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Flexibility: stretching vs SMFR<br />PRESENTED BY:<br />Max MARTIN BAppSc (Hons) AEP<br />

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Please keep your phone ON!!<br />&<br />This is a Friendly session!<br />@<br />iNformMaxMartin<br />Corrective<br />Exercise<br />Australia<br />

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Why flexibility<br />Allow joints to align in anatomically correct way.<br />Pain has greater correlation to joint stiffness than misalignment.<br /><ul><li>changes in ROM affecting pain more than posture</li></ul>Neuromuscular dysfunction results in: <br /><ul><li>Stabiliserstypically become hypotonic/inhibited – ‘allowing’ faulty posture

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Gross movers typically become hypertonic/facilitated – ‘driving’ faulty posture</li></li></ul><li>Flexibility vs Stability<br />Do flexibility and stability sit at opposite ends of a continuum?<br />Are we confusing stability and stiffness??<br />Flexibility Stability Stiffness<br />

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Why do people stretch<br />Overall flexibility<br />Muscle lengthening - Joint mobility<br />Release tension<br />Prevent delayed onset muscle soreness (DOMS)<br />Injury prevention<br />Performance preparation<br />

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Stretching:<br />To elongate, increase in length. The implied meaning is that the muscle is not beyond its normal length<br />Kendall et al. 2005<br />

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Stretching for Joint ROM<br />Harvey, Herbert & Crosbie (2002)<br />13 studies of poor to moderate scientific quality<br />Various stretching methods used<br /><ul><li>Range Of Motion (ROM) gains on average of 8%

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tighter muscles greatest measured improvements.

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Consistency of >3weeks for ‘plastic’changes.</li></li></ul><li>Stretching and Performance<br />Fowles et al. (2000), Kokkonen et al. (1998)<br /><ul><li>Stretching reduces maximal strength for up to 1 hr post stretching</li></ul>Cramer et al. (2004)<br /><ul><li>Decreased velocity of limb movement in leg extension post active and passive stretching</li></ul>Cornwell et al. (2001)<br /><ul><li>vertical jump performance reduced post passive stretching</li></li></ul><li>Stretching and Performance <br />cont.<br />Stretching as part of warm up (Young & Behm 2003) prior to jumping tests - concentric & drop jump<br /> Five groups:<br /><ul><li> control (no stretch)

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4 min run

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passive stretch

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run & stretch

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run, stretch & practice jumps</li></ul>Result:<br />1. run <br />1b. run, stretch & jump<br />3. Run & stretch<br />4. control<br />5. Passive stretch<br />

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Inconclusive whether or not to stretch before exercise<br /><ul><li>Reliability an issue</li></ul>Shrier (2004) <br /><ul><li>Timing of stretching may also play an important role

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found no effects of acute stretching,

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but positive effects of regular stretching away from event on strength, jump height and running speed.</li></ul>Stretching and Performance <br />cont.<br />

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Effects of Stretching on DOMS:<br />Herbert & Gabriel (2002), LaRoche & Connolly (2006), Dawson et al. (2005)<br /><ul><li>Post exercise stretching not found to be effective in reducing DOMS</li></ul>Dawson, et al. (2005)<br /><ul><li>Also no improvement in performance (AFL players)</li></ul>Reisman et al. (2005)<br /><ul><li>Stretch during DOMS may maintain and or increase movement allowing athletes to train at higher levels</li></li></ul><li>injury prevention?<br />Difficult to study – unreliable results<br /><ul><li>Hard to control

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Need very high intensity to produce risk of injury</li></ul>Most conducted studies suggest no change in injury rates<br />Different sports require different joint flexibility leading to inconclusive results in literature<br />

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Warm ups and injury<br />Faigenbaum et al. 2006<br /><ul><li>Warm up often uncontrolled in studies, could effect study outcome on injury risk

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Dynamic warm ups increase performance in children and athletes compared to static stretching alone

