Stretching: the truth

 In clinic, I will often do a treatment and incorporate some stretches to enhance the effect of the work done on a client. And it feels sooooooo good to be stretched!

But what is it I am trying to achieve?

Why do people incorporate stretching into their exercise program?

What are the benefits of stretching?

Well, there are different types of stretching and in clinic these are used for different purposes. Some examples are listed below.

Fascial stretches: can be long slow holds for a duration of 90s, which try to encourage and lengthen stuck connective tissue called fascia or it could be quite quick movements by the participant to help the fascia to respond under dynamic stress. Individuals often use a foam roller at home or in the gym to help with fascial stretching.

Passive stretches: where a stretch is held for 15-30s. These are great to help soft tissues, perhaps after trigger point work, and give that feeling of lengthening and opening.

PNF (Proprioceptive Neuromuscular Facilitation): Originally devised to help people with stroke recover movement and strength this encourages a client to resist a stretch for a short period of time but then allows the muscle to stretch to a greater degree once the resistance has stopped.

Active Isolated Stretching (AIS): A repetitive stretch that takes the muscle through its full range of movement and only holds the stretch for less than two seconds during which gentle overpressure is applied to enhance the movement before restarting. The repetitions help build stamina and strength.

Soft tissue release (STR): I have included this here as it is a technique I use in clinic to help stretch a muscle and is often used after trigger point work or to help release tension in big muscle groups such as the hamstrings or quadriceps. A muscle is contracted then pressure is applied at a point on the muscle and holds whilst the muscle is stretched. This again is a series of short, quick movements that is repeated at several points along the muscle.

Dynamic stretching: This is usually focused on sport specific movements where you start taking the muscle into a stretch gently and work to increase it taking it though the full range each time.

Ballistic stretching: This type of stretching lost popularity for a while as people were taking it to extremes, basically you take a muscle into a stretch then ‘bounce’ within a short range at the end of the stretch range. You are trying to increase the stretch each time but caution must be used as this type of stretching can lead to injury so it is not advised unless you really know what you are doing!

In addition, stretching as part of a warm up prior to exercising has been shown to reduce the risk of injuries, particularly in impact sports. Again, the type of stretching is important. For example, passive stretching can improve flexibility but decrease power for 30 minutes post stretching, this might be good for gymnasts and yoga practitioners but not so good for weightlifters and rugby players. Dynamic stretching is a useful warm up for many sports that involve sprinting, such as football. A good summary of the different types of stretching and the factors to be considered from a massage therapist perspective can be found in the book Massage Fusion(Fairweather and Mari, 2015:pp.157-176).

However, the evidence for stretching post event is inconclusive. What is highlighted is how people perceivestretching helps them: it is part of their cool down, enables individuals to feel they are getting rid of muscular tension from their chosen activity; helps them to feel realigned, it is part of their psychological de-stress from the activity; it has meditative effects; it prepares them to calm down the autonomic nervous system, etc.

This might also explain why some people do not feel the need to stretch after an activity.

Hopefully you can see from the variety of stretches available that there are different goals when using them. The main benefit is always to feel that the soft tissues feel lengthened. Stretching can be used to increase flexibility, to improve strength, to prepare muscles to work optimally under stress and to assist with proprioception. Pre-event stretching minimises injury and post-event stretching has many perceived benefits.

Now this article has been written, I need to get off the sofa and stretch myself!

DOMS: Delayed Onset Muscle Soreness

DOMS is frequently experienced when you exercise at a level the body is not used to working at. This means that athletes who have upped the intensity of their training can have DOMS just as much as complete beginners who are trying to improve their fitness and strength.

Photo by Victor Frietas

But what is it?

Well, truth be told, the science world does not have a definitive definition of what is happening when the body experiences DOMS! Typically, it has been described as the inflammatory response to small tears in the muscle; micro trauma of muscle tissues; and/or a reaction to the build-up of lactic acid. All of these have been investigated but the evidence to support them is weak.

What we do know is that DOMS is muscular pain that can be over a wider area than just the muscle activated. Usually it is the action of eccentric exercises (for example, if you are lifting a heavy weight in your arms you might contract a muscle to lift up the load but you eccentrically exercise the muscle as you go to lower the weight back down) that causes DOMS to be felt. Typically, the pain is felt 24 to 72 hours after the offending activity! However, it can take as long as a week to resolve. We also know that during this period the muscle has less strength and stamina than prior to the exercise.

