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The Thinking Practitioner Podcast:
Episode 11: Stretching the Tissues, or the Truth?

Broadcast date: 4/08/2020
©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

Til Luchau:

Thanks to Andrew Biel and Books of Discovery for their support and be sure to check out their great offer. Hey Whitney, how's it going?

Whitney Lowe:

Going well today. How are you doing?

Til Luchau:

I'm excellent. Been traveling a bunch and at home now and that's always pleasant.

Whitney Lowe:

Yeah, how were your trips?

Til Luchau:

Really fun. Really fun.

Whitney Lowe:

Good.

Til Luchau:

It was the triple whammy at Google and we stayed busy, but it was just a whole lot of fun to be seeing what they're up to and to be going from coast to coast and to get the juxtaposition of the different subcultures that we have in this big country we're in.

Whitney Lowe:

And tell me about briefly the triple whammy. That was three cities. It was New York, Mountain View and...

Til Luchau:

Seattle.

Whitney Lowe:

... Seattle, is that right?

Til Luchau:

Mm-hmm (affirmative).

Whitney Lowe:

Uh-huh (affirmative).

Til Luchau:

That's right.

Whitney Lowe:

Yeah. You we're at the big Google headquarters or Google locations at each one of those major cities then. Is that right?

Til Luchau:

That's right. Working with their in-house therapists and pretty high level of skill. Pretty high level of motivation and of course, they work in a unique environment, so those were all really fun things to visit and be a part of.

Whitney Lowe:

Yeah. It is really fascinating to see the way that they're doing things within the company with the services that they offer. And I think it's a great example of how this can be used in so many different ways there. And it's really cool.

Til Luchau:

They were remembering you fondly. I know you went and spent some time there and you made an impression left them some lasting things too, so it was fun to follow in your footsteps.

Whitney Lowe:

Yeah, all right. Good, good. Well, good, we got some-

Til Luchau:

What do you want to-

Whitney Lowe:

... interesting things-

Til Luchau:

You want to jump into our topic? Where do you want to go?

Whitney Lowe:

Yeah, I think let's hop into what we're doing today. And I think we had on our topic today is stretching if I'm thinking correctly. Is that right?

Til Luchau:

That's right. Stretching.

Whitney Lowe:

Yeah.

Til Luchau:

You had that proposal. I remember it started when you read Jules Mitchell's book and we'll talk about that, but then I think it expanded out from there. Maybe you could give us a little context. Why would stretching be interesting to manual therapist and massage and body workers and why did you want to discuss it here.

Whitney Lowe:

Yeah. As you mentioned, I wanted to give just a quick shout out. A lot of my recent interest in some of these topics had come about after I had read Jules Mitchell's recent book called Yoga Biomechanics, which I really strongly advocate everybody take a look at. Especially for those who are in the manual therapy world. It's not just about yoga, but about things that are pertinent to anybody who's involved in these types of manual therapy approaches like what we're doing. But her book is a compendium of a lot of the recent research on stretching and it helps dispel a lot of myths and misperceptions about stretching. And that's one of the things that really caught my attention a great deal is that there do seem to be a fair number of misperceptions and misunderstandings about stretching. So that's one of the things I thought we might talk about a little bit today because I hear a lot of those things bandied about in our profession and in lots of people who are doing all types of manual therapy approaches quite a bit. I thought there'd be some interesting things for us to dive into a little bit there.

Til Luchau:

You bet. Yeah, I also really enjoyed her book, two thumbs up on that one. Myths and misperceptions. That's fascinating. Okay.

Whitney Lowe:

Yeah.

Til Luchau:

That's almost tempting to dive into right there, but I'm wondering if we should step back a little bit and well, is there another bigger picture question that's raised for you? Is it just myths and misperception or is there another picture there?

Whitney Lowe:

Well, no. I think you're right. We should, really, to get into this, we want to talk about some of the other fundamental facets of stretching that I think are sometimes either taken for granted or maybe not even recognized thoroughly and look at some of those things first and that's how probably we'll get into some of these myths and misperceptions.

Whitney Lowe:

But one of the things that come to mind for me in looking at this topic of stretching is when we try to think about what actually happens when we are stretching. And lots of us give our clients suggestions about "Hey, you should do these stretches." Or we hear people talking about like, "You should stretch this as part of your rehab," or something like that. It is something that is advocated quite a lot by people who are in our field. And I think sometimes it's advocated without a really good physiological understanding of what happens to tissues in the process of stretching. And that whole understanding is really evolving a great deal. I don't think we really have a definitive understanding yet of exactly what happens in many instances here.

Whitney Lowe:

One of the things that I zero in on is when I think about stretching, there really seems to be two key elements of a stretching procedure. One of those is the connective tissue element, meaning what happens to the myofascia and the connective tissues of... and again, we're speaking about stretching mostly in terms of musculotendinous units here. When we talk about stretching, there's something happening to the connective tissues that are absorbing the tensile load of the pulling process from a stretching procedure. There is also-

Til Luchau:

Okay, you're saying, let me see if I follow so far. You're saying when we stretch, either when I stretch myself or when I stretch my client, we're mechanically loading the tissues.

Whitney Lowe:

Yeah.

Til Luchau:

The musculotendon unit you said.

Whitney Lowe:

Yeah. And also in thinking biomechanically, there's something that some people don't really think about as well, which is that in muscle contraction, tendons are getting loaded with tensile load. They're getting pulled just the same way they are during a stretching procedure, but obviously with a lot more force during a muscle contraction.

Til Luchau:

Aha.

Whitney Lowe:

During stretching procedures, muscle and tendon both get a tensile load, but during muscle contractions, whether they're isometric, eccentric or concentric contractions... Did I say concentric?

Til Luchau:

Yeah.

Whitney Lowe:

Three. There's concentric, eccentric and isometric. Regardless of the type of muscle contraction, the tendon is getting a tensile or pulling load in all of those instances. When we talk about stretching, we're usually talking about what happens to the muscle tissue or the myofascial tissue. So, yeah. There's something happening to the connective tissue elements, all of those layers of fascial tissue that surround individual muscle fibers, the bundles and the whole muscle itself. They're getting a tensile load. That is the connective tissue element.

Til Luchau:

Okay.

Whitney Lowe:

And then there is a neurological element to that, which is that the muscles, when they get a stimulus to contract, there is the overlapping of the actin and myosin fibrils in there that causes the muscle contraction process to occur and neurologically when we are stretching in many instances, at least this is the theory, that we are decreasing the neurological resistance to that muscle being able to... I hesitate to say the word elongate, because we're going to get into that little bit there about what actually do muscles truly elongate. Because that's another big question. So let's just say neurologically, there's some other things going on in a stretching procedure that makes that muscle be able to have a greater range of motion.

Til Luchau:

Okay. Is your interest in the debate about is it neurological or is it tissue?

Whitney Lowe:

Well, that's something that in reading a lot of this recent research and some of the things that Jules Mitchell had put in her book that was highlighting, there seemed to be these two competing theories. One being a mechanical theory that yes, we are stretching and elongating tissues when we do stretching. And the other being one predominantly a sensory of neurological theory saying the majority of this is really happening from neurological responses to the procedure that we're doing that's decreasing the neurological actually in there. And there is a force of-

Til Luchau:

So, we're stretching the, the question then, are we stretching fascia, myofascia or are we stretching our brain and our sensate thresholds. Those kinds of things.

Whitney Lowe:

Exactly. And there is some evidence for both of those things being present and I think the question sometimes comes up, how much of which one of these is really relevant and pertinent. But there's some interesting things that make you really ponder and wonder about this a lot. Like the ideas that when we think of people having really tight muscles that just don't seem to be able to fully... I'm going to say the word lengthen, but it's not truly lengthening the muscle tissue, but they don't seem to be able to allow full range of motion. And you might think, "Well, this person's incredibly tight because their fascial tissues are bound down and their connective tissues are bound down. We can't elongate them." But if that person goes in for a surgical procedure under anesthesia, now all of a sudden, they've got complete free range of motion. Maybe that limitation is not fully as much on binding down of connective tissues as we might have thought. It might be a much more neurological component.

Til Luchau:

That the anesthesia-

Whitney Lowe:

But then again there's-

Til Luchau:

... thing anesthesia thing is really interesting.

Whitney Lowe:

Yeah.

Til Luchau:

You're giving the example of when someone is under anesthesia, their range of motion often increases quite a bit. Even in situations where there is a painful limitation or a barrier that's not painful, often that changes under anesthesia. Which points to the nervous system. Next episode I'm talking to Robert and he talks about some of his early research there.

Whitney Lowe:

Yeah. And I'm curious to hear where we go with that and I'm curious to hear more about your perspective too, back onto the connective tissue element, because that's something that I know is emphasized a good bit more in the structural integration community of focusing on the viscoelastic nature of connective tissue and what happens when you apply those forces to that tissue because clearly, there are studies that do indicate an increased degree of pliability of some of those consultation tissue elements when a tensile load is applied to them.

Til Luchau:

Yes. And then we'll try to keep it concise, because there's so much to say about this and we're also going to ground it in what we would actually do in practice for sure toward the end of the episode, if not all the way along.

Whitney Lowe:

Yeah, yeah. What's your take on those two aspects of connective tissue element and the neurological element? Do you sense one being more pertinent or do you view what you're doing when you look at therapeutic stretching procedure there?

Til Luchau:

You're going right for the jugular. At least, it's the hot spot. That is the hot spot in our discussions these days. Is it tissue or is it the nervous system. And of course, it's not an "or".

Whitney Lowe:

Yeah.

Til Luchau:

And it's also not quite both. That's the easy answer. We can say, "Yeah, of course there are tissue effects." Although some people say there aren't. There probably is decent evidence that at least in some cases there is. And it's not just neurological effects. They seem to be very significant also and there's good evidence for those as well. But there's times when... I had for myself and the reason I got interested in your question was when, as a practitioner, do I think about the tissue and when do I think about the nervous system? When do I think about sensation and when do I think about the stuff we're made out of? When am I my technician, mechanic role and when am I my facilitator, psychologist listener role? When do I shift those hats back and forth in my work and what do we know and what can we say about stretching that is accurate and what are the debates where we're not quite sure yet?

