33 minute read
K9 Massageguild
The Rise & Rise of
Clinical Canine Massage Therapy
Advertisement
BY NATALIE LENTON
Have you ever considered offering massage to dogs alongside your human practice? According to the PDSA, in 2022, 52% of UK adults own a pet, with 27% of UK adults owning a dog, giving an estimated population of 10.2 million pet dogs in the UK alone. Clinical canine massage therapy has exploded in popularity over the last decade and with more people owning dogs than ever before, owners are looking towards complementary therapies to help their four-legged friends. But before you start entertaining the idea of treating dogs, there’s a few things that you need to know
But is it rewarding? Natalie Lenton, Director of the Canine Massage Therapy Centre and Founder of the professional association the Canine Massage Guild, says, “If you are someone who has a passion for dogs and complementary healthcare then this career path takes job satisfaction to a whole new level. In canine massage therapy, we get to help the dog, most frequently with mobility or performance issues, and we also get to help the human client by supporting them with concerns they have for their dog’s health and welfare. Our dogs are pivotal in our lives, not only providing us with companionship and the excuse for nice walks, but more than that, they give us unconditional love and a state of presence that makes the human to canine relationship unique. Many people are turning to canine massage to improve their dog’s physical health and vets are referring dogs for massage who are unable to tolerate NSAIDS”
Typical clients of the canine massage therapist include dogs with physical trauma, for example, soft tissue injuries and issues sustained from activities of daily living such as strains, trigger points and myofascial pain, as well as providing chronic pain management for dogs with orthopaedic conditions like arthritis, hip dysplasia, spondylosis and luxating patella. Other types of canine clients can include abused or traumatised dogs, agility and sporting dogs, and lots of senior dogs whose owners utilise the therapy to improve mobility and manage pain in the dog’s twilight years with often very profound results.
Firstly, unlike with human clients, you can’t just go ahead and treat. To be able to treat dogs, a therapist has to comply with the Veterinary Act 1966 and Exemptions Order 2015, and this means having the relevant training and insurance in canine massage therapy as well as obtaining veterinary consent for each dog that is treated. These standards were set by the Royal College of Veterinary Surgeons (RCVS), as canine massage comes under Section 19 of the Act meaning that massage therapy for dogs is classed as a minor act of veterinary surgery.
Overkill? Probably not, as providing massage to animals is distinctly different to providing it to their human counterparts. The therapist has to consider how working with the nonverbal client presents several challenges including taking into account:
• Canine behaviour and body language • Bite risks • The unique aspects of canine anatomy and physiology • Adaptations and variations of technique • Pain perception • Floor work, couch work and positional variations • Pain presentation and symptoms • Canine pathologies • Canine handling skills
In terms of its efficacy, much as with human massage, it’s going
to depend on the level of training and practice of the individual therapist.
There are several canine massage courses available in the UK with differing course content, but the most important piece of advice is to find a course that teaches the practical element in person. Whilst theory can be completed via distance learning, a student’s full potential can never be reached if all learning is online. You may choose your course based on content, the location or even price, but if you want this as a career or to supplement your existing practice, then consider the level of training you will receive as this will determine your future success. Ask yourself, can you learn everything you need to know on a 1-day course to effectively help a dog’s injuries/ condition? And more importantly, would you want your dog treated by a person who had never had handson supervision and only done a short course? It’s questions like this that your potential future clients will ask too. The Canine Massage Guild (Guild) is a professional association for Clinical Canine Massage Therapists, aiming to raise industry standards. All members have trained with the Canine Massage Therapy Centre Ltd, (CMTC) on the Clinical Canine Massage Practitioner Programme (Practitioner Programme) externally accredited by LANTRA which has a successful track record of training therapists for over 10 years. Indeed, both the association and the training company have gone on to change the face of canine massage therapy with the world’s first clinical trials in canine massage therapy.
