Contract Relax/Antagonistic Contraction Stretches for Running

I recently had the good fortune of attending a stretching seminar for runners at Pro Bike + Run, one of Pittsburgh’s local cycling and running stores. The seminar was presented by Ben Jennings, DPT, OCS at NovaCare Rehabilitation.

During the presentation, Ben introduced us to Contract Relax/Antagonistic Contraction (CR/AC) stretches. These stretches use a technique that utilizes isometric contraction (without movement) as well as active contraction of the Antagonistic or opposing muscle group of the muscle to be stretched. These stretches start out like traditional stretches and typically have 3 steps:

1. A strap is used to flex the joint to static stretch the muscle for 20-30 seconds. 
2. The second step is the isometric contraction part where you activate the muscle being stretched while the strap is used to prevent any movement. This step lasts for 6-10 seconds. 
3. The third step is to contract the opposing muscle group while simultaneously using the strap to extend the stretch. This step lasts 20-30 seconds. 

Rest and then repeat for a total of 2-3 times.

An interesting component for me regarding these stretches is the use of the opposing muscle group in the third phase of the stretch. Contracting the opposing muscle group will send a neurological signal to the muscle being stretched to relax, allowing a greater stretch to occur.

Some of the stretches that we performed during the seminar are shown below.

• Prone Quadricep Stretch with Strap (CR/AC): Laying on your stomach, attach a strap around your ankle. Pull on the strap to bend the knee, bringing your heel towards your buttocks as close as possible without pain, you should feel a tightness in the front of your thigh. Hold. While holding the strap tight, contract your quadricep to try to bring your foot back to the ground. Resist this motion with the strap. Hold. Engage your hamstring to move your leg further forward, towards your body. Use the strap to keep your leg in place. Hold. Return your leg to the ground. Repeat. 

 

• Seated Calf Stretch with Strap (CR/AC): Sit on the ground with your knee straight and a strap looped around your forefoot. Gently pull on the strap until a stretch is felt in the calf. Hold. While holding the strap tight, contract your calf muscle to try to move your foot forward. Resist this motion with the strap. Hold. Engage your shin muscle to move your foot further towards your body. Use the strap to keep your foot in place. Hold. Relax and return your foot to its starting position. Repeat. 

 

• Supine Hamstring Stretch with Strap (CR/AC): While lying on your back, place a strap around the one forefoot. Pull your knee toward your chest by pulling on the strap. Straighten the leg to the point of tightness in the back of your thigh. Hold. While holding the strap tight, contract your hamstrings to try to bring your foot back to the ground. Resist this motion with the strap. Hold. Engage your quadricep to move your leg further forward, towards your body. Use the strap to keep your leg in place. Hold. Return your leg to the ground. Repeat. 

 

The stretches listed above can be found in the Fitness Legs, Ankle & Foot, and Knee & Hip categories in our PT-Helper exercise library.

8 Tips to Help You Stay Regular While Traveling

by guest blogger Dr. Susie Gronski, DPT, PRPC, WCS

Traveling abroad can mess with your pooping schedule. Trust me, I know what it feels like when you’re on vacation and can’t pinch a loaf. Over the years, I’ve managed to perfect my traveling poops and thought I’d share with you my one-wipe wonders.

1. Chew – Digestion starts in the mouth. Chewing releases enzymes in the mouth which starts the digestion process. Conga dance anyone?


2. Pack plums - To help you rev up the colon, eat fiber. Plums are a great source of fiber with an added bonus… Plums draw extra fluid out of the colon for smooooooth sailing. No plums? No problem. Most fresh fruits come naturally equipped with both soluble and insoluble fiber.

Note: If you’re going to up your fiber game, make sure to drink more water. Fiber tends to clump poop into balls and no one wants to push out a dry, hard, crusty turd.


3. Move around – Motion is lotion as they say and the same goes for your gut. Movement helps stimulate the colon. What kind of movement, you ask? Anything that motivates you. Keep it simple and fun.


4. Take some deep belly breaths – Your colon has connections to the diaphragm and the organs underneath it such as the liver and stomach. You can massage your organs and stimulate digestion with deep belly breathing.

