Quite a Stretch

There is no “truth” about stretching

The truth about stretching is that there is no truth about stretching to be had: it’s just too complicated a subject. There are too many mysteries about muscle physiology, and too many different ways of stretching. For every answer there are ten more questions, and for every safe assumption there’s an exception. There won’t be a final word about stretching for a long time, and perhaps there never will be.

However, plentiful recent research now shows that stretching as we know it — the kind of stretching that the average person does at the gym, or even the kind of stretching that athletes do — could very well be a waste of time. Articles published in recent years, reviewing hundreds of studies, have concluded that there isn’t much evidence that stretching prevents injury or muscle soreness.23 Adding significantly to the credibility of those reviews, a major year 2000 clinical study of many hundreds of soldiers showed no sign of benefit from and even some risks to stretching.4 Some of this evidence, and similar evidence, is nicely summarized in a recent segment of a CBC Radio One science show (see Exorcizing Myths about Exercise).

Most importantly, trainers, coaches and health care professionals are starting to insist on making recommendations based on evidence, or at least a really convincing physiological rationale … and stretching just doesn’t hold up very well under that scrutiny. Nor is it even a new idea. Consider this great passage from an excellent 1983 Sports Illustrated article about David Moorcroft, a British middle and long distance runner and 5,000 metres world record holder:5

Stacked in a corner of Anderson’s [Moorcroft’s coach] office are bundles of scientific papers. “I’ve tried to interpret the findings of the best physiologists and translate them into sound practices,” says Anderson. “That’s made me a radical. We’ve turned some coaching sacred cows on their ear.”

For one, Anderson dismisses the stretching that most runners do. “It’s rubbish,” he says. “The received idea that by touching your toes you lengthen the fibers in your hamstrings is wrong. Soft tissue stretching like that is a learned skill and doesn’t carry over into running. Dave requires a flexibility, a joint mobility, but running fast is the right kind of stretching for him.”

The world-record holder mutely demonstrates his suppleness by reaching toward his toes. His fingertips get down to about midshin.

'What Made Him Go So Wonderfully Mad?' So Inquired a friend of David Moorcroft after the Briton broke the world 5,000 record in an amazing performance, Moore (sportsillustrated.cnn.com)

So why are people stretching?

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Why people stretch

When challenged, many stretching enthusiasts have a hard time explaining why they are stretching. The value of stretching has been elevated to dogma without justification. Everyone just “knows” that it’s a good thing.

When pressed for reasons, people will come up with a few predictable stretching goals. Here are the four hopeful reasons for stretching that I hear every day:

1. warming up
2. prevention of muscle soreness
3. prevention of injury
4. flexibility

And sometimes you also hear:

5. “performance enhancement” (faster sprinting, for instance)

Not one of these can be supported with evidence, or even has a persuasive rationale. Stretching for these reasons is probably a waste of your time.

Some therapists (and unusually well-informed laypeople) also suggest that stretching is good for relieving muscle knots or trigger points (see Save Yourself from Trigger Points & Myofascial Pain Syndrome!). I’ve even done so myself at times, and there are several good reasons to believe it probably has some beneficial effect. But there are two important caveats: (1) self-stretching is almost certainly an imprecise and inefficient way of relieving trigger points,6 and (2) stretching trigger points can sometimes backfire.7 These questions are considered in much greater detail in an important sister article to this one, Stretching for Trigger Points. This article is concerned only with examining the usual motives people have for stretching — not the more precise therapeutic usages (of which there are probably quite a few).

Stretching research shows that stretching is not an effective warmup

Warming up is an unclear goal with many possible meanings. The most obvious and literal — an actual increase in tissue temperature — is a reasonable goal. It's literally true that warm muscles function better than cold ones.

However, body heat is generated by metabolic activity, particularly muscle contractions. And it’s impossible to raise your metabolic activity without working up a sweat, which can't be achieved by stretching alone. You simply cannot “warm up” your muscles by stretching them: that’s like trying to cook a steak by pulling on it. Instead, the best way to warm up is probably to start by doing a kinder/gentler version of the activity you have in mind: e.g., walking before you run.

