Remember how we were all taught to stretch in physical education classes—bend forward, try to touch the floor and hold that position as long as you can to stretch your tight hamstring until you can’t endure the pain any longer?

Now we know a muscle has to be relaxed to stretch effectively. Active Isolated Stretching (AIS) takes us much further. We also know that flexibility is not achievable without strength—to move and control our muscles in all of the ranges of motion we wish to use. AIS is a flexibility training technique that employs focused, active exercises of the major muscle groups and a short-duration hold to stretch and strengthen muscles simultaneously.

Origins of AIS
AIS was developed by kinesiotherapist Aaron Mattes, who advanced the idea that collaborating with the body’s natural stretch reflexes, rather than fighting against them, would maximize circulation, oxygenation, relaxation, waste elimination, nutritional delivery and tissue elongation in the muscles and tendons.1 Using AIS, the muscle to be stretched is identified and isolated, gently and deliberately stretched as far as it can comfortably move with assistance (from a therapist or a rope), then nudged slightly further (potentiated) and held for two seconds. The muscle is then returned to rest, all the while in concert with conscious breath.

The results garnered by AIS are significant—increased muscle strength, improved joint flexibility and balance, reduced mechanical stress across the joint (the cause of degeneration and pain), expanded range of motion and restoration of function and stretching potential. However, AIS is not well-known in the medical community; it is practiced mostly by elite athletes. Yet, flexibility is a key ingredient to overcoming most common musculoskeletal conditions—Parkinson’s disease, multiple sclerosis, carpal tunnel syndrome, sciatica, tennis elbow, osteoarthritis, scoliosis, plantar faciitis and even cervical and back pain—and is critical to recovery from any injury. The muscles, fascial (connective) tissue and joints must maintain maximum movement to prevent postural changes, disease and injury.2

AIS today
From June 10 through 14, 2008, a small group of licensed massage therapists from across the United States, Canada and as far away as Hong Kong will come together for the first advanced AIS seminar, sponsored by the Flexibility, Sports, and Rehabilitation Clinic, a physiatry clinic specializing in AIS in Washington, D.C. At this seminar, massage therapists will learn more from physician specialists about common musculoskeletal pathologies and how AIS can bring about crucial improvements for clients in pain, contracture, spasm, imbalance or suffering from compensatory movement patterns. These therapists have been using AIS in their respective practices for years—they are master practitioners who have all been trained by Aaron Mattes and have worked closely with him. They are coming together to take their collective knowledge, experience and expertise with AIS a step further: They want to build tools to better serve their clients. These master practitioners want to understand and address the clinical questions they often encounter in their practice:

  • How do doctors think? 
  • What are the clinical reasoning processes they undergo to arrive at a diagnosis?
  • What are the cautionary issues for specific conditions? 
  • When do they need to refer out?
  • How can they apply AIS more precisely to address some of their clients’ problems?

AIS and the medical community
This is a critical time for AIS. Now, when almost half of Americans are using complementary and alternative medicine therapies, it’s more important than ever that massage professionals understand the clinical pathologies they might see on their table. A study released in May 2004 by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics found that almost three quarters of Americans (74.6 percent) had used complementary and alternative medicines.3 More than half (54.9 percent) of those thought that using complementary and alternative methods combined with conventional therapy would help their problems. Moreover, almost one third (27.7 percent) used these methods because they thought that conventional medicine would not help at all, and one quarter (25.8 percent) were recommended by a conventional medical professional. There’s no doubt that people are turning to massage practitioners for help.

Mattes is an important leader in his field. He is joined by the chief medical officer of the Flexibility, Sports, and Rehabilitation Clinic sponsoring the advanced AIS seminar, Dr. Jeffrey P. Haggquist. Haggquist is an osteopathic physiatrist who specializes in AIS and envisions how AIS can benefit the medical community, “AIS is like oil in the motor of a car. Musculoskeletal complaints are the primary reason people go to the doctor. AIS is a principled approach to health that utilizes the laws of medicine and the principles of musculoskeletal rehabilitation in a wonderfully simple yet profound way to restore range of motion, stimulate neuromuscular re-education and train strength.”

Haggquist began his training with Mattes more than 20 years ago, when he owned a Washington, D.C.-based neuromuscular practice and experienced his own shoulder injury. Mattes was the only practitioner who, using AIS, returned Haggquist’s shoulder function. Haggquist was quickly sold on AIS, and the partnership grew from there.

Now, Mattes and Haggquist are trying to move AIS into the medical mainstream and to enhance awareness of the therapy for general wellness. Haggquist lectures nationally on how AIS incorporates the principles of musculoskeletal rehabilitation (see “Principles of Musculoskeletal Rehabilitation”). AIS is good for the medical community, but progress is slow. AIS suffers from a lack of scientific evidence—it’s an exercise and few will fund the research when there’s little financial gain. Still, the practitioners coming to the seminar understand the importance of their role: it is they who must both learn from and teach the physicians and public who are interested.

The future of AIS
Flexibility training may be the single most important tool in musculoskeletal rehabilitation and general musculoskeletal wellness, but it needs research, training and education. The master practitioners who are convening in Washington, D.C., this summer will gather with the father of AIS to build to their toolboxes, but also to talk about the future of AIS—what they need to do collectively to move AIS forward to that this principled method of improving health can reach more people and improve more lives.

Principles of Musculoskeletal Rehabilitation

  • Treat pain 
  • Restore joint range of motion
  • Reconnect muscles to the brain
  • Restore muscles for strength and endurance
  • Train function

Heidi Worley is director of marketing and communications for the Flexibility, Sports and Rehabilitation Clinic in Washington, D.C., and executive director for a future foundation for AIS research and training currently in the works. She can be reached at Flexibility, Sports and Rehabilitation Clinic, 5506 Connecticut Ave, NW, Suite 27, Washington, DC  20015, (202) 244-8222, (202) 244-7432 fax, hworley@quistmd.com or www.quistmd.com.

1 Mattes, Aaron L., 2000, Specific Stretching for Everyone, Aaron L. Mattes, Sarasota: FL.
2 Mattes, 2000.
3 National Center for Complementary and Alternative Medicine (NCCAM), 2007, “The Use of CAM in the United States,” accessed online May 10, 2008 at: http://nccam.nih.gov/news/camuse.pdf.

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