When is it okay to stretch?

Show Notes

🎉🎉Sign up for the FREE PHT ROADMAP 🎉🎉
Learn more about Brodie's PHT AI Assistant 📄🔍
Sign up for the FREE PHT 5-Day Course HERE

This episode covers the beliefs behind stretching and when it is safe and not safe with proximal hamstring tendinopathy.

Stretching was once a common treatment option for this condition but as our understanding has changed, so has the management.

But a lot of people with PHT need to return to stretching. Whether it is a pilates or yoga class or stretching without their chosen sport or physical activity. In addition, stretching the hamstring is a part of everyday life. Bending forward to put on shoes or picking something up off the floor is required but can sometimes cause discomfort.

So, when is stretching okay for proximal hamstring tendinopathy? 

Book a free 20-min physio chat here

Click here to learn more about the PHT video course & to receive your 50% discount

If you would like to learn more about having Brodie on your rehab team go to www.runsmarter.online 

What is Overcoming Proximal Hamstring Tendinopathy?

Proximal Hamstring Tendinopathy is a horrible condition affecting athletes and non-athletes alike. If you fall victim to the misguided information that is circulating the internet, symptoms can persist for months, sometimes years and start impacting your everyday life.
This podcast is for those looking for clear, evidence-based guidance to overcome Proximal Hamstring Tendinopathy. Hosted by Brodie Sharpe, an experienced physiotherapist and content creator, this podcast aims to provide you with the clarity & control you desperately need.
Each episode brings you one step closer to finally overcoming your proximal hamstring tendinopathy. With solo episodes by Brodie, success stories from past sufferers and professional interviews from physiotherapists, coaches, researchers and other health professionals so you get world class content.
Tune in from episode #1 to reap the full benefits and let's get your rehabilitation back on track!