Deep breathing stimulates the parasympathetic nervous system, which is the rest and digest response for poop and pee. This relaxed state of the nervous system allows for digestion to work optimally. When you’re hurried, rushing or stressed, other areas of the body utilize more energy, diverting its efforts away from digestion and bowel function. In other words, it’s easier to ‘go’ when you’re relaxed, not tensed up.

Brushing your teeth could be a good prompt to remind you to take a few deep breaths.


5. Drink plenty of water – The colon’s main function is to absorb water and residual nutrients not picked up by the small intestine. Dehydration is the number one cause of hard, lumpy, pellet-like stool so make sure you’re drinking enough hydrating fluids.

Traveling often distracts us from our normal routine, including hydration. Airplane travel draws fluid out of the body in larger quantities than you’d expect, so make sure to pack your water bottle and refill it regularly. The little cup of water they give you on the plane just won’t cut it if you want to keep your poops regular.


6. When nature calls, go – Your gut is a creature of habit. The more you suppress the urge to purge, the more clogged up you’ll be. I know some folks who have an issue pooping in public, but everybody poops. Time to get over your phobia and answer the call of nature as soon as you notice it.


7. Squat to drop – The Squatty Potty is my friend, but most places don't have this luxury when you’re traveling, which means you gotta get creative! Use whatever you can to prop your feet up: a garbage can, a box, books, a stack of towels, your partner… (just kidding!)


8. Daily ritual – Just like you have your daily pooping ritual in your everyday life, incorporate a schedule while on vacation. Mimic the same routine you would have back at home, which means you might have to give yourself extra time to poop. If that means waking up 15 minutes earlier, then so be it.

Again, your colon is a creature of habit and will get ornery when the flow is interrupted.

Don’t rush your poops either. If you’re stressing out because you can’t poop, toileting will be more difficult. Even if you don't feel the urge to go, sit on the toilet anyway and breathe. This way you can retrain and encourage your colon to go at a regular time, the time you’re used to going back at home.

Don't freak out if you’re not able to drop the kids off at the pool. Whenever you travel, the colon has an adjustment period and sometimes it takes a day or two to catch up. No need to worry if it doesn’t happen right away. The more you worry about your bowels, the less likely they will cooperate. So let it go and then let it flow.

Don’t let traveling ruin your pooping experience. Better to be proactive than reactive to make each bowel movement poop-errific. Let’s chat!

About Dr. Susie Gronski, DPT, PRPC, WCS

Dr. Susie Gronski is a Doctor of Physical Therapy, a certified Pelvic Rehabilitation Practitioner, and a board certified Women's Clinical Specialist. Her passion is to empower and help people with pelvic pain get their life back.

New Lower Back Exercises on PT-Helper

If you are a therapist, you can create your own exercises within PT-Helper CONNECT or you can contact us at info@pt-helper.com to let us know which exercises you would like us to add.

We continue to add new exercises to PT-Helper as part of our on-going efforts to improve its capabilities for both therapists and patients. In today’s blog, we focus on 3 new Lower Back exercises that are available in both PT-Helper CONNECT and the PT-Helper mobile app.

• Vertebral Roll: Lie on your back on top of a foam roller. Bend your knees with your feet aligned with your hips. Raise one arm up into the air while simultaneously lifting the opposite leg off the floor. Tighten your abdominal muscles. Extend your raised leg, straightening the knee so that your leg is parallel to the floor. Simultaneously drop the opposite arm above your head so that the arm is parallel to the floor. Make sure to keep your back flat on the roller. Return to the starting position. Repeat 

• Lateral Hamstring Stretch with Strap: Lie on your back with a strap wrapped around your involved foot. Bend your involved leg while keeping your other leg straight. Raise your involved leg up into the air. Keeping your pelvis on the floor, pull on the strap with your opposite hand to stretch the outside hamstring. Hold. Return your leg to its starting position. Repeat. 

