WHEN DO YOU THINK YOU SHOULD STRETCH?

WHAT DOES THE SCIENCE TELL US ABOUT STRETCHING?

DO YOU KNOW WHEN STRETCHING COULD DO MORE HARM THAN GOOD?

Stretching is a common topic in the health and fitness world, but there are conflicting statements about when and how it should be done, as well as how effective it is thought to be.

In clinic patients often tell me they have used stretching to ease pain and stiffness in the early stages of an injury. The ‘word on the street’ is that it is still considered to be the ‘right thing’ to do and most of us would agree that it often feels good at the time.

Improvements in sporting performance and prevention of injury are also other areas that are considered to improve with a regular stretching regime.

However, the advice and guidance I provide is often very different so here is some up to date information to help you answer all those questions.

STRETCHING MAY NOT BE AS EFFECTIVE AS YOU MAY THINK

I will go so far as to say that stretching is likely to be the one thing you can confidently leave out of your fitness regime and not suffer for it. Here are some of the common reasons for stretching and why it doesn’t have the effect you think it might have;=:

  1. Injury prevention:

Stretching is a habit that we have all got ourselves into since the early days of PE in school. We have been conditioned to think that we must stretch out muscles if we are to avoid tearing them. If all those athletes you see on TV are doing it then surely you should, right?

Numerous studies and critical reviews of the clinical and basic science literature suggest that stretching does not prevent injury. Though there are always limitations to such studies, let’s consider some of the science.

A muscle that is more compliant in terms of temperature or fatigue has a reduced capacity to absorb energy. So why would stretching to make the tissue more compliant have a different effect? Injuries also commonly occur as we sprint or change direction. This coincides with a shortening of the muscle complex and is often when the muscle is in mid- range. Why would stretching make this any different? Mild stretching has also been shown to create damage at a low cellular level and can be considered to have a pain-relieving effect. Surely stretching and reducing pain will then increase the likelihood of tissue damage?

The evidence is simply not there – and when we delve deeper into the actual effect stretching has on the tissue, it may actually increase your risk of injury.

  1. Improve performance:

Have you been told you need to stretch more if you are going to improve your running times, lift heavier or jump higher?

In the sporting world we are always talking about tissue ‘stiffness’ which in simple terms can be considered as the ability of your muscle or tendon to resist stress. For example, consider how much work has to be done for someone to resist your biceps tendon when your elbow is fully bent. If this tendon was not stiff and it deformed easily then more energy would be required to contract the muscle to resist the tendon deforming and the elbow straightening.

We need an optimal amount of stiffness so the muscle force can be transmitted to the bone and for movement to be fast and efficient. Spend hours stretching you may actually be reducing your chances to store energy and thus impeding performance.

  1. Treatment/ management of injuries:

In the early stages of an injury there may be small or large amounts of damage sustained to the injured muscle, ligament or tendon.  Restoring range of movement and reducing stiffness are the common reasons that stretching is adopted. I sometime give out certain stretches for this reason – but overall achieving AND maintaining the range is reliant on active mobility and gradually increasing load control through range.

Most stiffness is simply a ‘sensation’ and it can commonly be mistaken for poor load capacity, or weakness in the affected tissue. Hip flexors are a common area that are thought to be tight or stiff and are frequently ‘stretched’ with little long- term benefit.

  1. Increase flexibility:

Yes, stretching will increase flexibility but it is a common misconception that the best athletes are the most flexible.

‘Eluid Kipchoge (in 2018, was the fastest marathon runner) can not touch his toes!’

So consider why you are doing it. Our range of motion and general flexibility will be genetic to some degree hence, we can’t all be ballet dancers and gymnasts. Most of us will sit in a ‘normal’ category for flexibility enabling us to perform all the functions that are required of us.

It is only when we need to perform a regular, necessary function that is inhibited by range of motion that flexibility become key. On these occasions strength through this added range is paramount to reduce injury risk and maintenance of this new range will require consistent work. In most cases it is therefore simply not a necessity.

Consider the following: those with greater flexibility do not live longer or sustain less falls as they age. Back pain and sustained injuries are actually more common in those that are more flexible and it does not mean you run further or lift heavier. So is flexibility a really important part of your health and fitness regime?

