Making the case for static stretching

February 8, 2011 – 7:35 AM

By now you should have heard about the importance of  “dynamic” or “active” stretching before a work out or vigorous physical activity versus the old “static” stretching variety.  (If you haven’t you should read more).

If you know what I’m talking about, you can skip to the next paragraph.  If not, let me get you updated on the recent research regarding stretching and performance. First of all, let’s define the differences between “static” and “active” stretching and we will use the hamstring as an example.  Static stretching of the hamstring involves putting your leg up on a chair and leaning forward until you feel a stretch under your leg and you would then hold it in a static position for 20-30 seconds and repeat.  An example of an active stretch of the hamstrings would be what we call “monster walks”.  Here, you would take big strides, lifting your leg high up in the air until you felt a stretch in the hamstring and continue “walking” like this for 20-30 seconds. 

       For the last 10 years or so, the literature has been consistently demonstrating that static stretching before physical activity does not help to reduce injury rates and actually decreases muscular force  between 5-28% for up to 30 minutes.  About 20-30 seconds of static stretching is the minimum dose to create an immediate 5% reduction in strength.  The more you static stretch, the further reduction in force output occurs.  Just what you want before your tennis match!

What’s as aspiring Nadal to do?  Before you perform your activity or sport, you need to do a specific active warm up, no static stretching. Static stretching plays an important part in our overall fitness plan, just not right before physical activity.

When to static stretch and why:  Static stretching is best done after your workout to help with overall flexibility and joint range of motion.  Remember, active stretching just warms up the muscle, not helping to gain long term changes in length. 

Frequency:  3 x week and after workouts.

Intensity:  You must stretch slowly, as the initial reaction of a muscle is to fight the stretch.  Slower stretching is more effective and it shouldn’t be painful.

Time:  4-5 stretches per muscle group, holding for 20-30 seconds.

The goal of static stretching is to maintain full active range of motion in all joints. Unless you’re hanging on monkey bars or still doing the splits, you need to have static stretching as part of your regular fitness routine.

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Environmental Adaptations

January 27, 2011 – 11:21 PM

It was a simple question posed by a patient last week. “What do you think about installing a railing next to the toilet?”  Why, I asked. “Well, it’s getting harder to lift myself up and I thought if I had one of those hospital bars,  I could use my arms to help pull myself up”.  Seems innocent enough, but it lead to this lengthy discussion on the environmental adaptations that we make to compensate for a loss of strength and range of motion as we become more “mature”.  For many, as long as they can figure out a way to adapt the situation, the problem’s solved.  In my opinion, changing the environment should be the last option, not the first.

Let’s play out the above scenario a bit.  So, first we install the rod to help pull ourselves up from the John because our hips and legs are weak and can no longer do a very basic function.  Time goes on, and guess what, now my arms hurt and I can no longer use them to pull up.  Problem.  Oh wait, I saw this thing in a magazine for old people. It’s this big plastic, hard, donut looking thing you can put on the toilet to sit you up higher.  Problem solved, right?…WRONG! Don’t give up function so easily.  Fight, claw, scratch, do what you need to do to keep those “doors” open.  If we can find a way around it, we think the problem’s solved.  However, we just shrunk our world a bit.

Commonly heard adaptation heard around PT clinics everywhere:

* Just moved in to a house without stairs…..what’s that going to do for your ability to climb steps out in the world….

* I can’t get on the floor, not sure if I can get back up again…..and if you ever fall?

* Had to buy a car that sat up higher, can’t get up from my old car, too low….

* I use to love playing (fill in the blank) but I had to give it up because my (blank) started hurting…….hold on to the things that bring you pure joy

* I need a chair with arm rests, or better yet, one that lifts me up with a push of a button…..

* Need to travel with my own pillow, otherwise my neck hurts…..

* I can still play basketball as long as I wear my back brace, ankle brace, elbow brace, knee brace, and I don’t have to run or jump…..

I understand some situations are unavoidable and require modifications to our environment for safety, etc, but  I feel we default to these lifestyle changes far too soon and without much of a fight.  The next thing we know, we have closed in our world, not really “living life”, rather just “existing”. 

  Aging is inevitable, but we can always improve our strength, range of motion, and flexibility regardless of our age.  Many of us just choose to use age as an excuse.  The question I have for you then is how much of your quality of life are you willing to give up?

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Acute management of a contusion

January 16, 2011 – 9:56 AM

One of the advantages of playing basketball two times per week with aging weekend warriors is that I’m never at a loss for blog material. Once again, I was a popular guy today. Let’s recap today’s injuries: right lateral ankle sprain, jammed fingers, kicked in the calve, and “tweaked” lower back.

Today I will quickly address the treatment of a calve or quadriceps contusion. “Terry” was beat badly on a drive to the basket by the guy he was supposed to be covering.  In the process of trying to foul him recover his defensive position, he was kicked in the calve.  As he came limping over to find me, I knew I was on the clock again.

