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Stretching and Exercise

by Simeon Niel-Asher(more info)

listed in exercise and fitness, originally published in issue 218 - November 2014

Fitness and Flexibility

An individual’s physical fitness depends on a vast number of components, and flexibility is only one of these. Although flexibility is a vital part of physical fitness, it is important to see it as only one ‘spoke’ in the ‘fitness wheel’. Other components include strength, power, speed, endurance, balance, co-ordination, agility, and skill.

Although particular sports require different levels of each fitness component, it is essential to plan a regular exercise or training program that covers all the components of physical fitness. Rugby and American football (gridiron), for example, rely heavily on strength and power; however, the exclusion of skill drills and flexibility training could lead to serious injury and poor performance. Strength and flexibility are of prime concern to a gymnast, but a sound training program would also improve power, speed, and endurance.

The same is true for each individual; while some people seem to be naturally strong or flexible, it would be foolish for such persons to completely ignore the other components of physical fitness. And just because an individual exhibits good flexibility at one joint or muscle group, it does not mean that the entire individual will be flexible. Therefore, flexibility must be viewed as specific to a particular joint or muscle group.

The Dangers and Limitations of Poor Flexibility

Muscles that are tight and stiff limit our normal range of motion. In some cases, lack of flexibility can be a major contributing factor to muscle and joint pain. In the extreme, lack of flexibility can mean it is difficult, for example, to even bend down or look over the shoulder.

Tight, stiff muscles also interfere with proper muscle action. If the muscles cannot contract and relax efficiently, the result will be a decrease in performance and a lack of muscle movement control. Moreover, short, tight muscles cause a dramatic loss of strength, power, and efficiency during physical activity.

In a very small percentage of cases, muscles that are tight and stiff can even restrict blood circulation. Good blood circulation is vitally important in helping the muscles receive adequate amounts of oxygen and nutrients. Poor circulation can result in increased muscle fatigue and, ultimately, will impede the muscles’ repair process and the ability to recover from strenuous exercise.

Any one of these factors can greatly increase the chances of becoming injured. Together they present a package that includes muscular discomfort, loss of performance, an increased risk of injury, and a greater likelihood of repeated injury.

Causes of Restricted Flexibility

The muscular system needs to be flexible in order to achieve peak performance, and stretching is the most effective way of developing and retaining flexible muscles and tendons. However, a number of other factors also contribute to a decrease in flexibility.

Flexibility, or range of motion, can be restricted by both internal and external factors. Internal factors such as bones, ligaments, muscle bulk, muscle length, tendons, and skin all restrict the amount of movement at any particular joint. As an example, the human leg cannot bend forward beyond a straight position, because of the structure of the bones and ligaments that make up the knee joint.

External factors such as age, gender, temperature, restrictive clothing, and of course any injury or disability will also have an impact on one’s flexibility.

Flexibility and the Ageing Process

It is no secret that with each passing year, the muscles and joints seem to become stiffer and tighter. This is part of the ageing process and is caused by a combination of physical degeneration and inactivity. Although we cannot help getting older, this should not mean that we give up trying to improve our flexibility.

Age should not be a barrier to a fit and active lifestyle, but certain precautions should be taken as we get older. Participants just need to work at it for longer, be a little more patient, and take a lot more care.

Stretching and Strengthening Exercises

Exercise should be regarded in the same way as a doctor’s prescription: it should have the appropriate dosage and, for maximum effectiveness, be targeted where needed (amount and type of exercise).


Stretching has a host of benefits, including:

  • Improved range of motion;
  • Increased power;
  • Diminished post-treatment soreness;
  • Reduced fatigue.

Stretching the muscles with trigger points, or the muscles that you are trying to strengthen, is important for breaking old holding patterns, restoring range of motion, and preventing injury. Gently stretching after a trigger point treatment session or after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible.

Types of Stretching

There are many different ways to stretch, each with its advantages and disadvantages. The two most recommended techniques are: 1) passive/static stretching, best used at home or after treatment; and 2) proprioceptive neuromuscular facilitation (PNF), best used with a partner. There is no such thing as a ‘good’ or ‘bad’ stretch, and the effects of different techniques vary from person to person. It is advised to warm up for 10 minutes before stretching, whether with some cardiovascular exercises or a warm/hot shower.

A passive/static stretching exercise: lateral side stretch

A passive/static stretching exercise: lateral side stretch

Passive / Static Stretching Technique

This technique is safe and effective for the novice.


Place the body in a position where the muscle you want to stretch can be put under tension; Slowly and cautiously approach the stretch; Do not stretch to the point of pain - discomfort is expected, but be cautious not to force the stretch; Hold for a minimum of 20 seconds (45-60 is best) and allow the muscle to lengthen; Breathe and relax; Gently come away and rest for 45-60 seconds; Repeat the stretch 2–3 times; Repeat 2-3 times daily; To make this more effective, stretch the antagonist (the opposite muscle) straight afterwards.

Foam rolling the outside of the thigh

Foam rolling the outside of the thigh 

Foam Roller Stretching

Foam rollers have been used since the 1950s to stretch ease and ‘rebalance’ muscular tension. Dr Moshe Feldenkrais is credited with having been the first person to use them for therapeutic purposes. Foam rollers come in various shapes, sizes and densities; they are cheap to buy and easy to use. Selecting the best roller is down to personal choice. Often this depends on your height, weight and the area you are looking to stretch.

