20250122 - MS Exercise vs Stretching - What Your Physical Therapist Wants You to Know - Finish by 1/13
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Dr. Gretchen: Hello, and thank you for tuning in today. I got a really great question in my inbox recently that I wanted to share with you and also answer because this topic that was asked about is so often misunderstood and understanding it can give you a much better sense of how to exercise with MS and how to differentiate the different types of exercises.
[00:00:28] The email - What is considered a stretch vs an exercise?
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Dr. Gretchen: Okay. So the email said, Hi, Dr. Gretchen. I've been using your book to help create a plan for addressing my symptoms And have found it to be most helpful. I signed up for your total strength program and have started the courses. Love it. I'm putting together my plan and understand that I should be doing X number of stretches and X number of exercises each day.
Dr. Gretchen: I'm confused by the difference between the two. I like the ankle dorsiflexion and the calf stretch in my daily plan. Do I count these as stretches or exercises or does it matter?
[00:01:02] The difference between stretches and exercise
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Dr. Gretchen: This is a phenomenal question because it does matter. Stretches are different from exercises, and oftentimes they're thought to be within the same umbrella.
Dr. Gretchen: And I can understand why someone might think that, but it's not true. That can be kind of dangerous because if you consider stretches and exercises the same, then it can be very easy for someone to feel like, I'm doing all my exercises, but they're only stretching exercises and that might be why they're not reaching their goal.
Dr. Gretchen: Or they're thinking, I'm doing all my exercises, but they're only strength based and that might be why they're not reaching their goal. So I personally feel it's really important to separate. Stretches from exercises, but then that leaves the question of, well, what are they? How do I tell a difference? And what do I do about this?
Dr. Gretchen: So let's dive in
[00:02:04] Stretching basics - Lengthen, reduse spacisity
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Dr. Gretchen: starting with the absolute basic. The most important thing you need to know is that stretches are the type of exercise where it's designed to lengthen the muscle and feel a stretch and feel less muscle tightness. So stretches might be. something that you would hold for anywhere from 20 to 30 seconds or maybe even a bit longer, and you would do that about two to four times per leg.
Dr. Gretchen: So if you're thinking like a calf stretch or a hamstring stretch, you would hold for about 20 to 30 seconds, typically, Do it two to four times on your right leg and two to four times on your left leg. That's an idea of what a stretch is. It's a longer hold. The goal is to lengthen the muscle, to stretch the muscle, and feel less muscle tightness or spasticity.
[00:03:00] Exercise Basics - Strengthening, stamina, endurance, speed
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Dr. Gretchen: Whereas exercises are more related to strengthening, stamina or endurance, and speed.
Dr. Gretchen: And let's also not forget that exercises can also relate to balance and of course, walking. So exercises in my mind, the way that I like to differentiate the two is stretching is lengthening the muscle, stretching. Exercises are strength based typically. It does go beyond that, but that's the easiest way to think about the two.
Dr. Gretchen: Now, strengthening. is the opposite of stretching. As I mentioned, stretching, nice long holds. And the goal, the physiological difference is that stretching is lengthening the muscle. Whereas exercises tend to involve active muscle contractions and tightening or shortening so that we can build strength, endurance, power, balance, etc.
[00:03:57] Physiological Differences
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Dr. Gretchen: So physiologically, The muscles are doing different things in each one. The nerve fibers are doing different things. The neural signals need to do more work with exercises compared to strengthening. So there's lots of physiological differences, but we're not going to go that deep. The main thing that you need to know in terms of your exercise routine is Stretches is stretching the muscle.
Dr. Gretchen: Exercises is strengthening. So it's going to be important that you include both types of movements.
Dr. Gretchen: And just to differentiate the two a bit further is that stretches
Dr. Gretchen: As mentioned are typically held a bit longer, 20 to 30 seconds, or in some cases, three to five or seven minutes. Whereas strengthening exercises are more so held for only one to two seconds or no seconds. You're just going slow and controlled. So it's much shorter of a hold and more repetitions.
Dr. Gretchen: So, for example, you might do. a marching exercise where you're lifting your knee up towards the ceiling and then lowering it down. You might do that movement slow and steady, maybe adding a one or two second pause at the top before lowering it down. And you might do up to 30 seconds. Good quality repetitions with rest breaks.
Dr. Gretchen: So maybe that's 10 repetitions, three sets, or maybe it's 15 repetitions, two sets, whatever it might be. So that's another way that we can differentiate the two is not just what the muscles are doing, but how long you would hold a stretch versus a strengthening exercise for, or how many repetitions you would do a stretch versus strengthening exercise for.
[00:05:48] So which should you be doing? *Spoiler, its both!*
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Dr. Gretchen: So let's talk about which you should do in your exercise routine, which I already gave a spoiler. It's both.
[00:05:56] Timing
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Dr. Gretchen: But there are different strategies on timing and when to do each one. So for some people doing your stretches before your strengthening based exercises can loosen up your muscles so that your strengthening exercises are even better, because You're feeling a little bit more limber now so you can move your muscles better.