Whitney Lowe:

Yeah. And for me, this is one of those places where... and again, you and I both come back to our home bases often and look at things through a particular lens of our backgrounds and training and interest and that kind of thing. And for me, a lot of this goes back to the idea of the importance of assessment in evaluating what do I really think is the primary nature of this kind of problem, because there are clearly types of problems where there is limited range of motion. You take something like adhesive capsulitis. When there is a true myofascial adhesion within the capsule, it may have some neurological components to it, but even under anesthesia, that capsule limitation to range is still present there. And that's a pretty clear mechanical viscoelastic limitation in the capability of range of motion in that joint.

Til Luchau:

Viscoelastic-

Whitney Lowe:

That's one where-

Til Luchau:

... or even, or even-

Whitney Lowe:

What's that?

Til Luchau:

Viscoelastic or even collagenous perhaps.

Whitney Lowe:

Yes. Right.

Til Luchau:

It could go even into more denser proteins.

Whitney Lowe:

Yes. And that seems like an intervention where the mechanical tensile loading of that tissue to try to encourage greater extensibility would be of significant benefit. That being different from something where there seems to be a limitation in range of motion that's primarily neuromuscular in its origin.

Til Luchau:

Yes. Yes. Well, again, the anesthesia thing is really interesting because turns out different types of anesthesia affect different joints differently. Depending on what they do in the nervous system. There's a way to dial that down. And then different joints in the body respond really differently too. Like the shoulder you mentioned, that changes in most cases quite a bit under anesthesia. The ankle changes very little. So there's places in the body too where structure seems to be the dominant limiter and then the nervous system or muscular control seems to be the limiter.

Til Luchau:

And then if we understand those mechanisms a little more and tease them apart, how does that inform what we do with our hands and our clients that?

Whitney Lowe:

And some other things that are interesting to look at in this perspective having to do with the way in which we can see... Oftentimes the benefits of stretching in a lot of the research studies that look at this are evaluated based on increases in range of motion of a joint. And they'll say, "Yeah, this stretching procedure either seemed to be effective or not effective because we got some improvement in range of motion at the joint." But the other thing that becomes a big question that comes up is there's all kinds of things that can see those same increases in range of motion at a joint, like breathing exercises, work on a contralateral limb, work on other parts of the body and also can produce changes in range of motion at a particular joint. That is something that seems to really reinforce the idea that maybe there's a lot more to this than just pulling on a tissue and increasing it and trying to increase its length. That lends a lot of credence to the whole neurological principle idea.

Til Luchau:

Yeah. And really very few people are saying it's one or the other. Most of us agree it's both. And then like I said, then it's the next step. When do we think about each one? What's going on in each case? How do we use because of those factors there? Is it time to dive into that? How does the tissue change do you think in stretching? What does that mean?

Whitney Lowe:

Yeah. My understanding about this, and again, this may have some degree of uncertainty around it in terms of what seems to be true. But the things that I have looked at around this seem to indicate that the plastic... We're going to call them plastic changes to connective tissue, meaning changes that you can make to a tissue because of an imposed load have a duration associated with them. It seems like when we do things like warm up myofascial tissues, do certain types of interventions with them, we can improve the connective tissue pliability, but it seems to be somewhat time dependent. Meaning, it doesn't necessarily last for a long period of time, just that alone.

Whitney Lowe:

And so, the idea that we'll necessarily make an intervention to stretch somebody, let's say in a clinic treatment and that's going to alleviate their problem may or may not be true because they may go back to the same degree of restricted motion that they had if they don't keep that area pliable, warm, moving and all those other things that allow those plastic changes to occur to the connective tissue element itself. It gets back to just that element alone. I think we are ideally trying to look at how do was enhance the capability of all of these things to work together in beneficial methods.

Til Luchau:

Okay. You're saying what we've been saying for a while, that the tissue itself probably isn't as plastic as we imagined it? Plastic meaning changes permanently or at least in a longer duration sense after we do an intervention. There is short term change and then the question is how... You mentioned some things people can do to make those changes persist or integrate those changes. There's debate there about whether the persistence is actually learning or actual tissue change too? The argument that actually the best hope we have for lasting change is the neurological learning of new movement patterns and learning to move anyway as opposed to trying to remold someone like clay and expect that to persist.

Whitney Lowe:

Yeah. And some of the other questions that come up that I think in debate clinically a great deal and we'll touch base on this maybe a little bit more in detail after our halftime sponsor message here in just a moment, but I'd like to look at this issue to, because we hear this a lot. What's the ideal type of stretching? There is a lot of debate about should it be 20 seconds? Should it be two seconds? Should it be three minutes? There's a lot of debate in some of the research literature about how long to hold a stretch for the most beneficial therapeutic outcomes there. Maybe we'll dive into look at that in a little bit here too and some other aspects of what happens during some of these different stretching techniques or procedures that people are commonly using.

Til Luchau:

Okay. You mentioned tissue change. How does neurological change happen? How is that a factor?

Whitney Lowe:

Well, at least the theoretical idea is that what we're doing is increasing the tissue's tolerance to... or maybe it's better spoken of as decreasing the tissue's resistance to elongation.

Til Luchau:

Okay, you're still talking about tissue now. We're not talking about neurology?

Whitney Lowe:

Well, in terms of the neurolo- let's say a muscle. Let's take a muscle as an example. What we're trying to do with the neurological aspects of stretching is a muscle has a certain resistance to lengthening. This is what happens when the Golgi tendon organs set off the stretch reflex, because it's responding to whether or not that muscle is lengthening too rapidly, which would be and indication like it's going to potentially tear and get damaged if it lengthens too fast and keep going. Or if it's pulled too far, like you keep stretching it and stretching it and stretching it and stretching it. At a certain point, the muscle says, "Hey, you keep doing this and this is going to damage this tissue." We have a resistance, a neuromuscular resistance to that process which kicks off a reactive muscle contraction. That's one of the major roles of those protective proprioceptive cells.

Whitney Lowe:

A lot of the idea is what happens neurologically is we're changing the way that neurological protective response is reporting or mediating our ability to move a muscle through a range of motion without it sensing danger or restriction to it. Does that seem to make sense?

Til Luchau:

It does. And I don't want to get too caught up in the semantics at all. You made that point in your notes that you sent earlier over. Some of this is semantic, but it's changing our narrative where we're thinking one, the actual tissue qualities on a say, a histological level or even down to the cells and fibroblasts and fluids, what they're doing, you've zoomed out a bit and you're talking about the muscles sensing and the muscle protecting, but I think you mean the brain is sensing and the brain is protecting.

Whitney Lowe:

Yes. The brain interpreting all of this mass of sensory information that's coming into it from the proprioceptors. Yes, in terms of semantic accuracy, yeah. Definitely.

Til Luchau:

All right. In one sense, there's tissue effects down at the cell and histological level. On the other sense, there's neurological control of movement and protection that happens through the nervous system which involves the brain and spinal cord and reflexes.

Whitney Lowe:

Yeah.

Til Luchau:

Okay. And the question then, when does stretching change histological factor to tissue changes? When does it change our neurological factors and how do we leverage both of those?

Whitney Lowe:

Yeah. And we'll take a break here for our halftime sponsor. But I just want to put this little quick plug in before we do that, of I heard a great quote from a colleague. This is from my colleague and friend, Benny Vaughn, who said this many years ago when we were talking about what is the best type of stretching for somebody to do to get benefit and he said, "The best type of stretching for somebody to do is what they're going to do." And so a lot of it may eventually come back to that. What are they actually going to do? Some people don't like long, static stretching because it's boring and it's not interesting. They like to do ballistic movement oriented stretching. Some people like the meditative, quiet, yoga-type of long holding posture. The point is, what are you going to do that's really going to be a repeated intervention that's going to have a benefit for you?

Til Luchau:

The doing it seems to be the most significant factor.

Whitney Lowe:

Yeah. I think when it all comes down to at the end of the day, that's probably where the rubber hits the road finally.

Til Luchau:

All right. Should we do our halftime spot?

Whitney Lowe:

Let's do. Yeah.

Til Luchau:

That is me again.

Whitney Lowe:

Yeah.

Til Luchau:

All right. Today, it's Handspring Publishing. When I was looking for a publisher for the book I wanted to write, I was lucky enough to have two offers, one from a huge, international media company and the other from Handspring, a small publisher in Scotland, run by four great people. And I'm really glad I chose them. I went with my gut and chose them as not only did they help me make the books I wanted to, the Advance Myofascial Technique series, but their catalog has emerged as one of the leading collections of professional level books written especially for body workers, movement teachers and all professionals who use movement or touch to help patients achieve wellness.

Whitney Lowe:

Yes. Certainly Handspring has done a great job of expanding those offerings for the movement and manual therapy professions and their author list reads like a who's who for many of the leading thinkers in our fields. Head on over to their website at handspringpublishing.com and that's where you can browse their outstanding catalog over there. And once you find any of the gems and the great books in there, you have to lave Til's book which is over there. Also, just put a shout out for Jules Mitchell's book that we announced or made reference to earlier today. That is published by Handspring as well. You can use the code TTP at checkout for a discount. Thanks again Handspring for sponsoring our episode here.

Til Luchau:

Yeah, we'll put that link and the name of her book in the show notes as well.

Whitney Lowe:

Yeah, good. Til, I want to ask you a question about going off on a slightly different direction here when we talk about stretching, because this is something else that she had mentioned in her book and it's a concept that we hear a great deal in the manual therapy world. And that's the idea of muscles being over stretched from let's say, a postural position. You have the classic upper thoracic kyphotic position, forward rolled shoulders and people look at this in their analysis and body reading position and say, "Oh that person has short and tight pecs and they have weak and over-lengthened rhomboids," so we need to work on those pecs, but don't stretch their rhomboids, because they're already over-stretched and over-lengthened. What's your take on that perspective based on the ideas of stretching physiology?

Til Luchau:

Based on stretching physiology and based on stretch tolerance, based on both of those and then based on my own questioning, it's not a model I use, is the short story. It's an interesting model. There is some therapeutic usefulness in it as a narrative. Let's strengthen where it's long, let's stretch where it's short. But I doubt... My own opinion, I doubt that those are literally or at least universally the case, that wherever we see a shape in the body like say, upper crossed syndrome, a position or shape, that we assume the tissues are either weak or strong, or over-stretched or under-stretched. And often, when you get in there and finally work on people, you realize, "Oh, this is supposed to be the tight zone and doesn't feel tight to me."

