The Art and Science of Recovery, Regeneration, & Rehabilitation
microStretching Science & Research
By referring to the anatomy and physiology of muscles, one easily appreciates the basis of microStretching®. As you know, myofibrils are constituted of myofilaments of actin and myosin proteins. These are well controlled, protected and maintained in a system of reflexes with stretch/tension sensors such as muscle spindles and tendon tension receptors (Golgi Tendon Organ). Any overstretch of muscle is reflexly protected as the muscle goes into spasm. If the stretch is beyond physiologic limits and there is damage of the myofilaments, the spasm continues and there is a degree of formation of fibrous tissue in the repair mechanism. Restoration of muscle function has to be gradual and within limits of function and stretch of the muscle fibres. If this is not carefully controlled, you end up causing more stretch damage and more fibrous tissue is formed with greater limitation to movement. The technique of microStretching® therefore is one that takes into account the micro-anatomy of muscle fibres, their physiologic functions and their limits of activity. The technique also takes into account the degree of fibrous tissue already formed and stretching is controlled to allow the microStretch of fibrous and ligamentous tissues to their functional limits in coordination with other muscles acting in synergy and involving related joints. Whenever there is inaction of muscle, fibrous tissue around joints where the muscle acts begins to shrink, causing“freezing”of the joint with limitation of movement within that joint. In microStretching®, this is taken into consideration so that the capsular fibres are not overstretched and damaged. In addition, microStretching® takes into account circulation of blood in the affected region and as the blood supply is improved, the healing process is facilitated and function is more readily restored.
MicroStretching® works within the parameters of the neuromuscular and myotendon junctions, as well as in conjunction with the autonomic (Sympathetic and Parasympathetic) nervous system. The belief is that pain, which is a sympathetic mediated response, provides the clue as to how one can progress with regards to the treatment and training of an athlete. Sympathetic activation is catabolic in nature and unless properly mediated continues its effect on the body through the inflammatory response, specifically the activation and perpetuation of the pro-inflammatory proteins. Therefore, the notion“no pain is no gain” with regards to recovery-regeneration stretching is very archaic often resulting in greater damage than benefit. Therefore, the purpose behind microStretching as a form of recovery regeneration is the modulation of the inflammatory response. Inflammation is responsible for a series of physiological, intellectual adaptations harmoniously carried out to sustain life. It is an integral and essential step of the repair and adaptive response of skeletal muscle trauma. In fact the bodily existence is determined by an invisible immaterial world of pure form and geometry.
The graph below illustrates a comparison of total hemoglobin, oxyhemoglobin, and deoxyhemoglobin following a microStretching intervention versus intense stretching. Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues back to the lungs. Removing carbon dioxide from the tissue (i.e accumulated during exercise), and exchanging it with oxygenated hemoglobin (blood) is important for recovery, regeneration and cellular respiration (metabolic reactions creating ATP). According to the graph, one can notice the increase in oxyhemoglobin (red line), total hemoglobin (light green line), and deoxyhemoglobin (blue line) during the initial phase of a microStretching intervention compared to intense stretching. The significance of having higher levels of deoxyhemoglobin can be explained by the Haldane effect which states that “deoxygenated blood can carry increasing amounts of carbon dioxide, whereas oxygenated blood has a reduced carbon dioxide capacity.” The Haldane Effect (along with the Bohr Effect) facilitates the release of oxygen at the tissues and the uptake of oxygen at the lungs. Therefore, an increase in deoxyhemoglobin (blue line) is beneficial because of its ability to carry and remove higher amounts of carbon dioxide from the tissue. Although more research may be needed, we have not only seen that microStretching moderates and modulated the inflammatory response, but it can also help with the oxygenation of tissue and removal of carbon dioxide better than intense stretching during initial and recovery phases.
Hemoglobin (Hb) – Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues back to the lungs.
Oxyhemoglobin (O2Hb) – The oxygen-loaded form of hemoglobin.
Deoxyhemoglobin (HHb) – The form of hemoglobin without oxygen.
Stretch Intensity vs. Inflammation: A Dose-dependent Association?