Ultrasound scans of muscles experiencing DOMS shows increased oedema (swelling) within the muscle fibres. There is strong support that this swelling is an inflammatory response to the trauma incurred during the exercise but it doesn’t explain the more widespread pain.

Recently, there is emerging evidence that chemicals that initiate nerve growth contribute to increased sensitivity to muscular pain when they are damaged. This substance is referred to as Nerve Growth Factor (NGF). It is the nervous system that causes muscles to contract as the nerves attach to various parts of the muscle cell at neuromuscular junctions. In addition, there are nerves that provide sensory information such as heat and pressure.

What if eccentric exercise damages the nerve endings as well as the muscle fibres? This would then release NGF into inflamed muscular tissue possibly causing additional reactions to occur.

The nerve and muscle relationship: it is easy to imagine how a tear in the muscle fibre could elicit a nerve ending response

 

We know that the body’s normal inflammatory response takes about 24 hours to kick in (which is why anti-inflammatories are discouraged at time of injury). DOMS also takes some time to exert its effect. So as the inflammation reaches its peak there appears to be a slight timelag before DOMS is fully experienced. At the injury site the body is sending a constant flow of inflammatory response cells to the area to repair the injured site leading to increased oedema but material is also being taken away.

Could the oedema then dissipate through lymphatic channels and along fascial lines (fascia is a type of connective tissue that among other things wraps around muscle and individual muscle fibres)? This would then explain why DOMS is felt over a wider area than just the injured muscle.

But why would the body produce a response that inhibited our strength and movement albeit for a short time?

Well, in our muscles there are various types of receptors, including a type called mechanoreceptors. These receptors respond to mechanical pressure or distortion. There is evidence that NGF helps to improve the threshold that these mechanoreceptors work: effectively increasing the resilience of these receptors.

We also know that as we repeat an exercise we get better at it and can increase the intensity of the workout. Thus making the muscles being worked stronger. This would make sense in evolutionary terms and survival of the fittest approach. It would also help to explain why, when we do a different exercise using the same muscles we can still get DOMS: because the mechanical pressure and distortion of the fibres is different.

This is interesting stuff! Although still unproven.

So, although we still don’t know what DOMS is, there are some new insights into our understanding of what it is! However, it is a good sensation to experience, just be careful, for your own comfort!

 

2017: Don’t worry, Be happy

 

I think many of us will look back at 2016 and for a variety of reasons reflect and think ‘What a year!’

Now that 2017 has arrived how can we look forward and feel (even) happier in our lives?

In a Ted talk on happiness, Matthieu Ricard, a Buddhist monk, is discussing the French and their attitude to life and says ‘We like our suffering because it’s so good when it cease(sic) for a while’! However he gives some valuable insights into happiness including that we can train ourselves to be more positive.  

We know that our brains have the ability to change and adapt (sometimes called neuroplasticicty) and we can influence this ourselves. Ricard advocates mindfulness and meditation.

Positive psychologists, such as Shawn Anchor points out how we are never happy as we keep moving the goalposts  but some simple tasks to acknowledge our successes help improve our happiness and have the knock on effect of improving how we work! This can be achieved in as little as 21 days. Below I have listed Anchor’s strategy to achieve this.

The Happy Secret to Better Work

Shawn Anchor, TedxBloomington, May 2011

1.   Write down three new things you are grateful for each day.
2.   Write up one positive experience you have had during the past 24 hours ‒ helps your brain relive it.
3.   Exercise ‒ teaches your brain that your behaviour matters.
4.   Meditate ‒ allows calm time to focus on a task away from our busy lives.
5.   Random act of kindness ‒ this can be something as simple as sending a positive email to someone in your social network
(https://www.ted.com/talks/shawn_achor_the_happy_secret_to_better_work)

These small acts can have a positive effect on our own individual wellbeing and can also ripple out towards others.

Perhaps by each one of us looking at how we can be happier individually we may find that our family, social and work lives are all happier and successful too!

 

Six ideas to exercise

Below, I have put together a few links to help make it even easier for you to start exercising.

 

1. Yoga

Six simple yoga poses to help ease back pain are shown in an Elite Daily article: http://elitedai.ly/1PBioW7.

 2. Mud runs

For those of you who are used to running but fancy something more of a challenge what about a muddy obstacle race? You can choose from short distances (2km) but with tough challenges, see http://www.muddyrace.co.uk/south-east/mud-fit-surrey-2/.

Easier but longer routes can be found at Polesden Lacey in May, sign up by 24th April to take advantage of discounted rates: http://maverick-race.com/event/the-original-surrey-2/.

