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How to Incorporate Flexibility Deficits into your Treatment

12/29/2015

1 Comment

 
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The Hyprid Perspective had an interesting post recently about stretching for gymnasts. The author discusses common stretches that gymnasts and their coaches frequently perform and then goes over the reasons behind their faults. A big focus is put on the issue of trying to stretch the hip flexors while in an extended lumbar spine position. This puts the capsule at risk of being stretched, which is not advantageous. While I wouldn't personally focus too much on this pathoanatomical model, the author makes an excellent point regarding incorrect stretching.

When looking to stretch a muscle, it is essential that compensations are not permitted as this can put adverse stress on adjacent joints and structures. For example, when trying to stretch the hip flexors, the lumbar spine should either be stabilized in neutral or in flexion so as to not excessively load the lumbar spine into extension. This commonly occurs in gymnasts, which is why they frequently are seen with spondylolistheses. With stretching hamstrings, people often bend forward, trying to touch their toes, while simultaneously going into excessive lumbar flexion. Many patients develop back pain as a result. The takeaway is when looking to stretch a muscle, stabilize the adjacent joints to avoid compensations.

Now whether or not we should actually try and stretch is another issue. From my experience, most "flexibility deficits" are actually secondary to either neural tension or relative hypertonicity compared to the antagonist muscle. What does this mean? If a motion is limited by neural tension (when I say neural tension, I am also talking about tightness that is increased with distal/proximal motions - not just patient symptoms), perhaps treatment is needed in the spine, along the path of the nerve or possibly some nerve glides to improve "flexibility." If it appears to be just a "tight muscle," it may be better to try strengthening the antagonist instead, due to some evidence saying we can't affect true muscle length. Regardless, when trying to stretch a muscle, makes sure you stabilize adjacent joints to avoid over-stressing them.

-Chris


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Like this post? Then check out the Insider Access Page for advanced content! And check out similar posts below!
Neural Tension vs. Muscle Strain
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Neurodynamics
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1 Comment
Dave link
12/30/2015 12:36:15 pm

Hey Chris,
Thanks for the article read and mention on your site. I think the main point of making sure we're hitting the correct tissue and stabilizing the other 'non intended' joints is important. In relation to your second point, I tend to follow the similar concept that the "tightness" is really just a manifestation of increased tone (protective or from a kinetic chain driver) Without truly knowing, my opinion and theory I think is very neurally driven in relation to altered gain of tonic/monosynaptic stretch reflexes peripherally or centrally, as well as central response to heavy nociceptive input from the structures driving the hypertonicity. I tend to use PNF techniques at end range, light soft tissue work, or competitive afferent stimulus like vibration to help modulate the "tightness" felt. Then from here I think we get a window of opportunity to repattern the new found motion seen with those neurally based tricks. Although I agree we shouldn't be nit picking exact pathoanatomical structures as sources, I can get behind the idea that the faulty biomechanics or poor motor control within the kinematic chain is sparking the nocicietpive drivers from those passive structures getting excessive strain. In this case I think knowing what structures are getting undue stress and understanding the anatomy can really help, especially for the gymnasts/dancers I treat who require huge arcs of motions for sport exposing the hip to high force. Lots of asymptomatic labral tears for example, but this could be the mechanism for those that are symptomatic within the region, (whatever structure it may coming from). Being able to first modulate their neurally based guarding, then repattern the range safely to reduce threat via proper end range control/strength to not become aggravated with sport patterns, then educate them about not cranking stretches improperly I think its important. That was really my drive behind the article series, I just didn't want to include all of that as many of my readers are non-healthcare trained coaches. Just sharing some thoughts, really enjoy your site and appreciate the work you do! - Dave

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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test