To stretch or to strengthen?
If I had a dollar for every time I was asked about the 'best stretches' for XYZ, I’d have several dollars.
A common misconception I’ve come to find in the rehab world is that clients believe their pain has arisen from a lack of proper “stretching”. The root cause of their symptom is derived from a lack of flexibility, and that’s that.
Having recently noticed this trend of online opinions, I decided to poll my followers, many of whom are physical therapists themselves.
I asked them how often they are prescribing static stretches vs. mobility under load exercises.
The feedback was almost unanimous. Physical therapists are rarely recommending static, low load, long duration stretches for their patients.
Now, of course there are the meaningful exceptions, such as surgical post-op patients, high-tone pelvic floor patients, patients with significant postural deficits, and patients who just simply want to stretch no matter what.
To proffess that stretching has no place in the rehab world would be plain wrong. BUT, I think it’s encouraging to see that the profession as a whole has shifted towards more of an exercise and strength training based mindset.
Let me give an example of what I’m referring to.
If a patient comes to me with low back pain and is convinced it stems from 'tight hamstrings,' I’ll definitely assess their hamstring length. But rather than give them a static, seated hamstring stretch, I’ll lean more towards giving them exercises that load the hamstrings as they lengthen (kettlebell RDL, single leg RDL, ball bridge curls).
While a classic hamstring stretch may feel temporarily relieving, that patient’s hamstring “tension” is likely to return if we only ever statically stretch.
The idea is that by loading and strengthening the muscle as it lengthens, the neuromuscular system will adapt and be better able to maintain this lengthened state.
This is the mental framework I often use when creating home exercise programs for clients. And trust me, it works!
<3 Roni
This week I get into the fun details of how I started my physical therapy practice. From randomly treating patients in my guest room to having a full-blown lease and client caseload, you can listen to the detailed inside scoop here.
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See you next time :)
