The Importance of Stretching

The Takeaway:

Every home physical recovery programme after stroke should include static stretching of tight muscles. This is especially true after Botox injections. HOWEVER the stretches must be held with minimal resistance but for at least 30-60 seconds.

WHAT ARE THE BENEFITS OF STRETCHING MUSCLES AND JOINTS AFTER HAVING A STROKE?

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Research suggests that the benefits of using stretching exercises after a stroke are enormous. According to recent studies, the benefits of stretching muscles include all of the following:

• Relief of muscle spasticity problems. (I talk about what spasticity entails later in this chapter).
• An improvement in motor function (the ability to move around and carry out activities).
• An increase in joint range of motion (the ability of the joints to move fully through their normal range, ensuring that all activities can be carried out).
• Prevention of contractures (stiffening of the muscles over time).
• Reduction of muscle and joint stiffening and pain.
• Preparation for muscles to become active (allowing your stroke survivor to have a better chance of performing normal activities).

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So, what happens when a stroke survivor does not stretch their muscles and joints regularly?

The following:

1.?????? Development of muscle contractures

2.?????? Development of chronic joint and muscle pain

As a reminder about the importance of moving your muscles and joints every day, consider that disuse atrophy (wasting away due to shrinking of muscle cells) is caused by not using your muscles enough. If you stop using your muscles, your body won't expend the energy it needs to take care of them. Instead,?your body will start to break down the muscles, which causes them to decrease in size and strength.?

MUSCLE CONTRACTURES

According to the University of Pittsburgh Medical Center (UMPC)(1), a contracture occurs when your muscles, tendons, joints, or other tissues tighten or shorten, causing a deformity. Both having a stroke and being inactive for a long time are considered strong risk factors for the development of a contracture. Contractures involve developing extreme stiffness in a stroke survivor’s muscles, joints, or connective tissue. Symptoms usually include pain and loss of movement in the joint.

?Flint Rehab (2), which develops products for stroke recovery, tell us that contractures are a common complication after a stroke and can develop in any joint or muscle group in the body. They are affected by the lack of normal electricity going to the muscles and thus inhibit purposeful muscle activation and the development of muscle tone (resistance when moving a muscle). The normal result of this is spasticity. Naturally, after developing contractures, a stroke survivor will find it difficult to walk, get up from sitting or lying to transfer, and dress.

Muscle spasticity is generally described as a poor connection between the damaged brain and the muscles in a stroke survivor. Because the muscles are not getting the correct electrical impulses, the muscles spasm in response, eventually causing muscles to become stiff and tight.

?Warning: If spasticity is left untreated (by moving the joints and stretching the tissues/muscles), then contractures of the muscles and joints will usually develop in a stroke survivor’s limbs. The curling inward of the wrists, hands, and fingers—causing the hand to remain in a clenched tight fist—is an example of how spasticity affects the body after a stroke.

CHRONIC JOINT AND MUSCLE PAIN

Most people would assume that not moving a limb for a period of time will simply lead to loss of movement in the joint as the tissues get stiffer. But in my experience of working with stroke survivors and from speaking to stroke patients and their caregivers for over 30 years, it’s clear to me that a second symptom of ?the development of chronic pain is not understood.

The Mayo Clinic (3) describes this well in telling us simply that—as a result of a lack of movement—sensitive areas of tight muscle fibers can form. These sensitive areas are called trigger points. A trigger point in a muscle can cause strain and pain throughout the muscle. Allied health professionals often call this “myofascial pain syndrome.”

If someone does not move their wrists or fingers for a period of a few weeks, they will gradually experience pain in these joints. This chronic pain (pain that lasts for more than a few months) will seriously interfere with their quality of life and their motivation to perform rehabilitation—double whammy for a stroke survivor! The solution is to move the limbs regularly. For a stroke survivor, sometimes this can mean simply undertaking a simple stretching program.

?Remember our mantra of 10,000 repetitions: moving joints and limbs on a regular basis will prevent chronic pain and improve movement.

?So, if I asked you as a caregiver, “Do unused muscles cause pain in your stroke survivor?”

The simple answer is yes. As detailed above,?inactivity can cause back pain, knee pain, and even neck pain.

STRETCHING IS BENEFICIAL EVEN IF YOU HAVEN’T HAD A STROKE

This newsletter is instructing on how to be your stroke survivor’s rehabilitation supervisor, but that doesn’t mean that all the good advice cannot benefit you as well.