Rollers can be very effective at deactivating trigger points both on their own, after hands-on techniques, and after dry needling. Using a foam roller is simple; used properly they can be very effective for improving:

  • Balance
  • Flexibility
  • Coordination
  • Relaxation
  • Range of motion


With self-help foam rolling, you are able to determine the amount of pressure you apply to a particular area and the duration of time you hold the point. Whilst they are relatively safe and easy to use, it is advised to seek an opinion from a doctor or informed therapist about the best way to use them. Here are some considerations for trigger point massage:

  • A firm circular roller is advised;
  • Always study the anatomy of the muscle before rolling;
  • When applying pressure, try to rest on the muscles/soft tissues and not the bones or joints;
  • Start close to the body and roll away from it;
  • Roll up and down the taut band until you hit the trigger point / sweet spot;
  • Pause on the pain spot/trigger point for up to 5 minutes, or until you feel it melt away. Repeat as necessary;
  • Be aware of the posture of the rest of your body when rolling;
  • Move up and down from the trigger point slowly and carefully;
  • The foam roller can be used up to 6 times a day.


Remember - pain is an alarm bell, so if you feel exaggerated pain, stop! Be gentle and respectful to the points.

Proprioceptive Neuromuscular Facilitation (PNF)

This is a more advanced technique and may be used for obtaining more permanent results; it also improves muscular strength. There are several forms of PNF stretches, including ‘hold relax stretch’ or ‘contract relax stretch’. Another variation is post-isometric relaxation (PIR).


Position the muscle group so that it is under tension, and hold; Contract the stretched muscle for 5-6 seconds while a partner resists you moving the joints; Stretch the muscle again for approximately 30 seconds; Rest/recover for 30 seconds; Repeat the procedure 2-4 times (up to 10 minutes); Repeat 2-3 times daily.

Protocol for Stretching

As a rule, any stretching program should be continued for four to six weeks, unless otherwise specified by your practitioner, doctor, or physical therapist. After your recovery, these exercises can be continued as a maintenance program for lifelong protection and health. Performing the exercises two to three days a week will maintain strength and range of motion. A goal should be to make a regular time at home every day for stretching the affected muscles toward obtaining full range of motion. It is also advised to keep a diary of any stretches that aggravate your trigger point symptoms.

Remember to warm up before doing stretches: perform 5 to 10 minutes of low-impact activity, such as walking or riding a stationary bicycle.

NB: Do not ignore pain. It is important to be aware that overzealous stretching can reactivate latent trigger points. The advice is to progress gradually from one stretch to another and listen to your body; different stretches work different types of fiber and afford the brain a better sense of self. You should not feel severe pain during or after a stretch: in general, if a stretch activates your trigger point pain, it should be stopped.

Pain on rest can indicate that the trigger points are very active. The advice here is either to rhythmically move the effected area in warm water or to apply moist heat and the gentlest of massage.

Talk to your practitioner, doctor, or physical therapist if you have any pain while stretching.


Strengthening the muscles improves their tolerance and stamina to exercise. Keeping muscles strong can relieve pain, improve the function of muscles with trigger points, and prevent further injury. As a rule, strengthening a muscle occurs when you hold maximal muscle contraction for 5-10 seconds.

Types of Strengthening

Here we will talk about two types of strengthening exercise - isometric and isotonic - although others exist.

An isometric strengthening exercise: the ‘plank’

An isometric strengthening exercise: the ‘plank’

Isometric Strengthening

Isometric exercises keep the joints in the same position and are non-traumatic. They are relatively simple to perform, require very little equipment, and do not require any previous fitness experience. They are a great first place to start on your strengthening program. Isometric strengthening occurs when you exert variable force to a fixed position: yoga and Pilates, for example, rely a lot on isometric loading. A simple example of an isometric exercise is the ‘plank’:

  • Lie face down on the floor or a yoga mat, with your hands directly beneath your shoulders;
  • Press down with your hands to lift your torso off the floor;
  • Flex your abdominal muscles to keep your back straight;
  • Your body should create a long, straight line.


Isometric exercises are specific to the joint angle: the greater the angle, the longer the lever and the more force required to maintain the position; To increase difficulty you can repeat isometric positions every 15-20 degrees throughout the range of motion; Hold most contractions for about 6-30 seconds, and repeat if you want to increase the effects; Do not forget to breathe; If you feel dizzy or light-headed, you should stop.

An isotonic strengthening exercise: incline barbell press

An isotonic strengthening exercise: incline barbell press 

Isotonic Strengthening

This occurs when you resist against a uniform force. This may involve:

  • Weights - barbells, dumbbells, or resistance machines;
  • Body resistance, e.g. press-ups;
  • Resistance bands;
  • Kettlebells.


  • Exercise each muscle group at least twice a week;
  • It is important that you get adequate rest between exercise sessions - at least 48 hours. Isotonic exercise strengthens muscles by creating small tears in them, which then repair. As you rest after your workout, your muscles heal and grow stronger;
  • Always warm up before working out and cool down afterwards;
  • Stretch at the end of every exercise session.

Protocol for Strengthening

Before doing strengthening exercises, warm up with 5 to 10 minutes of low-impact activity, such as walking or rowing.

NB: Do not ignore pain. You should not feel severe pain during or after exercise: in general, if an exercise activates your trigger point pain, it should be stopped.

Talk to your practitioner, doctor, or physical therapist if you have any pain while exercising.


The above article is reprinted with permission from The Concise Book of Trigger Points by Simeon Niel-Asher published by Lotus Publishing 2014. Further Information and resources at Available from Amazon


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About Simeon Niel-Asher

Simeon Niel-Asher B Phil BSc (Ost) qualified as an Osteopath in 1992. Simeon uses trigger point therapy in his everyday work and is the inventor of the Niel-Asher technique for treating frozen shoulder syndrome. Named by the Evening Standard newspaper as one of the top ten Osteopaths in London, he is the author of The Concise Book of Trigger Points, now in its 3rd Edition. He is involved in treating, writing, research and has been teaching his novel approach to the management of shoulder pain throughout Europe, the USA and the Middle East. He may be contacted via

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