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Re: Are You Really Testing Hamstring Length?
Re: The Use of the Term "Lengthen"
The Use of the Term "Lengthen"
Are You Really Testing Hamstring Length?
Comments on "The Bottom Line" to Our Article
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James Stephens, PT faculty Temple University
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jstephen{at}temple.edu James Stephens
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Rich, thanks for your comments. Yes, I suppose you are correct. We did no diagnostics to rule in or rule out any soft tissue impairments at end range in any of our subjects. We cannot rule out nerve tissue or connective tissue for that matter. It would be more correct to say that the posterior tissues of the leg all became longer. In our opinion, this would be true of any study that talks about hamstring lengthening, by stretching or any other process. |
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James Stephens, PT faculty Temple University
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jstephen{at}temple.edu James Stephens
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Andrew, thanks for your comments. In an early version of this article we discussed the various issues related to different kinds of lengthening, adding sarcomeres among them. This of course did not happen as the time course was way too short and the tension way too low. In several places in the paper we used the terms "active" and "functional" to qualify the idea of lengthening to indicate that this increased length was available in movement. Our outcome measure also was one of active, not passive, movement. In any case, the term "stretching" should not be used to describe what was happening. We are interested here in using language that will get people thinking of the body more in terms of a neurological control system as well as a mechanical tissue system. |
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Andrew M Jordan, physical therapist Cayuga Medical Center, Ithaca, NY
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ajordanpt{at}verizon.net Andrew M Jordan
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First, I want to thank the authors for beginning the process of demystifying Awareness Through Movement. It is great to see research that begins to bring Feldenkrais Method into the era of evidence-based practice. I do have one question about the use of the word "lengthen." To literally lengthen the hamstrings, sarcomeres would have to be added in series. And while this is a normal and expected response to sustained, end-range stretching, it is difficult to see how the ATM exercises could result in this type of muscle hypertrophy. If, on the other hand, the ATM exercises produce an increase in hamstring excursion (either through changes in motor control patterns or reductions in hamstring resting tone), perhaps some word other than "lengthen" should be used. Thank you again for the thoughtful research, Andrew M Jordan, PT, DPT |
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Rich D. Maas, physical therapist
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maaserati{at}sbcglobal.net Rich D. Maas
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How can you be so confident to think you are influencing primarily hamstring length/health and not sciatic nerve length/health? Some of your subjects' comments comparing prior static stretching to your ATM approach such as "...didn't experience the customary burn associated with stretching...didn't stress my back..." sounds to me more indicative of nerve tissue strain rather than muscle strain. I do appreciate your study, and I don't challenge your generally favorable outcomes with more gentle active motion, since I too as a clinician witness this same phenomenon frequently with a gentle, pain-free active neuromobilization approach. It's already well documented in the neurophysiologic literature that basically, in so many words, nerve does not like to be stretched, but it loves to move. In summary, according to most of the recent literature, most of us can agree with the principle that gentle, pain-free motion is a key factor in the healing of the locomotor system. However, in this study, I question your presumption of the type of tissue you are primarily influencing with your ATM approach. |
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James Stephens, PT faculty Temple University
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jstephen{at}temple.edu James Stephens
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We are honored that our article was selected for a Bottom Line translation for clinical practice application as this will bring more attention to this work as a useful clinical approach. The real question and challenge posed in our work is whether it is possible to increase the functional, active length of a muscle group without using a process of passive or dynamic stretching. We believe that we have demonstrated that it is. We have not done any type of stretching here, but a process of easy active movement in which subjects had to learn a nonhabitual, coordinated pattern of movement. This process of Awareness Through Movement can be applied in many ways other than in the particular types of movements described in this paper and is more closely related to the ideas of awareness and the complexity of whole-body engagement in functional movement than to lengthening a particular muscle. It is interesting that some subjects made large increases, whereas others made few or no gains. We showed the individual information so that readers could see this range of differences in response to the intervention. This is a common finding in any process like this, as illustrated in the literature on hamstring stretching in a paper by Worrell et al 1994, cited in our paper. We do not know why some people have been able to achieve large gains and others no gains. We only know at this point that it is unrelated to which ATM lesson they chose to do or the amount of practice that they did. Interestingly, one of the “non-responders” (as described by the Bottom Line) was the person who had the longest hamstrings at the initial testing. She stated in an exit interview that she had learned the ATM movements very easily, she did not realize that she had short hamstrings, and she was probably not very motivated to do the activity. So, as in so many other things, motivation may be an important intangible here as well. We did not include a control group that did stretching because there is a large amount of literature in this area. Our control group did not do “no activity” as suggested in The Bottom Line but simply continued normal activity. We did not ask people to stop any stretching activity that they normally did, which meant that if they did hamstring stretching as part of their normal activity, they continued to do it. In the follow- up questionnaire, 94% of those doing the ATM identified it as being different from any form of “stretching” that they knew about. The Bottom Line uses the phrase: “different from another stretching technique” suggesting that we did some type of stretching. No stretching was done. While the value of this approach in rehabilitation interventions is beginning to be tested with people with cerebrovascular accidents (Batson 2005) and multiple sclerosis (Stephens 2001) and there are some clinical case reports supporting its use with orthopedic patients (Stephens 2000), we acknowledge that much more work needs to be done before this method will be broadly accepted for use with clinical populations or for performance enhancement or injury prevention in athletes. Sincerely, Jim Stephens, PT, PhD, CFP |
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