Stretching, should you do it?

Stretching is a major subject of ongoing debate with regard to is effect on helping to prevent injuries. Frequently asked questions about stretching include "Whether or not is should be included as part of a warm up or cool down?" "Should you stretch before exercise or afterwards?" "How long should you hold a stretch for?" and "What is the best type of stretching?"

The above questions have lots of differing answers, with sometimes baffling and often opposing claims as to which answer is right or wrong. In the sports medicine and injury world the debate goes on, so runners seeking injury advice are often confused by the differing information they may find online or in printed press. The best way to explain stretching is to consider the current research that is available to us, what methods have been scientifically proven and what were the clinical results but I will also include some of my own personal opinion based my experience of what has worked for me and my patients.

To start with in this article I will be evaluating the two main types of stretching that we give to our patients. These are static stretches and dynamic stretches. We use these types of stretches regularly, and most people will be familiar with this type of stretching, plus you do not need any therapist assistance. The other types of stretches like MET or PNF - push/hold/relax type stretches do require help of a therapist and are best used within a clinical setting.

Static Stretching - What is it?

A static stretch is when you aim to lengthen a muscle, hold it in the elongated position for a set time, e.g. the standing quad stretch is commonly performed by standing upright and pulling your foot and heel towards your bottom, creating a stretch on the front of your thigh.

Dynamic stretching - What is it?

A Dynamic stretch is one which makes use of your movement and energy from a limb or your torso to move a muscle from one end limit to the other, making use of the full range of movement. Dynamic stretches carried out slowly in a controlled fashion and are never forceful or bouncy. For example in runners you may see them swinging their leg backwards and forwards like a pendulum, performing what is known as a leg swing.

So which is better, static or dynamic?

The answer to this question depends on what you are looking to gain from the stretch. Each has positives and negatives and they are both considered to be fit for differing objectives.

In short it is now widely considered that static stretching should not be used alone just before exercise or sports as it can have an effect on performance. As an alternative dynamic stretching should be used before activity. On the other hand static stretching is still seen as being a better stretch for improving and maintaining flexibility and increasing suppleness.

Is this correct?

It has been clinically proven that static stretching can reduce strength, power and performance, which is obviously an important part of most sports. Further research has concluded that static stretching should be avoided as "a sole activity during a warm up routine".

BUT WAIT!

It is important to remember that this is only if static stretching is the "sole" activity and this point must not be overlooked before completely eliminating static stretching from your warm up routine. It is true that this research review shows a reduction in strength, power and explosive performance in those athletes who statically stretched before exercise, BUT the effects were very small, causing decreases by 5.0 -1.0%, so although this is an important statistic it really will only matter to the professional, top level athletes, for most exercising or playing sports recreationally, you are not very likely to notice a reduction. Further more this applies even less so if the stretch was held for more than 45 seconds (most stretches are held for less time) and any negative effects only lasted a few minutes

So how about Dynamic stretching before sports as being more beneficial? Another study has shown that dynamic stretching has either no effect or may enhance subsequent performance, again this is only a "might do" so it is not the be-all and end-all for dynamic stretching as a choice over static stretching in preparation for exercise.

It has been further concluded that a combined approach including both static and dynamic stretching for a majority of sporting activities is the best option, with the type of sport being the determining factor as to which type of stretching is best and not that one type of stretching takes precedence over another.

Which type of stretching helps to reduce the risk of injury?

In short the scientific research to prove which type of stretching reduces the incidence of injury is 'inconclusive', so we basically just don't know. But once again employing a little common sense, if you are going to prepare your body for sport or exercise then some form of stretching can only be of benefit.

Every sport is different and in turn every warm up will be different, with a distinctive emphasis on the volume of activity and intensity of the exercises. This will change from person to person, as there is no one warm up routine that suits someone better over another.

What should we be doing?

All in all when considering stretching and warm up, it is fair to say that the clinical evidence suggests it is best to devote warm up time to largely dynamic stretching and low intensity aerobic activity similar to the sport of exercise to be carried out. For example for runners, brisk warm up walk with some dynamic stretches would be an example warm up. However if your sport requires large amplitude movements then the inclusion of some shorter duration static stretches would serve you well.

Do we need to bother stretching at all?

This is an extremely controversial, even risky statement. I personally find static stretching useful before a low intensity run but only for a short period of time (less than 15-30 seconds), I tend to always spend longer static stretching after exercise (holding a stretch for 30-60 seconds) and that works for me. But many people do not stretch, they simply put on their running shoes, go out running and they don't seem to suffer any more injuries than those who dedicate time to a comprehensive warm up. We know from clinical research that there is no evidence that stretching reduces the risk of injury, so you may ask what is the point then? This may well be just due to habit, psychologically because we have had it drummed into us for years that stretching is the most important part of a warm up and cool down.

The human body is very tough really and it has a great ability to adapt to the demands of activity it carries out. As far as warm ups go I would recommend to continue doing them, but it is less important to stretch as part of this warm up.

How long should you warm up for and what should it include?

Once again, clinically speaking there is no evidence to suggest a definitive answer to that statement, as regretfully the research is inconclusive, no surprises there really!

However as it is something that we get asked a lot in our job, our training and experience means we get a pretty good appreciation of some good pointers for our patients.

As a general rule it is a good idea to plan a warm up to be 25%-50% of your planned activity, this may vary depending on the intensity and whether it is high or low.

For example if you are going out for an easy run for half an hour, then this would be low intensity so spend 25% of the planned time warming up - approx. 7 minutes. However if you plan to do a 30 minute high intensity sprint session then increase your warm up time to 50%, approx. 15 minutes.

For high intensity work it is definitely worthwhile giving yourself the extra time to warm up, to get your body prepared for the demands of the more vigorous activity. This type of exercise involves maximal effort as with anything including sprints such as football or rugby, more time spent performing warm up drills is a good idea.

When considering how and what to warm up, it will depend on what you are planning to do. For example speed work or sprint sessions in running, warming up will need to include running drills, hops and skips in a singular forward direction with the inclusion of dynamic hamstring or hip flexor muscle movements. Football on the other hand with frequent twisting and turning, requires more multidirectional drills as well as time to warm up other areas such as the back, hips and groin not just the legs.

In conclusion static stretching does have a place in a warm up routine and can be included for the majority of people, without any major ill-effect. But it is likely that the best idea is to perform largely dynamic stretching before exercise and maybe leave static stretching on days between your exercise or training sessions and in the clinic treatment rooms. Nonetheless, if you have always stretched this way previously and have had no problems and this works for you - then by all means carry on doing it.

I personally like a warm up before exercise but again if you never have done any form of warm up or stretching and it has worked for you and you wish to continue that way then its probably ok for you to carry on doing so.

Last of all, if you want the best warm up routine 'out of the box' unfortunately there is is no one warm up solution that works for everybody, it really is down to individual experimentation to see what feels right for you, no matter what you may be told or read in the magazines, have a go and see how you get on.

Article by James Clapham, Chart Clinic Osteopath, keen runner and cyclist.

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