(Dr. Brett Frank is a graduate of the University of South Florida’s Physical Therapy Doctorate Program. He has had extensive training in orthopedics, and is highly experienced in orthopedic diagnosis, spinal manipulations, as well as Golf Specific Sports Enhancement. Brett has been at First Choice since 2003.)
It is common knowledge that stretching your muscles for athletic and fitness activities is an immensely important part of the exercise process. What most people don’t know however, is that prolonged stretching after properly warming up is just as important a factor, especially when it comes to improving flexibility and reducing incidental muscle and tendon injuries. For years, the standard instructions for stretching muscles prior to athletic/fitness activities was to hold the stretch for ten to thirty seconds, without any type of warm up beforehand.
Research done over the last thirty years or so has consistently shown that prolonged stretching is the key to improving muscle and tendon flexibility and length. The body’s tendons are charged with the task of attaching muscle to bone, with your fascia binding together muscle fibers. Tendons and fascia are made of a connective tissue known as collagen, which is a viscoelastic tissue. A viscoelastic tissue is a type of tissue made up of “Viscous” and “Elastic” properties, meaning it has the ability to stretch and lengthen, and then return to its normal form slowly. If a constant load or stretch is placed upon a viscoelastic tissue, it will lengthen and maintain that length for a certain amount of time even after the load has been removed, depending on how long the load was present. The tissue will stretch, and then it will stay stretched for awhile before returning slowly to it’s original length.
For the increased length to be maintained, the tissue must reach what is known as “Creep.” “Creep” is a phenomenon in which the connective tissue deforms and “creeps” in length, typically occurring after stress relaxation of the muscle has taken place. During those ten to thirty second stretches that many people consider to be efficient stretching, the only tissue lengthening that occurs is due to stress relaxation of the tissue, and does nothing to improve flexibility and decrease injury risk.
When it comes to stretching, the rate of deformation is load, frequency, and time dependent. Low Load prolonged stretching is considered ideal because it is more comfortable, and the tissue will elongate without causing tissue breakdown. To properly perform a low load prolonged stretch, one should begin the stretching motion until you feel the initial stretching sensation, holding the stretch in that position. As that stretching sensation lessens, you should gradually increase the stretching motion until the mild stretch sensation returns. An effective duration of a stretch is anywhere from three to five minutes per stretch, but can be maintained for as long as thirty minutes. (Some research indicates that these thirty minute stretches can help to achieve greater tissue elongation in a shorter period of time.) Remember that stretching is time and rate dependent, so the less time the stretch is held, the more frequent the stretch will have to be performed in order to increase flexibility. The opposite is also true, that the longer the stretch is held, the less frequently the stretch must be performed. You should consider performing a warm up at least eight minutes prior to stretching; but keep in mind that stretching is also ideal during or after a work out as well, because your tissue temperature is peaked during these times.
Here at First Choice Physical Therapy, our patients are instructed to perform their injury specific stretches for at least three to five minutes, twice a day, in order to improve their flexibility. Our patients are also educated on why this particular length of stretching is ideal, along with the notation that stretch durations less than three minutes require more frequent stretching sessions.
If you currently have an injury, or history of a reoccurring muscle or tendon injury, poor flexibility is likely one of the factors contributing to the problem. If you think this sounds like you, any of our Doctors of Physical Therapy would love to help heal and treat your injury, all the while instructing and educating you on how to reduce the occurrence of these injuries and the disruption they cause in your every day life!
Brett Frank, PT, DPT