Hannah Etlin-Stein
  • Hannah Etlin-Stein
  • About
  • Registered Massage Therapy
  • Pilates
  • Dance Science
    • Safe Dance Practice
  • Contact
  • Ramblings
  • Hannah Etlin-Stein
  • About
  • Registered Massage Therapy
  • Pilates
  • Dance Science
    • Safe Dance Practice
  • Contact
  • Ramblings

Massage Therapy --- Questions answered

14/2/2018

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In a venture to keep these posts varied and encompassing the many aspects to movement and health I am interested in, this next post will delve into my new profession:  Massage Therapy.

Over two years ago I set off on a new journey towards  becoming a Registered Massage Therapist. Last month, after 2,200 hours of classes and over 150 clinical hours, I picked up my certificate from the CMTO. Now, fully able to write the letters R-M-T after my name a new window has opened in my career as a therapist. Packed with a whole range of new tools and skills, I am so excited to officially begin to offer treatments.


As thrilled as I am to be offering Massage Therapy, I’ve also gotten some questions wondering how this will affect the work I do in other health related disciplines like Pilates and Dance Science. Here are some of the questions I’ve received answered.

What is the difference between a ‘Masseuse’ and a Registered Massage Therapist?

In Ontario, Massage Therapy is a regulated profession which means the title Registered Massage Therapist (RMT) or Massage Therapist (MT) is a protected title under the Regulated Health Professions Act and the Massage Therapy Act. By working with a Registered Massage Therapist you can ensure that you are being treated by a professional who has:
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  • Completed competency-based education at an educational institution recognized by the Government of Ontario
  • Studied anatomy, physiology, pathology, physical assessment, neurology, treatments, ethics and other subjects
  • Completed a minimum of 150 clinical hours;
  • Successfully completed examinations from and have been "registered" by the College of Massage Therapists of Ontario (the College) in accordance with the Regulated Health Professions Act and the Massage Therapy Act.
  • Maintained their registration by participating in continuing education and a Quality Assurance Program that assists them in the maintenance of high professional standards and quality care of their clients.
(From RMTAO) 

The terms 'masseuse' or 'massage' are not protected titles and therefore anyone can call themselves a masseuse with little to no training. When choosing a therapist, ensure you are working with a Registered Massage Therapist who has the education and experience to ensure a safe and effective treatment.

What 'style' of massage do you do?

I get this question a lot and always find it difficult to answer as the ‘style’ of massage therapy I do is completely dependent on who walks through my door and the type of treatment that is indicated by the patient's condition.

What I can say is that I aim to integrate my experiences and knowledge as a Pilates teacher and dance scientist into my work as a massage therapist. As a result, during my treatments I start by assessing how the body moves (I often have clients do some small movements before getting on the table), looking at their biomechanics, postural issues, or areas of dysfunction and pain (if that is a concern). From there, I try to work deeply but not painfully, always in tune with the nervous system and creating a deep sense of relaxation. I also aim to help my patients connect the dots between the treatment and exercises and movement they must do to help create meaningful and sustainable change in their body.

Who is massage for?

​Would it be completely unimaginable for me to say that massage therapy can be good for everyone? Massage therapy is ultimately an engagement with the body's nervous system, with some manipulation of soft tissue thrown in for good measure. The overwhelmingly powerful effects of touch are ultimately what creates such effective change. With the proper modifications along with proper communication, massage therapy is appropriate for almost all people. The type of treatment will obviously differ but I genuinely believe there can be benefits to everyone. In particular however, massage therapy can be beneficial to people with:​​
  • Lower/ Mid back pain
  • Headaches
  • Repetitive strain injuries
  • Muscle tension (ummm hello everyone?!)
  • Insomnia
  • Fibromyalgia
  • Constipation or other GI conditions
  • CNS disorders: Parkinson’s Disease, Multiple Sclerosis, Alzheimers,
  • Pre and Post natal
  • Cancer
  • Post-surgical rehabilitation
  • Stress and stress related conditions
  • Fractures and dislocations
  • Anxiety/ depression
  • Poor circulation
  • Edema (swelling)

The list of benefits you can get from a massage treatment is long and will fully depend on what you come in for and what your body needs.

​Overall though, people report that a massage therapy treatment makes them feel calmer, sleep better and just feels good!
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What techniques do you use?

As a massage therapist, I can dig into my toolbox and chose from a range of techniques depending on what my client needs. Some of these techniques include:​
  • Trigger Point Therapy
  • Hydrotherapy
  • Fascial work
  • Deep tissue massage
  • Sweedish techniques
  • Active and passive stretches
  • Lymphatic drainage
  • Tapotement
  • Joint manipulation

Are you still going to be doing Pilates and exercise?

