All the time, patients ask if stretching really helps reduce risk of injury - and the answer is…kind of and it depends (not a great start with this potential cop-out). Like most answers we give in healthcare, its multifactorial and we have to consider the variables. Personal factors, the type of activity, the mechanism for stretching, etc. Here, we break down the importance of stretching for different reasons and why you may or may not see some benefit in the short term.
The right way to stretch
I’ve covered it before and I will now cover it again - STOP warming up before stretching. Just stop. The goal is to lengthen the muscle and when you warm up first, you have to go much farther to get any value. Stretch should be done cold, following foam roll or other myofascial release strategy (lacrosse ball, Theragun, etc)
Stretch in 3D
When I teach clients to stretch in 3 dimensions, they look at me like I’m an alien. It’s an abstract concept. Most people stretch their muscles in one position for the same muscle group - going in a straight line. Trainers often teach the “technique” so you get the positioning right in the stretch. The intention is good, but flawed.
Muscles are 3-dimensional structures - and the forces placed on them are not linear. Therefore, we must stretch muscle by adding rotation and/or lateral bending to get all the fibers in a muscle on tension (slight movements in these directions usually changes the feel of the stretch).
Try adding trunk rotation to your standard hip flexor stretch and see if you recognize a difference between sides - I feel it more to the outside (on down leg) when stretching over the front leg, and more to the inside in the opposite direction.
Frequency over Duration
Change up your routine to be more efficient. You can reduce the total amount of time you stretch in a day, but improve results by upping the frequency (to 3-5x/day) and dropping the duration (15-30sec). Research does support 30-90 seconds of stretch to get muscle lengthening, but that’s not all we are after - I cover this below.
Stay on it
Consistency is key to success in any plan. Hang with it even when you don’t see dramatic results in a couple of weeks. It’s probably taken years to build up whatever you are trying to undo, so being patient and holding the line is important.
Types of Stretching
This is your basic stretch and hold for a long period of time. The goal here is straight muscle length. When performed before exercise, static stretching does not reduce risk of injury and may hurt performance - so stop with the stretch circles pre-game. That is a bad idea and coaches should be coached about static stretching pre-game.
Active Stretch: Actively contracting the opposing muscle to create a stretch.
Ballistic Stretch: Bouncing at end-range for a specified number of reps or period of time. Not recommended for novices and the benefits are suspect.
Dynamic Warm-up: Moving through near full ROM at submaximal speed. This is the boss of all pre-game routines and should be given attention, focus, and effort. Perform this before doing skills and drills for the best warm-up before exercise to reduce injury risk.
NOTE: I use a 5x5 method for active and dynamic stretches - 5 sec for 5 reps
Proprioceptive Neuromuscular Facilitation (PNF)
PNF stretching has great results for immediate ROM gains, and is very popular in the physical therapy / rehabilitation world, since many of these techniques are best performed manually by a trained pro.
Contract-relax (CR), hold-relax (HR), and contract-relax agonist contraction (CRAC); These techniques are beyond the scope of this article, but you can read about them here: https://humankinetics.me/2018/04/25/what-is-pnf-stretching/
The value of stretching
I bring this up first because it’s the most important benefit of stretching and the least discussed. Here’s an insanely brief anatomy lesson: muscles and tendons have sensors built in that try to stop motion to protect from tearing (end of lesson). Here is the kicker - those sensors are wrong a lot of the time. If you sit all day, the sensors in your muscles perceive sitting as the neutral position. So, when you stand, signals are sent that things are being stretched (when the tissue is really not yet anywhere near end-range).
The goal of stretching for neuro adaptation is to move the threshold that you and your neurologic system experience as a stretch, so that you can get deeper into a range of motion that is still OK for the muscles - and not actually headed towards a tear.
Yep, it can happen. It takes a long time and a lot of stretching at high duration (30-90 seconds), but it can happen. I don’t talk about it much or teach it since the results here are short-lived.
Range of Motion
This comes with the territory when considering the other two benefits of stretching. If you move the threshold for the neuromuscular system and increase the muscle tissue length, you will get more ROM.
Dave Gerbarg, PT