Til Luchau:

We went into that some with scoliosis too, where we predict to have tight tissue. If you go into bowstring model of tissue stretching, it's often not. And you've put some great notes there in your brainstorm before...

Whitney Lowe:

Yeah. Because the idea when we think about muscles, oftentimes it's said while these muscles that are short and tight are over strong and that's made the ones on the opposite side weak. But, one of the points that I came across in discussions about this was that muscles don't gain strength by being in a shortened position for prolonged periods. They gain strength by being loaded and they're not necessarily loaded to a higher degree by being in that shortened position.

Til Luchau:

Isn't that interesting? Our basic premise that the body is bowed or bent or curved or hunched in way because of a short, tight muscle depends on that muscle being loaded and wait a minute. It's not being loaded you're saying a lot of these cases.

Whitney Lowe:

Yeah. Right. The idea is that is may be shortened, but it doesn't necessarily mean those muscles are over strong and causing the opposing muscle to be weakened. Because for example, just because a muscle is, I used the word lengthened, it's not truly necessarily over-lengthened, but because there's a greater apparent holding length, let's say, to those muscles on the upper thoracic region in the posterior part of the thoracic area like the rhomboids or whatever in a forward rolled shoulder example, doesn't necessarily mean-

Til Luchau:

Yeah, I'm doing that right now.

Whitney Lowe:

Yeah.

Til Luchau:

I'm doing that right now on my computer as I'm talking to you. I'm hunched over a little bit and my back is being stretched and my front is being loaded? That's a question. That's a bit of a sarcastic emoji on that question too.

Whitney Lowe:

Yeah. Sure. And that certainly doesn't mean that your back muscles are weak. Just because you have a muscle that is able to go through long periods of lengthened position does not necessarily mean it's weak. Because certainly if that were true, then gymnasts and ballet dancers and everybody else with these very significant ranges of mother would be weak. And they're not. Clearly.

Til Luchau:

And you asked how I think about it. Just briefly, like I said, I don't use that map. I understand its value as a map and I wouldn't object to other people using it if they found it useful, because I believe in maps. Let's put it that way. But for myself, I'm thinking about let's say how aware am I? How much can I sense and how much can I find move in those areas as opposed to the passive stretchability or even actively trying to stretch them out. Except the stretching perhaps. I probably tend, I think in my interventions, to think more about lets change the way the brain feels those places and so controls posture and things like that as opposed to remodeling the clay that we're made out of.

Whitney Lowe:

And that's a great point that you bring up there too. Because I think a lot of times a lot of the great benefit of what we're doing is proprioceptive awareness and interoceptive awareness from an individual about how do I feel in my body to be able to change how I'm holding myself, moving myself, being in different positions. That's what we're really trying to aim at is to change their overall perception of how they feel so that makes them move differently and that really is at the core of what makes those changes long lasting as opposed to we're going to go in and make an intervention and do some to them, that way.

Til Luchau:

Yes, thank you. That's right.

Whitney Lowe:

Yeah.

Til Luchau:

Well, there's four different things I could ask you about. Davis's law, ballistic stretching, pandiculation and post isometric relaxation. Which one of those do you want to pick? We probably have time at least for one or two of those.

Whitney Lowe:

Yeah. Let me tackle a couple things that I wanted to mention about this, maybe go in a little bit of a reverse order here. Because some of the stretching research that had been reading really made me revisit some of the theoretical models that I had ascribed to for many years. And this gets into our discussion of misunderstandings that we talked about earlier as well. And that's the whole idea of the post isometric relaxation. That's a big part of procedures such as muscle energy technique, PNF or whatever you want to call it. Facilitated stretching going by lots of different names. But lots of people use this as a technique.

Til Luchau:

Can you say, sorry, briefly what that, for people who don't do that or don't know what you mean by post isometric relaxation?

Whitney Lowe:

Yeah. Absolutely.

Til Luchau:

Can you give a quick example?

Whitney Lowe:

Yeah. Going into that, the idea is in many of these stretching procedures, you engage your client in a contraction. Hold that contraction, so it's a resisted contraction. Let's say you're trying to stretch somebody's posterior cervical neck muscles, you'd have them attempt to push their head back against a resistance, using those muscles. Hold it for a certain period of time. And again, the time frame is somewhat limited or dependent on whose theory you subscribe to. But then they relax that contraction and then you stretch them by tilting their head forward in cervical flexion.

Whitney Lowe:

The idea behind this for years had been that there is a greater degree of rebound relaxation in that muscle immediately after the isometric contraction. In that rebound period, we stretch them and are able to get a better stretch on there.

Til Luchau:

And maybe the model, this is probably over simplified, by doing an isometric, we are increasing the passive range of the muscle so we can stretch its stuff more. I wonder if that's the background paradigm there.

Whitney Lowe:

Yeah. The thing that always bothered me the most about this was I couldn't ever really find good supporting research for the idea of how long is that period of the post isometric relaxation and why does that allow are a greater degree of stretch after that. And some more of the things that have come out in some of the stretching research recently about this whole sensory model of stretching being what we're doing oftentimes when we're stretching tissues is we are decreasing the muscles' resistance to elongation neurologically. A neurological repatterning process.

Whitney Lowe:

What I think may have actually been happening in the post isometric relaxation is in fact, we're taking a muscle near its end range and engaging in a contraction and essentially telling the brain, "Hey, contractions that this point of the range are okay." So when we let go of that contraction, we try to move a little bit farther in that direction, the brain still perceives this as something that's relatively okay.

Whitney Lowe:

And in Jules' book, she talks a good bit about something called resistance stretching. And I hadn't heard a whole lot about this, but it really began to make a great deal of sense to me and I started working with it a lot and doing a bunch of this stuff and found it actually really effective. And that is essentially engaging in long, slow, eccentric actions of a muscle for this stretching procedure. Essentially, take that same example we used a moment ago about the cervical muscles. What you would do is instead put your hand back behind the client's head, tell them to offer you some resistance and tell them to now slowly let that go as you tilt their head forward down into flexion, moving all the way through that range of motion in an eccentric action. And basically what you're doing is gradually telling the muscle and the brain, "Hey, this range is okay. Hey, this range is okay. Hey, this range is okay."

Whitney Lowe:

Because we still have a muscle contraction engaged to protect it going all the way through to the far end of that range and essentially we're telling the body all the way through there, this is really all okay. This is still okay all the way through there. And that type of stretching procedure seems to get some really good results and it's also one of the things that I've seen incorporated, I've been doing this with active engagement massage techniques, where we're massaging those muscles at the same time that we're doing that eccentric action with them. And I think that's one of the reasons that particular technique seems to be so effective as well.

Til Luchau:

Fascinating. I know there's been a lot of tendon recovery research, inflammation research on eccentric exercise, exercises that take the muscle through that eccentric load. You're describing a massage application of that. You say you were showing the body it's okay to lengthen and to have control during that process.

Whitney Lowe:

Yeah, yeah.

Til Luchau:

I like it.

Whitney Lowe:

And you just mentioned something too that I wanted to get back to because you had said that in some of your earlier notes when we were talking about this prior to the show. Because I wasn't as clear about this and hadn't seen as much about this, this is the role of stretching in inflammation reduction. Because you had called attention to some studies that had done that. Can you speak about that a little bit?

Til Luchau:

Yeah. There's mixed evidence, evidence from both sides of the argument. The old argument says, "Don't stretch if you injury it because it needs to heal." And there's pretty good in both clinical experience and evidence that if you stretch too much something that's hurt, it does take longer to heal. You keep the collagen from doing its job and reforming tissues in the acute phase. Jules Mitchell said don't stretch an acute injury for four to six weeks because the collagen's not ready. And that sounds like a good, safe bet. Or she says even one to two years for a strongest stretching on say a ankle injury that often takes a year, severe ankle injury, taking a year or two to really recover. And during that time, the collagens actually knitting and the argument is we don't want to be mechanically over stretching that as the knitting process is happening.

Whitney Lowe:

Let me pause there for just a moment-

Til Luchau:

Sure.

Whitney Lowe:

... and ask you this, because this gets into what we talked about with Davis's law which is Davis's law is a corollary to Wolff's law that relates to bone tissue and then Davis's law says essentially soft tissues will adapt in response to the loads applied to them. How does that jibe with what you're talking about. Maybe is there any benefit in a healing stage of stretching or loading those tissues, let's say, within safe parameters to increase that tissue's adaptability to managing loads.

Til Luchau:

Well, that's what... some of those are just born law breakers. I don't know about Wolff's law and Davis. Those of us who are experimenting with this and including Helene Langevin, her research says that, and again, this is in rats in her work. She did a project where she was stretching the rats for 10 minutes twice daily and it reduced inflammatory markers and improved pro resolution factors. It was a gentle stretch. The rats were just holding onto something and she's gently lifting them up by their tail and they gave signs of enjoying it. Things like that. She gave them a gentle stretch for 10 minutes and then they had reduced inflammatory markers in their tissues and there seemed to be better tissue healing too along the way.

Til Luchau:

A lot of it probably... And then other studies, I'll put them in the show notes, about stronger wound repair and smaller scarring if modeled myofascial release. These were actually tendon culture studies, both of these, where they grew some tendons and then applied different kinds of stretch to the tendons after wounding it and watched to see how the tendon tissue itself healed. And in both these studies, the ones that had a mild stretch healed better, healed quicker and healed stronger than the ones that had no stretch or the ones that had too much stretch. The moral probably is it's the Goldilocks effect. It's dose dependent. Some movement for sure is good, but even some stretching during the acute phase in certain cases. I wouldn't say, "Now go stretch every ankle twist you get," but I'm going to say there's a role, perhaps, in acute injury for gentle dosed careful stretching in people that are otherwise healthy.

Whitney Lowe:

Yeah. And another thing too that I'd come across in this stretching debate and this was over the last several years have been quite a good number of studies that have come out that have semi debunked the common sense wisdom that had been expounded for so long that you should be stretching before doing vigorous physical actually because stretching reduces injuries. And at least the clinical research on this has not really supported that idea really well. Again, I'm not necessarily going to say that's not true or therefore we shouldn't do stretching because I certainly do think there is instances where that can still be helpful and we got to be careful about interpreting a lot of the stuff that's done in the clinical lab experiment to how it applies to real life.

