SMI Newsletter — September, 2013

Autumn News

Greetings from SMI,

Putting together this newsletter every few months has been a fun and enlightening process. As we search the current library of literature we find ourselves learning new information as well as reviewing the research that has played such a crucial role in formulating our approach and techniques.It is always fascinating to see what has actually been studied and more importantly how we can apply this information both inside and outside the clinic. We hope this information has been as beneficial to you as it has been to us.

Enjoy the rest of your summer and we hope you are able to stay active, healthy and pain free!

~The SMI Team

SMI is excited to welcome Jenna Boren DeNucci as our newest team member!

Jenna recently relocated to sunny California from the colder climes of Minneapolis, MN. Upon obtaining her bachelor’s degree in Biology and Education from Saint Olaf College in Northfield, MN she decided to focus on running competitively. After struggling with a few running related injuries, she decided to go to chiropractic school and graduated from Northwestern Health Sciences in 2005 as a doctor of chiropractic. While in school she started her certification in Active Release Techniques (ART) and it has since been her primary form of treatment. She has worked at various Ironman events, local triathlons, and has spoken to running groups about injury treatment and prevention. Jenna has experience working with athletes of all abilities from someone who is just getting started to the professional athlete/performer. She also enjoys working with people who experience symptoms related to the repetitive stress of their daily lives like sitting, typing, and carrying children.

She loves helping people stay active and assisting them in achieving their own personal goals. She has coached high school, college, and recreational athletes. She competed in the USA Olympic Trials marathon in 2008 and 2012 and hopes to qualify again for the 2016 trials. Jenna and her husband, Chris, a resident physician at Stanford, enjoy exploring the world on foot or on their single speed bikes while stopping to eat as often as possible.

Jenna will be providing 30 minute ART only sessions. Call today to schedule an ART appointment with Jenna or one of our other ART specialists!


SMI in San Francisco!

Just a reminder that SMI therapist, Eva Popper, is available every other weekend in San Francisco. She is working in the Alamo Square district at 425 Divisadero St, Suite 209. You can schedule an appointment by calling the Palo Alto office at 650-322-2809.

Active Release Technique

Active Release TechniqueSMI has been offering Active Release Technique (ART) Therapy as part of a comprehensive treatment plan for many years. It is an indispensable aspect of the services we provide. For those of you who don’t know, ART is a patented, state of the art technique that combines massage with stretching to treat muscle, tendon, ligament, fascia and nerve dysfunction. During an ART treatment, your therapist evaluates the tightness and mobility of the soft tissue, looking for fibrous adhesion. Pressure is applied to the adhesion while at the same time stretching the tissue. This type of treatment can at times be uncomfortable but is extremely effective.


Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can permanently be resolved with ART.

Read what Olympic Silver Medalist Elaine Breeden has to say about her ART treatments performed at SMI:

“During my career as a professional swimmer, I experienced a significant amount of shoulder and upper back pain. I was a butterflier, and the repetitive overhead motion caused wear and tear on my upper body that could only be fixed by massage, and more specifically, by ART. I sought ART treatment every time my shoulders were locked up, and it provided instant relief for my pain. Often, I would go into a massage session with so much shoulder pain, I was afraid I wouldn’t be able to train through it. After just one session of massage and ART, I was back to my peak performance level. I could not have made it through the rigorous training and competition schedule without SMI providing ART treatment.”

SMI offers 30 minute ART sessions. If you have any questions about ART or want to find out if this type of treatment is right for you, please call SMI today!

Orthopedic Massage – Stretching: The Truth (part 2)

newsletter201309-2In the previous SMI newsletter I wrote the first of a three part expose on stretching. There has been a lot of conflicting information about stretching and I would like to help shed light on what the research has actually found and just as importantly what it has not found. More than anything else, it is important to realize that stretching cannot be nicely summed up as either being “good” or “bad.” It is a complicated issue that needs to be examined from a number of different angles such as when you are stretching, how you are stretching, your flexibility, age and activity. To recap the previous article, static stretching before you work-out has been found to have a negative impact on performance, whereas a dynamic, movement based warm-up, including dynamic stretching, has been found to have a positive impact on performance. In this article, I examine what the research has to say about stretching at other times.

