One of the most commonly prescribed at home treatments from coaches, doctors, and therapists is to stretch. Just about everyone, at some point or another, has been told to stretch because it is “good to be flexible.” However, should everyone be stretching? And if so, how much is too much?

One thing we can all agree on is that our bodies need to be in motion. Obtaining full range of motion through our joints is important for maintaining tissue integrity. When we lose motion through a particular joint, other joints have to compensate for that loss of motion and are forced into overuse, leading to injury.

For example, have you ever had a stiff neck and you can’t turn your head normally? Then you’re driving in the car and you have to check your blind spot, or someone calls your name and you have to look in another direction, you can’t move through your neck to turn your head because it hurts, so we make the Frankenstein turn with our backs to look behind us. Then you finally realize how silly you look after everyone asks, “How’s your neck feel?” This is a typical presentation which only lasts for a few days at most. However, what if you never regained that motion in your neck? How do you think your back would hold up compensating for your neck all the time? You would be “overusing” your back to turn your head. This can happen at any joint in the body and is actually quite common.

This is where stretching may be helpful. However, this is also where stretching may be harmful!

The graph above shows that the same force repeated over time to the same tissue lowers the tolerance of that tissue and leads to injury. Essentially, overuse leads to fatigue and fatigue leads to injury. Keeping our joints within a certain range of motion is important in avoiding overuse and compensation conditions.

We commonly keep joints within certain ranges of motion by stretching, right? So in order to avoid these overuse and compensation conditions … that means we should stretch every muscle and every joint in our body, as much as possible, all the time, to avoid injury … right?

NO!

Let me present you with an alternative scenario in a person who is, what we call, congenitally lax. Congenital laxity is a condition where the tissues which hold our joints in place have slightly (or sometimes excessively) more “give” than the typical person. In these patients, what we often find is that they still report feelings of being “tight” in certain regions. This feeling of “tightness” is NOT the result of the tissue becoming shorter. In fact, this is the result of the bodies attempt to gain stability where weakness is found. The tissue is actually contracting to stabilize the joint! If you stretched this tissue, you’d be making the problem worse.

I like to explain a lax joint like a suspension bridge with too much slack in the cable wires. The bridge would be unstable and able to move all over the place. When the body senses this instability in a joint due to laxity, it sends a motor signal to the muscles to contract and “tighten the cables.” It’s not that the cables are short, they are purposely tightening to stabilize.

If you went home and stretched your congenitally lax joint because your body was contracting for stability you would actually cause MORE instability and the body would become reflexively TIGHTER! Stretching would make your condition worse!!

Now, this is in the extreme case of someone who is congenitally lax. However, the same concept can apply to the variety of movement pattern dysfunctions we develop throughout our lives. Our bodies, in their infinite wisdom, will figure out a way for us to move and achieve certain tasks. Whether you are doing it appropriately is another story.

Clinically, we always ask ourselves, does this problem require WD40 or DuctTape? Are we trying to achieve mobility, or stability?

I offer another choice. First, determine if you should or shouldn’t be stretching by deciding whether or not you have congenital laxity. A test for this uses what’s called the Beighton hypermobility (increased motion) scale. Feel free to google that if you want more info. Here are 5 simple screens to see if you are congenitally lax.

1. Extend your elbow all the way. If your forearm can extend passed your upper arm by >10^o that joint is lax.
2. Stand tall and extend one knee as far back as you can. If your knee can go backwards >10^o that joint is lax.
3. See if your thumb can contact your forearm with ease (don’t force it). If your thumb can touch your forearm on both sides, those joints are lax.
4. With your palm facing up and parallel with the ceiling, see if you can get your pinky finger to point directly to the ground. If your pinky has a >90^o angle to your hand, that joint is lax.
5. Finally, see if you can put your palms flat on the floor without bending your knees.

If you can do all of these with no problem at all, you are probably congenitally lax. If you can do most of these tests but have trouble with one or two, you are probably still congenitally lax and need a STABILITY program (strengthening) rather than a mobility program (stretching). In fact, stretching would likely make things worse. If you can’t perform any of these tasks at all, you may be a candidate for stretching.

However, this is just a basic screening test. These tests are not meant to diagnose or treat any conditions you may have. The purpose of this post is to educate this community on the possibility that you may, or may not, want to be stretching. Most importantly, you should see a professional for accurate advice on any movement dysfunctions. For a further information or a comprehensive assessment call our office at 484.341.8598 x 701. If you have any questions, please email Dr. Zappy at joezappydc@gmail.com.