Warm Up More Productive Than Stretching to Avoid Injuries

Warm up More Productive Than Stretching-

I’ve read studies on the topic of stretching for several decades and the consistent evidence is as Dr. Mirkin presents it (below).

Every opportunity I get to work with competitive dogs is an opportunity to reeducate the human clients about sport training and competition. People in the pet competition world often promote ball stretching as an acceptable form of pre-competition warm up or exercise.

Ball stretching before an event is more destructive than helpful. Coming out of a crate and trotting around just a short bit is not enough of a warm up prior to competition. Dogs should do better in events with at least a quarter-mile slow jog warm up and then a few sprints. This would also be beneficial prior to training drills as well. Just the basics…

The article below comes from Dr. Gabe Mirkin’s Fitness and Health e-Zine
April 7, 2013

Stretching Before Exercising Provides Only Flexibility

Whenever I see someone stretching before running, cycling, tennis, swimming, or any other sport, I worry that the person doesn’t know much about training.

Exercise First and Then Stretch

Stretching Before Exercise Only Weakens Muscles:

Two recent studies show that stretching before competition and training weakens muscles. Stretching prevents you from lifting your heaviest weights or running your fastest miles. It limits how high you can jump, and how fast you can run (The Journal of Strength and Conditioning Research. April, 2013; The Scandinavian Journal of Medicine and Science in Sports, April, 2013).

Stretching weakens muscles by almost 5.5 percent. The longer you hold the stretch, the more strength you lose. Holding a stretch for more than 90 seconds markedly reduces strength in that muscle. Stretching reduces power: how hard you can hit a baseball or tennis ball, how fast you can swim, run or pedal, Stretching also does not prevent next-day muscle soreness, and it does not prevent injuries. On the other hand, warming up helps to prevent injuries and helps you to run faster and lift heavier.

Rudi Stretching Naturally After Exercise
Rudi the Brittany Spaniel in Rehab After Hip Surgery, FHO, Femoral Head Osteotomy. He’s Doing Natural Stretching AFTER exercise, and NOT Doing Forced Range of Motion Work by His Mom Owner

 

How Muscles Move Your Body:

Every muscle in your body is made up of thousands of individual fibers. Each fiber is composed of sarcomeres, repeated similar blocks, lined end-to-end to form the rope-like fibers. Each sarcomere touches the sarcomere next to it at the Z line. Muscles move your body by contracting, a shortening of each muscle fiber. Muscles do not shorten (contract) equally throughout their lengths. Muscles contract only at each of thousands of Z lines. It is the cumulative shortening of thousands of Z lines that shorten fibers to make muscles contract and move your body.

How Stretching Saps Strength:

When you stretch a muscle, you pull on the muscle fibers and stretch apart each fiber at the thousands of Z lines. This damage occurs only at the Z lines throughout the length of the muscle fiber, to weaken the entire muscle.

Prolonged Stretching Limits the Ability of Muscles to Store Energy:

Muscles are like rubber bands. They stretch and contract with each muscle movement. This constant stretching and contracting stores energy. For example, when you run, you land on your foot and the muscle stops contracting suddenly.

The force of your foot striking the ground is stored in your muscles and tendons and this energy is released immediately to drive you forward. Your foot hits the ground with a force equal to three times your body weight when you run at a pace of six minutes per mile. Up to 70 percent of the force of your foot strike is stored in your Achilles and other tendons. This energy is released by your muscles and tendons to drive you forward for your next step.

Stretching decreases the amount of energy you can store in muscles and tendons and therefore weakens you and you have less stored energy to drive you forward, so you have to slow down.

Stretching Saps Speed and Endurance:

Elite college sprinters were timed in 20 meter sprints, with and without prior multiple 30-second stretches of their leg muscles. Both active and passive stretching slowed them down (Journal of Sports Science, May 2005).