Without getting too technical and boring, thigh (quadriceps) and calve contusions are very common in contact sports, with the thigh being the most commonly injured.  Immediately after the injury (or as soon as you can) take the precautions we all know about:

  • Rest or protect the injured site.  Code for STOP PLAYING!
  • Ice.  Now this is important, you want to ice the injured area while the muscle is under stretch.  For example, for the thigh contusion, you would bend the knee in the fully bent position. For the calve, you would want the ankle pulled up, placing a slight stretch on the calve muscle.  The reason you do this is to prevent the effected muscle from tightening up in the shortened position.  Icing frequency is the most important in the first 1-2 days, every 2-4 hours for about 20 minutes.
  • Compression.  A compression sleeve or wrap should be on the effected body part as much as possible when you are up and about and after you return to the sport.
  • Exercise.  When you know the extent of the injury (after 1-2 days) and how serious it is, you can begin first with isometric exercises and progress into higher level activities as your leg heals.

And finally, Terry, stay with your man so you don’t get kicked in the first place!

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Need a last minute stocking stuffer? How about a Pedometer?

December 24, 2010 – 11:53 AM

OK,  I know it’s not the most fun gift under the tree, but it would make a great, inexpensive,  gift for you or that special someone to help get them moving!  Remember, it’s all about getting some exercise.

 This is what I suggest you do with your new pedometer: wear it with your “normal activity” during the day and log how many steps you take. 

Your goal should be a minimum of 10,000 per day which would be about 5 miles per day (2,000 steps on average is 1 mile).  The great thing is that just by wearing the pedometer, you will start taking more steps per day!

After you get an average number of steps per day, try to increase your steps by 500 steps per week until you hit that 10,000 threshold.  Then build on it, remember that 10,000 is the minimum.

 A recent study of US citizens and the number of steps they take per day is about 5,000.  In general, men take more steps than women and the number of steps declines with age. Now since I love history,  I’m going  historical on you. This level of 5,000 steps per day is very low from a historical perspective.  Researchers have studied the labor intensive farming lifestyles of most North Americans in the mid 1800′s suggest they averaged over 18,000 steps per day.  A study from 2002 of Western Australia adults found they took an average of 10,000 per day. 

Bottom line?  The US average of 5,000 steps is far too low.  You don’t need me to tell you the risk factors associated with a sedentary lifestyle.  So, go ahead and get yourself a gift, you have permission and let me know how many steps you average. 

I have challenged my lovely wife, Elizabeth,  to a “step off” and I’ll keep you posted on the results!!

Let me know how your doing: ed@integrativephysicaltherapyservices.com

Merry Christmas and Happy New Year,

Yours truly,

Ed

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Welcome to Health News

December 13, 2010 – 11:00 AM

Ed Deboo, PT, along with two other Bellingham Physical Therapists were profiled in the “Northwest Health” magazine.

“Ed Deboo, PT, doesn’t want to fix people. He wants them to fix themselves. ‘I don’t want you to come in and watch you ride my bike,’ he says.‘I help to facilitate the healing process and remove roadblocks, but you own your own health.’

To read the entire article and view the pictures, please click here to download the NW Health PDF

What’s new in the literature?

I will often come across an article that I think my patients would be interested in. I have included a short summary and then cited the source if someone was interested in the entire article. Enjoy!

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Cholesterol reducing drug, Statin, may be causing your muscle pain.

December 5, 2010 – 10:39 PM

I recently saw an old  patient of mine back in the clinic for complaints of diffuse, general muscle pain in her shoulders and neck that came on fairly suddenly.  After seeing him for a few visits without significant lasting changes, I decided to ask him again about any medications that may be a contributing factor.  He had been diagnosed about 2 months prior to starting PT with high cholesterol and was placed on a statin medication.

For those who do not know what Statin drugs are or what they do, they help to reduce cholersterol  (LDL’s) by blocking a crucial enzyme the liver needs to produce cholesterol.  Common names for statin drugs include: Lipitor, Lescol, Mevacor, and Zocor.  There are many documented benefits to statin drugs, besides just lowering cholesterol: they help to reduce cholesterol build up on artery walls that may lower the risk of a heart attack, they  have anti-inflammatory effects, and may also prevent certain forms of cancer (although the research still isn’t complete).

However, about 1%-5% of those taking statin drugs have side effects that include muscle pain and weakness.  The muscle pain and weakness can be  potentially dangerous  and needs to be discussed with your physician immediately.  Another side effected noted is memory loss.  The drug companies have added  this warning with  statin drug advertising  “Unexplained muscle pain and weakness could be a sign of a rare but serious side effect and should be reported to your doctor right away.”

Since my patient had no other reasons for his sudden onset of increased muscle pain, he was sent back to his physician who then took him off of the statin drug.  Although many of you reading this who are on statin drugs may already be aware of this rare, but potentially dangerous side effect, I felt it warranted a blog entry.

In summary, if you are on any form of statin drugs and feel as though you have an increase in muscle pain or weakness, please contact your physician immediately.

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Need clarity to the confusion of medical news in the media? Check out this website

October 31, 2010 – 3:26 PM

If you are like me, trying to make sound, educated health care decisions in today’s instant access world can  be a daunting task.  We are inundated almost daily with results of studies that claim to have the latest answers to improve our health.  However, not all studies are properly conducted and often the results then cannot be validated. 

