How then shall we stretch?

In the previous installment I was a stretching snob and offered much criticism regarding five common stretches. So here are a few alternatives. Please keep in mind that the suggested movements are not fitting for all people at all times. They are based on the typical stress imposed on our bodies and the typical response to movement. 

But we're not all typical. If you try these and feel pain or inordinate discomfort, 1.) your are performing the stretch wrong, 2.) stretching correctly but too aggressively, or 3.) the stretch simply is not good for you.

1. Instead of Neck Circles...Try cervical retraction and thoracic extension.

With cervical retraction, the lower cervical vertebrae are extending (moving backward) while the upper cervical vertebrae flex (move forward). This counteracts the typical slumped posture where the lower vertebrae are forward with the upper segments extended.  

You can also try thoracic extension stretches, which definitely reduce the strain placed on the neck by moving the mid- to upper back into a more upright position. Be sure to keep the head neutral (horizontal relative to the trunk).

[For all the videos, please excuse my less-than-polished commentary ; ) ]

2. Instead of Ankle Alphabets...Try ankle multiplanar stretches and some light balance work.  

For tight ankles, try something that will actually stretch the tissue you intend to be stretched. If you claim to have "weak ankles," make some single leg balance/reach type activities a part of every warm-up. 

3. Instead of toe touches...Try kneeling hip flexor/lower back stretches or prone press ups. 

Give your lower back and hips some much needed relief from all the forward bending. For the hamstrings try to hip hinge while keeping the knee extended and lower back neutral. 

4. Instead of the High Five Pec Stretch...try the "W" or low doorway stretches. 

Having the elbow well below shoulder level minimizes the risk of soft tissue impingement and does not promote more laxity of the anterior shoulder capsule. You may also want to consider thoracic mobility (see above) and the internal rotation "sleeper" stretch. 

5. Instead of Shoulder Circles...try push ups, yoga-push ups, shoulder elevation at wall and shoulder abduction with thoracic side bend.

Try to perform all of these while keeping the lower back neutral and the shoulder blades in proper position.

Many of the best dynamic warm-up movements provide a moderate stretch to many of the tissues involved above plus some dynamic movement with balance and control. While these do little to increase the flexibility of tight tissues, they do serve as a time efficient and much more effective warm up to physical activity. A few of my favorites are:

This list is not meant to be comprehensive, but certainly let me know if there any that I missed. Or if your shoulders did fine since the first grade with arm circles, well then, keep doing arm circles.


Top 5 Stretches to AVOID

Stretching is like dark leafy green vegetables. Some people love them. The other 99% of us feel that stretching is time consuming, mildly uncomfortable, and boring. But people who are healthy stretch. Because stretching is good for you. Right?

See this commentary [ Link: Stretching The Truth ] of what stretching does and does not accomplish.

While stretching is highly over-rated as a prelude to more vigorous exercise, it's often worthwhile in the context of physical rehab. Stretching may also serve as a simple and effective means of counteracting the daily demands we place on our bodies.

But not all stretches are created equal. Some are a waste of time and others may actually put you at increased injury risk. We've all seen and likely performed such ill-advised stretching.

I'll readily concede that there may be instances where some of these stretches may by warranted for select individuals. But here are the Top 5 stretches that most individuals should probably avoid:

Image: Dr. Gustav Zander's hip and abdominal stretching
machine circa 1880

Top 5 Stretches to Avoid:

1. Neck Circles

Neck circles are your grandfather's answer to every condition above the shoulders. Cervical disc herniation? Central canal spinal stenosis? Suboccipital muscle spasms? Whiplash? Give it some neck circles.  

It's easy to visualize how neck circles can be harmful when performed in less than ideal posture. But even in good posture, the 3 and 9 o'clock positions can be awfully hard on your neck.