You simply cannot warm up your muscles by stretching them: that’s like trying to cook a steak by pulling on it.

Metaphorically, “warming up” also refers to readiness for activity or body awareness. You are “warm” in this sense when you are neurologically responsive and coordinated: when your reflexes are sensitive and some adrenalin is pumping. Warmup for its own sake (i.e., without following it up with more intense exercise) is fairly pointless — the goal is to prevent injury and enhance performance. And those goals may be realistic. For instance, research has shown that a warmup routine focussed on these goals actually might provide significant insurance against the number and severity of both traumatic and overuse-caused injuries.8

So, warmups in this second sense might be helpful … but does stretching warm you up in this sense? No, probably not much — certainly no more than a bunch of other exercises you could do — and quite possibly not at all. The most compelling evidence that stretching doesn’t warm you up is the evidence that shows that it doesn’t prevent injury or enhance performance (discussed below). Static stretch is somewhat stimulating to tissue, but in ways that are quite different from most actual activities.

Because of all this, stretching to warm up barely even qualifies as “official” exercise dogma anymore — most professionals actually gave up on it many years ago, and it is passé even in the opinion of many joggers, weekend warriors and other amateurs. Yet there are still far too many people out there stretching before they run, trying to “warm up” almost exclusively by standing still and elongating muscles! Once again, the best way to prepare for an activity is probably to start it slowly.

Stretching research shows that stretching does not prevent delayed-onset muscle soreness (DOMS)

Another popular idea about stretching is that it prevents that insidious deep tenderness that follows a hard workout. That soreness is called “delayed onset muscle soreness,” or DOMS for short. People believe that stretching can help DOMS like it’s religion.

I saw a similar example of this when I was in school: a science-minded instructor shared a research paper with us (something no other instructor ever did, which is shocking in itself). The paper suggested that massage therapy has no effect on the phenomenon of delayed-onset muscle soreness, and the evidence was compelling.9 But this was heretical! It was a crushing blow to one of the sacred cows of my profession, most of the class reacted angrily, and the hapless instructor was practically shouted out of the classroom.

I think the really amazing part of that story is that the students’ popular belief was less than two years old and the only basis for it was what they’d heard from instructors in their first year massage therapy classes. Before that, most of them couldn’t have even defined “DOMS”! Yet already it was dogma, essential to their self-image as budding health professionals, a “fact” that they planned to use to promote their services, and so most of them were actually offended by the contradiction. It was a neat demonstration that most people are more interested in emotional continuity than the truth.

People believe that stretching reduces DOMS with the same force. This does not make it true. Unfortunately, the evidence strongly suggests that stretching is completely useless for preventing DOMS. In fact, many studies have shown that nothing short of amputation can prevent DOMS — and certainly not stretching.1011

Think of DOMS as a tax on exercise. As one clever commentator put it, “Only soreness can prevent soreness.”

Stretching research shows that stretching does not prevent injury

According to the evidence, stretching probably does not prevent injury. As I mentioned above, this has been suggested by a combination of recent literature reviews and large clinical studies, some of which I have already cited. Here’s some more.

In 2005, Clinical Journal of Sports Medicine published a review of the scientific evidence to date, and found that the (admittedly limited) evidence “showed stretching had no effect in reducing injuries.”12 Neither poor quality nor higher quality studies reported any injury prevention effect. Regardless of whether stretching was of individual muscles or entire groups, there was no reduction in injury rates.

More experimental research has been done since. For instance, a 2008 study published in American Journal of Sports Medicine showed “no significant differences in incidence of injury” in soldiers doing preventative exercises.13 Half of them participated in an exercise program including 5 exercises for strength, flexibility, and coordination of the lower limbs, and 50 of those soldiers sustained overuse injuries in the lower leg, either knee pain or shin splints. The other 500 soldiers were doing nothing at all to prevent injury in the lower limbs — no specific stretching, strengthening or coordination exercises — and only 48 of them had similar injuries. There were “no significant differences in incidence of injury between the prevention group and the placebo group,” and the authors concluded that the exercises “did not influence the risk of developing overuse knee injuries or medial tibial stress syndrome in subjects undergoing an increase in physical activity.”