• Transversus Activation: Lie on your back with your knees bent and hands resting on your stomach above your hips or by your side. Tighten your abdominal muscles, pulling your navel towards your spine and up. Keeping your abdominal muscles tight, slowly lift one leg up to 90 degrees. Keeping your abdominal muscles tight, slowly lift your other leg up to 90 degrees. Hold. Return your legs back down to the floor one at a time. Do not hold your breath. Repeat starting with the other leg.

 
You can find these exercises (and many more) in the Lower Back category in the PT-Helper mobile app to add to your Favorites which allows you to customize each exercise’s repetitions, sets, and hold time. You can also set up 3 daily reminders to notify you when to do your exercises.

Reminder: Please consult your physician or physical therapist before engaging in any physical activity and stop if you experience pain or discomfort.

Start your Free 30-day Trial of the PT-Helper CONNECT service for physical therapists and other wellness professional, to prescribe Home Exercise Programs.

Download the PT-Helper mobile app for patients and exercise enthusiasts to create your exercise program.

                       

PT-Helper’s June Blog Posts for Physical Therapists

Sacroiliac Joint Pain Exercises and Stretches
Published on June 20, 2019
Research indicates that about 80% of the population will experience low back pain at some point in their lifetime. This blog presents 4 exercises and stretches to strengthen and stabilize the sacroiliac joint of the lower back.

5 Reasons Hands-on PT May Supplement or Replace Pain Meds
by guest blogger Brian Scherff, PT
Published on June 6, 2019
Brian identifies 5 reasons when physical therapy trumps opioid use. “If preventing long-term opioid use is a treatment goal, the research all supports that those receiving early Physical Therapy had fewer long-term opioid use rates.”

Sacroiliac Joint Pain Exercises and Stretches

One of the most common causes of disability is low back pain with about 80% of the population experiencing low back pain in their lifetime. I too have experienced excruciating lower back pain which may have been caused by one of my many falls off the bicycle, sitting in front of a computer all day, or bad posture while watching TV on the couch. I was diagnosed with a mis-aligned sacrum and adjustments helped alleviate my pain.

In order to prevent a re-occurrence of my back pain, I wear a sacroiliac support belt while sitting in front of my computer and on long driving trips. I also do stretches and exercises to strengthen my sacroiliac joint.

Listed below are just a few exercises and stretches that I do daily and are also recommended by SPINE-health. These exercises are part of the PT-Helper’s exercise library.

Reminder: Please consult your physician or physical therapist before engaging in any physical activity and stop if you experience pain or discomfort.

• Hands and Knees Balance (Bird Dog): Position yourself on your hands and knees, with arms shoulder width apart and knees slightly apart. Tighten your abdominals, raise one arm and opposite leg slowly until they are horizontal. Keep hips even and back flat. Hold. Return to starting position and relax. Repeat with opposite arm and leg.

• Bridging: Lie on your back with both knees bent, feet flat on the floor and arms at your side. Engage your abdominal muscle then raise your hips up trying to make a straight line from shoulders to knees. Hold then lower down slowly keeping abdominals tight.

• Seated Hamstring Stretch: Sit on the edge of a chair, one leg bent and the other leg straight with toes pointing up. Lean over the straight leg. Gently let gravity pull you forward and stretch the hamstring on the straight leg.

• Single Knee to Chest: Lie on your back with both knees bent. Slowly bring one knee up, grab with hands and gently pull towards your chest. Hands can be under or over the front of your knee. You will feel a stretch in your lower back and buttocks.

5 Reasons Hands-on PT May Supplement or Replace Pain Meds

by guest blogger Brian Scherff, PT

The American Physical Therapy Association (APTA) is undertaking an anti-opioids campaign touting the benefits of Physical Therapy (PT) over highly addictive pain meds. The campaign is getting some negative buzz from opioid users but they, as well as others in the field, have some valid, statistical research on how PT can work better than pain meds. As with most issues, there are two sides to all opinions. This is how Excellence in Rehabilitation feels.

I’m not taking the stand that opioids should NEVER be used but the CDC released opioid prescription guidelines in March 2016 recognizing that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations—if—and it’s a big if—properly dosed.

So when could PT trump opioid use; or at the very least help reduce it?

