Stretching: Mechanisms and Benefits for Sport Performance and Injury Prevention

Abstract Stretching is usually performed before exercise in an attempt to enhance performance and reduce the risk of injury. Most stretching techniques (static, ballistic, and proprioceptive neuromuscular facilitation) are effective in increasing static flexibility as measured by joint range of motion, but the results for dynamic flexibility as measured by active and passive stiffness, are inconclusive. The mechanisms of various stretching techniques in terms of biomechanics and neurology, the effectiveness of the combination of stretching with other therapies such as heat and cold, and the effectiveness of stretching for performance and injury prevention are reviewed. The possible mechanisms responsible for the detrimental effects of stretching on performance and the minimal effects on injury prevention are considered, with the emphasis on muscle dynamic flexibility. Further research is recommended to explore the mechanisms and effects of alternative stretching techniques on dynamic flexibility, muscle soreness, sport performance, and rate of injury.

[1]  R. Herbert,et al.  Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review , 2002, BMJ : British Medical Journal.

[2]  J. B. Church,et al.  Effect of Warm‐Up and Flexibility Treatments on Vertical Jump Performance , 2001, Journal of strength and conditioning research.

[3]  A. Nelson,et al.  Acute Ballistic Muscle Stretching Inhibits Maximal Strength Performance , 2001, Research quarterly for exercise and sport.

[4]  G. Sleivert,et al.  The effect of warm-up intensity on range of motion and anaerobic performance. , 1998, The Journal of orthopaedic and sports physical therapy.

[5]  T. Best,et al.  Thermal effects on skeletal muscle tensile behavior , 1993, The American journal of sports medicine.

[6]  M. Kjaer,et al.  Viscoelastic stress relaxation during static stretch in human skeletal muscle in the absence of EMG activity , 1996, Scandinavian journal of medicine & science in sports.

[7]  R D Herbert,et al.  A randomized trial of preexercise stretching for prevention of lower-limb injury. , 2000, Medicine and science in sports and exercise.

[8]  M. A. Moore,et al.  Depression of Hoffmann reflexes following voluntary contraction and implications for proprioceptive neuromuscular facilitation therapy. , 1991, Physical therapy.

[9]  J. Halbertsma,et al.  Sport stretching: effect on passive muscle stiffness of short hamstrings. , 1996, Archives of physical medicine and rehabilitation.

[10]  David G. Behm,et al.  Factors affecting force loss with prolonged stretching. , 2001, Canadian journal of applied physiology = Revue canadienne de physiologie appliquee.

[11]  J. Lehmann,et al.  Heat and stretch procedures: an evaluation using rat tail tendon. , 1976, Archives of physical medicine and rehabilitation.

[12]  T. Fukunaga,et al.  Effects of resistance and stretching training programmes on the viscoelastic properties of human tendon structures in vivo , 2002, The Journal of physiology.

[13]  R. Gajdosik,et al.  Passive extensibility of skeletal muscle: review of the literature with clinical implications. , 2001, Clinical biomechanics.

[14]  S. Weldon,et al.  The efficacy of stretching for prevention of exercise-related injury: a systematic review of the literature. , 2003, Manual therapy.

[15]  P V Komi,et al.  Altered reflex sensitivity after repeated and prolonged passive muscle stretching. , 1999, Journal of applied physiology.

[16]  A A Vandervoort,et al.  Effect of a static calf-stretching exercise on the resistive torque during passive ankle dorsiflexion in healthy subjects. , 1999, The Journal of orthopaedic and sports physical therapy.

[17]  S. J. Sullivan,et al.  H-reflex modulation during manual muscle massage of human triceps surae. , 1991, Archives of physical medicine and rehabilitation.

[18]  A. Gollhofer,et al.  Changes in reflex excitability following isometric contraction in humans , 1997, European Journal of Applied Physiology and Occupational Physiology.

[19]  T. Worrell,et al.  Effect of hamstring stretching on hamstring muscle performance. , 1994, The Journal of orthopaedic and sports physical therapy.