:
On today's episode, when is it okay to stretch? bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. Thanks for joining me once again and today we have when is it okay to stretch. It's a interesting topic because the beliefs have kind of shifted from here to there as the decades have gone on. This is why I've decided to do this particular episode because I feel like, uh, when it comes to those free 20 minute injury chats that everyone's jumping on, you can find that link in the show notes just to see if your rehab is on the right track or if, uh, online physio is appropriate for you, exactly what that entails. That's just what we go through in those free 20 minute injury chats. Um, I feel like I'm talking. about this quite often. I feel like I'm trying to relay this message to a lot of people and the progression of beliefs has kind of shifted and why these particular beliefs have shifted. So I think about 10 years ago is when PHT started to develop into more of an understanding, it started to become more popular. and back when I first graduated, which was probably 10 years ago, no one really heard of PhD. Well, not in my circle anyway, I didn't really know much about it at uni. It might have been quite popular amongst other, you know, developing like maybe in the UK, but nonetheless, I didn't really know of it or make sense, much sense of it. But back then, if you had this PhD, people were advising to stretch to help with the recovery, stretch to make things feel better, help reduce symptoms. And so people with PhD would just say, okay, I was advised to stretch and then go home. And what they do usually with a stretch, they'd straighten out the leg and they'd bend forward or just have the leg out straight on their bed and try and like lean forward towards their toes. and it would produce a bit of soreness because that tendon is quite sore. And if you stretch it, it kind of targets that area and you're like, oh, it feels a bit sore, but it feels good. You know, it's that good kind of soreness, because you're just reaching that area, targeting that area and making things feel a little bit better in the moment, because if it's a little bit sore when you stretch, it's... this like 15 to 20 seconds like, I'm finally targeting the right area, this feels quite good. And then afterwards, maybe for a minute or two, the symptoms can subside because you've experienced a little bit of increased soreness. Therefore afterwards, you have this a bit of like pain inhibition where you kind of feel like you're doing good and therefore it feels a little bit better, but it's mainly just a short term solution to pain reduction. And so people were told you can stretch, go home, and they do so much stretching. And they, um, they overstretched because it's the one thing they were told to do to help with the rehab and to help make things feel better. So away they go with tons and tons of stretching. They just do it at home and made things worse in the longterm. Yes, it might've helped in the short term, but chronic stretching might've just, uh, kept that tendon in an irritated state. And so. This is where the evolution of this belief started to, you know, flip. And it's now slowly as the years have gone on, recommended to avoid stretching when it is in this really sore, tender state, because it is contributing to more irritation, because it's sort of like, um, stretching and wrapping around the bone. It's known as, um, an insertion or tendinopathy. So usually with insertion tendinopathy is we try not to stretch too much because it will further irritate its attachment. and not damage things, but just cause further irritation. Very similar to an Achilles tendinopathy. So there's two types of tendinopathies that are in your Achilles. There's mid portion, which is kind of like the middle part of the Achilles, but then there's an insertional tendinopathy that like the tendon pathology is straight as it inserts onto the heel. And people fare a bit different if we avoid stretching that area. So for the mid portion, Achilles, like you can stretch all day and it should be fine. You actually load up the tendon and stretch it for benefit. But if it's an insertion, we still want to load it, but we avoid deep ranges of stretch and they fare a lot better. So this is where the narrative has kind of shifted. This is where people have said, actually, you know, all these years and years of stretching, that's actually been unhelpful. And so that's where the particular narrative has shifted. People have developed more understanding. The evolving consensus was, okay, don't stretch. But I feel like it's the reaction has been a bit too severe. I think the don't stretch has been just perpetuated into you need to avoid stretching and then it's been perpetuated into everyone needs to avoid stretching otherwise it's going to get worse and it's going to contribute to further pathology and you should just avoid stretching in all circumstances. So I think it's just swung way too much in the opposite direction. We've gone from okay stretching all day is bad to any kind of stretching is bad where the The truth would lie somewhere in the middle and I'm not too sure. Perhaps I've been guilty with the words that I have used on the podcast because, um, again, on these injury chats, I've had people say, okay, I've stopped stretching because I've listened to your podcast and I hear that a number of times and I sort of think to myself, well, how, how much how powerful has my language been? Like what sort of language have I used? Have I said you need to avoid stretches? I'm not entirely sure. I'll have to go back and listen to all my past episodes to come up with an answer. But maybe this episode might help bring a lot of clarity to the middle ground that is when is it okay to stretch? So why it is why I need Why the concern is to make this episode is because I feel like just people need to stretch. People need to stretch in everyday life. It's similar to sitting. People avoid sitting with PhD even when they get a lot better. They avoid sitting because sitting has affected them, negatively affected them in the past. But you need to sit for everyday life. You need to drive. You need to sit down to have a meal with your family. You need to sit down to attend someone's wedding. You know, it's a part of everyday life. And stretching is a part of everyday life. You need to be able to stretch the hamstring, stretch the tendon if you wanna put on your shoes and socks, if you want to pick something up off the floor, if you wanna pick your kids up, you need to do some sort of stretching. And what I've seen is people have made really good recovery. People have done the right strengthening exercises, done the right load management, felt a lot better. but even now they're feeling a lot better, they are avoiding stretching altogether. They're fearful of if they do stretch, this PHT is going to come back and so have decided I'm now just going to go through everyday life without stretching. And there lies the problem and like I said the answer will lie somewhere in the middle and it lies somewhere in the middle and the information that I relay is like it's going