Stretching Does Not Prevent Next Day Muscle Soreness:

A review of 12 studies published over the last 25 years shows that stretching does not prevent muscle soreness that occurs 8 to 24 hours after you exercise vigorously (The British Journal of Sports Medicine, December 2011; 45:15 1249-1250). Researchers in Australia reviewed five studies, involving 77 subjects, to show that stretching does not prevent next-day muscle soreness. (British Medical Journal. December 2007; 325:468-70 and 451-2).

Stretching Does Not Prevent Injuries:

A review of the scientific literature shows that there is no good evidence that stretching prevents sports injuries (Clinical Journal of Sports Medicine. March 2005). Muscles and tendons tear when the force applied to them is greater than their inherent strength, so anything that makes a muscle stronger helps to prevent injuries. Strengthening muscles helps prevent muscle and tendon tears, but stretching does not make muscles stronger. This review showed that stretching does not prevent shin splints, bone stress fractures, sprains, strains or other arm and leg injuries.

 

Original Post August 3, 2014. Updated February 19, 2018

The Exercise Cure

How can we motivate people to take a free, safe, magic pill?

By Jordan D. Metzl

“Lack of fitness is the public health epidemic of our time,” says Bob Sallis, past president of the American College of Sports Medicine.

If there were a drug that treated and prevented the chronic diseases that afflict Americans and we didn’t give it to everyone, we’d be withholding a magic pill. If this drug was free, in a country that spends more than $350 billion annually on prescription drugs, where the average 80-year-old takes eight medications, we’d be foolish not to encourage this cheaper and safer alternative as first-line treatment. If every doctor in every country around the world didn’t prescribe this drug for every patient, it might almost be considered medical malpractice.

We have that drug today, and it’s safe, free, and readily available.

Exercise has benefits for every body system; it is effective both as a treatment and for prevention of disease. It can improve memory and concentration, lessen sleep disorders, aid heart disease by lowering cholesterol and reducing blood pressure, help sexual problems such as erectile dysfunction, and raise low libido. Exercise does it all. Even with cancer, particularly colon and recurrent breast cancer, the data show clearly that exercise is a deterrent. Newer studies on a glycoprotein called Interleukin 6 suggests that general body inflammation, a factor in almost every chronic disease, is reduced by regular exercise.

Even the most challenging cases of obesity can be helped with the right incentives.
The United States currently spends more than $2.7 trillion, roughly 17 percent of GDP, on a health care system that is financially incentivized to treat disease. The more tests that are run on patients, the more medicines that are dispensed, the more procedures that are performed, the greater the financial burden for us all. Despite far outspending any country in health care, the United States is currently ranked 28th in life expectancy. Our current system does very little to encourage preventive health care. We are mortgaging our country’s financial future to pay for increasingly expensive treatments for the same diseases we could effectively delay or prevent.

Professionally and personally, I have made dispensing the drug of exercise a large part of my life. I treat limping and hobbled athletes of all ages in my sports medicine practice at the Hospital for Special Surgery in New York City. My waiting room is filled with 8-year-old gymnasts to 80-year-old marathoners, all wanting one thing: movement. My job is to fix their aches and pains and to keep them going. Before and after work, I am one of them, an avid athlete who has run 30 marathons and 11 Ironman triathlons. I’m what you might call an exercise fanatic.

There probably is such a thing as too much exercise, but I’m much more worried about inactivity. As my colleague Bob Sallis, past president of the American College of Sports Medicine, says, “Lack of fitness is the public health epidemic of our time.”

Seventy percent of Americans are overweight, 30 percent are obese, and only a very small fraction exercise for the 150 minutes per week recommended by the American Heart Association. What can we do to motivate them?

In a recent study, Kevin Volpp from the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania took 56 morbidly obese, middle-aged, male participants and studied systems to incentivize weight loss. In the world of obesity, morbidly obese men are tough customers; it’s very difficult to get them to change their behavior patterns. Obesity and related conditions and diseases, including high blood pressure, diabetes, and high cholesterol, account for more than 50 percent of annual health costs in the United States. Solving the obesity epidemic is the key to reducing health care costs.

