Stretching Dos & Don’ts/Should You Stretch to Prevent Injury?

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Terms:

  • Static stretching: Holding a steady stretch for longer periods of time (usually around 30 seconds-1 minute) in a relaxed state. This stretch is usually done to the point of feeling an “uncomfortable” tension.
  • Dynamic stretching: Movements that mimic the motion involved in a sport. Generally thought of as a “warm-up”. Think of arm circles, Frankensteins, jumping jacks, etc.

Some people spend loads of time during their workout stretching, when the truth is that some of them may not need it. Not only can you injure yourself if you are stretching incorrectly, but it can also inhibit your performance when done improperly. So onto the main question of the day: Should an athlete stretch to prevent injury? This topic is very controversial and evidence is largely mixed. After reviewing several articles on the topic, my position on this is that it depends. While stretching may be important for some people to achieve an adequate amount of mobility and flexibility, it is not the only way to improve or maintain mobility and flexibility. In addition, not all athletes need a great amount of flexibility to perform their sport, in fact too much flexibility or participating in stretching activities (especially static stretching) could inhibit their ability to perform well or put the athlete at risk for injury rather than prevent it. I believe that whether or not stretching is a major part of a program should be sport and individual specific. In the anteceding part of this article I will be elaborating on this messy topic and summarize the efficacy of stretching to prevent injury in an athlete.

Whether or not an athlete should use stretching to prevent injury is dependent upon several factors: 1.) The range of motion (ROM) their sport requires, 2.) The level of movement quality of the athlete, 3.) The nature of their sport’s motion to produce muscle imbalances, 4.) How advanced the athlete is, and 5.) The need for speed of the sport (i.e. what kind of force production is needed?/ what are the primary muscle fiber types involved?).

In my research based opinion, if an athlete is involved in a sport requiring a larger range of motion such as a gymnast or ballet dancer, they should frequently engage in longer duration and higher intensity stretching (dynamic or static) to be able to move competently through those difficult motions which may reduce their chance of injury. From a practical perspective, these types of athletes need something to get their body warmed up and ready to execute these extreme ranges of motion (McHugh & Cosgrave, 2010). Research suggesting whether this should be achieved by static stretching, dynamic stretching, a combination of both, or some other type of warm up is inconclusive (Lewis, 2014; McHugh & Cosgrave, 2010; Weerapong et. al, 2004; Weldon & Hill, 2003). However, considering that static stretching does affect the performance of the muscle and may put a person at risk for injury if done right before the sport performance, it may be best to precede the sport with dynamic rather than static stretching. Not only does dynamic stretching improve flexibility but it also does not compromise the ability of the muscle to activate and in fact may improve performance if it is preceding a sporting event (Perrier et al., 2011). Furthermore, it may be necessary for these athletes to engage in longer duration static stretches (>/= 4 sets of 90 seconds) either immediately following a performance or on days that they will not be engaging in the sport (McHugh & Cosgrave, 2010). This could help maintain the extreme ROMs required for this type of athlete to perform well and will not inhibit the performance for this kind of athlete. According to Weldon & Hill (2003), there is evidence to suggest that when an individual participates in prolonged stretching (which they fail to define as static, dynamic, etc.) outside of the pre-participation period it reduces their chance of injury. They suggest that this occurs because stretching for long periods of time might “increase the energy absorbing capabilities of muscle thereby reducing the risk of injury” (Weldon & Hill, 2003).