to be totally dependent on you because every tendon is different. Not only is every tendon different and will have a different level of tolerance, but different tendons have different tolerances to different things. So the pathology just affects so many different domains so differently that it's really hard to just lay out general advice I work with PhD clients all the time. I'm pretty much seeing a new presentation of PhD, maybe twice a day. And if you were to step in my shoes for about a week, you'll see that some people like PhD running is fine, but doing squats and deadlifts like flares things up. You might find someone who cannot run at all, but they can cycle a lot. You might find people that can cycle a lot, but can't run. You might find people that Sitting really affects them, but they can do squats and deadlifts really heavy, but as soon as they sit for 20 minutes then it starts getting sore Similar with bending and stretching you might find people where bending and stretching is fine But sitting is bad and vice versa you might find people that can run But as soon as they stretch their tendon or a tender Pilates class that flares things up So people have different levels of tolerance, different levels of irritation in different domains. And it's all just because the tendon has adapted to certain domains and not really necessarily adapted or become resilient in others. Sometimes because it's been avoided or because it's been irritated in the past. And so let's just say, if you can imagine that you do too much running and things flare up. you're used to running 30 kilometers per week, keeping the PHT symptoms at bay, and then all of a sudden, instead of doing 30 kilometers in a week, you do 50 kilometers and it flares things up. That doesn't mean that running is bad for the tendon. It means you need to find your level of tolerance, find your new level of tolerance, and then build up from there. Similar to sitting, you might be able to tolerate sitting for 60 minutes. But then if you sit in a meeting, if you've got a conference for the weekend and you're doing so much sitting that all of a sudden the PHT becomes sore, that doesn't mean that sitting is bad for the tendon. It means that you've done a little bit too much beyond what it can tolerate and now it's a bit sore. You can consider that same thing for stretching. Stretching, you will have a certain level of tolerance to stretching. We need to find what that level of tolerance is. And if it's not enough for your everyday life or whatever goals you have, then we need to slowly build upon that tolerance. So you might be able to stretch stretching might be fine. If you just clean the house and you just start picking things up off the floor, picking up after your kids, you've got toys and everything around, and you spend 10 minutes just picking everything up, bending forward, standing up, bending forward, standing up and stretching that tendon. That might be fine. But if you vacuum the house straight after that and you spend another 20 minutes just bending forward and lunging forward, and that causes symptoms, that just means we need to build up the level of tolerance to tolerate those things. So like I say, everyday life, these sort of things happen throughout everyday life. You need to stretch, you need to be able to bend forward. Some people might have goals of returning to Pilates or yoga. to which the goals would slightly change. We're looking at more static stretching rather than just stretching the tendon to bend over once and then standing back up. But needs to be factored in. You can't have this absolute belief that stretching is bad for the tendon when there is some middle ground. And not only is there middle ground that it's currently successful, but you can learn and build upon that adaptation to tolerate more in the future. If that structure, if your rehab, goals in your rehab process is structured enough to allow that adaptation and to get stronger. And I do get where this fear comes from. I totally get that you've had this condition at whatever duration, but you want to avoid pain. People want to avoid pain, but sometimes in an irritated state, bending forward can cause pain. It can cause pain in the tendon. Really acute. symptoms like localized symptoms, I should say, that can be quite fearful, can be quite anxiety provoking if you don't have this particular understanding. For example, if you wake up in the morning, you bend forward to put on your socks, and there's a fair amount of pain localized to that sitting bone, you can attribute that you can attribute fear and anxiety to that. Totally understandable, but we need to start settling down those fears because that fear isn't really rational. The explanation like the tendon is sore, like no matter what you do, even if you're just standing and walking around without pain, it is still a sore tendon because if you start to run, sit, bend beyond its capacity, it's gonna feel sore. You're just stretching a sore tendon. And if you stretch a sore tendon, it's just gonna be sore, but it's not contributing to the pathology. The stretching in itself doesn't make things worse. It's not doing anything. It's just pressing a sore spot. It's kind of like if you have a bruise and you press that bruise, it's gonna feel sore, but it's not making the bruise worse. It's not further contributing or delaying the healing of the bruise. It just feels sore. That's what you do if you have a sore tendon and you just bend forward and it feels a bit sore. It's still okay to do. Just don't in excess, if you have that bruise and you just constantly push it, push it, push it, push it. then maybe that might delay the healing a bit. So, because you're kind of just irritating it further. But if you just do it a couple of times a day, if you just do it enough that just to get by everyday life, it's not going to contribute to, it's not gonna delay the healing, it's not gonna make the pathology worse. It's just a reminder, hey, you have a sore tendon. When you stretch it, it's gonna push itself onto the bone a little bit, and it's going to be a bit sore, but it's still okay to do. So we need to calm down the anxieties and fears of doing that particular stretch because if you avoid it altogether and you've convinced yourself that I just should avoid stretching altogether then what that's going to do week by week, month by month is going to make you deconditioned to stretching and you're not going to build that resiliency and it's going to be really hard to return that stretching the same with that pain, rest, weakness, downward spiral you are deconditioning the stretching and it's gonna be worse further down the track. So keep this in mind, make sure that if you do have any fears and anxieties that you pay particular attention to this episode and just recognize that it's okay. You're not gonna make things worse, it's not going to rupture the tendon or tear anything. The tendon, even if it's sore, tendons are really, really strong and they should be able to tolerate more than enough stretching, even if it's just to bend forward something really, really innocent, which is bending forward to put on your