WHEN DO I SUGGEST YOU DON’T STRETCH?

I will leave you to process the above information for yourself but if you re looking for my advice on when stretching is best avoided consider the following:

New/ acute injuries: in the early stages of an injury tissue damage will have been sustained so adding heavy stretches to a torn ligament or muscle will only be likely to make things worse. Anything that reproduces sharp or stabbing pain should be avoided. Modified rest is often advised but this will be variable according to the extent of the injury. Seek advice from a healthcare professional so you know how to best manage your injury.

At certain stages post- surgery: stretching may be indicated at certain points of the recovery process but it is essential that you do this at the right time. Done too early and you could damage the wound and increase risk of infection, overstretch the healing tissue resulting in poor surgical results and exacerbate pain. Done to late and you can end up with joint stiffness that is difficult to resolve. Above all else listen to the guidelines set by the consultant and physiotherapist.

Muscle spasms: when you suffer acute muscle spasms around your neck, lower back or other areas stretching will not help. When spasms or ‘knots’ occur the muscle is involuntarily shortening and pulling on it to make it ease will NOT work, it only makes it worse. Try to perform gentle movements within a manageable range and don’t’ pull on the affected muscle.

Tendinopathies: tendons attach muscle to bone and we commonly suffer from tendinopathies around the Achilles tendon, common extensor or flexor tendon of the elbow (tennis or golfer’s elbow), glutes (outside of the hip), hamstring insertion (around buttock fold/ sitting bone) and the shoulder. Tendinopathies make up a whole new blog but for the purpose of this one: PLEASE STOP STRETCHING THEM. A progressive loading programme is usually the gold standard treatment but ensure you have the right diagnosis and then the best programme can be designed for you and you. You may otherwise find yourself making things worse without even realising it!

Nerve pain: do you have pins and needles or numbness? Acute stabbing or electrical shocks going down a limb? Such symptoms are often attributable to neural irritation and nerves do not like to be stretched. I often describe a nerve like a hose pipe that you have in your garden! Imagine it has got caught round the corner of a wall and you keep pulling at the end to try and reach the plant you want to water. The more you pull you will add a compressive force around the restricted area and this can cause friction around that area and will effect the pressure of the water at the other end. Constant yanking will not help. You need to slowly tease the area loose and allow the nerve to move freely to ensure optimal function!

Pre sport or when cold: you will not and can not warm up a muscle by statically pulling on it. This is a FACT! It is purely habitual! To warm up your muscles you need to increase the metabolic activity within it so MOVE! Whatever activity you are doing start a slow milder version of it and gradually pick up pace and intensity.

Evidence is very, strong on this area. Stretching for 30-45 seconds as a warm -up has been shown to have no significant effect and may actually increase risk of injury.

Hypermobility: this is an interesting area for discussion as the most common reason for stretching is to increase flexibility. For those with range of motion that exceeds the general population, why is stretching necessary? Often it is because these individuals still experience the ‘sensation’ of stiffness. It is in these cases that we really need to consider what we are hoping to achieve. Is the stiffness eased by stretching and if not what other factor may be contributing to it? More commonly this sub-group of patients actually lack strength and/ or stability through the full joint ranges that they present with. The joint surfaces and associated structures are therefore put under heavy stress to cope with the loads applied to them and this can manifest in a sensation of ‘stiffness’ or mild pain. Consider increasing load tolerance but working on strength instead of length to ease such symptoms.

SO CAN YOU CONTINUE STRETCHING?

I enjoy the occasional stretch and that is the main reason I do it and the main reason I don’t stop my patients from doing it. If you are suffering from any of the above problems or adopt stretching for any of the reasons stated above then consider if it actually has the benefits you are aiming for.

If you don’t actually enjoy it then remove this from your routine and spend more time on efficient, dynamic warm ups and focused strength training through range to optimise your health and fitness.

IN SUMMARY……….

  • Modern research has challenged our original beliefs about the effects of stretching.
  • There are specific structures and occasions when stretching is actually considered harmful.
  • Consider you health and fitness regime. Is stretching necessary for  YOU?
Davina Sherwood
Specialist Musculoskeletal Physiotherapist