The answer is a large, emphatic YES. Yes yes yes! I have always intended to continue doing work as a Pilates teacher once I became a Massage Therapist. There are a few reasons for this. Primarily, I believe wholeheartedly in the value of BOTH soft tissue manipulation and exercise based treatments. They go hand in hand, and to create meaningful change in the body you need to incorporate both. In my experience, massage therapy can provide some profound immediate benefits in reducing pain and discomfort and restoring the health of the tissue, however without a long term exercise plan, those benefits will dissipate over time.

I get a massage and feel great but after a few days, the benefits all go away. 

My answer to this is of course it does! the majority of reasons people come in for a massage can be traced back to postural habits they have been living with for years. For example how they sit at their desk, use of their computer mouse, many hours of driving, etc etc. One hour long massage can cause temporary relief and help restore the health of the tissue, however naturally these old habits will likely creep back. Unless clients are doing a combination of both massage AND corrective exercises, we’ll be hard pressed to make lasting changes.

That is why massage and Pilates work so brilliantly together. During a massage, I can get the body in a prime state to move efficiently. I can find and release areas of tension, areas of the body that are unnecessarily holding, so that smaller deeper muscles have a chance to be activated. I can work with areas around a joint and encourage proper biomechanics  and I can give the body a dose of relaxation priming it to take on the daily stresses of life. ​


Massage, like many things, is a part of the larger process of body maintenance. Just like going to the dentist certain things need to be maintained. You don’t go to the dentist to get a cleaning and then say ‘great, that’s me done’.  6 months laster you will be back in that chair for a cleaning because dental hygiene needs to be maintained. In a similar way, stresses on the body may mean that massage therapy will always be a part of your life however by combining massage therapy with self care exercises that help keep the benefits of massage as long as possible, we can get to a place where massage is used as a maintenance program or a tune-up when life gets a bit too much.

Where can I find you?

I am thrilled to have opened my home studio in the west end Junction neighbourhood of Toronto. My hours are Thursdays 9am - 12pm, Fridays 2:00pm - 8:00pm and Sundays 1pm - 7:30pm. Online booking is available Here. 

I will also be working at a wonderful clinic Pinpoint RMT located at the corner of College and Yonge St. You can find me there Tuesdays from 9am - 1pm, Thursdays from 1:30 pm - 8pm and Saturdays from 10am-4pm.

You can also find me at The Runner's Academy located at St. Clair and Oakwood Ave on Mondays from 12pm- 8pm and Tuesdays from 3pm- 8pm. 

How can I get in touch?

As usual you can contact me via e-mail at hannahetlinstein@gmail.com or through the Contact area HERE. 
I hope to see you in a clinic room soon!
​
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How to make effective and lasting changes to Alignment

9/1/2018

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Posture and alignment are two of the concepts I speak about most in my dance science educational workshops. Alignment can give us valuable information on the body, it can (but not always) contribute to pain and dysfunction, and it can be a fabulous place to start when looking at how to optimize performance. 
For a long time I heard clients tell me that they felt great after our sessions together but as the night went on their old postural habits started to creep back and by the next morning they found the magic from our sessions had left. This lead me to do some more digging into how I, as a movement practitioner could go about creating alignment changes that stuck. Many different factors can influence a person’s alignment, some physical (skeletal structure), emotional and psychological (self esteem or how you view yourself in the world), or habitual (your occupation).  It’s important to recognize that for many people, alignment patterns can be deep rooted and thus trying to change alignment is not always as easy as it may seem. ​

Ideal Alignment 

‘Ideal alignment’ is one is which the body segments are stacked in a position where force falls directly through the centre of each joint and the least amount of stress is placed on each joint. In this position, the muscles are in a balanced state and are able to work most efficiently. When we start movement from a place of good alignment, the muscles can focus on the task at hand (running, walking, dancing) and not use up all their energy just holding the body upright. ​
A great example of this is to stand up and try to feel the weight evenly distributed between the balls of your feet and your heels. Gently start to rock yourself forward until most of your weight is on the balls of your feet. Go as far as you can being careful not to fall over and then start to shift the weight backwards into your heels. As you move from both extreme positions notice how the muscles in your lower leg, and then kinetically up the chain, your thighs, bum, maybe even abdominals react to these alternating positions. As your rock forward you will likely feel the toes curl under and the calf muscles activate to avoid you falling forward. As you shift your weight backwards you will likely feel your toes lift up to the ceiling, and your shin muscles grasp on for dear life to avoid you falling backwards. Now come to settle in a position between these two extremes. Feel the weight evenly distributed between the ball of your big toe, the ball of your baby toe and your heel. Feel this ‘tripod’ of support and how the weight is evenly balanced between your right and left feet.
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When the body is stacked in good alignment we create efficient and balanced muscle use, allow for the correct balance between stability and mobility at the joints and create the least amount of ‘wear and tear’ on our body. ​

The challenge is, how do we go about changing poor alignment? 

