The “New” guide to hypermobility – Part 3 – Stretching the truth
If you want a subject that will make your head spin, then welcome to Part 3- Stretching the truth. Why can some people do it and feel great, whilst others get injured? Is yoga the devil’s work or is the devil in the details? The myths surrounding hypermobility, in general, are shocking and things only get more confusing when we throw stretching into the mix!…..
In Part 2 we covered some of the various misconceptions and myths that surround hypermobility, including the not so important posture, Facia and my personal hatred .. that pesky weak core of yours! Today, I want to address the one that probably gets the most attention other than “core stability” and I am of course talking about stretching. I asked a little while ago on the various social media pages whether people with hypermobility were stretching or not and the reasons behind either choice. There was a good mixture of stretchers and non-stretchers. However, the reasons behind people choices were incredibly varied. We had;
- The Physio told me not to.
- I stretch because I have short muscles.
- If I don’t stretch, I will get stiff.
- I don’t stretch, I don’t want to cause damage.
- I tried yoga once and had a flare up, so I don’t stretch.
- I stretch before my strengthening exercises; I don’t want to be injured.
So, as you can see that is a pretty big spectrum of reasons behind why people are/aren’t stretching. People with hypermobility often get confused when it comes to stretching and rightly so! The sheer amount of misinformation out there is astounding. I think the only possible way forward into Part 3, has to be by actually taking a look at what stretching is, more importantly does, and what the cold, hard evidence implies.
What is Stretching
Everyone stretches. Athletes do it before training, my 7 cats all do it when they wake and people in pain do it because, most of the time, it makes them feel somewhat better. However, the evidence we have on stretching shows it doesn’t do half of what we have previously thought it had been. This is pretty worrying considering how mainstream it has now become! We had thought for many years that the plastic deformation theory was king, wherein we thought muscles changed in length to account for increased muscle extensibility. However, as science challenges theories and conducts new research, things regularly get debunked and this is precisely what happened here!
Multiple studies showed that the previous evidence just did not support this particular theory. Stretching does not change the length of tissue and, in the absence of disease, there are only three ways you can change a muscles length. You can contract it, you can relax it, or you can go crazy on it with a scalpel but I wouldn’t suggest the last one! In fact, there are several muscles in your body that are biomechanically impossible to stretch fully as your own body parts get in the way! When you stretch your hamstrings, you will eventually hit a point where you can’t go any further due to discomfort. If you start to go a little deeper, you may perhaps even find it painful. However, if you relax for a few seconds, breathe a little, take a big breath in followed by a big breath out and slowly go deeper into the stretch, your brain can effectively turn down the discomfort and allow you further into the stretch or allow more of what is commonly referred to as range of motion (ROM). Ultimately though, we are not making the tissue longer, we are only modulating our nervous system to allow us to get further into the stretch. If you are a gold medallist gymnast who stretches every day, then the repetitive nervous system modulation (Bioplasticity) is going to ensure that as soon as you go into that daily stretch, you are going to get close to that end range, straight off the bat. However, if you have recently been told the nocebo of “you have a slipped disk” then you may find that you don’t stretch very far at all due to protective measures. This model of the stretching effect is referred to as the sensory theory and it is currently the only explanation, given the available evidence and what we know about stretching that actually explains it.
What it doesn’t do
So, we know that stretching, in the long run, can help you to become more flexible, it’s just nothing to do with the actual length of the tissue, more so your brain’s ability to allow you into that certain range of motion. There have been many myths about stretching that have been debunked over the years. And sadly, we now know that it doesn’t warm you up before exercise, it doesn’t prevent injuries and multiple studies show that stretching doesn’t help whatsoever with helping to reduce delayed onset muscle soreness (DOMS), you know that achy feeling that has you walking like a cowboy many hours after a leg workout. In fact, we barely even understand how DOMS works in the first place.
