Stretching

Functions:

a)      increases the number of sarcomeres

b)      stresses the stretch elastic component of the muscle/tendon complex

c)      can reset the gamma efferents, which control muscle tension, allowing a fuller range of movement

d)     can prevent adhesions following injury

e)      provides a low load across the scar tissue, helping to orientate healing fibroblasts

Static stretching does not prevent injuries.

Methods of stretching

General

Streching is for the antagonist, which is the muscle that resists the direction of movement, and should be done with a relaxed, passive muscle; which is achieved by breathing out and relaxing to reduce muscle tension whilst by stretch is employed.

Passive stretching

This type of stretching is limited by joint range and soft tissue abutment. This is stretching where force out of athletes system does the movement above the maximum range.

Proprioceptive neuromuscular fascilitation

This is a method that tries to enhance the relaxation for passive stretching:

Method 1 – Actively works the antagonist against the resistance of the therapist, and then relaxes this muscle while the agonist is passively stretched by the therapist

Method 2 – The antagonist should relax when the agonist is worked, so the therapist resists the agonist, the muscle that initiates the movement, gradually stretching the antagonist at the same time

Active stretching

This requires muscle work from the agonist and relaxation from the antagonist. This is type of stretching where athletes reaches maximum amplitude by using his own force without load out of the system.

Yoga stretching

This allows the gamma efferents, which control muscle tone, to be reset, producing long-term elongation, and does not habituate protective spasm from an injury.

Bounce stretching

Habituates protective spasm from an injury and does not permanently lengthen the tendon muscle complex, but it does increase teno-osseous junction strength.

Ballistic stretching

Actively kicking a straight leg raise into the air, with increasing rapidity, will train the hamstrings( which are decelerating this movement) to decelerate the movement over a longer arc. EMG shows that the hamstring actively decelerates the swing phase of running so that the leg is braced ready for impact, and this combination of agonist and antagonist contracting together is known as coactivation. If the hamstring is stretched forcibly, it will encourage a contraction when the knee is nearly straight. Thus jumping into “front back” splits and “hurdle” stretches, if forced, may recruit active hamstring contraction at the very moment that relaxation is required, and therefore must be trained as a ballistic movement, or done slowly, with relaxation of the target muscle group at the end of range.

WARNING:  FORCED HAMSTRINGS  OVERSTRETCHING HAMSTRINGS MAY LEAD TO HAMSTRING AVULSIONS OF THE ISCHIAL TUBEROSITY.

Streching pre-exercise

a)      gently warm-up first

b)      active yoga stretch for muscle relaxation for 15-20 seconds

c)      passive stretch using gravity, or a partner for muscle relaxation, of both agonist and antagonist

d)     bounce stretch for teno-osseus strength

e)      ballistic stretch for muscle coactivation

f)       slow mimic of sport activities

g)      stretching on warm down

Stretching for injury

a)      Gently warm-up

b)      Active yoga stretch to stretch out scar tissue

c)      Proprioceptive neuromuscular facilitation stretch, for scar tissue

d)     Ballistic stretch, for scar tissue and muscle coactivation

e)      Stretch on warm down

f)       The warm up can slowly mimic activities required by the game, and this, therefore, encourages both active and ballistic stretching

Proprioception

Mechanoreceptors are joints, and the position sense in space, are enhanced by balancing exercises. However, if the eyes can be removed from helping the patient to balance, then the mechanoreceptors must contribute more. So balances may be done with the eyes shut or, on a busy day, by balancing whilst brushing the hair, cleaning teeth or talking on the telephone, because doing something else stops the eyes and brain from helping the movement and balance. This forces mechanoreceptors contribute more, which is of course more representative of normal life. Proprioception can also be enhanced by support strapping, which recruits the skin receptors into providing additional positional information.

Prophylactic strapping

Evidence from American basketball teams suggests that this does not help reduce the number of ankle sprains. However, no increase of knee injury has been shown. Fingers and wrists seem to benefit, and thermoplastic splints for skiers’ thumbs are invaluable. Sometimes strapping a muscle may be of help, possibly by acting as an exoskeleton so that the muscle achieves the purpose of support, which reduces the loads being transferred to its tendons. A particular example may be the tennis elbow supports. Some prophylactic strapping requires “underwrap” and metres of tape to be purchased, and these can be replaced by custom-made plastic, pneumatic, Velcro, or lace-up supports.

Convenient home rehabilitation

Most sportspeople simply have too much obligations, and exercises should be built inside of their obligations schedule if possible. They may attend two physiotherapy sessions a week for 15 minutes, which is hardly sufficient, but as they improve or run out of money, this attendance will be rapidly abandoned. They will have to be given formal exercises at home, although some exercises can be designed for the journey or workplace.

General proprioceptic exercises for ankle, knee, hip and back

Balance on one leg whilst cleaning the teeth, brushing the hair, putting on clothes, answering the telephone or waiting for the train, and indeed standing on the train.

Quadriceps and proprioceptive exercises

Balance, and hold a half knee squat on one leg, whilst doing the general exercises above. Walk upstairs placing the whole foot flat on each tread, so that no additional thrust is obtained from the calf, and propulsion is obtained only from the quadriceps. Walk slowly down stairs or slopes, trying to hold the rhythm consistent between both legs.

Calves

These should be trained one at a time by doing heel raises on one leg whilst, for example, waiting for a train, cleaning the teeth or answering the phone.

Hamstrings

Very adequate eccentric and concentric work can be performed at home by lying supine on the floor and placing the heels on the seat of a chair. Then raise one’s backside as high as possible off the ground and then lower it back to the floor again. This can be performed fast or slow, one legged or both legged, with the knees bent or nearly straight, and is reffered to as “chair raises”.

Isometrics

This represents the type of contraction where the athlete holds the position for amount of time, mostly between 15-25 seconds.

a)      Peroneals. Cross the ankles, with plantar flexed feet, and force the outside of both feet against each other. Do not turn the foot so that the tibialis posterior is doing the work.

b)      Posterior tibialis. Push the big toe joint of the target foot against the inside heel of the other foot.

c)      Tibialis anterior and flexor hallucis. Pull the dorsum of the foot and great toe up into the sole of the other foot.

d)     Quadriceps and hamstrings. Sit on a desk, cross the ankles and push away with the hindmost foot to extend the knee and work the quadriceps of that leg, whilst pulling back with the front leg heel, into the ankle of the back foot, to work the hamstrings of the other. This can be done sitting on the train, if required.

e)      External hip rotators. Whilst standing, tighten the buttocks, drive the knees straight and externally rotate the knees( the movement comes from the hip, but the patient often understands the phrase better). This then may be done whilst standing on one leg, and then drop into a half squat balance on this leg. However, the knee must not be allowed to drift into valgus, the foot of unsupported leg swing behind the other leg, nor the anterior superior iliac spine on the ipsilateral side swing forward. All of these unwanted movements are produced by the external rotators of the hip being weak.

f)       The rotator cuff of the shoulder may be exercised by isometrics against the resistance of the restraining other hand. External rotation for the infraspinatus, internal rotation for subscapularis, and elbow abduction, from a position tucked in to the side, for supraspinatus.

g)      Exercises for tennis elbow can incorporate: with the elbow held straight, resisted extension of the wrist, and then, as the pain settles, resist the extended fingers against the other hand.

h)      Exercise the golfer’s elbow may include pressing the pulps of the fingers into the trapezius and trying to pronate the target hand against the resistance of the other hand.

i)        Biceps isometrics, such as pulling the forearm up to the shoulder, can be done against the resistance of the contralateral hand.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English