Alignment deviations

With any deviation from ‘ideal’ alignment, one side of the joint will come into a shortened position while the other side will come into a lengthened position. If we want to look at the body from purely a biomechanical point of view, our fist first step would be to attempt to shorten what is long and lengthen what is short. ​
For example, a very common alignment deviation I see with dancers is lifted and protruding ribs resulting in extension of the thoracic spine. This ‘puffed up’ chest position is often caused from a misunderstanding of the cue ‘pull up’. The primary problem with this alignment deviation is the effect it has on our breathing mechanics. ​
Picture(Haas, 2010)
The diaphragm, which is the primary muscle for respiration, is nestled underneath the ribs in a a dome like shape, separating the thoracic cavity from the abdominal cavity. When we breathe in the ribs lift and expand 3 dimensionally while the diaphragm contracts and draws downward. This creates a pressure imbalance and thus air rushes in. The abdominals lengthen and thoracic spine moves into a slight extension. When we breathe out, the diaphragm relaxes and lifts while the ribs move downwards and inwards increasing the pressure in the thoracic cavity and forcing air to rush out. The abdominals contract and shorten. ​

When a dancer adopts a position where the ribs are lifted, the diaphragm is stuck in a depressed position and thus they are being held in a constant state of inhalation (how many dancers hold their breath while dancing???).  Additionally, because the diaphragm is interwoven within the fibres of the transversus abdominis (one of the deep core muscles important in spinal stability) during exhalation the diaphragm draws on the TvA which contracts. When the diaphragm is ‘stuck’ in a depressed position the deep core muscles aren’t able to fire as well. Lastly, this position will lift the centre of gravity effecting the ability to balance effectively. Ultimately, it is an inefficient holding pattern. ​
In this position of lifted ribs and extended thoracic spine, the muscles on the back of the spine (thoracic extensors) are in a shortened position and the muscles on the front of the body (the abdominals) are in a lengthened position. Any muscle that is either shortened or lengthened will be less efficient at producing force. To go about correcting this imbalance a first step might be to do some strengthening exercises to the abdominals especially the obliques in an attempt to draw the ribs down towards the pelvis. You may also do some lengthening work to the thoracic extensors like emphasizing the cat in the exercise cat/cow.

When unsure of what to do with an alignment deviation, addressing what is short and what is long is a great place to start however unfortunately, making lasting changes in alignment and having those changes transfer over to your dancing is more complex. ​

Creating Meaningful Change 

When the body is held in a position for a long period of time, the tissue surrounding the joint can begin to adapt to these new changes. When soft tissue is held in a shortened state for a long time this is known as ‘contracture’ and it may adapt to the point that you can’t actually get out of the position. In this case some sort of mechanical altering of the tissue through stretching or soft tissue work will be necessary.

​The nervous system however,  can adapt in a similar way.
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Within our muscles we have something called muscle spindles. These fibres are not actually able to produce force but they do have a sensory component to them that regulates stretch. When a muscle is stretched, the muscle spindles are put under tension and will send a signal to the brain to contract that muscle as a protective mechanism. It’s a fantastic reflex our body is capable of and ultimately protects muscles from being overstretched. When the body is in a position for an extended period of time, the brain will start to consider this new position as ‘normal’ and the reflex system will adapt accordingly.
So let’s take our example from above. If a dancer habitually has adopted this ‘lifted chest’ posture, her reflex system has set this new position as normal. Assuming there is no contracture and this dancer is able to move out of this position, strengthening and lengthening can help her voluntarily override her natural alignment and come into a more ‘ideal’ alignment. However, as soon as her attention is directed towards more complicated choreography, like chainé turns across the floor, she will subconsciously refer back to her habitually alignment.
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Thus correcting the mechanical issues is only half the battle. What we must do, is find a way to actually change this dancers’ neuro-patterning on a subconscious level, changing her 'normal'. One of the best ways to do this is through the use of imagery. ​
In their book ‘Motor Learning and Control for Dance’, Donna Krasnow and Virginia Wilmerding outline three ways in which imagery is an effective tool for changing alignment on a subconscious level.

