To Stretch or Not to Stretch: That is the Question – Part II
Hmm…Should I stretch or not?
Welcome back for another exciting week of fitness talk! This week I delve even further into the fascinating topic of stretching, and a discussion of whether or not you should do it. I will also get into some thoughts on performing an assessment, and whether or not professionals in the fitness world should be prescribing stretches to all of their clients.
Once again, whether you love to stretch or hate to stretch, keep reading! You’re bound to learn a thing or two (unless you’re smarter than me and already know it all :p).
Last week I began a two part series on stretching, entitled, “To Stretch or Not to Stretch: That is the Question – Part I.” In that article, I gave an overview of some popular forms of stretching and discussed their pros and cons.
I also began a discussion which I will pick up this week on how to know whether or not you should be stretching, and if you’re a fitness or healthcare professional, whether or not you should be prescribing stretches for your clients.
First, I want to take a look at something very important that you should do before you start stretching or prescribing stretches for your clients, and that is…assess.
If you’re not assessing, you’re just guessing at what is needed in a program. Starting off with a thorough assessment will ensure that you are giving yourself, or each one of your clients what is needed, and not just a cookie-cutter program that is given to everyone indiscriminately.
Of course, this is true of every aspect of an exercise program, but especially when it comes to stretching. Unfortunately, there are too many trainers out there who simply prescribe the same blanket stretches for all of their clients regardless of whether or not they actually need them. The problem with this is twofold:
Not everyone will benefit from the same stretches that someone else would.
Even worse, some people will be put at a greater risk of injury by doing those stretches because their body is not suited for those stretches.
At the same time, there are many people out there who feel like the cure to all their aches and pains is more stretching. The downside to this is that without an assessment of whether or not they actually need to stretch, they could be doing more harm than good to themselves.
So to start off this week’s post, let’s dive into a discussion on how to perform an assessment before you prescribe or start any kind of stretching program. After that, I’ll discuss some strategies for getting each person what they need as far as flexibility and mobility are concerned.
Assessing for Range of Motion and Flexibility
For the health and fitness professional, the first step to any well thought out and designed exercise program is a thorough assessment. This means that you are not only looking at different biometric and fitness measurements, but actually having a conversation with your client, getting to know them, and finding out their background and injury history.
Part of the assessment that I go through with each of my clients is an overview of how they move their body. Without getting too complicated by going into specific postural or movement compensations, it is important to simply determine where each person lies on the scale of mobility and stability.
To do this, I use several different means of assessment.
Now, I am not a physical therapist, nor do I play one on TV. So, when I do my assessment, I am not going to go into specific provocative tests, or try to diagnose anything. Instead, I am looking for general movement ability and screening for any pain during movement. I am also looking for any movement compensations that may lead to pain down the road.
To do this, I usually start by looking at larger functional movements which involve multiple joints and muscles. If I see a limitation in these movements, then I will go into some more specific tests to find out what is causing that limited movement.
Sometimes a limitation in movement is caused by mobility restrictions, but other times it can be caused by a deficit in strength and stability. At this point, it is a bit short-sighted to pin the limitation on one or the other. That’s why a functional screen such as an overhead squat can be useful, but if someone is limited in this, it doesn’t necessarily mean they just need to stretch more.
So, what are some ways to look at larger functional movements? Well, the Functional Movement Screen (FMS) is a great place to start.
This screen was designed to look at seven functional movements, and to give objective feedback on movement compensations, side to side asymmetries, and an individual’s balance between mobility and stability during movement.
Take a look at this video to see how the screen is performed and scored.
If there is a compensation or inability to perform one of the movements in the screen, then we need to break it down and determine if it is more tied to mobility or stability deficits, and where the compensation is originating from.
Of course, the FMS isn’t the only way to look at movement, but it is an easy standardized assessment of movement ability.
Another easy yet effective assessment is the Overhead Lunge Walk.
This is a great catch-all assessment as it takes into consideration mobility and stability requirements at a lot of joints. For example, if someone cannot get his/her arms all the way overhead, then you know there is some limitation in shoulder flexion range of motion.
Additionally, you can see compensations at the core and lumbar spine if they go into hyperextension at the low back. On the other hand, if they are able to remain in a stable and neutral position at the lower back, then core stability is not an issue in that movement.
From these general movement assessments, I now have an idea of what some specific limitations in movement may be for my client. If I want to dig deeper into a specific area of the body to look for restrictions in mobility, then I can move to some more specific range of motion tests.
Very simply, if I test range of motion at the joint in question and it’s adequate, then simply stretching the muscles around that joint is probably not the answer. I’m not going to spend time trying to fix something that isn’t broken.
However, if I determine that there is no restriction in range of motion at the joint, but there is still a limitation in overall movement, then it is a good bet that that person needs more stability and strength within their current range of motion to unlock that movement.
