>> Hello! Thank you so much for tuning in!
I'm Dr. Kathleen Davenport, and I'm here at HSS Florida to talk about maintaining flexibility,
and so I specialize in part in dance medicine.
That's a subspecialty that I do so flexibility is something that we talk about a lot,
but maintaining flexibility is good for all activities and all types of people,
so we wanted to make sure that we addressed this for everyone who needs
to maintain flexibility throughout their activities as well as their lives.
So I'm Dr. Kathleen Davenport at HSS Florida,
and I'm going to let George introduce himself as well.
>> Hi everybody, my name is George Giral.
I'm a Clinical Manager here at HSS Florida Rehabilitation and Performance Center.
I work closely with Dr. Davenport and her [inaudible] population in trying
to restore flexibility and strength for all of our patients here in Florida.
>> So we're going to have a conversation about flexibility.
A lot of these questions are questions that patients have asked us and that we've worked on,
talked together, and work with our patients here and elsewhere.
So one of the first questions that I get is what is the best type of stretch?
So George, what do you say when someone says, "What's the best stretch that I can do?"
>> I think the best stretch is one that gets incorporated into your daily routine
and is done on a continuous basis.
So it can be incorporated into your exercise routine if you're doing exercise three
or four times a week, or even after a sporting activity, whether it be tennis, golf, you know,
just taking the time after these activities and dedicating a good 15 or 20 minutes
for a proper cool-down and stretch.
>> I totally agree.
That's exactly what I tell my patients, and then I also add to them,
it's the one that you're going to do correctly, and the one you're going to do regularly.
And to be honest, with every single activity and every single body or body needs,
sometimes those stretches are a little different.
So it's nice to work with someone like myself and particularly with George to get
that right regimen of which stretches are best for you.
>> One of the questions that I get a lot is can I still become flexible
at you know during [inaudible] the stretching before,
is this something that can continue to be worked on?
So what is your typical answer for your patients that ask, "Can I still become flexible?"
>> I get that all of the time.
You know, we have people who live on the very flexible mobility end of the spectrum,
and then we have people who are just very tight, and what I say to people is
that you can be flexible at any age.
You know, it doesn't matter how old you are, how young you are,
you can absolutely gain both strength and flexibility throughout age.
A lot of times though I do see people stretching maybe not with the best technique
because when we focus on stretching, we're really focusing on stretching things
like muscles and stretching tendons, and sometimes people end
up just stretching joint capsules, and that's not necessarily getting where you want to go.
And so when we're starting a new stretching regimen, I usually ask people to really work
with someone like George with physical therapy to make sure they're doing it correctly
because absolutely I can start someone out with handouts and a program,
but it really is all about technique.
And so the whole goal of physical therapy is to learn the right stretches for you,
to do them with the right technique, and then to be able to incorporate them
in your life and continue with them.
How do you address that, George?
Like yeah, what do you like with becoming more flexible?
>> The first thing we've got to do is identify the target area that we're trying to address,
so you know for example, you know, we want to address the lower leg, you know,
[inaudible] doing a lot more, you know, stuff on the core or increase their walking.
Now that the weather's going to get a little bit nicer here,
what we want to do is really focus on the technique.
So just a quick example.
Two big things that we try to teach our patients is first thing is you know,
technique is everything, right?
So we want to make sure you know your traditional like stretch
through your lower leg will hit usually two muscle groups, your [inaudible].
So you want to maintain a nice upright body.
Okay, the back leg has to be nice and straight, and you'll see this a lot.
This is poor technique, right?
Leaning over, right?
[Inaudible] All you have to do is stay nice and tall, and then just lean forward, and you know,
hold that for a good 20 to 30 seconds.
And you should feel a nice stretch in the top of the lower leg.
Another exercise that we're going to do is to get the soleus muscle, and what we're going
to do is you're going to unlock your knee, which is going to be bending your knee.
You're going to sit back, and that should feel different, and it should feel the stretch
in a different part of the lower leg which I'll highlight.
You're going to hold that again 20 to 30 seconds, and again, the stretch should be felt
in the lower part of the lower leg.
And that's a good example of you know properly doing the exercise
with proper technique can really make a difference
in the patient feeling the stretch in the targeted area.
>> Those are great ones, and I really
like how you're keeping your feet very straight, or sometimes we say parallel.
I know sometimes people turn them in or out, so that was awesome, thank you.
Do you ever have someone who, you know, we're talking so much about technique.
Like does someone ever ask you, or do you ever see people come
in who are over-stretching and hurt themselves stretching?
>> You know, you know, obviously we have a lot of access to information now, right,
with the Internet, and so there's a lot of videos out there,
and you know I think the best thing is you know one of the main message we want
to provide is really gain that proper guidance [inaudible].
