Is Stretching Effective for Performance, Injury Reduction, Or Pain? || EP 52

Here's another episode that I have done in the past that a lot of people got a lot of value from. I wanted to just put this one back on just in case you have missed this.

In this episode, I dive deep into the research on stretching and seeing if it is effective for injury reduction, performance enhancement, or pain relief. 

Some of the facts may surprise you. Countless things that I've been told about stretching are vastly different from what I thought to be true. 

There are many forms of stretching, and some have been proven to be more effective than others. And some just don't make a huge difference at all for your overall health and fitness. 

Transcript

0:02

Welcome to the Won Body Won Life Podcast. Hi, I'm your host, Dr. Jason Won lifestyle, physical therapists. I talk about everything health and wellness related. So you too can have a more resilient body and a more fulfilling life. If you haven't yet, please support the channel by hitting that subscribe or follow button. So you never miss out on another podcast episode. Also, if you could please leave a review or ranking before leaving this episode, that way more people will be able to benefit from the content of my podcast. Today, I wanted to talk about a heavily debated topic. Is stretching effective? And that's a very blanketed statement that can then be transferred to many aspects of our health. And I'll keep this concise and break this down into three easy questions that you might want answers for. Number one, is stretching good for reducing injuries? And number two is stretching good for performance enhancement. And lastly, number three is stretching good for reduction in pain levels. Since many of us are already time strapped and it's already hard to prioritize exercise, we need to dive into the research and also a mixture of my clinical opinion to see if stretching is effective for anything. So let's dive into this now. So number one is stretching good for reducing injuries. And the answer is, not really. The research hardly backs that any form of stretching actually reduces your chance of injury. A large systematic review by Larson et al. in 2014 examined multiple studies on stretching and injury prevention. And they evaluated the results of 26, 000 people who between them had experienced 3, 500 injuries. And they found that good balance reduced injury by 35%. Better strength reduced injury risk by nearly 70%. And stretching. Stretching did not reduce injuries significantly at all. And this was taken into account all forms of stretching. And in my clinical opinion, if you're doing immense amounts of stretching before workout to reduce your chances of injury, taking your muscles through extensive lengths of motion can actually increase your risk for injury. More about this later when we answer the question about performance, but if you are prepping for a sport, let's say. Such as running and you're doing a ton of reaching for your toes to get a nice hamstring stretch. You really don't need that amount of range of motion to run. You're mostly upright and doing majority of your tasks unless you're running uphill, which accounts for a little bit of hip hinge and a little bit more hamstring stress. But hinging that far and stretching your hamstrings before an activity will not do you any good. And an adequate warmup of running drills that are more specific to the task at hand would be more beneficial. So taking this into account is that when you are thinking about stretching and reducing injury, you want to think of something which I call S. A. I. D. And what that stands for is Specific Adaptations to Imposed Demands. And so this means that if you want to reduce your chances of injury, let's say for another sport such as tennis, you need to ensure that in a gym setting or at a home gym, that you're replicating those exact demands via the form of using dumbbells, bands, kettlebells, or any form of resistance training that will greatly increase your. Athletic performance, it'll increase the 10 cell strength of your tendons and muscles and bones so that it gets used to the demands of tennis. But if you're thinking about I need to stretch my chest or stretch my hamstrings or stretch my calf in order to reduce my chances of injury. The research doesn't really back that. Instead, think about SED, which is Specific Adaptations to Imposed Demands. Now, there is some relevance to static stretching. Now, let's say if you are a gymnast and you need to be in very flexible positions, then it does make sense to sometimes take certain joints and muscles through larger ranges of motion. Or let's say if you are a baseball player. Occasionally, it may be beneficial for you to stretch your pectoral long term. So that way you do get more shoulder external rotation when you do decide to throw a baseball, but rarely in any circumstance would you say that static stretching would be beneficial for reducing injury and sometimes may actually increase your risk for injury. So more about this in our second question, which is stretching good for performance enhancement? And the answer to that is it actually depends on duration and when you stretch. So let's take static stretching, for example. And for so many guys that don't know static stretching, what that is, is any stretch held from 30 to 120 seconds. And in one research study, They examine the effects of static stretching on sprint performance in collegiate track and field athletes. Research reported actually a 3 percent decrease in sprinting performance on a 40 meter following pre event static stretching. An amazing study by Wallman et al. 2012 examined the effects of acute static. Dynamic as well as ballistic stretching and no stretching of the ilio psoas muscle on a 40 yard sprint time in 18 to 37 year old non competitive recreational runners. So to break that down before we dive into the results, acute static means that immediately before That sprint event is that they do that 30 to 120 second static stretch dynamic stretching is more movement based. So there is some evidence to show that dynamic increases warm to the tissues can increase joint pliability and is a little bit more effective than static