Whitney Lowe:

But that is something that comes up with at least our clinical applications with people to know that stretching from a therapeutic perspective certainly does have benefits. But there's not necessarily a guarantee that a person needs to be doing all kinds of stretching in order to... like if you don't stretch, you're going to get injured. We don't necessarily, we can't make that kind of blanket statement in a lot of instances.

Til Luchau:

That's right. And yet warming up, that's pretty widely accepted in sports conditioning field. But also what's pretty widely accepted is there does need to be some sort of preparation or easing into things. And Jules Mitchell's statement, she was actually working on getting less flexible. She wants more control and so she was doing poses and exercises that would help her actually strengthen along the whole range, kind of like you were describing in your pushing the head forward contraction.

Til Luchau:

She had a great story too about the Toronto Airport. Did you see that one in her book?

Whitney Lowe:

I saw you make a reference to that and I didn't know the whole story. Can you elaborate what that was in there?

Til Luchau:

Again, the example she gave in her book was that the Toronto Airport moved the baggage claim facility farther away from the international arrival gates so that people would walk farther before they were actually hoisting their heavy bags off of the belt, because there was a big incidence of back injuries. And their incidence of back injuries went down after they did that. After people walked and, because they warmed up or at least changed their connective tissue properties or change the way the brain was relating to that, they had fewer back injuries.

Whitney Lowe:

Yeah. I thought that was interesting. I'd be curious to know was there really biomechanical analysis that led to this decision. This is a perfect example of "Hey, we got to be a little bit careful about how we interpret this," because maybe it's that there was more bathrooms between the plane and the luggage thing now and they did, its more about taking time to move around different ways and go to the bathroom or do whatever it is. They got a sandwich before they

Til Luchau:

Probably the perfume shops. Walking by the perfume shops, you get that big whiff of perfume that helps your back.

Whitney Lowe:

That's right. Could be all kinds of things like that. Yeah. And there was something I was going to ask about this right before we got on the Toronto Airport thing and now I lost my train of thought of where we were going with that. It was something back to clinical applications of our stretching here.

Til Luchau:

Was could talk about now... There's a couple more points there we could hit. Do you want to say anything about ballistic stretching? Do you want to say anything about that or should we...

Whitney Lowe:

Yeah.

Til Luchau:

Yeah, go for it.

Whitney Lowe:

Again, it's back to stretching methodologies. Ballistic stretching is that rapid bouncing stretching procedure really got a lot of bad rap a couple decades ago and some people have come back and said, "Well, maybe it's not so bad." I think there's instances where it's not so beneficial because it does tend to stimulate some kinds of neurological activities. But the other thing is, certain types of stretching, I really do believe can take advantage of some of these either neurological or connective tissue facets a little bit more than others and then again, might be more applicable in certain types of situations.

Whitney Lowe:

For example, when you have something that seems to be a limited range of motion, stretching methodology like what's used a lot in the active isolated stretching that Aaron Mattes popularized for many years, which is a very short duration of stretch repeated numerous times. To me, that stretching method, which has been shown to be very effective for lots of people who have utilized it, I think is getting its primary benefits because of the number of times it reinforces going into that range of motion and telling the brain and body, "Hey, this movement is okay. Back off the stretch. Hey, this movement is okay, back off the stretch. Hey, this movement is okay." You're holding that stretch for repeated bouts for short durations, but it's the number of reinforcements of telling the body this movement is okay that really is beneficial.

Whitney Lowe:

But again, it gets into what really works well into the type of things that you're doing. And sometimes a long, slow held stretch just feels great in the midst of a treatment process as well.

Til Luchau:

That's great. And you could say there's a tissue explanation for that phenomenon and there could be a learning explanation for that phenomenon. As we know, repetition helps learning stick better. Are we easing into the tissue effects or are we embedding, facilitating those learning pathways that happen in the brain ?

Whitney Lowe:

Yeah, yeah. I think that's some of our big questions. And I don't think there was absolutely answers to a lot of this stuff. I think there's some instances where it's, hey it's really helpful for us to think about what's the primary nature of what's going on here and how might this stretching intervention be used most effectively along with what we're doing. That's the takeaway that I get from a lot of this stuff is really think a little bit more physiologically about what's happening and what type of situations are unique to this particular climate that would lead me to do one type of stretching versus another.

Til Luchau:

And then as usual, my interest is in the narrative or the story that we work from. The explanations we have for why we do what we do and what we're even feeling for. Because I think that changes them. I think about myself as just stretching tissue, I'm going to interact with people in one way, I'm going to do my work in another way. If I think about it as the other extreme, I thought if I was just learning, just the nervous system, I might be a different way. When can I mix narratives? When can I use both perspectives? When can I go back and forth according to what's presented to me and what the client wants and needs.

Whitney Lowe:

Yeah. And I thought of what I was going to mention a moment ago too. And this is going off on what you said there too is what are the unique, specialized needs of this individual client? For example, a great example of that is looking at the athletic world. If you make a blanket statement about everybody should be able, if they want to be really healthy and athletic and vigorous, they should be able to touch their toes and have this degree of extensibility of their muscles. There's a very different degree of mechanical requirement of what a defensive lineman needs to be able to do and a world class gymnast in terms of flexibility.

Whitney Lowe:

That defensive lineman may not want to have the same degree of extreme pliability of all their soft tissues in their extremities because they need greater stability for the activities of what they're doing. Same might be true in people in certain types of occupations.

Til Luchau:

Well, yeah. Where do you think body workers fall in the continuum. Are they more like defensive lineman or more like gymnasts?

Whitney Lowe:

I think it depends on your style of body work.

Til Luchau:

That's right.

Whitney Lowe:

Right. And who we're working with and what we're doing there. Again, that's why you want to become The Thinking Practitioner. That's why you want to be thinking about who you're working with and don't apply the recipes and routines to everybody one single way only.

Til Luchau:

Lovely. Is there anything you want to say about how you use this information... you said a bunch of stuff already. Anything else you want to add about using this information in a session with a client? And I'll give you my thoughts too.

Whitney Lowe:

Yeah. I would just wrap up by saying from the key takeaways here being think about mainly that the aspect that these stretching procedures do have these two major components. A connective tissue component and a neurological component and there are instances when we want to be thinking about those two things interacting with each other significantly. And also back to what you were saying about the narratives and the way we talk with our clients and the way we discuss things with our clients.

Whitney Lowe:

Keep in mind because everybody is unique and an individual to stay away from some of that what we refer to as noceboic language like, "Oh my God, your traps are so tight. There's no wonder your shoulders and your neck hurts," and that kind of stuff. Those kinds of things we can try to encourage tissue elasticity and pliability, but also be really conscious and aware of the way in which we talk about the things that we feel and perceive in terms of range of motion or movement capabilities or pliability of tissue in there because sometimes people don't need to have the greatest gymnast flexibility in the world in they're just fine. Be conscious of how you're doing that with each individual.

Til Luchau:

Mm-hmm (affirmative). Those are good. Shall I give you my things I think about?

Whitney Lowe:

Yeah, tell me 

Til Luchau:

I think it's reminders for myself in a training situation, reminders from the students, but I think it's really that I try not to assume that tissue length or range of motion length or length of a particular structure is the only or the main goal of my work. Historically, that's been a big focus in some styles of manual therapy and we're pretty good at getting length changes, whether that's tissue or brain stretch tolerance or histology. Who knows? Often both. But strategically, I don't want to assume that's my only or main goal. That's not always the most helpful one.

Til Luchau:

I make my clients sensation primary. I want to know what they're feeling and what it feels like to them and how it is for them. I keep their attention on that too as I work. Along with what I find in my own palpation and movement interactions along with them. I am constantly thinking about tolerance. Their ability to be comfortable and safe at different places in the joints range as well as any plastic remodeling of the tissues. And low amplitude, long duration. Jules Mitchell makes that... applying things at a low level of stretch, say, or a low level of force but for longer durations also seems to make a big difference for certainly the tissue level effect, but then for the brain too. The brain can adapt to those low amplitude things better. It doesn't trigger the protective responses and perhaps the long duration actually gets us accustomed to those sensations as well.

Whitney Lowe:

Yeah, yeah. Yeah, I like that.

Til Luchau:

The last one I got there, oh, last one. Careful dosing after acute injuries. I don't want to be thinking always stretch or never stretch. I want to be good at dosing, be good at watching the feedback and doing experiments so I know how much of a particular technique and how long to apply and how frequently to apply it given my client's circumstances and situation.

Whitney Lowe:

Yeah, very good suggestions, great suggestions there. Well, again, we could probably rap on this for quite a bit longer, lots of other things that we'll dive into and likelihood is a reason for us to revisit this topic a little bit farther down the road as well. But we'll cap that for our discussion here today. I will say a big thank you to... I enjoyed the discussion here on stretching, so hopefully that was helpful for everybody else.

Til Luchau:

Yes.

Whitney Lowe:

Big thank you to our sponsors for this particular episode and reminder that you can stop by our site for specific show notes, CE credit updates and other extras that are over there. That is at thethinkingpractitioner.com. And you can also find out more information about Til and the things that you're doing there. Til, where can people learn more about what you're doing there?

Til Luchau:

advanced-trainings.com. The show notes are there as well and things about what we do. How about yours Whitney? I know the show notes are on your site too.

Whitney Lowe:

Also over there, yeah. You can find out about courses, other types of things that we have going on at the academyofclinicalmassage.com.

Til Luchau:

Or social media.

Whitney Lowe:

Yep, social media stuff under my name or also Academy of Clinical Massage and you're over on social where ?

Til Luchau:

Just my name, Til Luchau, @ Til Luchau wherever you are. You'll find me there.

Whitney Lowe:

Yeah. Sounds great. And reminder too, if you've got questions or input or anything that you want to send over to us, you can email us a info@thethinkingpractitioner.com and if you will also please remember to rate us on Apple Podcast or wherever else you're listening to your podcasts. It really does help everyone else be able to find us over there. We certainly do appreciate that.

Whitney Lowe:

Big thank you, also shout out to all of our listeners and the people who support the podcast so far. We really hope this discussion gives you some interesting things to ponder about in your own practice.

Til Luchau:

Fun doing this with you, Whitney. Thank you.

