So what are the other reasons for knee pain if it’s not osteoarthritis? Many factors relate to knee pain, including overall fitness level, body weight, strength of the entire leg, joint stiffness of the ankle or hip, poor tracking of the knee cap and a lack of muscular flexibility are just a few. Seek the help of your physical therapist to determine what can be done and avoid surgery that may not be the right choice anyway.

This is important to keep in mind as you perform your stretching program because if you are not making gains in range of motion despite a regular stretching program, “muscle tightness” may not be the issue.
It may be restrictions around the joint capsule which would require a different treatment approach. The focus of this blog, however, is to discuss the different types of stretching and when they may be the most effective.

There are 3 main types of muscle stretching that are the most commonly used in exercise programs:
1. Static stretching: the most common type, defined as simply holding a specific position that creates a stretch sensation without any movement or muscle contraction. Usually held between 15-30 seconds. Example: static stretching of the hamstring would involve something like placing your outstretched leg on a chair in front of you and leaning forward until you felt a stretch in your hamstring muscle and then would hold it there for 15-30 seconds.
2. Dynamic stretching: this involves moving the joint through its full range of motion in a slow and controlled fashion, but not holding the stretched position. Example: a dynamic hamstring stretch would be to slowly kick your leg out in front of you while standing until you felt resistance in your hamstring and then repeat that movement a number of times, not holding the top position for more than 1-2 seconds.
3. Contract-Relax stretching or PNF stretching: There are many variations of this type of stretching, but it involves a maximal or sub maximal contraction of the muscle that you are stretching for about 5-10 seconds followed by a passive stretch for 20-25 seconds. Repeat the contract-relax steps for a total of 3-4 cycles. Example: if you were stretching your hamstrings from a seated position, you would place your leg (with your knee straight) on a chair in front of you and lean forward until you felt a stretch. Then, you would “contract” the muscle being stretched, in this case the hamstring, by pushing down in to the chair for about 5-10 seconds. The contraction is isometric, which means there is no actual joint movement. The force used is moderate and is held for 5 seconds, followed by a period of “relaxing” which then allows you to take up the slack in the hamstring by continuing to lean forward until a strong stretch is felt again. Repeat for a total of 3-4 cycles.

When is each type of stretching indicated?

As per the literature, static stretching is effective in making longer lasting changes in muscle length, should be held for about 15-30 seconds and repeated 3-4 times. Static stretching is most effective after an exercise session to help reduce muscle soreness (from tightness) and improve overall flexibility. However, Static stretching should not be used before exercises that involve high muscle activity as it has been shown to decrease maximum force output by 5-15% on average.

Dynamic stretching is the most effective way to warm up before an activity. It allows the muscle to warm up without the negative effects of static stretching. However, dynamic stretching alone has not been shown to consistently make long term changes in the length of a tight muscle.

“Contract/relax” methods of stretching appear to help make the most rapid changes in the length of a muscle. Therefore, if you have a chronically tight area, this may be the method of stretching that would afford the most beneficial changes.

In summary, most of us would benefit from both a combination of static and contract/relax stretching techniques after exercise and a sports specific dynamic warm up before we engage in sports or exercise. I hope this helps to clarify when to use the different types of stretching to maximize your fitness goals and to keep you moving!!! Let me know if you have any questions.
Cheers,
Ed Deboo, PT

THURSDAY, NOVEMBER 17, 2011 @ 7:00-9:00pm
Wine, Women & Song
Bellingham Sings Fundraiser at Lairmont Manor

Mark your calendars for the return of Wine, Women & Song, our popular, musical, fundraiser hosted at Bellingham’s elegant Lairmont Manor. From 7:00-9:00pm, you will enjoy an assortment of fine wine, delectable sweet and savory, after-dinner snacks, wonderful company, and loads of fantastic music performed by Whatcom Sound Jazz Singers, and Allegra Women’s Choir, in this beautifully, intimate setting. Please join us!

7:00 – 9:00pm
Lairmont Manor, 405 Fieldston Road, Bellingham, WA –

Tickets: $20, available at the door, from any singer, or by phoning 360-676-1024.

Elizabeth has graciously volunteered my services to help service the wine so I hope to many of you there!

Cheers,

Ed

Now, this is where the fun begins. Medtronics, the words largest manufacturer of medial devices, developed a bone morphogenetic protein, BMP-2, that has since become the standard of care.  Back in August of 2010,  John Fauber, of the  Milwaukee Journal reported that  ”in 2002 the FDA approved a product that many thought would revolutionize spinal surgery — recombinant human bone morphogenetic protein-2, or BMP-2, which could almost magically create bone where none existed”.  This eliminated the need for harvesting bone from the patients own iliac crest, thereby reducing complications and expediting recovery.  Great, winners all the way around….not quite so fast…

When Medtronics produced RCT (random controlled trials) demonstrating the superiority of their product over the old way of harvesting bone, there were many problems that were over looked at the time:

• 9 of the physicians that were involved in the research studies had financial stakes in the company, creating an obvious conflict of interest.
• The company sponsored research exaggerated the negative effects of the previously used methods of harvesting bone from the patients iliac crest while at the same time downplayed and under reported the complications from their product, BMP-2.