Evidence-based research
Last year, the world’s first peer-reviewed research on clinical canine massage therapy and the Lenton Method™ was released in the Vet Record published by the prestigious British Veterinary Journal. The Canine Massage Guild and Canine Massage Therapy Centre worked with Winchester University and University Centre Sparsholt to produce this pioneering research. University Centre Sparsholt is one of the UK’s leading providers of undergraduate courses for the land and environment. It has strong links with The Royal College of Veterinary Surgeons as well as a large number of RCVS Approved Training Veterinary Practices in the south of England. Winchester University’s Centre for Animal Welfare is an interdisciplinary centre that undertakes research, teaching and public engagement in the field of animal welfare. In the most recent Research Excellence Framework (REF 2014) 82 percent of its submitted research was considered to be recognised internationally, with seven out of eight units of assessment achieving world-leading quality. The study, named the ‘Effect of massage therapy on pain and quality of life in dogs: A cross-sectional study’ (Riley, Satchell et al, 2021) was across 527 dogs and the results of the study showed that over 95% of dogs respond to clinical canine massage therapy, and most specifically the Lenton Method®
Guild practitioners use the exclusive Lenton Method® of massage to treat soft tissue injuries and MSK conditions following veterinary referral direct from the practice or as client-led. Practitioners assess and treat issues with gait, posture, daily activity, behaviour, and performance, known as the Five Principles of Pain, seeking to improve a dog’s quality of life. Guild practitioners were asked to complete a standardised report per dog documenting life history variables (e.g. age, breed, sex), clinical diagnoses and known or deduced aetiologies, and number, severity (score) and improvement status (improved/ worsened/no change) of each Five Principles of Pain parameter before massage therapy commenced and after each of a maximum of three massages. Practitioners were asked to record if they considered the dog had improved post-treatment. Wellness, quality of life and mobility improved across all breeds and ages of dog with improvements
typically seen after the first treatment and increasing after the first session.
The Lenton Method®
So, what is clinical canine massage therapy and the Lenton Method?
Therapists in the Canine Massage Guild have trained for 2 years with the Canine Massage Therapy centre to master 4 disciplines of massage from the human world including Swedish, Sports, Deep Tissue and Myofascial Release, both the direct and indirect method. But where the therapy differs is in the provision of the Lenton Method, a modality invented by Natalie Lenton, the founder of both the Canine Massage Therapy Centre and Canine Massage Guild which celebrates its 10th anniversary this year.
The Lenton Method® is a 3-tiered approach to the evaluation, treatment and reevaluation of the canine patient who presents with soft tissue or musculoskeletal injuries and/or degenerative diseases like canine osteoarthritis. It is also used for emotional trauma and abuse cases. “The dog holds trauma and emotional distress in their myofascial network, just like the human. Over the years I have seen profound changes not just in the dog’s mobility and motor output but importantly in the way they process sensory input with my method which tends to get results between 1 to 2 3 sessions.”
The Lenton Method consists of the following:
Tier 1 - Advanced Palpation – the practice of informed touch involves the therapist’s ability to read and translate texture, tone tenderness and temperature of the many muscles of the body (the 4T’s) using a comprehensive and structured palpatory procedure. Guild therapists also utilise the ‘3 Interconnected Qualities of Fascia’ model (Luchau 2015) simultaneously with the 4T’s for assessment and re-evaluation of your dog’s soft tissues and fascial planes. The therapists use a range of palpatory techniques and are trained in appropriate grip modulation and force control for a comfortable experience for the dog who is often a lot more discerning and critical of touch than their human client counterpart. Palpatory literacy is a key skill necessary for gaining a thorough picture of primary and secondary issues including overcompensation and habitual patterns of tension arising from soft tissue, orthopaedic and neurological issues.
Tier 2 - BodyMapping – During their training, therapists commit to memory a comprehensive anatomical map of the dog’s musculature and fascia along with the precise locations of injuries which include strains, trigger points, hypertonicity and myofascial pain as catalogued over a decade by Natalie Lenton. This promotes consistency between practitioners and is utilised in conjunction with Tier 1: Advanced Palpation.