stretching. So they also dynamic and then ballistic stretching is basically taking a certain joint through very fast velocity ranges of motion. So if you're swinging your. Arm in a circular fashion, multiple times at a very fast speed. That is more considered ballistic stretching versus dynamic. And again, the fourth thing that they measured and that they did research on was a group that did no stretching at all of the iliopsoas muscle, which is a hip flexor muscle important for sprinters and runners. In eye popping fashion, the results concluded that there were no statistical differences in sprint time for ballistic, dynamic, or acute static stretching, and the only significant improvements came from the no stretching group. And they simply warmed up and walked on a treadmill. Now for me, this was very eye popping research because when you look at people that require fast velocity movements such as sprinters is that forms of stretching can actually reduce your performance and reduce your sprint speed. But if you don't do any stretching, you simply just warm up the tissues or you do specific exercises beforehand. That again, replicate the demands of sprinting. So let's say high knees or butt kicks or different things, which takes your joints through the ranges of motion required to complete that task, that is actually much more effective than ballistic stretching. So if you think about swinging your leg up and down which is like a dynamic hamstring stretch or swinging your leg side to side, which would stretch out your groins and your hips, even though that seems relevant, and these are things that. I actually did in the past before squats and deadlifts, that actually is ineffective for improving sprint speed or improving significant performance in many realms of athletes. So hopefully this can be very relevant if you are somebody that is trying to improve their performance, if you are a coach or an athlete or somebody that's recovering from an injury, is that static stretching and different types of stretching are actually very ineffective. Instead, just try to replicate the demands, try to do some strength training beforehand, which is like lighter amounts of strength training. My, my rule of thumb, especially if. I am a person that squats and powerlifts is that the best warm up for a squat is not stretching your quad. It's not taking your muscles through extensive ranges of motion. Simply the best warm up for a squat is simply a squat. If you're going to squat 200 pounds, try to squat something that's. 80 to 100 pounds, something that's going to just replicate that demand and that in itself will take your knees, your hips, your ankles, your lower back through the range of motions needed in order to complete that task. So strengthening in itself. Is actually the warm up versus stretching seem to be an effective in majority of cases. So lastly, in a large amount of studies, static stretching for longer than 120 seconds can and in most cases reduce maximal power output from the involved musculature. and can be extremely detrimental to athletic performance, which if there is any significant decreases to performance, you can infer a potential increased injury as well under any fatigue driven conditions. Now, this doesn't mean that stretching is completely insignificant, but acutely immediately pre or post these studies show that stretching either plays no significant role to performance or causes decrement to performance. The Reuben at all actually did a study and they called the effects of stretching on strength performance examine many forms of stretching chronically over time. So this is basically comparing now that acute stretching. We've concluded that is not very important, but there is very. A very small, minute amount of research that still gives stretching some credibility. And this was chronically stretching over time. And I'll tell you, there is a kicker to this. They harped on many studies of static stretching being detrimental, like we said before. And they did this on people that either did a counter movement jump or sprint speed. And most, most often the case, static stretching reduced performance in that sense. But, they did take people that did not do any stretching. During the workout, but instead when they were at home, they did perform a specific type of stretching, which is called PNF contract relax, which was done five days a week for three consecutive weeks. And so what this means is called peripheral neuromuscular facilitation, which basically you contract the muscle of interest, followed by taking that muscle through greater ranges of motion passively. So what they did show was that doing this for a three consecutive week span, it showed not just significant gains in flexibility, but also increases in eccentric peak torque measured at 120 and 60 degrees per second for the knee flexors and extensors. So while there is no research backing, static stretching almost at all, there is some benefit to specifically PNF contract relax done significantly over time, but in my clinical opinion, this does actually make perfect sense because if you've seen my social media or in my other podcast, I am very heavily biased towards strengthening over stretching PNF again is a form of technique where if you want to improve, let's say hamstring, you sit. flexibility. You will take the hamstring to near end ranges of motion and contract the hamstrings into knee bending or hip extension for 5 to 15 seconds. Then you are to proceed into greater hamstring length by passively pulling the hamstring into the opposite position. And this is called autogenic inhibition. An autogenic inhibition is contraction of the involved muscle group to then relax the muscle further. Hence the name inhibition, which is you contract the muscle. Once you relax it, it actually relaxes more, allowing you to get greater ranges of motion. But PNF is often preceded with contracting the knee extensors. So let's say if you gained more hamstring flexibility, you can contract the quadricep and the hip flexors. in order to take your leg through greater ranges of motion. And this is what we call reciprocal inhibition. Nonetheless, PNF, even though it's somewhat in the stretching category, it is actually a