14 Stretching and Foam Rolling

Stretching

There are three general stretching categories described in the literature, they are static, dynamic, and pre-contraction stretches.

  • Static stretching – A specific position is held with the muscle on tension to a point of a stretching sensation and repeated (this can be performed passively by a partner, or actively by the subject).
  • Dynamic stretching – Active movements where joints and muscles go through a full range of motion.
  • Pre-contraction stretching – This involves a contraction of the muscle being stretched or its antagonist before stretching. Examples of pre-contraction stretching include post-isometric relaxation (PIR) and proprioceptive neuromuscular facilitation (PNF).

The Science of Stretch

Changes in the passive elastic properties and range of motion induced by stretch training is due to both neurological increases in stretch tolerance and changes in passive properties of muscle (Freitas et al., 2018). Some positive adaptive mechanisms operate instantaneously (neurological adaptation), others take effect over months or years (musculoskeletal adaptation). In a rehab setting range of motion improvements in the first 4 weeks are often changes that occur in the nervous system. It is often much later down the road that muscle adaption helps to increase the individuals’ range of motion.

Studies have shown that consistent stretching routines can extensibility or range of motion (ROM) of the stretched muscle or joint (Behm et al., 2021). In most of these studies, it is proposed that improved range of motion is due to both neurological increases in stretch tolerance and changes in passive properties of muscle. The basic supporting science behind stretching will help therapists design rehabilitation programs for a wide variety of conditions, here are a few examples in the research literature.

Stretching for the upper body

  • Four weeks of soft tissue mobilization had an effect on tissue stiffness, shoulder internal rotation and horizontal adduction in baseball players with posterior shoulder tightness (Yamauchi et al. 2016)
  • Instrumented manual therapy with self-stretching significantly reduces ROM risk factors in baseball players with motion deficits (Bailey et al. 2017)
  • A 4-week treatment program of manual therapy or dry needling demonstrated a significant improvement in pain pressure threshold, muscle elasticity, and stiffness of neck and shoulder muscles (De Meulemeester et al. 2017).

Stretching for the lower body

  • In one study 8 weeks of high intensity stretch training on biceps femoris induced architectural adaptation and improved range of motion (Freitas et al. 2015).
  • Nordic hamstring extensions have been shown to be an effective rehabilitation exercise that stimulate architectural adaptation and assist return to play (Cuthbert et al., 2020).
  • 4-week static stretch training program changes the flexibility of the gastrocnemius muscle tendon unit (Nakamura et al. 2012)
  • 3 weeks of twice daily stretch training (4 × 30 s) lead to an increase in dorsiflexion range of motion (ROM) a 28% increase in passive joint moment (Blazevich et al. 2014).
  • 6 weeks of stretch training of the plantar flexors resulted in hypertrophic like adaptations of the gastrocnemius. (Simpson et al. 2017).
  • A 12 week stretching program was shown to have an effect on the mechanical properties of plantar flexor muscles and sciatic nerve (Andrade et al., 2020).

Rehabilitate the whole person, not just injured tissues

Research suggests that stretching may serve as a low intensity therapeutic intervention capable of improving several parameters of vascular function (Kruse & Scheuermann, 2017; Thomas et al., 2021). Additionally, through a process of gently stretching muscles, neurovascular structures and investing fascia nociceptive processing associated with tissue damage (actual or perceived) is modifiable in such a way that the pain subsides (Støve et al., 2019).


A video from Dr. Helene Langevin that highlights how connective tissue interacts with various other structures: muscles, nerves, vessels.


Self-Massage and Foam Rolling

The goal of performance support is ensuring that athletes have the physical and mental capacities necessary to compete at the top level. Which can be a challenge, due to the number of variables can affect athletic performance (e.g., fatigue, recovery, training status, health and well-being).

Increasingly athletes have taken soft tissue work into their own hands, using foam rollers to ease the pain of overexertion and support athletic performance.

Can Foam Rolling Ease the Pain of Overexertion?

There is conflicting evidence for the use of foam rolling for reducing pain perception after delayed onset muscle soreness (DOMS), but evidence seems to justify the use of foam rolling as a warm-up activity rather than a recovery tool (Wiewelhove et al., 2019). Other studies have demonstrated that the addition of self-massage significantly improved stretch tolerance and flexibility compared with isolated static stretching (Capobianco et al., 2018). As well decrease muscle excitability through central mechanisms, which may account for the post-treatment increase in range of motion and pain pressure threshold (Young et al., 2018, Wilke et al., 2020).

Key Takeaways

Stretching may decrease muscle excitability and improve stretch tolerance via neurological & musculoskeletal adaptations, which may account for increase in extensibility, range of motion, and pain pressure threshold. The addition of self-massage may decrease muscle excitability and improve stretch tolerance, which may also account for the post-treatment increase in range of motion and pain pressure threshold.

References and Sources

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Bailey, L. B., Thigpen, C. A., Hawkins, R. J., Beattie, P. F., & Shanley, E. (2017). Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits. Sports health, 9(3), 230–237. https://doi.org/10.1177/1941738117702835

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