The 7 Protocols – A series of complex direct myofascial releases to address chronic structural imbalance and fascial dysfunction as a result of soft tissue injury or degenerative joint disease. Following Tiers 1 & 2 the 7 protocols are preceded by Swedish, sports and deep tissue massage. The 7 Protocols are applied with often profound and long-lasting results as determined by the indicators presented and the outcome achieved and are a key factor in the success of the therapy. Typically, a therapist will have 60 techniques across 4 disciplines and the Lenton Method and 7 Protocols at the end of the 2 year training.
Further CPD can be accessed after the course in Manual Lymphatic Drainage, Neuromuscular Facilitation, Stretching and a range of other modalities for the dog.
Natalie Lenton says “Dogs have a way of making us become very present and just like with humans, they all have individual personalities, characters and pain levels. The dog can’t be told what massage is, why it’s happening or how to behave. It’s the role of the therapist to create meaning and trust and on a different level and communicate that. This means that a lot of the training we provide is to get the human student to listen to themselves on a different level too.
The dog can perceive things that the human client can’t and that means the therapist must employ a very different level of selfawareness and control. The dog can hear the heartbeat of the therapist, they can smell different hormones and chemicals on the breath and body of the therapist as well as other smells the therapist carries. They can detect brainwaves and other frequencies emitted by the therapist, so we train people in a very different way from how a human therapist is trained. Training in canine massage is a journey of self-discovery as well, it’s not just a case of press here, do this technique and this will happen. Dogs have made me a better person, they have made me reflect on myself and be more honest with myself on who I am and where I want to improve” The dog gets a chance to be heard on a different level with this therapy and to feel better in their body and mind so they can experience greater freedom in life. The clinical canine massage therapist gets to walk between the human world and the animal world every day and make profound changes in the dog’s life. There is a great sense of honour, of trust and magic when you watch a session of canine massage therapy.
“When I train students, I will often say, “We train you and the dogs teach you”, and to me, that’s what makes it the most beautiful therapy in the world.
To find out more about Canine Massage Therapy 1 day self-interest workshops across the UK and the 2 year Clinical Canine Massage Practitioner Programme, visit www.k9-massage.co.uk Email: jenny@k9-massage.co.uk
To find practitioners in the UK and other parts of the world visit
www.k9massageguild.co.uk
https://bvajournals.onlinelibrary.wiley. com/doi/10.1002/vetr.586
Adrenal Fatigue & Stress
By Amanda White
Even though stress is considered commonplace in our day-to-day life, it can lead to many problems. Adrenal burnout or the exhaustion phase is where the body has coped with long-term stress but cannot cope any longer, and symptoms start to show.
Signs of adrenal imbalance could include any of the following: • Exhaustion / Burnout intolerances / Rapid heartbeat /Headaches • Poor memory and concentration • Low or fluctuating mood • Frequent colds / Infections • Problems with sugar, salt or stimulants / Constant hunger • Menstrual difficulties / Skin problems • Muscle pain / Flu-like symptoms / Headaches • Lowered sex drive / Hair loss or thinning • Sweating / Palpitations / Rapid heartbeat /
Panic attacks The adrenal gland controls the bodies fight and flight system. Increased stress and anxiety cause a release of adrenalin into the blood supply. This response is your body’s instinctive response to stress from unexpected events. What is stress?
Many things lead to stress – from areas of physical, environmental, or emotional issues. We tend to feel less stress if we have time, experience, and the resources we need to manage a situation.
An accepted definition of stress (from Richard S Lazarus) is that stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual can mobilize.
Hans Selye (one of the founding fathers of stress research) in 1956 quoted “stress is not necessarily something bad – it all depends on how you take it. The stress of exhilarating, creative successful work is beneficial, while that of failure, humiliation or infection is detrimental.”
What are the adrenal glands?
The adrenal glands are triangular-shaped glands that sit on top of both kidneys.
The glands contain two different hormone-producing areas: the adrenal medulla and the adrenal cortex. The adrenal cortex - works on the production of steroid hormones. The adrenal medulla - secrete water-soluble hormones adrenaline and noradrenaline directly into the bloodstream in stressful situations. This triggers the fight and flight response by preparing the body for an emergency.