2. Ankle Alphabets

This is where you are supposed to trace each letter of the alphabet with your toes. While I'm sure AAs have never caused an ankle or foot injury, neither have they helped other than possibly providing circulation to the area. There are far more specific and effective ways to strengthen and stretch the ankle, foot, and lower leg.

If your physical therapist, athletic trainer, or personal trainer has you do AAs, what they are really telling you is that you should move your ankle around while they complete their notes or something.

3. Toe Touches

Ah, toe touches. THE classic stretch, standing or seated on the ground, where the lower back and hips both bend (flex) forward. So after you had your lumbar spine and hips flexed while sitting all day at work or in class, while driving to the gym or athletic field, and while putting on your socks and shoes, you're going to stretch the back and hips into a MORE forward bent position?

There are some instances where forward bending of the spine is warranted. But far more often than not, such excessive forward bending causes problems. There are better ways to stretch the lower back and hamstrings.

4. Shoulder Circles

This is the one where a person puts the sore arm out to the side and grinds away. Despite what every gym teacher believed in the1980s, this movement is a poor choice for healthy shoulders much less sensitive ones. Sorry Mr. Waller.

Raising your arm up and back in a palms-down position compromises the space occupied by the rotator cuff tendons, subacromial bursa, and other soft tissues. Shoulder Circles cause these structures to get caught on or pinched between the humerus and shoulder blade.

5. High Five Pec Stretch

Most athletes who throw, hit, and serve with an overhead movement naturally acquire some degree of laxity or looseness in the front aspect of the shoulder joint. The rest of us desk jockeys and weekend warriors chronically sit with the shoulder blades tilted forward and the humerus seated forward in the socket of the shoulder blade. The High Five Pec Stretch is a great way to take both of these problems from bad to worse.

For healthy shoulders that enable you to do something that's worthy of an actual high five, avoid the High Five Pec Stretch.

Stay tuned for appropriate alternatives to these Bottom 5!


Why CUSTOM Orthotics?

Did a guy at Foot Locker or the Dr. Scholls machine at Walmart say that you need a certain insert? Do these gel inserts and other off-the-shelf varieties really accomplish much the same at half the cost of a custom orthotic?

These are good questions. My informal on-line search reveals a lack of quality advice on this topic. Those who manufacture and sell off-the-shelf inserts portray their product as pure nirvana for any and every foot condition. On the other hand, many medical professionals promote custom orthotics as if they are the only treatment option.

Not every person with a foot issue needs a custom orthotic (or an orthotic at all). Some will do perfectly fine in the right off-the-shelf insert while others clearly need custom inserts. And the Dr. Scholl's (and other) gel liners? If that's all it takes to clear up your chronic leg or foot problems, consider yourself fortunate.

Which type of insert is best for you? First a disclaimer!

Everyone has a unique set of circumstances. Some of the more obvious variables to consider include foot structure, movement quality (strength, flexibility, etc), and activity level. But there are an equal number of soft variables. What kind of shoes do you wear and are you willing to wear? How compliant will you be with instructions regarding orthotics, exercises, and a slow return to desired activities? How sensitive is your foot (really your entire being) to change?

Given the disclaimer, here are a few important considerations regarding off-the-shelf versus custom orthotics.

1. Soft off-the-shelf inserts:

There is a reason why most off-the-shelf inserts are made of gel or other squishy material: they will hurt people far less often than a more rigid off-the-shelf insert. The problem with gel inserts is that the treatment effect is minimal. While almost everyone will tolerate a gel or soft foamy insert, very few will see actual change in terms of pain and functional ability.

Take plantar fasciitis, for example. This problem is not due to ground pressure into the foot, but from abnormal strain ACROSS the length of the foot. The chronic pain, inflammation, and degenerative changes are caused by the PF being pulled apart and/or twisted, not from being pressed into. This is why squishy shoes, gel heel cups, and soft cushioning inserts rarely provide long-term relief.