[20]  R G Eston,et al.  The Role of Passive Muscle Stiffness in Symptoms of Exercise-Induced Muscle Damage , 1999, The American journal of sports medicine.

[21]  G. Sundelin,et al.  The effects of preexercise stretching on muscular soreness, tenderness and force loss following heavy eccentric exercise , 1999, Scandinavian journal of medicine & science in sports.

[22]  D. Knudson,et al.  Acute Effects of Stretching Are Not Evident in the Kinematics of the Vertical Jump , 2001, Journal of strength and conditioning research.

[23]  R. Enoka,et al.  Changes in excitability of tendon tap and Hoffmann reflexes following voluntary contractions. , 1980, Electroencephalography and clinical neurophysiology.

[24]  Robert D. Herbert,et al.  Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits. , 1998, The Australian journal of physiotherapy.

[25]  D. Sale,et al.  Reduced strength after passive stretch of the human plantarflexors. , 2000, Journal of applied physiology.

[26]  D. Blanke,et al.  Flexibility training: ballistic, static or proprioceptive neuromuscular facilitation? , 1982, Archives of physical medicine and rehabilitation.

[27]  Malachy P. McHugh,et al.  Mechanical and physiological responses to stretching with and without preisometric contraction in human skeletal muscle , 1996 .

[28]  A. Murphy,et al.  Musculotendinous stiffness: its relationship to eccentric, isometric, and concentric performance. , 1994, Journal of applied physiology.

[29]  T. Uhl,et al.  Duration of Maintained Hamstring Flexibility After a One-Time, Modified Hold-Relax Stretching Protocol. , 2001, Journal of athletic training.

[30]  A. Nelson,et al.  Inhibition of Maximal Voluntary Isokinetic Torque Production Following Stretching Is Velocity‐Specific , 2001, Journal of strength and conditioning research.

[31]  S. Hall,et al.  Effect of superficial heat, deep heat, and active exercise warm-up on the extensibility of the plantar flexors. , 2001, Physical therapy.

[32]  D. E. Brooks,et al.  Viscoelastic characteristics of muscle: passive stretching versus muscular contractions. , 1997, Medicine and science in sports and exercise.

[33]  J A Nicholas,et al.  Viscoelastic stress relaxation in human skeletal muscle. , 1992, Medicine and science in sports and exercise.

[34]  David G. Behm,et al.  Effects of running, static stretching and practice jumps on explosive force production and jumping performance. , 2003, The Journal of sports medicine and physical fitness.

[35]  J. Godges,et al.  Effects of exercise on hip range of motion, trunk muscle performance, and gait economy. , 1993, Physical therapy.

[36]  M. McHugh,et al.  Mechanical and physical responses to stretching with and without preisometric contraction in human skeletal muscle. , 1996, Archives of physical medicine and rehabilitation.

[37]  M. McHugh,et al.  The role of mechanical and neural restraints to joint range of motion during passive stretch. , 1998, Medicine and science in sports and exercise.

[38]  C. Jackson,et al.  199 DELAYED ONSET MUSCLE SORENESS (DOMS), SERUM CREATINE KINASE (SCK), AND CREATINE KINASE-MB (CK-MB) RELATED TO PERFORMANCE MEASUREMENTS IN FOOTBALL , 1990 .

[39]  Julie Gilchrist,et al.  The impact of stretching on sports injury risk: a systematic review of the literature. , 2004, Medicine and science in sports and exercise.

[40]  Joseph W Freeman,et al.  Collagen self-assembly and the development of tendon mechanical properties. , 2003, Journal of biomechanics.

[41]  F G Shellock,et al.  Warming-Up and Stretching for Improved Physical Performance and Prevention of Sports-Related Injuries , 1985, Sports medicine.

[42]  E. Howley,et al.  The effects of static stretching and warm-up on prevention of delayed-onset muscle soreness. , 1989, Research quarterly for exercise and sport.

[43]  L. Danneels,et al.  Stretching and Injury Prevention An Obscure Relationship , 2004 .

[44]  E M Hennig,et al.  The influence of stretching and warm-up exercises on Achilles tendon reflex activity. , 1995, Journal of sports sciences.