Volpp randomly divided subjects into three groups: a control group and two financially incentivized groups, in a study in which the goal was to achieve a 16-pound weight loss over 16 weeks. The control group was weighed at regular weekly intervals with no financial reward. One financially incentivized group was given a fixed sum of money weekly that they could win if they hit their target weight-loss goal per week, and the other group was enrolled in a lottery system in which they had the chance of winning smaller or larger amounts of money but could qualify for payment only if they hit their weekly weight goals. Subjects from all three groups were educated on the role of exercise and nutrition for weight loss at the beginning of the study. After 16 weeks, both the fixed payment and lottery system subjects had lost more than 16 pounds while the control group had not. The financial incentive was relatively small, averaging $350 in total payments over 16 weeks. This isn’t a long-term solution: Four months after the study’s completion, most subjects had returned to their prestudy weight. But it shows that even the most challenging cases of obesity can be helped with the right incentives.

In the United States, we routinely incentivize behaviors deemed conducive to a highly functioning society. Financial incentives encourage marriage, having children, owning property, even accruing debt. As much as we believe we are free to choose, Big Brother’s tax code is pulling our strings from above. I’m not arguing that this is poor policy. On the contrary, encouraging favorable behavior for the greater good helps keep the fabric of our society together and the wheels of our economy turning.

When I began writing The Exercise Cure, my thought was to provide a guidebook to encourage healthy behavior. Having investigated the correlation between disease and fitness, I now believe that we can save billions of health care dollars by incentivizing movement. Rather than mortgage our financial future on a bloated health care system that isn’t doing a very good job of making us healthy, we’d be much better served by incentivizing people to get off the couch. Ideas to make this happen include lowering health care premiums based on activity levels: The more steps you take per month or year, the less you pay. This doesn’t have to be large amounts of money—even a little bit of incentive goes a long way. We also should encourage the use of a fitness vital sign for annual medical checkups where the amount of physical activity that someone is doing per week is monitored in the same way heart rate and blood pressure are. These methods will help encourage movement and health and will reduce disease prevalence.

I can’t promise you that if you work out daily you won’t get sick. I’m also not suggesting that exercise cures all ills. Genetics, chance, socio-economic, and other factors clearly play significant roles in affecting health profiles. What is becoming increasingly apparent, however, is that the drug called exercise can help prevent, alleviate, or treat almost every disease state. I hope my book inspires you to take it for yourself.

Jordan D. Metzl, MD, is a sports medicine physician at the Hospital for Special Surgery in New York. His newest book is The Exercise Cure. Follow him on Twitter.

Goals of Therapeutic Exercise

Previously Published on Medscape

 

What should you expect from therapeutic exercise? (italicized bits are my own additions-rehabdeb)

Therapeutic exercise should…

  • Enable ambulation (or bring about improvements from baseline status)
  • Release contracted muscles, tendons, and fascia
  • Mobilize joints
  • Improve circulation
  • Improve respiratory capacity
  • Improve coordination
  • Reduce rigidity
  • Improve balance
  • Promote relaxation
  • Improve muscle strength and, if possible, achieve and maintain maximal voluntary contractile force (MVC)
  • Improve exercise performance and functional capacity (endurance)

The last 2 goals mirror an individual’s overall physical fitness, characterized by good muscle strength combined with good endurance.

No matter which types of exercise may be needed initially and are applied to remedy a patient’s specific condition, the final goal of rehabilitation is to achieve, whenever possible, an optimal level of physical fitness by the end of the treatment regimen.

Medscape, Feb., 2012

All of my rehabilitation programs produce the above results, I’m stoked to say!

Formerly paralyzed Sully the Great Dane walking around the block demonstrating benefits of therapeutic exercise
Formerly paralyzed Sully the Great Dane walking around the block.

Anecdotal Progress

Anecdotal Progress – Am I Seeing What I Think I’m Seeing?

Exercise is thought to have beneficial effects on Parkinson’s disease.

Jay L. Alberts, Ph.D., neuroscientist at the Cleveland Clinic Lerner Research Institute in Cleveland, saw this firsthand in 2003 when he rode a tandem bicycle across Iowa with a Parkinson’s disease patient to raise awareness of the disease. The patient experienced improvements in her symptoms after the ride.