  1. By using imagery, you avoid using conscious muscle contraction to change alignment patterns. Our brains are brilliant and by giving the body a task to do the brain can go about selecting the correct muscles in the most efficient way.
  2. Imagery allows the brain to organize multiple muscle groups simultaneously which we aren’t able to do with conscious muscle selection
  3. Imagery can help make learning more permanent by creating associations. Neuroscientists often say ‘neurons that fire together, wire together’.
Ultimately, if tissue has adapted over time to the point that it can no longer reach this position no amount of imagery is going to get it there. In this situation a combination of soft tissue work, stretching or strengthening will be necessary. However ultimately it is the combination of both mechanical change and neuromuscular change that will lead to lasting changes in alignment. ​
“Body therapies agree on the same fundamental belief that changes in alignment need to occur at the subconscious, subcortical level of the brain. Imagery and visualization are common tools used in these practices”  Eric Franklin
In Safe Dance Practice Module 1, we go through all the segments of the body (spine, pelvis, knees, lower legs, feet and shoulder complex) and discuss the anatomy of the joint, common postural deviations and how to go about optimizing alignment using both mechanical and neuromuscular approaches. ​Once we understand that changes in alignment happen both at the physical and neurological level, we can start to make meaningful changes that stick. 

References

Haas, J. (2010). Dance anatomy. Champaign, IL: Human Kinetics.

Krasnow, D. H. & Wilmerding, M.V. (2015). Motor Learning and Control for Dance. Champaign, IL: Human Kinetics. 
​

Quin, E., Rafferty, S., Tomlinson, C. (2015). Safe dance practice: An applied dance science perspective: Champaign: Human Kinetics
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October NEWS!

18/10/2017

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Hello again!

It's been a busy 2 years as I've been engrossed in full time education to become a massage therapist. Now that classes have finished, one of my two college exams is complete and the dust has settled a bit, I'm looking forward to what lies ahead.  I have some exciting things happening in the coming months and I wanted to share them with you! 
  • Firstly, I am excited to announce that I will be presenting at the Healthy Dancer Canada conference in Calgary, Alberta next month. Healthy Dancer Canada is an organization that aims to support the health and wellness of dancers in Canada. Bringing together dancers, dance educators, health care professionals and researchers, HDC is one of the leading forces in creating a culture of healthy dance practice in Canada. I am so honoured and proud to be presenting at this conference. I will be speaking about supplementary training for dancers, more specifically how to go about structuring this training throughout an annual training year. The conference will be happening November 10-12, and I highly encourage anyone in the dance community who is interested in the health of dancers to attend this conference. Visit www.healthydancercanada.org to learn more!​ See you in Calgary!

  • After an amazing first round of my Safe Dance Practice course, I’m thrilled to say I will be running it again in the new year! York University has asked me to come in and teach the full course to their students. I will be revamping the material to prepare these students for a certificate in healthy dance practice from Safe in Dance International. This course is unfortunately full, but if there is interest I will look into running it again for dance educators looking to increase their knowledge and application of safe dance practice.  Don't be shy!

  • With some more time on my hands (now that school is complete) I have taken on some new private clients. These young dancers are looking for help with technique, alignment and injury management. I am still taking on a few more private clients so please be in touch if you are interested in working privately with me in whatever capacity. 

  • This year, I will be starting to teach supplementary training classes at some local dance schools in Toronto.  These classes will prepare dancers for the demands of dance and ensure they are strong, mobile and injury free! Classes will use a combination of strength training, Pilates, imagery work and dance specific movements. If you are interested in having me come in to teach at your school please be in contact. ​ These can be arranges as weekly classes, or as workshops. 
 
  •  Lastly, the process of becoming a registered massage therapist in Ontario is long and full of many different hoops but I’m thrilled to say I’m almost there! As soon as I am registered I will be seeing private clients for massage therapy and will be providing a combination of both active and manual therapy. If you’re interested in learning more about what massage therapy can do for you, please be in touch. 



That's all for now! 

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Stretching for dancers Part 2

4/6/2017

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http://www.livestrong.com/article/531304-dance-dynamic-stretching-exercises/
In Part 1 I discussed stretching as one way of increasing ROM at a joint although the research has shown it’s not always effective. In fact, it may be that stretching has more of an effect on increasing stretch tolerance than anything else. Either way, stretching should only really target the muscles and potentially the fascia (again - research pending!). 

