Thursday Thoughts: The Perception of Stretching | Modern Manual Therapy Blog

Thursday Thoughts: The Perception of Stretching


At a recent The Eclectic Approach to IASTM 2 Day, there were many demonstrations of rapidly improving ROM and decreasing pain.

As a reference, you may read this article that summarizes what we know about increasing muscle "length."



If you want the cliff notes version (am I dating myself?) it says we know that muscle does not lengthen rapidly, and that it actually grows length via new sarcomeres in series. Similar to how hypertrophy does not happen rapidly, but takes time, so does true lengthening.

Improving movement and decreasing "tightness" is only changing patterns in the CNS, tone via peripheral stimulation and descending inhibition, as well as changing the perception of stretch/discomfort.

The next time your IASTM, mobilizations, neurodynamics, or any other reset does not modulate stretch/discomfort perception during movement, try this

  • ask the patient at what point during the range they feel the discomfort
  • having them move actively just short of the range
  • perform IASTM stroking the skin lightly in the direction opposite their movement
    • example: pain with cervical rotation left at 30 degrees
    • actively patient moves to short of 30
    • IASTM with EDGE Tool along the painful or tight area of skin from left to right as they rotate left
  • have them gradually increase the ROM so that they eventually move into and through the perceived area of tightness
  • essentially, you are modulating the perception of stretching/discomfort and replacing it with the novel stimulation of skin stroking
  • repeat for 1-2 minutes
  • maybe add scapula depression, posterior chain activation with bands, as in this video
  • then have patient re-test the movement actively
Now that you have changed the stretch/threat perception, the patient may actively reinforce with pattern assisted movement or perform repeated passive end range loading into a directional preference for homework. A full eval and treat where I perform this and a few other patient "distractions" - as worded by my patient who is an ortho instructor will be uploaded next week under The Assessment Channel for OMPT Channel Subscribers


Keeping it Eclectic...

4 comments:

  1. Another good post, Dr. E! "Stretching" always seems to be one of those controversial topics in PT, like SIJ dysfunction. I like how you make the distinction between neuro-mediated tone and the biomechanical properties of pathologically short muscle. Most of the patients we see are under the influence of tone, not pathologically short tissue that benefits from stretching in the classical sense.

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  2. Ah SIJ Dysfunction, something I recently disagreed with all 3 of my follow Therapy Insider Podcasters on. I agree more with the research on that one, less than 10% of all low back pain cases are true SIJ. Thanks for reading Aaron!

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  3. Then you and I are of the same mind on SIJ as well. By the way, I appreciate the re-tweet on my blog post! Thanks again!


    -Andrew

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  4. Andrew, you keep writing and I will keep sharing! It's tough to come with with regular content, but there are no shortage of appreciative readers.

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