Tuesday, 28 March 2017

Is There A Case Against Stretching?

Hello, reader. Welcome to the world of fitness. In this world, you warm your body up, lift things up, put them down, maybe repeat a few more times, and then stretch after. It's tried, true, and timeless. Or is it?

I've been having reflective thoughts on the static stretch following exercise. There isn't much of any school of thought to argue against stretching, but I have to say this: In my experience, whether or not I prescribe stretches to clients hasn't seemed to affect their progress, from what I've been able to tell. As such, I decided to make this the point of my research this week.

But if I don't stretch, how will strangers know that I just worked out?

Preventing Delayed Onset Muscle Soreness

It makes perfect sense that stretching reduces the muscle soreness that follows intense exercise. You've just worked the muscle, so it's likely going to become tight afterwards. As such, you should stretch it out before it tightens up so that the contracture doesn't occur as severely.

However, while science hasn't quite determined what DOMS is actually caused by, it's almost certain that the soreness is not due to a shortening of the muscle (which stretching would thus alleviate). Rather, it's more likely pain caused by muscle damage, lactic acid, enzyme accumulation, or simply inflammation.

Regardless, it seems crazy that stretching wouldn't still help reduce the soreness. However, experiments have demonstrated just that. In fact, depending on the study you read, it's even suggested that static stretching after exercise, as opposed to an active cool-down, actually resulted in increased DOMS. Again, these mechanisms aren't clear, but the results speak for themselves.

Increasing Range Of Motion

An increased in muscle lengthening and range of motion has been well-supported by science for years. However, what I've witnessed, anecdotally, is countless individuals who are still barely able to touch their toes despite consistent stretching on a daily basis.

Does this suggest that these people simply aren't stretching enough to compensate for their mechanical demands? Is more stretching the answer? Probably not, unfortunately. Whether it's the time spent stretching during each individual session or the overall length of time you've been following a stretching protocol, no difference in range of motion has been measured between doing more or less.

So at least moderate stretching should be beneficial, by that logic. Even this principle is being challenged by some researchers, though. For instance, one group of researchers were able to show that range of motion increases from static stretching were lost after only three minutes following cessation of the stretch. Granted, this experiment did not measure gains made during a long-term protocol, but it definitely piques interesting thoughts behind the concept of stretching at all.

Finally, I'd like to point out that static stretching isn't the only method of gaining range of motion, as demonstrated in one study that compared stretching to strengthening of the hamstrings. As it turns out, eccentric training of the muscle actually resulted in greater range increases than statically stretching did. Interestingly, increasing neural control over the muscle seems to do more than simply trying to lengthen it.

Is There Any Use At All?

So I seem to have effectively picked apart all rationale for including static stretching in exercise programs. It's not so black and white, though, as studies have still definitely demonstrated a decrease in musculotendinous injury in programs that included it. With the above considered, however, it suggests that we simply may not know why this may be.

One realm that the newer research hasn't addressed is the effects of stretching on muscular spasm following pain or injury. When a muscle is guarding in response to some sort of trauma, is stretching a method of overiding those neural signals to allow it to release? Certainly, this decreased neural activity is the reason for reduced muscular power output following a static stretch, and stretching definitely helps relieve cramps. Is the same mechanism useful for when trying to get a painful, spastic muscle to relax during a rehab program? Is this the reason behind reduced injury risks when part of the program? These are just a few things to consider from this point forward, and hopefully the science continues to develop our understanding of the subject.

All in all, I'll leave you with this as punctuation:

Subscribe to the Weekly Updates

Do you like the content that you're reading? Sign up to receive the weekly blog update from Cain Exercise Rehab directly to your email!

Tuesday, 21 March 2017

What Can Speed Bone Healing?

I've been fortunate to never have had experienced a bone fracture in my own life. (I figure that I'll probably get hit by a car in the week following this blog post.) I understand how much fractures are a drag, though. Not being able to do anything except immobilize it and let time heal it enough to start doing any rehab.

A topic that's starting to pop up, however, is if there are modalities which can increase the rate of bone healing and accelerate the recovery process. Well, I decided to surf through the research and see what I could dig up.


Let's start with the modality that I'm clearly the most focused on. It's common that weight bearing and physical activity will increase the rate of healthy bone formation in healthy populations and those with osteoporosis. But can early exercise while a fracture is still in its healing phase be beneficial?

Unfortunately, there's not a whole lot of research that I could find on exercise, although it's clear that weight-bearing is a definite factor in increase bone formation. Research does suggest that regular contraction of the muscle around the injured bone may decrease the rate of bone loss, but it's not conclusive.

With this information, the only safe advice to give would be that weight-bearing (standing and walking on a fractured leg, for instance) is beneficial to the healing process, but only under the clearance and supervision by a professional when the bone is stable enough for each progression.