So to wrap up assessing for flexibility, it is important to look at large functional movements as well as movement at specific joints. You may find that some people are limited in range of motion because they have tight muscles. In this case, it is probably OK to stretch them, as long as they are not put into bad positions during stretching.
However, just because someone has tight muscles, doesn’t necessarily mean they have short muscles. Stretching is designed to add length to the muscle, but just because a muscle is tight, doesn’t automatically mean it’s short. Keep reading to find out some other strategies for managing tight muscles!
On the other hand, you will see some people who are very flexible, but are still unable to perform functional movements adequately. Often, this is not a case where they need to stretch, they just need more strength and stability to allow them to access their full range of motion.
Assessing and Managing Joint Hypermobility
Another thing that you will find in certain populations is not just excessive flexibility, but also excessive joint hypermobility. This is something that can be advantageous for certain populations, such as gymnasts, dancers, or even baseball players, who use this extreme range of motion to be successful in their sport.
But, while it is a blessing for some, it can also be a curse. Joint hypermobility leads to instability at the joints, which can cause a higher risk for injuries. I referenced this in last week’s post, but I’ll say it again: stretching someone who has hypermobile joints is not a good idea. Doing so can take someone who is at risk for injury and increase that risk.
So, how do you know if you have hypermobile joints? A good assessment is the Beighton Hypermobility Score:
The first test to determine hypermobility is the palms flat on the floor test. Many people view it as a positive sign of good flexibility if they can get their palms flat on the floor, but as you saw in the video, a positive score on this and the other tests in the screen actually puts people at a higher risk for injury. Not such a good thing after all!
Something else that I mentioned last week, was the fact that many people who have hypermobile joints actually feel tight all the time. That’s why they constantly want to stretch! But this feeling of tightness is more so due to their muscles holding tension to make up for the unstable joints, rather than true shortness.
To deal with this, there are two main strategies that can be extremely helpful. The first is to use soft tissue massage to relieve excessive tension. This can be done by a massage therapist, instrument assisted soft-tissue mobilization, or by simply grabbing a foam roller or lacrosse ball and performing self-massage.
Here is a quick video demonstrating a good foam rolling circuit that can be used to relieve tension in tight muscles.
This can be done as part of your warm-up, or just in general to relieve stiffness. However, once the tension is relieved, you’re not done. The problem that created that tension in the first place has to be resolved, or it will simply come back.
In the case of someone who has hypermobile joints, the solution is to provide strength and stability to the muscles around the joints. This can be done with some good old-fashioned progressive resistance training, provided that the exercises are taught and performed properly.
Another reason why excessive tension can be present in the muscles is due to poor postural alignment. Although I won’t spend much time on this one, the bottom line is this: fix the posture, and the muscles won’t have to work overtime to prevent injury to the joints.
You can stretch the muscles all you want, but if you have inadequate stability or poor postural alignment, that isn’t going to fix the problem. In this case, stretching will just be like taking a pain reliever. It covers up the symptoms for a bit, but does nothing to solve the underlying cause of the pain.
So, Wait…Should I Stretch?
By now, you’re probably just wondering if you should stretch or not. Whether it’s for yourself or for your clients, you’ll be a lot better off if you take the time to perform some of these assessments prior to answering that question.
If you’re someone who gets all 1’s or 2’s on the Functional Movement Screen, has limited joint ranges of motion, and is not hypermobile, then stretching may not be a bad idea. However, static stretching alone may not be enough.
In many cases some foam rolling or other soft-tissue work will make a big difference in your mobility. Additionally, before each workout you should be performing some dynamic stretching and mobility work for the muscles and joints that are limited. This will allow you to move the muscles and joints through a large, functional range of motion, as well as build in some balance and stability where it is needed.
If you are still very limited in range of motion, then some regular static stretching on off days or after your workout may be helpful to increase range of motion long-term.
On the other hand, if you are someone who is already very flexible, and even hypermobile, you don’t need more stretching. In fact, even if you feel tight, stretching will likely make that tightness even worse in the long run.
In this case, you should still perform a certain amount of soft-tissue massage to relieve excessive tension. You should also perform dynamic stretching and mobility drills prior to your workout, but only if they are done without irritating already unstable joints by going into hyperextension and locking out on the joints.
Building in more stability and strength will ultimately help stabilize your joints, so the more time spent performing strength and stability exercises, and the less time spent stretching, the better.
The bottom line is that stretching is not inherently bad, but like most other things in the fitness world, it depends on the context. A thorough assessment should take place before you jump into stretching because you feel tight.
And if you’re a fitness or healthcare professional, you need to know the dangers of stretching those clients that are already hypermobile. You should be able to assess for this and prescribe the right exercise and flexibility routine for each client.
I hope this two part series on stretching has helped you learn a little bit more about whether or not you or your clients should be doing a lot of stretching. It tends to be overprescribed in some cases, so make sure that you are a candidate for stretching before you begin a stretching routine or randomly give stretches to all of your clients.
This will help you move better and feel better in the long-run.