To Stretch or Not to Stretch

It often surprises people that ‘stretching’ is not a word that is often used in the Feldenkrais Method  (in my experience). However there is a rather different – and very valuable – approach to enabling muscles to find their length in the Method. So I put up an article from the New York Times called ‘Reasons Not to Stretch’ (April 2013)  about research into static (usually passive) stretching before exercise on my Facebook page a short while ago, because I felt it represented a piece of scientific understanding that is potentially going in our direction. (The link to it is currently broken everywhere so will have to refind the original research or find another way to get the article to post it!)

However,  it caused a little bit of a stir, partly because the arguments around stretching are confusing and partly because there is a question about whether these reductive studies are meaningful when applied to human systems. I am not going to get much into the latter question as it is a huge topic for a post (though see note at bottom ⁱ  for a brief comment on it) But what I am going to have a go at saying something about is  stretching, this research and what light Feldenkrais has to shed on it in my opinion.

First, to be very clear about this article: The extensive Croatian study into research since 1966 cited in the article is an attempt to isolate the effect of static (mostly passive) stretching on production of power, strength and explosive strength in exercise undertaken straight after (the finding is that power and strength are diminished in acitivites immediately after static stretching). It is NOT about a lot of things. It is not about any OTHER kinds of stretching (ballistic, dynamic..), it is not about stretching AFTER exercise or at other times when you are NOT exercising and it is not about the effect of stretching OVER TIME. Its also not about stretching COMBINED with other kinds of activity. The research also does not come up with ‘evidence based’  reasons why power is reduced in exercise immediately after passive static stretching although suggestions are made. As a result it is clearly limited in what it can tell us, but I think it is still interesting for sports people and martial artists – and because it might turn out to fit with a Feldenkrais perspective which would actually apply to stretching in wider terms as well. And that’s why I posted it on Facebook.

Static stretching is where the targeted muscle or group of muscles is pulled beyond its habitual length and held in that stretch for a period of time (there are disagreements about the length of time that is most effective) and passive stretching is when that is achieved by external means – gravity, body weight, a strap, another person – but crucially not by actively contracting the muscle(s) that would normally produce lengthening in the targeted muscle(s). Sometimes the argument against passive static stretching is that because it is not achieved by the active shortening of the opposing muscle(s) as would usually happen, the muscles are weakened – perhaps by disrupting the functional synergy at the level of the nervous system. Sometimes the argument is that it makes the stretched muscle ‘baggy’ and so less springy and powerful. Both may well be true. I would like to offer slightly different perspective from my understanding of the Feldenkrais Method which has a relation to those ideas in that it centres on functionality but it also widens the argument to question some of the aspects of traditional stretching in any situation and of stretching a muscle or group of muscles in isolation in particular. I am sure another Feldenkrais teacher could have another  (better) way of thinking about it/explaining it, but this is my current stab at it.

The easiest way to explain is probably by an  example. Being an example it is not going to be true in the same way for everyone but it serves as an illustration. Ann believes she has short hamstrings (the muscles that run from the sit bones down the back of the leg and insert around and beyond the knee joint). She doesn’t like not being able to sit on the floor with her legs long in front of her; she would like to be able to bend forward when standing and reach the floor more comfortably; she would like to be freer when she goes to her dance/exercise class; she sometimes gets aches in her back – and she just doesn’t like the feeling or even the idea that she is limited in this way. She stretches regularly hoping to improve the situation using passive static hamstring stretches.  She likes to push into the stretch as she has been told that stretching more will achieve a better effect and there is a pleasure in the feeling of pushing into the stretch: the sense that something must be happening  and that she is doing something beneficial that she needs to do. After stretching she feels better because its easier to reach down her legs and they feel a little longer at the back in standing which is a good feeling. However, frustratingly, the day after she has stretched like this the back of her legs often feels short and tight again. Sometimes even more so in fact. The only solution is to stretch again and keep at it. However, she thinks she does feel some improvement over time and is hopeful that bit by bit it will change if she just keeps going.