Whitney Lowe:

Sounds good and we'll see you all again in two weeks.

 

Til Luchau:

Thanks to Andrew Biel and Books of Discovery for their support and be sure to check out their great offer. Hey Whitney, how's it going?

Whitney Lowe:

Going well today. How are you doing?

Til Luchau:

I'm excellent. Been traveling a bunch and at home now and that's always pleasant.

Whitney Lowe:

Yeah, how were your trips?

Til Luchau:

Really fun. Really fun.

Whitney Lowe:

Good.

Til Luchau:

It was the triple whammy at Google and we stayed busy, but it was just a whole lot of fun to be seeing what they're up to and to be going from coast to coast and to get the juxtaposition of the different subcultures that we have in this big country we're in.

Whitney Lowe:

And tell me about briefly the triple whammy. That was three cities. It was New York, Mountain View and...

Til Luchau:

Seattle.

Whitney Lowe:

... Seattle, is that right?

Til Luchau:

Mm-hmm (affirmative).

Whitney Lowe:

Uh-huh (affirmative).

Til Luchau:

That's right.

Whitney Lowe:

Yeah. You we're at the big Google headquarters or Google locations at each one of those major cities then. Is that right?

Til Luchau:

That's right. Working with their in-house therapists and pretty high level of skill. Pretty high level of motivation and of course, they work in a unique environment, so those were all really fun things to visit and be a part of.

Whitney Lowe:

Yeah. It is really fascinating to see the way that they're doing things within the company with the services that they offer. And I think it's a great example of how this can be used in so many different ways there. And it's really cool.

Til Luchau:

They were remembering you fondly. I know you went and spent some time there and you made an impression left them some lasting things too, so it was fun to follow in your footsteps.

Whitney Lowe:

Yeah, all right. Good, good. Well, good, we got some-

Til Luchau:

What do you want to-

Whitney Lowe:

... interesting things-

Til Luchau:

You want to jump into our topic? Where do you want to go?

Whitney Lowe:

Yeah, I think let's hop into what we're doing today. And I think we had on our topic today is stretching if I'm thinking correctly. Is that right?

Til Luchau:

That's right. Stretching.

Whitney Lowe:

Yeah.

Til Luchau:

You had that proposal. I remember it started when you read Jules Mitchell's book and we'll talk about that, but then I think it expanded out from there. Maybe you could give us a little context. Why would stretching be interesting to manual therapist and massage and body workers and why did you want to discuss it here.

Whitney Lowe:

Yeah. As you mentioned, I wanted to give just a quick shout out. A lot of my recent interest in some of these topics had come about after I had read Jules Mitchell's recent book called Yoga Biomechanics, which I really strongly advocate everybody take a look at. Especially for those who are in the manual therapy world. It's not just about yoga, but about things that are pertinent to anybody who's involved in these types of manual therapy approaches like what we're doing. But her book is a compendium of a lot of the recent research on stretching and it helps dispel a lot of myths and misperceptions about stretching. And that's one of the things that really caught my attention a great deal is that there do seem to be a fair number of misperceptions and misunderstandings about stretching. So that's one of the things I thought we might talk about a little bit today because I hear a lot of those things bandied about in our profession and in lots of people who are doing all types of manual therapy approaches quite a bit. I thought there'd be some interesting things for us to dive into a little bit there.

Til Luchau:

You bet. Yeah, I also really enjoyed her book, two thumbs up on that one. Myths and misperceptions. That's fascinating. Okay.

Whitney Lowe:

Yeah.

Til Luchau:

That's almost tempting to dive into right there, but I'm wondering if we should step back a little bit and well, is there another bigger picture question that's raised for you? Is it just myths and misperception or is there another picture there?

Whitney Lowe:

Well, no. I think you're right. We should, really, to get into this, we want to talk about some of the other fundamental facets of stretching that I think are sometimes either taken for granted or maybe not even recognized thoroughly and look at some of those things first and that's how probably we'll get into some of these myths and misperceptions.

Whitney Lowe:

But one of the things that come to mind for me in looking at this topic of stretching is when we try to think about what actually happens when we are stretching. And lots of us give our clients suggestions about "Hey, you should do these stretches." Or we hear people talking about like, "You should stretch this as part of your rehab," or something like that. It is something that is advocated quite a lot by people who are in our field. And I think sometimes it's advocated without a really good physiological understanding of what happens to tissues in the process of stretching. And that whole understanding is really evolving a great deal. I don't think we really have a definitive understanding yet of exactly what happens in many instances here.

Whitney Lowe:

One of the things that I zero in on is when I think about stretching, there really seems to be two key elements of a stretching procedure. One of those is the connective tissue element, meaning what happens to the myofascia and the connective tissues of... and again, we're speaking about stretching mostly in terms of musculotendinous units here. When we talk about stretching, there's something happening to the connective tissues that are absorbing the tensile load of the pulling process from a stretching procedure. There is also-

Til Luchau:

Okay, you're saying, let me see if I follow so far. You're saying when we stretch, either when I stretch myself or when I stretch my client, we're mechanically loading the tissues.

Whitney Lowe:

Yeah.

Til Luchau:

The musculotendon unit you said.

Whitney Lowe:

Yeah. And also in thinking biomechanically, there's something that some people don't really think about as well, which is that in muscle contraction, tendons are getting loaded with tensile load. They're getting pulled just the same way they are during a stretching procedure, but obviously with a lot more force during a muscle contraction.

Til Luchau:

Aha.

Whitney Lowe:

During stretching procedures, muscle and tendon both get a tensile load, but during muscle contractions, whether they're isometric, eccentric or concentric contractions... Did I say concentric?

Til Luchau:

Yeah.

Whitney Lowe:

Three. There's concentric, eccentric and isometric. Regardless of the type of muscle contraction, the tendon is getting a tensile or pulling load in all of those instances. When we talk about stretching, we're usually talking about what happens to the muscle tissue or the myofascial tissue. So, yeah. There's something happening to the connective tissue elements, all of those layers of fascial tissue that surround individual muscle fibers, the bundles and the whole muscle itself. They're getting a tensile load. That is the connective tissue element.

Til Luchau:

Okay.

Whitney Lowe:

And then there is a neurological element to that, which is that the muscles, when they get a stimulus to contract, there is the overlapping of the actin and myosin fibrils in there that causes the muscle contraction process to occur and neurologically when we are stretching in many instances, at least this is the theory, that we are decreasing the neurological resistance to that muscle being able to... I hesitate to say the word elongate, because we're going to get into that little bit there about what actually do muscles truly elongate. Because that's another big question. So let's just say neurologically, there's some other things going on in a stretching procedure that makes that muscle be able to have a greater range of motion.

Til Luchau:

Okay. Is your interest in the debate about is it neurological or is it tissue?

Whitney Lowe:

Well, that's something that in reading a lot of this recent research and some of the things that Jules Mitchell had put in her book that was highlighting, there seemed to be these two competing theories. One being a mechanical theory that yes, we are stretching and elongating tissues when we do stretching. And the other being one predominantly a sensory of neurological theory saying the majority of this is really happening from neurological responses to the procedure that we're doing that's decreasing the neurological actually in there. And there is a force of-

Til Luchau:

So, we're stretching the, the question then, are we stretching fascia, myofascia or are we stretching our brain and our sensate thresholds. Those kinds of things.

Whitney Lowe:

Exactly. And there is some evidence for both of those things being present and I think the question sometimes comes up, how much of which one of these is really relevant and pertinent. But there's some interesting things that make you really ponder and wonder about this a lot. Like the ideas that when we think of people having really tight muscles that just don't seem to be able to fully... I'm going to say the word lengthen, but it's not truly lengthening the muscle tissue, but they don't seem to be able to allow full range of motion. And you might think, "Well, this person's incredibly tight because their fascial tissues are bound down and their connective tissues are bound down. We can't elongate them." But if that person goes in for a surgical procedure under anesthesia, now all of a sudden, they've got complete free range of motion. Maybe that limitation is not fully as much on binding down of connective tissues as we might have thought. It might be a much more neurological component.

Til Luchau:

That the anesthesia-

Whitney Lowe:

But then again there's-

Til Luchau:

... thing anesthesia thing is really interesting.

Whitney Lowe:

Yeah.

Til Luchau:

You're giving the example of when someone is under anesthesia, their range of motion often increases quite a bit. Even in situations where there is a painful limitation or a barrier that's not painful, often that changes under anesthesia. Which points to the nervous system. Next episode I'm talking to Robert and he talks about some of his early research there.

Whitney Lowe:

Yeah. And I'm curious to hear where we go with that and I'm curious to hear more about your perspective too, back onto the connective tissue element, because that's something that I know is emphasized a good bit more in the structural integration community of focusing on the viscoelastic nature of connective tissue and what happens when you apply those forces to that tissue because clearly, there are studies that do indicate an increased degree of pliability of some of those consultation tissue elements when a tensile load is applied to them.

Til Luchau:

Yes. And then we'll try to keep it concise, because there's so much to say about this and we're also going to ground it in what we would actually do in practice for sure toward the end of the episode, if not all the way along.

Whitney Lowe:

Yeah, yeah. What's your take on those two aspects of connective tissue element and the neurological element? Do you sense one being more pertinent or do you view what you're doing when you look at therapeutic stretching procedure there?

Til Luchau:

You're going right for the jugular. At least, it's the hot spot. That is the hot spot in our discussions these days. Is it tissue or is it the nervous system. And of course, it's not an "or".

Whitney Lowe:

Yeah.

Til Luchau:

And it's also not quite both. That's the easy answer. We can say, "Yeah, of course there are tissue effects." Although some people say there aren't. There probably is decent evidence that at least in some cases there is. And it's not just neurological effects. They seem to be very significant also and there's good evidence for those as well. But there's times when... I had for myself and the reason I got interested in your question was when, as a practitioner, do I think about the tissue and when do I think about the nervous system? When do I think about sensation and when do I think about the stuff we're made out of? When am I my technician, mechanic role and when am I my facilitator, psychologist listener role? When do I shift those hats back and forth in my work and what do we know and what can we say about stretching that is accurate and what are the debates where we're not quite sure yet?

