Stretching exercises for sports injury prevention

Stretching: Does Stretching Work?

For many athletes it is axiomatic that stretching before or after exercise reduces subsequent muscle soreness, cuts injury risk and may even improve their performance. But are they deluding themselves?

The answer, according to Australian physiotherapists Rob Herberts and Michael Gabriel, is ‘probably yes’. The pair, based at Sydney University, carried out a systematic review of relevant good-quality literature on the impact of stretching in order to produce the most reliable estimate of benefit, and their results were published recently in the British Medical Journal.

Since they found only one small study investigating the effects of stretching on athletic performance, which in any case produced inconclusive results, this line of inquiry was abandoned. However, they did find conclusive studies on the effects of stretching on soreness and injury risk, and their key discoveries were as follows:

- Meta-analysis of five studies on the effects of stretching (either immediately before or after exercising) on delayed onset muscle soreness (DOMS) showed that stretching reduces soreness in the 72 hours after exercising by, on average, less than 2%. ‘Most athletes’, the Australian researchers conclude, ‘will consider effects of this magnitude too small to make stretching to prevent later muscle soreness worthwhile’; - Pooled results of the two studies evaluating the effects of pre-exercise stretching on injury risk (based on new military recruits undergoing 12 weeks of initial training) were equally discouraging, with stretching decreasing the likelihood of injury by a mere 5%.

Such an effect, comment the researchers, ‘would not be large enough to be of practical significance. In army recruits, whose risk of injury in the control condition is high (approximately 20% over the training period of 12 weeks), a 5% reduction in relative risk implies a reduction in absolute risk of about 1%.

‘Thus, on average, about 100 people stretch for 12 weeks to prevent one injury and (if the hazard reduction was constant) the average subject would need to stretch for 23 years to prevent one injury. Most athletes are exposed to lower risks of injury so the absolute risk reduction for most athletes is likely to be smaller still.’

However, the researchers are not totally dismissive about the potential benefits of stretching for injury prevention because the muscle stretching protocols used in these two studies were specific to the military populations being observed.

They conclude that ‘It is not possible to rule out with certainty a clinically worthwhile effect of other stretch protocols on risk of injury in other populations. It would be particularly interesting to determine if more prolonged stretching carried out by recreational athletes over many months or years can produce meaningful reductions in risk of injury’.

BMJ 2002;325:468

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