 3. Dance

Missing the winter TV schedule of Strictly Come Dancing? Why not learn some Ballroom and Latin dancing in your area? Beginners classes in Woking on Friday nights with Surrey Swing Dance starting end of January . Check out the website: http://www.steprightdance.co.uk/.

 4. Swimming 

Around 1 in 5 adults are unable to swim and in many areas there are adult swimming classes. Check out your local leisure centre for classes that range from complete novices to experienced swimmers. The ASA Framework also has a structured programme that swimming clubs can use for motivating adult swimmers and provides information on clubs such as diving or water polo. Click http://www.swimming.org/poolfinder/?utm_campaign=WaterPolo_PoolFinder&utm_source=Join_a_Club for more information.

 5. Football

Find out where to play near you at Surrey FA. Not only does this provide details of clubs in your area but it also has information on women’s and girls football also. See http://www.surreyfa.com/ for more information

6. Climbing

Surrey Sports Park and Craggy Island both have extensive climbing facilities see http://craggy-island.com/ and http://www.surreysportspark.co.uk/facilities/climbing/ for specific details but some local leisure centres, such as Woking also have climbing tuition and are worthwhile looking at as a place to start a new activity.

 

So those are some ideas to learn, adapt or enhance an exercise routine that might interest you. Now all you need to do is try one out.

 

Have fun!

My top 5 tips to reduce stress

1. Make sure you have some personal time

We live in a society where we have many demands placed upon our time: at home it may be sorting out children in the morning or chauffeuring them to and from after school activities, running a home, supporting elderly parents; and at work it may be attending meetings, travelling both here and abroad, or making phone calls at home so as to work with colleagues in other countries. All these factors reduce the time available to fit in an activity that is just for you. So try and schedule some time aside each week to do something you want to do. It might be to go and watch a rugby match with friends; have a long uninterrupted soak in the bath; read a book; or to try a meditation class. Whatever you choose to do that time is precious and to be enjoyed so do not feel that it has to be the first activity to be dropped if you run out of time, your well-being is a priority otherwise you cannot perform your other tasks to the best of your ability. You are important and sometimes you do need to put yourself first.

 

2. Exercise  

Most of the companies that I work in, staff are fortunate to have either an on-site gym or access to a subsidised gym. Use it! If your working day involves spending hours at a desk and then you relax at home by sitting watching TV or gaming for example, then some of your muscles will forget how much they can contract or stretch. Typically hamstrings can become shortened, which in chronic conditions can contribute to low back pain; shoulders can become rounded due to some muscles like the rhomboids being pulled out of position and lengthened.

Stress 1Regular exercise can break this pattern and help maintain balance in the body. A general gym workout will exercise all the major muscle groups and will invigorate the body. Exercise increases levels of endorphins in the body, which appear to be linked to pleasure centres in the brain and contribute to the feeling known as ‘runner’s high’!

If the gym isn’t for you there are numerous other options: yoga, running, dance classes, pilates, netball or football clubs. Don’t be afraid to try something new!

 

3. Have a ‘To Do’ list 

I love a ‘To Do’ list: sad but true. It can really help to write down all the things you know you need to do, that you are juggling in your head, as the demands these tasks require press upon your time. Even as you write the list remember the SMART mnemonic so that you break down large tasks into smaller components that are easier to achieve. This means that even on a busy day although you may not complete the entire task you will have taken steps towards it. At the end of the day/week, look back at your list and tick off all those you have accomplished. This then allows you to reorganise outstanding tasks and helps prioritise your goals for the next day/week.

 

4. Take a break away from your desk

It’s so important just to change your position and stretch out. If you own a cat or dog you will see for yourself that after it has been fixed in a position for a while it will turn round and just

Stretch

If you are unsure what stretches would be best for you then call me on 0759 050 1552 or email susan@powertouchtherapy.co.uk to book an appointment when we can look at your daily activities and devise some simple stretches to meet your needs.

 

5. Have a massage  

Well, obviously I am going to promote massage! But that is because it reduces stress levels. Studies have shown that massage is more effective in altering the body’s biochemistry than just resting or meditating, and has proven effectiveness in reducing anxiety, depression, lowering blood pressure and reducing heart rate. This is achieved by altering the level of pressure applied to each stroke, the fluidity of movement and the techniques used by the therapist.