“”The finding was serendipitous,” Dr. Alberts recalled. “I was pedaling faster than her, which forced her to pedal faster. She had improvements in her upper extremity function, so we started to look at the possible mechanism behind this improved function.” As part of this inquiry, Dr. Alberts, researcher Chintan Shah, B.S., and their Cleveland Clinic colleagues, recently used fcMRI to study the effect of exercise on 26 Parkinson’s disease patients.”

RehabDeb says: The above is a quote from an article regarding research looking at the benefits of exercise for Parkinson’s patients, found on Science Daily dot com, and as I read it this morning, I thought it to be a perfect example of the practice protocol I have developed that has proved beneficial for several orthopedic conditions in lieu or surgery…whatever reasons one might have for not having surgery performed on their pet.

I am one person working alone, however I have over 35 years background and experience in principles of human sport science, exercise physiology, program design, and the like. There are a few others with similar backgrounds working in veterinary rehabilitation. I began using simple principles based on years of experience, and I’ve seen much success, as evidenced by improved quality of life, improved function, and veterinary professional confirmation.

I don’t have money to drive clinical research, and while I have ideas about whom I could approach about getting involved with this research, I am busy in my practice and haven’t wanted to take the time aside to pursue individuals, grants or corporations. At some point I intend to write more about the beneficial outcomes and to further discuss cases, however in the meantime, take the first paragraph as affirmation that science is observation of a particular outcome or experience as well as the steps to prove what we imagine/postulate/thought we observed.

It has been proved anecdotally time and again that when the conservative and slowly progressive non-surgical interventions I have outlined in the homework discussions on this site and/or in my books are followed within the parameters I outline, improvement of the condition ensues, barring extenuating circumstances. I do not see the discussion as being whether surgery or no surgery is better; I present the protocol I use as beneficial guidelines instead of not giving a program of recovery to those who choose to wait or altogether forego surgery for some conditions.

AND, I have provided return-to-function programs that are for pets that have had surgery. Following a program of progressive and structured recovery will only serve to improve the outcome and the pet’s quality of life if done well and correctly.

In other words, for injuries and conditions that are not “life or death”, the fact is there are very many people who will not choose surgery for their pet (or for themselves, for that matter). The instead-of-surgery protocol I develop and use fills a need to help the pet recover.

Keep moving forward; there is no time constraint on the “one step at a time” methodology…you can always begin, again, now.

Blessings-Image

Range of Motion Drills for Your Pet

When and Why to Perform Range of Motion Drills for Pets

If you are going to do range of motion drills on your pets, you should have an experienced practitioner demonstrate them to you, preferably on your own pet.

Anatolian Shepherd standing with one hind paw turned under, knuckling
Parker was partially paralyzed and once he could walk again, he couldn’t plant his hind paw on his own at first. Parker needed flexion and extension drills for his toes and foot to keep them from locking in place over time.

Passive Range of Motion (PROM) really only needs be performed on animals limbs that the animal is not able to move on their own. PROM is the passive version, and describes range of motion drills when your pet is passive and unable to move their limb.

Range of motion exercises (ROM) are exercises that we may do for others, yet those others are also capable of moving on their own.

ROM drills are often recommended in veterinary medicine. I disagree with doing ROM on the majority of pets, and I do not recommend it for my veterinary rehab patients after hip or knee injury or surgery. 

This recommendation, to do ROM, comes from the “human side”, like a lot of good information for pet recovery does, however pets operate differently with respect to their damaged bodies than humans do. Making blanket recommendations to pet peeps to do ROM is not the best approach.

After Surgery?

BJ cavaletti work in harness with short leash, doing her own range of motion drills after doing the foundation program.

I do not recommend doing ROM if the pet is able to move on their own, even if they are not moving a lot after surgery or injury.  