Talk about a kick in teeth! Here we are stretching our non-contractile tissue like the I.T. band or foam rolling away on that £45 state of the art foam roller, all in a bid to stretch out a tissue, prevent muscle soreness or warm us up before exercise and in actual fact, it’s simply not doing any of that
So what does stretching actually do?????
Given the fact that stretching isn’t doing a lot of things we thought it did, then surely it must do tonnes of things we didn’t realise? Well, you would think this is the case, but it’s not! Stretching has been shown to be really beneficial when it comes to creating enhanced vagal modulation (effects of vagal nerve activity on the rate of the heart’s contractions), something that becomes important for those with hypermobility, those who are deconditioned and the elderly. In short, stretching is really good for the heart. S0, that’s a pretty big win on the side of the stretchers, but what else? Well, we do know that regular stretching helps people become more flexible (more ROM not length) but if your hypermobile this becomes fairly irrelevant. A big thing with stretching is that it feels good and anything that feels good, releases pain-killing endorphins, something that we can definitely use to our advantage. Stretching is also very good at creating body awareness, it doesn’t take any fancy equipment to do and it doesn’t need prior experience to do. Stretching allows someone who is frightened of pain associated movements to get used to the discomfort and slowly adapt past that discomfort. There is also a lot of evidence to show that stretching can make athletic performance worse and can in some case cause injury. Now with all of that being said, there was one study in 2015 (which you can read here) that could prove to be very promising for a legitimate reason to stretch. In this study they found good evidence to suggest that stretching reduces inflammation in connective tissue. This could be very important for those with hypermobility and who are prone to excessive microtrauma from recurrent subluxations. However, the study comes with a few problems as stated in the original study;
“It is important to stress that the rodent model of “active” stretching used in this study was not intended to simulate a clinical stretching treatment that can be directly applied to humans. For example, the duration of stretching (10 minutes) is longer than typically used in physical therapy or yoga. It will, therefore, be important in further studies to determine the shortest duration of stretching that can have pro-resolution effects. On the other hand, the position adopted by the rats during active stretching, with pulling of the thoracolumbar fascia resulting from the simultaneous extension of fore and hind-limbs, is remarkably similar to some basic yoga and “core” exercises. Furthermore, shear plane deformation of the thoracolumbar fascia has been shown to be reduced in human subjects with chronic low back pain (Langevin et al., 2011). It is thus plausible that the findings of our study could translate to humans once the optimal duration of stretch has been determined.”
Stretching and hypermobility
Now that we have gotten the science bits out of the way and we know what stretching does and doesn’t do, we are left with only one more question to answer. What are the complications of stretching if you’re hypermobile?
If you know me at all then you will know I hate the word “Hypermobile”, its just not really an accurate description of whats going on, it causes confusion and creates a lot of misinformation in the process. I’m much more of a fan of “Hyperlaxity” and it’s this that we need to be concerned with. A lot of people who are hypermobile aren’t actually stretching when they think they are. If you stand someone who is hypermobile with their back against a wall, get them to walk their legs out a little, tuck their bum underneath themselves and very, very slowly, have them perform shoulder flexion, most won’t get past more than 130 degrees. However, ask them to do it quickly and most will achieve full flexion. In the first version, they are stretching the tissue and most will feel the sensation of pulling until the brain shuts down the tissue and they cant move the arm anymore. In the second, those with hypermobility use the “hyperlaxity” of the tissue to essentially rearrange the joint into a position that allows them to attain the desired range of motion. This is important to understand because you will be doing this a lot of the time for certain movements and the more you do it the better you will get at doing it. This can lead to problems when you are older and are no longer as lax as you once were. You may find it difficult to be able to actually use the tissue to perform the movement and you can essentially lose the mobility to perform the task.
