and Salvatore J. Minicozzi, D.C., C.C.E.P.
Chiropractors have taken up the banner for pro-active health care. Adjustments to the spine play the most important role, yet again it is the holding of the adjustment for which we strive. Without flexibility training, patients tend to lose their adjustments faster. Physiologically, there doesn’t seem to be any better system of flexibility training than Active Isolated Stretching (AIS).
The benefits of AIS are numerous. This system is derived from a need to “unglue” the effects of fascial sheath adhesions. The directional forces that are applied help to realign the collagen fibers. Both lymph drainage and circulation are improved. Collateral circulation is also improved as new vessels grow in response to the greater need for blood flow.1,2,3 Joint range of motion improves and the health of connective tissue increases. There is a better quality of life associated with freer movements and less constriction. Athletic performance is enhanced as athletes become more efficient in their movements. Longevity of an athletic career may also be increased. Muscles, tendons and ligaments resist the micro-tearing longer and are able to recover faster from the trauma associated with workouts, athletic events or even stress.
Flexibility training goes beyond simply being able to touch your toes—it is more than stretching the muscles of your inseam or twisting your torso. True flexibility training at its core adheres to certain physiological principles, which is the basis for Active Isolated Stretching. Active Isolated Stretching (AIS) utilizes the principle of reciprocal inhibition. According to Sherrington’s Law, muscles on one side of a joint will relax upon contraction of the antagonist muscle or muscles. It’s this physiological fact that is at the root of AIS.
AIS Methods
The methods of AIS utilize most muscles or muscle groups in the body. This system was developed nearly forty years ago by Aaron Mattes. According to the Mattes Method of AIS, there are seven body part protocols. Each protocol has the specific muscles and tissue that are targeted. The protocols of AIS are divided into the seven following areas: neck, shoulders, hands, trunk, pelvis, thighs and feet. We will delve into the different protocols in part 2 of this series. This article however, will first address the procedures of the Mattes Method of AIS.
Traditionally, the norm for flexibility training has been a static stretch of 10 seconds or more. Electro-myography testing demonstrates that this approach, which is still widely used today, in fact leads the muscle to guard.4 Muscle guarding via the myotatic stretch reflex is initiated after three seconds. Reflexive guarding is in response to prolonged, static overloading of the muscles attempted to be stretched. This protective feature exists because muscle spindles are found in the muscles and Golgi tendon organs are present in the tendons. These structures are there to prevent tearing of tissue. During static stretching, we hope to have muscle surrender to a sustained hold. Both muscle spindles and Golgi tendon organs reflexively aid in the resistance to overstretch. Additionally, static stretching is nothing other than an eccentric contraction of the muscle. Eccentric contractions, you may well recall, occur when the muscles are asked to act as a brake against some force, usually gravity. Since the muscle is in a state of eccentric contraction, it is physiologically unlikely that additional muscle/fascia elongation will occur.
Conversely, AIS uses a two second principle that avoids initiation of the myotatic reflex. Multiple repetitions of one to two seconds are favored in place of longer sustained stretching. This two-second principle helps to prevent an ischemic muscle response that is found in prolonged, static stretches. Because muscles lose the ability to oxygenate during an ischemic response, lactic acid builds up quicker.5 This leads to greater and quicker fatigue, more micro bleeding, and ergo greater scar tissue buildup. Preliminary study also indicates that short term AIS stretching is a positive influence for reduction of spasticity, while numerous studies indicate that prolonged static stretching is ineffective in reduction of spastic tissue.
Scar
tissue and adhesions, as we all know are major obstructions to movement. Adhesions
form in the connective tissue which is most affected. These adhesions form in
response to trauma, poor posture and environmental stress. AIS focuses on improving
connective tissue health. Fascia, which is a specialized type of connective
tissue, surrounds and protects many structures in the body. Adhesions found
in the fascia restrict movement and diminish a person’s capacity for wellness.
The movements that are incorporated in the Mattes Method of AIS are designed
to “unglue” fascial sheaths. This ungluing improves a person’s
range of motion, freeing them to move more easily. It’s not a far leap
to say that increasing motion also increases health.Just like 90 percent of our body, fascia arises embryonically from mesenchyme tissue. Mesenchyme cells differentiate into our internal organs, bone, lymph, muscles, ligaments and fascia. Mesenchyme cells are responsible for many vital functions. Toxins are removed from the body via the lymphatic system (mesenchyme). Blood circulates via the circulatory system (mesenchyme). Nutrition of cells, oxygenation and homeostasis are all provided because of mesenchyme tissue. The mesenchyme derived tissue that is most responsible for these functions is specifically fascia.
There are two types of fascia. Subcutaneous fascia connects most structures of the skin, muscles, bones and joints. Subserous lines the body cavities. The subcutaneous fascia is further divided into deep and superficial fascia. The superficial fascia is elastic when healthy. After trauma due to accidents or prolonged periods of poor posture, it becomes less elastic and movement is restricted. Deep fascia is denser and is necessary in protecting deeper structures such as organs. The deep fascia also is vital in water storage and plays a critical role in temperature regulation. Fascial health is the primary focus of AIS. It is scarring to this connective tissue, which runs everywhere and connects everything in the body, which would prevent our patients from holding their adjustments.
AIS Principles
The principles of AIS are as follows: The doctor must first identify the tissue to be stretched. Since a lot of different muscles are in a small area, specificity is a must.
By properly positioning the patient, the targeted tissue is readily accessed. Precise movements are important to isolate the specific muscle. The movements are active on the patients’ part. This is of the utmost importance to achieve a reciprocal inhibitory signal for the targeted tissue to relax.
Patient breathing is necessary to achieve oxygenation of the muscle. Patients are encouraged to exhale as they are activating the necessary muscles for movement. The tendency on the patients’ part is to hold their breath. This can be overcome if the doctor or therapist breathes with the patient. The other side of the coin is to prevent the patient from breathing too deeply. Rigorous breathing can leave the patient feeling dizzy or light headed. The patient may also experience nausea if their breathing is too deep.
After completion of each two second repetition, the patient is asked to return the tissue to the starting position in order for movement to occur at the site. Movement is needed so that the muscles can act like a pump. Muscles need to pump blood so that oxygen and nutrients are transported into cells and toxins and metabolic waste are transported out.
Conclusion
Chiropractors have historically emphasized pro-action with regard to a patient’s health care. Doctors of chiropractic advocate diet, exercise and stress management. Recently some offices have added to these a system of gentle stretching exercises that their patients can do at home. AIS fits a need for patients who have such a system of flexibility training; AIS is something that patients can do regularly during the times when they are not in the office. This system additionally helps patients hold their adjustments longer. After all, it’s not the adjustment alone that matters; it’s the holding of the adjustment that counts.
In the July/August issue of Today’s Chiropractic, protocols of AIS will be explained more fully.
References