Stretching and Injuries

Everyone has probably heard that stretching helps prevent injuries. As mentioned inthe previous newsletter, there has not been an extensive amount of research on the relationship between stretching and injuries. Based on the work that has been done, it has generally been found that pre-exercise staticstretching has neither a positive nor negative impact on the incidence of injuries. (1, 2) A 2004 literature review concluded that stretching, either before or after activity, “was not significantly associated with a reduction in total injuries.” (3) However, studies have also found that soccer players with greater ranges of motion experience fewer injuries. (4, 5) And, flexibility asymmetries from the left side of your body to the right side of your body result in a higher incidence of injuries. (6) So it appears that having greater flexibility can decrease your risk of injury. At the same time, a 2010 meta-ananalysis found that joint hypermobility (being excessively flexible) resulted in an increased risk of knee injury in athletes performing contact sports.(7) Based on the current evidence, we should assume that there is an ideal range of motion. This probably varies from activity to activity. In the meantime, if you have what appears to be limited flexibility you should increase the range of motion in order to decrease your risk of injury. When a flexibility asymmetry is present you should make a concerted effort to increase the range of motion of the side that is more restricted and attempt to make your body more symmetrical. At the same time, if you are excessively flexible you should focus less on stretching and more on strengthening.

If you have a limited range of motion, how do you increase it?

The research has found that PNF or proprioception neuromuscular facilitation is the most effective way to increase range of motion in a single stretch session.(8) PNF is different than basic contract/relax stretching. PNF uses contract/relax techniques but very specific movement patterns are incorporated into PNF stretching. Over multiple stretch sessions lasting weeks or months, it appears that static stretching, defined as getting into a stretch position and holding it for an extended period of time and PNF stretching produce very similar results. (9, 10) Furthermore, static stretching has been found to be much more effective than dynamic stretching (movement based stretching) and contract/relax stretching for increasing flexibility. (11, 12) Based on this evidence and the ease of use, we recommend a static home stretching routine.

For most people, holding a static stretch for at least 30 seconds resulted in the greatest increase in range of motion. Furthermore, only 1 repetition was needed for maximum effectiveness. (13) Multiple repetitions did NOT result in any additional increase in range of motion. BUT, as we get older (research has focused on over 65) you actually need to increase your static stretch time to 60 seconds or longer for maximum benefit. (14)

Does stretching help with recovery from a workout or race?

The short answer is no. Based on levels of post-exercise soreness, neither pre nor post-exercise stretching had a significant impact on recovery from a race or workout. (15)

What should you do?


Pre-exercise: This should consist of dynamic, movement based stretching incorporated into a thorough warm-up.

Post-exercise: If you have a limited range of motion OR if you have flexibility asymmetries, you should engage in static stretching. If you are under 40 this should consist of 1 repetition of 30 seconds per stretch. For those of you who are 40-60 this should consist of 1 repetition of 45 seconds per stretch. If you are over 60 this should consist of 1 repetition of at least 60 seconds per stretch.

If you are hyper mobile then focus more on strengthening and less on stretching.

Clearly more work needs to be done to determine optimal ranges of motion. And this probably varies greatly from activity to activity. Hopefully we can gain an even better understanding of stretching and its benefits in the coming years. Stay tuned!

1. POPE, R. P., R. D. HERBERT, J. D. KIRWAN, and B. J. GRAHAM. “A randomized trial of preexercise stretching for prevention of lower-limb injury.” Med. Sci. Sports Exerc., Vol. 32, No. 2, pp. 271-277, 2000.

2. Thacker S, Gilchrist J Stroup D, and Kimsey C. “The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature.” Medicine & Science in Sports & Exercise, Vol. 36, No. 3, pp. 371-378, 2004.

3. Thacker S, Gilchrist J, Stroup D, Kimsey, CD. “The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature.” Med Sci Sports Exerc. 2004 Mar;36(3):371-8.

4. Witvrouw, E, Danneels L, Asselman P, D’Have T, Cambier D. “Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players. A prospective study.” American Journal of Sports Medicine, 2003 Jan-Feb; 31(1)41-6.

5. Bradley PS. Portas MD. “The relationship between preseason range of motion and muscle strain injury in elite soccer players.” Journal of Strength and Conditioning, 2007 Nov;21(4):1155-9.