Whitney Lowe:

Yeah. And for me, this is one of those places where... and again, you and I both come back to our home bases often and look at things through a particular lens of our backgrounds and training and interest and that kind of thing. And for me, a lot of this goes back to the idea of the importance of assessment in evaluating what do I really think is the primary nature of this kind of problem, because there are clearly types of problems where there is limited range of motion. You take something like adhesive capsulitis. When there is a true myofascial adhesion within the capsule, it may have some neurological components to it, but even under anesthesia, that capsule limitation to range is still present there. And that's a pretty clear mechanical viscoelastic limitation in the capability of range of motion in that joint.

Til Luchau:

Viscoelastic-

Whitney Lowe:

That's one where-

Til Luchau:

... or even, or even-

Whitney Lowe:

What's that?

Til Luchau:

Viscoelastic or even collagenous perhaps.

Whitney Lowe:

Yes. Right.

Til Luchau:

It could go even into more denser proteins.

Whitney Lowe:

Yes. And that seems like an intervention where the mechanical tensile loading of that tissue to try to encourage greater extensibility would be of significant benefit. That being different from something where there seems to be a limitation in range of motion that's primarily neuromuscular in its origin.

Til Luchau:

Yes. Yes. Well, again, the anesthesia thing is really interesting because turns out different types of anesthesia affect different joints differently. Depending on what they do in the nervous system. There's a way to dial that down. And then different joints in the body respond really differently too. Like the shoulder you mentioned, that changes in most cases quite a bit under anesthesia. The ankle changes very little. So there's places in the body too where structure seems to be the dominant limiter and then the nervous system or muscular control seems to be the limiter.

Til Luchau:

And then if we understand those mechanisms a little more and tease them apart, how does that inform what we do with our hands and our clients that?

Whitney Lowe:

And some other things that are interesting to look at in this perspective having to do with the way in which we can see... Oftentimes the benefits of stretching in a lot of the research studies that look at this are evaluated based on increases in range of motion of a joint. And they'll say, "Yeah, this stretching procedure either seemed to be effective or not effective because we got some improvement in range of motion at the joint." But the other thing that becomes a big question that comes up is there's all kinds of things that can see those same increases in range of motion at a joint, like breathing exercises, work on a contralateral limb, work on other parts of the body and also can produce changes in range of motion at a particular joint. That is something that seems to really reinforce the idea that maybe there's a lot more to this than just pulling on a tissue and increasing it and trying to increase its length. That lends a lot of credence to the whole neurological principle idea.

Til Luchau:

Yeah. And really very few people are saying it's one or the other. Most of us agree it's both. And then like I said, then it's the next step. When do we think about each one? What's going on in each case? How do we use because of those factors there? Is it time to dive into that? How does the tissue change do you think in stretching? What does that mean?

Whitney Lowe:

Yeah. My understanding about this, and again, this may have some degree of uncertainty around it in terms of what seems to be true. But the things that I have looked at around this seem to indicate that the plastic... We're going to call them plastic changes to connective tissue, meaning changes that you can make to a tissue because of an imposed load have a duration associated with them. It seems like when we do things like warm up myofascial tissues, do certain types of interventions with them, we can improve the connective tissue pliability, but it seems to be somewhat time dependent. Meaning, it doesn't necessarily last for a long period of time, just that alone.

Whitney Lowe:

And so, the idea that we'll necessarily make an intervention to stretch somebody, let's say in a clinic treatment and that's going to alleviate their problem may or may not be true because they may go back to the same degree of restricted motion that they had if they don't keep that area pliable, warm, moving and all those other things that allow those plastic changes to occur to the connective tissue element itself. It gets back to just that element alone. I think we are ideally trying to look at how do was enhance the capability of all of these things to work together in beneficial methods.

Til Luchau:

Okay. You're saying what we've been saying for a while, that the tissue itself probably isn't as plastic as we imagined it? Plastic meaning changes permanently or at least in a longer duration sense after we do an intervention. There is short term change and then the question is how... You mentioned some things people can do to make those changes persist or integrate those changes. There's debate there about whether the persistence is actually learning or actual tissue change too? The argument that actually the best hope we have for lasting change is the neurological learning of new movement patterns and learning to move anyway as opposed to trying to remold someone like clay and expect that to persist.

Whitney Lowe:

Yeah. And some of the other questions that come up that I think in debate clinically a great deal and we'll touch base on this maybe a little bit more in detail after our halftime sponsor message here in just a moment, but I'd like to look at this issue to, because we hear this a lot. What's the ideal type of stretching? There is a lot of debate about should it be 20 seconds? Should it be two seconds? Should it be three minutes? There's a lot of debate in some of the research literature about how long to hold a stretch for the most beneficial therapeutic outcomes there. Maybe we'll dive into look at that in a little bit here too and some other aspects of what happens during some of these different stretching techniques or procedures that people are commonly using.

Til Luchau:

Okay. You mentioned tissue change. How does neurological change happen? How is that a factor?

Whitney Lowe:

Well, at least the theoretical idea is that what we're doing is increasing the tissue's tolerance to... or maybe it's better spoken of as decreasing the tissue's resistance to elongation.

Til Luchau:

Okay, you're still talking about tissue now. We're not talking about neurology?

Whitney Lowe:

Well, in terms of the neurolo- let's say a muscle. Let's take a muscle as an example. What we're trying to do with the neurological aspects of stretching is a muscle has a certain resistance to lengthening. This is what happens when the Golgi tendon organs set off the stretch reflex, because it's responding to whether or not that muscle is lengthening too rapidly, which would be and indication like it's going to potentially tear and get damaged if it lengthens too fast and keep going. Or if it's pulled too far, like you keep stretching it and stretching it and stretching it and stretching it. At a certain point, the muscle says, "Hey, you keep doing this and this is going to damage this tissue." We have a resistance, a neuromuscular resistance to that process which kicks off a reactive muscle contraction. That's one of the major roles of those protective proprioceptive cells.

Whitney Lowe:

A lot of the idea is what happens neurologically is we're changing the way that neurological protective response is reporting or mediating our ability to move a muscle through a range of motion without it sensing danger or restriction to it. Does that seem to make sense?

Til Luchau:

It does. And I don't want to get too caught up in the semantics at all. You made that point in your notes that you sent earlier over. Some of this is semantic, but it's changing our narrative where we're thinking one, the actual tissue qualities on a say, a histological level or even down to the cells and fibroblasts and fluids, what they're doing, you've zoomed out a bit and you're talking about the muscles sensing and the muscle protecting, but I think you mean the brain is sensing and the brain is protecting.

Whitney Lowe:

Yes. The brain interpreting all of this mass of sensory information that's coming into it from the proprioceptors. Yes, in terms of semantic accuracy, yeah. Definitely.

Til Luchau:

All right. In one sense, there's tissue effects down at the cell and histological level. On the other sense, there's neurological control of movement and protection that happens through the nervous system which involves the brain and spinal cord and reflexes.

Whitney Lowe:

Yeah.

Til Luchau:

Okay. And the question then, when does stretching change histological factor to tissue changes? When does it change our neurological factors and how do we leverage both of those?

Whitney Lowe:

Yeah. And we'll take a break here for our halftime sponsor. But I just want to put this little quick plug in before we do that, of I heard a great quote from a colleague. This is from my colleague and friend, Benny Vaughn, who said this many years ago when we were talking about what is the best type of stretching for somebody to do to get benefit and he said, "The best type of stretching for somebody to do is what they're going to do." And so a lot of it may eventually come back to that. What are they actually going to do? Some people don't like long, static stretching because it's boring and it's not interesting. They like to do ballistic movement oriented stretching. Some people like the meditative, quiet, yoga-type of long holding posture. The point is, what are you going to do that's really going to be a repeated intervention that's going to have a benefit for you?

Til Luchau:

The doing it seems to be the most significant factor.

Whitney Lowe:

Yeah. I think when it all comes down to at the end of the day, that's probably where the rubber hits the road finally.

Til Luchau:

All right. Should we do our halftime spot?

Whitney Lowe:

Let's do. Yeah.

Til Luchau:

That is me again.

Whitney Lowe:

Yeah.

Til Luchau:

All right. Today, it's Handspring Publishing. When I was looking for a publisher for the book I wanted to write, I was lucky enough to have two offers, one from a huge, international media company and the other from Handspring, a small publisher in Scotland, run by four great people. And I'm really glad I chose them. I went with my gut and chose them as not only did they help me make the books I wanted to, the Advance Myofascial Technique series, but their catalog has emerged as one of the leading collections of professional level books written especially for body workers, movement teachers and all professionals who use movement or touch to help patients achieve wellness.

Whitney Lowe:

Yes. Certainly Handspring has done a great job of expanding those offerings for the movement and manual therapy professions and their author list reads like a who's who for many of the leading thinkers in our fields. Head on over to their website at handspringpublishing.com and that's where you can browse their outstanding catalog over there. And once you find any of the gems and the great books in there, you have to lave Til's book which is over there. Also, just put a shout out for Jules Mitchell's book that we announced or made reference to earlier today. That is published by Handspring as well. You can use the code TTP at checkout for a discount. Thanks again Handspring for sponsoring our episode here.

Til Luchau:

Yeah, we'll put that link and the name of her book in the show notes as well.

Whitney Lowe:

Yeah, good. Til, I want to ask you a question about going off on a slightly different direction here when we talk about stretching, because this is something else that she had mentioned in her book and it's a concept that we hear a great deal in the manual therapy world. And that's the idea of muscles being over stretched from let's say, a postural position. You have the classic upper thoracic kyphotic position, forward rolled shoulders and people look at this in their analysis and body reading position and say, "Oh that person has short and tight pecs and they have weak and over-lengthened rhomboids," so we need to work on those pecs, but don't stretch their rhomboids, because they're already over-stretched and over-lengthened. What's your take on that perspective based on the ideas of stretching physiology?

Til Luchau:

Based on stretching physiology and based on stretch tolerance, based on both of those and then based on my own questioning, it's not a model I use as the short story. It's an interesting model. There is some therapeutic usefulness in it as a narrative. Let's strengthen where it's long, let's stretch where it's short. But I doubt... My own opinion, in doubt that those are literally or at least universally the case, that wherever we see a shape in the body like say, upper crossed syndrome, a position or shape, that we assume the tissues are either weak or strong or over-stretched or under-stretched. And often, when you get in there and finally work on people, you realize, "Oh, this is supposed to be the tight zone and doesn't feel tight to me."

