Effective stretching for tendons and fascia

There was a study that came out a few years back in the Journal of Bodywork and Movement Therapies. It was done by a couple of really smart Germans with lots of letters after their names and dealt with different kinds of connective tissue and how best to keep them healthy. This is going to be a little more technical than most of my posts here, but I thought I’d summarize some of the findings for you.

The first thing to realize is that different kinds of connective tissue have different collagen structures, and that means that they will respond to different kinds of treatments. If you look at Figure 1, reproduced from the paper, it shows that the four major kinds of connective tissues have very different fiber arrangements. Aside from just looking kind of cool, you’ll see that tendons, out of all of them, have the most linear fiber structure. If you’ve read some of my previous posts, you know that long-term tendon pain is due mainly to “knots” forming in the collagen fibers, which then hurt when you try to move that bodypart. It’s sort of like getting a knot in your hair; it’s agonizing to comb it out, but once you do, the pain goes completely away.

Types of connective tissue

Interestingly, the techniques I give in Target Tendonitis work on both tendons and the plantar fascia, and of all the connective tissues proper fascia is the least like tendons. They do not work on ligaments, even though ligaments have a more similar structure to tendons. I admit I have no idea why this would be, I just know that it is. It only goes to show that we don’t know anywhere near everything there is to know about the body yet.

(As a side note, I will say that while tendons and fascia can generally be repaired without surgery, ligaments often cannot. Once you stretch a ligament out of its natural range, it’s very difficult to regain the original structure. It’s sort of like a silk tie; silk is very strong and will endure a lot of abuse. Crumple it up and throw it in a suitcase, no problem. It’ll shake out very nicely. But if you stretch it too far, you will never get that tie back into its proper shape again. Just won’t happen.)

Anyway, if you already have tendon (or plantar fascia) pain you should order one of my books. If not, the paper gives some good techniques to help make sure you never develop it. So let’s get to those.

Everybody probably knows that stretching (within reason) is good for connective tissues. What you may not know is that different kinds of stretching reach different kinds of tissues. So the first overall recommendation is not to limit yourself to one type of stretching.

And just to be clear, by “stretching” I don’t mean just traditional ballet-bar type protocols. Weight training produces a stretch in some types of fascial fibers, Hatha yoga produces it in others. So you should, ideally, be doing both.

Second point: your connective tissue is in a constant state of flux. In other words, it is continually being repaired. You’ve probably heard that each cell in your body gets replaced every seven years. Well, with connective tissue the process is faster. In fact, half the collagen fibers in your body are replaced every six months.

So here are some concrete recommendations to keep your fascial tissues healthy:

1. About two-thirds of your collagen mass is water. Make sure you drink enough of it.
2. Relatively few reps are required to produce a beneficial effect on connective tissue. So you don’t need to spend hours a day on this stuff.
3. The single most bang-for-your-buck type of stretching you can do will be soft bounces at the end ranges of motion. (If you’re still stuck in the 1970s and think that bouncing stretches are bad, you’re wrong.) So for example, try to touch your toes. When you get down to the limit of where you can comfortably reach, try bouncing a little, and softly, a few times to help get that bit extra stretch.
4. As noted above, various different types of stretching will be complementary and beneficial. Static stretching, dynamic stretching, pandiculation (yawning and stretching in the morning, for example – https://www.ncbi.nlm.nih.gov/pubmed/21665102), and so on all have their place. I do, however, recommend that if you are engaging in serious athletic activity, you save the real stretching for after the event. And if you do stretch beforehand, make sure that you do some type of easy loading before you really test yourself. Going from a good strenuous stretch right into a maximal or near-maximal exertion is just a recipe for injury.
5. Foam rolling, which technically involves temporarily squeezing water out of a tissue before allowing it to flow back in, is a good idea. I personally like to do it before a workout, but anytime is okay. If you’re new to foam rolling, use a soft roller to begin with.
6. Total-body “cat stretches” – where you would for example grab a tree branch overhead and then slowly turn and twist your body like a cat clawing a rug – are very good for the overall fascial network that covers your body. A few minutes of this will make you feel looser and “longer” in several different planes, and should give you an increased sense of well-being. (Now you know why cats do it.)

There are more specific suggestions in the actual paper (here’s the link again: http://www.fasciaresearch.de/Schleip_TrainingPrinciplesFascial.pdf), but these are the most immediately constructive ones. The good news is that you only have to do the above a couple of times a week, for a few minutes each time, for stretching to be effective. The bad news is that it will take somewhere between six months and two of consistent application to really start to get the benefit. So this isn’t a quick fix by any means. But the reward is a more comfortable, healthier, less injury-prone body, and that’s definitely a goal worth working toward.