Stretch after your workout


July 08, 2005|By Judy Foreman | Judy Foreman,Special to the Sun

How important is it to stretch before or after exercise?

Coaches and exercise gurus have long advocated stretching before exercise to avoid injuries. But what little research there is doesn't support that idea. Instead, experts suggest stretching after you're warmed up to increase overall flexibility. In a paper published last year in the journal of the American College of Sports Medicine, Medicine and Science in Sports and Exercise, researchers from the federal Centers for Disease Control and Prevention analyzed the limited number of studies available and concluded that "stretching had no effect in reducing injuries."

A separate paper in the March issue of The Physician and Sports Medicine noted that stretching may even slightly impair performance because, as with weight lifting, muscle force decreases slightly, by 2 percent to 5 percent, immediately after stretching.

After your workout or race, when muscles and tendons are warm, is the time to really stretch to improve overall flexibility, said Dr. Edward Phillips, director of outpatient medical services at Spaulding Rehabilitation Hospital in Boston. Or use hot packs before stretching. Scientists demonstrated the value of hot stretching decades ago in rats, or more precisely, rat tails, which could be stretched farther and with less damage when they were warmer.

Physiologically, stretching increases the elasticity of muscles, and tendons and, to a lesser extent, ligaments. Ideally, you should hold a stretch for 20 to 30 seconds without bouncing or pushing, said Dr. Brian Krabak, a physiatrist at Johns Hopkins. Then repeat this two or three times, several times a week at least, daily if you can.

Phillips makes a distinction between stretching and warming up. Instead of worrying about lengthening muscles at the beginning of a workout, he suggests jogging slightly or moving your limbs around to get your heart rate up a bit. The idea, he said, "is to go through the motions you will do in your event or workout."

Are there any new treatments on the horizon for endometriosis? All I've heard about is hormonal drugs and surgery.

In the near term, traditional hormonal drugs and surgery (a last resort) will continue to be the main treatments for endometriosis, in which tissue from the lining of the uterus grows around the ovaries, fallopian tubes and elsewhere, triggering pain and infertility. Overall, an estimated 10 million to 12 million American women of reproductive age have chronic pelvic pain, most of which is caused by endometriosis.

But new, nonhormonal drugs are now being tested in baboons, and even the hormonal options are improving. In March, the U.S. Food and Drug Administration announced approval of depo-subQ provera 104, a new, easier-to-use formulation by Pfizer of an existing injectable contraceptive.

Both the old and new Depo-Provera drugs work by stopping the pituitary gland from pumping out the hormones that stimulate ovulation, essentially creating a state of "pseudo pregnancy." Without ovulation, the ovaries also pump out less estrogen, and less estrogen means less stimulation of uterine tissue, both inside and outside the uterus. The result is less swelling and pain.

On the downside, these hormonal drugs and a stronger one called Lupron can decrease bone mineral density, but so far this has not been linked to an actual increase in fractures, said Dr. Lee Shulman, a reproductive geneticist at Northwestern University and a consultant to Pfizer on the new drug formulation.

Researchers are now pursuing other hormonal approaches, including the use of selective estrogen receptor modulators such as Evista and other drugs that block estrogen known as aromatase inhibitors.

A completely different approach is also showing promise in baboons -- controlling pelvic inflammation and pain by blocking certain chemicals pumped out by the immune system. If all goes well with this and other research, "the landscape for medical treatment for endometriosis will be dramatically different in the next five to seven years," said Dr. Mark Hornstein, director of the division of reproductive endocrinology and infertility at Brigham and Women's Hospital in Boston.

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