To Stretch or Not To Stretch

Much has been written in the literature over the years regarding stretching. Some of the research supports static stretching, while more recent studies advocate dynamic stretching.  Before I go into the differences of the two, one must understand what stretching is. It involves a reflex response by the golgi tendon system that responds when the muscle spindle is activated in the joint.

Static stretching involves taking a muscle to its end range and holding it for a certain amount of time. Most people hold stretches for 10-45 seconds and may repeat it several times. The muscles actually “stretch” over time and need to be held for a minimum of 3 minutes for any tissue deformation to take place. Stretching muscles actually causes a temporary weakness in the tissue, as small muscle fibers are torn. Most people perform this type of warm up prior to their athletic event, not knowing that they are actually putting their muscles at greater risk of injury.

Dynamic stretching incorporates using an antagonistic muscle, the muscle opposite the one being stretched, to actively contract, thereby causing a stretch of the agonistic muscle. This also involves performing functional activities that one is about to undertake. An example of this would be to perform some lateral jumps and skips, as well as forward and backwards running for soccer. For skiing, one would squat up and down and perform lateral trunk movements to simulate the movement of skiing. Statically stretching the quad does not benefit the skier, as this muscle is actually shortened during skiing and is rarely extended. The idea behind dynamic stretching is that you are actually warming up the muscle by replicating the movement patterns that the sport requires. With each subsequent warm up, the muscles receive more blood supply and actively “awake” for the real activity. This type of warm up does not require aggressive exercise, but a more gradual approach. Think about the activity that you are about to participate in. If it does not involve running, then a warm up run is not indicated.

While static stretching prior to activity is the not the mode of choice, for this clinic, it does not mean that there are not benefits to be received from it. Once the event is completed, such as soccer or tennis practice, then one should take the time to statically stretch the muscles that have been used. Hold each stretch for 45 seconds to 1 ½ minutes. The muscles will respond better after the workout secondary to the increased blood supply and warmth of the tissue.

Fit for the Golf Course

Golf is an athletic activity, which would benefit from athletic training and conditioning. Just like any other athlete, golfers can improve their performance and prevent injury by performing sport specific stretching and strengthening in preparation for the golf course.

By the time warm weather arrives in Vermont, most skiers are ready to put away the skis and dust off the golf clubs. Just like the first day of ski season, the first day on the golf course can leave a golfer with a mixed bag of emotions. The pleasure of swinging a club can sometimes be overshadowed by the frustration of a bad score or the rusty feeling in one’s muscles and joints. As golf becomes increasingly recognized as a sport which requires both physical and mental fitness, more golfers are beginning to understand the importance of physical preparedness necessary to perform well on the golf course.

Golf is a low to moderate intensity activity that combines some aerobic and anaerobic exercise. It also requires endurance to walk 4-5 miles and repetitively perform the same action for 4-5 hours. It involves explosive power, as well as adequate flexibility, balance, strength and coordination of the trunk, hips and arms. Therefore, many overuse injuries are due to poor swing mechanics and poor conditioning. Injuries typically involve the low back, neck, elbows and shoulders.

Low back pain comprises 70% of golf injuries. Golfers can bend up to 50 times while on the course, teeing up the ball, marking the ball on the green, and retrieving the ball from the hole. Therefore, back pain associated with playing golf can be viewed as an overuse injury.

One of the main reasons golfers have back pain is because they are unable to perform the necessary rotation of the hips or have tightness in the shoulders that results in too much rotation and force being translated through the spine. Below is a list of basic exercises for hip and shoulder flexibility and range of motion that can be done in preparation for golf. In addition, balance exercises and core strengthening can be helpful in preventing an injury.

Knee to Chest stretch: Lying on your back, bring one knee toward the chest stretching the hip into a flexed position. Hold 20-30 seconds. Repeat 3-5 times.

Piriformis stretch: Perform the knee to chest stretch described above, then modify the position by pulling the knee across the body toward the opposite shoulder.

Butterfly stretch: While sitting on the floor or ground, put the bottoms of your feet together with knees bent and out to the side, gently stretching the hips. To increase the intensity of the stretch, gently lean forward. Hold 20-30 seconds. Repeat 3-5 times.

Posterior shoulder stretch: Bring one arm across your chest applying overpressure with the opposite hand to stretch the back of the shoulder. Hold 20-30 seconds. Repeat 3-5 times.

Pectoral stretch: Put one hand inside a door frame and gently turn your body away from an extended arm to stretch the front of the chest and bicep area. Hold 20-30 seconds. Repeat 3-5 times.