The adrenal gland controls the bodies fight or flight system. Our busy lifestyle puts considerable stress on our bodies. Increased stress and anxiety cause a release of adrenalin into our blood supply, increasing the heart rate and muscle tension, readying the body to react quickly to the specific situation. Even though these situations appear commonplace, the adrenals still react, building up chemicals in the body. Initially, the body responds quickly to these stimuli, however over a long period of time the body adapts to the stress and sooner or later stops being able to cope and you then get the exhaustion phase/burnout, where you are more likely to go down with flu-like symptoms and stimulants such as coffee, or forced to stop working as the body can’t cope with being pushed any further. One of the big problems with burnout is that you often don’t notice that it’s happening until it’s too late. Case History
When I saw Jack, he was very stressed at work and was feeling under pressure to keep up with his caseload. He felt tired, anxious and was starting to get panic attacks. He had a twitchy eye and was getting quite irritable and not sleeping well. Jack was also craving stimulants to keep himself going.
I recommended he learn some stress release techniques such as Emotional Freedom Therapy (EFT), increase his water intake, adding a 50mg B complex tablet, a Milk Thistle tablet to calm his liver energy, and for him to stop the caffeine completely as 1 cup of a stimulant such as tea or coffee stays in the body for 24 hours and doesn’t allow the body to switch off properly as it is being continuously topped up. Jack also received acupuncture to boost his adrenal (kidney energy). For the 1st week,
Jack suffered a bit with headaches as he went through a caffeine withdrawal. After a week he said he missed the caffeine, but he felt calmer, the panic attacks reduced in number and his eye stopped twitching. Over the next few weeks with the treatment, plus the acupuncture all his symptoms cleared, and he was able to cope again at work. “Thank you Amanda for giving me my life back”. How do I fight stress?
The 3 major approaches to manage stress are: 1/ Action-oriented: By confronting the problem causing the stress and then changing the environment or the situation. 2/ Emotionally oriented: You might not have the power to change the situation, but you can manage the stress differently by changing your perception of the situation and the way you feel about it. 3/ Acceptance-oriented: Where something has happened over which you have no power and no emotional control, and where your focus is on surviving and getting past the stress. • Increasing water intake, as our body needs water to flush out toxins. If you are dehydrated (it’s the difference between a free-flowing stream or a stagnant puddle). • Adding a 50mg B complex tablet, as the more stressed you are the more B vitamins you absorb therefore the more you need. (Be aware the B vitamins can turn your urine fluorescent yellow and this is ok). • A Milk Thistle tablet to calm the liver energy as the liver in Chinese philosophy works with the emotions of anger, frustration and irritability. • Take Vitamin C as this is necessary to protect the adrenals from high levels of free radicals produced during times of stress. • A Calcium & Magnesium supplement is helpful as the Magnesium works with muscle aches and aids sleep, and Calcium helps calm an overactive nervous system. • Stop the caffeine completely as 1 cup of a stimulant such as tea or coffee stays in the body for 24 hours and doesn’t allow the body to switch off properly, as it is being continuously topped up. This includes coke, green tea, and energy drinks. • Balance blood sugar levels – by reducing excess sugar and eating more slowly digested carbohydrates.
But in smaller amounts as wheat-based products and high carbohydrate diets can make you tired. • Eat more antioxidant-rich food, fruits and vegetables. • Increase intake of oily fish and take fish oils – if the skin is dry or itchy. • Cut down or stop alcohol as this can irritate the liver and make the symptoms worse. • Eat regularly but healthy foods to keep the blood sugar balanced. • Exercise can help lift moods and aid detoxification but avoid excess or high intensity as this can drain the adrenals. Gentle regular exercise that calms the mind and body such as walking, dancing, yoga or swimming can aid proper adrenal recovery. • Deep breathing – can be calming as when we are stressed we tend to curl in on ourselves. Dropping the shoulders down and slightly back opens the chest area and allows for deeper breaths.
