinian corpuscles and Ruffini endings. When these receptors are stimulated by tape (or braces, wraps, tights and/or sleeves), they override the pain response so you feel the tactile stimulus instead. As for the reason why it is used by health care professionals, it is a combination of falling for the latest trend, focusing treatment on pain relief instead of function, and marketing.

Unfortunately for patients, there have been many gimmicks over the recent years (tape, needling, shoe inserts, lotions, machines, etc.) that the medical “experts” have allowed to take over their practices. If all you want is symptom modification, don’t waste your time at physical therapy or the chiropractor. You can buy kinesio tape, braces, lotions, shoe inserts and many other gimmicks at your local sporting goods or grocery store. If you really want to recover from an injury, or prevent one, find an expert that identify and treat the root cause of your symptoms, rather than just cover them up.

Why MoStreBility Beats Flexibility and Mobility.

Over the past several years, the term “mobility” has become very popular in the exercise community. When it comes to pre-exercise warm-ups, the new and cool “mobility work” (based on foam rolling), has even come to rival the old-school standard of stretching. Although one term his hip, and the other is an old standard, they both shoot for the same results, more joint motion caused by less muscle contraction. Let’s take a look at the definitions of terms that mobility is based on, stretching, flexibility and mobility.

  • Stretching – according to one of the biggest publishers of human performance books, “The goal of a static stretching is to overcome the stretch reflex in order to coax a joint into a wider range of motion.”
  • Flexibility – defined by Gummerson as “the absolute range of movement in a joint or series of joints that is attainable in a momentary effort with the help of a partner or piece of equipment.”
  • Mobility – the ability to move or be moved freely and easily.

What should set off alarms to anyone in the medical and/or human performance field when reading the above is the use of the phrases “overcome the stretch reflex,” “coax a joint into a wider range of motion,” “absolute range of movement,” “with the help of a partner or piece of equipment,” and “moved freely and passively.”

As a professional that helps patients recover from and avoid injury, I understand that all joint movement should be a byproduct of normal neuromuscular facilitation, muscle should be reactive and resist external forces, the stretch reflex is a healthy protective mechanism, absolute range of motion should be dictated by joint stability and strength, forcing muscles to give into external forces provided by partners or equipment is dangerous, and joints that move freely and easily eventually break down.

Because they conventional medical model continues to follow the mantras above, The One80 System has developed a unique alternative,

Motion + Strength + Stability = MoStreBility.

See if the following sounds like a healthier and wiser replacement for flexability and mobility;

  • Motion – a change in position of an object over a period of time.
  • Strength – inherit capacity to manifest energy, to endure, and to resist.
  • Stability – the strength to stand or endure, a condition of equilibrium or study motion, to develop forces or moments that restore original condition.

When we combine these, we get to controlled motion over a period of time, while resisting external forces, storing of energy, and the ability to endure an event or restore the original condition. That is why MoStreBility is more effective and safer than flexibility and mobility, and is always the goal of The One80 System.

One80 System Overview Part 1

Work Place Injury, Prevention is the Key.

Most of a typical person’s day is spent at work. It should be no surprise that a good portion of the patients we see at One80 are coming to us due to job related injuries. Just like athletes who do active warm ups prior to exercise and use proper equipment in order to minimize the risk of injury, everyone should be preparing themselves for the activities of work.

Work related injury can range from a stiff neck due to poor ergonomics, a lumbar disc injury from lifting a heavy box, foot pain from improper shoe wear, or shoulder pain from repetitive reaching. Just by changing a few things, like your desk set up, doing a pre-work warm up, assessing footwear, and learning proper body mechanics, you can decrease the chances of a work-related injury.

Assess your workstation

Follow these tips to decrease the likelihood of cervical issues, thoracic outlet syndrome and carpal tunnel problems.

Keyboard: Place the keyboard directly in front of you, your arms should hang comfortably and your elbows should be at a 90 degree angle. Adjust the slope of the keyboard so that your forearms, wrists and hands feel comfortable, and avoid resting on hard edges.

Mouse: Make sure the mouse is located immediately to the right or left of your keyboard. Use a mouse that fits well in your hand.

Monitor: The middle of the screen should be at eye level and directly in front of you so there is no need to turn your head. The monitor should be approximately two feet away from you. If you find yourself leaning forward or backwards, you may need to check your eyesight.