However, what is clear is that the exercise regimen certainly included static stretching, and it certainly did not work any prevention miracles for some of the most common athletic injuries from the knees down. If stretching performs that poorly in such an experiment, how good can it possibly be at preventing other injuries? Probably not very.

I’m never surprised by such findings, because I’ve never heard a sensible explanation for how stretching can generally prevent injury. Usually, advocates have a vague notion that “longer” muscles are less likely to get strained: even if garden-variety stretching made muscles longer (which is doubtful in itself), and even if we knew exactly what kind of stretching to do (we don’t), and even if we had the time to stretch every significant muscle group, the benefits would still be relevant to only a small fraction of common sports injuries. An ankle sprain, for instance, or a blown knee — two of the most common of all injuries — probably have nothing to do with muscle length.

In truth, there may prove to be some modest injury prevention benefits to stretching — but I imagine that they are quite specific and missed by most stretching regimens. For instance, it is likely that diligent and specific calf and arch stretching can prevent plantar fasciitis.14 But for “general” injury prevention, I can think of Five Ways To Prevent Sports Injuries that are probably more effective than stretching.

Hardly anyone needs to be more flexible

“I want to be more flexible,” people say, even when they have normal range of motion in every joint. What’s this about? Why are people so worried about being more flexible?

Most people have a normal range of motion — that’s why it’s normal! Unless you are specifically frustrated because you lack sufficient range of motion in a joint to perform a task, you probably don’t need to be more flexible.

Obviously, stretching can be effective at increasing flexibility — acrobats, gymnasts, yogis and martial artists have been doing it for centuries, sometimes achieving uncanny mobility. But these are highly motivated athletes with specific and extreme goals and stretching regimes that would intimidate the rest of us, and with good reason: they often injure themselves along the way.

Stretching probably doesn’t enhance performance (and it definitely doesn’t make you spring faster)

You don’t hear this argument for stretching as often as your hear the others. And yet it comes up, especially with athletes who play team sports. It’s a common practice to stretch when you’re off the field. The habit is probably usually rationalized as an injury prevention method, but many of those athletes will also claim that it enhances performance — that the muscles “spring back” from the stretch and make them run faster. There’s actually an entire stretching book that is largely based on this idea (The Stark Reality of Stretching: An informed approach for all activities and every sport) — but that book is conspicuously full of armchair science, and no actual evidence that the ideas are true.

Predictably, research has shown that stretching does not improve sprinting. More surprisingly, research has shown the opposite. What happens to your sprint if you stretch first? All other things being equal, the athlete who didn’t stretch is going to leave you behind!

Isn’t testing things just a marvelous idea? If you’re not sure what effect stretching has on sprinting, why not just try it? With measurements and stuff! It’s amazing what you can learn.

An Australian research group in Perth did exactly this in early 2009. They rounded up a few athletes and tested their sprinting with and without a stretching regimen between sprints.15 And of course they didn’t just ask the atheletes, “So, how did you feel? Faster? Slower?” No, they cleverly measured the results: “Mean, total (sum of six sprints), first, and best sprint times were recorded for each set” … instead of relying on the athletes impression of how they did.

The results of the tests were clear: “There was a consistent tendency for repeated sprint … times to be slower after the static stretching.” In other words, if you want to perform in a sprinty sport, you might not want to stretch right before getting your cleats dirty.

There are many possible mitigating factors here.16 However, the complexities only emphasize the absurdity of the legions of people who have an oversimplified faith that “stretching works.”

Stretching and irony in Runner’s World

One of the most interesting chapters in my history of criticizing stretching was being quoted in the September, 2009, issue of Runner’s World, in an article called “The Rules Revisited.” Contributing editor, Bob Cooper, asked for my assistance: “Can you tell me everything you know about stretching in 4 or 5 sentences?” An interesting challenge!

The result was a rare and overdue example of critical thinking on the subject of stretching in a major magazine. Cooper does an admirable job of summarizing and challenging several chestnuts of conventional wisdom, including stretching.

