Long-Term Static Stretching

I previously wrote a post on the topic of acute stretching, injury, and performance and recently published a study in the same vein in the Journal of Strength and Conditioning Research. At that time, I made only a brief reference to long-term stretching. A recent article regarding a long-term static stretching intervention resulting in strength increases in the contralateral muscle from Nelson et al. 12 inspired me want to write a little more about long-term stretching.

What do we know about the effects of long-term stretching? At this time, we know we can use it to improve static range of motion (ROM)8,9, muscle strength, endurance, and power 7,8. There is also some evidence that long-term (again not acute!) stretching has a role in decreasing musculotendinous injury2.  The mechanism involved in producing improvements in ROM from long term stretching is unknown at this time. Classically, the belief was that we are primarily “lengthening the muscle”. However, ROM improvements related to long-term static stretching appear to be largely related to increased stretch tolerance and not an actual changes in tissue extensibility 3,5,9, which would indicate some sort a neurological influence. The exact mechanism for the strength, endurance, power, and injury prevention benefits are also unknown, but a couple of thoughts seem to permeate. The first being that hypertrophy of skeletal muscle tissue and/or connective tissue may play a role, but this has only been demonstrated in animal studies 14.  Which brings us to a neural influence. We typically think about the neural influences of stretching on the acute effects of performance, but between previous evidence3,5,9 and now Nelson et al. 12, I am hedging a bet towards long term neural adaptation being a key component in the positive outcomes of long-term stretching.

Briefly, Nelson et al. examined  the cross training effect of a 10-week static stretching in an untrained population (important note) on calf strength which demonstrated a 29% increase (higher than contralateral resistance training studies!) in strength of the contralateral calf, as well as a statistically significant 1% increase in ROM for the contralateral calf12.  This change in ROM may seem minimally relevant, but the fact that there was a detectable change in ROM of the contralateral limb may provide additional support for a neurological influence in this change. This is because if hypertrophy had occurred, increased tendon stiffness would likely be noted 15, which probably would have prevented a detectable change in calf ROM. Further yet, previous examinations on unilateral resistance training and its effect on the contralateral limb demonstrated strength increases in the absence of hypertrophy11 and appear to be related to neurological changes4, and there is little reason to believe the effects of stretching would be different than resistance training.

So what is the practical application of this discussion? Mechanism wise, whether hypertrophy or neural based, it doesn’t matter, both are synergistic benefits of long term training. The fact that there are physiological changes with concurrent performance improvements indicate a value in us maintaining or adding a long-term stretching regimen.

More specifically, most athletes can benefit from increasing static ROM. I state this with some caution as there definite risks with excessive flexibility, in particular at the spine. Greater flexibility of the lumbar spine is associated with disc degeneration6,17, and excess flexion and rotation are associated with disc herniation1,10.

Regarding improvements in muscle strength, power, and endurance, these benefits have only been demonstrated in the untrained population7,8,12, so it is difficult to apply to the higher level athlete because neural changes primarily are a part of early training with the influences of hypertrophy primarily playing a role in later gains. As stated by Nelson et al., there may also be a benefit in managing strength loss in an immobilized limb12.

Ultimately, the most practical application for chronic long-term stretching may lie in prevention of musculotendinous injury , although only one study has provided evidence for this proposal2. It appears that this injury reduction is the result of a training response over time, not an isolated occurrence, not in relation to pre-exercise stretching, but a long-term adaptation. As has been repeated to death at this point, no evidence for pre-exercise stretching reducing injury risk currently exists2,13,16,18, but a long-term relationship does exist, and justification for static stretching over time as a method to reduce injury risk is very plausable. There is some suggestion and guidance to the exclusive emphasis on dynamic stretching with no thought towards a post-exercise or separate static stretching sessions, and this may come at the detriment of some benefits we still do not understand. Needless to say, beyond the time commitment, unlike pre-exercise static stretching, there really is no evidence to demonstrate a negative impact of post-exercise static stretching or independent static stretching sessions.

So now it is your turn. What are your thoughts regarding keeping or adding a long-term stretching intervention? Is it worth the time it takes to keep or add it in your program?

1. Adams MA, Hutton WC. Prolapsed intervertebral disc. A hyperflexion injury 1981 volvo award in basic science. Spine (Phila Pa 1976). 1982;7(3):184-191.