[45]  P. Clarkson,et al.  Influence of previous concentric exercise on eccentric exercise-induced muscle damage. , 1997, Journal of sports sciences.

[46]  L. E. Holt,et al.  Effects of Hot or Cold Water Immersion and Modified Proprioceptive Neuromuscular Facilitation Flexibility Exercise on Hamstring Length. , 2001, Journal of athletic training.

[47]  J. Houmard,et al.  The effects of static and ballistic stretching on delayed onset muscle soreness and creatine kinase. , 1993, Research quarterly for exercise and sport.

[48]  E. Ribot-Ciscar,et al.  Post-contraction changes in human muscle spindle resting discharge and stretch sensitivity , 2004, Experimental Brain Research.

[49]  S. Magnusson,et al.  Passive properties of human skeletal muscle during stretch maneuvers , 1998, Scandinavian journal of medicine & science in sports.

[50]  M. Kjaer,et al.  Biomechanical Responses to Repeated Stretches in Human Hamstring Muscle In Vivo , 1996, The American journal of sports medicine.

[51]  H. D. de Jongh,et al.  Prevention of running injuries by warm-up, cool-down, and stretching exercises , 1993, The American journal of sports medicine.

[52]  Richard W. Bohannon,et al.  Lasting effects of one bout of two 15-second passive stretches on ankle dorsiflexion range of motion. , 1997, The Journal of orthopaedic and sports physical therapy.

[53]  G A Wood,et al.  Stretch shorten cycle performance enhancement through flexibility training. , 1992, Medicine and science in sports and exercise.

[54]  N. Dawson,et al.  The effect of therapeutic muscle stretch on neural processing. , 1994, The Journal of orthopaedic and sports physical therapy.

[55]  K. Wiemann,et al.  Influences of Strength, Stretching and Circulatory Exercises on Flexibility Parameters of the Human Hamstrings , 1997, International journal of sports medicine.

[56]  A. Nelson,et al.  Acute muscle stretching inhibits maximal strength performance. , 1998, Research quarterly for exercise and sport.

[57]  P J McNair,et al.  Stretching at the ankle joint: viscoelastic responses to holds and continuous passive motion. , 2001, Medicine and science in sports and exercise.

[58]  Michael Kjaer,et al.  Role of extracellular matrix in adaptation of tendon and skeletal muscle to mechanical loading. , 2004, Physiological reviews.

[59]  E B Simonsen,et al.  Viscoelastic response to repeated static stretching in the human hamstring muscle , 1995, Scandinavian journal of medicine & science in sports.

[60]  W. Prentice Therapeutic Modalities for Physical Therapists , 2001 .

[61]  P. Zehr Considerations for use of the Hoffmann reflex in exercise studies , 2002, European Journal of Applied Physiology.

[62]  C. Waring,et al.  The effects of therapeutic application of heat or cold followed by static stretch on hamstring muscle length. , 1995, The Journal of orthopaedic and sports physical therapy.

[63]  R. Jensen,et al.  Effects of PNF stretching phases on acute arterial blood pressure. , 1995, Canadian journal of applied physiology = Revue canadienne de physiologie appliquee.

[64]  M. Kjaer,et al.  Passive energy absorption by human muscle-tendon unit is unaffected by increase in intramuscular temperature. , 2000, Journal of applied physiology.

[65]  S. J. Sullivan,et al.  Changes in h-reflex amplitude during massage of triceps surae in healthy subjects. , 1990, The Journal of orthopaedic and sports physical therapy.

[66]  A W Watson,et al.  Sports injuries related to flexibility, posture, acceleration, clinical defects, and previous injury, in high-level players of body contact sports. , 2001, International journal of sports medicine.

[67]  J. Duchateau,et al.  Mechanisms of decreased motoneurone excitation during passive muscle stretching , 2001, Experimental Brain Research.

[68]  A. Seaber,et al.  Viscoelastic properties of muscle-tendon units , 1990, The American journal of sports medicine.

[69]  M. Kjaer,et al.  A mechanism for altered flexibility in human skeletal muscle. , 1996, The Journal of physiology.

