Stretching for Injury Prevention: A Coach's Perspective
As a stretching and flexibility coach, I'm often asked about the role of stretching in injury prevention. While the research can seem contradictory at times, a closer look reveals valuable insights that can inform our training strategies.
Distinguishing Between Injury Types:
A crucial point to understand is the difference between all-cause injuries and musculotendinous injuries.
All-Cause Injuries: This broad category includes everything from bone fractures and ligament tears to concussions and overuse injuries. Stretching is unlikely to prevent many of these types of injuries.
Musculotendinous Injuries: These injuries specifically involve muscles and tendons, such as strains, sprains, and tears. This is where stretching can play a more significant role.
The Role of Stretching in Musculotendinous Injury Prevention:
While pre-exercise static stretching doesn't appear to significantly reduce the risk of all-cause injuries, the evidence suggests that chronic, long-term static stretching protocols can indeed decrease the incidence of muscle and tendon injuries.
How Stretching Protects Muscles and Tendons:
Increased Force Absorption: As discussed previously, stretching improves musculotendinous compliance, allowing muscles and tendons to absorb forces over a longer duration, reducing peak stress and the risk of injury, especially during high-velocity movements and changes of direction.
Reduced Injury Rates: Studies have shown that regular, long-term static stretching can lead to a significant decrease (18-54%) in muscle and tendon injury rates, reduce time lost due to injury, and decrease the severity of such injuries.
Key Considerations:
Type of Activity: Stretching seems to be more effective in preventing muscle and tendon injuries in activities involving high-velocity movements and changes of direction (e.g., sprinting, agility sports) compared to endurance activities where overuse injuries are more common.
Duration and Frequency: Regular, long-term stretching is key for injury prevention. Short bouts of pre-exercise static stretching are less likely to have a significant impact on injury risk but can be beneficial as part of a comprehensive warm-up.
Comprehensive Approach: Stretching is just one piece of the injury prevention puzzle. Other important factors include proper warm-up, strength training, proper technique, adequate recovery, and appropriate training load management.
Addressing Limitations in the Research:
Several limitations in the existing research need to be considered:
Lack of Research on Individuals with Limited Flexibility: Most studies have focused on individuals with normal flexibility. More research is needed on the effects of stretching on those with pre-existing ROM limitations. It's possible that stretching has a greater injury-preventive effect in this population.
Focus on Isolated Stretching: Many studies have investigated stretching as a sole intervention, not within the context of a comprehensive training program. A more integrated approach, including strengthening, activation, and functional movement, is likely more effective for injury prevention.
Unrealistic Stretching Durations: Some studies have used excessively long stretching durations, which don't reflect real-world practices. This can skew the results and lead to inaccurate conclusions.
Lack of Individualization: Many studies have taken a "one-size-fits-all" approach, not considering individual needs and movement assessments.
Applying the Evidence in Practice:
As a coach, I use the following principles to guide my recommendations on stretching for injury prevention:
Prioritize Regular, Long-Term Stretching: Encourage clients to incorporate regular stretching into their routines, focusing on major muscle groups and areas prone to injury.
Integrate Stretching into a Comprehensive Program: Combine stretching with other injury prevention strategies, such as strength training, plyometrics, balance exercises, and proper warm-up and cool-down protocols.
Individualize Stretching Programs: Conduct thorough assessments to identify individual needs and tailor stretching programs accordingly. Consider factors such as posture, movement patterns, muscle imbalances, and activity demands.
Educate Clients: Explain the benefits and limitations of stretching for injury prevention. Emphasize the importance of a holistic approach that addresses multiple risk factors.
Use Stretching Strategically: Use static stretching primarily for improving ROM and addressing muscle imbalances, and dynamic stretching for pre-activity preparation.
Focus on Quality over Quantity: Emphasize proper form and controlled movements during stretching. Avoid excessive force or bouncing.
Summary of Evidence-Based Recommendations:
Strong Evidence: Stretching of all types (static, NMS, dynamic) improves ROM.
Moderate Evidence: Dynamic stretching can positively affect strength and performance. Static stretching can decrease muscle and tendon injury risk in healthy individuals without identified flexibility limitations.
Moderate Evidence: Acute, prolonged (>60 seconds per muscle group) pre-exercise static stretching and NMS performed in isolation can decrease strength and performance. However, when integrated into a comprehensive warm-up, these effects are minimal.
By understanding the nuances of the research and applying these practical recommendations, we can effectively use stretching as part of a comprehensive strategy to enhance performance and reduce the risk of musculotendinous injuries.