combination of isometrically contracting the muscles, which I perceive it more as a strength training protocol versus a stretching protocol. All right. So hopefully that makes sense that. Static stretching, very little relevance, but PNF, when you do combine it with some sort of contraction of the involved musculature or the opposite musculature, that can enhance your flexibility and it can reduce your chance of injury and increased performance. All right. So lastly, let's dive into number three and number three is can stretching actually reduce pain? And the answer to this is it also depends. So the answer right now is research shows that acute bouts of any form of stretching can reduce pain short term, but the effects are short live. I'm personally still a big fan of isometric strength strengthening, which is where a given muscle group in pain is contracted for 20 to 60 seconds at 3 to 5 reps. And research shows that it can reduce pain significantly, but also increase range of motion of a given joint and increase 10 cell strength, which is noteworthy for those with tendonitis or chronic tendinosis, a study compared the effectiveness of isometric strengthening. with static stretching versus static stretching alone in nonspecific chronic neck pain. So they took 52 patients randomly assigned to receive either isometric training of their neck muscles combined with static stretching versus static stretching alone. And both groups were also assigned for a general aerobic training protocol. Now, the research concluded that both groups after one month of consistency. had some improvement to pain scale and the neck disability index score. However, the group that added isometric strength had greater improvements on the disability index scale. Now, if you are working out though, there is some research to back that dynamic forms of stretching can reduce the duration of delayed onset muscle soreness, inclusive of static stretching. Anecdotally speaking, and that means in my clinical opinion and in my experience with working out, I find that static stretching actually increases the duration of DOMS, which is delayed onset muscle soreness. I believe that other, after muscles have been broken down through strength training, that pulling muscles apart further through static stretching actually can cause more micro damage. And I don't have research in this, but this is just after years of trying this after multiple bouts of workouts, is that it actually increases. My duration of Dom's, and also it decreases my performance, but for me, a combination of self massage, foam, rolling, dynamic, stretching, active recovery, and other things that we've talked about in other podcast episodes, but a large amount of protein and sleep have been the most effective to decrease the late onset muscle soreness and increase athletic performance. And rather than just presenting the research to you, which can be intriguing for some. But boring for some other listeners, I can tell you firsthand that 99 percent of my clients benefit more from a strength training protocol over a stretching protocol, as much as doctors, PTs, chiros, even personal trainers, prescribed static stretching for pain. I've seen time and time again, that these patients rarely get long term relief and in fact, continuously get flare ups of pain. So I'll give you an example. I had a client named Carol, who she had. years of neck pain. She had two kids. She was on to her third, but her protocol and what doctors told her was if you have neck pain, just simply stretch out your upper traps, simply side bend your ear or look towards your armpit and hold that for 30 to 60 seconds. And that is enough. That's all you need to reduce pain. So she followed that. And quite frankly enough, after doing that for years and seeing Kairos PTs and seeing a bunch of people and having her husband basically massage her every single day, she was fed up. She was having more pain. She felt like her neck was very unstable. She felt that after 10 to 20 minutes of just sitting with her kids. That she needed to lie down and rest and put a heat pack on her neck. So when I met her, she was in a pretty debilitated state. Basically when I did talk to her and she was considering working with me, she was not sitting at a table. At our home in Texas, she was not sitting, she was actually lying down with her neck rested against a pillow. Alright, so that's another topic to talk about, which is basically bedrest being one of the worst things you can do for long term pain relief. But she was talking to me, and she's yeah, I can't even hold my neck up for longer than 20 minutes. And in my opinion, when you're looking at that long term. effects of static stretching, like we talked about decreases her performance. She wasn't even a high level athlete. She was just a stay at home. Mom had a lot of job demands, a lot of chores, a lot of things to do, but she was not getting relief. And in fact, her performance at home was getting much worse and she couldn't do her job as. Mom, she couldn't cook. She couldn't do anything. And I think it's honestly because all she did was static stretching. Her neck was very much unstable. When you do a lot of static stretching long term, you're just pulling the sarcomeres apart. You're pulling that muscle apart and it's. It's rendering it ineffective and unable to do things such as just keeping your head on, on his body. So what I instead had her do was I just started having her do isometric strengthening. I told her that you need to start breathing more because that can at least calm the nervous system down. I gave her a number of foam rolling dynamic stretching, stretching exercises to reduce some stiffness in the shoulders and her upper back, the areas below her neck. Thank you. And then I actually got her husband involved and this wasn't her husband. I actually saved her husband, her, his thumbs, because he was massaging her neck every day. Instead, what he instead did with his hands was I told him to apply pressure to different parts of her neck. And I just had her sit for 30 to 60 seconds. And he started applying pressure to the right side of her head, left side to forward and backwards, applying pressure to different parts of her shoulders and