The Stages and Effects of Stretching during Rehabilitation
If you have recently suffered a soft tissue injury, then you are probably going to learn a lot about stretching in the next few weeks. Stretching is a great way to prevent an injury, but also speed up rehabilitation and allow for a smoother recovery.
However, not all stretching was created equal. If you are working with a physical therapist, you will be educated on how and when to stretch. Improper stretching could complicate your recovery process with delays or further injury.
Whether you are working with a professional or not, the following information can guide you in focusing on correct stretching techniques. The phases of rehabilitating soft tissue injury with stretching can be broken down into 4 stages.
Stage 1
This stage is the first 72 hours after the injury. During this stage, there should not be any stretching at all…completely avoid it. Instead, focus on what is called the R.I.C.E.R. treatment. This is the acronym for rest, ice, compression, elevation, and a referral for professional treatment with a physician and physical therapist.
Let’s emphasize again…stage one, no stretching at all to avoid further injury.
Stage 2
The second stage is the next 1-2 weeks following the injury and resting period. It’s at this point that the swelling induced by the injury should be subsided significantly. It’s possible that stage 1 might be a bit longer for some people. If unsure, a medical professional can guide you on the timing.
Throughout this period, the patient might expect a mix of heat and massage, along with relatively light static and passive stretches. This stretching, following heat or massage treatments, will aid in speeding up the healing process.
Static stretching is when your muscles are stretched through tension, starting by a relaxed position, and then carefully moving the body to slowly and slightly increase the tension of the muscle group. That position is then maintained, which helps to lengthen the group of muscles being stretched.
Passive stretching is using the same theory, but requires help from another person or an object to stretch your muscles. Even though someone might be helping you, passive stretching is more risky because there is a greater force being utilized on the muscles. So, make sure the person helping you is either a professional physical therapist, or someone who has been instructed by one.
A word of caution, this is not necessarily supposed to cause pain. If that occurs, ease up on the amount of tension you are applying to the muscles. Discomfort is expected, but not pain.
Stage 3
This stage is the time period from approximately 2-5 weeks post injury. This stage is more intense, but will bring you the greatest amount of recovery. You should be able to regain most, if not all of your strength, flexibility, and endurance, as well as coordination and balance.
While you might feel as though you are well into recovery and may be tempted to skip this stage, don’t. Without it, the chances of a full recovery are slim, at best.
This is where Proprioceptive Neuromuscular Facilitation, otherwise known as PNF stretching should be introduced, in addition to the passive and static stretching mentioned above. PNF is an advanced phase of flexibility training, involving contraction of the muscles, along with stretching.
Stretching and contracting is a common way of increasing strength, flexibility, and range of motion, even when there is no injury to rehabilitate. Take a look at some samples of PNF stretching:
• Hold and Relax
• Contract and Relax
• CRAC (contract, relax, antagonist, and contract)
• Rhythmic Initiation
• Rhythmic Stabilization
• Alternating Isometrics
• Slow Reversals
The type of PNF stretching that would most benefit you should be prescribed by a physical therapist and physician. They will know your injury, therefore what your limitations and abilities will be during your recovery process.
Stage 4
This really isn’t a stage, as much as it’s a new way of stretching for life. The long term outlook can be determined by a lifetime practice of appropriate stretching. Two areas of stretching you should now be considering are dynamic and active stretching.
Dynamic stretching incorporates controlled swinging or soft bouncing motions, reaching for the muscle’s realistic limitation. The goal is to increase range of motion in a controlled stretch, never out of control movement.
And, active stretching is achieved without the use of assistance from another person or piece of equipment. One example of this is when you lift your leg out in front of your body, as high as you can, and then holding that position for as long as possible without any help.
Regardless of which stage you are in, and as with all exercise and rehabilitation, all stretching techniques should be discussed with your health care professional. No injury should be treated as if it’s a cookie-cutter incident. A physical therapist will guide you to the proper treatment, so you can get on the right track to the best and quickest recovery.