Stop ‘just’ stretching for injury prevention.
Stretching is often publicised through the media as a way of warming up, cooling down, and is said to prevent injuries in running when at work etc… (1,2,3).
BUT… what does stretching actually do? And why do so many people still get injured even when they are very flexible and adhere to a stretching program
Reason for the blog post
Running as a form of exercise or sport is extremely popular. Especially during the summer (which has unfortunately ended in Ireland ). I would regularly see runners, tri-athletes, footballers coming into the clinic having done some form of running complaining of ‘tight (insert relevant muscle here)’ that needs to be stretched. Whilst sometimes this might be the case that their range of motion is poor too often they have hamstrings which when tested fly straight up in the air and don’t’ have an issue with tissue length even though they feel ‘tight’
For this article I limited the search of research to searching for ‘injury prevention’, ‘stretching’, and ‘running or runners’. The vast majority of the literature is looking at lower limb injuries and the stretching described is static stretching.
Generally static stretching is a 30 second hold in the same position
So what does the research say?
Research, articles and evidence
Systematic reviews on static stretching and its effect on injury prevention (4, 5) give an overview of what the high quality trials have shown.
The results of ‘static stretching’ programs showed that there was no reduced risk of injury, despite increasing flexibility. The outcome out of a lot of the trials was that a ‘sport specific’ warm up did reduce the risk of injury and injury rates.
Sports specific warm up basically meaning;
What exercise are you planning to do - e.g. running
What movements are involved in that exercise; - running in a straight line
Do those movements starting slowly and build up speed and intensity; - Run a little and slowly get up to pace
Hey Presto you’ve reduced your injury risk.; - Is that it?
That simple yeah…..uh no.
Unfortunately, if it was that simple then no one would get injured. Everyone would just warm up before sport or exercise.
We are human beings not robots. Whilst the physical ability or readiness of your body plays a big role in injury risk there are other factors which are shown to have a notable impact on your injury risk and performance levels
In other words, doing “too much too soon”. The New Year, New me gym brigade are a great example of this. Eating copious amounts of chocolate, turkey, and booze over the Holiday period and then going all guns blazing on January the 2nd is good way to increase your injury risk.
Whilst I would rarely advise someone not to hit the gym, run or take up a new sport. Trying to go from no exercise to 1 hour 5 times a week is asking for trouble. Every year from around mid February to April coming I would see this increase in people with the same story.
“I started running; cycling, weights, Crossfit, HIIT classes, yoga, and I think I’ve hurt something”
Generally they haven’t damaged anything, just their body wondering what the hell has been going on.
A good general rule to follow is by increasing your training load by 10% per week. Measuring this can be tricky as you may feel more tired after a 3K run than a 8K depending on your sleep quality, stress level, nutrition and level of physical condition.
Generally the 2nd most neglected part of training for most amateur runners. (the most neglected one comes next). Accumulated training fatigue through lack of good quality sleep is something that I see regularly in clinic.
Athletes can start to pick up joint, tendon or muscle issues whilst trying to increase their training having had just a few nights of poor quality sleep. 7-8 hours of uninterrupted sleep is the best advice to go by.
Sometimes getting more sleep isn’t an option, (young children being the most frequent reason I hear in clinic) so adapting your training plan (short term) to accommodate this may well be necessary to help you stay running.
If you don’t get a good recovery you don’t get full performance.
So how could you improve your body’s ability to deal with an increased amount of running without actually running more.
This applies to not only running but to a wide range of sports, but to all areas of the body. This could be another topic itself but just a few misconceptions that we need to address.
Runners, resistance training will not make you ‘bulk up’ too much.
Resistance training or weightlifting has a significantly lower injury rate than running. And can reduce your risk of getting injured whilst running.
Getting stronger improves your ability to run further, faster and more efficiently.
Resistance training is for everyone!!!!
A recent review of strength training (9) showed that it reduced lower limb injuries by 66% on average amongst total of almost 4000 individuals. This included ACL, hamstring, knee, foot and ankle injuries and also agreed with resistance training being beneficial for adolescents.
There as a reduction in both overuse (repetitive strain) injuries and acute injuries e.g. strains and sprains
But what if I ‘just’ want to improve my flexibility???
Static stretching can do that for sure. But what if I told you can get stronger and increase your flexibility at the same time
Eccentric muscle training is a part of resistance training where you slowly lengthen the muscle under whilst controlling the weight. This is clinically proven to help with flexibility and injury prevention. If you’re unsure of what this looks like.
Here are some video links.
RDL for Hamstring;
Rear foot elevated split squat for Glutes and quads; https://www.youtube.com/watch?v=rH9Mnt2nxrw
Heel drops for Achilles
*DISCLAIMER THESE ARE NOT INTENDED AS REHAB EXERCISES; SEEK ADVICE BEFORE COMMENCING THEM*
Flexibility can be improved by static stretching, we generally don’t see less injuries because of it though. You just get more flexible which is fine if that is all you want.
Looking at how much and what type of training you’re doing, getting regular good recovery and eccentric training/getting stronger are much more likely to give you the best bang for your buck if you’re looking to improve flexibility and reduce injury.
Life’s too short to be a patient, take control
Thanks for reading
Leppänen, M., Aaltonen, S., Parkkari, J., Heinonen, A., & Kujala, U. M. (2013). Interventions to Prevent Sports Related Injuries: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Sports Medicine, 44(4), 473–486
Lewis, J. (2014). A Systematic Literature Review of the Relationship Between Stretching and Athletic Injury Prevention. Orthopaedic Nursing, 33(6), 312–320
Videback S., Bueno AM., Nielson RO.,et al (2015). Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Medicine, 45, 1017-1026
Gabbett T. (2016). The training-Injury Paradox: Should athletes be training smarter and harder? British Journal of sports medicine, 50, 273-280.
O’Sullivan, K., McAuliffe, S., & DeBurca, N. (2012). The effects of eccentric training on lower limb flexibility: a systematic review. British Journal of Sports Medicine, 46(12), 838–845.
Laursen JB., Andersen TE., Andersen LB., (2018). Strength training as superior, dose dependent, and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. British journal of sports medicine. In print. [31.08.2018]. doi:10. 1136/bjsports-2018-099078