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Does Stretching Decrease Injury & Performance?

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

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.

References:
1.Marek S, Cramer J, Culbertson J, et al. Acute effects of static and proprioceptive neuromuscular facilitation stretching on muscle strength and power output. Journal Of Athletic Training [serial online]. April 2005;40(2):94-103. Available from: CINAHL with Full Text, Ipswich, MA. Accessed February 16, 2012

2.O'Sullivan K, Murray E, Sainsbury D. The effect of warm-up, static stretching and dynamicstretching on hamstring flexibility in previously injured subjects. BMC Musculoskeletal Disorders [serial online]. January 2009;10:1-9. Available from: Academic Search Premier, Ipswich, MA. Accessed February 16, 2012.

3.Yessis M. Runners Need Active Stretching. AMAA Journal [serial online]. Winter20062006;18(2):8-18. Available from: Academic Search Premier, Ipswich, MA. Accessed February 16, 2012.

4.Youdas JW, Krause DA, Egan KS, Therneau TM, Laskowski ER. The effect of static stretching of the calf muscle-tendon unit on active ankle dorsiflexion range of motion. J Orthop Sports Phys Ther. 2003;33(7): 408-416.

5.deWeijer VC, Gorniak GC, Shamus E. The effect of static stretch and warm-up exercise on Hamstring Length over the course of 24 hours. J Orthop Sports Phys Ther. 2003;33(12)727-733.

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7.Perrier E, Pavol M, Hoffman M. The acute effects of a warm-up including static or dynamic stretching on countermovement jump height, reaction time, and flexibility. Journal of Strength and Conditioning Research, Jul;25(7):1925-1931, 2011.

8.Rodacki, A.F., Souza, R.M.., Ugrinowitsch, C., Cristopoliski, F., and Fowler, N.E.(2009) Transient effects of stretching exercises on gait parameters of elderly women. Manual Therapy,(14), 167-1729.Murphy, J. R., Di Santo, M. C., AlKanani, T., and Behm, D. G. (2010). Aerobic activity before and following short-duration static stretching improves range of motion and performance vs. a traditional warm-up. Applied Physiology, Nutrition and Metabolism, (35), 679-690.

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11.Ghaffarinejad, F., Taghizadeh, S., & Mohammadi, F. (2007). Effect of static stretching of muscles surrounding the knee on knee joint position sense. Journal of Sports medicine, 41, 684-687.12.DePino, G., Webright, W., & Arnold, B. (2000). Duration of Maintained Hamstring Flexibility After Cessation of an Acute Static Stretching Protocol. Journal of Athletic Training, 35(1), 56-59.

13. Weerapong P, Hume P, Kolt G. Stretching: mechanisms and benefits for sport performance and injury prevention. New Zealand Institute of Sport and Recreation Research, Division of Sport and Recreation. Physical Therapy Reviews. 2004; 9: 189-206. Available at: http://web.ebscohost.com/ehost/detail?vid=4&hid=11&sid=c01c234c-7496-43ec-be03-093ea65bf62e%40sessionmgr15&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=afh&AN=16092939


14. Shrier, I. Does stretching improve performance? A systematic and critical review of the literature. Clin J Sport Med. 2004;14,5:267-273. Available at: http://journals.lww.com/cjsportsmed/Fulltext/2004/09000/Does_Stretching_Improve_Performance___A_Systematic.4.aspx

15. McMillian DJ, Moore JH, Hatler BS, Taylor DC. Dynamic vs. Static-Stretching Warm Up: The Effect on Power and Agility Performance. Journal of Strength and Conditioning Research. 2006; 20 (3):492-499. Available at: http://www.castonline.ilstu.edu/lagally/KNR%20451/uploads/RB

article2.pdf

16. Manoel M, Harris-Love M, Danoff J, Miller T. Acute Effects of Static, Dynamic, and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Power in Women. J Strength Cond Res. 2008; 22: 1528-1534.