This will be a short and sweet entry. After a scan of journal databases, I found no research directly on the stimulation of soft tissue over the site of a fracture. Being that a fracture is a widely-taught contraindication of massage, we can only assume that manual therapy is off-limits when it comes to bone healing.


Here's where we can get interesting!

I found one fantastic journal review that compiled everything nicely for us. It cited multiple studies that found a positive effect of specific ultrasound signals on the rate of bone healing. Even when it came to applying the modality to smokers, who are known to have decreased rates of fracture and tissue healing, ultrasound was able to counteract the effect.

It seems that, despite my recent post about why ultrasound probably does nothing for you, that there is probably some use for it after all.


The findings here were interesting, as I was taught in college that electrotherapy such as IFC (interferential current) could accelerate the bone healing process. However, this is another modality that does not seem to have much research behind it, What I was able to find was little more than a suggestion that electrotherapy may help prevent complications of fracture non-unions. On the other hand, one newer study seemed to find that IFC made no difference in bone healing times.


Laser is a newer therapy on the block. With it emerging more recently, there's been a bit more hype to research it.

The research, so far, has been positive when it comes to the effect of laser on the acceleration of bone healing. However, it's important to note that most of the studies to this date have been done on rabbits and rats. Nonetheless, bones are bones, and this find is still a promising one. I'll be careful about getting too excited until I see a bit more evidence, though.

In short, there's still some research to be done before we can say anything for sure. At this time, it's safe to say that weight-bearing to stimulate bone growth using mechanical stress is the best advice to accelerate fracture healing, although ultrasound shows a lot of promise as well. Massage is a no-go, electricity probably has little effect, and we should probably wait on more results about laser.

Regardless, make sure to do your rehab once the cast comes off.

Tuesday, 14 March 2017

The Top 6 Band-Mobility Mistakes

I have this tendency to go off on the reasons of why most band-mobility work that we see at gyms these days is so unnecessary. I'm going to sidestep, however. Like everything, these band drills have a time and place, so allow me to provide some guidance on the most common errors we see.

1) Becoming Addicted To Short-Term Benefits

The biggest issue with these mobility exercises that everyone is doing these days is that they are being widely performed with no long-term plan in mind. Individuals at the fitness clubs are working on regaining the same degrees of range of motion before every single workout. If you're spending this much time on gaining those degrees of range, then you should absolutely be doing the subsequent work to make sure it stays! Otherwise, you're simply bailing the boat without plugging the hole, so to speak.

This brings us to our next fact:

2) Freeing Up Ranges That You Aren't Strengthening In

How do you maintain range of motion once you free it up? You strengthen and stabilize the soft-tissue around it by training IN that range. It blows my mind when I see people at the gym spending 20 minutes working on their overhead shoulder flexion, yet they're only pushing half-reps on the shoulder press.

I can't wait to never do an overhead press!

Not bothering to do the necessary work to strengthen those ranges of motion, at best, means that that range is never going to stick and stay available to you. At worst, you're going to hurt yourself. Which leads us to...

3) Freeing Up Too Much Range Too Soon

Going back to the stabilization point, if you don't strengthen within a range, that range is useless to you. On the same train of thought, if you mobilize a joint too aggressively and your range drastically increase, there's a risk even if you do try to strengthen there; that risk being that if there's not enough existing stability already, then the joint may fail you if you try to lift too heavy or stress the joint into that range. Think of that joint as a Jenga tower. If you're removing blocks to increase its movement, you need to reinforce and balance it out to prevent collapse.

And at the same time have hours of family fun!

4) You're Mobilizing Past The Limits Of The Joint

Another problem we run into is when people are trying to mobilize into ranges that aren't even supposed to be mobile. My favourite example is when I see individuals using those bands to stretch their shoulders behind them into extension.

Taking this photo actually made my shoulder sore, but I did it for you!

News flash: You don't do any activities or exercises in that excessive range (except for those ones that you should probably be avoiding anyway). Furthermore, your joints do not appreciate being pulled that far.

At points such as this, we've completely stopped gliding the joint along its surfaces or stretching the muscle tissue. By this time, all that you're doing is stretching the ligaments. Last time I checked, you don't want to stretch your ligaments.

5) You're Trying To Mobilize When Mobility Isn't The Problem

You have trouble getting into a deep squat, so let's mobilize those hips into flexion! Right?

Wrong! Probably.

So often, I see people thinking that they're lacking the ability for their joint to fully glide, and so they waste time trying to increase those ranges. But wait, can you pull you're knee into your chest? If so, then the joint can glide just fine. If anything, you probably have a problem with muscular spasm and tension.

So, before grabbing that band, take a moment to assess where the problem is actually coming from.

6) Not Understanding How Joints Move

Lastly, once you've completely determined that, yes, you have an actual joint restriction, that you will definitely strengthen in the increased range, that you won't stress your ligaments, and you have a long-term stability plan in mind, let's mobilize that joint!

But let's mobilize it properly, mmkay?

