Almost everyone associates running and stretching, but how much do you know about the when, how, why, and what of stretching? Some runners stretch fanatically, and others not at all, but one thing is clear: injury rates for runners are not going down. It seems no one can really decide what the answer is. This post tries to shed some light on this controversial subject.
I'm Dr. Allan Buccola, physical therapist and owner of Impetus Physical Therapy in Greensboro, NC. This blog is intended to serve education purposes only, not medical advice. I have not examined you personally and am in no position to offer advice to you. If you are having pain or dysfunction related to movement, please contact me directly or other qualified medical practitioner to be examined thoroughly.
The Basics of Flexibility
Despite the gray areas related to stretching, there are a few things that are of resounding consensus in the world of biomechanics. Firstly, 'flexibility' is not simply a term that relates to tightness in muscles. Flexibility, or the ability to move a joint through its full range of motion, is a factor defined by mechanic properties of multiple factors, including soft tissue compliance and elasticity, bony joint alignment, joint capsule tightness, and joint effusion (fluid content). All of these things (and more) can change the way a particular joint is able to move in space.
Secondly, there is no clear cut stretching protocol that is recommended for every runner. Arguably, it's not even recommended that every runner should be stretching, and certainly limited evidence to support the notice that stretching will prevent injury. The key here is to know the different type of stretching and their best utility and use them when you have a particular goal in mind.
Number three is the most important of them all. Flexibility is a continuum of mobility, with reduced performance and increased injury risk at both ends. Exercise scientists everywhere concur that both too much flexibility and too little put athletes at risk. The goal is to keep everything in perspective, always keeping overall performance the main determinant.
Finding that sweet spot of mobility is kind of like finding the right pair of shoes, and no...not talking high heels: think function. You know when they're too tight and you know when there's too much wiggle room, but ultimately it all depends on the the task at hand. Are you hiking in a river bed? Are you running 13.1 miles? Are you walking down to the mailbox? The task is what ultimately determines the right amount of mobility.
The fourth and final key is that creating real change to muscle length requires lots and lots and lots of stretching. The immediate changes that occur after stretching are short term and should be understood as temporary muscle relaxation; however, repeating this process consistently over a long stretch of time (think weeks to months) can create true and actual growth of muscle tissue in a linear fashion. The big question, of course, is who needs to do this in the first place.
Flexibility Red Flags
When trying to decide if you have a flexibility problem consider these three Red Flags. These are often a good indicator that your mobility needs to be addressed or investigated in detail.
1. A sudden loss in flexibility in a particular area
2. Major flexibility asymmetry, even if longstanding
3. When 'fixing your posture' requires great effort
When are mobility deficits revealed?
Many of the runners that I have worked with, seem to discover mobility problems in one of three scenarios. The first area is often when running faster workouts or performing speed-work. Slow running or jogging simply doesn't engage full joint mobility the way faster running does. In fact, the faster one begins to run, the great joint range they typically utilize. The combination of tightness and speed-work puts maximal loading at the absolute end of a rigid system. This can be a recipe for disaster.
Running hills is another typical scenario that conjures discovery of bodily limitations. The steeper the hill, the greater the stresses and joint range required in the hips and ankles. This often results in complaints of anterior hip impingement, Achilles tendinopathy, or even worse. On a related note, it also puts additional loading on the hip stabilizers and the patellofemoral joint, which will result in additional strife.
Another classic scenario of mobility deficits becoming problematic is when runners undergo a mileage increase, especially a quick one. No athlete has perfect mechanics. The human body is a constantly adapting machine that reshapes gears over time as needed. Response to stress is a defining characteristic of exercise. If you gradually increase mileage over time, the body can cope with high degrees of mechanical imperfection to some extent. Every runner does have a breaking point however, and whether that point is 15 miles per week or 150 miles per week is where a physical therapist can make a difference.
Three Easy self mobility screening
Bridging, knees and feet together- hips, IT bands, knees: This position is the typical posturing of the non weight bearing leg during swing phase. Coming into this position, normalized mobility will allow the feet and knees to stay together while the pelvis comes up from the floor. Tightness in the hips, IT bands, or knees, along with some potential other areas, will create difficulty in bringing the pelvis in line with shoulders and knees. It may also cause some difficulty maintaining knees or feet together.