Til Luchau:

We went into that some with scoliosis too, where we predict to have tight tissue. If you go into bowstring model of tissue stretching, it's often not. And you've put some great notes there in your brainstorm before...

Whitney Lowe:

Yeah. Because the idea when we think about muscles, oftentimes it's said while these muscles that are short and tight are over strong and that's made the ones on the opposite side weak. But, one of the points that I came across in discussions about this was that muscles don't gain strength by being in a shortened position for prolonged periods. They gain strength by being loaded and they're not necessarily loaded to a higher degree by being in that shortened position.

Til Luchau:

Isn't that interesting? Our basic premise that the body is bowed or bent or curved or hunched in way because of a short, tight muscle depends on that muscle being loaded and wait a minute. It's not being loaded you're saying a lot of these cases.

Whitney Lowe:

Yeah. Right. The idea is that is may be shortened, but it doesn't necessarily mean those muscles are over strong and causing the opposing muscle to be weakened. Because for example, just because a muscle is, I used the word lengthened, it's not truly necessarily over-lengthened, but because there's a greater apparent holding length, let's say, to those muscles on the upper thoracic region in the posterior part of the thoracic area like the rhomboids or whatever in a forward rolled shoulder example, doesn't necessarily mean-

Til Luchau:

Yeah, I'm doing that right now.

Whitney Lowe:

Yeah.

Til Luchau:

I'm doing that right now on my computer as I'm talking to you. I'm hunched over a little bit and my back is being stretched and my front is being loaded? That's a question. That's a bit of a sarcastic emoji on that question too.

Whitney Lowe:

Yeah. Sure. And that certainly doesn't mean that your back muscles are weak. Just because you have a muscle that is able to go through long periods of lengthened position does not necessarily mean it's weak. Because certainly if that were true, then gymnasts and ballet dancers and everybody else with these very significant ranges of mother would be weak. And they're not. Clearly.

Til Luchau:

And you asked how I think about it. Just briefly, like I said, I don't use that map. I understand its value as a map and I wouldn't object to other people using it if they found it useful, because I believe in maps. Let's put it that way. But for myself, I'm thinking about let's say how aware am I? How much can I sense and how much can I find move in those areas as opposed to the passive stretchability or even actively trying to stretch them out. Except the stretching perhaps. I probably tend, I think in my interventions, to think more about lets change the way the brain feels those places and so controls posture and things like that as opposed to remodeling the clay that we're made out of.

Whitney Lowe:

And that's a great point that you bring up there too. Because I think a lot of times a lot of the great benefit of what we're doing is proprioceptive awareness and interoceptive awareness from an individual about how do I feel in my body to be able to change how I'm holding myself, moving myself, being in different positions. That's what we're really trying to aim at is to change their overall perception of how they feel so that makes them move differently and that really is at the core of what makes those changes long lasting as opposed to we're going to go in and make an intervention and do some to them, that way.

Til Luchau:

Yes, thank you. That's right.

Whitney Lowe:

Yeah.

Til Luchau:

Well, there's four different things I could ask you about. Davis's law, ballistic stretching, pandiculation and post isometric relaxation. Which one of those do you want to pick? We probably have time at least for one or two of those.

Whitney Lowe:

Yeah. Let me tackle a couple things that I wanted to mention about this, maybe go in a little bit of a reverse order here. Because some of the stretching research that had been reading really made me revisit some of the theoretical models that I had ascribed to for many years. And this gets into our discussion of misunderstandings that we talked about earlier as well. And that's the whole idea of the post isometric relaxation. That's a big part of procedures such as muscle energy technique, PNF or whatever you want to call it. Facilitated stretching going by lots of different names. But lots of people use this as a technique.

Til Luchau:

Can you say, sorry, briefly what that, for people who don't do that or don't know what you mean by post isometric relaxation?

Whitney Lowe:

Yeah. Absolutely.

Til Luchau:

Can you give a quick example?

Whitney Lowe:

Yeah. Going into that, the idea is in many of these stretching procedures, you engage your client in a contraction. Hold that contraction, so it's a resisted contraction. Let's say you're trying to stretch somebody's posterior cervical neck muscles, you'd have them attempt to push their head back against a resistance, using those muscles. Hold it for a certain period of time. And again, the time frame is somewhat limited or dependent on whose theory you subscribe to. But then they relax that contraction and then you stretch them by tilting their head forward in cervical flexion.

Whitney Lowe:

The idea behind this for years had been that there is a greater degree of rebound relaxation in that muscle immediately after the isometric contraction. In that rebound period, we stretch them and are able to get a better stretch on there.

Til Luchau:

And maybe the model, this is probably over simplified, by doing an isometric, we are increasing the passive range of the muscle so we can stretch its stuff more. I wonder if that's the background paradigm there.

Whitney Lowe:

Yeah. The thing that always bothered me the most about this was I couldn't ever really find good supporting research for the idea of how long is that period of the post isometric relaxation and why does that allow are a greater degree of stretch after that. And some more of the things that have come out in some of the stretching research recently about this whole sensory model of stretching being what we're doing oftentimes when we're stretching tissues is we are decreasing the muscles' resistance to elongation neurologically. A neurological repatterning process.

Whitney Lowe:

What I think may have actually been happening in the post isometric relaxation is in fact, we're taking a muscle near its end range and engaging in a contraction and essentially telling the brain, "Hey, contractions that this point of the range are okay." So when we let go of that contraction, we try to move a little bit farther in that direction, the brain still perceives this as something that's relatively okay.

Whitney Lowe:

And in Jules' book, she talks a good bit about something called resistance stretching. And I hadn't heard a whole lot about this, but it really began to make a great deal of sense to me and I started working with it a lot and doing a bunch of this stuff and found it actually really effective. And that is essentially engaging in long, slow, eccentric actions of a muscle for this stretching procedure. Essentially, take that same example we used a moment ago about the cervical muscles. What you would do is instead put your hand back behind the client's head, tell them to offer you some resistance and tell them to now slowly let that go as you tilt their head forward down into flexion, moving all the way through that range of motion in an eccentric action. And basically what you're doing is gradually telling the muscle and the brain, "Hey, this range is okay. Hey, this range is okay. Hey, this range is okay."

Whitney Lowe:

Because we still have a muscle contraction engaged to protect it going all the way through to the far end of that range and essentially we're telling the body all the way through there, this is really all okay. This is still okay all the way through there. And that type of stretching procedure seems to get some really good results and it's also one of the things that I've seen incorporated, I've been doing this with active engagement massage techniques, where we're massaging those muscles at the same time that we're doing that eccentric action with them. And I think that's one of the reasons that particular technique seems to be so effective as well.

Til Luchau:

Fascinating. I know there's been a lot of tendon recovery research, inflammation research on eccentric exercise, exercises that take the muscle through that eccentric load. You're describing a massage application of that. You say you were showing the body it's okay to lengthen and to have control during that process.

Whitney Lowe:

Yeah, yeah.

Til Luchau:

I like it.

Whitney Lowe:

And you just mentioned something too that I wanted to get back to because you had said that in some of your earlier notes when we were talking about this prior to the show. Because I wasn't as clear about this and hadn't seen as much about this, this is the role of stretching in inflammation reduction. Because you had called attention to some studies that had done that. Can you speak about that a little bit?

Til Luchau:

Yeah. There's mixed evidence, evidence from both sides of the argument. The old argument says, "Don't stretch if you injury it because it needs to heal." And there's pretty good in both clinical experience and evidence that if you stretch too much something that's hurt, it does take longer to heal. You keep the collagen from doing its job and reforming tissues in the acute phase. Jules Mitchell said don't stretch an acute injury for four to six weeks because the collagen's not ready. And that sounds like a good, safe bet. Or she says even one to two years for a strongest stretching on say a ankle injury that often takes a year, severe ankle injury, taking a year or two to really recover. And during that time, the collagens actually knitting and the argument is we don't want to be mechanically over stretching that as the knitting process is happening.

Whitney Lowe:

Let me pause there for just a moment-

Til Luchau:

Sure.

Whitney Lowe:

... and ask you this, because this gets into what we talked about with Davis's law which is Davis's law is a corollary to Wolff's law that relates to bone tissue and then Davis's law says essentially soft tissues will adapt in response to the loads applied to them. How does that jibe with what you're talking about. Maybe is there any benefit in a healing stage of stretching or loading those tissues, let's say, within safe parameters to increase that tissue's adaptability to managing loads.

Til Luchau:

Well, that's what... some of those are just born law breakers. I don't know about Wolff's law and Davis. Those of us who are experimenting with this and including Helene Langevin, her research says that, and again, this is in rats in her work. She did a project where she was stretching the rats for 10 minutes twice daily and it reduced inflammatory markers and improved pro resolution factors. It was a gentle stretch. The rats were just holding onto something and she's gently lifting them up by their tail and they gave signs of enjoying it. Things like that. She gave them a gentle stretch for 10 minutes and then they had reduced inflammatory markers in their tissues and there seemed to be better tissue healing too along the way.

Til Luchau:

A lot of it probably... And then other studies, I'll put them in the show notes, about stronger wound repair and smaller scarring if modeled myofascial release. These were actually tendon culture studies, both of these, where they grew some tendons and then applied different kinds of stretch to the tendons after wounding it and watched to see how the tendon tissue itself healed. And in both these studies, the ones that had a mild stretch healed better, healed quicker and healed stronger than the ones that had no stretch or the ones that had too much stretch. The moral probably is it's the Goldilocks effect. It's dose dependent. Some movement for sure is good, but even some stretching during the acute phase in certain cases. I wouldn't say, "Now go stretch every ankle twist you get," but I'm going to say there's a role, perhaps, in acute injury for gentle dosed careful stretching in people that are otherwise healthy.

Whitney Lowe:

Yeah. And another thing too that I'd come across in this stretching debate and this was over the last several years have been quite a good number of studies that have come out that have semi debunked the common sense wisdom that had been expounded for so long that you should be stretching before doing vigorous physical actually because stretching reduces injuries. And at least the clinical research on this has not really supported that idea really well. Again, I'm not necessarily going to say that's not true or therefore we shouldn't do stretching because I certainly do think there is instances where that can still be helpful and we got to be careful about interpreting a lot of the stuff that's done in the clinical lab experiment to how it applies to real life.