You know, your physical therapist, your doctor, you know, one of our great colleagues at HSS,
exercise physiologist who help provide that guidance
and the proper way to perform these stretches.
And again, I think you really got to identify, you know,
when am I going to incorporate these in my daily routine?
Am I doing the proper technique to address the muscles that have been trained
with that exercise or sport, and making sure that your [inaudible].
How long are you holding it for?
Are you going to hold for five seconds?
You're probably not going to get the best effect from the stretch,
so kind of really gain those guidance and the key principles
that will make each stretch be more effective.
>> I agree!
And with that guidance on the correct stretch, it's also about getting the correct diagnosis.
I know particularly in my dancers, any single tweak or injury or pain, they stretch it out,
and sometimes that's exactly the wrong thing, and it can make an injury worse.
And so sometimes I see people come in.
Hamstring is a great example of that.
I've seen a lot of people come in with a hamstring pull, and they're like, "Oh!
I'll stretch it," and I'm like, "Oh, whoa!
We need to give that a chance for those tissues to come back together."
Hamstring stretches are great, but not if it's an acute tear.
That's not going to get you where you want to go.
You really need to get that to come back before we get some stretches,
and so definitely getting that right diagnosis.
So I'll see people, do an exam, maybe get some imaging if we need it before sending them
to you, as you know, to then, and the--
you might be starting them with strengthening before we get them
into stretching, depending on the diagnosis.
So that's why I love working so closely with you so that we can come up with that plan.
>> And then so another question we get a lot is, you know, we touched on it a little bit,
is when is the best time to stretch?
>> This is a great question, and again, I get this one a lot,
and we talk about it a lot, so I love, I love this question.
And I like to use this as the time to talk about different types of stretching,
because stretching is not stretching.
You know, there are very different types of stretching, and there are three main types
of stretching: static stretching, dynamic stretching, and then ballistic stretching.
So static stretching is really when you like gain or maintain flexibility.
That's like holding those stretches, just like you showed with that calf stretch,
holding that for a really long time, really getting more flexible.
And those really you get the most bang for your buck kind of at the end of an activity.
So maybe getting up first thing in the morning when you're super, super tight,
you're not necessarily going to really get the most bang for your buck for that,
and sometimes your tissues are a little too cold, or they haven't really warmed up enough,
and you could potentially injure yourself with that.
I don't know, do you have a few other ones in addition to that calf stretch that you really
like for some static stretches, when people are already warm?
>> Yeah, so one of the big ones that we'll start setting up is you know, we tend to be a very,
a society that we sit a lot, whether driving to the office or on the computer,
so one of the ones that we really try to incorporate with most all of our patients is
to really try to get, you know, flexibility back along the anterior aspect of the thigh.
So you try and get someone into a good position, you know and half-kneel, one leg in front,
one down, and we really talk about getting nice and tall, tucking that pelvis under you,
and tucking your tailbone under you and really squeezing that glute, and they should,
you should feel a nice pull along the top of that anterior aspect of your thigh,
and then you can also go ahead and add some rotations and some twists, right,
and feel a nice, you know, pulling and nice gentle discomfort with your stretches.
So we always tell people I want to feel stretch discomfort,
but no pain when we're doing our stretches, so you should feel
like a stretch discomfort but no pain.
That, to me, that's key, so that's one good one we like to give to our patients.
Taking this thing down to the floor, another one is, you know,
a lot of our glute musculature does tend to get very tight, so we'll take them down to the floor
or in their bed and what we'll do is going to a bigger floor, we'll pull up the leg, right?
And what we'll do is we'll come in, and we'll bring that knee to the chest, and again,
trying to get that nice stretch discomfort along the back of the hip and the glute, and again,
holding the stretch for 20 to 30 seconds.
I usually tell people, you know, about a good three to four repetitions per side.
>> Yeah, and now with our handwashing, you should know all the 20-second songs,
so you could sing any one of those.
Do you have any other ones, like any good hamstring ones?
I know we just said to watch out for hamstring stretches, but when it's appropriate
to do it, do you have some favorites?
>> Yep, so you know taking it back to your point about you know someone's, you know gets,
they strain their hamstring, or they're out on the tennis court doing things.
You know, one of the things we will have them do is some ability drills
which we'll demonstrate by, I think they say, "Well, you know, it felt tight to me so I just
like got my strap, yoga strap which I found in my bag,
and I started doing some really heavy stretches."
So what we tend to show our patients is to have like an acute hamstring strain
that have been assessed by our docs is, you know we'll have them on the floor.