her spine. And she started to gain more stability. In her spine and after just 2 days, she reported that her pain went from an 10 every single day to basically a 3 and then we started to progress to dumbbell training. I had her buy a set of dumbbells. I had her buy a set of bands. I told her to throw out the heat pack or put that into the closet and she started getting onto a legitimate strength training protocol. Which again, after two days, she was experiencing significant relief. And then after that, she noted that after she was doing the strength training, that her body felt way more conditioned, she was ready for her third kid to come out and she had no issues whatsoever. And I think to this day, she continues to strength train. She does not do any more static stretching because. If she does, it's to feel good just in that moment, but she replaces a lot of that with her isometric strength training protocols. She moves a lot more, she strength trains consistently, and I think that's where the money's at. If you're somebody that's struggling with chronic pain as of now, is that to consider that static stretching can feel short term. Good. It can feel good when you're sitting at your computer, but as you can see in the long term, I felt that caused extreme detriment, not just to Carol's performance, but also her pain levels as well. Okay. So I wanted to just conclude this with lastly, two frames of thought. So I know we answered the three questions, but I want to leave you with two more frames of thought, connecting the stretching with pain reduction. So in the short term, it always feels good to stretch. I can even say that if I pull my heel towards my butt right now, I can tell that, man, that feels like a good quad stretch. If I pull my right ear toward my right shoulder, I can tell that, man, that feels good on my left side of my neck, but your brain is always going to be very receptive to the stretch reflex, and I think it's more ingrained into us because society, either on social media or. Or let's say a lot of pictures and let's say screenshots and things that are presented to us. There's a lot of pamphlets that just show a bunch of static stretches. It continues to push for stretching as the means for longevity. But in this episode, we have now found that strength training and a mixture of different types of stretching, specifically PNF. can be effective to help you with increasing your longevity, your joint range of motion, but also increasing your performance. We have still not factored in, though, that the entire pain experience relies on other pivotal factors, such as your nutrition, your stress levels, your sleep quality, and self reported perceptions of our health. So take what I said into account with all the different research and anecdotal evidence I'm supplying to you, but understand that doesn't even cover half the picture of the pain experience. You have to address your habits, how you perceive your own health. People don't realize that if you perceive your health as it's going downhill, that you actually will slide downhill and you won't take much actions towards improving your health. And take into account stress, sleep, and nutrition, all big pieces, so that when you decide that hey, strength training is the long term plan, that you need to recover from that in the form of decreasing stress, optimizing your nutrition, and optimizing your sleep quality and quantity. So we cannot discount stretching as somewhat therapeutic in the short term, but you can stretch at work while sitting at your desk and get some relief, but chronically over time, there is still to this day, very little research on this now, unless it's PNF contract relax specifically, and that was only one research article. But my last concluding statement number two is if you are trying to improve your performance and decrease your risk for injury and ensuing pain. You must consider that value of strength training for all of these things. If you take in the following research, I've given you today, the only time at which stretching was beneficial is peripheral neuromuscular facilitation. And that is something that I can show you or another PT can show you, but all of which that if stretching had any relevance whatsoever, it was combined with either isometric strengthening, or it was combined with some sort of actual contraction of the musculature at hand. So as I would tell my clients in the pain free academy all the time, there is nothing wrong with getting strong strength training consistently over the long term will cover the basis of reducing pain, reducing chances of injury, decreasing perception of disability, and increasing your ability to do more things long term. And this is why I rarely stretch for anything, why I rarely prescribe it, and why majority of my programs that I prescribe are strength training protocols. A little bit of mobility for times that you're stagnant, like sitting at a desk, honing in on your stress, sleep and nutrition. And I think right there is the whole pie, that is a great protocol for those that are either just simply trying to increase their athletic performance, decrease the risk for injury, or if you do have any chronic pain, I highly suggest that you review this episode time and time again. To. Connect the dots. So stretch if you want, just don't consider it a long term solution. If you have pain or looking to increase your performance. So that's what I got for you today. If you enjoyed this episode, definitely hit that subscriber follow button, share this episode onto your social media. I do release episodes. Every morning on Wednesdays. And I'd love if you can also leave a review rating or review on your podcast. So my content will reach more people who could benefit from the tips I put out. And if there is any feedback about the content I'm putting out good or bad, or if there's any specific things you want me to cover in future episodes, send me a quick text to 4 1 5 9 6 5 6 5 8 0, or email me at jason@flexwithdoctorjay.com and I reply to all my messages personally. And I'll leave you always with these last words of advice. We only have one body, one life, make every action you take, be the one that makes you a better version of you. Take care.