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To Stretch or Not to Stretch:

My injured athletes often confide and confess to me, 'I know I don't stretch enough'.  And it
leads me to discuss another myth equally as strong to dispel as 'advil' and sports injury
treatment, that of stretching and injury preventio
n.

Since the fitness craze inception 40 years ago, stretching has been ingrained as a must for
anyone participating in sports.  It's been advocated by coaches, physical education teachers,
and doctors for decades as a method to prevent injury and improve performance.

Have you ever seen an animal stretch before it pounced on its prey or went for a run?

So why do we stretch?  Have we been wrong all these years?

Stretching has evolved from the hurdler's stretch and calf stretch of pushing a wall (though I
still see these at the gym)  to at least 7 different forms:

ballistic stretching
dynamic stretching
active stretching
passive (or relaxed) stretching
static stretching
isometric stretching
PNF stretching

The most common being the static stretch, such as touching your toes.

In addition, some stretch before working out, others stretch after, some stretch at night, some
'warm-up' prior to stretching.

With so many types of stretches, times to stretch, and sports one might participate in, it has
been difficult to rigorously study whether stretching improves performance or prevents injury.

After reviewing 361 articles reporting on stretching and injury prevention, Dr. Stephen
Thacker from the CDC, found only 6 articles that met strict scientific inclusion criteria of
sound medical study.  None of them found stretching to prevent injury.  He concluded that '
at
this point in time, there is no sufficient evidence to endorse or discontinue routine
stretching before exercise to prevent injury
'.

Herbert and Gabriel reviewed the literature on stretching and muscle soreness prevention and
risk of injury and found that stretching prior to or after exercise appears to have no meaningful
effect on soreness or risk of injury.

Schier performed a systematic critical review of the literature on stretching and improving
performance and found that an acute bout of stretching had no benefit for improving force,
torque or jumping height.  In regards to running speed, there were just 4 articles to be found,
and 1 suggested it was beneficial, 1 suggested it was detrimental, and 2 had equivocal results.

So how does one make sense of the limited scientific data?

First, don't feel bad if you feel you don't stretch enough and don't blame your injuries on your
lack of stretching.  You may actually be doing yourself a benefit by not stretching.  If you
stretch incorrectly it is known you cause injury.  If you stretch prior to working out it is known
you can actually lose strength or power.  

Stretching is a lifelong process.  If you have stretched your entire life, don't stop now.

If your sport requires you to be flexible such as in dance, gymnastics, diving, hurdling to name
a few, then stretching may be of benefit and I would recommend a regular stretching routine
under the guidance of a coach or trainer skilled in stretching.

For the majority of athletes I advocate
a dynamic warm-up (activating muscles using similar
actions as those the athlete uses during sport) rather than the traditional static stretch.

A dynamic warm-up may include the following:

Quarter-speed jog/Back pedal return
Toe walk/Heel Walk
Skip forward/Skip Backward
Lunge Forward/Lunge Backward
Half-speed jog/Back pedal return
Carioca
Crossover Step (half-carioca: trailing foot always comes in front, never behind)
Front Step-over/Reverse Step-over
Three-quarter sprint/Back pedal return
High knees/Butt Kicks
Frankenstein Walk (hand straight in front/kick leg to meet hands)
Straight Leg Bound
Full-speed sprint/Back pedal return

I also recommend regular sessions of
massage and assisted stretching with a therapist
skilled in sports massage for injury prevention and improved performance.

Most of all, if you feel tight or sore, back off on your training and rest and recover.  If
symptoms last more than 3 days, then seek professional guidance from a sports medicine
physician.

References:

Hart L. Effects of stretching on muscle soreness and risk of injury: a meta-analaysis. Clin
Journal Sport Medicine. 2003:13(5):321-322.

Herbert RD.  Effects of stretching before and after exercising on muscle soreness and risk of
injury: systematic review.  BMJ. 2002:325:468.

Shrier I. Does stretching improve performance?:A Systematic and critical review of the
literature [Critical Review]. Clin Journal Sport Medicine. 2004: 14(5):267-273.

Thacker SB. The impact of stretching on sports injury risk: a systematic review of the
literature. Med Sci Sports Exerc. 2004:36:371-378.
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