To Stretch or Not to Stretch- That is the Question

Whether ’tis nobler to suffer the strains and pains of prolonged stretching, or to take arms through dynamic warm ups and replace them.  This post will not end as a Shakespearean tragedy, for there is not a plague on either form (static or dynamic) of stretching.  Recently, a group of therapists at our clinic got together to discuss evidence surrounding the topic of stretching.

Our meeting was inspired by questions from patients regarding our opinions on stretching regimens.  Static stretching, holding a muscle in a lengthened position for at least 20 seconds for a low number of repetitions, has been widely touted in the past for improving flexibility and preventing injuries.  Dynamic stretching, bringing muscles into lengthened positions without holding and performing several repetitions, which resembles more of a warm-up, has fallen into favor as the pre-sport regimen of choice to improve performance and prevent injuries.  O Research, O Research, wherefore art thou Research?

Static stretching has been shown to improve flexibility and range of motion and this form of stretching is used widely in physical therapy.  Several studies we discussed and researched showed that immediately following static stretching, including up to an hour afterwards, a muscle can be weakened.  In terms of injury, when a muscle is weakened it may not give the best joint protection, thus there may be more injuries and certainly impaired performance.  Looking through some of this research, the ways in which muscles are weakened is uncertain.  One study found that stretch-induced muscle weakness may only be present at certain positions when a muscle contracts.  I wasn’t able to find research on effects of static stretching on injury prevention in sports.  A question I had following reading through some of the research on the topic was, “How long does this stretch-induced weakness last?”  Can we stretch a few hours ahead of a sport-activity and return to pre-stretch strength?

Because of these findings many trainers and physical therapists advocate against static stretching immediately before sports events.  Not only can static stretching immediately before sports activities put you at potential risk for injury, but it can also negatively impact sports performance.  In regard to golf, static stretching pre-round has been shown to reduce clubhead speed, accuracy, drive distance, and ball contact. Thus, I recommend a specific dynamic warm-up that targets key muscle groups for golf.

What about those who participate in a regular static stretching program.  Is regular stretching beneficial?  A study published in Medicine and Science in Sports and Exercise by researchers from Brigham Young University-Hawaii and Louisiana State University shows a regular stretching program alone can improve physical performance.  After 10 weeks of a regular stretching program 3 days per week,  muscle strength, power, and strength endurance was improved.

In terms of static stretching’s ability to prevent injuries, a review of literature from 2002 in the British Medical Journal concluded that the reviewed articles deemed reductions in muscle soreness following exercise were not significantly impacted by stretching.  Injury risk reduction in military recruits was insignificant based on review and there was insufficient evidence to make a conclusion for athletes.   I reviewed an article from 2003 in Military Medicine, that examined the effects of stretching in 901 Japanese military recruits during their 3-month basic training.  The authors stated that most of the military recruits were not used to the regular, strenuous activity that basic military training entails.  The stretching group of this study engaged in 20 minutes of a stretching program prior to and immediately following daily physical training.  It was found that recruits that were assigned to the stretching group had lower injury rates for muscle and spinal injuries, though overall rates were not significantly different.  The muscle and spinal injuries include strains, tendinitis, and back pain.  As a physical therapist who sees many people with these types of injuries, it does not surprise me that those who stretched regularly endured less of these types of injuries.  To stretch, perchance to reduce injuries, seems plausible if done regularly for certain types of conditions.

It’s hard to research the effects of regular static stretching on injury prevention in the general population, those who are coming to physical therapy.  I have a few words that come from my experience and training.  Regular static stretching is particularly important to prevent painful conditions and injuries in those who are not flexible.  Inflexibility in certain muscles can cause altered postures and bad joint positions, which can in turn lead to most significantly- back pain and rotator cuff disorders to name a few.  If a muscle is tight, it must be stretched.  As we age, our muscles lose elasticity, thus it becomes more important to stretch the older we get to prevent joint stiffness and maintain good mobility.  If you are as bendable as Gumby, you shouldn’t be focusing on stretching.  When muscles and ligaments are stretched too much, it can render a joint unstable.  If a joint is unstable it can move slightly in and out of position or it’s joint socket.  Over time this can create painful conditions including arthritis.  In this condition, it is important to do strengthening, resistive training.

Prior to doing strenuous work, say shoveling snow, gardening, or moving furniture, I recommend warming up dynamically and avoiding static stretches as discussed previously.  Because static stretches can weaken muscles and these types of physical activities can demand full muscle strength, you may be setting yourself up for an injury.  A warm-up would include any aerobic activities that get the body moving, say, repeated squats, biking, jumping jacks, or walking in place for 5 – 10 minutes.

If you are unfortunate enough to have sustained an injury or are dealing with a painful musculoskeletal condition, a physical therapist is best trained to determine A: Whether you need to do certain stretches  and B: What stretches you should be doing.

My final thoughts on stretching:

• Generally, if you are not flexible you need to engage in a regular static stretching program
• Perform dynamic warm-ups and stretches prior to athletic events to prevent injury, this is not the time to do static stretches
• Stretching helps many people overcome pain and injury and should be prescribed by a trained, educated professional for such cases
• Don’t overstretch- if you are VERY flexible, you should be focusing on getting stronger, so you can add stability to your joints

References

Arnold G Nelson, Jason D Allen, Andrew Cornwell, & Joke Kokkonen. (2001). Inhibition of maximal voluntary isometric torque production by acute stretching is joint-angle specific. Research Quarterly for Exercise and Sport, 72(1), 68-70.

I Shrier. (2004). Does Stretching Improve Performance? A Systematic and Critical Review of the Literature. Clinical Journal of Sports Medicine, 14(5), 267-273.

Gergley, J.. (2009). ACUTE EFFECTS OF PASSIVE STATIC STRETCHING DURING WARM-UP ON DRIVER CLUBHEAD SPEED, DISTANCE, ACCURACY, AND CONSISTENT BALL CONTACT IN YOUNG MALE COMPETITIVE GOLFERS. Journal of Strength and Conditioning Research, 23(3), 863-867.

Rob D Herbert, & Michael Gabriel. (2002). Effects of stretching before and after exercising on muscle soreness and risk of injury: Systematic review. British Medical Journal, 325(7362), 468.

Masatoshi Amako, Takaaki Oda, Kazunori Masuoka, Hiromichi Yokoi, & Paolo Campisi. (2003). Effect of static stretching on prevention of injuries for military recruits. Military Medicine, 168(6), 442-6.