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Does Stretching Decrease Injury & Performance?

A look 'under the hood' of why stretching with movement works.

Michelle Tedman

on 4 January 2013

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Transcript of Does Stretching Decrease Injury & Performance?

Certain muscles are prone to tightness How can we quickly and effectively become more flexible? Ways in which stretching effectively alters one's flexibility:
Neurogenic contraints
Myogenic Contraints
Joint Contraints
(Skin) This presentation will review the concepts of when and why a patient or population might benefit from stretching. As well as answer the question: Does stretching decrease injury and performance? Why Stretch?
= in attempt to
•Enhance performance
•Increase range of motion
•Reduce the risk of injury A closer look at stretching After all the literature is reviewed; DOES STRETCHING DECREASE INJURY? Michelle Tedman, SPT
July 3rd Inservice for VMH Thank you.

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25. O’Sullivan K, Murray E, and Sainsbury D. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskeletal Disorders. 2009; 10:37-46. Available at: http://www.biomedcentral.com/1471-2474/10/37

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27.American College of Sports Medicine, (2000) ACSM's Guidelines for Exercise Testing and Prescription, 6; 158.

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34 Jones BH (1997). The role of medical surveillance and research in army injury prevention. American College of Sports Medicine Conference abstract, Denver.

3 5. McCallister TL, et. al. (2004) Days of rest between stretching bouts increased hamstring flexibility. Journal of Athletic Training. Supplement 39(2), 99-100.

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40. Young WB, Behm DG (2003) Effects of running, static stretching and practice jumps on explosive force production and jumping performance. J Sports Med Phys Fitness. 43(1):21-7. Dynamic Stretching Repetitive bouncing movements at the end of joint range of motion Advantages Disadvantages Proprioceptive Neuromuscular facilitation (PNF) Ballistic Stretching Separating the Types Static Stretching Definition Reflex activation and inhibition of agonist and antagonist muscles Advantages Disadvantages Definition Passive movement of a muscle to maximum ROM & being held there for an extended period of time, 30-90 seconds. Advantages Disadvantages Definition Advantages Disadvantages Definition Movements that mimic a specific sport or exercise in an exaggerated yet controlled manner. Can fatigue the muscles prior to activity and decrease performance
Can overstretch a muscle and cause injury if not properly done
Can injure a post-op/acute injury and older adults
Contraindicated in: acute/inflammatory phases of injury
Limited target audience of athletes Decrease season injury (Cadet study)
Events requiring high muscular power and/or strength
To improve power and agility tasks
Increase O2 uptake, lower lactate concentration, and raise blood pH and improve efficiency of thermoregulation Often need a partner to get passive relaxed motion Increased ROM, simple technique Reduced muscle strength, may cause injury Increased ROM; some suggest capable of achieving greatest flexibility.

*Everyone can use Reduced muscle strength; may cause injury (1); not for everyday use Increased ROM
Maintain flexibility
Allow for efficient body mechanics

*Well conditioned athlete
in preparation for competition

ACSM recommends a 6 second contract followed by a 10-30 second assisted stretch DOES STRETCHING DECREASE PERFORMANCE? Greater flexibility may impair performance in sports that that do not require a high degree of flexibility such as running. Runners with less flexibility are actually more efficient at running (Jones 2002). Intense static stretching may also reduce maximum force production. The loss of voluntary strength and muscular power may last up to one hour after the static stretch (Evetovich 2003, Young 2003). People who participate in activities that require more than average flexibility (eg: gymnasts, dancers, figure skaters) may still find stretching beneficial to their performance.
The ACSM recommends flexibility training a minimum 2 to 3 days per week holding each stretch for 10 to 30 seconds to mild discomfort; 3 to 4 repetitions per stretch.

Although stretching does not seem to offer many short term benefits when performed before exercise, stretching does seem to offer other long term benefits.
Improved flexibility may help:
prevent back and other orthopedic problems
Individuals with certain muscular imbalances or postural problems can benefits from stretching
maintain flexibility which may otherwise decline with age or inactivity due to an injury.
may be more safely performed after dynamic exercise, when muscles are warm. Unless this is your goal...or a goal of your patient's

Stretching should be done in conjunction with a warmup and performed on target muscles or in activity specific ways. Research Clinical applications:

Static stretching should be done at times other than pre-participation.2
Ballistic, PNF or Dynamic are best suited for pre-activity due to the thermodynamic component.
Static stretching should be performed if the aim is to increase flexibility.2
Events that require high muscular power and/or strength have shown improvements when dynamic stretching. 16
Clinicians should be aware of the possibility for stretching-induced strength deficits when conducting strength tests on patients.1
Static and PNF stretching in elderly women helped to improve gait patterns and decrease risk for falls.5
Static stretching with warm-up for athletes did not elicit benefits from stretching when the athlete waits longer than 3 minutes to enter the game.12
Dynamic stretching is believed to increase O2 uptake, lower lactate concentration, and raise blood pH all which improve the efficiency of thermoregulation. Research supporting the beneficial nature of stretching Research findings supporting stretching is not beneficial The Bottom Line ■Mechelen, Hlobil, Kempers, and Voorn's 'Prevention of Running Injuries by warm-up and cool-down and stretching exercises' published in the AJSM in 1993, suggested that a standard warm up, cool down and stretching exercise program did not prevent running injury for male recreational runners.

■A study by Knapik, et al. conducted a randomized study on 138 collegiate female athletes. 40% of the women suffered one or more injuries during their sport season. Athletes experienced more lower extremity injuries if they had: 1) a right knee flexor 15% stronger than the left knee flexor at 180 deg/sec; 2) a right hip extensor 15% more flexible than the left hip extensor; 3) a knee flexor/knee extensor ratio of less than 0.75 at 180 deg/sec.
=Suggesting flexibility imbalances are prone to injury/ flexibility needs to be sport specific

■Subjects with less gross flexibility were found more economical in walking, jogging, and bicycling with better oxygen consumption*.

■No significant difference was found on hip range of motion, by comparing 15 minutes static stretching exercise with same period of cyclic exercise (both improved). Physiologic Mechanisms:
a. Increased HR (therefore increased blood flow)20
b. Greater nervous system activation ( EMG activity) 20,24
c. Increased body temperature 15, 20, 24, 25
d.Enhanced neuromuscular function (Postactivation potential-PAP) 20, 23 Some Key Points:
1. The mean power was significantly lower when comparing dynamic stretching to PNF
2. For peak power, significant differences were observed b/n more comparisons, with PNF providing the lowest result
3. A consistent increase of time to reach the peak was observed after all stretching exercises when compared to non-stretching
4. The type of stretching, or no stretching should be considered by those who seek higher performance and practice sports that use maximal aerobic power.
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