Stress Management needs lifestyle changes, such as the above to maintain a calmer mind and body. There are many areas you can work with, but it pays to take a 3-prong approach by working with the nutritional, emotional and physical sides. • Start a relaxation technique such as (EFT)
Emotional Freedom therapy, which is a technique where you tap on points on the body that are linked to different emotions and works as a flush or a release valve for emotional stressors. • NLP (Neuro-Linguistic Programming) helps you change your way of looking at things and think more positively. • Music, meditation and visualisation techniques to relax the mind and find a relaxed state. • Find time to turn off, power nap with deep breathing and relax. • Make sleep important - drink a camomile tea before bed as it helps relax the body.
The best way to manage burnout is to prevent it from happening in the first place. Consider your health and mental state as important parts of your life and develop new ways of enjoying life more. Take it back to basic needs. Remember to seek help from friends, family, and therapists if you need it.
“Another day above ground is a good day!”
Amanda Madeleine White is a Registered General Nurse, Licenced Acupuncturist, Cert Education, Health Consultant, and the founder and CEO of SKART International Ltd. Structural Kinesiology Acupressure Release Technique (SKART) is a cutting-edge new diagnostic and therapeutic technique that is designed, trailed, and used for the efficient management of back, neck, hip, and leg pain. During her career in nursing (RGN 1989), Amanda developed ME & back problems. This sent her on a journey of discovery. From there, she travelled to China to study basic acupuncture with a group of trainee doctors. When Amanda returned, she completed 3 years of training to become a qualified acupuncturist (British Acupuncture Association) in London. Amanda has been on a lifelong journey into complementary therapy, searching for answers and cures. She has also trained as an Advanced Kinesiologist, Reiki Master, NLP master practitioner and EFT therapist, whilst curing herself of several issues along the way. To share her passion and knowledge, she chose to qualify as a certified teacher (Cert Ed) so that she could start training other individuals in these subjects, that she feels passionate about. info@myskart.org
◆ ADVANCED CPD ◆ STRETCHING THE TRUTH Using stretching in massage
BY RACHEL FAIRWEATHER
What the new evidence tells us about stretching
Stretching – it’s good for you- isn’t it? Surely it’s common wisdom that stretching makes you feel better, increases flexibility, prevents injury before sports challenges, improves athletic performance, reduces muscle soreness after exercise and alleviates the pain of a bad back (that is if you actually DID the exercises your physio had prescribed). Runners and cycling magazines promote the value of stretching for “leaner,thinner bodies”, Google harangues us with ads for stretching-friendly lycra clothing, and yoga has never been more popular. Stretching has become a whole industry in itself with ever- fancier names applied to the latest stretching methods. Indeed it can be dizzying to try and keep up with the current state of the art stretchy technique. Stretching is “dynamic, baliistic, proprio- neuro- facilitated, active isolated, passive, contracty- relaxy and above all finger lickin’ good!”
Yet an explosion of academic interest into stretching over the past decade has suggested that maybe stretching isn’t the absolute panacea for all ills that it has been built up to be. The truth is much more complex than the simple dichotomy of “stretching is good for you” or “stretching is useless and a waste of time”. So lets break down the magic from the myth, hyperbole from hard fact, as we look at the academic evidence and expose the real truth about stretching.
Common Wisdom about stretching
If you are at all interested in bodywork, complementary therapies or the health and fitness industry you will probably subscribe to one or more of the following beliefs about stretching.
◆ Stretching helps you be more flexible - it permanently lengthens short and tight muscles ◆ You should stretch before you work out as it helps prevent injury ◆ If you stretch before and after exercise it helps prevent and reduce muscle soreness (known in the trade as
DOMS – delayed onset muscle soreness) ◆ Stretching before an event helps improve performance in sport ◆ Stretching makes you feel good ◆ Stretching is helpful for musculo-skeletal pain such as a bad back
What the evidence says
Lets take each of these beliefs one by one and see what the research evidence has come up with.
Stretching helps you be more flexible
Well yes it does – numerous research studies have shown that regular stretching does indeed make us more flexible. If we regularly stretch our hamstrings we should be able to reach further (Decoster 2005) Depending on your starting place this may mean you are now able to do up your shoelaces while standing, get further into that pesky forward bend in yoga or win that circus job you have been after.
