Stretching injured areas

[Simon Granit]

Hi, new here, this seemed like the best place to post this.

A little bit of background: I am very very good at accumulating injuries. This has led me into the field of rehab, and the topic I wanna discuss now is the topic of stretching injured areas, whether they are long term parasitic injuries or newly accumulated injuries.

So first of all, the biggest problem with an injury is that you can lose the ability to stretch. If you move into end ROM it's not a healthy stretch, but a suddenly painful experience. Many of my chronic cases have evolved to this.

What I've found works the best for me to get the ability to stretch is conscious and explorative movement in and out of the tough-to-stretch area. I try to embody a feeling of ease throughout the movements. If I don't have this movement ease I easily go in too deep and get a rebound in the form of protective tension or pain.

I also feel like warming the area up is particularly important here. Here is an example: Both of my ankles have some protective post-injury tension due to two bad sprains and walking on the balls of my feet since from basically around 4 years old to 15 years old. They have a fairly poor ability to stretch in dorsiflexion. They have what I would call a parasitic injury. I always have to be very careful when stretching them to not get more protective tension/inability to stretch (rebound). Sometimes I do my rehab/mobilisation in the morning and sometimes around lunch. If I do it around lunch I will have gotten about 40 minutes of walking before the rehab, and my ankles are fairly warm. The difference it makes is very big. I run a much lower chance of getting a rebound protective tension.

Once, when I did an eccentric calf stretch in the morning (fairly cold) I got A LOT of protective tension and pain that lasted the whole day. Note that I am otherwise doing acrobatics and parkour regularly more than half a year after the actual injury with the same ankles. This is solely an inability to stretch.

When doing the rehab in the morning I warm the area up with some band movements before applying any harder stretch.

After having tried a lot of things in areas that I have been unable to stretch this is what I have found not to work as well:

Static stretching

I think it is because statics just allow you more comfort. My experience when trying to stretch injured areas with statics is that they take make you too comfortable after a while, so you cannot properly feel if it is too much. When in the static position you don't get these small painful sensations that keep you in from going too deep into the stretch. Usually after coming out of a static stretch in an injured area I am more likely to feel a rebound, sometimes not immediatly but after I have cooled down.

Active loaded stretching

Isometrics, eccentrics, concentrics. They simply pull too much in the area with the inability to stretch. Too much of a stretch = rebound = bad time. Makes sense that you shouldn't add muscle tension if your joint doesnt even work properly.

 

Bottom line:

I have found that low load dynamic explorative end ROM stretching/movement works best for regaining the ability to stretch for me. This post is just to start a discussion and share some of my thoughts.

Questions:

How have you come back from injuries you previously could not stretch?

Am I nitpicking, and the emphasis is simply on just not applying too much force in the stretch?

Other thoughts?

 

[Cooper]

I have noticed exactly what you are talking about regarding ankles, it took me a couple years to finally realise this. No matter what I did I could not feel a stretch in the ankle, a blocked feeling. It was only through gentle rebounding movements while trying to maintain a sense of safeness that I was able to feel any sort of stretch (or even movement it was that bad), any forcing of the movement resulted in this protective sort of reflex. Like you said being warm is important, the protective reflex is much stronger in the mornings I find.

I try to do gentle micro bouncing movements in the most relaxed way possible trying to get deeper as I progressively bounce. I will also contrast this with stronger contractions but only after I am sufficiently warm. 

Its been a long 3 year journey so far with my ankles but I am finally starting to see progress, desperate to able to get that squat!

[Simon Granit]

Oh, the ankle mobility struggles

I have become very obsessed with getting a good squat, I understand your desperation to get it. I can squat fairly ok, but not narrowly. I have good hip mobility so I manage.

I've been wondering a lot about how often you should stretch your ankles. Often after stretching I get a soreness in the joint the next day. I wonder how many times a week would be good if you do stretching, not just limbering (hope im using this word correctly now) for the ankles.

The low intensity movements also make sense since the soleus is mostly slow-twitch composed.

[Cooper]

Im pretty close to getting a wide squat, hips just need to be a bit looser and I should have it. 

I do constant limbers for my ankles throughout the day, whenever I have a spare moment like waiting for the kettle to boil etc. I usually also do a more focused session everyday or every second day. The focused session will also include calve stretches and attempting to mobilise the ankle in this calve stretch position as well (quite a different sensation compared to when the working leg is closer to the body). Experiment with different angles, try driving the knee out as if you were going into a squat. 

It interests me what makes gaining ankle mobility so dam SLOW, everyone I talk to who has major ankle issues often takes many months to see progress and even years in bad cases. Before I started working on my ankles I literally couldn't dorsiflex at all, completely locked. My progress has ramped up recently though which is a good sign, it seems to become easier the more mobile they get. 

[Simon Granit]

Yeah, I usually squat a bit through the day and so, so im always getting some limbering done too.

I do three more focused sessions, which consist of different squat locomotion patterns. I find that just works best in gaining range. There is just something about using a more complex pattern that makes the stretch work better for me. Could upload some of the patterns if you wanna see

The interesting thing is that the blockage for me is primarily impingement in the front, and stiffness on the inside of the joint from my sprains, so when I do straight leg calf stretching, i get a lot more range, but the impingement is still there, so it just makes my ankles feel kinda bad. If I do mostly bent leg work on the other hand i can get rid of the impingement to some degree.

Honestly, I mean the ankles carry your whole bodyweight, it would make a lot of sense that they shouldn't budge that easily. Since you're constantly using your ankles too, they probably respond to the sedentary lifestyle with stiffness to protect the joint from damage and make it able to handle load, instead of becoming disinhibited like for example back muscles usually become from sitting. The achilles is also the strongest tendon in your whole body, so getting the tissue deformed and reformed must also be a much harder process.

[Cooper]

I currently don't feel any ankle stretch in the squat position for whatever reason, I may need to get my heels down first by working on the hips before I can start feeling the stretch. Elevating my heels with a towel or something when squating lets me feel somewhat of a stretch in the ankle. Ive noticed that I get a lot of muscle fatigue when I hold this for prolonged periods (tibialis anterior?), perhaps I should work to hold this elevated heel squat position for longer. This could be viewed as a more active form of ankle stretch.  

It does make sense, I guess it would be safer for the body to opt for a more rigid ankle as opposed to a hypermobile one which would likely result in injury. For me I think the stiffness definitely relates to how I walked and used them during my childhood, I also remember getting a very bad sprain on my right foot as a kid (my right ankle is a lot stiffer). Walking on the balls of feet like you mentioned in your original post could have potentially caused problems for me as well. 

Regarding your blockage, have you tried banded distraction stuff (search Kelly Starrett on youtube)? In short, it basically involves putting a band around the ankle joint then mobilising from that position. This helped me primarily at the start to get over that blocked feeling.

[Simon Granit]

Yeah, if youre leaning back more youre leaning less into the stretch, so having something under your heels makes sense if you want a bigger stretch. The stretch easily becomes too intense for me if i lean more into it, so being on my heels in a deep squat makes me feel enough of a stretch.

Yeah, i have tried the banded distraction, but it simply gives me too much rom and makes it feel pretty bad. I feel like i have to gain the range slower.

[Tones]

From personal experience. Get range of motion back. Basic strength work to stimulate functional healing once every 20-30 reps broken up however necessary. Proprioception done from day 1 and throughout. Most things will take a month.

If something reoccurs there is something underlining not being addressed.