Dr. Gretchen: You could also think about stretching after you're strengthening exercises because as mentioned, strengthening exercises are geared towards tightening your muscles and contracting your muscles. So if you are. If You're doing a bunch of strengthening exercises to help with your hip strength and leg strength and walking and walking distance and quality, stair climbing, things like that.
Dr. Gretchen: If you're doing a lot of strengthening exercises, then, and then just stop. and go about your day, your muscles have just been tightened. So stretching after your exercises can allow your muscles to go back to feeling a bit limber and a bit more mobile. So you could do the stretches before. Or after, or both.
Dr. Gretchen: Before and after, if you have the time to do that.
[00:07:11] Not all are equal
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Dr. Gretchen: Another thing that's really important to think about when we're discussing stretching is that not all stretches are created equal. I've shared this story a few times, but it's always worth sharing again because it's such a common misconception and mistake that a lot of people make. I was working with one of my in person clients and She was telling me, Dr.
Dr. Gretchen: Gretchen, my thighs are so tight. They're so spastic. And I don't know why, because I stretch all day long every day. And so my first question to her was, okay, what stretches are you doing? And she honestly listed probably 7 10 different stretches, but not one of them worked. was for the specific thigh muscle that she was sharing was tight and uncomfortable and spastic.
Dr. Gretchen: And so that just goes to show you not all stretches are created equal. So this person who emailed me, she said she loves the calf stretch, which is great. If her calf is the muscle that is tight and causing pain. limitations and difficulties and discomfort. But let's just say her tight muscles that are making walking challenging are her hip flexors.
Dr. Gretchen: If she is only focusing on hamstring stretches and calf stretches and inner thigh stretches and maybe glute stretches, these are all phenomenal stretches to be doing. But if she's working on walking and posture while walking and standing up tall, The hip flexors are the muscles that are tight, and so if she's not doing a hip flexor stretch, then these stretches, while they are still generally good for your body, they're not going to make the biggest impact in your walking.
[00:08:59] Self Analysis
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Dr. Gretchen: So with that in mind, it's important to do A self analysis and ask yourself what muscles feel tight to me or what muscles feel like they are bothering me or limiting me making movement challenging because of tightness. And you don't need to know the muscle names. You could just say the front of my hip, the back of my thigh, my ankle, you know, whatever it is.
Dr. Gretchen: But what muscles feel like they're making life hard because they're tight? Write those down. And then what muscles feel like they're tight? They're making life harder and things are more challenging because these muscles are weak. Like, it's hard for me to lift my leg or bend my knee because of weakness.
Dr. Gretchen: And that is where you'd focus your strengthening based exercises on or speed based or stamina, whatever it is. The exercises are more so for the areas that you feel are weak. Not necessarily tight. Anything that feels tight goes into the stretching category. Anything that feels weak or challenging due to weakness goes in the exercise category.
Dr. Gretchen: And the same concept applies here. You could be doing 20 different strengthening based exercises, but if you're having difficulty bending your knee and not one of those exercises that you're doing works on bending your then of course your walking is not improving because you're not doing an exercise for the specific body part that is limiting your walking, probably in addition to others, but you've got to include that knee bending if that's something that you're working on and that is feeling weak for you.
Dr. Gretchen: So do an analysis of what muscles feel tight, what muscles feel weak, And then find the appropriate exercises for those things. And one way to do that is through my total strength program, which is what this, person who emailed me is using to help create her routine. I'll link that in the show notes below if you want to learn more about it.
[00:11:14] Monthly Q&A inside the MSing Link
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Dr. Gretchen: And of course, we always talk about this type of topic on the monthly Q& A call that we have inside my online program, The MSing Link. The last Wednesday of every month, we all hop on Zoom and you can submit questions to me that I can help you brainstorm through and troubleshoot. So if an exercise is too easy or too hard, we'll work through that or If you're not sure, this is a perfect question that would get answered on that Q and A call.
Dr. Gretchen: If you're not sure what the difference between stretches or exercises are, I can answer it on that Q and A call. And if you need demonstration of the difference between stretches and exercises, that's something else that we do on that Q and A call. So if you are in the MSing Link, don't forget to join us live for those live Q and A calls.
Dr. Gretchen: But if you can't tune in live, they are always recorded and put inside the program and emailed to you afterwards.
Dr. Gretchen: And just to take the exercise portion a step further, you would be exercising differently If your goal is to work on strength versus speed, versus stamina versus balance. So the exercise category is big.
Dr. Gretchen: Stretches is definitely more niche. It is a specific component. It's just stretching. Whereas exercises can be broken down into lots of different categories. I do have a podcast episode going into the 10 different types of exercises. So if you want to listen to that,
Dr. Gretchen: check out. MSing Link Podcast, episode number 133.
Dr. Gretchen: But for now, I hope that provides some clarity because this is a really important topic so that you know and understand the difference and also how to combine them into your exercise routine so that you get the most effectiveness and most benefit from your exercises.
