Flexibiliy: Stretching vs Self-myofascial Release. From research to practice in the fitness industry

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Flexibility: stretching vs SMFR PRESENTED BY: Max MARTIN BAppSc (Hons) AEP

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Presentation for WAFIC 2011 by Max Martin AEP, Director of Corrective Exercise Australia. This workshop will equip you as an exercise professional to understand the impact, relevance and correct application of flexibility, stretching and self myofascial release (SMFR) on musculoskeletal health, function and performance. At the workshop you will establish a strategic approach to dealing with muscle tightness affecting injury, posture and movement, based on clinical evidence and current research, theories and practices.

Transcript of Flexibiliy: Stretching vs Self-myofascial Release. From research to practice in the fitness industry

  • 1. Flexibility, Stretching & Myofascial Release iNform ACADEMY PRESENTED BY: Max MARTIN BAppSc (Hons) AEP Scott WOOD BAppSc AEP
  • 2. Why Flexibility? Allow joints to align in anatomically correct way. Joint fixation more implicit in pain than actual degree of misalignment. With subsequent greater changes in ROM and pain than posture Joint mobility imperative for pain free movement.
  • 3. Flexibility vs Stability Typically stated that Flexibility and stability sit at opposite ends of a continuum. Is this true?? Are we confusing stability and stiffness?? Flexibility Stability Stiffness
  • 4. Injury prevention Performance preparation Muscle lengthening Joint mobility Overall flexibility Release tension Prevent delayed onset muscle soreness (DOMS) Why do people stretch
  • 5. Stretching: To elongate, increase in length. The implied meaning is that the muscle is not beyond its normal length Kendall et al. 2005
  • 6. Stretching for Joint ROM Stretching can result in ROM gains on average of 8%- tighter muscles greatest measured improvements. Stretching program must be performed consistently for >3weeks for plastic changes. Various stretching methods used. Studies (13) of poor to moderate scientific quality Harvey, Herbert & Crosbie, 2002
  • 7. Stretching and Performance Stretching reduces maximal strength for up to 1 hr post stretching (Fowles et al. 2000, Kokkonen et al. 1998) Stretching decreases velocity of limb movement in leg extension post active and passive stretching bouts (Cramer et al. 2004) Passive muscle stretching reduces vertical jump performance post stretching (Cornwell et al. 2001)
  • 8. Stretching and Performance cont. Stretching as part of warm up (Young & Behm 2003) prior to jumping tests - concentric & drop jump Five groups: control (no stretch) 4 min run passive stretch run & stretch run, stretch & practice jumps Result: 1. run 1. run, stretch & jump 3. Run & stretch 4. control 5. Passive stretch
  • 9. Stretching and Performance cont. Correlation between flexibility and walking/running performance on treadmill (VO2): The greater flexibility, the lesser performance (Gleim et al. 2000) Overall, still inconclusive whether or not to stretch before exercise Reliability poses problem with numerous studies to date Timing of stretching may also play an important role A review by Shrier (2004) found no effects of acute stretching, but positive effects of regular stretching away from event on strength, jump height and running speed.
  • 10. DOMS: delayed onset muscle soreness Muscle soreness occurring post exercise due to damage of muscle fibers DOMS peak around 24-48 hrs, mostly subside within 96 hrs. Post exercise stretching found to be not effective in reducing DOMS (Herbert & Gabriel 2002, LaRoche & Connolly 2006, Dawson et al. 2005) Also no improvement in performance (AFL players) (Dawson, et al. 2005) Stretch during DOMS thought to not reduce DOMS but to maintain and or increase movement allowing athletes to train at higher levels (Reisman et al. 2005) Effects of Stretching on DOMS:
  • 11. Difficult to study unreliable results Hard to control Need very high intensity to produce risk of injury Most conducted studies suggest no change in injury rates Some lesser quality studies found positive link between pre-exercise stretching and injury rates via PNF Different sports require different joint flexibility leading to inconclusive results in literature Stretching for injury prevention