The problem however, is when the restriction is not in the length of the muscle or fascia. When a muscle feels tight, people often assume the muscle needs to be stretched. It’s the natural conclusion; something feels tight stretch it! In reality, just because a muscle feels tight (i.e. it feels restricted) it doesn’t mean the muscle is necessarily short. 

Let’s clarify. A short muscle is different from a tight muscle. A short muscle indicates that the muscle has difficulty lengthening during movement, or at its resting state it is actually shorter. This is referring to more of a structural property of the muscle. A tight muscle on the other hand refers more to the inability of the muscle to relax due to tension within the muscle - usually due to overuse. Muscle tightness and muscle shortness can both impact range of motion but will need to be treated differently. 

If  a muscle is short but relaxed, then stretching could be useful to increase the length of the muscle. If the muscle is tight and as a result has lots of adhesions (knots) however, stretching could actually exacerbate the problem.

Other ways of increasing ROM:

Strengthening a joint: This may sound counterintuitive, but if a joint is dysfunctional in some way, it may not be that the muscle needs to be stretched but that the opposing muscle group needs to be strengthened. During every movement at a joint one muscle group must shorten while the opposing muscle must lengthen. If you find you aren’t able to lengthen one side of a joint properly, it could be that there isn’t enough tension coming from the opposing side of the joint to create enough stability to allow this side of the joint to release. For example, if you feel like your calf muscle is really tight, try doing some strengthening work for the ankle dorsiflexors. The increased stability at the joint as well as the opposing tension may help the calf muscles relax. 

I once had a really nice analogy made for me by a Pilates instructor of mine. If a joint isn’t functioning properly and the muscles around the joint are super ‘tight’ you should stop and think about WHY the muscles are tight before you go ahead and stretch the hell out of them. Those tight muscles might be the only things holding that joint in place. It’s important to add stability to a joint before you take away muscular tension.
 ‘Deep Tissue work’:  You may have heard this term before. Deep tissue work is really just an umbrella term for any type of work that targets the deep muscles or connective tissue. There are many ways to do this including myofascial therapy, trigger point therapy, Muscle Activation Technique (MAT) or massage. Many of these require seeing a qualified bodywork therapist, but if this isn’t in your budget there are ways to do this type of work on your own. 

Foam rollers, tennis balls or yoga Tune Up balls (slightly softer than tennis balls) can be your new best friend. Areas of particular focus for dancers should be the lateral quads, deep external rotators (piriformis), TFL, and gastrocnemius/soleus complex. Although Psoas and Iliacus are often in need of some work too, I would recommend having them treated by a trained and qualified bodyworker as they are quite deep to get into (and there are some kind of important organs you want to avoid in there).  By working deep into the tissue you can start to break apart some of the adhesions and restore their proper function without actually stretching the muscles. 
Food for mobility: Sometimes, lack of mobility at a joint can be caused by inflammation and increased fluid buildup. If this is the case, certain foods can help reduce inflammation at a joint and impact fluid easeful movement. Some studies have shown that ginger extract can be as effective as ibuprofen in reducing joint pain (1), fish containing Omega-3 fatty acids can slow the progression of osteoarthritis (2), and antioxidants like the ones found in dark-coloured fruits and vegetables can increase cell-wall elasticity and joint mobility. I would urge dancers who want to look more into this area of training to contact a holistic nutritionist to get more detailed information on the topic - Contact me if you need a referral! 
Traction: In most cases, you will likely go to a health professional to get traction work done. As a massage therapist, I incorporate joint play including traction into most of my treatments. The reason for this is that joints are constantly being compressed by tight muscles, tendons and fascia, not to mention gravity! The two bones in a joint are brought closer together and the arthrokinematic movement at that joint can be compromised. Traction is a way of restoring the integrity of a joint by bringing apart the two connecting bones, restoring the circulation and bringing in new nutrients in to the joint. 

Again, traction can be done on your own with the use of a thick band and any immovable post. Attach one end of the band to a pole (banister, bedpost, squat rack etc) and wrap the other end around your ankle. Begin to move back away from the pole putting the band on stretch. Lie back and feel the band tugging at your leg. Take deep breaths. 
Neuromuscular processes: The last way to increase ROM doesn’t involve changing the tissue at all, but involves restoring the nervous system. When joints are held in positions for prolonged period of time the tissue surrounding the joint can adapt and become adaptively shortened/ lengthened. This is where the term ‘locked long/ locked short’ comes from. A similar process can happen with the nervous system. Because the nervous system has decided this new position is now normal, bringing the joint back into a neutral position will be interpreted by the nervous system as a stretch. Now if you try and increase the range even more to achieve the desired range of dance movement you will most definitely activate the stretch reflex (you can go back to part 1 to remind yourself what the stretch reflex is). Therefore, incorporating somatic work (imagery, breath, visualizing, etc) into your practice will be essential to allow the nervous system to let you achieve these new ranges of motion. 

