www.njchiropractors.com I 19 our stretching protocols undertaken in the clinic. So, if our goal is to increase tissue extensibility and joint range of motion in a more permanent fashion, what does the research suggest as a viable approach? Eccentric training may be the most effective method to consider. O’Sul- livan and colleagues (2012) undertook a systematic review of the literature, and found that eccentric training encourages sarcomerogenesis, as well as altering the muscle’s length-tension curve to allow greater peak torque to be produced at longer muscle lengths. This is important, as some theories suggest muscles may adaptively shorten if the nervous system cannot effectively control force production at the end ranges. Eccentric training may assist in remedying this effect. Brughelli and Cronin (2007) suggests the research supports this shift in the length-tension curve to the right, allowing for optimal force devel- opment through a greater range of motion. Clark (2005) suggests this shift can occur in as little as four weeks of eccentric exercise training. An example of this type of training could be adding stiff-leg kettlebell deadlifts, with an eccentric emphasis (Figure 2), or unilateral eccentric reaches (Figure 3). As the patient becomes stronger, low intensity plyometric exercises, such as hopping, skipping, and bounding can be added to the rehabilitation continuum. Ballistic type movements improve collagen health and force transmission properties of the tissues. It is important to note that not every patient is a candidate for plyometric activity, and doctors should consider alternatives in this population of patients. In summary, there is evidence to suggest that adding eccentric load training to your flexibility protocols may be more effective for increasing overall joint range of motion and tissue extensibility. Progressing patients to controlled plyometric activities may further enhance the force transmission capabilities of the tissues and facilitate a more complete healing response. In part two of this article, we will explore the underlying mechanisms behind assisted stretching methods, and how foam rolling may be an effective alternative to influence tissue texture and mobility. Figure 1: Static Cage Stretch Figure 2: Stiff-leg Kettlebell Deadlifts Figure 3: Unilateral Eccentric Forward Hamstring Reaches Ken Cieslak, DC, LAT, ATC, CSCS, has been in the fields of chiropractic and athletic training for over 28 years. He is a 1989 graduate of the Kean College athletic training program and completed his Doctor of Chiropractic degree in 1995 at Life University, where he graduated as valedictorian. Since 1997, he has been employed at Teaneck High School, serving as the certified athletic trainer, in addition to having a practice of chiropractic in Bogota, NJ. He is also a preceptor in the Montclair State University AT program. He lectures frequently, including upcoming presentations at the National Athletic Trainers convention in New Orleans, and the National Strength and Conditioning Association national conference in July, in Indianapolis.