2. Amako M, Oda T, Masuoka K, Yokoi H, Campisi P. Effect of static stretching on prevention of injuries for military recruits. Military Medicine. 2003;168(6):442-446.

3. Ben M, Harvey LA. Regular stretch does not increase muscle extensibility: A randomized controlled trial. Scand J Med Sci Sports. 2010;20(1):136-144. doi: 10.1111/j.1600-0838.2009.00926.x.

4. Fimland MS, Helgerud J, Solstad GM, Iversen VM, Leivseth G, Hoff J. Neural adaptations underlying cross-education after unilateral strength training. Eur J Appl Physiol. 2009;107(6):723-730. doi: 10.1007/s00421-009-1190-7.

5. Folpp H, Deall S, Harvey LA, Gwinn T. Can apparent increases in muscle extensibility with regular stretch be explained by changes in tolerance to stretch? Aust J Physiother. 2006;52(1):45-50.

6. Fujiwara A, Lim TH, An HS, et al. The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine (Phila Pa 1976). 2000;25(23):3036-3044.

7. Kokkonen J, Nelson AG, Tarawhiti T, Buckingham P, Winchester JB. Early-phase resistance training strength gains in novice lifters are enhanced by doing static stretching. J Strength Cond Res. 2010;24(2):502-506. doi: 10.1519/JSC.0b013e3181c06ca0.

8. Kokkonen J, Nelson AG, Eldredge C, Winchester JB. Chronic static stretching improves exercise performance. Med Sci Sports Exerc. 2007;39(10):1825-1831. doi: 10.1249/mss.0b013e3181238a2b.

9. Magnusson SP. Passive properties of human skeletal muscle during stretch maneuvers. Scandinavian Journal of Medicine & Science in Sports. 1998;8(2):65-77.

10. Marshall LW, McGill SM. The role of axial torque in disc herniation. Clinical Biomechanics. 2010;25:6-9.

11. Munn J, Herbert RD, Gandevia SC. Contralateral effects of unilateral resistance training: A meta-analysis. J Appl Physiol. 2004;96(5):1861-1866. doi: 10.1152/japplphysiol.00541.2003.

12. Nelson AG, Kokkonen J, Winchester JB, et al. A 10-week stretching program increases strength in the contralateral muscle. J Strength Cond Res. 2012;26(3):832-836. doi: 10.1519/JSC.0b013e3182281b41.

13. Pope RP, Herbert RD, Kirwan JD, Graham. A randomized trial of preexercise stretching for prevention of lower-limb injury. Medicine & Science in Sports & Exercise. 2000;32(2):271-277.

14. Sasai N, Agata N, Inoue-Miyazu M, et al. Involvement of PI3K/Akt/TOR pathway in stretch-induced hypertrophy of myotubes. Muscle Nerve. 2010;41(1):100-106. doi: 10.1002/mus.21473.

15. Seynnes OR, Erskine RM, Maganaris CN, et al. Training-induced changes in structural and mechanical properties of the patellar tendon are related to muscle hypertrophy but not to strength gains. J Appl Physiol. 2009;107(2):523-530. doi: 10.1152/japplphysiol.00213.2009.

16. Shrier I. Stretching before exercise does not reduce the risk of muscle injury: A critical review of clinical basic science literature. Clinical Journal of Sport Medicine. 1999;9(4):221-227.

17. Tanaka N, An HS, Lim TH, Fujiwara A, Jeon CH, Haughton VM. The relationship between disc degeneration and flexibility of the lumbar spine. Spine J. 2001;1(1):47-56.

18. Thacker SB, Gilchrst J, Stroup D, Kimsey D. The impact of stretching on sports injury risk: A systematic review of literature. Medicine & Science in Sports & Exercise. 2004;36(3):371-378.

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About Leonard Van Gelder

Leonard Van Gelder is a physical therapist, athletic trainer, therapeutic pain specialist, and strength and conditioning specialist. Leonard has strong interests in pain science and the use of Therapeutic Neuroscience Education (TNE) and manual therapy based on the body Neuromatrix model in his rehabilitation and performance enhancement approaches. Leonard also develops strategies for injury prevention and sports performance enhancement. He is a clinical scientist and occasionally contributes to scientific literature through authorship in peer reviewed publication and serving as a peer reviewer. View all posts by Leonard Van Gelder

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