Whitney Lowe:

But that is something that comes up with at least our clinical applications with people to know that stretching from a therapeutic perspective certainly does have benefits. But there's not necessarily a guarantee that a person needs to be doing all kinds of stretching in order to... like if you don't stretch, you're going to get injured. We don't necessarily, we can't make that kind of blanket statement in a lot of instances.

Til Luchau:

That's right. And yet warming up, that's pretty widely accepted in sports conditioning field. But also what's pretty widely accepted is there does need to be some sort of preparation or easing into things. And Jules Mitchell's statement, she was actually working on getting less flexible. She wants more control and so she was doing poses and exercises that would help her actually strengthen along the whole range, kind of like you were describing in your pushing the head forward contraction.

Til Luchau:

She had a great story too about the Toronto Airport. Did you see that one in her book?

Whitney Lowe:

I saw you make a reference to that and I didn't know the whole story. Can you elaborate what that was in there?

Til Luchau:

Again, the example she gave in her book was that the Toronto Airport moved the baggage claim facility farther away from the international arrival gates so that people would walk farther before they were actually hoisting their heavy bags off of the belt, because there was a big incidence of back injuries. And their incidence of back injuries went down after they did that. After people walked and, because they warmed up or at least changed their connective tissue properties or change the way the brain was relating to that, they had fewer back injuries.

Whitney Lowe:

Yeah. I thought that was interesting. I'd be curious to know was there really biomechanical analysis that led to this decision. This is a perfect example of "Hey, we got to be a little bit careful about how we interpret this," because maybe it's that there was more bathrooms between the plane and the luggage thing now and they did, its more about taking time to move around different ways and go to the bathroom or do whatever it is. They got a sandwich before they

Til Luchau:

Probably the perfume shops. Walking by the perfume shops, you get that big whiff of perfume that helps your back.

Whitney Lowe:

That's right. Could be all kinds of things like that. Yeah. And there was something I was going to ask about this right before we got on the Toronto Airport thing and now I lost my train of thought of where we were going with that. It was something back to clinical applications of our stretching here. 

Til Luchau:

Was could talk about now... There's a couple more points there we could hit. Do you want to say anything about ballistic stretching? Do you want to say anything about that or should we...

Whitney Lowe:

Yeah.

Til Luchau:

Yeah, go for it.

Whitney Lowe:

Again, it's back to stretching methodologies. Ballistic stretching is that rapid bouncing stretching procedure really got a lot of bad rap a couple decades ago and some people have come back and said, "Well, maybe it's not so bad." I think there's instances where it's not so beneficial because it does tend to stimulate some kinds of neurological activities. But the other thing is, certain types of stretching, I really do believe can take advantage of some of these either neurological or connective tissue facets a little bit more than others and then again, might be more applicable in certain types of situations.

Whitney Lowe:

For example, when you have something that seems to be a limited range of motion, stretching methodology like what's used a lot in the active isolated stretching that Aaron Mattes popularized for many years, which is a very short duration of stretch repeated numerous times. To me, that stretching method, which has been shown to be very effective for lots of people who have utilized it, I think is getting its primary benefits because of the number of times it reinforces going into that range of motion and telling the brain and body, "Hey, this movement is okay. Back off the stretch. Hey, this movement is okay, back off the stretch. Hey, this movement is okay." You're holding that stretch for repeated bouts for short durations, but it's the number of reinforcements of telling the body this movement is okay that really is beneficial.

Whitney Lowe:

But again, it gets into what really works well into the type of things that you're doing. And sometimes a long, slow held stretch just feels great in the midst of a treatment process as well.

Til Luchau:

That's great. And you could say there's a tissue explanation for that phenomenon and there could be a learning explanation for that phenomenon. As we know, repetition helps learning stick better. Are we easing into the tissue effects or are we embedding, facilitating those learning pathways that happen in the brain ?

Whitney Lowe:

Yeah, yeah. I think that's some of our big questions. And I don't think there was absolutely answers to a lot of this stuff. I think there's some instances where it's, hey it's really helpful for us to think about what's the primary nature of what's going on here and how might this stretching intervention be used most effectively along with what we're doing. That's the takeaway that I get from a lot of this stuff is really think a little bit more physiologically about what's happening and what type of situations are unique to this particular climate that would lead me to do one type of stretching versus another.

Til Luchau:

And then as usual, my interest is in the narrative or the story that we work from. The explanations we have for why we do what we do and what we're even feeling for. Because I think that changes them. I think about myself as just stretching tissue, I'm going to interact with people in one way, I'm going to do my work in another way. If I think about it as the other extreme, I thought if I was just learning, just the nervous system, I might be a different way. When can I mix narratives? When can I use both perspectives? When can I go back and forth according to what's presented to me and what the client wants and needs.

Whitney Lowe:

Yeah. And I thought of what I was going to mention a moment ago too. And this is going off on what you said there too is what are the unique, specialized needs of this individual client? For example, a great example of that is looking at the athletic world. If you make a blanket statement about everybody should be able, if they want to be really healthy and athletic and vigorous, they should be able to touch their toes and have this degree of extensibility of their muscles. There's a very different degree of mechanical requirement of what a defensive lineman needs to be able to do and a world class gymnast in terms of flexibility.

Whitney Lowe:

That defensive lineman may not want to have the same degree of extreme pliability of all their soft tissues in their extremities because they need greater stability for the activities of what they're doing. Same might be true in people in certain types of occupations.

Til Luchau:

Well, yeah. Where do you think body workers fall in the continuum. Are they more like defensive lineman or more like gymnasts?

Whitney Lowe:

I think it depends on your style of body work.

Til Luchau:

That's right.

Whitney Lowe:

Right. And who we're working with and what we're doing there. Again, that's why you want to become The Thinking Practitioner. That's why you want to be thinking about who you're working with and don't apply the recipes and routines to everybody one single way only.

Til Luchau:

Lovely. Is there anything you want to say about how you use this information... you said a bunch of stuff already. Anything else you want to add about using this information in a session with a client? And I'll give you my thoughts too.

Whitney Lowe:

Yeah. I would just wrap up by saying from the key takeaways here being think about mainly that the aspect that these stretching procedures do have these two major components. A connective tissue component and a neurological component and there are instances when we want to be thinking about those two things interacting with each other significantly. And also back to what you were saying about the narratives and the way we talk with our clients and the way we discuss things with our clients.

Whitney Lowe:

Keep in mind because everybody is unique and an individual to stay away from some of that what we refer to as noceboic language like, "Oh my God, your traps are so tight. There's no wonder your shoulders and your neck hurts," and that kind of stuff. Those kinds of things we can try to encourage tissue elasticity and pliability, but also be really conscious and aware of the way in which we talk about the things that we feel and perceive in terms of range of motion or movement capabilities or pliability of tissue in there because sometimes people don't need to have the greatest gymnast flexibility in the world in they're just fine. Be conscious of how you're doing that with each individual.

Til Luchau:

Mm-hmm (affirmative). Those are good. Shall I give you my things I think about?

Whitney Lowe:

Yeah, tell me

Til Luchau:

I think it's reminders for myself in a training situation, reminders from the students, but I think it's really that I try not to assume that tissue length or range of motion length or length of a particular structure is the only or the main goal of my work. Historically, that's been a big focus in some styles of manual therapy and we're pretty good at getting length changes, whether that's tissue or brain stretch tolerance or histology. Who knows? Often both. But strategically, I don't want to assume that's my only or main goal. That's not always the most helpful one.

Til Luchau:

I make my clients sensation primary. I want to know what they're feeling and what it feels like to them and how it is for them. I keep their attention on that too as I work. Along with what I find in my own palpation and movement interactions along with them. I am constantly thinking about tolerance. Their ability to be comfortable and safe at different places in the joints range as well as any plastic remodeling of the tissues. And low amplitude, long duration. Jules Mitchell makes that... applying things at a low level of stretch, say, or a low level of force but for longer durations also seems to make a big difference for certainly the tissue level effect, but then for the brain too. The brain can adapt to those low amplitude things better. It doesn't trigger the protective responses and perhaps the long duration actually gets us accustomed to those sensations as well.

Whitney Lowe:

Yeah, yeah. Yeah, I like that.

Til Luchau:

The last one I got there, oh, last one. Careful dosing after acute injuries. I don't want to be thinking always stretch or never stretch. I want to be good at dosing, be good at watching the feedback and doing experiments so I know how much of a particular technique and how long to apply and how frequently to apply it given my client's circumstances and situation.

Whitney Lowe:

Yeah, very good suggestions, great suggestions there. Well, again, we could probably rap on this for quite a bit longer, lots of other things that we'll dive into and likelihood is a reason for us to revisit this topic a little bit farther down the road as well. But we'll cap that for our discussion here today. I will say a big thank you to... I enjoyed the discussion here on stretching, so hopefully that was helpful for everybody else.

Til Luchau:

Yes.

Whitney Lowe:

Big thank you to our sponsors for this particular episode and reminder that you can stop by our site for specific show notes, CE credit updates and other extras that are over there. That is at thethinkingpractitioner.com. And you can also find out more information about Til and the things that you're doing there. Til, where can people learn more about what you're doing there?

Til Luchau:

advanced-trainings.com. The show notes are there as well and things about what we do. How about yours Whitney? I know the show notes are on your site too.

Whitney Lowe:

Also over there, yeah. You can find out about courses, other types of things that we have going on at the academyofclinicalmassage.com.

Til Luchau:

Or social media.

Whitney Lowe:

Yep, social media stuff under my name or also Academy of Clinical Massage and you're over on social where ?

Til Luchau:

Just my name, Til Luchau, @ Til Luchau wherever you are. You'll find me there.

Whitney Lowe:

Yeah. Sounds great. And reminder too, if you've got questions or input or anything that you want to send over to us, you can email us a info@thethinkingpractitioner.com and if you will also please remember to rate us on Apple Podcast or wherever else you're listening to your podcasts. It really does help everyone else be able to find us over there. We certainly do appreciate that.

Whitney Lowe:

Big thank you, also shout out to all of our listeners and the people who support the podcast so far. We really hope this discussion gives you some interesting things to ponder about in your own practice.

Til Luchau:

Fun doing this with you, Whitney. Thank you.

Whitney Lowe:

Sounds good and we'll see you all again in two weeks.