Sitting vs standing: Standing desks and workstations have become very popular recently. We are big fans of using both a sitting and standing workstation in order to change position throughout the day. If you don’t have a standing option, try to get up every 15-20 and take a short walk around your work area. Spending some of your workday sitting on a physioball is another great way to put your body in a different position and engage different muscles.

Heavy duty

If your job involves lifting, pushing, pulling, reaching, squatting or maybe even throwing, there are a few things you should due to avoid injury:

Are strong enough for the job? Employers usually give a baseline assessment to new hires in order to make sure they can tolerate the job. This doesn’t mean you are in great shape, it just means you meet minimum requirements. Employers would be smart to include a gym membership or an onsite work out area with some type of exercise education in order prevent on the job injury.

Use a daily warm up routine. Once again, a savvy employer would integrate an active total body warm up into the work day. In as little as 10 minutes, many workman’s compensation claims could be eliminated. This plan would also educate employees on the dangers of stretching, foam rolling, massage, etc.
Report injuries immediately. The faster you assess and treat an injury, the faster you can recover. Having either an onsite medical professional (PT, ATC, MD) or one close by that your company contracts with, can make the difference in missing a week or a month of work.

Break it up. Try to avoid doing the same task repetitively or sitting in one position all day. Take a quick break to do a functional movement pattern or take a short walk. No time? No room? No clue what a functional movement pattern is? Ask One80, we can show you that you do have time, you do have room, and the exercises are easier than you think.

As you can see, some easy preventative ideas can keep employees and employers from falling into the workman’s compensation rut. If you’d like One80 to help your company design a specific prevention plan or provide rehabilitation services, give us a call and add us to your team. As always, “Think Different. Live Well.”

What is MoStreBility [mō-stru-bility]?

One of my favorite things to talk about is MoStreBility because it has so much to do with what we do as physical therapists, coaches, trainers, and professionals throughout the medical community.  Before we get too far, let’s first take apart the pieces of MoStreBility, which are motion, strength, and stability.

Motion – The ability of a joint to experience full motion, actively, both with and without load, in a functional plane (a-planar).  We want our athletes and patients, healthy or injured, to obtain full, active, functional range of motion. Be careful when talking about motion, it is NOT synonymous with “flexibility.” Stay tuned for the pitfalls of flexibility in a future blog.

Strength – Strength is what gets us in and out of the end range of motion.  It’s what produces the power for us to do work at our highest level of performance. It is what gives our joints stability allowing them to function efficiently and avoid breakdown. One huge component of strength that many people, including medical and performance experts, forget about is that: strength (more specifically neuromuscular facilitation) is what allows normal joint motion. When people say, “I need to get my motion back,” they forget that motion is directly dependent on strength.

Stability – This is the ability to move from one position to another, under a load, without a loss of strength or reduction in performance. A stable joint will neither move too much (hypermobile) or too little (hypomobile).  We want joints to go through full range of motion, with normal tension (supplied by muscle) so unnecessary tension, compression and shear are not being transferred to tissue such as a ligament, cartilage, or bone.

So, motion + strength + stability is MoStreBility.  And if you have MoStreBility, your chances of being injured are little, your chances of recovering from an injury are much greater, and your performance level increases.  Without MoStreBility, you may have motion, but you don’t have the strength or the stability to make that motion safe. Let’s look at an example of a runner who’s healthy, but has some hip pain.

After performing a functional screen, we conclude that a patient doesn’t have enough internal hip rotation.  If we’re just looking for motion, we can simply stretch the hip rotators by using external pressure to force joint motion. We could also find the “tight” muscles that are limiting motion and massage or foam roll them. Both of these scenarios will get us motion. But what did we sacrifice to get that motion?  We sacrificed strength, and we sacrificed stability.  The patient then runs a 5-10K with great range of motion, poor strength, and poor stability. What’s going to happen? Decreased performance, increased risk of injury, and joint breakdown.

After the run, they will most likely say something like, “I felt good for a while, but now my hip is really tight and hurts even more.” If we don’t know any better, we give them another massage, send them home with a handout of 5 pre-run stretches, and sell them a foam roller. Eventually they stop running, continue to run with pain, or find someone who understands MoStreBility.