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Is Your Stretching Regimen Helping or Harming You?

October, 2016

Stretching is a common prescription to help with back pain. At https://www.healthoutcome.org, the world’s first crowdsourcing platform to rate medical interventions, stretching is the 6th most commonly used intervention, after physical therapy, NSAIDs, heat, rest, and cortisone injections. On a scale from 0-5, stretching (rated 2.6) is the 5th most highly rated intervention after Postural Modification (3.8), Yoga (3.1), Supplements (2.9), Weight Loss (2.8), and Meditation (2.7).

 


Back pain caused by tight muscles is common

 

The Gokhale Method considers stretching to be one of many essential pieces in solving most people’s back problems. Even though stretching alone cannot give an equivalent result to that of a well-crafted Postural Modification approach, it is a good thing, and if slightly tweaked, could give better satisfaction and results in less time. If done poorly, on the other hand, stretching can harm, rather than help you.

 

A few key concepts that can help your approach to stretching are:

  1. Your hunter gatherer ancestors, with whom you share the vast majority of your genes, didn’t do stretches per se. In the course of their daily activities, their bodies were self-stretching, self-maintaining, and mostly, self-healing. It’s true our lifestyles are different from theirs, but this realization should provoke some enquiry about small modifications in our ways of moving that would enable us, too, to be as efficiently and effectively stretched out as our ancestors were.

 


This hunter gets a natural shoulder stretch from using a bow and arrow

 

  1. Not every muscle in your body needs to be super flexible. Unless you’re a gymnast or yogi, some stiffness here and there is well-tolerated, and can be beneficial when there isn’t great strength to balance extreme flexibility.

  2. Flexibility is very useful in the following muscles: hamstrings (allows pelvic anteversion and hip-hinging), psoas (allows a full length stride without a swayback), external hip rotators (allows deep hip-hinging), pecs and traps (allows normal shoulder alignment and prevents pathology in the shoulder, facilitates good range-of-motion for the arms), and calves (allows the heels to remain on the ground for an extended time in a stride).

 


Calf stretches can help achieve a healthy stride

 

  1. The reason these flexibilities are useful is that they facilitate normal human movement, which also gives a clue on to how to keep these flexibilities: PERFORM NORMAL HUMAN MOVEMENT! Hip-hinge well, stride well, maintain shoulder alignment well while moving the arms extensively, etc., and you’ll be largely covered for flexibility.

 


Hip-hinging in the garden keeps hamstrings flexible

 


Actor Shemar Moore keeps his shoulders rolled back when playing on the beach with some spare children

 

  1. If your day does not include enough movement, supplement with a few, well-chosen stretches. It’s extremely efficient to do several stretches simultaneously. It’s even more efficient if you combine this with strengthening several muscles simultaneously.

 


Stretching the psoas (enables a healthy stride) and pecs, while strengthening the quads

 

  1. Yoga and dance are two approaches to exercise that are especially efficient and effective for satisfying stretch (and strengthening) needs. Most approaches to yoga and dance could use some tweaking to “do no harm” and do more good, but it’s hard to match the possibilities with these traditional, multi-faceted, tried and true practices.

 

Dance is excellent for increasing flexibility - and strength

 

  1. Distinguish between flexibility of your muscles and laxity in your ligaments. This is a big one, folks! Flexibility in appropriate muscles is terrific; laxity in your ligaments is not! Ligaments are a type of connective tissue that connect bones and cartilage in your joints and provide stability to the skeleton. Overstretched ligaments become too loose to hold your joints together under pressure or tension. People with lax shoulder ligaments, for example, can sometimes dislocate and “pop” their shoulders back in too easily. People with lax ligaments in their spinal column are able to round their spines excessively.


    This common approach to stretching the hamstrings, done poorly, causes laxity in spinal ligaments

 


This person would be better off lying on his back and raising one leg at a time to stretch out his very tight hamstrings

 

Do you have any favorite stretches? Please share them with us! We can then talk about pro's and con's for the stretches you share.

