Stretching: General Principles

Here are my 13 Stretching Tips for every muscle/tendon in the lower extremity (hips, knees, ankles, and feet). These general principles help to avoid injury and should be used daily. Proper stretching is vital to the health of our muscles.

•#1   Hold each stretch for 30(minimum) to 60 seconds, and repeat twice.

•#2    Alternate between sides while stretching (for example, right achilles with knee straight, then left achilles, then right, then left).

•#3    Do not bounce while stretching, hold steady.

•#4    Deep breathe to get oxygen into the muscles while stretching. Normally 5 deep breathes equals 30 seconds.

•#5    Stretching before exercise should be done after a light warm up, like walking or stationary bike or jog, and is crucial, and is crucial in preventing many injuries due to tightness like achilles or hamstring strains. Julie Cox, PT, recommends pre-activity stretching to be slightly less time (20 to 30 seconds) followed by gentle rhythmical motion to warm up the muscle group involved for another 30 seconds. For example, achilles stretching pre-workout could be followed by a gentle rhythmical motion for 30 seconds (back and forth) between raising the heel up off the ground and then lowering the heel back down. Stretching hard when the muscles are cold (based on weather or time of day) can injure the muscle and gives pre-workout stretching a bad name. I personally like 5 minutes of stationary bike or walking or a sport specific activity (shooting before a basketball game) before starting my pre-workout stretch.

•#6    Stretching after a work out is the most important time to gain flexibility since the muscles are heated up.

•#7    If one side of your body is tighter, do twice as many stretches on that side versus the looser side.

•#8    If you want to gain flexibility, stretch the desired muscle group three times per day, whether you work out or not.

•#9    If you want to maintain flexibility, average one time per day stretching the desired muscle group.

•#10  Never stretch through pain, it only makes the muscle tighter afterwards.

•#11  Make sure when stretching that your body is stable (not likely to fall over, etc)

•#12   Most muscle/tendons can be stretched for better results in various positions. For example, when stretching the hamstring, you need to stretch both the upper and lower parts. And especially for the lower hamstring, you can stretch various parts by positioning your foot straight, externally rotated, and then internally rotated. You will feel the pull on the hamstring at different parts.

•#13  With many muscle/tendon injuries, if you can find a way to stretch it which relaxes the sore area, you are going to heal much faster. As long as you can stretch without making it painful, you can stretch an injured muscle/tendon 5 to 10 times daily.

Achilles Stretching Technique

Proper Stretches for the Achilles Tendon are a vital part of every pre and post activity, and especially with injuries to the achilles, calf, plantar fascia, and hamstrings. Please refer to the post entitled "Generalizations in Stretching". There are two muscles, gastrocnemius and soleus, that make up the achilles tendon. These two muscles can be stretched separately by first having the knee straight (gastroc stretch on the left photo above), and then having the knee bent (soleus stretch on the right photo above). With both stretches, it is important to keep the heel on the ground. Hold each stretch for 30 to 60 seconds, or 8 deep breathes. Deep breathing gets oxygen into the stretch, a good yoga principle. Do not bounce, ballistic stretching. It is never good to jerk the muscle or stretch through pain. You want that good ache feeling. Try to stretch several times a day to actually gain in flexibility, even on days you do not do your normal activities. When non-athletes complain of cramping in their calves, often low potassium or dehydration is blamed. Have them try stretching 2 or 3 times a day and many will experience complete elimination of the cramps.

Hamstring Stretch: Various Positions can be Key to Flexibility

Hamstrings tightness is very common to athletes. Stretching of the hamstrings is one of the 3 most important lower extremity stretches that should be done both before (to prevent injury) and after (to gain flexibility and relax muscles) exercise. The other 2 muscle/tendon groups crucial to stretch are achilles and quadriceps. Various posts will be dedicated to each variation of stretch. I feel most stretching articles are too overwhelming with 5 plus exercises. I would rather you understand one well, before proceeding further.

The photo above shows the basic lower hamstring stretch getting the muscle/tendon loose around the back of the knee. The patients are told to place their heel on an elevated surface, like a chair or bench, where they feel no tension placing it there. The knee should be held straight and the toes straight upwards. The patient should not attempt to touch their toes which places too much stress on the back. It is emphasized to the patient to lean forward over the leg being stretched feeling the bend at the hip joint, not the back. Imagine the back as completely straight. Lean forward over the leg until you feel tension behind the knee. It is very important since you are standing on one leg to feel very stable. Be near a wall or table that you can hold on with your arms if needed to gain stability.

           Once you feel a great stretch, hold the stretch for 30 to 60 seconds (I love 8 deep breathes to get oxygen into the stretch. With every exhale, go slightly deeper  into the stretch). There should never be pain with stretching either during or after. Pain during stretching will always mean 2 hours later you are tighter than when you started. Pain after stretching means you stretched too hard and next time stretch easier. Please read the separate post on Generalizations of Stretching.

When stretching both legs, I like to alternate sides. The three stretch variations for the lower hamstring is all based on the big toe position. Let us discuss the right side, and I will leave it up to you to do the opposite for the left side. With the big toe at 12 o'clock, lean forward over the leg until you feel the pull of the hamstring behind the knee. Hold this painfree stretch for 30 to 60 seconds, or 8 deep breathes. Then do the left side. The second stretch for the right side is with the big toe at/near 9 o'clock. This gets a greater stretch on the medial hamstrings (semi-tendinosis and semi-membranosis). Then do the left side. The third stretch for the left side is with the big toe near 3 o'clock. This gets a greater stretch on the lateral hamstrings (biceps femoris).

You may be very surprised that one of the three stretches gets the sore muscle/tendon better than the other two. If so, do one more stretch to this variation for 8 more deep breathes, or go back it that stretch alone several times a day. Soon I will have a post on Upper Hamstring Stretching (the apparent mystery stretch to 99% of my patients whom have never heard of it).

Achilles StretchIng: One Stretch to Avoid (when you have achilles tendinitits or plantar fasciitis)

     A vital part of the treatment of achilles tendinitis and plantar fasciitis is stretching these structures. Please check out the post on the Generalizations of Stretching. The photo above shows a very powerful achilles and plantar fascial stretch. It normally feels great as you lower one or both heels off the edge of a stair or curb. But this stretch called Negative Heel Stretching can be damaging to your tendon and/or plantar fascia. I do not recommend it at all, but I emphasize it with my achilles and plantar fasciitis patients to avoid with a passion. With the heel in a vulnerable, non-protected, position, the heel is lowered into a position it is just not used to being. If you think about heel position in life activities (functional activities), our heels are either at the same height as the front of the foot, or elevated above the front of the foot as in a normal heeled shoe. Negative Heel Stretching places our heels in a position that life has not accustomed them to being. Almost our full body weight goes into the achilles attachment in the back of the heel and into the attachment of the plantar fascia into the bottom of the heel. Golden Rule of Foot: Avoid Negative Heel Stretching. Do not take a chance that this stretch is overloading the weakened areas leading to greater damage of the tissues. There are too many other ways to stretch these areas which will be handled in other posts.