Other benefits of stretching

Up until this point I've discussed stretching from a purely mechanical point of view. There are however, benefits to stretching that go beyond the physical tissue which can be just as, if not more important.

The primary way is that stretching can help activate the parasympathetic nervous system, which is the body’s ‘rest and digest’ system. In simpler terms, it can help you RELAX! It will likely come as no surprise that in this day and age, people are spending more and more time in their sympathetic nervous system (the fight or flight system). For determined and hard working dancers, this is even more true. The importance of rest and relaxation cannot be stated enough as an essential element of dance training.


Static stretching can actually slow down the body’s sympathetic nervous system resulting in lower blood pressure and heart rate, it can control stress, increase focus, increase blood flow from the extremities post class, and just generally make you feel really good! From a motor learning perspective, stretching included at the end of class can provide a time for reflection, integration and help solidify learning. Taking that 15 minutes to stretch after a class can ensure dancers aren’t running to their next appointment and psychologically digest what has just been learned.

When discussing the effects of a purely relaxation based massage, I once had a teacher make a comment that stuck with me. You don’t hear of people dying from ankle sprains, but people die every day due to stress. Don’t underestimate the powerful effects of relaxation. 

At the end of the day, we need to remember that ultimately, our nervous system runs the show. If it doesn’t want us to go into a range of motion, it will be pretty darn hard to get there without injuring ourself in the process. No amount of mechanical work on the body will give the nervous system the urge to release a muscle that feels tight. Incorporating somatic practices including breath, imagery and mindfulness are the ultimate pathways to increased range of movement. 

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  1. Bliddal, H. (2000). A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis and Cartilage, 8(1), 9-12.
  2. Hutchins-Wiese, H. (2013). The impact of supplemental n-3 long chain polyunsaturated fatty acids and dietary antioxidants on physical performance in postmenopausal women. The Journal of Nutrition, Health & Aging, 17(1), 76-80.
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Stretching for Dancers

19/4/2017

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It’s safe to say that most people like to stretch. When I was doing mostly personal training, all I would hear from my clients was how much they were looking forward to the stretch at the end of the session. Teaching pilates, clients constantly ask if we can incorporate some ‘stretching’ into the session. Why? Because stretching feels good!  

Dancers are no exception and in fact, are usually on the far end of the spectrum. Flexibility is no doubt an  important element to certain styles of dance, but how to achieve optimal flexibility is the real question. 
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It's not unusual then, that when discussing flexibility your mind is immediately drawn to stretching. Stretching is a controversial subject to say the least, and recent years have seen a real shift in how movement practitioners and body experts are using it. I’ve recently changed my own approach to stretching as I’ve learned more about it - and definitely differ in my approach to stretching depending on who I’m working with.
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We now understand that the amount of motion at a joint is impacted by many factors, and is actually more complex than just the 'flexibility' of the muscles surrounding it. 

Stretching CAN be used as an effective way of achieving greater ROM as long as it is done with awareness and mindfulness. Stretching is not the time to ‘check out’ - in fact it requires a deep tuning in to the body. ​


The information following is directed towards dancers or those working with dancers, NOT the general public. For dancers, flexibility is an important part of dance training. I write a lot about dance as a unique area of sports science. Whereas other athletes require flexibility for functionality, dancers’ flexibility is an inherent element of functionality. Achieving range of motion beyond the functions of daily life is part of the aesthetic of dance. 

In this post I will discuss how to use stretching to your advantage by explaining the what, how, why and when. In part two, I will discuss other ways of increasing your range of motion that does not include stretching. 

So first a little background info on the topic:

Flexibility Vs. Range of Motion ​

Often these two terms are used interchangeably but they are in fact different. 

Range of motion (ROM) refers to the degree of motion that occurs at a joint. This will be impacted by many factors including the structural anatomy of the joint, the surrounding soft tissue and connective tissue, muscle mass as well as neurological tissue. 