In my search for credible information on the web, I came across this website, Healthnewsreview.org.  This is an an award winning U.S. website devoted to objective, evidence based reviews of medical articles and studies.  It is headed by Gary Schwitzer, long time medical journalist and professor at the University of Minnesota.

The mission of the website is to improve the accuracy of news stories about medical treatments, tests, products, and procedures, and help consumers evaluate the evidence for and against new ideas in healthcare.

It is then up to the consumer to make an educated decision, weighing both the pros and cons.  Healthnewsreview.org.  uses 10 criteria for evaluating medical news  and then rates them on a scale from 1-5 stars.  

The internet is a wealth of information and  Healthnewsreview.org  will help bring clarity to a sometimes confusing barrage of information so you may make the best possible decision for you and your family.

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The effects of prolonged bed rest on muscles of the spine and vertebral discs

October 14, 2010 – 1:38 PM

When I first graduated from PT school over 16 years ago, bed rest was still a very popular treatment for acute back pain.  Luckily, over the years, the medical community has taken a much more “active” approach” to treating back pain.  However, there is still a small portion of the medical field that believes in bed rest for the management of back pain.

An interesting study published in Spine recently may have them thinking otherwise.  German researchers wanted to know the effects of 60 days of bed rest on the discs of the spine and other soft tissues of the spine. 

Their conclusions were not good for bed rest advocates:

  1. There was a loss of the normal lordosis usually seen in the lower back from L1-L3.
  2. There was an increase in the volume of the intervertebral discs as they imbibed fluid that leads to greater stress on the facet joints when you do finally stand up and ambulate.  Ever wonder why you have more back pain in the morning?  You now have a possible answer.
  3. All spinal muscles atrophied (lost strength) with the greatest rates occurring in the multifidus muscles at the L4-5 level. The multifidus has been identified as a major stabilizer of the lower lumbar spine.

We need to understand there are numerous other deleterious effects of bed rest, including vascular changes, bone loss, joint contractures, bed sores, breathing issues, the list goes on and on…….

One caveate to the study:  it looked at individuals who were on bed rest for 60 days, not the typical length of time prescribed for individuals with back pain.  However, other studies have shown similar results (to lesser degrees of course) even after 2-3 days of bed rest.

Take home message:  take an active approach to the management of lower back pain and avoid much more than 1 day of bed rest if possible.  Remember, Movement is Life!!

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Popular supplement for back pain may not be helpful

September 16, 2010 – 7:26 PM

Glucosamine is a hugely popular supplement taken by millions of people in hopes of helping with arthritic pain. It is estimated that up to 25% of all back pain suffers will try the supplement glucosamine “to see if it helps”.  

How helpful is it for arthritic back pain?  Well, an impressive research  study from the University of Oslo in Norwaysuggests that you should save your money as glucosamine  proved no more helpful than the placebo.

The study looked at 250 patients with lower back pain that had confirmed arthritic changes on MRI.  One group was given glucosamine and the other a placebo and both groups were monitored for 1 year.  Patients taking glucosamine had no statistically or clinically significant advantage over those taking placebo on any outcome measures at either the 6 month or 12 month interval.

The study was limited to those with confirmed arthritic changes as per MRI and the authors of the study caution against making broad conclusions about the effectiveness of glucosamine for helping other types of musculoskeletal pain.

 In my clinical experience, it seems that about 50% of the people who take glucosamine for various aligments seem to benefit from it.  My advise would be to try it anyway for about 6 weeks and then make your own decision.  Good luck!

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Does Pilates help increase abdominal and upper extremity strength and endurance?

August 1, 2010 – 2:28 PM

One of the common questions I get from patients in the clinic  is “will doing Pilates help me” and then I answer their question with another question “well, what are your fitness goals?”.  If you need to increase your core strength, flexibility, and muscular endurance, then the answer is an unequivocal YES!

Pilates can be a very important component of your fitness program since the emphasis is on core strengthening and improving flexibility, both of which most of us lack as we become more “mature”.  I just read a study by June Kloubec from Adolphus College in St. Peter, Minnesota that looked to see if doing a 1 hour session of mat based Pilates exercises 2  times per week could effect abdominal endurance, hamstring flexibility, upper body muscular endurance, posture and balance.

After 12 weeks, the participants were re-tested and the results were very favorable:  the participants in the study demonstrated significant increases in abdominal endurance, hamstring flexibiliy, and upper body strength. 

So how do you know if you have core muscular weakness issues?  One example would be if you injure your back without doing anything dramatic, such as ”I just bent over to pick up a pen” or my favorite, ” I must have hurt myself in my sleep since I  just woke up with this pain” .

For my local Bellingham readers who have been thinking about giving Pilates a try, the Pilates Studio of Bellingham would be an excellent choice.  Maria and Geoffrey Knight do an outstanding  job and they are constantly learning to add new classes to compliment their Pilates classes. 

Remember, movement is life, so get moving!

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