Nikos Apostolopoulos BPHE, George S. Metsios, Alan Nevill, Yiannis Koutedakis, Matthew Wyon
Abstract Background: The intensity of stretching is rarely reported in scientific literature. In this study, we examined the effects of stretching intensities at 30%, 60%, and 90% of maximum range of movement (mROM) on the inflammatory response of the right hamstring muscle. Methods: A randomised within-subject trial was conducted with 11 healthy recreationally active males over a three week period. Participants were strapped into an isokinetic dynamometer in the supine position, with the right knee fastened in a knee immobilizer. After randomising the ROM percentages, the hamstring muscle was moved to one of the three chosen ROM percentages for that week and held there for 5 x 60 seconds followed by a 10 second rest between repetitions. A 5ml blood sample was collected pre-, immediately post, and at 24 hours post intervention for high sensitivity C-reactive protein (hsCRP) assessments. Results: Significant increases in hsCRP levels were observed between 30% mROM and 90% mROM (p=0.004) and 60% mROM and 90% mROM (p=0.034), but not between 30% and 60% (p>0.05). Conclusions: Muscle stretching at submaximal levels does not elicit a significant systemic inflammatory responses.
Acute Inflammation Response to Stretching : a Randomised Trial.
Nikos Apostolopoulos 1 George S. Metsios 1 Jack Taunton2 Yiannis Koutedakis1,3,4 and Matthew Wyon 1,4
Abstract Background: The aim of the study was to examine the effects of an intense stretch on selected serum-based muscle inflammation biomarkers. Methods: A randomised within-subject crossover trial was conducted with 12 healthy recreationally active males (age: 29±4.33yrs, mass: 79.3±8.78kg, height: 1.76±0.06m) participating in both an intense stretching and control intervention. During the stretch intervention the hamstrings, gluteals and quadriceps were exposed to an intense stretch by the same therapist, in order to standardise the stretch intensity for all participants. The stretch was maintained at a level rated as discomfort and/or mild pain with use of a numerical rating scale (NRS). Each muscle group was stretched for 3 x 60 seconds for both sides of the body equating to a total of 18 minutes. During the control intervention, participants rested for an equivalent amount of time. A 5ml blood sample was collected pre-, immediately post, and at 24h post for both conditions to assess the levels of interleukin (IL)-6, interleukin (IL)-1β, tumour necrosis factor (TNF)-α, and high sensitivity C-reactive protein (hsCRP). Participants provided information about their level of muscle soreness 24, 48, and 72h post treatment, using a numeric rating scale. Results: hsCRP increased significantly at 24h compared to control and immediate post stretch intervention, for time (p=0.005), and time x condition (p=0.006). No significance was observed for IL-6, IL-1β or TNF-α (p>0.05). Conclusion: It is observed that intense stretching may lead to an acute inflammatory response supported by the significant increase in hsCRP.
The effects of different passive static stretching intensities on recovery from unaccustomed eccentric exercise – a randomized controlled trial
Nikos C. Apostolopoulos, Ian M. Lahart, Michael J. Plyley, Jack Taunton, Alan M. Nevill, Yiannis Koutedakis, Matthew Wyon, George S. Metsios
Abstract Background: Effects of passive static stretching intensity on recovery from unaccustomed eccentric exercise of right knee extensors was investigated in 30 recreationally active males randomly allocated into 3 groups: high-intensity (70%–80% maximum perceived stretch), low-intensity (30%–40% maximum perceived stretch), and control. Both stretching groups performed 3 sets of passive static stretching exercises of 60 s each for hamstrings, hip flexors, and quadriceps, over 3 consecutive days, post-unaccustomed eccentric exercise. Muscle function (eccentric and isometric peak torque) and blood biomarkers (creatine kinase and C-reactive protein) were measured before (baseline) and after (24, 48, and 72 h) unaccustomed eccentric exercise. Perceived muscle soreness scores were collected immediately (time 0), and after 24, 48, and 72 h postexercise. Statistical time × condition interactions observed only for eccentric peak torque (p = 0.008). Magnitude-based inference analyses revealed low-intensity stretching had most likely, very likely, or likely beneficial effects on perceived muscle soreness (48–72 h and 0–72 h) and eccentric peak torque (baseline–24 h and baseline–72 h), compared with high-intensity stretching. Compared with control, low-intensity stretching had very likely or likely beneficial effects on perceived muscle soreness (0–24 h and 0–72 h), eccentric peak torque (baseline–48 h and baseline–72 h), and isometric peak torque (baseline–72 h). High-intensity stretching had likely beneficial effects on eccentric peak torque (baseline–48 h), but likely had harmful effects on eccentric peak torque (baseline–24 h) and creatine kinase (baseline–48 h and baseline–72 h), compared with control. Therefore, low-intensity stretching is likely to result in small-to-moderate beneficial effects on perceived muscle soreness and recovery of muscle function post-unaccustomed eccentric exercise.