However what is fascinating is that the reason we can stretch further is probably nothing to do with elongating the muscles permanently. A thorough systematic review of academic studies on the subject (Weppler 2010) proposes that any change in muscle (or connective tissue) length is transient and in fact the only reason we can go further on repeated exposure to stretching is due to an alteration of sensation only. In other words our brains just get used to stretching a little further each time – our resting muscle length remains exactly the same. Bad news for health and fitness magazines promising a “longer leaner body” through stretching!
You should stretch before and after you work out as it prevents injury
Mixed news on this one. There is conflicting evidence as to whether stretching can prevent injury and the somewhat unsatisfying conclusion when reviewing all of the evidence is that stretching “might prevent some injuries in some sports at least some of the time”
There are several authors who have looked at all the research studies out there – for example a systematic review of the literature by Thacker et al (2004) concluded that “Stretching was not significantly associated with a reduction in total injuries”. This is not particularly helpful for the athlete wondering if they should stretch or not before exercising –the authors’ summary of the study ends with the politician’s “we can neither confirm or deny” type advice that:
“There is not sufficient evidence to endorse or discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes.”
Another systematic review (Hart 2005) was less circumspect, concluding baldly “Limited evidence showed stretching had no effect in reducing injuries.”
However it seems that perhaps stretching may help to reduce injury for some sports but not others (Witvrouw et al 2004). Stretching seems to reduce injuries in sports that involve bouncing and jumping activities with a high intensity of stretch-shortening cycles (SSCs) (e.g. soccer and football]. However when the type of sports activity contains low-intensity, or limited SSCs (eg: jogging, cycling and swimming) stretching may not be helpful in preventing injury. This is seen in the literature, where strong evidence exists that stretching has no beneficial effect on injury prevention in these sports.
Other authors (Woods 2007) suggest that it has been difficult to interpret all the available research due to the number of different stretching techniques used and felt instead “that certain techniques and protocols have shown a positive outcome on deterring injuries.” They recommend that a warm-up and stretching protocol should be implemented prior to physical activity. The routine should allow the stretching protocol to occur within the 15 minutes immediately prior to the activity in order to receive the most benefit.
Small et al 2008 concluded that although static stretching does not reduce overall injury rates, there is preliminary evidence that static stretching may reduce musculotendinous injuries.
It also seems that stretching as a regular routine rather than just before you exercise is more likely to reduce injury – so going to that regular yoga class may be more likely to reduce your possibility of injury than the short stretching procedure before sports. (Shrier 2007)
The research is pretty unequivocal on this one – it doesn’t, or at best only a little bit. A large review of all the relevant studies (Herbert 2011) concluded that:
“The evidence from randomised studies suggests that muscle stretching, whether conducted before, after, or before and after exercise, does not produce clinically important reductions in delayedonset muscle soreness in healthy adults.”
There was one large study showing that stretching before and after exercise reduced peak soreness over a one week period but this was only by, on average, four points on a 100-point scale. Hardly something to write home about.
There is a bit of a shock-horror headline about this one as research over the past decade has suggested that not only does stretching have less impact than previously thought on performance but in some cases actually has a negative impact. That’s right – depending on the sporting event, pre-event stretching may actually cause you to do worse.
This finding specifically applies to sports that require isolated force or power (such as jumping) –in these cases stretching prior to an event can cause diminished performance. This is true whether the stretching technique used is static, ballistic or PNF. So elite basketball players would jump less high if they stretched immediately before playing. Maybe this was the problem in the 1990s movie “White men can’t jump” –perhaps the white guys were sticking too strongly to their pre- event stretching routine!
On the other hand, regular stretching at other times (not immediately before an event) actually improves the results for many sporting activities including enhancing running speed. (Shrier 2004). In other words regular stretching after exercise or at a time unrelated to exercise is more beneficial than your pre-exercise stretching “warm up” routine.
So if you want to improve general sporting performance, get to that regular stretching or yoga class!
