The Imagined Benefits of Stretching Perpetuated by the Sunk Cost Fallacy & Social Media Influencers

Disclaimer: Stretching actually does have merit. I learned something new, but I was wrong before, and I'm leaving the proof of my mistake right here.

A few seconds is all it takes to get a feel-good-stretch, Ahhh!... beyond that it's a waste of valuable time (unless you enjoy it).

The sedentary lifestyle is trending. The majority of Americans don't exercise enough. The U.S Department of Health and Human services considers Twenty-one minutes of cardio every day, and an unspecified amount of resistance training twice each week, enough.

Yoga doesn't count. Stretching is better than sitting, reclining or laying down, but that's about it.

Stretching is gaining popularity, however, and yoga enthusiasts across the globe are providing demonstrative instruction on social media. While the yoga, stretching videos are rather entertaining, the beneficial claims that accompany them are often false. Aside from flexibility, which is inconsequential, stretching yields nominal benefit, and for athletes, it may be worse than worthless.

2003 Stacy J. Ingraham, Ph.D. published an article that presented studies that examined the merits of stretching in isolation or as stand-alone training. Dr. Ingraham concluded that there is little or no evidence to support the use of stretching to prevent injury, offset muscle soreness or improve performance, and “recent research suggests that stretching, which increases flexibility beyond that needed for sport-specific movements, may cause injury.”

Ingraham references a study by Shrier, Ian MD PhD (1999) which presents 5 reasons why stretching before exercise would not prevent injury which include: “First, in animals, immobilization or heating-induced increases in muscle compliance cause tissues to rupture more easily. Second, stretching before exercise should have no effect for activities in which excessive muscle length is not an issue (e.g., jogging). Third, stretching won't affect muscle compliance during eccentric activity, when most strains are believed to occur. Fourth, stretching can produce damage at the cytoskeleton level. Fifth, stretching appears to mask muscle pain in humans.”

A randomized controlled trial (2009) found that the improvements in range of motion were associated with increased tolerance to stretch sensation, but with no real change in muscle extensibility, supporting Ingraham’s suggestions that stretching won’t affect muscle compliance and may mask muscle pain.

An article published in The Journal of Strength & conditioning Research (2020) found that static stretching produced meaningful reductions on functional performance consequently increasing the risk of injury.

A systematic review and meta-analysis of randomized controlled trials (2014) found that “strength training reduced sports injuries to less than 1/3 and overuse injuries could be almost halved” but found “no beneficial effect for stretching.”

There is enough evidence to reasonably conclude that stretching does not prevent injury, improve athletic performance or reduce muscle soreness. In fact, studies have shown the opposite to be true. Yet the prevailing opinion is that stretching is a requirement for injury prevention, rehabilitation and even a healthy lifestyle.

The imagined benefits of stretching have predominated for so long that an irrational adherence to the importance of this exercise has prevented the dissemination of evidence to the contrary. The Sunk Cost Fallacy (in for a penny in for a pound) coupled with the emergence of attractive, athletic, social medial influencers has made yoga training seem more favorable. The fitness industry as a whole is motivating individuals to start stretching as part of a healthy lifestyle. Sadly, stretching lacks utility of any kind as "the metabolic costs of yoga do not meet recommendations for levels of physical activity for improving or maintaining health or cardiovascular fitness (1)."

Yoga and stretching are great for people that enjoy it, but for individuals looking for a return on their investment, cardiovascular and strength training are superior options.

1. Does practicing hatha yoga satisfy recommendations for intensity of physical activity which improves and maintains health and cardiovascular fitness? | BMC Complementary Medicine and Therapies | Full Text (biomedcentral.com)

The Philosophy of Profit over People

“Don’t borrow trouble” is an idiom that means don’t worry about something before it is time to worry about it. This is especially true when a chiropractor wants to take X-rays of your low back. An x-ray is incapable of diagnosing nonspecific low back pain and seeing degenerative changes only extends the length of the care plan, not the type of care provided. Unless there is justified concern of an underlying pathology, like metastasis, it is in the patient's best interest to reject the x-ray and move on to the adjustment.

“Straight” and "Mixed" chiropractors often use evidence for best care practices to increase profit at the cost of patient health. They are ignoring evidence-based advocacy guidelines for patient care while profiting from the rationale of those recommendations for profit.

The guidelines

According to the guidelines from The American College of Physicians and Pain Society, imaging studies are only appropriate when severe or progressive neurologic deficits are noted, or if an underlying pathology is suspected. The use of x-rays, or any routinely obtained imaging is not recommended.

The Rationale

Pain science is changing our understanding of pain. “It’s all in your head” is now a working diagnosis. Pain is always a construct of the mind and that complicates diagnosing and treating chronic pain conditions. Nociplastic pain in combination with ongoing nociceptive or neuropathic pain can be exacerbated by images of disc degeneration, spondylosis and spinal osteoarthritis which are often asymptomatic.