 

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Comments

Hi Esther,

What do you think about Sun Salutations? Can you show us a proper posture modified version?

What about cat-cow, downward dog, spinal twist, plough, and shoulder stand?

Thank you!

Laura MacDonagh

Hi Laura,

I think Sun Salutations are fabulous and a very healthy balance of poses to start the day well. It's one of my daily practices. I do show my students how to modify each pose in Sun Salutations, but it takes prep to do this justice.

First I like to introduce a broad overview of what a human needs and what constitutes normal static posture. I see that you've attended our free workshos both in person and online, and that's a good start. The book 8 Steps to a Pain-Free Back also provides this overview.

Next you need to learn how to do the poses of everyday life more skillfully - the recommended way is hands-on in one of our Gokhale Method Foundations courses. You will learn basic posture principles this way, and be covered for what you are doing 95% of the time.

Next comes learning how to do special activities, like dance poses, yoga poses, sports, playing instruments, etc. I consider these graduate activities - it's challenging to pay attention to all that's going on without having a basic layer of postural understanding in place.  We have a program called Online University that has a video of me doing and teaching sun salutations - but we only make it available to graduates of the Gokhale Method Foundations course - the information and practices would be overwhelming to those without any background in basic posture. 

I'll list a couple of principles that are more understandable to help you with the other yoga poses you list: 

Cat: don't arch your lumbar spine - you've probably filled your quota on that.

Cow: dont' tuck your pelvis - you've probably filled your quota on that.

Downward facing dog -  most poeple need to lift their heels off the ground and significantly bend their knees to get their backs to remain a healthy J-shape. Orientatin of the legs is improtant in this one also. 

Spinal twist - spread it evenly throughout our spine rather than force the twist in a few levels. 

Plough - lots of blankets - don't force your neck to do a big bend. You dont' need to touch the ground. 

Shoulder stand - lots of blankets - don't force your neck to do a big bend.

 

Thank you Esther for the yoga tips. It sounds like we should just forget doing the cat-cow! I have your book and hope to do a course next time one is in town.

Cat can be good if you restrict the arching to the upper back / shoulder area.

Cow can be done with benefit as well - getting rid of any lumbar sway and stretching out the rhomboids.

You can request a course in your town here; this can accelerate the process of bringing a teacher to your town. 

Hi Esther,
I exercise Yoga and Chi Gong for flexibility. Are these postures safe? Many of them are bending forwards, backwards, to the left and to the right.
I also exercise Pilates for strength.
All of them for many years without back pain.
Since I bought your book, I try to modify the bending according to your method.
Thank you,
Gila.

The safety and effectiveness of everything you do depends on how you do it. That's true for each pose and exercise as well as each endeavor. See above for some hints on yoga poses. Tai Qi is usually done gently enough and slowly enough it's a great place for beginners to explore healthy posture in movement. Also the poses are not extreme. I think it allow you to expereince your body not only at the beginning and end points of each action, but all the way through. Some schools of Tai Qi like a base position of tucking the pelvis which I don't advocate, but also don't think does great harm if done only for the length of the routine. If itucking the pelvis in Tai Qi reinforces an incorrect baseline posture, that's another story.

Pilates is great for strength but I have a couple of quarrels with many Pilates approaches (they lost their trademark so there's no standard) - the neck gets strained in some of their common exercises (like the "Pilates100")


The Pilates 100 with usual neck strain

and they're into tucking the pelvis (sometimes extremely, like in the pics of Joe Pliates himself) and sometimes less - in these cases they use the term "neutral pelvis" but demo something that isn't quite the anteverted pelvis I teach). 


Joseph PIlates showing severely tucked pelvis in a knee stretch exercise.


Joseph Pilates demo'ing the tucked pelvis as a base for reformer exercises

 

Found your comments about lax ligaments interesting. My wife, who is just starting an exercise regimen after years ot little exercise, has naturally lax ligaments. Physical therapists have commented on how flexible her joints are. You suggest this is a problem. What can be done about it?

