Stretch or not stretch? This is the question :)

Van Sports Physio Tips

Stretching is one of the most common types of exercise performed by people who are into fitness activities, athletes, and clients undergoing rehabilitation. They are prescribed to stretch as a form of treatment/prevention for multiple injuries. Based on research, we know that stretching benefits the soft tissues, but depending on the purpose of the treatment or sport/activity played, one type of stretch might be more advisable than others.

As per definition, stretches can be performed through active and passive tension applied to muscles and other soft tissues around the area such as fascia, capsular joint and ligaments. The goal of stretching is usually to elongate structures that might have increased ‘tightness’ which can reduce range of motion or reproduce pain due to its shortened length.

Types of stretches: Static, Dynamic, and Pre-Contraction stretches

  1. Static stretching: Most common type
    Position is held with the muscle on tension to a point of a stretching sensation for a determined period and repeated for a few sets. It can be performed alone or by someone else.
  2. Dynamic stretch:
    1. Active stretch: Moving the part/limb being stretched to full range of motion and repeated several times.
    2. Ballistic stretch: Performed by rapid and alternate bouncing movements of the limb being stretched. This type of stretch is not frequently performed and prescribed due to high risk of injury
  3. Pre-contraction stretching: technique widely applied by physiotherapists – with small differences between them. Consult your health care provider to see which one could be helpful to facilitate your rehab/life goals 😊
    The most common technique is PNF – Proprioceptive Neuromuscular facilitation. These are generally performed by having the client contract the muscle being used and/or the opposite muscle group, followed by relaxation/stretch period.

    1. HR=Hold relax; CR=Contract relax; CRAC=Contract relax agonist contract;
    2. PIR=post-isometric relaxation; PFS=post-facilitation stretching; MET=Muscle energy technique
      Post-isometric relaxation (PIR) small contraction of muscle followed by stretch
      Post Facilitation Stretch (PFS) maximal contraction of muscle at mid range followed by a static stretch
      Muscle Energy Technique (MET) contraction of a muscle followed by stretching of the opposite or same muscle group

Comparing stretch modes

But what stretch should I be performing?

It depends on a few factors such as goal with stretching, age, activity/sport performed, or rehab outcomes.

From previous research, authors have found that both static and dynamic stretching help to improve range of motion in the short-term or over time with training (1). However, static stretching was found to reduce strength and performance deficits when compared to dynamic stretch (3), it being more suitable for activities requiring more flexibility such as dance or gymnastics. In contrast, dynamic stretch has been shown to improve jumping, running performance and muscle power measured by a dynamometer (4,5).

The American College of Sports Medicine recommends stretching for general fitness goals, to be performed after an active warm-up. Each stretch should be performed 2 to 4 times and held for 15-20 seconds (6).  Static, dynamic and pre-contraction stretching seem to be effective methods of increasing flexibility and muscle extensibility overall. However, if you are going for a run or to play a sport, it is more recommended to warm-up and stretch dynamically (1).

On the rehab side, stretching is often included in physiotherapy interventions for soft tissue strains, loss of range of motion, and management of chronic pain. Stretching has been found to be as effective as strengthening exercises (12) for chronic neck pain (7). However, in the long term, strengthening exercises are more beneficial for the prevention of new episodes of neck pain and therefore should be a major part of an exercise program.

Static stretch as well as PNF has been reported to increase knee ROM in patients with Osteoarthritis (8), increase hamstring flexibility (9,10) in tight muscles, and improve gait in older adults (11).

In summary, stretching is beneficial for multiple scenarios. Factors such as age, type of activity/sport performed, and goal should be considered when deciding which stretch is more recommended. Our team of physiotherapists can help you make clinical recommendations and start your home exercise program 😊

References

  1. de Weijer VCGorniak GCShamus E. The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours. J Orthop Sports Phys Ther. Dec 2003;33(12):727–733
  2. Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther. 2012 Feb;7(1):109-19. PMID: 22319684; PMCID: PMC3273886.
  3. Yamaguchi TIshii K. Effects of static stretching for 30 seconds and dynamic stretching on leg extension power. J Strength Cond Res. Aug 2005;19(3):677–683
  4. Curry BSChengkalath DCrouch GJRomance MManns PJ. Acute effects of dynamic stretching, static stretching, and light aerobic activity on muscular performance in women. J Strength Cond Res. Sep 2009;23(6):1811–1819
  5. Ce EMargonato VCasasco MVeicsteinas A. Effects of stretching on maximal anaerobic power: the roles of active and passive warm-ups. J Strength Cond Res. May 2008;22(3):794–800
  6. Medicine ACoS ACSM’s guidelines for exercise testing and prescription. 7th ed. Baltimore: Lippincot Williams Wilkins; 2006
  7. Hakkinen AKautiainen HHannonen PYlinen J. Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study. Clin Rehabil. Jul 2008;22(7):592–600
  8. Weng MCLee CLChen CHet al. Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis. Kaohsiung J Med Sci. Jun 2009;25(6):306–315
  9. Youdas JWHaeflinger KMKreun MKHolloway AMKramer CMHollman JH. The efficacy of two modified proprioceptive neuromuscular facilitation stretching techniques in subjects with reduced hamstring muscle length. Physiother Theory Pract. May 2010;26(4):240–250
  10. Aquino CFFonseca STGoncalves GGSilva PLOcarino JMMancini MC. Stretching versus strength training in lengthened position in subjects with tight hamstring muscles: a randomized controlled trial. Man Ther. Feb 2010;15(1):26–31
  11. Rodacki ALSouza RMUgrinowitsch CCristopoliski FFowler NE. Transient effects of stretching exercises on gait parameters of elderly women. Man Ther. Apr 2009;14(2):167–172
  12. Warneke et al., 2023. Comparison of the effects of long-lasting elastic stretching hypertrophy training on maximal strength, muscle thickness and flexibility in the plantar flexors. EJAP, 4(8), Epub ahead of print.