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Étirer l’élastique

écrit par Philippe-Olivier Jasmin
7 février 2018

S’étirer est inutile. Depuis quelques années, plusieurs études attaquent les bénéfices des étirements. La conclusion : s’étirer est inutile et peut même être contreproductif. Depuis, la mode incite à exhiber le sujet sur la place publique pour le lapider. L’étirement subit une crise existentielle où il a perdu sa raison d’être.

Malheureusement, le sujet ne se veut pas aussi binaire. Si nous épluchons cette panoplie de récentes études, nous remarquons qu’elles se posent sur l’emploie classique de l’étirement par monsieur ou madame Tout-le-monde. C’est-à-dire l’utilisation d’un étirement statique comme réchauffement précédent un exercice ou un effort afin de tenter de prévenir des blessures et d’augmenter la performance. Sous cette optique, l’étirement statique échoue effectivement lamentablement.

Cependant, l’étirement statique ne représente pas tous les types d’étirement existants et le maniement couvert par les récentes recherches n’englobent pas l’entière application possible de cet outil.

Avant de poursuivre, définissons quelques concepts clés.

Types d’amplitude

Si nous simplifions le sujet, nous disposons de trois amplitudes :

  • L’amplitude anatomique : à l’extrémité de notre jeu articulaire se retrouve la frontière du mouvement permise par les ligaments. Pousser davantage occasionnera l’entorse et la dislocation.
  • L’amplitude physiologique : quelque part entre la position neutre et la limite de l’amplitude anatomique se trouve les limites des mouvements actif et passif permises par le système nerveux et musculaire.
  • L’amplitude pathologique : fréquemment surnommée barrière restrictive, il s’agit simplement de l’amplitude physiologique réduite par une condition problématique du client.

Ceci fait, différentions les types d’étirement.

Étirement passif statique

Je mets un élastique sous tension. J’attends patiemment pour finalement relâcher. J’exécute le redoutable étirement statique.

L’étirement est dit passif puisqu’il requiert aucun effort de la part du segment cible et statique puisque la tension sera constamment maintenue sans mouvement. Le client invitera son segment à s’étirer ou sera assisté par un tiers parti.

Étirement actif dynamique

Je mets un élastique sous tension. Je relâche presque aussitôt pour revenir en position neutre et je répète les mouvements. J’accomplis un étirement dynamique.

Contrairement à l’étirement précédent, l’étirement sera actif, c’est-à-dire que le segment visé fournira l’effort nécessaire au mouvement et dynamique puisqu’il demeurera en constant déplacement.

Cet exercice tentera de tricher en dupant le système nerveux. En effet, le mouvement actif et sa contraction musculaire entraîneront l’inhibition réciproque de notre muscle cible, facilitant son relâchement.

Étirement balistique

Je mets un élastique sous tension. Je tire ensuite rapidement et avec faible amplitude pour pousser la barrière plus loin avec un effet de rebond, et ce, de manière répétitive. J’effectue un étirement balistique.

Notons que ce type d’étirement est habituellement proscrit puisque le changement brusque d’amplitude nargue le réflexe myotatique qui contractera la musculature en mécanisme de défense pour protéger l’articulation.

Facilitation neuromusculaire proprioceptive (FNP)

Combinez un relâchement post-isométrique à un étirement statique ou dynamique et vous obtiendrez la facilitation neuromusculaire proprioceptive. L’étirement se fera fréquemment de manière assistée par une autre personne ou par un outil comme une bande d’exercice afin de fournir la résistance nécessaire à la contraction isométrique.

Comment ça marche? On amène le segment visé à la barrière restrictive, on applique une contraction isométrique contre résistance pour ensuite faire reculer l’amplitude pathologique en employant le relâchement post-isométrique.

Mais à quoi ça sert?

Notre premier objectif clinique consiste à réconcilier l’amplitude pathologique avec l’amplitude physiologique. Vous pouvez réussir avec l’étirement statique, mais l’étirement dynamique et la FNP risquent d’être de meilleurs paris.

En même temps, nous pouvons désarmer des mécanismes de défense en utilisant la proprioception. De ce côté, il est préférable de débuter avec l’étirement statique pour ensuite progresser vers l’étirement dynamique. En effet, puisque l’étirement statique ne requiert aucun effort, il est habituellement moins agressif. Nous désirons simplement communiquer au système nerveux « Hey! Regarde! Tu peux aller plus loin que tu pensais et il n’y en a pas de problème. Arrête d’être paranoïaque et relâche! »

Finalement, il peut être adéquat de revenir à notre objectif initial, soit de réchauffer la musculature en vue de prévenir les blessures et augmenter la performance. Mais les recherches ne concluent-elles pas que l’étirement échoue dans cette mission? Pas dans le cas d’étirements dynamiques. C’est pourquoi le monde du sport s’est depuis tourné vers ceux-ci. En effet, ils préparent plus adéquatement la musculature sur deux principaux fronts. Premièrement, ils réveillent le système nerveux et facilitent les connexions employées par l’influx. Deuxièmement, ils favorisent une circulation appropriée grâce au pompage musculaire résultant de l’alternance entre contractions et élongations.