Some pet caretakers I have counseled have left the vet’s office with surgery discharge instructions that tell them to do massage or ROM exercises. Most of the time the animal caretaker/pet owner does not truly know what this means or how to do it so that the pet is not injured or so that the person is not wasting time.

People are sometimes injured accidentally by their pet if they push ROM drills. Correct range of motion drills that make a difference are likely to cause pain in a pet that has neuromuscular function and feeling. If the limb is not paralyzed, the pet can most likely feel. Sometimes a pet that appears paralyzed is able to feel pain, too. The pet doesn’t understand and they might nip at people when they cause pain with ROM drills.

Comfortable Joints –

If pets are comfortable with joint use after injury or surgery, they will use their joints. As pets recover, their joints will be less swollen and more normal use will increase naturally. This is especially true if the pet is doing a good rehabilitation program.

Rudi the Spaniel using a steep hill incline to stretch naturally after exercise
Rudi the Brittany Spaniel in Rehab After Hip Surgery, FHO, Femoral Head Osteotomy. He’s Doing Natural Stretching at the Right Time, and NOT Being Forced with Range of Motion Work by His Mom Owner. His original surgery was not entirely successful, because too much of the femur head was left during surgery. I did extensive rehab with him to increase muscle mass and avoid a second surgery.

People also usually do not know when to stop pushing a joint and where to start working with ROM drills. This leads to non-compliance on an exercise the clinic recommended, and usually this drill is an unnecessary expense of time if the pet is able to move their limb on their own.

A referral to a strength and conditioning rehab practitioner or a neurological recovery specialist to judge protocol and beneficial movements is a great idea for pet caretakers in these cases.

Joint Stops –

I have consulted on several cases wherein people were really trying and forcing range of motion drills with no improvement in their pet’s natural joint movement. Most of them had been back to the surgeon or regular veterinarian at least once to have the practitioner check the case. In these particular cases I found that there was a “stop” in the joint that should not have been pushed. The people didn’t know that, and in some cases the veterinarian and surgeon did not know, either.

The “stops” I mentioned above are due to different circumstances in different cases. One cat had a pin in her knee that was part of a fracture repair, and the pin was stopping the joint from opening more fully. A surgeon needed to remove the pin. The client had been to the surgeon and to the surgeon’s rehabilitation practitioner. Both of those practitioners kept telling the client to push ROM on the cat. The CCRP rehab person had forced the knee joint during many visits. Of course, it wouldn’t open further, and any perceived gains were likely due to the pin digging into the opposing bone.

The cat was mad and in pain, as you can imagine, and was hiding under the bed when I arrived for my consult. My advice, after finally getting to gently examine the cat, was that the client pursue a second opinion from a different surgeon in a different practice.  It’s probably obvious to you that this cat didn’t need more range of motion exercises; she needed surgical intervention to correct the pin.

Then Why Did my Veterinarian or Surgeon Recommend These Drills?

Most of the time, I believe the veterinarian is trying their best to catch up with some of the rehabilitation protocol promoted at conferences and seminars. Veterinarians and veterinary rehabilitation practitioners are doing what they have been told to do when they recommend ROM. I think they are really trying to do a good job. There is just so much to know that they may not have experienced some of the “bad” situations I mention in this post and therefore they haven’t had opportunity to come up with other solutions to the problems or think differently about the solutions.

ROM, water treadmill and balance board use are some hot topics in rehab practice. As hot as they may be, they are not the best unique approach to home or clinic-based rehabilitation. If they are to be used, they should be used in a planned order along with other work to compliment strength-building and recovery.

Alone, the types of drills I mention above only put a small piece, usually out of place, into the puzzle of recovery. Clumped together, these drills and others like them are often not in an order that compliments the science we know of exercise physiology and recovery.

Also, most of the time, veterinarians, medical doctors, and surgeons do not have extensive experience in functional rehabilitation. That is why there is a need for many types of recovery specialists in human medicine and why rehabilitation is a specialty in veterinary medicine as well. None of us has time to know everything about even our own specialties, much less all other specialties of interest.

