Warning: Stretching and Exercise Can Be Hazardous

From the Author

Because of the importance of the case I am about to present, I decided to postpone writing “Miracles and Mysteries in the Field of Massage – Part 3.”

In the meantime, for those who have not had a chance to read Part One and Part Two, you are welcome to click the links below. Even if you already read them, I highly recommend revisiting the paragraph from Part One, as it is directly related to the science and clinical application of medical massage, including — but not limited to — the cases I present.

https://www.medicalmassage-edu.com/blog/miracles-and-mysteries-in-the-field-of-massage-part-1.htm

https://www.medicalmassage-edu.com/blog/miracles-and-mysteries-in-the-field-of-massage-part-2.htm

The Hazard of Stretching and Exercise

One of my first jobs in the United States was as a staff trainer at a large physical therapy company in Southern California. The owner of the company was fascinated by the concept and clinical efficiency of medical massage. He wanted his PTs to have the opportunity to learn fascia release, mobilization techniques, and other medical massage protocols. I wrote about this previously and will not repeat myself here.

At that time, PTs treating painful back and limb disorders emphasized exercise, stretching, PT equipment, and hot/cold applications. I witnessed situations where patients, whose every movement caused sharp pain, were stretched and actively or passively moved. PTs would encourage them to “ignore the pain” and exercise.

After observing this approach for some time, I noticed that even simple cases did not achieve quick results. In some situations, I witnessed worsening conditions that required referring patients back to orthopedic surgeons. I spoke with the owner and told him directly that this was the wrong concept and approach. Yes—stretching and exercise are important therapeutic tools, but they can become a disaster when applied to a patient in severe pain. These actions are counterproductive: instead of normalizing muscle function, they trigger additional protective muscle spasms.

He told me:
“Boris, regrettably we are not an independent field. Orthopedic surgeons refer patients and prescribe what must be done. PTs have to follow those orders.”

I investigated the issue and quickly learned that orthopedic surgeons receive no training in physical rehabilitation. They often have no understanding of what to do in such cases. Their prescriptions for aggressive exercise sometimes create conditions that later require surgery. I emphasize aggressive, because I personally saw written prescriptions using this term. BTW, in severe cases, any attempt at exercise is aggressive.

These events took place in 1992. I was shocked to learn that orthopedic surgeons and other physicians, who were never trained in therapeutic exercise or stretching, were prescribing modalities that PTs were obligated to perform.

Stretching and exercise are extremely important in rehabilitation—but they must not begin until pain is significantly suppressed.

Recent Case: Proof That Little Has Changed

A 52-year-old male shoe designer, tall and previously healthy, developed pain between the scapulas a few months before he came to see me. Sitting and working became difficult. At night he would wake from pain and could not take a deep inhalation. Not knowing what caused the problem, he went directly to an orthopedic surgeon.

After radiological and other examinations, the doctor told him that his problem was “terrible posture.” The surgeon instructed him to stand with his back, shoulders, sacrum, and head pressed against the wall many times a day to “stretch and engage anterior muscles.” The patient felt pain performing this in the office, but the doctor told him, “No pain, no gain.”

He was then referred to PT, where the same “bad posture” diagnosis was repeated. During forceful exercise and stretching — along with a home program — his pain worsened. His symptoms progressed to severe neck pain, headaches, and radiating pain down the right arm. He became unable to work or sleep. Pain medication barely helped.

After negative brain and neck MRI findings, a neurologist referred him to me.

The patient presented with an obviously aggravated myofascial syndrome. There was significant tension buildup within the fascia and muscles of the neck and upper back. This tension had developed before the muscular symptoms appeared and was now compromising nerves and blood vessels.

My examination showed compression of the greater occipital nerve, the brachial plexus, and the subclavian vein. His right hand was turning bluish. No physical activity should be initiated before releasing fascia and decreasing muscle tension, and before increasing the threshold of pain and irritability.

Let’s Discuss the Diagnosis of “Bad Posture”

In the first year of school we learn that soft-tissue insufficiency determines posture, compensatory movement patterns, etc. Bad posture may develop from bad habits, but once posture changes, you cannot simply force it back into alignment.

What you can do is restore the function of muscles and fascia, and then introduce corrective exercises, including neuromuscular re-education. Forcing posture, as this surgeon did, only increases tension — in this case spreading into the neck.

Again:
Stretching is a great therapeutic tool, but when applied at the wrong time, it is crippling. It becomes a hazard.

I have interviewed many patients with joint replacements at unusually young ages. They all told the same story: “All my life I exercised and stretched every day to stay healthy, and now at age 50 I’m replacing joints, with no autoimmune diseases.”

If you do not release fascial and muscular tension before stretching, you create joint instability, fuel arthritis, and eventually require joint replacement.

Forceful stretching feels “good,” just as excessively strong pressure during massage feels “good.” But these are forms of anger management, not therapeutic treatment. Strong pressure triggers protective spasm and can cause additional trauma.

Resolution of the Case

I asked the referring neurologist to pause physical therapy temporarily. I cannot independently contradict an orthopedic surgeon’s order, but I can request consideration.

Within five treatments, I was able to control the patient’s condition by gradually releasing fascial and muscular tension and eliminating pressure on nerves and vessels. His right hand returned from blue to normal, indicating restored venous drainage.

The neurologist was very professional and supportive. I suggested that once tension decreased and the threshold of pain improved, PT would become beneficial — and it was. When I reached a certain level, the DPT began working with him again, and we achieved excellent rehabilitative results. The patient regained the ability to maintain normal posture.

The DPT and we even became friends. Over coffee, he told me:

“Boris, we were poisoned with all this BS about posture and alignment. You helped me understand very obvious and simple that we knew, soft tissue determines posture.”

He remembered my simple example of a kitchen door:
When one spring weakens, the stronger spring pulls the door to its side. The same principle applies to the human body.

**Please share your opinions, questions, agreements, or disagreements. Let’s keep the educational discussion active.**

Best wishes,
Boris

PS. For curious minds only.

Fourteen years ago, I developed an educational video explaining and warning about the causes of osteoarthritis and why, as I mentioned in the article, many young people end up needing joint replacements. Please keep in mind that the reasons for these pathological developments were presented from massage science textbooks, which differ significantly from orthopedic surgery textbooks. These were my observations fourteen years ago.

Has anything changed today? As I demonstrated in this article — it has not.

For those who are curious, here is the link to my video explanation.

If you decide to watch, please don’t forget to subscribe to my YouTube channel. In the coming days, I will begin uploading new educational videos. And if you find my presentation valuable, please click “Like.” The YouTube algorithm favors it, and I would truly appreciate your support in spreading information about the uniqueness and scientific foundation of massage.

Thank you.

https://www.youtube.com/watch?v=qd6p6FCEI9M