Generally there are one of two scenarios related to musculoskeletal pain and injury. Either there is not enough movement or there is too muchmovement. If a muscle is in spasm, if a joint is stuck, or if a muscle tendon unit has adaptively shortened in length are all examples of not having enough movement. If a muscle tendon unit has been strained, or if a joint ligament has been strained (torn) or a “pulled muscle” are examples of having too much movement.
Clients frequently report that one of the first actions they took to manage an injury was “I tried to stretch it out”. The concept of managing an injury by “stretching it out” is wide spread. The following are examples of comments of believing it is appropriate to “stretch it out”. I was playing tennis and “I pulled my calf, I felt something pop”. I tried to stretch it out, but it didn’t relieve the pain. “I have a strained hamstring, and I have been stretching the heck out of it, but it is not getting any better”. “I have plantar fasciitis, and I have been doing calf stretching 3 times a day, but the pain continues”
A common misconception is all musculoskeletal injuries should be‘stretched out”. If you feel/hear something pop and the calf hurts it mostlikely means something is torn. The logic of stretching a tissue that hasrecently been torn or strained escapes me. If joint motion is limitedbecause the joint is swollen stretching it out will not eliminate the swelling.If a painful joint has a loose body in a joint space (piece of cartilage)resulting in limited joint motion stretching it out will not eliminate theblockage. Trying to stretch out a joint that has a blockage (loosecartilage, or bone spur) is analogous to trying to shut a door when apencil is wedged between the door jam and the door, either the pencilwill get crunched and/or the door will be damaged.
There are times when stretching it out is a very appropriate treatment,such as, a classic muscle cramp, when a joint is stuck or frozen (adhered),or when a muscle tendon unit has adaptively shortened.In order to determine if stretching it out is appropriate it needs to bedetermined if there is too much movement or not enough movement. If there is not enough movement what is limiting the movement, will itrespond to stretching it out.
Distinguishing whether there is too much movement requires knowledgeof what is considered a normal amount of joint range of motion.Generally there is consensus among healthcare professionals as to whatis the normal amount of joint range of motion or joint flexibility for aparticular age, sex, and fitness level. If the injury and pain is on one side ofthe body the assumption is often made that the range of motion on thenon-injured side of the body is the normal amount of joint range ofmotion.
For example, when laying down it is expected that raising the leg straightup keeping the knee straight the leg will move to a vertical position (rightangle relative to the ground), this is considered a normal amount ofmotion and infers the hamstring muscle is normal length. If the hamstringmuscle has been strained this movement may be painful. If the activestraight leg raise goes beyond vertical it infers too much movement(relatively long hamstring) this may or not be painful. If the active straightleg raise can not achieve a vertical it infers a relatively short hamstringmuscle and this may or may not be painful.
The human body is basically a closed system. If there is limited movementin one region of the body it is likely an adjacent region of the body there iscompensatory excessive movement. It has been hypothesized that withplantar fasciitis (pain on the bottom of the heel) there is limited movementof the ankle (short calf muscle), and compensatory strain and excessivemovement (excessive pronation) occurring in the foot and arch. Astandard treatment for this scenario is to use shoe therapy, orthotictherapy, arch strapping to immobilize the hyper-mobile foot, while doingcalf stretching exercises. There is evidence both supporting and refutingthis hypothesis. Studies have reported reduced ankle range of motion(short calf muscle) in the limb affected by heel pain compared with theunaffected limb and compared to healthy control subjects. In contraststudies reported ankle range of motion was the same in individuals withplantar fasciitis compared to control subjects. Therefore if you have heelpain (plantar fasciitis) do not assume it should be treated with stretchingexercise. An individual evaluation needs to determine if the calf muscle isshort not allowing enough movement of the ankle, and to determine ifthe plantar fascia tissue is short not allowing enough movement or toolong allowing too much movement.
In my experience most recreational athletes have a difficult time
accepting the recommendation that the most appropriate treatment is to
© Damien Howell MS, PT, OCS – www.damienhowellpt.com
rest and protect the injury, they prefer to keep moving and “stretch it out”.
My belief is “stretch it out” is not always the correct thing to do.
- If you experience a musculoskeletal injury do not automatically assume the best treatment is to “stretch it out”.
- If you experience a musculoskeletal injury determine am I experiencing pain because
- something is short, stiff, stuck
- something is loose, long, and lax
- something is both short, stiff, stuck and loose, long, and lax?
- If the problem is related to short, stiff, or stuck stretch it out.
- If the problem is related to loose, long and lax, support it protected, rest it do NOT stretch it out.
- If you are not sure whether to stretch it out or immobilize it error towards do no harm, do not stretch it out.
Damien Howell Physical Therapy – 804-647-9499 – Fax: 866-879-8591 At-Home, At Office, At Fitness Facility – I come to you, I do home visits Damien@damienhowellpt.com