But, in a truly dazzling display of irony, Runner’s World published another article in the same issue — “All in the Hips,” p. 46 — that very un-critically promoted another idea that I’ve been busily debunking on this website: that hip strengthening can treat and/or prevent lower leg injuries. It’s based on a pet theory championed since about 2005 almost exclusively by Calgary researcher Reed Ferber. Ferber’s confidence in his theory is way out of proportion to the evidence he presents, and there are many problems with it.17

But he’s in Runner’s World promoting a new myth to a new generation of runners! Even as I am quoted trying to debunk the (still prevalent!) myths of the last generation.

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Irony, Man

In a dazzling display of irony, the September, 2009, issue of Runner’s World both quotes me as an expert debunking conventional wisdom about stretching, and uncritically promotes a new myth for a new generation of runners: the hip-strengthening myth.

There is basically no hope that the average reader will know that Ferber’s advice is really weak, just as there was no hope for the last thirty years that the average person would understand how weak stretching science has been. Most will simply believe the article. About a million Runner’s World readers are going to conclude that hip strengthening “probably” works!

“Falsehood flies, and the truth comes limping after.” Falsehood was a sprinter long before Swift first wrote that in 1710, and little has changed in the 300 years since. So it has always been with stretching: an idea promoted with much greater confidence than has ever been justified by the evidence, and it’s only several decades later that — very slowly — the truth is catching up.

So … is stretching good for anything?

Probably not for the reasons or in the manner most people are stretching, no — not much good, anyway, and certainly not in a way anyone has figured out how to measure.

Undoubtedly, some specific stretching techniques are good for specific purposes … but quite different from the stretching goals that most people actually have in mind, if they have any clear goals at all. My concern is not that stretching itself is useless, but that people are stretching aimlessly and ineffectively, to the exclusion of evidence-based alternatives, such as a proper warm-up or mobilization.

For most people, most of the time, stretching has a lousy effort-to-reward ratio.

I don’t believe that stretching is any more generally useful for people than it is for cats — you do it when you get up in the morning for a few seconds and then you’re off to the sandbox. That feels good — it’s stimulating and enhances your body awareness, it scratches some simple physiological itch, and that’s fine and dandy. But for most people, most of the time? As a time-consuming therapeutic exercise ritual? Stretching simply has a lousy effort-to-reward ratio.

In the next few sections, I will respond to some of the common objections and questions that readers often have.

So if all that’s true, if nothing I ever thought I knew about stretching turns out to be true, then why is it that I feel like I have to stretch or I’m going to seize up like an old piece of leather? Why do I have this compulsion to stretch, and why does it feel so good, if it’s not actually doing anything?

Because it is probably actually doing something! It’s just probably not doing what you thought it was doing. And we don’t really know for sure what it is doing. If we are intellectually honest, we simply have to admit that.

People routinely report that stretching feels good, that it reduces muscle soreness, or that they feel a strong urge to stretch. And I’m one of them. I have a stretching habit because it feels good, and because it feels like I’m going to “seize up” if I don’t. In particular, I stretch my hamstrings regularly and strongly, and it feels as pleasantly essential to my well-being as slipping into a hot bath — but the exact nature of the benefits are completely unclear to me.

It’s probably a complex stew of genuine but mysterious and subtle physiological benefits, plus placebo. I was raised on stretching. Despite my doubt about the conventional wisdom, I tend to emotionally “believe” in stretching just like everyone else — it’s deep in our culture, and, since stretching feels good, it’s easy for my mind to jump to the conclusion that it must be good. But of course that’s not really helpful at all — lots of things feel good without having any clear physiological benefits. Stretching might be like scratching: an undeniably strong impulse, but with almost no relevance to athletic performance or overall health. Or it might be like getting a massage for muscles that are sore with DOMS: undeniably pleasant, but with a proven lack of actual efficacy.

I just don’t know. And based on the research to date, no one else does either.