I know some people feel that if they have a massage they might feel too relaxed to work the rest of the day. Not a problem! I always tell my clients that if ever they have an important meeting or deadline to attend to after a treatment to let me know and I will incorporate some invigorating techniques in the session to leave you relaxed and refreshed. Indeed, a study by Field et al in 1996 showed that as well as reducing cortisol levels (a neurotransmitter that increase with increased stress levels) maths tests were completed faster and more accurately by the massage group than the control group who just sat in a chair.

 

With all these stress-relieving tips, they need to be incorporated into your daily life to feel the benefit. Spending 30 minutes away from a task may seem like time wasted but is it really if the result is that you come back clear headed, with better focus and clarity to evaluate and complete your task?

If you want to book a massage with me then please call me on 0759 050 1552 and leave a message to let me know your name and contact number or email me: susan@powertouchtherapy.co.uk.

 

 

© Susan Harrison, 2014, Powertouch Therapy

Trigger Points

What are they?

Trigger points are highly irritable bands of muscle that are causing referred pain and irritation to the body. The key to trigger points is that they present with a predictable pain pattern. These can be in the immediate area of the trigger point or it can be referred further afield and some examples are shown in the images below.

TrP1 Headaches occurring in the red zone can be caused by trigger points in the muscle just below the base of the skull. Typically the muscle can get contracted and tight when a computer screen is not at the right height and the user has to tip their eyes slightly upwards.
TrP2Many people will not have
heard of a muscle called infraspinatus but they will have heard of ‘rotator cuff’ with respect to injuries. Infraspinatus is one of the rotator cuff muscles. It is the muscle that covers the shoulder blade (as indicated by the ‘x’ marks on the far left diagram). However, look where this muscle can refer pain and discomfort to!

It is amazing to think that irritation of muscle in the shoulder blade could potentially be causing pain down the arm as far as the hand. Usually the irritation for this muscle is on the upper arm and more to the front than the back but to feel it further along the limb is not a surprise, just less common.  Frequently one of the causes of trigger points in the infraspinatus is the position of the arm at night when sleeping.

TrP3In this diagram a muscle in the neck causes a much more localised pain pattern, with most of the referred pain occurring in the same position as the muscle, in this case the levator scapulae. This is one of the muscles that people feel tension in when they feel their shoulders have moved upwards and are now are stuck just below their ears. Treating this muscle can sometimes feel quite intense so it is always good to let the therapist know if you feel any discomfort during a treatment so that the techniques can be modified to ensure you are comfortable throughout.

 

How do you treat trigger points?

Well massage is very effective in treating this type of soft tissue problem. Frequently, clients might be having a massage and say something like ‘I felt that in my arm’ when you are working their shoulder for example. So although the client may not have persistent pain, it is present. If the warning signs are ignored, that pain may become a constant nagging ache as the trigger point progresses to a more chronic state. As the muscle with a trigger point becomes contracted and not functioning as smoothly as it should, neighbouring muscles start to be affected as their movement is inhibited. This then leads to the spread of tension and discomfort in the body.


Massage works to manipulate the soft tissues to find any trigger points and then use techniques such as compression, myofascial release and soft tissue release to relieve them. Ideally, you want to be able to improve the blood flow to the area, find the key trigger points and treat them. As muscles are sticky and are used to being stuck in a particular position it can take a few sessions to ensure you have treated them all successfully. However, the end result is that you no longer have those muscles causing pain and restrictions in your body. Perfect!

If you would like to book in for a massage contact Susan Harrison on 0759 050 1552 or email susan@powertouchtherapy.co.uk

 

© Susan Harrison, 2014, Powertouch Therapy

 

 

Rumour has it… Movement has it all!

So I have corrupted Adele’s lyrics but I wanted to discuss the benefits of movement as not moving can lead to a host of musculoskeletal problems that could potentially also affect mental well-being.

So many aspects of our lives are sedentary: driving, working at a desk, using a laptop or computer, gaming, eating out with friends or even socialising down the pub! If you think about our body position during these activities, although varied, we have hardly moved our muscles or bones!

I see many clients who have problems with their neck, shoulders, hamstrings, quads, calves or buttocks and usually the reason they have come to see me is because the body is not being moved back to centre (neutral) enough. Look at the images below to see what I mean about the body being stuck in the same position all day.

Posture 1Posture 2Posture 3Posture 4Posture 5

 

Head forward, shoulders rounded, back curved, bent legs and inactivity throughout. The lack of movement of the body can lead to a host of musculoskeletal imbalances. Fortunately, massage can take away the discomfort associated with poor posture and even recommend exercises to help you redress some of the imbalances in your body.