[70]  R. Marshall,et al.  Effects of power and flexibility training on vertical jump technique. , 2002, Medicine and science in sports and exercise.

[71]  H. Dickhuth,et al.  Effects of contract-relax stretching training on muscle performance in athletes , 1997, European Journal of Applied Physiology and Occupational Physiology.

[72]  R W Bohannon,et al.  Passive compliance and length of the hamstring muscles of healthy men anc women. , 1990, Clinical biomechanics.

[73]  M. Kjaer,et al.  The Effect of Strength and Flexibility Training on Skeletal Muscle Electromyographic Activity, Stiffness, and Viscoelastic Stress Relaxation Response , 1997, The American journal of sports medicine.

[74]  J. Spriggs,et al.  Investigation into the effect of static stretching on the active stiffness and damping characteristics of the ankle joint plantar flexors , 2001 .

[75]  L. Osternig,et al.  MUSCLE ACTIVATION DURING PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF) STRETCHING TECHNIQUES , 1987, American journal of physical medicine.

[76]  D. Pincivero,et al.  The effects of acute stretching on hamstring muscle fatigue and perceived exertion , 2003, Journal of sports sciences.

[77]  Ray Vanderby,et al.  Collagen in connective tissue: from tendon to bone. , 2003, Journal of biomechanics.

[78]  G A Cavagna,et al.  Effect of stretching on the elastic characteristics and the contractile component of frog striated muscle , 1974, The Journal of physiology.

[79]  L. E. Holt,et al.  The Theoretical Basis of Proprioceptive Neuromuscular Facilitation , 2000 .

[80]  D. Steenbeek,et al.  Warm-up, Stretching and Massage Diminish Harmful Effects of Eccentric Exercise , 1994, International journal of sports medicine.

[81]  Malachy P. McHugh,et al.  Exercise-Induced Muscle Damage and Potential Mechanisms for the Repeated Bout Effect , 1999, Sports medicine.

[82]  A. Nelson,et al.  Chronic stretching and running economy , 2001, Scandinavian journal of medicine & science in sports.

[83]  D. Morgan,et al.  The association between flexibility and running economy in sub-elite male distance runners. , 1996, Medicine and science in sports and exercise.

[84]  Hiroaki Kanehisa,et al.  Is passive stiffness in human muscles related to the elasticity of tendon structures? , 2001, European Journal of Applied Physiology.

[85]  T Sinkjaer,et al.  Biomechanical properties of the human ankle in relation to passive stretch. , 1989, Journal of biomechanics.

[86]  Harm Kuipers,et al.  The Incidence of Injuries in Elite Junior Figure Skaters , 2003, The American journal of sports medicine.

[87]  R. Kvitne,et al.  Electromyographic Investigation of Stretching: The Effect of Warm‐up , 1998, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[88]  P. McNair,et al.  Effect of passive stretching and jogging on the series elastic muscle stiffness and range of motion of the ankle joint , 1996, British journal of sports medicine.

[89]  P. Tiidus,et al.  Effleurage Massage, Muscle Blood Flow and Long-Term Post-Exercise Strength Recovery , 1995, International journal of sports medicine.

[90]  A. Nelson,et al.  Acute effects of stretching on the neuromechanical properties of the triceps surae muscle complex , 2002, European Journal of Applied Physiology.

[91]  N. Westlin,et al.  The effect of heat and stretching on the range of hip motion*. , 1984, The Journal of orthopaedic and sports physical therapy.

[92]  Birgitta Öberg,et al.  Effects of warming up, massage, and stretching on range of motion and muscle strength in the lower extremity , 1983, The American journal of sports medicine.

[93]  C A Smith,et al.  The warm-up procedure: to stretch or not to stretch. A brief review. , 1994, The Journal of orthopaedic and sports physical therapy.

[94]  H. Lund,et al.  The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise , 1998, Scandinavian journal of medicine & science in sports.

[95]  M. McHugh,et al.  Flexibility and Its Effects on Sports Injury and Performance , 1997, Sports medicine.