6. Knapik JJ, Bauman CL, Jones BH, Harris JM, Vaughan L. “Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes.” American Journal of Sports Medicine, 1991 Jan-Feb; 19(1):76-81.

7. Pacey V, Nicholson LL, Adams RD, Munn J, Munns CF. “Generalized joint hypermobility and risk of lower limb joint injury during sport: a systematic review with meta-analysis.” American Journal of Sports Medicine, 2010 Jul;38(7):1487-97.

8. Gonzalez-Rave JM, Sanchez-Gomez A, Santos-Garcia DJ. “Efficacy of two different stretch training programs (passive vs. PNF) on shoulder and hip range of motion in older people.” Journal of Strength and Conditioning, 2012 Apr;26(4):1045-51.

9. Yuktasir B, Kaya F. “Investigation into the long-term effects of static and PNF stretching exercises on range of motion and jump performance.” Journal of Bodywork Movement Therapy, 2009 Jan;13(1):11-21.

10. Davis DS, Ashby PE, McCale KL, McQuain JA, Wine JM. “The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters.” Journal of Strength and Conditioning Research, 2005 Feb;19(1):27-32.

11. Bandy WD, IrionJM, Briggler M. “The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles.” Journal of Orthopedic and Sports Physical Therapy, 1998 Apr;27(4):295-300.

12. Bandy WD, Irion JM, Briggler M. “The effect of time and frequency of static stretching on flexibility of the hamstring muscles.” Physical Therapy, 1997 Oct;77(10)

13. Feland JB, Myrer JW, Schulthies SS, Fellingham GW, Measom GW. “The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older.” Physical Therapy, 2001 May; 81(5):1110-7.

14. Herbert RD. de Noronha M, Kamper SJ. “Stretching to prevent or reduce muscle soreness after exercise.” Cochrane Database Syst Rev.2011 Jul 6;(7)

Nutrition: Coffee…It just keeps getting better!

picture of cup of coffeeIn the February 2013 issue of the SMI newsletter, we wrote an article espousing the benefits of drinking that morning cup of joe. New research continues to find more and more reasons to keep drinking it. A recent long term study by the American Cancer Society tracked the habits of nearly 1 million people for a period spanning 26 years. Those who drank at least 4 cups of caffeinated coffee daily had a 50% lower risk of dying of mouth and throat cancer compared to those who drank coffee occasionally or never at all. (1) Those who drank decaffeinated coffee found a slight benefit with regard to mouth and throat cancer whereas tea drinkers found no benefit at all.

An additional study that just came out of the Harvard School of Public Health found that adults who drink two to four cups of coffee per day are 50 percent less likely to commit suicide than those who don’t. (2) The study went on to state that those who consume one to seven cups daily report improvements in energy levels, mood, sociability, self-confidence, and motivation for work. However, that kind of pickup is limited to habitual coffee drinkers. Those who drink coffee sporadically were more likely to report feelings of anxiety and general ill-being.

Why the recent shift in sentiment?

So over the last couple of decades coffee has gone from being unhealthy to being a health powerhouse. Are the lattes and cappuccinos made at today’s artisanal coffee shops just different from the Folgers Crystals and gas station brew of the 70’s and 80’s? Although today’s coffee beverages do taste a lot better, the health benefits have probably always been there. One possible answer is that years ago drinking coffee would often be accompanied by unhealthy activities such as smoking and eating donuts. This skewed the data and the initial research didn’t take these other activities into consideration. As studies have become more sophisticated the information obtained by research has become more accurate.

So go have a cup or two from one of our favorite local coffee houses. We strongly recommend Philz Coffee, Zombie Runner, Douce France and Coupa Cafe!

1. Hildebrand, Janet S. “Coffee, Tea, and Fatal Oral/Pharyngeal Cancer in a Large Prospective U.S. Cohort.” American Journal of Epidemiology. 2012 December.

2. Lucas M, O’Reilly E, Pan A, Mirzaei F, Willett W, Okereke O, Ascherio A. “Coffee, caffeine, and the risk of completed suicide: Results from three prospective cohorts of American adults.” The World Journal of Biological Psychiatry. 2013 July.

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