She might be right. However, what no one has told Ann is that there is a much bigger pattern going on for her of which her tight hamstrings are just a part. Muscles don’t tend to operate in isolation, they only work as instructed by the nervous system and the nervous system has a bigger overview than one muscle or group – it is working to the best of its ability in relation to what the person intends or needs to do, whether that is simply a multitude of micro-adjustments to maintain balance in standing or a major activity such as reaching for a cup or walking, running, jumping which requires both specific activity and adjustment through the whole system to support/enable that activity. Lengthening the hamstrings is not something that happens in isolation or is likely to be successfully retained out of context.  We all have our individual habits and patterns that we have learnt and  developed since we were born, our preferred ways of doing things (which may be very successful or not so successful) so the pattern we are going to discuss is specific to Ann – its not true of everyone with tight hamstrings although some of the main issues are fairly common – and as it involves adjustments through the whole of her as directed by the nervous system we cannot hope to pick it all apart muscle by muscle – there is simply too much involved – but we can bring out a few major elements to help explain what is going on and illustrate why a whole system approach may be needed.

So, one aspect of Ann’s pattern has to do with a very significant muscle pair called Iliopsoas. Psoas runs from the front/side of the bodies of the vertebrae in the lower back through the pelvis joining up with Iliacus which starts from the inside of the wing of the hip and attaching to the inside of the top of the thigh bone.. Together they are Iliopsoas. The action of this muscle is to draw the front of the thigh and the front of the pelvis (belly) towards each other which means it can lift and draw up the leg towards the belly (one foot off the floor) but can also mean it can tip the top of the pelvis forward (with both feet on the floor) and arch the lower back. Ann happens to have a habitually tight Iliopsoas almost all of the time that is therefore tipping her pelvis almost all of the time. And one of the main ways her system has to balance the pelvis and stop it from tipping further and putting too much strain on her back is to pull down the sit bones by … tightening the hamstrings. So every time she stretches the hamstrings without addressing the tightening in Iliopsoas she sets up a situation in which the pelvis will tip more afterwards and the hamstrings will therefore be instructed to tighten immediately undoing all her good work – which may be  part of why she feels them tight again the next day.

Well you say. She could stretch both her hamstrings AND Iliopsoas and that would sort it, and while it might help more, it still doesn’t acknowledge that this is part of a pattern that involves the whole of her and there is a lot more going on. Another piece of this jigsaw for example, is that the over arching in her lower back is being countered not only by her hamstrings but by the muscles of her back and chest which are producing a slightly excessive rounding in her upper back to balance the arching of her lower back and then there is a shortening in the back of her neck so that her head and eyes can be level (or is it all the other way round? We can’t know what causes what, better to think of it all as a pattern that incorporates all). She has been like this for so long that she doesn’t know it could be different and  isn’t aware of it beyond that niggly discomfort in places in her back from sitting which she has put down to her short hamstrings. Another part of it is that her  diaphragm (the big breathing muscle that separates the chest cavity from the abdominal cavity) is also tight which reinforces the pull on her lower back (because it attaches by stalks down the lower vertebrae) and means  she breathes less efficiently than she could. She also has a low level of fairly constant anxiety (which she normalised as her usual mode of being long ago and so isn’t aware of unless it gets unusually strong)  which has something to do with her overall muscle tightness and inefficient breathing, including the muscles of the abdomen, chest – and Iliopsoas. Then the rounding in her upper back means that her shoulders don’t have enough of her chest to rest on easily and so are hanging a bit from her neck and are fixing in certain ways to the ribs that they should be free to slide over with a reciprocal limitation of the ribs in both movement and breathing. Unless she can do something to mobilise her shoulders, chest and upper back it will be hard for her lower back to find its length and so for Iliopsoas and the hamstrings to find theirs. And vice versa. It sounds drastic written out like this, but actually none of this is so pronounced that it is easy to notice unless you look carefully, but it is enough to cause her the issues she has.

Inevitably this is still a partial picture as there would be an impossible amount of detail to put into it (we haven’t even mentioned what the muscles of the lower legs are doing in lengthening her legs or what her ankles/feet have to do with it, or the many other places that are feeding into and re-inforcing this pattern), however it should be enough for  you to get the idea that stretching her hamstrings in isolation simply isn’t going to be all that successful even if feels nice. Its just one piece of a very complicated jigsaw. Something might stick from stretching, as the sensation of longer hamstrings might offer iliopsoas and other places a new possibility for a moment that her system might integrate, but its unlikely to be enough on its own. This may be the big picture behind the idea that passive static stretching disrupts the neuromuscular synergy of the targeted muscle(s) and its agonist(s).  It is done out of context of the whole and not integrated back into the whole and so at best not necessarily functional and at worst disruptive.

