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ESSENTIAL SKILLS The key to avoiding the stretch reflex altogether is to hold a stretch for only a short time—no more than two seconds. recommended holding stretches for much longer periods of time, up to 60 seconds. (This is referred to as static stretching.) However, research has shown that such prolonged stretching initiates the stretch reflex, decreases blood flow within the tissue, and leads to a buildup of waste products, such as lactic acid, that contribute to muscle fatigue and soreness.3 When people stretch in this way, they're working against themselves, causing a contraction of the very muscles they're trying to lengthen (sort of like trying to drive a car with the parking brake on). As a result, the tendons and ligaments get stretched more than the muscles, which can lead to tendon or ligament irritation and even laxity, and thus predispose these structures to future injury.4 6. MulTiPlE rEPETiTionS Static stretching relies on a principle known as stress relaxation: when muscles and connective tissues are held at a constant length, they eventually fatigue, release, and lengthen. In addition to promoting muscle fatigue, this type of action is also relatively slow. AIS achieves results much more quickly by using 6–10 repetitions of shorter stretches. This method can help increase the range of motion in a particular area by as much as 60 degrees in a relatively short period of time. 7. dEEP brEaThing Throughout an AIS session, the client coordinates his or her movements with regular, relaxed breathing. Deep breathing helps to increase the flow of oxygen to the muscles, decrease muscle fatigue, and encourage the release of muscle tension and fascial restrictions. It is important to avoid holding the breath. With oxygen available as fuel, muscles burn fatty acids and glucose (aerobic metabolism). Without sufficient oxygen, glucose gets converted to lactic acid (anaerobic metabolism), again leading to muscle fatigue and soreness. By adhering to these seven principles, AIS can bring about more reliable, consistent results than any other exercise system I've encountered. In Part 2 of this series, we'll go into more detail about how to incorporate these techniques into a massage therapy practice, as well as the reasons why it makes sense to do so (the specific ways in which AIS adds to the efficiency and effectiveness of bodywork). education and sports medicine. He is founder of the Muscular Therapy Institute. Benjamin has been in private practice for more than 45 years and has taught communication skills as a trainer and coach for more than 25 years. He teaches extensively across the country on topics including SAVI communications, ethics, Ben E. Benjamin, PhD, holds a doctorate in and orthopedic massage, and is the author of Listen to Your Pain, Are You Tense? and Exercise Without Injury, and coauthor of The Ethics of Touch. He can be contacted at 4bz@mtti.com. who specializes in physiatry, a branch of medicine focused on restoring optimal functioning and quality of life to people with physical impairments or disabilities. Haggquist completed his residency training in physical medicine and rehabilitation at Temple University Hospital in Philadelphia, his osteopathic internship at the University of Medicine and Dentistry of New Jersey, and his medical education at Kansas City University of Medicine and Biosciences. He teaches widely on flexibility and neuromuscular reeducation, and is a national specialist on Active Isolated Stretching. He has trained elite athletes and is the medical director of the Flexibility, Sports, and Rehabilitation Clinic in Washington, D.C. Prior to his medical training, he practiced as a neuromuscular massage therapist for more than two decades. Jeffrey P. Haggquist, DO, is an osteopath Editor's note: Massage & Bodywork is dedicated to educating readers within the scope of practice for massage therapy. Essential Skills is based on author Ben E. Benjamin's years of experience and education. The column is meant to add to readers' knowledge, not to dictate their treatment protocols. noTES 1. Dr. James Cyriax, author of a major text on orthopedic assessment and treatment, and now commonly known as the father of orthopedic medicine, was a teacher of mine in the late 1970s. 2. J.C. DeLee, D. Drez, and M.D. Miller, eds. Orthopaedic Sports Medicine, 2nd ed. (Philadelphia, PA: Saunders, 2003). 3. A.L. Mattes, Active Isolated Stretching: The Mattes Method (Sarasota, FL: Aaron L. Mattes, 2000), 1. 4. For more information on the effects of stretching tendons and ligaments, see Ben E. Benjamin, Exercise Without Injury (Cambridge, MA: MTI, 1992). connect with your colleagues on massageprofessionals.com 105