 

 

L’effet de contre-ballant

Il est possible de pousser un peu plus loin les effets de nos étirements en y insérant un contre-ballant. Comment ça fonctionne? L’exercice est simplement précédé d’un mouvement dans une direction opposée. Par exemple, un étirement cervical en flexion serait précédé d’une légère extension. Encore mieux, nous pouvons jouer davantage sur cet effet en alternant deux étirements dynamiques opposés.

Deux phénomènes nous avantagent :

  • Les muscles agonistes contracteront avant de s’étirer et nous savons que la musculature relâche plus facilement à la suite d’une contraction;
  • Les muscles antagonistes s’étireront avant l’étirement souhaité. Puisque la musculature possède une capacité élastique, nous pouvons exploiter son désir à revenir en position neutre et profiter d’un élan dans la direction souhaitée;

En bonus, il existe une théorie qui porte sur l’harmonisation du sens des fibres des fascias. Puisque ce point est présentement débattu, nous vous laissons juge et maître de vous faire votre propre idée.

Approche clinique

Souvenons-nous que :

  • Un étirement ne devrait être en aucun cas douloureux. Surtout dans des cas problématiques, il risque d’y avoir présence d’une certaine sensibilité, mais il y a une différence entre un muscle qui vous communique sa mauvaise humeur et celui-ci qui grimpe dans les rideaux pour hurler à tue-tête.
  • Que ce soit à l’intérieur d’un même type d’étirements ou en passant d’un type à l’autre, respectez une progression. Si vos recommandations deviennent trop agressives, descendez d’un cran; si votre client est capable d’en prendre davantage, grimpez.
  • Défoncer la barrière restrictive pathologique pour aller trop loin trop rapidement implore votre musculature à se défendre avec un spasme. Dès que votre client ressent l’élongation, il n’a pas besoin d’aller plus loin. Soyez progressifs dans la tension appliquée. Respectez la barrière restrictive.
  • Il est contre-productif de tenter d’étirer un muscle hypertonique s’il est en contraction excentrique. Ici, nous pouvons viser un étirement dynamique afin de doucement l’amadouer pour ensuite progresser vers l’activation par renforcement.

Vous avez de la difficulté à discerner quel exercice recommander? Simplifiez-vous la vie :

  • Suggérez un exercice qui continuera à travailler un muscle que vous avez visé lors de votre soin;
  • Conseillez un exercice afin de préparer un muscle que vous désirez travailler prochainement lors d’un rendez-vous ultérieur ou que vous avez mis de côté faute de temps.

Ce n’est aucunement un secret : une majorité des clients ne feront pas les exercices suggérés. Afin de les motiver, restez simple et limitez-vous. Une imposante montagne d’étirements compliqués peut promptement ensevelir la motivation de votre client. Un exercice moins idéal, mais adopté par le client battra à tout coup un exercice pertinent, compliqué et ignoré. Ajustez-vous.

La recommandation d’exercices cimentera vos soins. Votre client continuera d’avancer sans que vous ayez vos mains sur lui et il récidivera moins aisément. Puisqu’une problématique consiste en la rencontre entre une circonstance et une prédisposition, l’étirement peut contribuer à équilibrer la balance. De ce fait, les prédispositions seront moins ébranlées lorsque les circonstances se pointeront le bout du nez. Cependant, en tant que massothérapeutes, nous ne sommes pas physiothérapeutes ou entraîneurs. N’hésitez donc pas à référer ou à travailler en tandem si vous jugez que votre client nécessite un programme davantage élaboré que quelques suggestions.

Bons soins!

Commentaires

  1. geoff dit :

    Je ne comprend pas cette obession des élastiques. Puisqu’il est question de muscles, pourquoi vous parlez pas de muscles? Vous pensez que votre lectorat est trop abruti pour comprendre directement le sujet alors vous utilisez des analogies simplettes?
    Il a fallu que je relise parce que je n’étais pas sûr si vous décriviez des étirements faits avec des élastiques.

  2. Mon Réseau Plus dit :

    Bonjour,
    L’utilisation de l’analogie de l’élastique est une manière de rendre le texte plus léger. Comme il s’agit d’un contenu plutôt technique, l’auteur aime créer des analogies simples pour rendre plus accessible le texte à un plus grand nombre.

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