There is much debate as to the effects of stretching and whether it is important for injury prevention, performance enhancement, rehabilitation post-injury, flexibility and reducing muscle soreness after exercise. To start with it is important to know what type of stretching techniques are used and what is the difference between these stretches.

Static stretches

Static stretching is when the position of the stretch is held for 30-60 seconds. The stretch SHOULD NOT BE PAINFUL! As the stretch is held, there is a reflex reaction which occurs and causes the muscle to relax. You can then stretch the muscle a little further with less discomfort.

Ballistic Stretching

Ballistic stretching is not commonly used, except in gymnastics, ballet and dance. Ballistic stretching is when the muscle is stretched almost to it’s limit and then a bouncing movement is used to stretch the muscle further. The bouncing component of this stretch causes a strong reflex muscle contraction. It is thought that stretching in these high tension movements may increase chance of injury.

Proprioceptive Neuromuscular Facilitation Stretching (PNF Stretching)

PNF stretching involves a static muscle contraction, followed by a static stretch of the same muscle groups. PNF stretching is performed with a partner who will move the muscle into a range where you feel a stretch, then you will contract the muscle against your partners resistance and repeat again.

Does stretching have an effect on increasing joint range of motion and strength?  What we know from the research is this:

• It can increase joint range of motion for a short period of time. Best results with 15 to 30 seconds and between 2-4 repetitions
• PNF stretching (a static muscle contraction followed by a static stretch) is proven to be MORE effective at increasing joint range of motion than pure static stretching
• Static stretching actually DECREASES muscle strength output temporarily if performed immediately prior to exercise.
• Dynamic stretching (moving smoothly through your joints range) can increase length AND strength output!

The type of stretching that you should perform will vary depending on your reason for stretching. For example, static stretching of the calf following an ankle sprain could increase joint range of motion and stiffness, allowing you to walk normally. However if a high jumper performed a static stretch of the calf before an explosive jump, there could be temporary decrease in calf power which may result in a lower jump. Therefore the TYPE and TIMING of stretching plays a crucial role on the impact stretching has on performance.

So does stretching decrease your chance of injury? Does stretching reduce muscle soreness post exercise? The current research has shown:

• Pre-exercise stretching DOES NOT  decrease overall injury rates
• A large study conducted on Fire Fighters and Military recruits who included REGULAR stretching into their training regime (not prior to exercise) resulted in 32% decrease in injury.
• A number of studies have shown that muscle stretching before and after exercise does not produce clinically important reductions in delayed onset muscle soreness

The debate as to whether stretching prevents injury is ongoing. The evidence is conflicting. If you are an active person who feels stretching makes your move and feel better, there is no harm in continuing to stretch. If you are an high level athlete, you need to think harder about the pro’s and con’s of stretching on your performance. This is an area of ongoing study and hopefully in the future the research will give us more answers.

Ankle sprains are one of the most common sporting injuries especially in sports such as netball and basketball. They tend to be viewed as minor injuries that will heal over time because of their common presentation and quick resolution of symptoms. However, ankle sprains often lead to persistent problems such as increased laxity and chronic instability. If not treated correctly there is a 70% chance of re-injury to that initial ankle sprain. The good news is that we can prevent recurrent ankle sprains!

The ankle is made up of 3 main structures: bone, ligament and muscle. The term ankle sprain describes an injury to a ligament meaning that a ligament has been stretched and damaged which then results in laxity. This means that there is an increased chance for the ankle to “give way”. Our muscles around the joint also provided stability to the ankle. This is where an effective exercise program will help prevent recurrent ankle sprains. The stronger the muscles are the less likely the ankle will “give way” and the muscles will provide more stability and support. Retraining our balance is also a very important factor as this will also help prevent the ankle giving way. Decreased balance is seen frequently following ankle sprains. The quicker our muscles are able to detect to an unexpected movement the less likely re-injury will occur.

In this video, Megan Tomkins runs us through some examples of exercises for improving ankle strength and balance before returning to sport.

Megan is a physiotherapist who loves treating netball injuries! She is a go to for all things ACL and ankle. You can make a booking with Megan online or by calling 4721 5567.

Ah the achilles tendon. That big rope-like structure connected to your calf muscle and heel. So useful when things are going well… and oh so crippling when you did just that little bit too much hill running or those 1000 box jumps you did last week.  If you have ever felt this pain before and it stopped you from your usual exercise – chances are you had some form of Achilles Tendinopathy.

