If stretching is the answer, then what is the question? I used to believe that treating musculoskeletal conditions was simple; strengthen what is weak and stretch what is tight. The biopsychosocial model has however proven it is not so straightforward to manage pain. But what does the evidence suggest when it comes to flexibility? Is stretching still the gold standard?
I have come to realise through my time as a Physio that “the more you know, the less you understand” couldn’t be truer. By trying to find an answer to a particular topic, time and again I have ended up with more questions than when I started. Due to the vast evidence base and widely split opinions on treatment, finding the ‘answer’ can be difficult. My aim throughout my blogs is to summarise the best up-to-date evidence to determine if static stretching is still relevant in our practice.
When I was a student, social media wasn’t used for healthcare as heavily as it is now. This meant that there was not the guidance from other clinicians highlighting what the current evidence suggests. Keeping up with the most recent and high-quality evidence was therefore a lot harder than it is now. As a result, my initial practice was shaped from previous clinical educators on placement – if their practice was outdated, then so was mine.
Upon qualifying, I therefore had my first experience of ‘Imposter syndrome’ when my new colleagues questioned my ancient methods. Since then, I have strived to keep up to date to avoid becoming a ‘dinosaur physiotherapist’.
Despite only qualifying 4 years ago, stretches at that time still appeared to be a popular treatment method. They were used to help manage pain, improve flexibility and even prepare the body for activity (Hartig and Henderson 1999). It wasn’t until recently where they have come under more scrutiny. They are still regularly used by clinicians, however there appears to be more and more studies questioning its effects. Are they beneficial in reducing pain? Do they help to prevent injury? How effective are they at improving flexibility?
As a newly qualified physio, a large focus of my assessment was observing for abnormalities in posture, looking for what might be tight in order to locate what I believed to be causing the patients pain. Recent evidence however suggests that posture isn’t as important as previously thought in relation to pain (Slater et al 2019).
I first started questioning the effectiveness of stretching in my own practice when upon re-assessment, patients would demonstrate an improvement in muscle length but no change in symptoms. I also had patients returning to see me with an increase in their symptoms following advice to stretch. Based on this, what exactly was the role of stretching in my treatment plan and what are they trying to achieve?
Since then, I have had a particular interest in stretching as a form of treatment. Our time as Physiotherapists is precious, especially working within the time constraints of the NHS. Our patients also understandably want to be better as quickly as possible. Are stretches worth investing in or are they only lengthening the time to recovery?
Keep up to date with my blog, where I will look to collate the evidence to determine whether stretches should be a thing of the past, or if they still have a role to play in our practice.
References:
Hartig, D and Henderson, J. Increasing hamstrings flexibility decreases lower extremity overuse injuries in Military Basic Trainees. American Journal of Sports Medicine, [online] 27 (2), pages 173–176. Available at https://journals.sagepub.com/doi/abs/10.1177/03635465990270021001. [accessed 20th November 2019].
Slater, D et al 2019. “Sit up straight”: Time to Re-evaluate. Journal of orthopaedic and sports physical therapy, 49 (8), pp562-564.
Images:
McGuire, R (2019). Stretching Sports Woman. [online]. [Accessed 10th November 2019]. Available from: https://www.needpix.com/photo/260409/stretching-sports-woman-athlete-fitness-sport-healthy-exercise-workout.
Wintecare, S (2018). T-rex physio at the European championships. [online]. [accessed 12th January 2020]. Available from: https://www.youtube.com/watch?v=1-Av4Dq6gdM
Peter Thomason Physiotherapy Blog 