Stretching makes you feel good
This is an easy one to prove or disprove as it is firmly based on the scientific foundation of your own personal laboratory. Does stretching make you feel good? Great – do more of it! Do you hate it? Then find another way to exercise or increase flexibility if you need to.
The potential psychological benefits of stretching seem to have been largely overlooked in the research studies as lets face it, academics are usually in pursuit of more “science-y” things to prove. Yet anecdotal evidence suggests that humans love to stretch – it helps us feel more balanced, less tired and is a good form of stress relief. Stretching is the basis of spiritual practices such as yoga – the poses (asanas) help prepare the body for the contemplation of meditation afterwards. Eastern massage practices such as Thai massage and shiatsu incorporate stretching as an integral part of the art. The purpose of these stretches is not to increase flexibility but to promote balance and harmony in the meridians and energy of the body.
One of the few studies conducted on stretching and mood was in a Spanish workplace that implemented a short
Stretching Techniques for the Massage Therapist
So now we have looked at the evidence, what different methods of stretching can be incorporated into our massage treatments?
There are a myriad of different types of stretching used by the bodywork therapist both within a treatment and for client self care purposes. Stretching has always been big in manual therapy both East and West - Thai massage, shiatsu and Tuina all feature stretching as an integral part of the therapy. Massage therapists, Physiotherapists, osteopaths, chiropractors, personal trainers, Pilates teachers and the emerging role of yoga therapist (using yoga techniques for the treatment of pain conditions) all use stretching techniques to varying degrees for rehabilitation of acute and chronic pain conditions.
In addition to a range of benefits, stretching also looks and feels impressive to the client - I had one woman who came back to me solely on the basis that you “did that stretchy thing to my neck that no- one else ever did”. My lovely Thai massage teacher Asokananda (sadly no longer with us) had a great phrase for some of the more dramatic stretches of Thai bodywork dubbing them “show business massage”. At Jing we always use these stretches when we want to “show off” - at exhibitions a few classy stretches is enough to bring a crowd gathering! I know it’s shallow but hey massage can be a lonely business so take the attention when you can get it, I say.
The names of different stretching methods can be bewildering so it is helpful to break them down into 3 broad categories of how the muscle is stretched: static, dynamic and pre-contraction stretching. We will also discuss a couple of ‘newer’ forms of stretching: therapeutic stretching and fascial stretching.
1. STATIC STRETCHING
This good old traditional method is still the most popular and widely known form of stretching. In static stretching the muscle is elongated to the point of a stretching sensation and held in position. This can be done in 2 ways:
◆ Passively with a therapist or partner (client lies on their back and therapist takes hamstrings to the point of stretch and holds leg in position). This is also the type of stretching commonly used in shiatsu and Thai massage ◆ Actively where the client is engaged in the movement (client lies on back and raises leg themselves; then takes leg into full stretch with assistance of rope, belt, or the hands. This could also be achieved by placing leg against wall. This is the type of self stretching used in yoga poses.
2. DYNAMIC STRETCHING
Dynamic stretching can be divided into active and ballistic. It is REALLY important to understand the difference between ballistic and other forms of active stretching as they can seem similar but are actually quite different
Ballistic stretching This involves bouncing at the end range of a stretch - the good old reach for your toes and bounce up and down in the same position is a ballistic stretch for the hamstrings. PE teachers in the seventies were big on this one as was Jane Fonda (although she apparently corrected herself in later teachings so she should not be blamed entirely for the fad that probably bumped up an entire generation’s musculoskeletal injury rate)
Ballistic stretching is generally not recommended due to its potential for injury - as the American Academy of Orthopedic Surgeons sternly warns on their website “Do not bounce your stretches. Ballistic (bouncy) stretching can cause injury” (Orthoinfo.aaos. org, 2014) .Personally I love that the orthopaedic surgeons are using the word bouncy. Although ballistic stretching is generally not recommended for most sports people, there is some new evidence suggesting that ballistic stretching significantly increases tendon elasticity and therefore might be helpful for both preventing and treating tendon injuries (Witvrouw 2007; Mahieu 2007). Indeed ballistic stretching may well regain its place in the sun as new fascial research suggests that elastic type bouncing movements are important to build the “silken fascial bodysuit” needed to prevent injuries to the connective tissue. The fast dynamic stretches included in Schleip and Mullers (2013) Fascial fitness suggestions are modified forms of ballistic stretching.