You can get your strap, and what we'll do is nice, gentle gliding.
Okay? So what we're trying to do is get nice mobility to a tissue without going
to an aggressive stretch, so again, doing 20 to 30 passes, nice, gentle gliding motions,
and trying to restore the mobility as opposed to giving a very firm, hard, static stretch.
>> I really like how you say the "restoring mobility."
You know that's such a nicer way to think about flexibility,
because sometimes when I have people hear flexibility, they're thinking like they need
to do splits or something like that.
I, I really like that term "restoring mobility," George.
Thanks. Yeah, that's a good one.
I wanted to go now, so that was our static stretching.
Did you have anything else to add to that before we talk about dynamic stretching?
>> No, I think the dynamic one's a good thing to segue
into since that's a time of when should I stretch?
You know, when's the best time?
I think depending on the activity you're going to be doing, you know,
I think it's getting the tissue ready to do whatever you're going to be doing,
whether it be going out to play golf, tennis again, any kind of sport,
because really getting the tissue prepared to be doing that.
So you're not, we're not coming straight out of our car, you know, and going out to the court,
doing anything that's going to get the tissue ready to prepare
for what's about to happen on the court.
So I think some of the dynamics that we can kind of go over real quick.
If you're ready?
>> Yeah, I love the dynamic stretching, to really think of it as a warmup and making sure
that we're doing the dynamic stretch at the beginning, and thinking about the flexibility,
the restoration of movement, not just as the static stretching,
but also these with the dynamic warmup, so yeah, go!
What you got?
>> Yeah, and I think one of these things that's important is really timing out your day,
so like if you know you're going to need a little bit of time to get yourself ready
to do what you need to do for your sport is, you know, making the time to get yourself early
to the, the training center or the facility or the park, wherever you're going to be meeting,
wherever you're going to be doing that exercise.
So the first one we'll talk about is going ahead and doing some like knee hugs.
Coming up, right?
Trying to get nice, good mobility there.
You know, and then we're going to bring up, you can grab and come up here, grabbing up, nice,
then if you can get the back, doing some scoops, right?
Nice and easy.
Again, these are nice, just trying to get the heart rate up a little bit.
You can come across and try to come over, right?
Coming across, come over, and that's challenging.
Now, you can simplify things, okay?
So you can do this nice, and do some like nice heel-butt walks, right?
And again, depending on what you're going to be doing,
you can come to each side, do a couple repetitions.
You're just saying, you know, five to ten on each side would be good.
Trying to get, you know, the body ready
to have a specific movement pattern that you're going to be doing.
Again, still working on some balance here.
Right? So you're going to work from here.
Again, getting that posterior [inaudible] ready to go.
Again, I'm showing this version right here.
Now a nice way, and again, you know, doing some movement patterns, getting ready for what--
especially if we're talking about the lower extremity.
If you're doing some upper extremity, you can bring out your band
and get your arm ready to go as well.
>> And these are great to do, too, you know, whether you're going out to the tennis court
or you're at home and just need to get up out of your chair a little bit.
These are also some good ones to do, and then maybe doing some of the static at the end.
And I really want to point out something important that you were doing
which is not ballistic stretching.
So the third type of stretching is what we call ballistic stretching.
That's kind of like bouncing, like you're in kind of bouncy, bouncy, bouncy, and,
and tissues don't really like that.
So we recommend against that type of bouncy stretch.
So it's important to notice that the movement that you're doing, George, is very much moving
through it, holding it, but you're not trying to like bounce, and I also notice you're not trying
to go to your end to end to end to end range.
You know, you could push your flexibility harder,
but that's not the point of the dynamic stretch.
That really is to warm it up, to help go through the motion without trying
to push it beyond where it really wants to be.
>> Yeah, the thing that's really, again, getting the body ready, you know, little by little.
And each one of those reps can go into a greater depth as you feel more ready
and you feel more warmed up, so you gradually get yourself into that position
that you're going to be mimicking when you're doing your sport.
And I think, going back to the ballistic stretching, I mean,
there's a very small population that it's probably indicated for whether that be you know,
your jumping athletes, your dancers, you know, which is you're priming the neurological system
to be ready to perform at a high level, at high height and high levels of difficulty,
so the majority of the population is, you know, probably not indicated for, and I think things
that we cover today are, you know, are what's really going to help everybody, you know try
and stay healthy and trying to keep the tissues in a good state
so it will do what you like to be doing.
>> Awesome.
Thank you so much for preparing such awesome stretches for us and taking the time to do that.
This was super helpful for me, and super fun to chat about, so thank you so much!
>> Alright, it was a pleasure.
>> Alright, take care!
>> Alright, you too.
>> Alright!