Multiple studies have shown that disc degeneration, bulge, protrusion and annular fissures are common and often asymptomatic. A systematic literature review found that the prevalence of disk degeneration in 3,110 asymptomatic individuals was around 37% of 20-year-olds and 96% of 80-year-old individuals. Disk bulge, disk protrusion and annular fissure were also common in both younger and older pain free individuals.

A study published in 2013 found that low back pain patients that received imaging studies early in care, despite guideline recommendations, were associated with worse outcomes. The study concluded that early imaging provides no benefits, worse outcomes and could result in unnecessary medical procedures.

Early imaging has been associated with greater acute care costs and less favorable patient outcomes. Apparently being shown “evidence” of something wrong increases pain and the amount of money spent on treatment.

No brain, no pain: it is in the mind, so test results can make it worse (theconversation.com)

Profiting from the Rationale

This is how x-rays can be used to “certify necessity for care” and “support long-term chiropractic treatment plans.” Research findings and a better understanding of pain science is influencing medically inappropriate diagnostic studies that are entirely profit-motivated.

Chirotouch offers a webinar on “how to effectively apply the tool of x-ray imaging to your daily practice” (routine). This type of instruction disregards evidence-based advocacy guidelines for patient care while exploiting the rationale of those recommendations for profit.

Mark Studin, FASBE(C), DAAPM, lacks the necessary credentialling to provide qualified professional instruction on radiographic diagnosis. The illegitimacy of the presenter is further clarification of the medically inappropriate, profit motivated nature of this instruction.

The Chiropractic Subluxation Does Not Exist.

A Mixers vs. Straights Debate:

Philosophy is a soft science. May the Best Argument Win.

Palmer College is slowly refashioning the pseudoscientific chiropractic paradigm. The curriculum is evolving from the philosophical to the evidenced-based approach to patient care. The new course is expanding the scope of practice by favoring instruction on active care and clinical reasoning over chiropractic dogma.

Transitioning away from the dogmatic inspired resistance from the Straight chiropractic group, that have built their practice on Subluxation Philosophy and wish to continue. An outright upheaval was out-of-the-question, so Palmer College decided to take baby steps.

This gradual transition has pitted the hard science, evidence-based classes firmly against the chiropractic philosophy and technique courses.

It’s true! Here's one example of blatant contradiction.

In chiropractic technique classes Radiographic line analysis is used to determine the presence and type of chiropractic subluxation. The technique of line analysis involves finding anatomical landmarks on an x-ray image and plotting several points with pencil and drawing lines to connect them. If the anatomical landmark isn’t visible, close is often good enough, otherwise an alternate landmark can be used. The lines are then used to determine the position of the vertebrae.

Even if you know little else it’s clear that line analysis misses the mark of mathematical certainty.

The first day of Diagnostic Radiography all previous instruction was contradicted when the instructor stated, “A chiropractic subluxation is not visible on a radiograph.”

He was right of course. Small changes in spinal rotation or pelvic shift vary greatly from one X-ray to the next. An anterior pelvic tilt is largely mis-interpreted by an irreproducible standing posture, and that’s on asymptomatic individuals.

Radiographs are a valuable diagnostic tool, but they have limitations, and their interpretation can be unreliable. Broken bones and serious pathology can be overlooked or completely imagined!

A scoliotic cure is a real spinal misalignment that can be discovered upon visualization and diagnosed in clinic without the need for radiographs. The extent of the curvature is assessed with X-ray. A Radiographic measure of a single scoliotic curve can differ as much as six degrees from one measured interpretation to the next for the same patient. Considering that the difference between a mild cure and a moderate curve is approximately 6 degrees that discrepancy seems substantial.

What does this mean?

The half millimeter difference the chiropractor found at C1, isn't the cause of your neck pain, headaches, or high-blood pressure.

The most prevalent subluxation philosophy being sold to patients:

A subluxation is the misalignment of a vertebrae that puts pressure on a nerve root causing pain and disease. Therefore, the correction of subluxation releases nerve pressure resulting in the restoration of health though innate intelligence.

As B.J. Palmer explained it, “the power that made the body, heals the body.”

(But that same life force can't correct a subluxation)

Real spinal misalignments, like scoliosis are clear yet often asymptomatic and have never been associated with organic disease from nerve irritation.

Direct observation and the necessary foundation in vitalism of the subluxation philosophy should provide the commonsense nails for the subluxation coffin, yet it continues to persist.

Supernatural elements aside, let's consider only observable evidence in juxtaposition, with the help of adobe stock photos and paint.net.

NOTE: [Routine adjustments at C1 do not change a spondylolisthesis at L5 and will only help with low back pain if you truly believe it].