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Dynamic warm up achieved higher anaerobic performance than static stretching protocols</li></li></ul><li>Summary<br />May help increase joint ROM long-term.<br />Stretching away from exercise environment may increase performance and reduce injury risk (yet to be confirmed)<br />(Pre/post Exercise) No evidence for :<br />Performance improvement (potential decrease)<br />Prevention of DOMS (post) or increased performance<br />Effect on injury rates<br />

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The Physiology of Tightness<br />Joint ROM can be limited by the following factors (Hutton, 1992):<br />Joint constraints<br />Subcutaneous connective tissue.<br />Neurogenic constraints (voluntary and reflexive)<br />Myogenic constraints<br />

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Muscle Fibres<br />(myogenic effect)<br />Can stretch to at least 50% greater length that resting (last cross bridges intact).<br />Magnesium deficiency can cause tightness (cramping) as magnesium facilitates actin-myosin release.<br />

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Muscle Spindles<br />(neurogenic effect)<br />Primary stretch receptors in the muscles.<br />reflexive capabilities via alpha-motoneuron.<br />Strong phasic contraction upon detection of stretch, followed by controlled tonic contraction.<br />Regular stretching may decrease sensitivity of muscle spindles<br />This may explain acute performance decreases post-passive stretch<br />

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Continuous structure that surrounds and integrates tissues and structures<br />Can affect relationship amongst structures<br />Composed of collagen and elastin, providing tensile and elastic properties.<br />Fascia<br />

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Contributes >40% of resistance to movement<br />Immobilisation decreases space between collagen fibres- causing a sticking together<br />Muscle overactivity can result in increased fibroblast activity (>collagen deposition).<br />Interconnectedness of fascia can result in patterns of tightness in muscle slings.<br />Fascia cont’d<br />

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Myofascial restriction:<br />Restriction in normal muscle function due to injury or biomechanical force imbalance<br />

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Trigger points<br />Discrete, focal, hyperirritable spot in taut band of muscle<br />Occurring in all patients with musculoskeletal pain<br />Can be active or latent<br />Symptoms:<br />Painful on compression<br />Referred pain/tenderness<br />Motor dysfunction <br />No evidence for development mechanism of Trigger Points<br />Acute and chronic trauma, chronic lengthening, sleep disturbance, anxiety<br />

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Myofascialrelease – the alternative<br />Similar to massage<br />Uses palpation, pressure and tissue stretch to relieve tension and improve:<br />Muscle tone, <br />Length, <br />Timing, <br />Strength, <br />Endurance, <br />Control <br />Can be used on various soft tissue abnormalities:<br /> Local increased muscle tone<br /> Trigger points<br /> Muscle shortness<br /> Fascial tightness <br /> Deficits in motor activity or control<br />Can result in pro-inflammatory effect and decreased fibroblast activity (short-term). <br />

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Exercise and myofascial release<br />Exercise is vital for myofascial release treatment<br />Resets neurological programming<br />Both needed for permanent change<br />

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Self Myo-Fascial and Trigger Point Release<br />Interactive soft tissue release requiring feedback from patient to determine correct position, amount of pressure and duration of stretch<br />Uses body weight on tool i.e. foam roller or tennis ball<br />Penetrates into muscle and or fascia<br />Easy and effective<br />Releases tightness and trigger points<br />Can be painful<br />Research to prove efficacy is poor and inherently<br />difficult to achieve.<br />

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Practical programming<br />Look at what is short-tight and facilitated (assess!!)<br />Address Right/left and front/back imbalances<br />Consider performance effect of chosen modality <br />Warm up:<br /><ul><li>Self-myofascial release

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Activation exercises

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Dynamic warm up with progressive loading

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(jog, add speed and direction change, dynamic stretch, agility, skill)</li></ul>Cool Down<br /><ul><li>Decrease metabolic load for waste product clearance

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Slow dynamic stretching movements

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SMFR

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Static stretching later</li></li></ul><li>PRESENTED BY:<br />Max MARTIN BAppSc (Hons)AEP<br />