microStretching® Attributes

Introduction

A proper recovery and  regeneration technique optimizes the healing processes. These processes are a complex response, a psychophysiological input, with adaptation mediated between the paired antagonism of the sympathetic and parasympathetic nervous systems (1, 2). As mentioned previously (see benefits), the sympathetic nervous system is responsible for increased tension/activation in the musculoskeletal system. It prepares the body for action (fight, flight, or fright) as well as initiating the inflammatory response, if the stimulus is pain or injury.  On the other hand, the parasympathetic nervous system relaxes the body (3), suppressing the magnitude of an inflammatory response (4). Thus, it is reasonable to suggest that stimulation of the sympathetic nervous system is counterproductive for the proper recovery and regeneration of muscle and connective tissue, since it can perpetuate an inflammatory response on an already inflamed and injured tissue. When considering stretching intensity or stretch load (the amount of force placed on the tissue), a thorough understanding of this concept is necessary. In what follows, evidence will be presented showing that a low-intensity gentle stretching is preferred for its relieving effect, and not a high-intensity stretch that may well provoke an inflammatory response (5, 6). (refer to microStretching®research).

Since stretching is considered a force placed on a muscle and held for a length of time (7,  8,  9), this force affects tissue integrity, based on the difference in tensile strengths of tendons and muscle. Therefore, it is very important to keep stretch intensity low to prevent injury and the development of scar tissue (10, 11). Investigations by Dr. Robert Salter observed the importance of passive gentle motion, a low-intensity of stress, as a therapeutic modality following trauma to connective tissue, accelerated the healing of articular cartilage and peri-articular structures (joint capsule, ligaments, and tendons) (12). In addition, gentle, continuous passive stress allowed for the formation of parallel collagen and elastin fibers necessary for restorative movement of the acute disorganized scar tissue (12).

References

  1. McEwen, B.S. (2003). Interacting mediators of allostasis and allostatic load: towards an understanding  of resilience in aging. Metabol Clin Exper. 52: 10-6.
  2. Porges, S.W. (2009). The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleve Clin J Med. 72: s86-90
  3. Everly, G.S. & Lating, J.M. (eds)(2019). The anatomy and physiology of the human stress response, New York: Springer, New York, NY.
  4. Tracey, K.J. (2002). The inflammatory reflex. Nature.  420: 853-9.
  5. Apostolopoulos, N.; Metsios, G.S.; Taunton, J.; Koutedakis, Y & Wyon, M. (2015). The relevance of stretch intensity and position – a systematic review. Front Psychol.  6 (art. 1128): 1-25.
  6. Apostolopoulos, N.C. (2018). Stretch intensity and the inflammatory response – A paradigm shift. Switzerland, Springer-Nature.
  7. Sapega, A.A.; Quedenfeld, T.C.; Moyer, R.A. & Butler, R.A.  (1981). Biophysical factors in range-of-motion exercise. The Phys & Sportsmed. 9: 57-65.
  8. Maffuli, N.; King, J. & Helms, P. (1994). Training in elite young athletes (the training of young athletes (TOYA) study): injuries, flexibility and isometric strength. Br J Sports Med. 28: 123-36.
  9. Weerapong, P.; Hume, P.A. & Kolt, G.S. (2004). Stretching mechanisms and benefits for sport performance and injury prevention. Phys Ther Rev. 9: 189-206.
  10. Apostolopoulos, N. (2004). Microstretching® – A new recovery and regeneration technique. New Studies in Athletics. 19: 47-54.
  11. Jacobs, C.A. & Sciascia, A.D. (2011). Factors that influence the efficacy of stretching programs for patients with hypomobility. Sports Health. 3: 520-23.
  12. Salter, R. B. (1989). The biological concept of continuous passive motion of synovial joints. The first eighteen years of basic research and its clinical application. Clin Orthop. 242: 12-24.

The Primary Four

Introduction

The fundamental goal of Stretch Therapy™ and microStretching® is to decrease neuromuscular tension, or more simply, relieve muscle tightness, from the brain to the muscles themselves, by activation of the relaxation response in the form of low-intensity gentle stretching, which in turn optimizes healing. microStretching® is an evidenced based, low-intensity passive and active gentle static stretching technique with specific attributes and principles. It has been observed to decrease muscle soreness, diminish inflammation, and increase muscle function (1, 2). The attributes associated with microStretching® are similar to those of other training programs – intensity (how much), duration (how long), frequency (how often), and volume (how many). Below are explanations of each attributes as it relates to proper Stretch Therapy™ and microStretching®.

References

  1. Apostolopoulos, N.C. (2018). Stretch intensity and the inflammatory response – A paradigm shift.  Switzerland, Springer-Nature
  2. Apostolopoulos, N.C.; Lahart, I.M.; Plyley, M.J.; Taunton, J.; Nevill, A.M.; Koutedakis, Y.; Wyon, M. & Metsios, G.S.(2018). The effects of different passive static stretching intensities on recovery from unaccustomed eccentric exercise – a randomized controlled trial. Applied Physiology, Nutrition, and Metabolism. 43: 806-15.