  • 12. Warm up, stretching and injury Warm up often uncontrolled in studies, could effect study outcome on injury risk Dynamic warm ups led to increased performance in children of various ages and athletes compared to static stretching alone Dynamic warm up achieved higher anaerobic performance than static stretching protocols Faigenbaum et al. 2006
  • 13. Stretching for Decreasing Pain Stretching may be useful for decreasing work related msk disorders. No consensus on optimal type or duration. Work requirements must be considered (consider research covered thus far...). Stretching must be used in conjunction with good ergonomics. Da Costa and Vieira, 2008
  • 14. Summary May help increase joint ROM long-term. Decrease in strength with pre-exercise stretching (reliability questioned) Stretching away from exercise environment may increase performance and reduce injury risk (yet to be confirmed) May be helpful for reducing work-related MSK disorders. (Pre Exercise) No evidence for : Performance improvement Prevention of DOMS (post) or increased performance Effect on injury rates
  • 15. The Physiology of Tightness Joint ROM can be limited by the following factors: Joint constraints Subcutaneous connective tissue. Neurogenic constraints (voluntary and reflexive) Myogenic constraints Hutton, 1992
  • 16. Muscle Fibres Can stretch to at least 50% greater length that resting (last cross bridges intact). Magnesium deficiency can cause tightness (cramping) as magnesium facilitates actin-myosin release.
  • 17. Muscle Spindles Primary stretch receptors in the muscles. Small bundles of six muscle fibres with reflexive capabilities via alpha-motoneuron. Strong phasic contraction upon detection of stretch, followed by controlled tonic contraction. Regular stretching may decrease sensitivity of muscle spindles This may explain acute performance decreases post-passive stretch
  • 18. Golgi tendon Organs Receptors of muscle tension Found at muscle-tendon junction Will decrease contracting muscles tension and activate antagonist to help protect tissue damage. Tendencies of GTO s justify PNF CRAC method
  • 19. Fascia continuous structure that surrounds and integrates tissues and structures Can affect relationship amongst structures Three types in body myofascia (myo = muscle) most important in this issue: Dense connective tissue Surrounds structures like muscles, tendons, joints, ligaments Composed of collagen and elastin, providing tensile and elastic properties.
  • 20. Fascia cont d Contributes >40% of resistance to movement Immobilisation decreases space between collagen fibres- causing a sticking together Muscle overactivity can result in increased fibroblast activity (>colagen depostion). Interconnectedness of fascia can result in patterns of tightness in muscle slings.
  • 21. Myofascial restriction: Restriction in normal muscle function due to injury or biomechanical force imbalance
  • 22. Trigger points Discrete, focal, hyperirritable spot in taut band of muscle Occurring in all patients with musculoskeletal pain Can be active or latent Symptoms: Painful on compression Referred pain/tenderness Motor dysfunction Autonomic phenomena No evidence for development mechanism of Trigger Points Acute and chronic trauma, chronic lengthening, sleep disturbance, anxiety
  • 23. Ballistic stretching Dynamic stretching Active stretching Passive stretching Static stretching Isometric stretching Proprioceptive Neuromuscular Facilitation (PNF) stretching Stretching Methods
  • 24. Myofascial release the alternative Similar to massage Uses palpitation, pressure and tissue stretch to relieve tension and improve: Muscle tone, Length, Timing, Strength, Endurance, Control Can be used on various soft tissue abnormalities: Local increased muscle tone Trigger points Muscle tightness Muscle shortness Fascial tightness Deficits in motor activity or control Can result in pro-inflammatory effect and decreased fibroblast activity (short-term).
  • 25. Exercise and myofascial release Exercise is vital for myofascial release treatment Resets neurological programming Both needed for permanent change
  • 26. Self Myo-Fascial and Trigger Point Release Interactive soft tissue release requiring feedback from patient to determine correct position, amount of pressure and duration of stretch Uses body weight on tool i.e. foam roller or tennis ball Penetrates into muscle and or fascia Easy and effective Releases tightness and trigger points Can be painful Research to prove efficacy is poor and inherently difficult to achieve.
  • 27. Practical programming