Stretching to Prevent Injuryby Hamid L. Sadri, DC, CCSP, ICSSD, CSCS, CKTP, CES, PESInjury Prevention Part II: Why, When and How to Stretch Show Stretching is perhaps one of the most frequently discussed topics with our patients on a daily basis in our practice. There are many schools of thought out there when this question arises. In my 25 years of practice, I have certainly witnessed a great deal of change in what is considered to be the proper method and timing for stretching, to prevent injuries, exercise and athletic performance. For the purposes of this article we will discuss the three elements of why, how and when stretching should be done based upon the latest available research, clinical data and literature reviews. Although there are many methods of stretching such as Active Isolated Stretching (AIS), Resistive or Assisted Stretching (known as PNF-proprioceptive neuromuscular facilitation), Isometric Stretching, Progressive Static Stretching, Post Isometric Relaxation (PIR), and Prolonged Sustained Stretches to name a few; we will discuss 3 of the most frequently used types of stretching: Static, Dynamic and Ballistic. Static Stretching: This is a type of stretch where the individual limb/joint is taken to its available end range and then pushed slightly beyond this range to a point of discomfort (notice I said “discomfort”, not “pain”). The position is then held for 20-30 seconds. The seated-toe-reach is an example often used to stretch the hamstrings. There are 2 additional subcategories under this type: 1. Progressive, during which the stretch is increased every few seconds as the tissue allows, and, 2. Prolonged Sustained stretching where the stretch is held for at least 2 minutes or longer. Dynamic Stretching: In this method of stretching there is active movement involved. The individual will perform controlled, exaggerated movements that simulate the motion patterns that they will be using during their particular type of exercise they plan to undertake. High knee raises and wide arm swings are examples. Ballistic Stretching: This is a form of rapid and repeated “bouncing” beyond the comfortably available end range of motion. An example would be bending forward and repeatedly and quickly trying to reach your toes with your fingers. This is almost never recommended as it has a very high likelihood of causing injuries to the muscle. Some rare exceptions are highly conditioned athletes who have already gone through a proper warm up and who are about to undertake explosive movements in their athletic event. All others should always avoid this form of stretching. Why: For many years it was suggested that we should stretch before exercising and the typical type of stretching was in the static form. Studies have shown that this not only does not help reduce muscle injuries, it actually contributes to a higher rate of joint injuries as well as reducing the overall athletic performance of the individual. When a muscle is stretched, especially through static methods, it will actually become weaker by as much as 8%-15% in both strength and endurance outputs, which can last for 1-2 hours after the stretching. This obviously is an outcome that is hardly desired in any athletic endeavor. This is considered to be one of the reasons why the rate of joint injuries appears to be higher in athletes who follow this older and now outdated way of thinking in their training. When: However, if you are about to begin a bout of exercise it is recommended that you follow a protocol that has now shown to be the most effective in improving performance and reducing injuries. There should be a period of pre-exercise warm up, generally lasting 10-12 minutes. During this time it is suggested that movements that simulate the athletic activity be done at a slow and controlled pace. This is to be followed by 5-8 minutes of gentle and easy dynamic stretches. The general purpose of this is to increase the blood flow to the muscles that are about to be used, which helps to increase their core temperature, dilates blood vessels and brings in more Oxygen into the muscle tissue, as well as lubricating the joint structures that will be utilized during the exercise. Post-exercise, there should be a cool down period that should include 8-10 minutes of static stretching. Remember that exercising results in overall shortening of muscles and restoring their length not only aids in injury prevention but also a better and faster post-exercise recovery. An often asked question by our patients is “Does it matter if I stretch immediately after exercising, or can I do it at a later time?”. The answer I am sure is obvious to most readers! Yes, it matters. It is always better to stretch a tissue when it has been warmed up (as this aids in softening the collagen matrix that the soft tissues are laid in). How: It is only through regular, repeated prolonged and sustained stretches that one can have actual retainable gains in soft tissue extensibility that will extend beyond a few hours. Otherwise, one can never stop stretching and continue to maintain his or her flexibility and range of motion. Use it or lose it holds very true when we talk about stretching and its effect on flexibility. Dr. Sadri has been practicing in Decatur, GA for 25 years and specializes in athletic injuries and rehab. The clinic, 1st Choice Sports Rehab Center, was named “The Best Sports Injury Center in the Southeast” by Competitor Magazine. To subscribe to our newsletter click here. To schedule an evaluation, call 404-377-0011. Does stretching actually help prevent injury?More studies have concluded that stretching mainly reduces injuries by increasing flexibility. While immobilization and a sedentary can cause long term injuries, range of motion exercises can protect the body.
Does stretching before exercise prevent injury?Stretching a healthy muscle before exercise does not prevent injury or soreness. Muscles are made of bundles of tiny fibers. In a typical exercise-related muscle strain, these fibers develop microscopic tears. Theoretically, stretching before exercise should make the muscles more pliable and less likely to tear.
Does not stretching lead to injury?Do it after exercise if you specifically want to increase your flexibility, or simply if you think it feels good, MacIntosh suggests. But if you don't want to stretch, you don't need to worry — there still isn't strong evidence that it'll increase your risk of injury.
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