Flexibility, is the ability of the soft tissue to elongate - so more specifically the muscles, tendons and fascia. ROM will therefore be impacted by the flexibility of the muscles however also takes into account other impacting factors. Someone who is hypermobile may therefore have a large amount of ROM at a joint, however still have ‘tight’ muscles. In fact, in my experience the more hypermobile dancers I work with often feel like their muscles are the ‘tightest’.

Common wisdom would assume that to increase ROM at a joint you need to stretch stretch and then stretch some more! And while stretching PROPERLY may impact the ROM, muscular factors will actually only account for about 10% of the limiting factors of ROM. I know!! 85% of these factors are joint factors which are largely genetic!! Some of these joint factors include the articulating bone and cartilage and the ligaments surrounding the joint (which we absolutely do NOT want to stretch).  Muscular factors include the muscles and tendon extensibility. The other 5% will include more general factors like age, gender, body fat and environment. So therefore it’s important to know that some people will genetically be more flexible than others. 
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ROM can be either 
Passive or Active. 

Passive range of motion, involves the amount of movement you have at a joint without any muscle activation. The joint is being moved by an external force  (either another person, or a resistance band or towel). Active range of motion is the amount of movement you have at a joint through active contraction of the muscles surrounding the joint. 

Dancers require both passive and active flexibility in different situations. The nervous system plays a huge role in mediating these two systems and so changing one type of ROM will not necessarily transfer directly to the other. Therefor it is important to train the type of ROM you require for your sport.  ​

Increasing ROM 

This is the million dollar question!

Surprisingly, there is no ONE answer for the best ways of increasing range of motion at a joint. It will depend on so many different factors. Some research advocates for stretching as a way to increase ROM at a joint, whereas other studies have found no increased benefits from certain types of stretching. This lends itself to the idea that different techniques are going to work for different people. 

It's valuable to look at dance specific research wherever we can - and doing so, it appears that stretching can be an effective tool in increasing the flexibility of the soft tissue therefore effecting the ROM but only in that 10% that is muscular. If that is where your limitation is, then it would appear stretching could be quite effective. IF however, the limitation in ROM is coming from the other 85%, then stretching alone might not make a change. 
Research has also found that stretching can increase the ROM at a joint by increasing 'stretch tolerance' without any change in the muscular tissue. This will likely be an effect on the nervous system more than anything else. 

​I will be discussing some of the other less 'measurable' benefits of stretching more in part 2. 

Types of Stretching

There are 4 main types of stretching and each can be beneficial if used safely and effectively. 

Static Stretching: This involves taking a muscle into a lengthened position and holding it there.  Research has shown that 15-30 seconds is adequate for holding a static stretches as it is more effective than stretches of a shorter duration but no different from stretches of a longer duration (like this study or this study). 

Dynamic Stretching: This type of stretching involves a controlled and dynamic movement of the joint through its full range of movement. An example of this would be leg swings, lunges or arm arcs. 

Ballistic Stretching: This type of stretching involves a repetitive bouncing movement. This form of stretching has been shown to produce short term flexibility gains however as it inherently lacks control, it is definitely the most dangerous so needs to be performed with care and caution.
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PNF stretching: This type of stretching uses one of the body’s reflex systems called autogenic inhibition. There are various ways to perform this type of stretch but simply put, it involves taking the target muscle into a lengthened position and then getting it to contract against resistance to create an isometric contraction (contraction with no movement at the joint). The contraction is held for approximately 5 seconds and then released as the joint is brought to its new ROM. 

Stretching Intensity

Stretch intensity is where I encounter the most misconceptions. Many people believe that you need to feel a stretch intensely  to gain the benefits that will come from that stretch. The harder you stretch the more your flexibility will improve right? Nope. This has been challenged by recent research looking into the intensity of stretch! 

A 6 week experimental study was conducted looking into the intensity of stretches. Dancers were split into two groups: Group 1 stretched at their usual intensity of 8/10. Group 2 stretched at a lower intensity of 3-6/10. Results showed the the lower intensity group increased grand battement and developpé height by 20 degrees! The high intensity group on the other hand saw a very slight but not significant increase of only 5 degrees. 

The results from this study also found that the high intensity stretching group showed an increase in inflammation blood markers. This means that the muscle being stretched was actually being traumatized (take a read here!). 

