Is Stretching a Questionable Act?
We all do it because we feel like we should. We stretch our muscles out after every workout, we may even stretch as part of our warm-up to help prevent injury, but is it actually doing anything?
Stretching is a widely controversial topic, with some experts saying it’s helpful and others telling us to stop wasting our time. However, scientific reviews are showing us that stretching doesn’t seem to have the impact we once thought it had on injury prevention or muscle soreness (Herbert R.D., 2002; Pope et al, 2000; Shrier, 1999). But what about stretching for rehabilitation?
First of all, let’s consider some of the reasons why people stretch. Here are the two most common reasons I hear from my patients:
1. To relieve muscle tension in order to decrease pain
2. To prevent injury
Let’s dive deeper into these two reasons in order to understand the link between stretching and pain/injuries.
1. Relieving Muscle Tension
There are many reasons why a person may feel “tight” or “stiff”. In some cases, it’s not even related to muscle shortness but rather to inflammation (Ingraham, 2019). If this is the case, stretching may not help as it is not dealing with the root cause of your inflammation.
However, sometimes the stiffness and pain is related to a muscle contracture. A contracture is defined as “a permanent shortening (as of muscle, tendon, or scar tissue) producing deformity or distortion” (Merriam-Webster, 2019). In this situation, many people think that passive stretching will help relieve the contracture. Unfortunately, this is not the case, because the muscle is actually stuck in a contracted state. In other words, pulling on it won’t change its length. So how do we make this muscle relax? The answer can be found by looking to neuromuscular physiology.
In the research world there is something called proprioceptive neuromuscular facilitation (PNF). This is simply a stretching technique which utilizes principles of neuromuscular physiology in order to alter the length of a muscle. To learn more about how PNF works, consult the article by Sharman et al. referenced at the end of this article.
In simple terms, the length of a muscle is determined by the nervous system. This means we must find a way to change the signal that is travelling through the nerve to the muscle in order to change the length of that muscle. We want the nerve to tell the muscle that it does not have to remain contracted. It is through reflex loops that exist between our muscles and our central nervous system that we are able to accomplish this. This means that by using PNF stretching techniques, a clinician can release a patient’s contracture in order to provide them with symptom relief.
2. Preventing Injury
As we’ve already mentioned, the research appears to be showing us that stretching does not reduce the risk of injury. Now you’re probably thinking: but didn’t you just say that PNF works? Let me explain where PNF fits into all of this.
Let’s consider two hypothetical people, Bob and John. Both play on the same soccer team and play the same amount of games. Bob receives osteopathic treatments when needed in order to ensure that his joints and tissues are moving well and his body is in tip top shape. John on the other hand does not seek out any form of manual therapy and simply practices passive stretching before and after each game. Now let’s say both Bob and John injure themselves. Bob visits his osteopathic practitioner who uses principles of neuromuscular physiology to help relieve the contractures in Bob's muscles. On the other hand, John decides to just passively stretch it out and let the pain go away on its own. Little does John know that as his body self-regulates, it compensates for this injury. This means that another part of his body may tense up or loosen in response to the original injury. Now John has 2 or more issues that are intricately connected to the original injury through the mechanics of the human body, and Bob is injury free. Knowing this, who do you think is more susceptible to injury at their next soccer game? If you guessed John, you’re absolutely right.
Now what does this all mean? You’ve probably already understood at this point that passive stretching seems questionable, maybe not just from the research but also from your own personal experience. What the research seems to say is that you cannot passively stretch a muscle. You can stretch the fascia, which is the connective tissue surrounding the muscle (among other things), but the length of the muscle is determined by the nervous system. This is why it is best to use stretching methods that take into account the connection between the central nervous system and your muscles. However, when this is not enough, an osteopathic practitioner can accurately determine where the problematic areas are in your body and help you relieve muscle contractures and prevent injury.
Herbert, R. D. "Effects of Stretching before and after Exercising on Muscle Soreness and Risk of Injury: Systematic Review." Bmj 325, no. 7362 (2002): 468. doi:10.1136/bmj.325.7362.468.
Pope, Rodney Peter, Robert Dale Herbert, John Dennis Kirwan, and Bruce James Graham. "A Randomized Trial of Preexercise Stretching for Prevention of Lower-limb Injury." Medicine & Science in Sports & Exercise 32, no. 2 (2000): 271. doi:10.1097/00005768-200002000-00004
Shrier, Ian. "Stretching Before Exercise Does Not Reduce the Risk of Local Muscle Injury." Clinical Journal of Sport Medicine 9, no. 4 (October 1999): 221-27. doi:10.1097/00042752-199910000-00007.
Paul Ingraham. "Quite a Stretch: Stretching Hype Debunked." Www.PainScience.com. Accessed June 13, 2019. https://www.painscience.com/articles/stretching.php.
"Contracture." Merriam-Webster. Accessed June 13, 2019. https://www.merriam-webster.com/dictionary/contracture.
Sharman, Melanie J., Andrew G. Cresswell, and Stephan Riek. "Proprioceptive Neuromuscular Facilitation Stretching : Mechanisms and Clinical Implications." Sports Medicine (Auckland, N.Z.). 2006. Accessed June 13, 2019. https://www.ncbi.nlm.nih.gov/pubmed/17052131/.