If feeling good was the only thing that stretching was good for, most people — especially the athletes — would drop it from their exercise routine immediately. Most of us have better things to do. However, if someone firmly declared, “I stretch just to feel good,” I would applaud and say, “Hallelujah! That is an excellent reason to stretch! And one of the few that I can defend!”

And, then again, there may actually be real physiological benefits to stretching — just not the usual ones that get tossed around.

“But I find that stretching helps muscle soreness …”

I hear this one a lot, and I experience it myself as well. There is one plausible and partially understood mechanism by which stretching might actually reduce muscle pain and stiffness: by “releasing” myofascial trigger points, commonly known as muscle knots. I do take this idea seriously and explore it in (excruciating) detail in this article:

However, to boil that article down to a single brief paragraph: although stretching probably does help trigger points, I suspect it’s only one piece of a complex puzzle. There are simply too many problems with the theory, too many little niggling doubts, not the least of which is that it’s pretty clear that stretching routinely fails to treat serious trigger points, and can even aggravate them. It’s just too complicated and mysterious a relationship to say anything firm about it. Trigger point release is almost certainly a partial explanation for why stretching sometimes feels good, but it is just as certain that it isn’t the whole story.

“But don’t people just need to be taught how to stretch properly?”

No, they don’t — because it’s impossible. There is just no way, so far, to confirm what a “proper” stretch is. Trying to teaching people “proper” stretching is like trying to teach children “proper” finger painting: there’s no standard.

This is another protest I frequently hear from people who are clinging to the stretching dogma. The choice of words ranges widely, but the sentiment is always the same: stretching is only valuable if you know what you’re doing. And so a number of experts stay in business by advocating a stretching method or rationale that seems to trump all the others. Unfortunately, none of them agree with each other.

My own colleagues are sometimes the worst perpetrators of this idea, that clients just need to be “educated” and their stretching will magically become much more valuable than it used to be. Valuable for what, I am not sure — as we discussed above, we’ve pretty much eliminated all the popular reasons. But even if we generously allow that there may be some other benefit to stretching, who are we to say how it should be achieved? Show me an authoritative source of information about stretching! Show me a “correct stretch”!

Here is a vivid example of the problem. This is an excerpt from one of my text books, a weighty and authoritative tome, a bible of therapeutic exercise:

Several authors have suggested that a period of 20 minutes or longer is necessary for a stretch to be effective and increase range of motion when a low-intensity prolonged mechanical stretch is used.

three citations listed, Therapeutic Exercise, 3rd Ed., Kisner/Colby, p157

Twenty minutes? I don’t know anyone who is stretching a muscle for twenty minutes! I don’t know a single therapist or trainer who is recommending it either! And yet “several authors” have found that it is “necessary”! It would seem to be a “correct” method of stretching, yet it is absent from professional wisdom on the subject … because, of course, it is contradicted in other text books, by other experts, not to mention the fact that it’s completely impractical. Imagine trying to stretch for injury prevention: 20 minutes for each of 20 important muscles!

You can see the problem. Even if you had clear and defensible goals for stretching, it is effectively impossible to form an evidence-based opinion on what “stretching properly” looks like.

The unstretchables: the many muscles that are biomechanically impossible to stretch

Another significant practical difficulty with stretching that never gets discussed: there are several important muscles and muscle groups that are mechanically impossible to stretch, including ones (like the quadriceps) that people think they are stretching. Even if stretching actually had the benefits that people want to attribute to it — which it clearly does not — those benefits would still not actually be available in large sections of the body. See:

The Unstretchables: Ten major muscles you can’t stretch, no matter how hard you try

“But isn’t yoga all about stretching? An Yoga has lots of benefits, doesn’t it?”

Yes, it is, and yes, it does — but not the benefits that people normally attribute to stretching. Same with qigong, and the martial arts are full of stretching techniques — some of them appropriated from the modern Western fitness tradition, and others inherited from traditional practices. I advocate this kind of stretching elsewhere in my writings. So what’s the difference?

The difference is in intention. The intention of stretching in the context of good qigong, yoga or martial arts is to focus the mind, to stimulate vitality through a combination of mental and physical exercise. The intention is everything — without the intention, you might as well not bother with these activities.