A big argument for not stretching hypermobile folk comes from some of the myths that we have already busted, so we can just go and cancel those out. The biggest argument against stretching is that it causes damage. This would be true if stretching actually did any of the things we previously thought it did, but it doesn’t. If you are constantly bypassing the tissue and forcing the joint into hyperextension, then it doesn’t take a genius to figure out you’re not going to have a good time with it. However, the main reason this happens in the first place is that, as mentioned before, people are not actually stretching tissue and are instead manipulating their joints via hyperlaxity. Poor proprioception (not knowing where your joints are in the space around you) is a common thing amongst those with hypermobility. Skin is collagen based and hyperlaxity in this area can cause many problems and given that a large portion of proprioception comes from the skin it’s understandable. Tactile cues such as KT tape or compression wear can help increase the information the brain receives on the location of the joint and will help you to better use the tissue or even stretch it.
The biggest argument that the community has presented for stretching is to lengthen tight/short tissue. Again this would be a good argument if it was true. We know that stretching doesn’t change the tissue length. Most of the time tissue stiffness is a subjective feeling, pretty much unmeasurable and more to do with the brain than the actual tissues. Can stretching help you to “feel” looser; most definitely. Can it also backfire and cause more problems? Absolutely! Most things in life are subjective and that’s because we are simply brains floating in a dark tank pulling in information from the outside of the world, processing it, and then projecting our own subjective view of the world. There are many variables in how people process the information based on context, emotions or beliefs. If you have a bad history with stretching, then its fair to assume years of reinforcing that belief with cause an equally bad time, the next time. If stretching helped ease that bad back you had for a long time, then it gets reinforced as a useful thing for your toolbox. The rest of the arguments for stretching are also a little flawed, especially when it comes to the famous trigger points! Something that’s never been proven to actually exist and with the main body of evidence being a little sketchy, to say the least. But, that’s another blog in its self lol. As far as the other reasons to stretch including, it helps to prevent injury, reduces post-exercise soreness and it’s a good warm-up, the evidence simply shows it’s not true.
Stretching doesn’t do a lot of what we thought, but it does do a few things that we didn’t think it did. We are not changing the length of tissue when we stretch, we aren’t making joints looser or more unstable, so it really doesn’t matter if you stretch and you are hypermobile. What matters is that if you do stretch, you make sure you stretch the tissue and not just simply manipulate the joint. Stretching can provide a good way to create body awareness and help to increase proprioception allowing you better control over joints. Anecdotally, it is also a very good way to change the subjective feeling of constant tightness. Those with a bad history with stretching may find that as soon as they stretch the brain may engage protective measures and spasm the muscle in a bid to pull the joint together. In fact, a lot of times when people understand that they aren’t changing the length of the tissue, this spasm response doesn’t even start. There are other alternatives to stretching such as foam rolling or using massage balls. However, its still important to realise that you do not have the physical strength to make the slightest bit of change or deformation to the actual tissue (unless you’re the Hulk), things like foam rolling and trigger point balls only add to creating “descending inhibition” and in doing so increase your tolerance to the external force. Stretching, foam rolling or using trigger point balls, it’s always important to understand what we are actually doing. These modalities offer a good way for those who have pain associated movement to condition themselves out of it. Whether you stretched before you read this or you didn’t, you have the facts above and if people really want them I will add the references in so you can see the studies I’ve cited (I used to add them in, but literally no one clicked them). You may have hated the idea of stretching or some archaic health professional filled you with misinformation and that’s why you have avoided stretching or perhaps even exercise. Perhaps you thought you were releasing muscles or blasting fascia and that’s why you stretch. Ultimately, you have the truth about stretching in the paragraphs above, what you choose to do with that information is up to you. Maybe this blog will encourage someone to try stretching and it eventually leads them to start an actual exercise programme that benefits them. Maybe someone who thought stretching was doing something it does not, decides to research more and it leads to something great, who knows.
When stretching is done right it can feel good and anything that feels good releases endorphins that kill the pain. In the simplest terms, stretching is touching your brain with movement, there are lots of variables and it always has been and always will be a subjective experience.
I hope you have enjoyed Part 3 and if you have any questions, I will try my best to answers them!
Happy stretching or not stretching!
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