Man and woman stretching

Stretch It Out

Simple movements provide daily benefits for people with bleeding disorders
Author: Matt McMillen

Stretching is a low-impact form of exercise that encourages movement, relieves stiff joints and supports recovery after a bleed.

“When you have a muscle bleed, you lose flexibility in that muscle. You need to stretch to get it back,” says Heidi Lane, PT, DPT, PCS, a physical therapist at Intermountain Hemophilia and Thrombosis Center in Salt Lake City, Utah. Plus, stretching is a feel-good activity. “You feel more mobile, flexible and free when you stretch.”

Stretching also can help you return to activities that you may have given up. For example, if you no longer ride a bicycle because you can’t bend your knee fully, a successful stretching program may help you regain enough range of motion to take a spin around the block again.

The basics and benefits

Stretching involves putting controlled, moderate pressure on your muscles and joints until you feel a slight tension. You then hold that position for about 20 to 30 seconds. “Don’t bounce,” says Lane. “Instead, gently hold it steady.”

To understand how a stretch should feel, bend your index finger backward, says Cindy Bailey, PT, DPT, OCS, SCS, a physical therapist with the Orthopaedic Hemophilia Treatment Center at the Orthopaedic Institute for Children in Los Angeles. “There’s discomfort, but it’s not injurious,” she says.  “You want to feel that level of tension, but no more on your hamstring, shoulder or whatever you’re stretching.”

The key to a good stretch is to engage the muscle or joint until you reach the end of its range of motion. “The motion you have, you want to keep,” says physical therapist Nancy Durben, PT, of the Mountain States Hemophilia Center at Oregon Health and Science University in Portland. When you stretch, you also promote joint health. Stretching through your full range of motion stimulates the production of synovial fluid inside the joint’s lining. That fluid helps protect and preserve the shock-absorbing, friction-reducing cartilage found at the ends of your bones. “Synovial fluid is the grease for our joints,” says Bailey. “Without it, cartilage starts to deteriorate.”

Form matters

Before stretching, warm up. Do a few minutes of light aerobic exercise, such as a brief ride on a stationary bicycle. Your muscles will be a little more elastic, and that will allow them to stretch more easily. “It helps to get some blood flowing before you stretch,” says Durben.

Stretching requires precise movements and proper form. If you stretch incorrectly, you risk muscle and joint injury, including strains, pulls and bleeds. This is especially true if you have target joints. Before you start any new exercise, no matter how gentle it may be, talk with your physical therapist. “You need instructions on how to be safe when you stretch that joint so that you don’t create a bleed,” Bailey says.

Practice your stretching routine with your PT, who can correct any mistakes in form. A common error occurs when people try to stretch their hamstrings, Lane says. People sit on the floor with their legs stretched out in front of them. When they reach forward to touch their toes, they wrench their backs rather than engage their hamstrings. “You need proper technique and good alignment,” says Lane. “That means keeping the back straight and bending forward at the hips.”

Alternately, Lane suggests, lie on your back in front of an open doorway. Raise one leg and place your heel against the wall with your knee slightly bent. Rest your other leg on the floor and extend it through the doorframe as much as necessary. This allows you to keep one leg straight while you stretch the muscles in your other leg. Carefully straighten your raised leg until you feel slight tension. Hold that position for 20 to 30 seconds to stretch your hamstring, then switch legs. Work with your PT to be sure you do this correctly.

Your stretching program should be tailored to your needs and abilities, but should give your whole body a workout. That includes your leg muscles, hip flexors, arms, shoulders, abs and more. No matter what your routine, make stretching a daily practice. “It doesn’t have to be difficult,” Durben says. “Feed your muscles with movement every day and throughout the day.”