Why Do You Keep Stretching That Stubborn Injury?

My blog this week is inspired by a recent conversation I had with a patient. She came to see me due to hip pain that never seemed to go away. Every time she sat or walked for an extended period of time, the pain would come back. I could tell she was frustrated, and rightfully so. Who wouldn’t get sick and tired of pain that never seems to go away? She even walked me through her stretching routine, which wasn’t providing her with any relief. Why wasn’t she getting better?

Most people will attempt to “fix” their problem on their own before seeking professional help. Of those people, the most common self management they will implement is stretching. The question I have is “why are you assuming that stretching is going to fix it?”. The likely answer is that most people think their injury is solely muscle related and by stretching their muscles, they will experience relief. Of course, this may absolutely be true, but it is often not the case. Let’s take low back pain for example. “Low back pain” is not a diagnosis! When I perform an exam, I want to know what exactly it was that you injured in your low back. Options are: muscle, tendon, nerve, ligament, disc, facet joint, sacroiliac joint, lumbosacral joint, or none of the above. Of these options, if you happened to suffer a muscle injury, then the stretching may help. Unfortunately, for the rest of these issues, you’re probably self treating incorrectly.

What about people that are already super flexible? I see people like this all the time, such as dancers or gymnasts who have the ability to do a complete split. If these people are already so flexible, is more stretching their answer to fix their chronic pain? Believe it or not, people who are hypermobile (too flexible) often suffer from persistent pain because their joints don’t have enough stability! In these cases, they need to think about strengthening their muscles instead. Sometimes, it’s beneficial to have less flexibility.

I know I’m being very critical of stretching here. Don’t get me wrong, I do prescribe stretches on a daily basis, but the key is to know which muscles to stretch and why you’re stretching them. You also need to know if stretching is warranted based on your type of injury. There are some conditions when I won’t teach stretches at all. In most cases, muscles tend to heal quickly. If your injury is lasting longer than a week or two, there’s a fairly good chance there’s more going on than a simple muscle injury.

Let’s circle back to my hip patient. As it turns out, during her stretching routine she was stretching many muscles except the one crucial muscle that really needed it! She definitely had good intentions, but needed to make some changes. I helped her make the necessary corrections and gave her new exercises to focus on, which included only one stretch and much more strengthening. Ultimately, time will tell how things turn out for her, but I’m confident that she’s made some initial changes to help her get back on track.

The moral of the story: Identify first what exactly the injury is, then provide the appropriate treatment for it. That’s how you get better.

Dr Rob Liguori