17. Little, T. Williams, A. Effects of differential stretching protocols during warm-ups on high-speed motor capacities in professional soccer players. Journal of Strength and Conditioning Research. 2006;20(1):203-207. Available at: http://e-space.mmu.ac.uk/e-space/bitstream/2173/3519/3/williams%20-%20effects%20of%20differential%20stretching.pdf


18. Bradley P, Olsen P, Portas M. The Effect of Static, Ballistic, and Proprioceptive Neuromuscular Facilitation Stretching on Vertical Jump Performance. J Strength Cond Res. 2007; 21: 223-226.


19. Turki O, Chaouachi A, Behm DG, Chtara H, Chtara M, Bishop D, Chamari K, Amri M. The Effect of Warm-Ups Incorporating Different Volumes of Dynamic Stretching on 10- and 20-m Sprint Performance in Highly Trained Male Athletes. J Strength Cond Res. 2012;26:63-72.

20. Thompson D. Somatic Research. The stretching debate. Massage & Bodywork. November 2010;25(6):116-121. Available from: CINAHL with Full Text, Ipswich, MA. Accessed February 8, 2012. Available at: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=d7dc0df7-b78e-4464-9cef-8b9237f972d1%40sessionmgr11&vid=5&hid=18


21. Mann DP, Jones MT. National Strength & Conditioning Association. 1999; 21:53-55. Available at: http://www.castonline.ilstu.edu/lagally/KNR%20451/uploads/RBarticle1.pdf.

22. Woolstenhulme M, Griffiths C, Woolstenhulme E, Parcell A. Ballistic Stretching Increases Flexibility and Acute Vertical Jump Height when Combined with Basketball Activity. J Strength Cond Res. 2012; 20:799-803.

23.Faigenbaum A, McFarland J, Schwerdtman J, Ratamess N, Kang J, Hoffman J. Dynamic Warm-Up Protocols, With and Without a Weighted Vest, and Fitness Performance in High School Female Athletes. Journal of Athletic Training. 2006; 41 (4):357-363. Available at: http://web.ebscohost.com/ehost/detail?vid=6&hid=11&sid=c01c234c-7496-43ec-be03-093ea65bf62e%40sessionmgr15&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=afh&AN=23643151

24. Sek ir U, Arabaci R, Akova B, Kadagan S. Acute effects of static and dynamic stretching on leg flexor and extensor isokinetic strength in elite women athletes. Scandinavian Journal Of Medicine & Science In Sports [serial online]. April 2010; 20 (2):268-281. Available at: http://www.mendeley.com/research/acute-effects-of-static-and-dynamic-stretching-on-leg-flexor-and-extensor-isokinetic-strength-in-elite-women-athletes

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


26.Behm, DG, et al. “Factors Affecting Force Loss With Prolonged Stretching.” Canadian Journal of Applied Physiology. 2001;26(3):262-72.

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

28. Bracko, MR (2002). Can stretching prior to exercise and sports improve performance and prevent injury? ACSM's Health & Fitness Journal, 6(5), 17-22.

29. Evetovich TK, Nauman NJ, Conley DS, Todd JB (2003). Effect of static stretching of the biceps brachii on torque, electromyography, and mechanomyography during concentric isokinetic muscle actions. J Strength Cond Res. 17(3):484-8.

30. Gleim, GW & McHugh, MP (1997). Flexibility and its effects on sports injury and performance. Sports Medicine, 24(5), 289-99.

31. Hedrick A (2000). Dynamic flexibility training. Strenght and Conditioning Journal 22, 33-38.

32. Herbert, RD & Gabriel, M (2002). Effects of stretching before and after exercising on muscle soreness an risk of injury: Systematic review. British Medical Journal, 325 (7362), 468-470.

33. Jones AM (2002). Running economy is negatively related to sit-and-reach test performance in international-standard distance runners. Int J Sports Med. 23(1):40-3.

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.

36. Minos J (2001). PNF-Self Stretching Techniques, Strength and Conditioning Journal 23(4); 28-29.

37. Shellock, FG & Prentice, WE,(1985). Warming-Up and Stretching for Improved Physical Performance and Prevention of Sports-Related Injuries, Sports Medicine, 2: 267-278.

38. Shrier I (1999). Stretching before exercise does not reduce the risk of local muscle injury: a critical review of the clinical and basic science literature. Clin J Sport Med. 9(4): 221-7.

39. Surberg PR (1983) flexibility exercise re-examined. Athl Tr 18:37-40.

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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