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To Stretch or not to stretch?: Case Study

Written by Kento Kamiyama PT, DPT

star-wars-quotes-for-star-wars-quotes-collections-2015-36
Just honoring Star Wars here

As I have yet to see the new Star Wars movie, I wanted to post a case study regarding a client (which I received consent from) in todays blog along with the idea of stretching something that is ‘tight’.

Whenever I choose a manual technique or even non-manual techniques my patient preference will matter significantly and I will try to find a mutual goal to make the healing start.  This will matter from a pain science perspective  which I highly recommend reading if you haven’t (here).

On to the case study: this is a client who came in for chronic low back pain which we are making good strides in.  Recently, one of his older injuries are coming back where he feels brachial plexus (ulnar/median) symptoms on his R upper extremity.

In the past, he has performed nerve tension stretches which has relieved some symptoms immediately, however, the symptoms have not dissappeared.   After further assessment, it became clear the symptomatic side of the neck was long and weak which for the patient ‘feels’ tight.  It became even more clear when a scapular clock type of movement was assessed.

I apologize for the bad camera work here.

For this particular client, his neck was not necessarily short and tight, but it was actually long and even inhibited.  This is where I educate and tell the client to put the brakes on stretching and perform different drills with the yoda like wisdom aura.  I will use analogies of how that muscle is like a rubber band that is being stretched.  A stretched rubber band tends to have a lot of tension within the structure and that could be what the ‘tight’ feel is.

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Once the client understood that the scapula needed to learn how to upwardly rotate or elevate, the symptoms has been getting better progressively.  The client is learning how to utilize the scapula while keeping a good rib position through breathing drills.

In the past, I used to give stretching to clients without thinking of it whenever the patient complaint of ‘feeling tight’.   Then I realized, the ‘feeling of tight’ can mean many different things: a tissue that is short OR long, stress, poor rib position, lack of hydration, lack of sleep, etc.  Similar to the mechanism of ‘pain’, the ‘feeling of tight’ is also a signal from our system sending communication signals that there might be something going on in that area.  After that signal, the individual will communicate to the therapist through their perception what may be going on.  I acknowledge their complaints and make sure to assess to double check.  This has helped me improve my outcomes in the long run.

Acknowledge the symptoms, become aware, get assessed and implement the intervention.

Have a great week guys!!

 

 

Several honorable mention articles:

Dr. Kathy Dooley’s blog about the The Stretching Instinct.

An article through the PRI lens on how a scapular position can alter neck muscle length by Mike Cantrell.  His explanation on the elevator scapula was on point.  An excellent piece.

Stretching has been one of the more controversial topics.  Greg Lehman does a great job with his blogs which I posted before.

 

vegeta
Just had to put this in here.

 

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