Before doing a lot of research on this topic, I hypothesized that older athletes who do not have normal ROM to efficiently complete tasks needed in activities of daily living might reduce their risk of injury from stretching. My thought process was that older people tend to lack mobility and flexibility and if they didn’t have appropriate ROM then they could hurt themselves, so stretching (static) would help loosen them up and likely prevent injury. For example, a master’s water aerobics class may benefit by stretching some of the more common tight muscle groups such as the hamstrings, glutes, shoulder flexors and internal rotators, and scapulothoracic muscles. Stretching some of these more commonly tight muscle groups may prevent postural deficiencies and/or imbalances, which are often accompanied by either structural or functional pain and/or insufficient movement patterns (which are risk factors for injury). Another group of athletes I would have associated this idea with are athletes who frequently utilize powerful repetitive motions that may cause agonist/antagonist or asymmetrical muscle imbalances (such as a pitcher or sprinter). However, the general consensus among researchers is that there is not enough evidence to support the idea that stretching reduces the risk of injury in athletes (McHugh & Cosgrave, 2010; Ostojic & Stojanovic, 2011; Rogan et al., 2013; Weerapong et al., 2004; Weldon & Hill, 2003). Although evidence regarding this idea is mixed, a general agreement among studies is that dynamic stretching or a “warm-up” (which is loosely defined in the literature) preceding athletic performance may be beneficial to athletes and reduce the risk of injury (McHugh & Cosgrave, 2010; Lewis, 2014; Perrier et al., 2011; Taylor et al., 2009; Weerapong et al., 2004). One interesting finding is that it may not necessarily the dynamic “stretch” of the muscle but rather the increased temperature as a result of the dynamic motion that yields the reduced risk of injury to athletes (Lewis, 2014). Another concept of interest to this topic is that dynamic stretching or a warm up is only beneficial when it is specific to the sport related tasks (Lewis, 2014; Taylor et al., 2009). I believe that dynamic stretching may also be more beneficial for reducing injuries due to the fact that one study demonstrated that athletes with greater active ROMs had lower injury rates (Siozos et al., 2011). Overall, for these populations I would say that static stretching might not be necessary if these athletes can achieve adequate ROMs for their sports, but they may need to spend some time in static stretching outside of pre-performance windows if they can not get proper ROM with other methods of increasing mobility and flexibility such as foam rolling, dynamic stretching or “warm-ups”.

On the other hand, if an individual is an Olympic powerlifting athlete then they may not need to focus much, if at all, on static stretching. Research suggests that static stretching may inhibit the neural activity of the muscles and might reduce their ability to perform well, which could lead to injury (Cannavan et al., 2012; Costa et al., 2010). While some lifts require larger ranges of motion (snatch, clean and jerk, deadlift,etc.), research has shown that resistance training helps improve/maintain flexibility when utilizing full range of motion while lifting (Carneiro et al., 2015; Morton et al., 2011; Saraiva et al., 2014; Taxildaris, 2006). Interestingly, higher intensity resistance training (>/= 60% 1RM) results in greater magnitude of flexibility improvements than lighter intensity resistance training (Taxildaris, 2006). These results defy the common idea that lifting weights will make your muscles tight and inflexible, and rather suggest that it makes them more flexible and extensible. While greater intensities of resistance training might be beneficial in increasing flexibility, they should be preceded with lighter intensity lifts (a warm-up set), which in my opinion mimics the idea of dynamic stretching. From a practical standpoint, it is probably not a great idea to have an athlete go straight into a 400-pound squat without a warm-up set.

While reading through these studies it appeared that studies that did show significant reductions in injury due to stretching were of poor methodological quality, and those that did not show significant reductions in injury as a result of stretching were of better quality. Another problem with the research on this topic is that the methodology is all over the place. The term stretching is used loosely and some articles fail to define their method of stretching (static, dynamic, etc.). Furthermore, methodology is not consistent between articles at all. Some articles used very short duration static stretches (10 seconds) others used very long duration (90 seconds) and the number of sets was not consistent either. There does not seem to be a general standardized protocol for stretching. Overall, further research needs to be conducted on this topic in a more organized manner with better methodology and more definitive terms. The conclusion that I have come to is that static stretching may or may not be necessary for an athlete to prevent injury depending on the sport and other individual factors. I have also determined that static stretching should not precede anything performance-related or anything strenuous because it may actually lead to an injury, however dynamic stretching is encouraged. Lastly, people engaging in sports or activities that require powerful, explosive movements that demand higher proportion of type II muscle fibers shouldn’t engage in a lot of static stretching, if any, due to the fact that it reduces rate of force production and inhibits the ability of the neural system to perform well. Another note related to this is that weightlifters might not need static stretching if they are producing adequate ROM during their lifts because resistance training alone has been shown to produce adequate and favorable results in muscle flexibility and extensibility.

