“I stretch all the time but it doesn’t seem to help.” Have you ever had that thought or said those words? You could be missing a key part of stretching.  In the previous edition of the Sports Medicine Corner, I briefly touched on things that you could be doing to help yourself through various phases of injury. Using ice or heat, stretching, massaging, and strengthening are all important activities to keep up with when you are trying to overcome an injury. Today, I am going to address tissue extensibility and how it relates to stretching.

Many people spend time during the day stretching, whether it’s after a run, before they get out of bed in the morning, or at the end of the day. Sometimes they feel better after they stretch, sometimes not. Typically, the muscle tightness will come back soon after they finish stretching. This is a frustrating experience for many! If the tissue that is being stretched lacks extensibility it will be resistant to gaining flexibility through traditional methods of stretching.

To better understand what’s going on, let’s talk about the difference in flexibility versus extensibility. Tissue flexibility refers to the ability of a muscle or tendon to lengthen to allow normal joint motion. Flexibility is important for gross motions, such as the knee bending and straightening to appropriate degrees during the gait cycle. On the other hand, tissue extensibility deals with the individual fibers that make up muscle and tendon. With motion, these fibers must “glide” over one another to allow smooth motion to occur. Anything that inhibits the gliding, or extensibility of the fibers will, in turn, affect the overall flexibility of a muscle or joint.

When an injury occurs, whether it’s an acute injury or something more chronic that slowly develops over time, the tissue of the body is affected by it. Normal, healthy tissue functions quite well and glides smoothly. With injury (or any chronic stress to the body) scar tissue develops. While scar tissue is a good thing because it indicates the body’s natural healing response, it can be a bad thing if it’s not properly taken care of.

One thing that really sticks in my mind from college (well, there’s a few things I guess), is how one of my professors explained scar tissue. Think of freshly cooked spaghetti, nice and hot, flexible, and each strand gliding nicely over the strand next to it. Now, when you take those leftovers out of the fridge the next day, they are cold, stuck together, and in a big mess that looks like a bird’s nest. Freshly cooked spaghetti is healthy tissue and leftover cold spaghetti is scar tissue! Which kind of spaghetti do you think functions better? The freshly cooked spaghetti not only tastes better, but it also functions better as the strands (muscle and tendon fibers) glide over one another with ease.

If there are areas of scar tissue (trigger points) built up within our tissue, flexibility and muscle function will be limited. There is some controversy as to whether the trigger points form first and contribute to injury, or if injury occurs and as a compensatory result, trigger points form. Either way, keeping the tissue free from trigger points is necessary for injury prevention, injury rehabilitation, and optimal performance.

I recently read “Running ith the Kenyans,” by Adharanand Finn. I won’t give away the book, but one thing that was really interesting to me was the importance that the Kenyans give to tissue massage. As you can imagine, the resources in Kenya (other than for the elite athletes) are quite limited as far as access to doctors, physical therapists, massage therapists, and many of the other healthcare practitioners that we have available to us. The one thing that they do not skimp on is daily soft tissue massage. Whether they are getting a professional massage in their training camp, massing their running partners, or performing self-massage they are finding a way to keep their tissue extensible. Now I’m not saying that all we have to do here in America is some tissue massage and we will all run like Kenyans! However, the fact that they run so well and relatively injury-free (for the amount that they run) is no coincidence!

Taking the time to work on trigger points will help to break up the scar tissue and encourage blood flow to that area. The increased blood flow will make the tissue more receptive to any stretch that you are going to place on it. Not only will you get better results from stretching if you add massage, you will also be enhancing your body’s ability to perform. Tissue extensibility relates to tissue flexibility, which is related to the strength and power that your muscles are able to generate. If you have healthy, extensible, flexible muscle, you are going to be able to perform much better than if your muscles are scarred down, hard, and inflexible.

Of course, the hand of a trained massage therapist is the ideal way to increase tissue extensibility. Most of don’t get massages often enough to rely solely on a professional massage. So what else can we do? Unless you have a really awesome running partner that wants to dedicate their time and effort towards your injury prevention (hint, hint, running partners!), I would suggest spending some time self-massaging. There are many tools available to help runners perform soft tissue massage. Simple to use devices like foam rollers, the Stick, the Trigger Point Ball, the Orb, and Trigger Point kits are all available to help you release trigger points and keep your soft tissue healthy. Some are more intense than others, providing deeper, more focal pressure to the trigger point. Take some time to figure out which device is best for you. We have demos of all available products in our stretching area. Ask a staff member for help if you don’t know how to use something.

In about 5 minutes per day, you can start increasing your tissue extensibility, improving your muscle function, and preventing injury. Maybe next time someone asks you if you stretch, you can say “Yes, and I massage my trigger points before to help increase the blood flow and make the tissue more extensible and receptive to the stretch.” Ok, maybe you won’t say that, but at least you can think it and know that’s why it works!