Stretching for Pain Relief
Many patients tell me how diligently they do their stretches that they got from another health care provider, internet, or other source. However; now they are in my office presenting with pain. In this post I'm going to discuss some theories about the effectiveness of stretching for pain relief and what seems to make the most sense to me as far as application.
Why are some patients still in pain after doing their daily diligence of stretching? Several factors could lead to sub-optimal outcomes regarding stretching for pain management. First find a qualified individual to figure out where the pain is coming from and what causes the pain. Hip problems such as ITB and bursitis are most likely not going to go away with a few stretches of your leg but they may feel better right after a stretch. Problems like these are often due to faulty movement patterns that can be evaluated and treated with some simple exercises.
Another common mistake is stretching muscle when the pain may be neurogenic or coming from the nerve. Sometimes this can even have a detrimental effect because an inflamed nerve being maximally tensioned can cause pain. There are techniques to facilitate nerve mobility in hopes to decrease symptoms throughout our daily activities and ultimately stimulate axoplasmic flow within the nerve to improve function. Although I prescribe these neural techniques (called ‘neural stretching’ ‘neural glide’ ‘neural slide’ or ‘neural tensioning’) and have seen decent results clinically, there is not much literature backing the effectiveness of these techniques to decrease nerve symptoms. However; the lack of peer-reviewed support regarding neural stretches decreasing symptoms could be due to most providers performing them differently and the ‘textbook’ approach to these techniques will not be targeted enough from patient to patient.
Next; if there is a 'knot' in the muscle, stretching is probably not the best treatment option. I've heard this example that I really like. Picture three elastic bands of which two are light gauge and one is heavy. If you tied the heavy gauge between the two light gauge then tried to stretch the entire thing, which would stretch? The two light gauge would stretch leaving that tighter heavy gauge band or 'knot' to remain tight. Now applying this theory to stretching a tight muscle, you may be stretching what is already loose but failing to release that knot. If you don’t want to see a chiropractor, massage therapist, or physical therapist to loosen these knots, then go to the foam roller, tennis/lacrosse ball, massage stick/rolling pin and try to release it yourself before stretching.
The easier way to ‘feel better’ instead of just stretching a tight muscle is to find out why it is tight and get the correct muscles working so the tight muscle can relax and/or offer more support without irritation. Once you get a more ergonomic or cleaner movement by just rehabbing the correct muscles, you will feel a difference.
If there is an inherent lack of mobility and that barrier needs to be addressed, then I will usually stretch with awareness (Diane Lee), take it really gentle, and pair it with breathing. Stretching with awareness is picturing the muscle you are trying to stretch and once you reach that first gentle barrier just picture letting that muscle go or melt. You can try and touch the muscle with your hand to help you ‘picture’ it better. When stretching just go to the first barrier or resistance you feel and hold until you do not feel that barrier anymore. If you go too much you may stimulate reflexes within connective tissue that will counteract what you are trying to do. Next just try and pair the stretch with breathing because this has been shown to be effective for pain relief while stretching.
This post is just ideas for stretching as it is applied to pain relief. It is not for pre or post workout/competition. For those circumstances dynamic stretches are more indicated but once again not backed by a lot of research. Although there are many times I would prescribe something other than stretching to my patients, I don’t tell them to disregard stretching. This is because it feels good, if only for a short time, and I stretch too.