• When the risk of the opioid outweighs the benefit. Using opioids for pain relief can include some horrible side effects, including depression, overdose, and addiction. And stopping the opioids can cause severe withdrawal symptoms. Consider whether long-term benefits outweigh the risks. The CDC states, “Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, ‘risks are much lower’ with non-opioid treatment plans.”

• When the pain becomes chronic (defined as lasting beyond 90 days). At that point, opioids may only be masking the pain where non-opioid therapies “are preferred” for chronic pain according to the CDC. Again, weighing benefit to risks, PT administered by a clinician could lead to greater benefits in both pain and function, and result in lowered risk to the patient.

• When mental health issues exist. A study supported by the National Institute of Drug Abuse of the National Institutes of Health showed a link between mental health, opioid use, and opioid risk factors citing those with higher negative affect (a constellation of anxiety, depression, and catastrophizing cognitive style) were at a higher risk of opioid misuse. Subjects in the high risk group also tended to have a more frequent history of substance abuse and every subject in the high group had a psychiatric diagnosis of some type of an affective disorder. Identifying patients with affective disorders could be key in implementing PT to replace opioid use.

• When a reduction in pain is possible without pain medication. The APTA shows a JAMA Network Open article that reports early Physical Therapy was associated with a reduced risk of any opioid use in all 4 conditions tested: a 16% drop for knee pain patients, a 15% reduction for those with shoulder pain, 8% for neck pain, and 7% for low back pain. Among patients who were prescribed (and used) opioids, early Physical Therapy seemed to have an association with fewer pills taken for 3 of the 4 conditions.

• To follow expert recommendations. The CDC recommends non-opioid treatment as a primary method to address chronic pain, including low back pain. Physical therapy is considered a safe alternative to manage chronic low back pain.

One review of the research from Oregon Health and Science University found that rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. “Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care.” And for chronic back pain, there is “scant evidence of efficacy…Opioids seem to have short-term analgesic efficacy for chronic back pain, but benefits for function are less clear.”

According to the APTA, part of the problem with patients seeking PT is the barrier to entry. They say “current policies create barriers for patients seeking physical therapist treatment. In most cases, it’s easier and less expensive for physicians to prescribe opioids and for patients to receive opioids.” Insurance providers may require a primary care provider referral, which, while beneficial, may delay physical therapy. And the Duke Clinical Research Institute says high co-payments can also be a barrier—often, the co-payment for a one-month opioid prescription is less than the co-payment for a single session with a chiropractor or physical therapist.

Based on this research and my 20+ years as a Physical Therapist and Instructor in the field, for me, the biggest takeaway is that early Physical Therapy may be an option for several musculoskeletal conditions. If preventing long-term opioid use is a treatment goal, the research all supports that those receiving early Physical Therapy had fewer long-term opioid use rates.

If knowledge is power, that’s important information for Physical Therapists to have in their treatment toolbox.

About Brian Scherff, PT

Brian has spent most of his PT career in outpatient therapy and home care. He has specialized in spine pain, vestibular treatment and balance. Brian is currently preparing to launch a new type of exercise table, the Multiple Applications Table (MAT). The MAT table advantage is that it offers both rehabilitation treatment and multi-function exercise capabilities in a single table at a remarkably small footprint.

PT-Helper’s May Blog Posts for Physical Therapists

Easy Mobile Access for Home Health Providers
Published on May 23, 2019
We have listened to home health providers and have made improvements to our PT-Helper CONNECT web-based exercise prescription service. It is now even simpler to use on both smartphones and tablets.  You can easily create home exercise programs on your mobile devices.


5 Easy Exercises to Help Ease Pregnancy Aches and Pains
by guest blogger Sigourney Cross, DPT  at Pelvic Health and Rehabilitation Center
Published on May 16, 2019
Pelvic and low back pain during pregnancy affects up to two-thirds of women and can start anytime from the first trimester to months after giving birth. Sigourney provides exercises can ease the aches and pains of pregnancy and prepare your body for the rigors of labor.


New Features on PT-Helper Mobile App
Published on May 9, 2019
We continue to work on improvements in our PT-Helper mobile app to make it even easier to use and more useful to patients and health professionals. We share 2 new features available on the mobile app to help patients complete their home exercise program.