I don’t do everything perfectly in my practice. I have, however, had a lot of experience in a broad variety of conditions and situations, and on this website I give to you more ways to think about solving problems.

Back to ROM –

ROM drills are not usually necessary if the pet is moving on their own! Other physical activities will be a better use of rehabilitation activity time than ROM. Other work will do a better job of encouraging overall limb and body use. Start with this foundation if you want to do some work yourself.

My Pet Already Moves Their Leg –

If your dog or cat or other pet is moving and flexing & extending their knee or other joint after surgery, very likely their joints are staying mobile enough for beginning recovery. They are as mobile as they are comfortable with moving.

Often better movement is dependent on better pain control. You may achieve better pain control in the short-term the most effectively with medications prescribed by your pet’s veterinarian. Supplements are usually helpful with long-term pain control. I have taken supplements for over 40 years and using the effective ones in my pet patients for over 25, if you count my own pets as patients! Unfortunately there is not a supplement at the time of this writing that will do the job that focused and thoughtfully applied pharmaceutical medications will do. At this time you cannot overcome big pain with supplements.

My own soulmate pet, RIP Grace Dane, xox. She had two TPLO’s, which I would never do again and did before I developed my rehab practice. Both surgeries were extremely problematic. She ended up with all three ligaments torn in her right knee and two torn in the left. Bone-on-bone in both knees. Her story is long. She received both drugs and supplements most of her life. I drove and pushed for the right drugs for her situation. They helped a lot, in context.

You don’t need to bug (and probably cause pain to) your pet by making them endure “bicycling” of their leg(s).  Other drills and exercises will bring about better recovery and use of the joints. You subsequently have less opportunity to hurt your pet (or you) if you are not trying to forcefully manipulate them. Please start with and complete this foundation if you want to do some work yourself.

Pain? Or “Just” Needs More ROM?

If your pet is able to move on their own yet is choosing to hold a limb in flexion, bent at the joint, and isn’t using the limb much, then the problem is most likely pain. Usually the issue is NOT that the pet needs to be forced to extend/unbend and flex/bend with painful drills we make them do by our own hand. Please see my posts on pain for more info.

Animals do not have the same hesitancy to use their damaged joints in the same way that humans are reluctant to do. This means that if a dog sees a cat it wants to chase, then most of those dogs will chase now and endure the consequences later!

Movement and Reasoning –

In fact, even though I could make an argument for animals demonstrating reasoning ability, I have seen plenty of “act now, consequences later” results! In humans we call this impulsive. Sometimes I also have impulse control issues. You probably do, too. More on that another day.

We humans are usually going to stop moving. We usually think hard about how much pain we think the movement will cause. Our pets seem to do the same thing when they are in pain, but they don’t always restrict themselves.

In those cases humans need excessive coercion, like the ROM machine after knee surgery. Or sometimes we just need the best basic exercise drills for our situation. My dad has shoulders that freeze up due to old injuries. He gets physical therapy once in a while and he can afterward move better. Slowly over time, he forgets to do his exercises. Then his shoulders freeze and are very painful. Then I remind him to start with the simple exercises. The pattern continues today because he forgets. He needs to continue the best drills for his situation. So does your pet, until there is better function.

Conclusion on Forced Range of Motion –

Forced ROM is largely unnecessary for our pets unless the animal has nerve damage and cannot move their limbs; THEN you should do PROM.

The only time it is necessary to use ROM drills is when the pet is unable to move their limbs. Then you must incorporate several sessions of range of motion drills daily. Do this so that the muscles don’t contract and the joints don’t freeze.

Later I might post about proper range of motion for a pet that cannot move its limb. There are already videos galore on the webbage that show a lot about ROM and PROM. I don’t need to duplicate those. Most of the time those vids are encouraging you to do ROM on pets that don’t need it. I’m not necessarily talking about the models for the videos not needing ROM; I can’t comment on all those vids and whether those pets need ROM. I’m talking about necessity of ROM or PROM regarding the content of this post.

Thank you!

Rehabdeb

(Published August 3, 2014. Updated April 6, 2018)