Balance and core: Stand on one foot with arms crossed over your chest. Practice rotating your body as if performing a golf swing. Keep abdominals tight. Maintain single leg standing balance and repeat 10 times on each leg.

Golfers who are interested in resolving a current injury, preventing an injury, or improving their score are recommended to follow up with their golf professional as well as a local physical therapist proficient in golf swing biomechanics.

Tennis Injuries….Can you avoid them?

Tennis is a fast paced, anaerobic game that relies on core strength, agility and explosive power. Technique plays a large role as well. Many are weekend athletes that play once a week and others play 4-6 times a week for several hours. Whatever the type of tennis player you are, you may have experienced some sort of injury. This may include muscle strain to the hamstring, calf or back, or a more chronic, disabling injury to the elbow or the shoulder. Below are a few exercises and pointers that may help you prevent injury down the road or teach you how to treat it.

Many tennis players are injured during the serve, as this involves excessive rotational forces to the shoulder, hyperextension of the back, and “valgus” stress to the elbow. Weak links in any of these areas and you have set yourself up for an injury. A solid foundation of lower and upper extremity strength is needed as well as a strong core, to prevent excessive hyperextension of the lumbar spine. Gripping the racquet too hard or trying to use too much elbow with a top spin can cause tennis elbow, as can a grip that is too small or too big. 

Start with a brief active warm up/ stretching phase that includes trunk rotation with arms in front of your body. Overhead throws performed with a partial squat are great for trunk extension and serving. Active hip flexion with opposing leg knee extension, while walking is excellent warm up exercise for the hamstrings, calves and hip flexors. Repeat each exercise 5 times.  Side step laterally along the baseline and then go back the other way. Do this 4 times. Start at the midline and run forward to the net. Quickly stop and then run along the net to the right and then return to the middle of the net. Run Backwards to the midline and then forwards again to the center of the net. Then side step laterally. Repeat 3 times. This should be done at a light jog, as this is a warm up. 

Rotator cuff strengthening exercises are paramount for preventing overuse injuries in the shoulder.  Some of these injuries may be rotator cuff tendonitis, impingement syndrome or bursitis. Using a theraband or cable, follow thepicture series above.  Repeat these exercises 15 times for 3 sets. Try this series for 3-4 weeks then attach the band to your tennis racquet and practice serving, forehand and backhand. Repeat for 30 times with 1 min. rest between.

Core strengthening exercises: these exercises provide the trunk with stability by stabilizing the hips, the pelvis and the lumbar spine and the abdominal muscles. Having a strong core allows you to have a stable foundation and possibly limit the amount of strain at the lumbopelvic joint. 

The side plank and the plank are great exercises to start with. Hold each one of these for 30-45 seconds and then repeat 3 times. 

Bridging: Lie on your back, bend knees to 90 degrees, keeping feet flat on the floor. Raise butt off ground, keeping abdominal muscles tight and drawn towards the spine. Extend one knee to 0 and then lower back to 90, making sure that your pelvis remains level. Repeat 15 times 2 sets. Switch legs. 

Supermans: Lie over a ball with toes touching the ground, not your knees. Extend one arm while extending the opposite leg. Stabilize your trunk. Repeat 15 times, each leg and arm. Do 2 sets. 

Trunk rotation with a band: Standing sideways to the band with feet shoulder width apart and core stabilized. Grab the band and keep elbows straight. Pull the band so that your trunk twists away from the band. Repeat 15 times 3 sets each side. 

Overhead Medicine ball throws: Stand with feet shoulder width apart holding medicine ball in front of chest with arms extended. “Throw” the ball overhead diagonally 15 times each direction. Repeat for 2 sets. 

Once tennis is over, you can perform static stretches that involve the hamstrings, gastroc, soleus hip flexors, quads, back and shoulder. Hold all of these stretches for 45 seconds-90 seconds and repeat 1 time. Make sure that you have been hydrating well throughout the game or practice and remember to eat a light meal 30-60 min .afterwards with a mixture of carbohydrates and protein. Peanut butter on graham crackers is great, or cheese with crackers or fruit.

If you should feel a pull or a sharp pain while playing tennis, stop playing and ice immediately for 10-15 minutes. This will minimize any swelling and start the healing process immediately. You should ice for the next 48-72 hours 4-6 times/day. If pain persists, call your primary MD or consult a physical therapist for further evaluation. 

While the above exercises and stretches can in no way guarantee that you will be injury free, you may be well on your way to the prevention of most.