socks or pick something up off the floor. So unless you go overboard and you continue pressing on that bruise, maybe that might hinder things, but you just need to do a lot of it. And as long as you do your rehab, or like the rest of these episodes. If you start doing your deadlifts, heavy lifting, everything that we've suggested in this podcast to date, then over time that bending pain will start to ease. And if you're noticing that currently, if you wake up in the morning and you put on shoes and socks and the pain level's about a four out of 10, do your proper rehab week by week. And then one day you'll wake up, you do some stretches or you'll bend forward to put on those socks again as just a two out of 10. Then... couple of weeks later to one out of 10 and then just slowly just fades off into the background and starts to become a lot, a lot easier. This podcast episode is sponsored by the Run Smarter Physiotherapy Clinic, which is my own physio clinic where I help treat a wide range of PhD sufferers, both locally in person and all over the world with online physiotherapy packages. In the years I've been self-employed as a physio, close to 70% of my entire caseload has been helping people with proximal hamstring tendinopathy. which is why I decided to launch this podcast. So if you're building upon your own rehab knowledge through the podcast, but still require tailored assistance, I'd love to be on your rehab team. Whether you are a runner or not, head to runsmarter.online to see your available options for working together. If you're still unsure if physiotherapy is right for you, or if you need a rehab second opinion, you can always schedule a free 20 minute injury chat with me. Find the free injury chat button on my website. or in the podcast show notes to be taken to my online calendar to book in a time. So when is it okay to stretch? I'd say it depends on your level of tolerance. If you've sort of gathered things by now, you'll know that every tendon's different and the tolerance to different domains is totally different as well. So it all depends on you and depends on what level you can tolerate. Um, also depends on your goals. Like I say, you might love Pilates and want to get back to doing a Pilates class. You might love yoga and just want to do 30 to 40 minutes of stretching in the morning. You might love gymnastics, who knows, anyone who just requires a lot of stretching. In that particular case, your goals are so different to someone who just wants to get through everyday life and just wants to bend forward, pick up their kids, you know, several times a day. That's totally different. But if you are like a yoga person or gymnast, then you might trial just doing some stretches for five to 10 minutes. do some hamstring stretches for about five minutes and see if you can tolerate it, see what happens during, see what happens after, see what happens the next day. This is just like any other trial that we do. If it doesn't elevate, it doesn't irritate symptoms. If things settle back down to baseline within 24 hours, then you just build upon that. If we go for a run and we wanna test a trial or run, then we run for 10 minutes at a certain speed. We see what it's like during, we see what it's like after, we see what it's like the next day. If pain levels are less than a four out of 10 during that run and everything returns back to baseline within 24 hours, we know that we have tolerated that particular dosage and then we just build upon that. Same thing can be said with stretching. We do it any other way. We try five minutes of hamstring stretching, see what it's like during, after, the next day. Everything's fine with that, then we just build upon it. So those trials, as long as symptoms don't get elevated, then you just build. If you want to run, cycle, just get by everyday life, then you don't need something that's structured in terms of five minutes of stretching. It might just be trial, you know, cleaning, trial vacuuming for 15 minutes where you have to bend forward or lunge or things. It might be washing the dishes for 10 minutes and then seeing how that feels. It might be just putting on your shoes, maybe bending forward in the morning just to prepare things and then reduce the amount of stretching that you do later on in the day and then see how you feel the next day. And then when the next day rolls around and things aren't elevated, symptoms have returned to baseline, then you can maybe do a bit more bending. Maybe do your regular routine in the morning, then do a little bit more bending in the afternoon, whether that's like... cleaning up, whether that's picking up the kids a little bit more. I don't really know what you do throughout the day, but you know, if you do have to bend forward, don't avoid doing it for, you know, just put it into your everyday life more and more and more, and then to see how the tender responds. And if it does get to a point where it does irritate and increase symptoms the next day, then you just fall short of that and just trial that bending forward, you know, several days in a row. and over time the tendon will get used to that particular, will tolerate that particular movement and become easier. Then you can slowly integrate more and more and more. And so this is the particular understanding and the narrative that we need to follow to help calm down a lot of these fears and anxieties. And if you do have a fear of stretching, rest assured when you do bend and it is sore, it is not doing any more damage to the tendon. You don't damage things by just bending over the tendon that is sore just gets compressed a little bit. Like I say, just poking that bruise, you're not doing further damage. Like I said, same with sitting. It's a part of everyday life. You need to integrate it back into your routine. If you're tolerating it well, introduce more, just follow that particular process. Over time, the body will adapt to it. The body will adapt to more sitting. The body will adapt to more stretching, heavier lifting, more running, more cycling, provided that the... the environment that you and the structured environment that you progress is methodical and you're paying attention to symptoms accurately. Um, you should be fine, especially if you, um, follow the rest of the rehab principles that we have in this episode, uh, in this podcast, slow, heavy lifting, um, making sure that we're introducing the things that you love very gradually, all those episodes, you've listened to them already. So I don't really need to relay them. Um, if you do need assistance, if you're struggling, if all of this is quite overwhelming, that's why I have those free 20 minute injury chats there in the show notes of every episode, click on that and we can have a chat to see where there might be some missing pieces in your rehab to see if there's anything that we could do and if you'd like to work together with online physio, we can explain exactly how that works. If it'll be appropriate, answer all your questions and we can take it away from there. So good luck with your rehab this week and I'll catch you in two weeks time. pain-free future and remember knowledge is power.