1. Strengthen the muscles around the joints.

2. Learn how to use the body well and not take the joints to unhealthy configurations. For example I had to learn not to routinely exploit my ability to excessvily sway my back.

My favorite way to stretch is using Active Isolated Stretching techniques. In my massage practice I also assist clients in this modality. The advantages I see in this type of flexibility training are that the stretches are dynamic but gentle, rhythmic movements that work with the body and are not forced upon it. The difference lies in actively "holding" a stretch for not more than 2 seconds to avoid triggering a rebound contraction in the muscle and also to reduce prolonged ischemia (reduced blood flow) in the area being stretched. Numerous and active repetitions create a vascular pumping action in the venous and lymphatic system to flush the tissues with the nutrients and oxygen they need to thrive and recover as well as to facilitate the removal of metabolic waste products.

Thank you for sharing! Do you have any favorite resources - books? websites? authorities?

I'm not the original poster, but this website: http://www.stretchingusa.com/active-isolated-stretching will give you the information about Aaron Matte's method.

Hi Esther,

The photos are very helpful. Thank you. I know there are prone hamstring stretches, but I can't always lie down, so I am looking for a good standing hamstring stretch. I am an active eighty-year-old with very tight hamstrings. I have learned your method from your book, DVD, YouTube and website, and using your techniques eliminates most of my lower back, upper back, shoulder, neck and sciatica pain. You are a blessing!

Thom

I'm delighted to hear that you are getting so much benefit from the "long distance" offerings! You go, Thom!

For a good standing hamstring stretch I reommend the wall stretch on page 208 in the Appendix of the book. Placing your hands on the wall makes it much less likely you'll round your back as you hip-hinge forward, and you get an extra stretch to settle your shoulders further back. 

Hi Esther,

i wanted to post a comment about positions used in gymnastic exercising like "hollow" and "plank".
I need to post here some imagine to make my questions more effective...
... how can i do that? I've tried but... PC wins :-)

Thanks!

Hi Alessio,

 

Images posted in this forum will need to be hosted - if you'd like to send your images along with the text of the comment to [email protected], I'm happy to upload the photo and post your comment. 

I love the advice given at nr. 5: 'It’s extremely efficient to do several stretches simultaneously. It’s even more efficient if you combine this with strengthening several muscles simultaneously.'

Do you have more examples of those types of stretches? I liek the efficiency of the stretches, and it saves energy as well!

Greeting from Holland,
Judith

I like making up poses that stretch and strengthen what my body is asking for on a particular day. Here's a favorite that's difficult but worth building towards:

The base is a leaning forward arabesque like on page 213e. The arms are swirling snake arms like this (though I like to have my descending arm externally rotated with the palm facing upward: 


Snake arms: I like to have the descending arm be externally rotated with the palm facing upwards

On a good day I use my standing foot to pivot myself around, a little bit at a time. On a really good day, I do it in both directions. 

Another way to look for effiicient exercise is to look at traditional activities - martial arts, sports - if the activity has been around for a century or more, it has likely been "vetted" for healthy posture. You may still need to add some extra filters, considering some of us are still reconstructing ourselves and can't immediatley jump into vigorous traditional activities (like gyating the head around in circles the way many African dancers are able to do.)

 

As a little history, I have had 3 surgeries for Scoliosis, and now a 4th surgery to replace a disc in my lumbar spine. My doctors are now telling me that I may have another lumbar disc wearing out as well. Needless to say, I have relied on exercise and physical therapy to keep me moving!
One of my favorite stretches is "Scapular Retraction." It just makes my upper back feel so good!
I do have a question on a few of the exercises prescribed for me by a physical therapist: what are your thoughts on abdominal bracing (lying on back, tightening stomach muscles as you draw your navel down towards the floor) and bridging (lying on back, squeezing buttocks and lifting up as creating a bridge with body). As well as squats? Just using pain as a guide, I have found that these in particular seem to aggravate my lower back pain. I have often wondered if repetition of them could be contributing to the problem of discs wearing out. Thanks for any tips!
~Jaimee

Sorry to hear you have had so many challenges with your back.