At Powertouch Therapy (www.powertouchtherapy.co.uk), we are trained in a variety of different stretching and rehabilitation techniques to help improve your posture. So why not book in for a session. Email susan@powertouchtherapy.co.uk or call her on 0759 050 1552 to discuss your particular needs with her. It may take some time before we get you to work with a spring in your step as shown below but we can certainly help you on your journey!

And if you plan to do this, well I would love to be in on that meeting!

Posture 6

© Susan Harrison 2014, Powertouch Therapy

Tension headaches

“Tense, nervous headaches…”

Well, I am old enough to remember the advert used by a company to promote their tablets for the relief of headache pain. These painkillers are effective and reduce the symptoms but do not get to the root cause of the headache.

Headaches generally fall into two categories:

  1. Primary headaches, which are the most common type and include tension headaches, migraines and cluster headaches.
  2. Secondary headaches, which have an underlying cause such as too much alcohol, concussion, cold/flu, hormonal influences and tempero-mandibular joint pain.

(Source:  www.nhs.uk/headaches)

The vast majority of headaches are tension related. A number of studies exist which show that massage is proven to be effective in treating these types of headaches as well as improving sleep quality in people who suffer from them.

I tend to only ever have a headache if I have a bad head cold. For some of my clients it can be very different and I recall one conversation I had with someone who, when I asked how often they had a headache, replied ‘A normal amount,‘ so I asked what a normal amount was and she replied ‘Every day’. That is not normal in my experience! Fortunately after a few treatments her headaches decreased quite markedly, to the point where I would just see her every couple of months for headache maintenance.

 

So how does massage work?

Treatments for tension headaches will work both front and back of the neck and shoulders to look for knots or adhesions that might be causing the problem. Sometimes when an area is worked the client can feel the headaches developing, this is an indication of trigger point pain. By massaging the muscles, applying heat and stretching, the adhesions can be worked out, muscles re-aligned and headache pain decreases.

Usually a short burst of regular massage therapy is needed to ensure muscles do not return to the knotted position they were in originally when they were causing the headaches. As the knots reduce and the frequency of headaches decrease, appointments can be eked out.

 

What else might be contributing to my headaches?

From my experience with my clients there are a number of factors that can also cause headaches and if you suffer from them regularly it might be worthwhile checking if any of these factors apply to you.

  1. Are you drinking enough fluid? Frequently clients can resolve their headaches by ensuring they drink 2 litres of fluid a day. Central heating in winter, sweating in summer can affect your own hydration levels so try an extra glass of water if you feel a headache developing and see if that helps.
  2. Working from a laptop that is not correctly positioned for you? Well not only can this cause headaches but it can really affect your posture, and not in a good way! If your head is pointing down at your lap some of the muscles in the front of your neck are working so hard to contract and hold your head in that position while muscles down the back of the neck try to maintain balance that you can develop ‘forward head posture’. Try operating the laptop on a desk with the screen at eye level and use a separate keyboard so shoulders are not hunched up.
  3. Similarly if you hot desk the PC might not be set up for you and the screen height could mean you are tilting your head to see it correctly and overworking some small muscles in the back of your neck causing headaches.  Adjust the screen height and see if that reduces tension in the upper part of your neck.
  4. Certain foods may act as triggers for headaches or migraines: coffee, chocolate and cheese are the main culprits but keeping a food diary and seeing if there are any relationships between what you eat and your headaches might be an area you would like to explore.
  5. Grinding your teeth can cause jaw pain and tension that can contribute to headaches. Speak to your dentist but a massage therapist who can work in and around the mouth and neck may help reduce the tension in this area and any resultant headaches.
  6. Tension can build up if there is a lack of physical activity. Try to ensure that you at least take a brisk walk during your lunch hour. See if you can do a regular activity such as football, squash, dancing, yoga or tai chi ‒ anything you think you would enjoy to get you moving!
  7. However if you are always on the go and are exhausted from working hard, looking after family, socialising, etc  then you might have a headache because you are overtired so get some rest. You can’t burn the candle at both ends…
  8. Get your eyes checked! Squinting or peering over glasses that have fallen down your nose can again cause your neck muscles to tighten and again lead to headaches. A trip to the opticians will quickly resolve the problem.

Although not exhaustive, I hope this checklist of factors that contribute to causing headaches may prove useful. However, if you have gone through the list and still have a headache that you feel is muscular in its origin then why don’t you book an appointment to visit a massage therapist.

 

Susan Harrison

Powertouch Therapy

 

© Susan Harrison 2014, Powertouch Therapy