My best example of this is one that I see constantly: the hip extension stretch with the band pulling back on the hip.

Here's the thing, which I will so artfully articulate in my MS Paint diagram here. When the limb goes in one direction, the joint surface that is moving does not necessarily go the same way.

This example is quite easy to visualize. When the hip flexes forward, the head of the femur moves back in the opposite direction. Oh-so coincidentally, the direction that the femoral head moves is the opposite way that people seem to enjoy pulling on it with their bands. Counterproductive, as you can see. Here's the right way to be doing that exercise.

These same principles apply to every other joint. Unfortunately, not every joint glides in an as-easy-to-picture fashion. So please, if you're going to force a joint surface in a specific direction, please do your research correctly or speak to a professional.

Band mobility definitely has it's place in certain rehab and training plans. It's a temporary measure only, however, as the subsequent training should involve strengthening to stabilize that newly-acquired range so that it sticks around. Know the joint that you're trying to mobilize, understand the joint's limits so that you don't unnecessarily stress them, and only increase the range if you require/intend to use it.

Tuesday, 7 March 2017

The K-Tape Review

We all remember the 2012 Olympics where Kinesio Tape (K-Tape or KT) first became widely-known to the public. Whatever the use for it, slapping patterns of brightly-coloured adhesive on insanely fit and tan world-class athletes sure brought the stuff to popularity.

There are a lot of claims surrounding the use of KT. Some people swear by it, others have thrown it into the alternative category of pseudoscience, right next to aura-rearranging.

One thing that I immediately notice is that the KT website is purposefully vague about it's claims. Citing them, KT "helps"with a variety of injuries. It "provides support" as well as 24-hour relief. A lot of very nonspecific stuff. The most specific it gets is that KT provides proprioceptive feedback to help with relaxation or activation of muscles.

But let's find out what weight Kineseo tape (or whatever other knockoff brand of it) really holds... with science!

Increased Muscle Activation and Strength

One of the biggest uses cited by KT lovers is that the application over certain muscles or tendons can facilitate an increased activation of that muscle. The mechanism supposedly works by providing neural awareness (proprioception) of the area that will trigger the nervous system to more-easily contract the targeted muscle.

Looking at the literature, it seems that, indeed, KT does have a proprioceptive effect on the muscles and can increase bioelectrical activity to the area. However, the significance of this is still in question. Other studies have found that while the tape improved sensory perception of force, actual muscular strength and power was unaffected.

The verdict here might suggest that the KT can be useful as a tool for sensory feedback propagation, possibly allowing for the correction of motor habits. However, expecting the tape to actually increase the contractile strength of the muscle is likely to be a folly.

Range of Motion

On the support side for KT, though, there was a use found for the application when it comes to range of motion. Specifically, it seems like if there is a limited range of motion due to muscular reasons (such as tension or weakness) there may be some proprioceptive mechanism that causes an increase range with the tape applied. I found studies experimenting with this concept on both the lower back as well as the knee following ACL repair. It must be noted, however, that the jury is still out on what this exact mechanism may be.

Pain and Injury

This one is another gray area. Can KT decrease pain caused from specific injuries? Yes and no.

I selected experiments using KT on subjects with patellofemoral pain who saw improved symptoms due to the aforementioned proprioceptive effects of the tape promoting more-balanced activation of the quads. Similar results are suggested in subjects with chronic low-back pain. Shoulder interventions have been mildly positive as well, but not significantly more effective than other modalities. Interestingly, one more study on shoulder pain found that subjects improved in one specific range of motion only from the tape but not overall function, suggesting that there may be limited application of biomechanical corrections with the application. If no direct motor pattern is present to offer immediate pain relief, such as with knee osteoarthritis, the KT proved useless.

I think we'll be waiting a few more years on anything concrete in this realm.


This is one of the few effects that I really enjoy using KT for.

One fascinating use of KT is its ability to increase drainage of swelling, bruising, and edema. Looking at the research, it looks like there's a definite increase in the distance between the epidermal and dermal layers of the skin with KT applied which may allow for an increased lymphatic flow. Another study found the tape even more effective than some manual drainage techniques. However, there is also an definite limit in the effectiveness of KT when it comes to severe edema.


So can we put stock in Kinesio Tape? Well, it definitely may be useful for providing the neural feedback to cue the correction of certain muscular firing patterns and motor habits. Don't expect it to magically increase your strength or whisk away your pain, however. If you have a bruise, though, give it a shot!

Just don't wear it to play sports without covering it. Otherwise, you're advertising to every single opponent of what kind of injury you have.

It should be noted that virtually every one of the studies that I cited involved very small subject groups. Furthermore, KT is still in such an early stage of research that repeated validity is hard to confirm at this point.

Subscribe to the Weekly Updates

Do you like the content that you're reading? Sign up to receive the weekly blog update from Cain Exercise Rehab directly to your email!