Scapular retraction is fine to do, but protracted scapular retraction is not the way to get your shoulders to align more posteriorly. You need shoulder rolls for that. Periodically strengthening the rhomboids is a good thing, but holding that position for extended periods is fatiguing for the muscles and can inflame the attachment points of the rhomboids.

For abdominal stengthening, we teach to not send the navel back towards the floor (that just flattens the lumbo-sacral angle); it's the back of the rib cage you want to send backwards. I also don't agree with the squeezing your buttocks to tuck your pelvis direction - that's another way to flatten your lumbosacral angle and detroy the wedge-shaped disc at that level. I speak from my personal experience...

Do an intial consultation with one of our qualified teachers - you'll learn a lot. 

Comments and photos from Alessio Rubele:

 

"In some ancient sports I can see people training on a regular basis with positions requiring shoulders pushed forward and hypercifotic spines"

 

"the top athletes, like our fantastic Yuri Chechi are performing at the olympics some extreme position,

it seems it's a line between what human body CAN do to reach a peak performance, and what is HEALTHY to do"

All these poses are clearly impressive and not ones I can speak to from personal experience. That said, I don't think it is very healthy to force (or reinforce) that much kyphosis in the thoracic spine (the first pic is paticular extreme in this). Check out now-deceased Yoga master Iyengar's rendition of similar poses without the thoracic kyphosis - it's much ore respectful of a healthy baseline upper body posture. Not easy to get here! 

Or this even amazing pose from the Iyengar website. 

Hi again Esther, forgive me if i go personal about some exercising:
my neck is going better and better and i'm now exploring the plank exercise on your book, but in this position i notice a significant scapula winging.
I'm working on it, but i can't "feel something" yet.
I will adress myself on the foundation course, that will work good for sure... meantime got you some tip?
Thank you very much, not just for this, but for all the hope and courage you'r giving to all this people!

Definitively the answer to my question was in the position of the shoulder blades of the great Iyengar in these pics.
Your tip was under my eyes!
Thank you !!!

I'm now 73, and 35 years ago I compromised my L4-L5 disc by carrying a heavy object up a steep hill. An MRI of the disc showed it has a slight bulge that for many years caused either chronic low back pain, or a right Tibialis Anterior spasm that would wake me from a sound sleep. During all those years I've seen Ortho MDs, Chiros, PTs, Acupuncturists, etc. Most were helpful, none delivered permanent cures, not even 25 hours spent over several weeks in a DRX-9000 spinal decompression machine - although that machine provided the most relief. Two years ago, while rehabbing a glute medius tendonopathy, quite by accident I discovered a permanent cure: using a gym workout machine that simply strengthened my back muscles - especially lumbar area back muscles. In all those years of seeing medical practitioners, NO ONE ever mentioned BACK MUSCLE STRENGTHENING exercises!!! It's also missing in the list of interventions in the first paragraph above. Of course mine is just an "N=1" experience that may not be generally applicable, but back muscle strengthening seems to be a missing element that many medical practitioners seem to overlook. That's a tragedy. (FWIW, the machine I use is here: https://www.youtube.com/watch?v=mwHMvmKcrU0 ).

I know there are many schools of Tai Chi that may have varying ideas about the pelvis, but this is my own experience. I studied Tai Chi Ch'uan with Professor Ch'eng Man Ch'ing in New York in the late 1960's and early 1970's. He died in 1974. Throughout my life I have considered his postural teachings to be the standard, and that there is only one correct posture.
Professor Ch'eng did teach that the lower back should be "ramrod straight." However, in practicing the positions--though Tai Chi is movement, we would hold positions for correction--he would say to "drop the tailbone." The idea was to let the tailbone fall freely of its own weight, and to relax the muscles that are tense and holding. I don't think he was teaching to tuck the tailbone, which would require using muscles to tuck it. As a result of my Tai Chi practice, my swayback straightened. My back is now somewhat curved at times, but I feel best when it is straight.
I don't know if any of this is in conflict with the Gokhale method.