Most of my patients who exhibit a lack of flexibility will benefit from participating in stretching programs: yoga, for instance, has gained a lot of traction. My wife, Maria, has started attending a yoga class for the first time and already reports great benefits not just in flexibility but also in a reduction in her arthritic pain that had started to creep up. I find this fascinating and through good research evidence, it’s clear that regularly stretching your muscles and joints is one of the solutions to problems of flexibility and pain.

HOW SHOULD YOUR STROKE SURVIVOR STRETCH?

(‘Playdoh’, Contractures and Stroke Rehabilitation).

Including stretching regimes into a fitness program is vital to allowing us to have normal movement and strength. In fact it is the key ingredient in achieving rehabilitation success for a stoke survivor but it has to be done correctly.

?Speaking of ingredients, what can I make with a mixture of water, flour salt??

?Well, I guess bread is one good suggestion and for those of a fancy nature perhaps ‘tortilla dough’ but would the suggestion of PLAYDOH have been on your list.

PLAYDOH AND STROKE REHABILITATION

Apparently, over 3 billion playdoh cans have been sold since 1956. That’s enough to reach the moon and back three times and amazingly playdoh started life as a ‘wallpaper cleaner.

If you roll it across the surface of wallpaper it removes soot and dirt from walls. Not bad for a simple mixture of water, flour and salt!

?To understand how to maximise the stretch on muscle let’s use an example of ‘Playdoh’. What is interesting is that if you have a thick roll of playdoh and you hold it in both hands and very quickly and forcefully try to stretch it apart, then you are going to be unsuccessful.

However, if you apply a gentle pressure instead to try and stretch the playdoh apart then you will be very successful (it just takes a little bit longer), and here is the link with stroke rehabilitation.

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Message: It’s the same principle to stretch tight soft tissues

Tissues = muscles/ligaments/tendons/connective tissue.

If you try and stretch your muscles and put so much strain on them that they are shaking like a guitar string, then you will have lots of discomfort and little success. However, if you stretch muscles with a very minimal force, so that you feel just the start of a gentle resistance and then hold for 30 to 60 seconds, you will have brilliant success.

Both playdoh and human muscles behave like a ‘VISCOELASTIC MATERIAL’. To some extent they behave like both a liquid and a solid material and it has a time dependent strain (we don’t need to know more about this but certainly check in the appendix if you are interested).

Basically, when you stretch your stroke survivor’s limbs, you need to do so in a very specific way to be successful. Once you know what to do to ensure your stroke survivor does not develop contractures, you will easily be able to assist with the required stretches, then the mirror strength repetitions, walking, and sensory substitution will do the rest.

Important Rehabilitation Message for Caregiver:

In rehabilitation—as in many aspects of life—prevention of problems is better than having to find cures later. An important function of rehabilitation is to prevent muscle loss and retain flexibility. You are capable of achieving this with the correct guidance.

When stretching your patient’s limbs, only push the joints to where you feel the start of some small resistance in the muscle (or to when they tell you that they feel a minimal stretch). But then hold the stretch for at least 30 to 60 seconds and repeat as prescribed in the following exercises.

As has been said, “Time is Brain” in stroke recovery, so the quicker you start stimulating your stroke survivor’s brain, the less damage will be done and the quicker the recovery will be. But of course it’s not just the brain that is affected by a lack of attention in the stroke survivor, the muscles and tissues will also be affected.

Including stretching regimes into a fitness program is vital to allowing us to have normal movement and strength. In fact it is the key ingredient in achieving rehabilitation success for a stoke survivor, but it has to be done correctly. If you try and stretch your muscles and put so much strain on them that they are shaking like a guitar string, then you will have lots of discomfort and little success. However, if you stretch muscles with a very minimal force, so that you feel just the start of a gentle resistance and then hold for 30 to 60 seconds, you will have brilliant success.

Thank you: Can I thank Marco Giovannoli who sugested that stretching might be a good topic to discuss this week. Marco I hope this helps. Also can I mention Marco's brilliant new book about his experience of stroke. Great read!! Congrats.

Miracle In The Desert Book

Marco contact details

References

1. https://www.upmc.com/services/orthopaedicorthopedics/conditions-treatments/contractures-and-stiffness
2. https://www.flintrehab.com/contractures-after-stroke/#:~:text=Spasticity%20is%20best%20understood%20as,the%20muscles%20spasm%20in%20response.
3. https://www.mayoclinic.org/diseases-conditions/myofascial-pain-syndrome/symptoms-causes/syc-20375444#:~:text=Sensitive%20areas%20of%20tight%20muscle,call%20it%20myofascial%20pain%20syndrome.