Intensity (how much)

Exercise and physical activity are generally categorized into three different types of intensity: low, moderate, and high (sometimes referred to as vigorous).

Intensity is defined as the magnitude of force or torque being applied to the muscle (and joint) during a stretching exercise (1).  For microStretching®, the intensity of the stretch is between 30 to 40% of a maximum perceived stretch.

A study investigating the effects of a high intensity passive static stretch observed that individuals stretching at an intensity level of 80% of a maximum perceived stretch incurred significant inflammation as evidenced by an increase in hsCRP immediately post and 24 hours post stretching (2)

References

  1. Jacobs, C.A. & Sciascia, A.D. (2011). Factors that influence the efficacy of stretching programs for patients with hypomobility. Sports Health. 3: 520-3.
  2. Apostolopoulos, N.C. (2018). Stretch intensity and the inflammatory response – A paradigm shift. Switzerland, Springer-Nature

Duration (how long)

The optimal duration for microStretching® is 60 seconds. A study investigating the effects of various durations of stretching of the hamstring muscle in the elderly concluded that a low intensity, passive static stretch held for 60 seconds produced the greatest increase in rate of gain in terms of range of motion (1).

In addition, at the microStretching® clinic, it was observed that if a stretch was held greater than 60 seconds, patients experienced greater discomfort and tightness. This feeling may be attributed to a slight occlusion of the blood vessels causing ischemia since the muscles are being held in a set position for a duration greater than 60 seconds.

References

  1. Feland, J.B.; Myrer, J.W.; Schulthies, S.; Fellingham, G. & Measom, G. (2001). The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people age 65 years or older. Phys Ther.  81: 1110-17.

Frequency (how often)

Repetition is integral for motor learning and skill acquisition. In order to create a new motor pattern, one must break the previous neuromuscular pattern and replace it with a new one (1). In addition, any pain associated with injury or trauma causes an involuntary shift of load from the affected limb and joint towards the sound limb. These compensations become an automatic response which could cause repetitive strain to the unaffected side and should be avoided, but more importantly affect the proprioception of the body.

Frequency sharpens the motor system, allowing an individual to master an alternate strategy of movement. The greatest change to the muscle tendon unit occurs in the first four [4] stretches (2, 3). Therefore, the microStretching® recommendation for self-exercise is to perform three [3] repetitions of a stretch per muscle group. For example, a person stretching their left calf will hold this stretch for 60 seconds at an intensity level of 30 – 40% of a maximum perceived stretch, followed by a stretch in the same form for the right calf. This is repeated two [2] more times for a total of six [6] minutes (i.e., three [3] minutes per side).

References

  1. Bhatia, D. (ed.) (2020). Chapter 21-Muscular load compensation patterns in patients with knee osteo-arthritis. Academic Press.
  2. Taylor, D.; Dalton, J.; Seaber, A. & Garrett, W. (1990). Viscoelastic properties of muscle-tendon units: the biomechanical effects of stretching. Am J Sports Med 18: 300-9.
  3. Taylor, D.C.; Brooks, D.E. & Ryan, J.B. (1997). Viscoelastic characteristics of muscle: passive stretching versus muscular contractions. Med Sci Sports Exerc. 29: 1619-24.

Volume (how many)

The number of sessions  across a distinct period of time (e.g., a week) describes volume, which plays an important role in the restoration of function for injured, damaged, or overused muscle and connective tissue (1). Mathematically it is characterized by the other three attributes of a stimulus (intensity, duration, and frequency) and is considered when referencing a proper dose-response relation (2).  Similar to training recommendations, where the various combinations of load and volume are used to target specific physiological adaptations through activation of distinct cellular and molecular events, volume allows for the target of specific mechano-biological adaptations (3, 4). The prescription of volume helps to reinforce the mechanical changes needed to alter the structural and cellular behaviour of the tissue associated with an adverse tension, which will enhance blood supply and neural conductivity as well as reduce inflammation (5)

References

  1. Herold, F.; Muller, P.; Gronwald, T. & Muller, N.G. (2019). Dose-response matters! – A perspective on the exercise prescription in exercise-cognition research. Front Psychol. 10(2338): 1-17.
  2. Lee, I.M. & Skerrett, P.J. (2001). Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc. 33: S459-71.
  3. Toigo, M. & Boutellier, U. (2006). New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol. 97: 643-63.
  4. Ruimerman, R.; Hilbers, P.; Van Rietbergen, B. & Huiskes, R. (2005). A theoretical framework for strain-related trabeucular bone maintenance and adpatation. J Biomech. 38: 931-41.
  5. Apostolopoulos, N.C. (2018). Stretch intensity and the inflammatory response – A paradigm shift. Switzerland, Nature-Springer.