Brian Schiff’s Blog

Well, after a silent stretch the past 2 weeks or so related to my study/preparation for the OCS exam, I am back to blogging! Today’s post is a pertinent one for runners and athletes suffering from lower limb injuries.

Static stretching has taken a bit of a beating in the strength and conditioning world in the last few years. Dynamic warm-ups and active mobility have taken center stage as of late.  While these active modalities are certainly superior for prior to practice, play and ballistic activity periods, I still believe stretching has a place in rehab and conditioning.

Interestingly enough, a study recently published in the March 2012 Journal of Strength & Conditioning Research examined the effects of static stretching of the calf and its impact on the strength/ROM of the contralateral side.  Click here for the abstract.

In a nutshell, the authors had two groups of untrained individuals: test group (6 male and 7 female subjects) and control group (6 male and 6 female subjects) who participated.  The test group did supervised active right calf stretching 3 days per week for 10 weeks (four 30 sec stretches w/30 sec of rest between stretches).  They stood on a beam 30 cm above the floor with the left knee slightly bent to offload the left leg as well as placing the hands on the wall while they leaned forward allowing the right heel to drop toward the floor until a max tolerable stretch was felt.  The knee was straight throughout on the stretch side.

Control subjects did no stretching at all.  All subjects were instructed to maintain their normal physical activity but refrain from any resistance training or stretching during the 10 week investigation.  The results:

• 29% increase in 1RM calf raise strength on the right
• 11% increase in 1RM calf raise strength on the left
• significant 8% increase in calf ROM on right
• significant 1% decrease in calf ROM on the left (non stretch side)
• No change in strength or ROM for control group

The authors conclude that the results of this study best apply to rehab settings.  For example, they suggest that this procedure may be an effective way to combat the loss of strength in limbs that have been immobilized after injury or surgery simply by stretching the mobile (unaffected) side.  They also point out that this may be a way to mitigate strength loss when access to traditional strengthening modalities are not readily available.

Clearly, athletes suffering an acute ankle sprain as well as runners suffering soleus/Achilles/lower limb overuse injuries would benefit from such a strategy. So why does this work?  Zhou in earlier work describes a cross training effect due to neural adaptations regulated in the spinal cord.

What does this mean for you and me?  Well, as someone who works with many runners I am always looking at eccentric control of the G/S complex as well as effective single leg heel raise strength.  The idea that stretching the uninvolved side to strengthen the involved side seems like a no brainer.  Clients suffering from tendonitis, plantar fasciitis, stress reactions, sprains and other injuries can use this as an early intervention without stressing the involved side.

More importantly, I like the idea of increasing neural adaptation and ROM in the stretch side through eccentric load as the dissipation of ground reaction forces will be more efficient in a calf that effectively handles eccentric loads through a sufficient range of motion.  This study definitely highlights the importance of stretching in novice runners and those with tight gastrocs. I am curious if the bent knee stretch would have had a similar effect primarily on ROM – perhaps they will investigate that further in the future.

As we move more toward mid and forefoot running gait, I believe the fitness of the G/S complex will be even more important than before as stress is transferred away from the knee and more toward the foot/ankle complex.  Clearly, we need more studies in trained subjects on unilateral stretching to determine if the same effects and degree of impact will be seen, but this study shows some promise for active static calf stretching in the appropriate populations.

I work with many runners in our clinic.  I often see restrictions in the soleus.  While the running community is warming up to soft tissue mobilization, many runners are still resistant to embrace it routinely and engage in it more so only when they are hurt or lacking flexibility.

STM (soft tissue mobilization) should be part of every runner’s maintenance program.  Why?  Simply put, repetitive stress takes its toll on the body.  Rolling or releasing the tissue increases blood flow, eliminates trigger points, and facilitates optimal soft tissue mobility and range of motion.

In the diagram below, you can see common trigger points in the soleus.  The X represents the trigger point & the red shaded area is the referred pain caused by the trigger point.

In the case of the soleus, restricted dorsiflexion could lead to other biomechanical compensations with running.  Initially, this often creates a dysfunctional and non-painful (DN) pattern.  Over time, this may eventually become a dysfunctional and painful (DP) pattern forcing runners to seek medical care.  The terms DN and DP come from Gray Cook’s Selective Functional Movement Assessment (SFMA).

The gait cycle is certainly altered from dysfunction in this muscle.  If ankle joint dorsiflexion is compromised (a common effect of soleus restrictions), there can be increased strain on the quads and altered movement in the hip.  Overpronation and excessive hip adduction and internal rotation are common compensations seen with running.  Other signs and pathology that may be associated with a soleus trigger point may include:

• Plantar fasciitis
• Heel pain
• Shin pain
• Knee or hip pain
• Back pain

As such, restoring mobility is important.  A recent study revealed that immediate improvement in ankle motion can be attained with just a single treatment (click here for the abstract).

So how do you effectively resolve soft tissue issues in this area?  I suggest using a foam roller or better yet the footballer and baller block in the Ultimate 6 Kit for Runners by Trigger Point (see pic below)

Continue reading…

Often, people assume hip and knee pain begin and end in those respective joints. While this can be the case, the truth is the ankle may also have a say in the matter. In my practice, I often see gait deviations, IT band issues, patellofemoral pain and many other issues related to ankle stiffness or soleus issues.

In assessing athletes, runners and weekend warriors, I often pick up asymmetries when measuring closed chain ankle dorsiflexion. I have even observed people who have active dorsiflexion within normal limits while seated on a treatment table, but once they become weight bearing things change. Even small differences can dramatically affect the body as the brain will find a way to get the motion it needs to squat, run, lunge, etc.

This often involves a compensatory pattern at the knee and/or hip joint. So, to that end, I recommend several strategies to improve mobility. I am currently doing a three part series on this for PFP magazine to provide some effective exercises to improve ankle and soleus mobility. Click here to read the latest column.

Below is a sample video of the wall touches I use to improve ankle motion after mobilizing the soft tissue.

Typically, I advocate doing 1-2 sets 10-15 repetitions.  Using the wall allows clients to have tactile feedback and a target to focus on.  This is a simple, yet effective way to gain motion in a loaded closed chain fashion as the hip, knee and ankle flex together in running, landing, squatting, lunging, etc.

If you are curious how I assess side-to-side differences, click here to read my initial column on assessment.  I hope these tools enhance your training and/or those you work with.