Stretching the marionette

Many of us, myself included, were raised in a sporting environment that emphasized stretching.  As a distance runner, I was routinely advised to stretch for 1/2 hour or more prior to running every day.  Unfortunately, many continue to repeat what they were taught and never question the status quo. There is a wealth of evidence that suggests static stretching can rob us of performance, although I do acknowledge some degree of tissue extensibility/mobility is necessary.

Liars! Changing the length of my strings makes things harder.

Those who treat runners know motor control (stability) is often an issue, particularly in the frontal and transverse planes.  Recently I saw the most under-controlled runner I’ve seen in a long time.  After an evaluation, corrective strategy, and conversation we reassessed and saw a nice improvement in symptoms and movement quality.  We discussed the future course of care and home exercise prescription and were about to part ways when…. the patient asked me what stretches he should add to the 2 exercises I just taught him.  Maybe I did the world’s worst job communicating what I thought the problem and potential solution were, but I suspect I was just up against an insurmountable preconceived notion.  Stretching is not a panacea solution.  It is also not a necessity for all activities, in particular running.  See NY Times Article: Reasons Not to Stretch.

There is also abundant evidence questioning the value and timing of static stretching.  A random selection, in no particular order:

I understand that handing out copies of the NY Times article or giving patients research citations, abstracts, or even full text articles isn’t a solution to the problem.  Further, in the current healthcare setting time and efficiency is often a key factor in clinical treatment.  So how do we effectively communicate this idea that stretching may impede performance as clearly and succinctly as possible?

Here’s one way I’ve had success.  I recommend you judge your successful communication by the change in facial expression (shocked), demeanor (surprised and curious), and the light bulb appearing above your patient/clients head.   

The way you move is coordinated in the subconscious portion of your brain.  This is done based on feedback regarding length and tension.  Changing your length and tension by stretching just before you run is like changing the length of the strings on a marionette just before the puppeteer takes the stage.  The performance will suffer.

I’m not sure why this analogy works better than all others I’ve tried, but it seems to.  Perhaps it’s the image of the clumsy puppeteer?  Maybe it’s the non-threatening nature of the analogy as it doesn’t directly compete with what so many ‘experts’ have told the athlete before?  Either way, it seems to be a way for people to grasp a complex concept that is often in opposition of their existing beliefs.

 

This conversation often continues into why they feel ‘tight’.  Here’s a nice recap of Professor Janda’s thoughts by Craig Liebenson, DC.

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Do I need orthotics or special running shoes???

An age old question from so many runners, walkers, athletes, and those who work on their feet.  In hopes of catching the blog up, this along with others, will be old posts that I often find myself discussing with patients and colleagues.

Read NY Times Blog Post below:

http://well.blogs.nytimes.com/2010/07/21/phys-ed-do-certain-types-of-sneakers-prevent-injuries/

While not a definitive study, it appears to have debunked the idea that so many people need ‘motion control’ shoes due to foot problems.  The original idea was that a ‘motion control shoe’ reduces pronation and would subsequently reduce injury in those pronators who wear them.  I suspect that more often pronation is the end-result of another issue  and should not be our main focus.  While in a small number of cases pronation may be solely a foot issue, it is likely that it is the result of a problem farther up the chain (most likely the hip; with delayed onset or weakness of the gluteus medius or lateral rotators).  My estimation is that as we fix pronation with a ‘motion control’ shoe, the compensation for the hip issue is eliminated.  This prevents energy leakage from the system and as energy remains during each step it overloads a different tissue/structure/joint leading to the increased rates of injury noted in the article.  Further study is needed, but we need to be aware of these sacred cows and exercise myths.  Look for future posts on strengthening the foot (foot drills & short foot exercises) as well as hip stability exercises.