Most westerners stretch without the foggiest notion of this underlying complexity. Stretching is generally stimulating to body awareness, of course: but that awareness is unsophisticated and incidental, rarely involving any insight more complex than “ooh, that muscle sure is sore.” Without education about intent — without a rich philosophical context — the value of stretching in yoga is just as dubious as it is in any other situation.

And stretching in yoga also involves risks. Too often people perceive yoga as a wholesome and harmless activity, when injuries are actually common. As with dancing or martial arts, there are many ways to hurt yourself practicing yoga.

Further Reading

• SY The Unstretchables — Ten major muscles you can’t stretch, no matter how hard you try
• SY Five Ways To Prevent Sports Injuries — Get warm, co-ordinated, relaxed, smart and mobilized!
• SY Mobilizing! — An alternative to stretching that “massages you with movement”
• SY Basic Self-Massage Tips for Myofascial Trigger Points — Learn how to massage your own trigger points (muscle knots)
• Other articles that critically examine popular ideas about health: Do Epsom Salts Work? and Water Fever and the Fear of Chronic Dehydration and Posture Exercises for Posture Correction.

Other interesting reading relevant to stretching:

• “Stretching ‘fails to stop muscle injury’,” a webpage on news.BBC.co.uk.
• “Reducing risk of injury due to exercise: Stretching before exercise does not help”. This is a superb British Medical Journal editorial, which adds about fifty pounds of credibility to this article.
• “Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review”. This is the much more technical article, to which the editorial mentioned above is referring.
• “Stretching before exercise: an evidence based approach”. Another more technical article, but also excellent and heavily referenced.
• Published since this, my article SY You Can’t Beat DOMS! — The myth of treatment for nature’s little tax on exercise, delayed onset muscle soreness (DOMS) covers the subject of preventing DOMS more thoroughly.

Notes

1. Cooper, Bob. “The Rules Revisited.” Runner’s World. September, 2009. p. 59. Return to text.
2. Shrier. Clinical Journal of Sports Medicine. 1999. This paper and Herbet are literature reviews: that is, they are reviews of many other studies. They both show many contradictions in existing research, but they both conclude that there is no convincing evidence that stretching is useful. Return to text.
3. Herbet et al. British Medical Journal. 2002. Return to text.
4. Pope RP, Herbert RD, Kirwan JD, et al. A randomized trial of preexercise stretching for prevention of lower-limb injury. Medicine & Science in Sports & Exercise 2000;32:271–7, abstract. Return to text.
5. Tip of the hat to reader Jennifer M, who sent me this. Jennifer added that this passage reminded her of her father, “who remained competitive at the 800m until into his 60s, but could never come close to touching his toes.” Return to text.
6. Davies et al. The Trigger Point Therapy Workbook, p8. “Trying to get at ... relatively small trigger points by stretching whole groups of recalcitrant muscles seemed unnecessarily indirected and inefficient.” Return to text.
7. Simons et al. Myofascial Pain and Dysfunction, pp127–135. Many therapists mistakenly believe that Travell and Simons’ well-documented “spray and stretch” method means that stretching is unequivocally good for trigger points. But the point of the vapocoolant spray is to “distract” the nervous system from the pain of stretching a dysfunctional muscle, which has both small patches of hypercontracted sarcomeres (trigger points) and long stretches of sarcomeres that are overextended. Without the spray, muscles in this predicament may contract defensively. Consequently, Travell and Simons do not recommend stretching trigger points without the spray. Return to text.
8. Soligard et al. British Medical Journal. 2008. In 2008, Norwegian researchers compared injuries in over a thousand female footballers who participated in such a warmup for a season, to another several hundred who didn’t. The athletes with the warmup had fewer traumatic injuries, fewer overuse injuries, and the injuries they did have were less severe. Static stretching was not part of the warmup. “Active stretching” was … but “active stretching” is what I would call “mobilizations” — doing moving lunges, for instance — as opposed to the kind of static or passive stretching that most people think of when they think of stretching. Return to text.
9. I am not certain, but I believe this is the paper in question: Tiidus. Journal of Orthopaedic & Sports Physical Therapy. 1997. Return to text.
10. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness : treatment strategies and performance factors. Sports Medicine 2003;33(2):145-64, abstract. From the abstract: “Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms.” Return to text.
11. Weber MD, Serevedio FJ, Woodall WR. The Effects of Three Modalities on Delayed Onset Muscle Soreness. Journal of Orthopedicand Sports Physical Therapy, 20(5):236-42, 1994 November, abstract. From the abstract: “ …analysis indicated no statistically significant differences between massage, microcurrent electrical stimulation, upper body ergometry, and control groups.” Return to text.
12. Hart. “Effect of stretching on sport injury risk: a review.” Clinical Journal of Sports Medicine. 2005. Full Abstract:
    

