Stretching and flexibility – what your physio wishes you knew!
I’m fortunate enough to work with many amazing physios and osteos.
Here’s the low down on why we need to be more flexible,
with physiotherapist Rebecca van Klinken:
Becca, you’re a highly experienced physio – which means you’ve seen a lot of folk! Where do you think patients are going wrong when it comes to staying robust and comfortable?
Becca: I think it’s a bit unfair to say that patients are doing things wrong because the vast majority of people are never taught how to do things right! For example, we’re all taught at a young age how to keep our teeth healthy but we’re not taught how to move properly and to protect and look after the mechanics of our body.
90% of my patients spend at least 7 hours a day sitting at their desks, not even getting up for lunch. When they do get up and go out, they’re hunched over their phones like zombies. Our constant use of laptops and phones is simply not conducive to good care of our bodies. Being flexed over a computer/phone screen repetitively often leads to discomfort which may become chronic.
An important part of my role is educating patients to help them to look after their bodies more effectively, not just when they are playing a sport or exercising, but throughout their whole day. So patients are going wrong by spending too much time in one, often bad, position.
Many patients and clinicians are confused about the whole concept of stretching. On the one hand, it’s often recommended by therapists, but no studies show that it prevents injury. What’s your take on it, and why?
Becca: I believe certain types of stretching are a super important part of my treatment. Patients often need either their joints or muscles mobilised via dynamic stretching (i.e. a stretch which involves movement in a controlled manner) which relieves tightness.
If you try to move in demanding ways with tight joints or muscles, it can result in injury. Whilst dynamic stretching alone cannot prevent injury, it can certainly contribute to reducing the risk of it occurring. At this point, I have to say that static stretching (whereby you hold a muscle or joint in one position for a period of time) should never be done before or during exercise and sport. This is because it could actually increase your injury risk due to the effect it has of lowering muscle firing thresholds. Static stretches have been shown to make muscles less responsive in the immediate time post-stretching.
Dynamic stretching of muscles and joints should be something we all do as general maintenance of our bodies whether we’re injured or not. However, this is not the case for tendon issues. Static stretching is bad for tendons and I have to say in my experience I agree with research about this particular aspect of stretching!
The full benefit of dynamic stretching comes from when it is done regularly rather than just now and then, so I encourage all of my patients to include dynamic stretching as part of their lifestyle. A big problem I see at work is City workers who have stiff backs from sitting at their desk all day. They then go out and play tennis/golf and end up with an injury due to the lack of flexibility in their trunk. They need to mobilise their spines and not just once, but regularly in order to keep stiffness at bay.
Over the years there have been ‘fashions’ in terms of diagnoses (whiplash and piriformis syndrome spring to mind), and exercises that we ‘should all be doing’. There’s a vogue lately to blame everything on slack bottoms (weak glutes). Whilst this may be true for some patients, I’m not convinced the world can be cured with yet another round of ‘clams’. How you any pet-hates when it comes to diagnoses or remedial exercises?
Becca: Oh, the clam….how many times have I met a patient with hip or back issues who were prescribed the clam and they just didn’t get better!
I think my big pet hate would be a prescription of exercise that is not specific to the lifestyle of the patient. You cannot expect the latest fad exercise to suit everyone when we all have different demands on our bodies. Coming back to the clam, it is a floor based exercise used to fire up the external rotators of the hip. The exercise bears no resemblance to how we move on a day to day basis. It’s far more effective and inspiring to prescribe a functional, standing exercise to get the external rotators working. Not only do they work on a muscular level, our brains will also start to recognise how to use the muscles in a functional position. It’s a win-win!
Bad Posture’. Does it exist? Is there such a thing as good posture?
Becca: Absolutely! Bad posture exists but the remedy isn’t quite as simple as “stand up straight”. We all have different body shapes and bony structures so what is “good posture” for you will be slightly different to a “good posture” for me. I think it is better to say we need to hold ourselves in a safe, supported posture rather than a ‘good’ one.
A great way to find your ideal posture is to be analysed by a health professional who knows what they are talking about. They can then give you guidance on how to stand from your feet up to your head. So often meet patients with lower back or hip pain who have been told to “tuck their bottom down/under more” which, the majority of the time, is the total opposite of what they need to be doing.
If you could advise patients to make one change in their lives or rehab, that would bring the greatest benefits, what would that be?
Becca: Move more! I know it’s unrealistic to expect everyone to have a standing desk but try to avoid being static for prolonged periods. A quick walk to the water cooler once an hour will make a massive difference.
Rebecca van Klinken is a physiotherapist at the Octopus Clinic in Holborn.
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