The Stretch Reflex

The body is much more intelligent than we give it credit for. Its main priority is to protect against damage. ​

That is why the body has a mechanism called the Stretch Reflex. We have sensory receptors within our muscles called muscle spindles. When a muscle is lengthened too quickly or too intensely, these muscle spindles are put under tension and send a message to the muscle to contract as a safety precaution. This means that if you stretch a muscle too much, or too quickly that very same muscle will protectively (and reflexively) contract. If you are stretching so intensely that the stretch reflex is coming into play you are completely negating the effect of the stretch and because the muscle is going through an internal battle with itself you are likely putting it at increased injury risk. That feeling when you are stretching your hamstring and your leg begins to shake is probably a good time to back off the stretch!
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What should be stretched and what shouldn't be stretched

Muscles and their surrounding connective tissue SHOULD be stretched. This will include the fascia that wraps around the muscles like a sheet. 

Ligaments and the joint capsule SHOULDN’T be stretched. Ligaments are intended to hold a joint in place and by stretching them you are actually decreasing the integrity of the joint. Think of the ligaments as the seat belts of your joint. You wouldn’t go around ripping out the seat belts of your car. Because ligaments are non-elastic, if you stretch these tissues you will permanently elongate them. In response, the muscles surrounding the joint will have to work harder to keep the joint stable making them less efficient and more likely to fatigue. This will likely start a viscous cycle of the muscles feeling ‘tight’ because they are working so hard, stretching more, destabilizing the joint more, and feeling even ‘tighter’. Answer? Stop stretching the ligaments. 

There may be times when it is appropriate to stretch the joint capsule or connective tissue to maintain the integrity of a joint due to injury or adaptive shortening in the tissue. This however, should only be done with the guidance of a health professional and with the appropriate strengthening work. 
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Of course the question then becomes how do you know what tissue you are stretching and that you aren’t in fact stretching ligaments? That is a really good question, and is why it’s important to work with knowledgeable and experienced practitioners with an extensive understanding of anatomy. A tip to get you started is you should feel the stretch in the belly of the muscle, rather than near the attachment points, or deep in the joint. There should be no sharp sensations or pain when stretching. 

RULES for stretching

Here are a few rules that are good to live by when using stretching to as part of your practice. 

1) Prolonged static stretching should be avoided before class, rehearsal or performance. It’s now pretty well unanimously thought by experts that prolonged static stretching before class or rehearsal can be temporarily damaging to the muscle and neurological tissue leading to temporary impaired performance. Numerous research studies have found that prolonged static stretching prior to class or performance impairs performance strength, power, endurance, balance, jump height, reaction time and movement time. etc. Although the neurological deficits resulting from static stretching may dissipate in up to 15 minutes, the muscular tissue can take up to an hour to regain it’s full strength . So no splits warm up!

2) Dynamic stretching should be included before class, rehearsal or performance.  
Stretching however, shouldn’t be ignored entirely before class as it’s an important element of a proper warm up. When dynamically stretching, gradually increase the range of movement throughout the warm up moving into a larger range as the tissues become warm, and the muscles become activated. 

3) The tissue surrounding a joint should be warm before it is stretched. This will ensure that injury doesn’t occur and will also ensure a longer retention of the tissue length.

4) Include some BRIEF static stretches before class, rehearsal or performance. Brief static stretches no more than 8 seconds can be used in a dance warm up so long as the tissue is warm, and they are not held for more than 8 seconds. This will insure that the joint is not weakened by the stretches (that is why it’s really important they aren’t any longer than 8 seconds) but the required flexibility is still achieved prior to dancing.

Why? different factors will impact a muscles ability to transmit force effectively to the bones. Neurologically as well, a muscle will exhibit less ability to activate after a prolonged stretch. So to make a long story short, DON’T do prolonged static stretching before a class and expect that you will be able to achieve your optimal performance. Remember, we’re trying to get the joint to it’s ‘functional’ range of motion before dancing.

5) Longer duration stretches for the purpose of increasing flexibility should be done when the tissue is warm and after class or rehearsal. If you are following a program to increase your flexibility, and are holding stretches for longer than 30 seconds it should be done either after class or rehearsal or at a different time completely in the day. If being done at a different time, make sure the tissue is warmed up properly through 10 minutes of light activity.  

That all being said, for many people stretching will not make any change in their ROM at a joint. Insanity is defined as doing the same thing over and over again and expecting a different result. So if stretching isn't working for you, there could be another answer! 

In PART 2, we will look at some of the other benefits of stretching that aren't mechanical in nature, as well as other ways to increase ROM that doesn't involve stretching. ​
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    Hi, I'm Hannah. I'm a Registered Massage Therapist, Movement specialist and dance science consultant,  I am a Registered Provider for Safe in Dance International and teach workshops and courses related to Safe Dance Practice. Here is what I have to say about all things health and movement related. 

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