Active stretching This type of stretching involves the client actively moving their limb through a full range of motion to the end range and repeating the cycle several times. Examples of active stretching include:
Dynamic Stretching - a dynamic standing stretch of the hamstring involves swinging the leg back and forth to the end range.
Active isolated stretching - this involves several repetitions of a movement to end of range followed by assistance into a short stretch by a therapist or the client themselves using a rope or belt.
It is easy to get confused between ballistic stretching (boo hiss - bad for you) and active stretching (yayy great) as they both seem a bit “bouncy”- the big difference is that in active stretching techniques you are taking the limb or body part through a full range of motion each time whereas ballistic stretching involves bouncing up and down
on a fully stretched muscle. If ballistic stretching is “bouncy” then active stretching could be considered more “swingy”. Yes I know- highly technical language, but do keep up.
3. PRE-CONTRACTION STRETCHES
This involves a contraction of the muscle being stretched or it’s agonist before stretching. PNF (proprio- neuro facilitated stretching) and MET (muscle energy technique) both fall into this category. These type of stretches seem to “trick” the body into a greater stretch and are fantastic for increasing range of motion especially in the short term.
“Newer” forms of stretching are usually variations on one of the above themes. Two of our favourite new ways of working with stretching include:
4. THERAPEUTIC STRETCHING
Developed by osteopath Eyal Lederman, (2013) this form of stretching emphasises the functional requirements of the desired ROM increase and is based on the scientific principles of training. Lederman contends that stretching exercises used in the clinic should approximate the desired functional tasks for the client and emphasises the maximal part that must be played by the client in their own self care. Lederman provides extensive academic support to back up his theories which happily all boil down to common sense principles.
5. MYOFASCIAL STRETCHING
The fascial fitness work of Robert Schleip and Divo Muller (2013) uses two approaches: -Fast dynamic stretching very similar to old style ballistic stretching (but carried out with a ninja type presence and focus) -Long slow stretches that attempt to engage long fascial continuities. John Barnes also teaches long slow fascial stretching with stretches held for a minimum of 90120 seconds.
Recommendations for using stretching in treatment
◆ Stretching in treatment will only achieve limited results and clients should be taught self stretching routines to supplement treatment.
Stretching as part of regular routine will be more effective both for treatment of pain and prevention of injury for athletes ◆ In general, there are few differences in outcome between different methods of stretching. Type of stretching used should be chosen with outcome and individual client differences in mind
◆ Stretching will be more effective if combined in the treatment after heat, fascial work and trigger point work ◆ For pre-event massage, stretching should not be carried out immediately prior to performance especially for sports requiring a lot of jumping or explosive power. However, carrying out stretching prior to other warm up activites should not adversely affect performance and may help to reduce musculo-tendinous injuries. Active stretching methods such as dynamic stretching or active isolated stretching are likely to be more effective for pre-event massage.
RACHEL FAIRWEATHER
Rachel is author of the best selling book for passionate massage therapists – ‘Massage Fusion: The Jing Method for the treatment of chronic pain”. She is also the dynamic co-founder and Director of Jing Advanced Massage Training (www.jingmassage.com), a company providing degree level, hands-on and online training for all who are passionate about massage. Come and take part in one of our fun and informative short CPD courses to check out the Jing vibe for yourself!
Rachel has over 25 years experience in the industry working as an advanced therapist and trainer, first in New York and now throughout the UK. Due to her extensive experience, undeniable passion and intense dedication, Rachel is a sought after international guest lecturer, writes regularly for professional trade magazines, and has twice received awards for outstanding achievement in her field. Rachel holds a degree in Psychology, a Postgraduate Diploma in Social Work, an AOS in Massage Therapy and is a New York licensed massage therapist.