2. Rigid off-the-shelf inserts:

Rigid inserts have greater potential for providing support and relief as compared to gel inserts. They stiffen the shoe and help the entire leg function with improved leverage. The problem with off-the-shelf rigid inserts is that they are constructed according to the average, most probable foot. So if your foot is a little wider or narrower, higher or lower in the arches, or the proportions and contours vary from the norm, the insert will often cause more grief than relief. This is an issue because it's those without "average" feet who have the most problems.

An easy way to see if you can get by with a rigid off-the-shelf insert rather than a rigid custom orthotic is to simply stand in them. Place them on the ground and then in your shoes. Walk around for 5 or 10 minutes if you can. If you feel contoured support but no ridges, abrupt creases, or edges, then it's probably worth the time and cost to give them a try.

3. Rigid custom orthotics:

These are constructed from a foam impression or a plaster cast that enables the clinician to capture the exact width, length, contour, and proportion of the feet. This allows for improved tolerance to a fairly rigid device. The clinician can also more easily identify high-pressure areas and perform various custom accommodations. Do you need a little or lot more arch fill than the norm? Do you need a metatarsal pad just proximal to (but not on) the a neuroma? Custom orthotics leave out any guesswork as to where various modifications should be placed.

It's important to keep in mind that orthotics are not magic. All inserts are most helpful when used in conjunction with other treatments that can help alleviate swelling and inflammation, improve strength, mobility, and gait pattern, and a skilled eye that can help you "marry" the appropriate orthotic to the right footwear.


No pain - no gain - no motivational cliche

"No pain - no gain" is a half-truth.

"Pain is weakness leaving the body," is dead wrong.

Suffering an injury when you're on the brink of a major challenge or p.r. is like picking Mr. Peppermint when you've just cleared the Molasses Swamp. But maybe if we combine the two oft quoted but false sayings we'll come out with something semi useful.

"Pain is weakness leaving the body - no gain." Or something like that.

While I don't often seriously utter motivational quotes, this mish-mash may be on target. What people are usually trying to convey is the value of toughening up mentally and physically. They're reminding us that there's no reward without intention, grit, and usually plain old suffering.

And it's the regular and disciplined practice of intention and grit that helps mold who you are, what you do, and how you respond to life above and beyond the gym or athletic field.

No, really, check THIS out. Also this.

[And yet all good things can easily be taken to unhealthy extremes. I believe there is more to living than the mechanical and biological...]

Compared to everyday existence, purposeful exercise is physically uncomfortable and mentally irritating. But those are some of the things we need most in our relatively comfortable society.

Name something that...

provides genuine physical and mental benefits
with a regular opportunity to take on challenge and risk
in a relatively safe but real environment
with parameters that you do realistically have some degree of control over?

Now how do you obtain the full dose of physical activity while minimizing the risk?

1. Smart programming. Study up so you know what you're doing or find someone who does.

2. Let gradual, process-focused progression be your guide. When we want results yesterday, we miss the value and built-in safety mechanisms of the ride.We do too much too soon and something suffers.

3. Watch the extremes: dead lifting your body weight for many reps with ease = good. Dead lifting triple body weight for one rep = risk. 5 K for faster time = good. Completing five marathons - risk.
Risk is fine if you're aware of what you're getting into.

4. Smart programming: Some degree of variety helps hold your interest and keeps you from over-training any one area or component of fitness. But too much variety never allows you to know where you stand in terms of truly facing limits. Doing too much at once often leaves you spinning your wheels due to incompatible goals (like improving both strength and running endurance). Think in terms of months and years not days and weeks. Set a goal and stick with it for a while. 

You don't have to destroy yourself with effort and injury in order to enjoy the plethora of "gain" associated with physical activity. The process need not require much time or expense. But the practice of discipline is a must, and that's never easy. Feeding your system relatively controlled doses of discomfort is absolutely good for us on a number of levels. The key is discovering the zone where you actually find joy in it.

"No hurries. No short-cuts."