Micro-Stretching: it Works!

Workplace stretching has historically been controversial. But it has been rather conclusively shown to be highly effective… if it is done right. Our practice is perhaps the MOST experienced of all entities on this topic. Yes, it does work, very well, if done right (many do it wrong, even some PTs). You can find evidence summarized at our prevention site at http://www.impacc.com .

What is the critical value of micro-stretching? Many jobs have MSD risks that cannot be re-engineered away… no ergonomics corrections available. How do we protect these workers? Job task rotation to minimize uninterrupted exposure time… and micro-stretching.

Micro-stretching is a concise collection of very brief 10-second stretches that specifically target muscle-tendon-joint units that are exposed to the MSD risk. But ten seconds is not prolonged enough to lengthen tight soft tissues, right? Probably so. But that is not what we seek. We seek a relaxation of the overworked muscle-tendon unit, to allow a restoration of tissue perfusion. Repeated or sustained contraction blocks tissue perfusion, causing anaerobic metabolism causing buildup of metabolic wastes, which stimulate inflammation. Ten seconds mild sustained stretch stimulates Golgi Tendon Organs (remember those?) which then inhibit spindle activity… relaxing the contractile unit, allowing perfusion to pour through.

For 30 years we have been badgering employers to implement stretching. Most have now done so. But most are doing it incorrectly. Example: tennis elbow stretch has elbow straight, forearm pronated, wrist flexed down toward floor, person uses other hand to stretch wrist into full flexion. Right” Nope. Place your own arm in this position and ‘feel’ the stretch. Now, one simple change: close your fingers into a fist. Feel the change? Much more of a stretch now. The extensor digitorum shares the origin of the ECR muscle and is often part of tennis elbow and radial tunnel compression. This is the correction: do the tennis elbow stretch with fingers closed, for much more effective stretch.

Another example is stretching wrist-digit flexors to prevent CTS and wrist tendinitis. Most do this with elbow straight, forearm pronated, stretch hand into extension. Try this on yourself and ‘feel’ the stretch. BUT… try it with forearm in supination instead of pronation. Feel the difference? It is much more effective done in supination than in pronation… because we need to stretch the pronator teres in this stretch… to reduce pronator compression of median nerve (a risk factor for CTS or median nv compress at pronator) and reduce risks of medial epicondylalgia. This is another important correction for reducing workplace MSD through micro-stretching.

We also see an epidemic of including too many stretches in a program. That raises risk of improper stretching or abandoning stretching altogether. I see this error among PTs in the clinic. Give people the lowest number of exercises needed to gain accurate compliance. A typical microstretch program usually consists of only 8 stretches, customized to the job. Companies need a concises program that does not consume more than 3-5 minutes… or else it won’t happen at all.

Also we include stretches at neck to reduce forward head and tight thoracic outlet. Many workplace neglect the neck role in UE MSD risks.

MicroStretching may occur on a structured schedule such as at start of shift, return from each greak… but even more effective, employees should be professionally trained to self-select stretches whenever they notice discomfort to target relief to the affected body part. The key to this is excellent employee education by the PT expert.

Another effective component is a concise set of after-work recovery stretches.

Always include a disclaimer! “These exercises are prevention and wellness stretches. if you already have problems, consult your own PT to approve or modify stretches that are proper for you. Do NOT start doing any stretches without professional instruction by a physical therapist.”

And please, do NOT post your stretch programs online for people to download. You would not do that with clinic-based back exercises, right? Why? Because not everyone needs the same stretches. You would not want someone with disc herniation doing sit-ups and crunches and bilateral flexions stretches, right? And you don’t want someone with grade 4 spondylolisthesis doing prone pressups, right? Same with workplace stretches. They need (1) to be customized to the job risks and (2) people must be professionally instructed how and WHY to do each stretch, to assure safe execution.