Muscular Stretching: Facts and Fallacies C. S. Nasin, MD Adapted from A. Buetler, MD Primary Care Sports Medicine Learning Objectives Review the history and cultural importance of muscular stretching Review the current literature on stretching Improved flexibility
C. S. Nasin, MD
Adapted from A. Buetler, MD
Primary Care Sports Medicine
Yoga: sanskrit ‘to unite’
A series of spiritual practices arising > 5,000 years ago.
“Stretching has become embedded in sport folklore as the universal strategy for injury prevention”
-Thacker S., et al Med Sci Sports Exerc. 2004.
Epidemiology of Injuries Associated with Physical Training in Young Men in the Army
Jones et al - Med Sci Sports Exer, 1993
Risk FactorOdds Ratio
Q1 (lowest 20%) 3.6*
Q3 (mid 20%) 1.0
Q5 (highest 20%) 3.3*
Low Mileage 1.0
High Mileage 1.6
Risk FactorOdds Ratio
Age > 24 4.3*
No Injury 1.0
Non-Sprain Injury 0.6
Ankle Sprain 1.7*
Above Average 1.0
At or below Avg 2.2*Defining Flexibility & StretchingSafety in Middle Ground
Risk Factors for Lower Extremity Musculoskeletal Injuries
* = 95% CI greater than 1.0
Epidemiology of Injuries Associated with Physical Training in Young Men in the Army – Jones et al
Least Flexible Mid Most Flexible
The Impact of Stretching on Sports Injury
Risk: A Systematic Review of the Literature
STEPHEN B. THACKER1, JULIE GILCHRIST2, DONNA F. STROUP3, and C. DEXTER KIMSEY, JR.3
1Epidemiology Program Office, 2National Center for Injury Prevention and Control, and 3National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
361 Articles reviewed
-Only RCT or cohort studies that included stretching
-Studies that lacked controls
-Studies where stretching could not be independently assessed
-Studies that did not include subjects in sporting activities
Medicine & Science in Sports & Exercise 2004
High-School football injuries: effects of a post-halftime warm-up and stretching routine.Bixler B, Jones RFamily Practice Residency Journal
Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in army recruitsPope R, et alAust J Physiother 1998; 44(3): 165-172.
Effects of a static stretching program on the incidence of lower extremity musculotendinous strainsCross K, Worrell TJ of Athletic Training, 1999 34(1): 11-14.
Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees.Hartig D, Henderson JAm. J. Sports Med 1999 (27)
Thacker et al (MSSE 2004)
“I pity the fool who does this research”
Stretch-Shortening cycles (SSC):is a natural muscle function where a concentric action is preceded by an eccentric action, and this leads to a higher concentric torque value in healthy persons.
-High SSC Sports (i.e. bouncing and jumping activities): soccer, football, rugby
-Low SSC Sports: jogging, swimming, cycling
Stretching and Injury Prevention: An Obscure Relationship
-Witvrouw E, Mahieu N, Danneels L, and McNair P
Sports Medicine 2004 34 (7): 443-449.
High Compliance tendon: more energy can be absorbed by the tendon tissue, reducing trauma to muscle.
Low Compliant tendon: forces will be transferred to the contractile apparatus and little will be absorbed by the tendon
The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules Football players.Verrall GM - Br J Sports Med - 01-JUN-2005; 39(6): 363-8
A survey of flexibility training protocols and hamstring strains in professional football clubs in England.- Dadebo B - Br J Sports Med - 01-AUG-2004; 38(4): 388-94
Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union.- Brooks JH - Am J Sports Med - 01-AUG-2006; 34(8): 1297-306