To Stretch or Not to Stretch

PT's stretch stuff. Maybe the most common belief of PT's is that they stretch hamstrings. Interesting given the lack of physiological rational for passive stretching. This is not to stay that it's not beneficial, as many studies prove that it does seem to be helpful in preventing injury. Additionally there is a substantial body of evidence supporting the addition of passive stretching as part of a rehab program. However, the practice tends to favor most other forms of mobility work to passive stretching. Yet here we are...in the minds of our patients we stretch people.

So if we are going to stretch something, we need to at least make sure we do it for the right reasons. Another common belief about PT's is that we stretch tight muscles. This brings me to the next point, which has to do with tightness. What is tightness? What does it mean? What exactly does it feel like? How should we entertain the complaint of tightness?

First of all, the most important thing for us to understand is that tightness is a symptom, and alone means next to nothing. Tightness coupled with an objective measurement still is only partially useful. To illustrate how this is possible, consider the following example. A patient comes in with legitimately short hamstrings (less than 80 degree on passive SLR). You do a straight leg raise on him, and he says it feels tight around 60 degrees. Providing the issue is indeed hamstring shortness and not nerve tension, and providing that his hamstrings are sufficiently strong, stretch away. Now consider another example. A 23 year old gymnast presents w/ spinal hypermobility, and constantly twists to make her back pop because it feels good for about 17 and a half seconds. She states that she does this because her back always feels tight. However, upon examination she has full (probably excessive) lumbar ROM in all planes. Both patients have the same subjective complaint for completely opposite reasons. One has a very clear justification for stretching, while the other probably would not benefit from passive stretching.

Most likely scenario is that both patients will benefit from strengthening in end range positions, and this will be more helpful than any passive stretching. However, that's a topic for another day. Mobility work is an essential part of what therapists do, though we need to be careful about the reasons that we look to improve mobility. The feeling of tightness is not a indication that something needs to be stretched, but is quite often the way the brain processes a tissue that is not happy with it's own ability to sustain a load in a particular position.

Happy stretching my friends!