As a physical therapist, stretching is a part of my daily existence. If I'm not teaching patients to do certain stretches, I'm probably doing some myself. As a runner, I also get to bear witness to a lot of stretches: particularly at races or group runs around town. I often see a lot practices that are curious if not concerning.
Many runners stretch out of habit, or maybe on the suggestion of another runner. Maybe they're trying to avoid injury or re-injury. Perhaps they saw an article in a magazine or a video that challenged them to change up their routine.
Whatever the reason, there is still a great deal of misunderstanding out there regarding this practice that our cats and dogs do so well. Below is a list three more stretches that are commonly abused and overused (this is part two in a series).
Improving ankle dorsiflexion (toes toward the nose) can be tricky. In healthy people, the problem can be joint stiffness, muscle tightness, or anterior compartment weakness. The challenge with many who lack it, is that they often develop strong compensations that can be difficult to identify and harder to correct. One of the most common ways this happens is through collapsing the arch of the foot, which doesn’t fix the problem and may lead to new ones.
When performing calf stretches, it’s critical to not allow these compensations to persist. In these situations, attempts to correct this mobility issue will likely be met with failure, or aggravate the problem further. You may reach for the right solution, but performing it incorrectly is futile. Imagine trying to hammer in a nail using the claws instead of the head.
Be sure that when you stretch the calf that your arch stays high and that your tibia (shin) leans toward the outside of the foot as it moves forward. This is the natural axis of the ankle joint, and typically where the joint restriction is. You may feel tightness in other places, but this is the way the joint is anatomically designed to move. I often recommend my patients turn their feet slightly in, to spare the arch and focus on the talocrural joint itself.
The poor little piriformis takes the blame for so many other hip problems. It’s no doubt that this muscle, only about the size of a strip of bacon, is regularly included in many runners’ stretching routines. It’s basically on the ‘most wanted’ list in distance running.
Firstly, unless a healthcare professional, or human movement specialist has indicated the need to stretch the piriformis, ask yourself why you’re doing it in the first place. Arbitrary stretching of any tissue can sometimes cause more harm than good. Overstretching of injured tissue can cause injury to worsen.
Secondly, the hip joint is extremely complex in its intricate muscle and ligament attachments. A universal stretching position for the piriformis simply isn’t possible. Three people could assume an identical stretching position and each be stretching a different tissue. One must account for all the other things that may be getting stretched with it.
When one combines multiplanar movements to achieve the stretch, it becomes difficult to predict which tight tissue will be stretched first. Common errors in the typical ‘figure-4’ stretch can easily overstretch a weak glute medius, a strained glute max, or put undue stress on an unstable SI joint.
Fishing out an isolated involvement of the piriformis is difficult in the rehab setting and can easily mimic other common problems. Stretching of the piriformis is rarely an initial go to. My recommendation here would be to address any posterior tightness initially with some foam rolling. Any additional problems not solved should be taken to a professional for in depth evaluation.
Iliotibial (IT)Band Stretches
This one had to be covered. For the record: most of these stretches are awful and rarely target the correct tissue in the first place. I, myself have been victim of this as a patient in PT several years ago.
The IT band is a long, thin piece of connective tissue that runs from the front of the pelvis (ilium) to the side of the shin bone (tibia) just below the knee joint. The majority of this tissue is non-contractile, or in other words, does not physiologically get shorter when stimulated by the brain, much as muscle tissue does.
To understand the nature of the tissue, you could imagine stretching a leather belt from your hip to your knee. This is a great analogy because attempting to stretch the IT band is typically about as effective as attempting to stretch a leather belt. It simply doesn’t happen. There are no high quality research studies that show that the IT band can be stretched.
There is a small central portion of the IT band that is contractile, but aggravation of this muscle presents in a way that typically very different than what runners describe as IT band syndrome. When runners get on the foam roller to roll out those ‘sore IT bands,’ it’s almost guaranteed that the tenderness is actually in the lateral quads.
I frequently see runners with 'tight' IT bands, but the vast majority of them are not having IT band issues. When running at faster speeds, tightness from the IT band can provide powerful elastic recoil needed for energy efficiency. For this reason, I am often hard-pressed to blindly recommend any stretches merely for the sake of rectifying tightness.
What is typical of IT band syndrome is pain at the outside of the knee just below the joint line. Less commonly pain can come from its attachment at the top of the pelvis. Also a possibility is muscular pain from the contractile part, wherein the entire side of the leg may hurt.
Occasionally, I see irritation of the sensory nerve that anatomically pierces the IT band, causing burning pain along the side of the leg (Skinny Jeans Syndrome). My personal experience tells me this is more common in non athletic populations, but with the aforementioned nickname, I suspect that may be subject to change.
For each of these, accurate diagnosis is tricky, but strengthening (not stretching) is often the cornerstone of corrective action. Persistent pain at the knee should be evaluated by a professional quickly so that it doesn’t turn into something more limiting or serious.
I'm Not Saying 'Don't Stretch'
Stretching is a complicated area in which to give advice. In general, I let my patients' body guide my treatment. If they tell me that stretching something makes them feel good or obliterates their pain: awesome! That becomes the thing to do. The body gives excellent feedback if one knows what to listen for.
Unfortunately, I've also had patients who have stretched themselves into injury. Stretching is not always the answer. There is consistent research that shows that runners who lack flexibility run with a great degree of economy. As a clinician who works with injured runners, a lack of strength or joint mobility is more often the blame.
If you have nagging pain or injury and stretching is helping you feel better: great! You should probably do it. It it isn't helping, stop doing it, and go have that problem checked out. The longer an injury persists, often the more time it tasks to resolve.
Check out the first article in this series if you haven't seen it already.
Until next time: keep moving!