    OBJECTIVE: Effect of Stretching on Sport Injury Risk: a Review To assess the evidence for the effectiveness of stretching for the prevention of injuries in sports.

    DATA SOURCES: MEDLINE (1966 to September, 2002), Current Contents, Biomedical Collection, Dissertation Abstracts, the Cochrane Library, and SPORTDiscus were searched for articles in all languages using terms including stretching, flexibility, injury, epidemiology, and injury prevention. Reference lists were searched and experts contacted for further relevant studies.

    STUDY SELECTION: Criteria for inclusion were randomized trials or cohort studies of interventions that included stretching compared with other interventions, with participants who were engaged in sporting or fitness activities. One author identified 361 articles reporting on flexibility, methods and effects of stretching, risk factors for injury, and injury prevention, of which 6 articles fulfilled the inclusion criteria for meta-analysis.

    DATA EXTRACTION: Three independent reviewers blinded to the authors and institutions of the investigations assessed the methodologic quality of the studies (100-point scale) and reached consensus on disagreements. Details of study participants, interventions, and outcomes were extracted. Weighted pooled odds ratios were calculated for effects of interventions on an intention-to-treat basis.

    MAIN RESULTS: Reduction in total injuries (shin splints, tibial stress reaction, sprains/strains, and lower-extremity and -limb injuries) with either stretching of specific leg-muscle groups or multiple muscle groups was not found in 5 controlled studies (odds ratio [OR] 0.93; 95% CI, 0.78 to 1.11). Reduction in injuries was not significantly greater for stretching of specific muscles (OR, 0.80; CI, 0.54-1.14) or multiple muscle groups (OR, 0.96; CI, 0.71-1.28). Combining the 3 ratings of methodologic quality, median scores were 29 to 60/100. After adjustment for confounders, low quality studies did not show a greater reduction in injuries with stretching (OR, 0.88; CI, 0.67-1.15) compared with high quality studies (OR, 0.97; CI, 0.77-1.22). Stretching to improve flexibility, adverse effects of stretching, and effects of warm up were not assessed by appropriate intervention studies.

    CONCLUSION: Limited evidence showed stretching had no effect in reducing injuries.

    Return to text.
13. Brushøj et al. American Journal of Sports Medicine. 2008. Return to text.
14. There is extensive experimental evidence showing that stretching is effective treatment for plantar fasciitis. See Wolgin, Giovanni, Batt, Barry and Powell. Return to text.
15. Beckett et al. Medicine & Science in Sports & Exercise. 2009. Return to text.
16. The most obvious wrinkle is that the negative impact of static stretching on sprinting might be short term — were the runners slowed down for only ten minutes? Twenty minutes? As much as sixty? Another important consideration is that the potential therapeutic effects of stretching — still remarkably unproven at this late date in history, but still hypothetically possible — could conceivably outweigh the relatively small cost of being slowed down. For instance, if (big if) stretching significantly stretching reduced the risk of a muscle strain, would that risk reduction be worth the cost to sprinting speed? Probably! If. Return to text.
17. For more detail, see another article on SaveYourself.ca, Does Hip Strengthening Work for IT Band Syndrome? Despite its popularity, “weak hips” is a weak theory, and there is no compelling evidence that hip strengthening can treat or prevent running overuse injuries of leg. Return to text.