Many surgeons, not aware of the flawed research procedures, began using MMP-2 on a regular basis, to the tune of 500,000 fusion procedures alone in the US.  The result is that many tens of thousands of patients may have suffered adverse effects from surgeons unknowingly using BMP-2. According the the Back Letter, Vol 26, No.8, August 2011,  “Complications can include back and leg pain, disc space collapse, infections, and retrograde ejaculations and associated infertility-as well as implant displacement, catastrophic airway problems, cancer, and perhaps even death”.

So where does the field of spine research go from here to prevent something like this from happening again?  The US Senate has launched an investigation in to how research is conducted and are patients given the full picture before they consent to a procedure. 

The bottom line is that a system needs to be adopted to produce unbiased, scientific research that can safely help the millions of people with chronic back pain.  

Ed Deboo, Physical Therapist,  Bellingham, Washington

As a manual structural therapist, I have always had a  different take on carpal tunnel syndrome.  First, let’s talk about the make up of the median nerve:  the median nerve is made up of nerve roots that exit the spinal column at the levels of C5-T1 that pass just under the clavicle and then travel down the arm (see picture below, courtesy of Grant’s Anatomy).   You can see the thick, canvas like tissue at the wrist.  This is what is “released” in surgery.

Since the median nerve roots come out of the middle and lower neck, it makes good sense to first look at the mobility of the cervical spine to determine if there is any segmental vertebral joint restrictions that may be playing a role in the arm symptoms.  I just read a research article from some Physiotherapists in Spain that give this treatment approach some scientific credibility.  To summarize the article:

71 women with diagnosed CTS had their cervical (neck) range of motion tested to see if they also demonstrated restrictions proximally (the area that the median nerve is formed from).

Conclusion:  Women with mild to severe CTS all exhibited less cervical spine range of motion compared to women of the same age without CTS.

My take home message is this:  if you have CTS and are being treated, make sure your practitioner is also addressing your cervical spine, clavicle, and explaining the role of the neck in your hand symptoms.  Good luck!

Ed Deboo, Physical Therapist

Bellingham, Washington

Nerve: median nerve
Diagram from Gray’s anatomy

Summary of the study:  67 women diagnosed with Fibromyalgia where placed in to two groups:

Group 1:  low intensity walking without walking sticks only once a week for 20 minutes.

Group 2:  Nordic walking (used two walking sticks/hiking poles).  This group started each session with low intensity walking followed by a series of 2 minute intervals of higher intensity walking including both flat and hilly surfaces for a total of 20 minutes 2 times per week.

According to the researchers “after 15 weeks, the women in the Nordic walking group experienced improved function, decreased activity   limitation, and improvements in fatigue levels compared with the control group”.

This is promising on many levels.  You have often heard me preach the importance of daily exercise and walking is something that we can all do, anywhere we are at, without the use of expensive gear or equipement. A quick search for hiking poles on Amazon.com showed multiple pairs for about $25, not a big investment. 

 The results of this study are preliminary and we cannot make vast, sweeping judgements.  However,  I will be recommending this program to my Fibromyalgia patients as an alternative to steady state walking to get them to exercise and hopefully improve their quality of life. Good luck!

Ed Deboo, PT,

 Bellingham, Washington

He asked me what I thought and my first question to him was whether or not he still enjoyed playing basketball.  His response was a resounding “yes, I love playing but I’m afraid I’ll never be able to play again”.  In response to his Eyore like answer, I gave him my suggestions:

1. Get your hip and back looked at by someone who will do a comprehensive bio-mechanical analysis of his gait and running technique, not just give you hip stretches that you can find on the internet. (FYI: upon evaluation, we found that his ankle on the opposite side of his painful hip was severely restricted, placing more stress on the opposite hip with running, jumping, etc)

2. Tell yourself everyday in the mirror that you will return to basketball, you must believe it.

3. Until you can do it on land, take up deep water running to keep the movement strong without the gravitational impact.

4. Get some body work done either by your Physical Therapist, massage therapist, or local Rolfer.  In addition, try a course of acupuncture.

5.  Start a strengthening program with body weight resistance and free weights, no machines.

6. Lose weight, no excuses, just do it.

7. Try Glucosamine/Chondroiton for 6 weeks

The results?  He’s had to limit the number of days in a week that he can play, but he’s BACK, doing something he loves, how great is that?

Sobering stats:

• According the the American Arthritis Foundation, 27  million Americans have osteoarthritis that effects their quality of life. 
• 632,000 joint replacements are performed each year in the US.
• obesity is one of the main culprits of advancing osteoarthritis.

The mainstream medical community is finally understanding that the best thing for arthritis is to get moving!  Gone is the old attitude of rest and medication.  Studies have shown that reducing weight, starting a strength training program, and performing range motion/stretching exercises can significantly improve your quality of life as compared to medication alone.  Good luck!

Ed Deboo, Physical Therapist, Bellingham Washington