To Stretch or Not to Stretch?

Lee,

Good work on all of the posts you have been writing! I must say that the protocol in this study completely ignores the body of medical literature on the topic of stretching. If the goal is to improve extensibility then the literature suggests that one needs to perform 5, 90 second stretches per muscle group. Please read the work by Peter Magnusson, Cosgrove, and Malachy McHugh to gain more insight into this controversial topic. 10 second static stretches is bizarre! Look forward to hearing more from you and I would like to know your expert opinion on these topics. Hope you have a great rest of the summer.

There is an article in the NY Times today on the same subject.

http://well.blogs.nytimes.com/2010/09/01/phys-ed-does-stretching-before-running-prevent-injuries/

The topic of stretching/flexibility training in re to injury prevention continues to be a debated topic in part because the literature has not shown a clear answer. There are studies that have both shown reduced injury rates as well as no benefit. A definite problem is the choice of protocols used as well as the types of stretches done. Inherently I believe there exists an issue even at the heart of this topic…are we suggesting that injury prevention as it relates to muscle/tissue length is dependent on only pre-participation stretching or do we believe that maintaining good/adequate length is the goal – aka flexibility. Many studies aim to examine the benefit or lack thereof of simply doing a few stretches beforehand. We need to be asking different questions maybe…what is the required optimal length of the major muscle groups in let’s say running for example, that will promote performance and minimize injury risk? Can we identify then which muscles/groups are limited and then “stretch” only the needed groups and not others that already have good length and then study the outcome of a customized vs what has otherwise been a “one size fits all” approach? Would the inclusion of more multiplanar dynamic stretches that both require length but also some neuromuscular activation simultaneously (eg. in standing hams stretch with foot on stair but moving slowly in frontal and transverse plane at hips/trunk – requiring muscle length in more than just a single “groove” position but optimizing lengthening of more of the hamstrings fibers while still producing some muscle contraction that might help promote the use and maintenance of that length and replicates the actual functional need of that hamstrings when length is required in function) result in better outcomes because of the closer replication of length-muscle activation to that function vs the present focus on static, single plane, isolated, relaxed lengthening – that is being used to promote performance in a physical activity that is 3D in nature, involves activity of the body segments above and/or below the specific targeted muscle group, and requires muscle contraction while on length.

We know static stretching isn’t optimal to be done alone just prior to sporting activity and should be followed by a dynamic locomotion type warm up series but other questions remain about stretching that have not yet been answered by the research yet. We need to be cautious in the rehab and performance enhancement professions to not jump to conclusions about the value or necessity or benefit of stretching until some of these have been better studied and answered. We are dealing right now with very limited information. Unfortunately, once professionals who don’t ask the right questions or who read only the conclusions to articles or journalists with good hearts but who lack the education and training to be critical reviewers of what they read get a hold of published studies the misinformation to the public can be fueled greatly and we are all left to mop up the mess as patients and clients come in having seen or read blanket statements such as “stretching does not prevent injuries” that are often headlined in papers or throw aways or on the web.

Lee, great job bringing up an important topic and remaining critical and thoughtful.