In addition to that there are other questions about traditional stretching that advocates pushing into the stretch and holding for periods of time. If Ann just continues to just pull on her tight hamstrings, she could end up pulling on her ligaments and tendons and stretching them instead of the muscles. There IS evidence that stretching and holding a muscle for a period of time can increase its viscoelasticity (and so an argument for its careful use in some medical or rehabilitation situations or perhaps in conjunction with other kinds of exercise), but if she gets into pulling on her ligaments and tendons it is a different story because they are not viscoelastic and will not spring back like a muscle does. Done repeatedly over time that damage can be permanent and then indeed we are into ‘bagginess’ and, if it went too far, unstable joints which is one of the issues the research we started with suggests.

And there is another factor: when she is pushing into the stretches in that way she finds satisfying she also, ironically, triggers the muscle to contract through something called the stretch reflex. It is there to protect the muscle from being torn or pulled off the bone and is a contraction of the muscle that is being stretched when it reaches a length and tension her nervous system considers too much. That may be another reason her legs feel even tighter after stretching. Because all she has done is trigger a contraction. The stretch reflex is something that some stretching methods (like Proprioceptive Neuromuscular Facilitation) actually take advantage of (sort of in reverse) to ‘trick’ the opposite muscle into lengthening and you find another idea of going with the nervous system rather than against it in the Feldenkrais idea of spending considerable time going ‘with the pattern’ and clarifying it – ie facilitating the contraction pattern more rather than pulling against it -and then gently suggesting a different direction, which is often more available after such a process, and so enabling  lengthening.  The idea of gradual passive static stretching is to re-set the levels and to push back the threshold for the stretch reflex but in this situation there is always the risk that if Ann is too successful in resetting the stretch reflex and so allowing her hamstrings to have a longer length without addressing the rest of the pattern, she may be in trouble because she will have removed the break the hamstrings have been providing to Iliopsoas etc which could put more strain on her overarching lower back.

Of course this is just one example but the ideas are applicable widely and perhaps this is a picture that can help elucidate why passive static stretching doesn’t appear to enable powerful functioning – because by nature it isolates a muscle or muscle group rather than enabling it within the context of the function. Its not to say this kind of stretching can never help anyone because clearly it has and does when used carefully eg in some rehabilitation situations, in conjunction with other more dynamic stretching or exercise  or within a system like yoga if it is well taught, but even then it may not always be the only, or even the best, solution for functional movement.

The Feldenkrais Method does also offer a possible route for Ann. Gradually she could learn to notice what is going on for her and how the different parts of her relate in many kinds of simple and more complex movements – especially in a wide variety of movements that help her feel and clarify her patterns of holding and/or invite lengthening of the hamstrings.  She might begin to have a clearer sense of her skeleton and the pathways it takes in movement so that it supports her better and the muscles can give up some of their unnecessary work and be free do the work they need to do better.  She may find she can work with her breathing to enable a change in her movement and vice versa, and gradually she may find that these new possibilities change how she sees herself and interacts with the word and even impacts on her level of anxiety – or she may need to work with that alongside. And as a result she might be able to find gradual change throughout the system to enable and support a different organisation in her legs, so it stays as an integral part of her – at which point she will probably promptly forget it was ever an issue – as that will have become just a bit part in the story of her development.

 

i)                    Briefly on the subject of randomised control testing – I do agree it is not perfect and that its exclusive status is problematic, but if you accept the limitations (eg be clear that these pieces of research are only able to look very specifically at one small part of the picture, are based on the idea of ‘cause and effect’ and the results can only be statistical) this kind of research does make up part of our picture and understanding even if it can’t represent it in total.  I don’t think it will continue for ever to be the one and only ‘gold standard’ it is considered today as it represents ways of thinking that are being fundamentally challenged as insufficient (sometimes even by their own results –as I would argue this one does!) but it has historically yielded the information on which much of what we have learnt is based so while this kind of study remains the mainstay of research it is – to me anyway – interesting. (See Carl Ginsberg for a much more informed and articulate argument about the problems with this kind of ‘cause and effect’ based research on humans than I could put together right now, I think its in the Feldenkrais Journal but will go looking and put up a reference when I can )