During the run, this translates into loss of hip rotational mobility at the end of the gait cycle or toe-off or pre-swing. Inexperienced clinicians may see this as a lack of hip stability, when in fact, further investigation will reveal that a mobility deficit is the problem. This change in mobility deficit detracts from clean, straight-plane motion, and as mileage increases, will likely result in knee or hip pain. There is no clear-cut stretch to offer here, as it will take the expertise of a physical therapist to full investigate the type of tissue that's causing the restriction. It could be tight muscles, but it could also be aberrant bony joint alignment, in which case stretching would not be the likely first approach.
Overhead Squat- hips, ankles, shoulder, and spine: The functional, overhead squat continues to grow in popularity as the go-to functional movement screening tool. It's fast, easy, and familiar to most people to perform. The plus side of this is that there is a lot of information available from a single task. The down-side is that it can be easy to miss the subtleties. I find that for many clinicians with limited exposure to the running population, it is also easy to address mobility deficits that are unrelated to the patient's current problem.
For the runner with limited experience, the two most important pearls from this self-assessment are going to be ankle mobility and hip mobility. As you squat down, normal mobility should allow the thighs to drop slightly below the parallel line with the floor, while the heels remain flat on the ground (while barefoot, not shod.)
A deficit in mobility of the hips may be experienced as pain in the hip joints while descending and coming to a abrupt stop, perhaps feeling the need to move your knees around to go lower. A restriction in ankle mobility, will result in a similar experience in the ankle joints, perhaps with more rolling in or out of the feet, and likely heels leaving the ground as you try to squat lower.
Mobility restrictions in the ankles and hips are commonly associated with a handful of classic running related injuries. Risk increases for everything from plantar faciitis and Achilles tendon ruptures, to anterior hip impingement and hip labrum tears. Additional deficits in spine mobility and strength in the lower back may also be noted, but are harder to detect without the eye of a professional.
Child's Pose- hips, ankles, shoulders, and spine- This classic Yoga pose is another great example of normal mobility that most runners should have available. Child's pose puts the hips, knees, and ankles at or close to the end range of each joint respectively. It also brings the shoulders, thoracic spine, and cervical spine (neck) into a synergistically common posturing that is required for everyday over-head tasks.
A general loss of mobility in the thoracic spine, shoulders, and neck should be obvious in general posturing, but all of these areas have to work together in the productions of arm swing and hip rotation to allow the legs to move through an effortless and clean trajectory. Stiffness in any of these areas can drastically cut down on running economy and may lead to issues with chronic headache or nerve pain in the arms.
In Yoga, this pose is sometimes used to elicit relaxation and help bring energy down. If you find that this pose creates discomfort or pain, I recommend that you get checked out by a physical therapist or other human movement specialist. This is especially true when the discomfort or stiffness is found at the knee joints or higher (toward the neck). Stretching may be a component of resolving these issues, but often what happens is that stretching causes the other hyper-mobile segments to become even more loose, while no changes occur in the targeted, deficient segment.
I hope this post has been helpful. This is a topic that is commonly misunderstood, and difficult to touch on with brevity. Tightness in runners has been associated with higher levels of energy efficiency and faster running, but must be in the right areas. Tightness that drastically alters normalized movements, or creates additional workload on the system will inevitably cause problems to an otherwise healthy system.
Stretching, on the other hand, has certainly been shown to decrease muscle performance and perhaps even lead to higher propensity for injury. Be that as it may, there are certainly times when stretching is a good idea. The best advice in this post is to always act with purpose. Know your goals and reasoning when performing any stretching type activity. If you aren't sure, than connect with a qualified professional in the area who can help give you personalized advice. Don't just start doing what other runners are doing because it looks good. No two bodies are alike and no two runners are alike.
Thanks for reading, and please contact me directly with any questions, or schedule an appointment for a full evaluation. Until next time...
Never stop moving!