 

References

Cannavan, D., Coleman, D. R., & Blazevich, A. J. (2012). Lack of effect of moderate-duration static stretching on plantar flexor force production and series compliance. Clinical Biomechanics, 27(3), 306-312. doi:10.1016/j.clinbiomech.2011.10.003

Carneiro, N. H., Ribeiro, A. S., Nascimento, M. A., Gobbo, L. A., Schoenfeld, B. J., Achour Júnior, A.. . Cyrino, E. S. (2015). Effects of different resistance training frequencies on flexibility in older women. Clinical Interventions in Aging, 10, 531-538. doi:10.2147/CIA.S77433

Costa, P. B., Ryan, E. D., Herda, T. J., Walter, A. A., Hoge, K. M., & Cramer, J. T. (2010). Acute effects of passive stretching on the electromechanical delay and evoked twitch properties. European Journal of Applied Physiology, 108(2), 301-310. doi:10.1007/s00421-009-1214-3

Lewis, J. (2014). A systematic literature review of the relationship between stretching and athletic injury prevention. Orthopedic Nursing, 33(6), 312.

McHugh, M., & Cosgrave, C. (2010). To stretch or not to stretch: The role of stretching in injury prevention and performance. Scandinavian Journal of Medicine & Science in Sports, 20(2), 169-181. doi:10.1111/j.1600-0838.2009.01058.x

Morton, S. K., Whitehead, J. R., Brinkert, R. H., & Caine, D. J. (2011). Resistance training vs. static stretching: Effects on flexibility and strength. Journal of Strength and Conditioning Research, 25(12), 3391-3398. doi:10.1519/JSC.0b013e31821624aa

Ostojic, S., & Stojanovic, M. (2011). Stretching and injury prevention in football: Current perspectives. Research in Sports Medicine, 19(2), 73. doi:10.1080/15438627.2011.556476

Perrier, E. T., Pavol, M. J., & Hoffman, M. A. (2011). The acute effects of a warm-up including static or dynamic stretching on countermovement jump height, reaction time, and flexibility. Journal of Strength and Conditioning Research, 25(7), 1925-1931. doi:10.1519/JSC.0b013e3181e73959

Rogan, S., Wüst, D., Schwitter, T., & Schmidtbleicher, D. (2013). Static stretching of the hamstring muscle for injury prevention in football codes: A systematic review. Asian Journal of Sports Medicine, 4(1), 1.

Saraiva, A. R., Reis, V. M., Costa, P. B., Bentes, C. M., Costa E Silva, Gabriel V, & Novaes, J. S. (2014). Chronic effects of different resistance training exercise orders on flexibility in elite judo athletes. Journal of Human Kinetics, 40(1), 129. doi:10.2478/hukin-2014-0015

Siozos, A., Malliaropoulos, N., Tsiftsogloy, D., & Xristodoulou, D. (2011). The role of active knee rom for posterior thigh muscle injuries prevention. British Journal of Sports Medicine, 45(2), e1-e1. doi:10.1136/bjsm.2010.081554.41

Taylor, K., Sheppard, J. M., Lee, H., & Plummer, N. (2009;2008;). Negative effect of static stretching restored when combined with a sport specific warm-up component. Journal of Science and Medicine in Sport, 12(6), 657-661. doi:10.1016/j.jsams.2008.04.004

Taxildaris, K. (2006). resistance training and detraining effects on flexibility performance in the elderly are intensity-dependent. Journal of Strength and Conditioning Research, 20(3), 634-642. doi:10.1519/00124278-200608000-00027

Weerapong, P., Hume, P. A., & Kolt, G. S. (2004). Stretching: Mechanisms and benefits for sport performance and injury prevention. Physical Therapy Reviews, 9(4), 189-206. doi:10.1179/108331904225007078

Weldon, S. M., & Hill, R. H. (2003). The efficacy of stretching for prevention of exercise-related injury: A systematic review of the literature. Scotland: Elsevier Ltd. doi:10.1016/S1356-689X(03)00010-9

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