Achilles Tendinopathy is a common overuse injury of the Achilles tendon and a condition we treat ALOT in the clinic.

What is Tendinopathy?

The widely accepted Cook and Purdum model explains Tendinopathy in 3 stages:

1. Reactive tendinopathy: When compressive or tensile overloading takes place, the tendon thickens and stiffens in attempt to reduce the stress on the tendon.

2. Tendon disrepair: If the tendon is not offloaded and allowed to repair back to stage 1, the tendon cell matrix will start to separate and breakdown physiologically.

3. Degenerative tendinopathy: If the tendon is further overloaded, permanent damage of the cellular makeup will occur.

Tendon change occurs along this continuum and may go back and forth between these 3 stages.

How does overloading occur?

Overloading commonly occurs in the form of:

· Excessive loading through high impact activity such as running or jumping. The Achilles tendon may take loads of up to 2x your body weight when running.

· An increase in training load of high-impact activity or resistance training.

· A return to training after weight gain.

How can improve you improve your Achilles pain?

The key to moving back through the stages of tendon damage needs to follow 2 simple yet crucial steps.

1. UNLOAD – Give the tendon the rest it requires to move back down the stages of damage. This may not be complete rest, but instead a “relative” reduction in your activity e.g. reduce kilometres running by 20%

2. LOAD the tendon to prevent further disrepair. This step requires a careful gradual and progressive loading program which is tailored to the individual’s needs. Rehabilitation with a safe loading can begin straight away and reduces recovery time versus complete rest.

Check out the video below I posted on Facebook for some examples of exercises we use in the clinic to gradually load the achilles tendon during a tailored rehabilitation program.

If you need help managing your Achilles pain pop in to see Sam Mullany at the practice. You can make a booking with him online or by calling 4721 5567

Overuse injuries are by far the most common type of presentation I encounter in runners presenting for physiotherapy.

When you run (or do any form of physical activity) you create micro-trauma to your tissue (bone, muscle and tendon) which is then replaced, regenerated and strengthened by the laying down of new cells such as collagen. Each individual has a certain rate at which they can lay down this new tissue. This process actually strengthens your tissue and improves its ability to withstand more load

Overuse occurs when the amount of loading has exceeded your ability to lay down this new tissue.

Here is a great picture expanding on this principle from Tom Goom’s Running Repairs course I attended 2 years ago now

This picture on the left shows the different components that can make up your training load. It is important to note that these aren’t JUST running! They can also include other activities like work or going to the gym.

On the right side we have a list of ways we can increase your tissue load capacity. Plenty of options to explore there and a lot of stuff you can start looking at right now!

So looking at both sides of the see-saw – the main things I see increasing people’s risk of overuse injury are generally pretty simple errors:

1. Increasing training load by too much too quickly e.g. increasing kilometres by more than 30% compared to the previous week or that moment of brilliance when you decide to start running up a whole heap of stairs this week.
2. Non optimal structuring of your total exercise program (doing a massive run after training legs hard at the gym)
3. Rapid change in running technique e.g. change to forefoot strike done in one fell swoop and getting a calf blowout
4. Changing external factors too quickly e.g. significant change in footwear type without a transition period
5. Not doing enough strength conditioning to increase tissue capacity

These are errors we can all make and they are understandable. All part of just being excited about running!

So if you are a runner here are a couple of things for you to consider right now:

1. Make sure you are doing adequate strength conditioning particularly for calf, glute, hamstring and hip flexors. Can you do 30 single leg calf raises? Can you do 30 single leg bridges? If not put in some work!
2. Keep an eye on your kilometres and incline – try not to increase your km’s more than 10% per week
3. Check how stable you are – can you balance easily on single leg? Can you hop side to side/forward and back with ease? Can you stand on a Dura disk for 30 seconds? If not, you may need to work on some balance and core stability
4. If you’re trying to change your running style or footwear – don’t do it all at once! Do small doses of the new change and ramp it up gradually 10-20% more each week

Jared Reyes is a physiotherapist who has extra training in running gait analysis and management of runners. He enjoys running on the Blue Mountains trails each and every week.

If you would like his assistance managing your running injury or would like to have a running assessment Book Now or call us on (02) 4721 5567