Stretching - Is it necessary ?December 2000 (first published in the Baltimore Sun newspaper)
Some truths seem self-evident, such as the importance of stretching before exercise to prevent injury. Too bad the scientific evidence doesn't support it. In recent years, recreational athletes have gotten conflicting advice about how and when to stretch. But just about everyone agreed that stretching was a good thing.
Then earlier this year, a group of Australian researchers made news when they reported in an article published in the journal of the American College of Sports Medicine: "The findings of the present study clearly indicate that a typical pre-exercise stretching protocol does not produce a clinically useful reduction in injury risk." In other words, the study says stretching before exercise is a waste of time. People took note because the study involved 1538 Australian Army recruits in basic training, a large number of men doing strenuous exercise. And in case you're thinking: "Well, that's just one study," consider this: In August, an overview that appeared in Physician and Sports Medicine on the research on stretching - and there's been a significant amount of it - came to a similar conclusion.
"Stretching immediately before exercise has never been shown to prevent injury," one of the authors, Dr Ian Shrier, says of his findings. "I wouldn't say it is conclusive evidence, but overall, there is strong evidence. Some people can still argue that it might prevent injury in certain populations, for example, elite athletes; but there's no basic science research or clinical research to support this idea."
"His (Dr Shrier's) study is a particularly enlightened view," says Dr Ed McFarland, an orthopaedic surgeon and director of sports medicine at the Johns Hopkins University School of Medicine. "But it's yet to have much impact. It's probably the truth, but the dogma we've all been sold is that you have to stretch." Even if you believe that stretching increases flexibility, most recreational athletes have a limited amount of time to exercise and may not need a greater range of motion to, say, jog efficiently. For them, a warm-up rather than stretching would be the best way to avoid injury. Some research suggests that a regular stretching program (more than the five or 10 minutes recreational athletes spend before exercising) might help prevent injury. Shrier thinks that probably is true, although, he says, the evidence so far is sketchy.
Shrier used to stretch before he exercised, but no longer does. "I should be doing regular stretching in the morning, but I've replaced it with walking my dog. I really should do both." Some stretching proponents agree that pre-exercise stretching isn't necessary, but would argue for stretching after exercise to prevent muscle-joint stiffness and soreness. But is this any more effective than, say, spending the time in a hot shower?
Shrier feels there's no theoretical reason why stretching after exercise would be better than stretching every morning. Still, it's easier to remember to stretch if you stick it on the end of your exercise routine. Those that argue for stretching argue vigorously; but their evidence is largely anecdotal. On the other hand, if you feel better stretching, want the increased flexibility, and believe there's a chance it keeps you from getting injured, why not? John Newman, 49, an American college professor and a runner, has been going to stretch therapist Ali True twice a week for the past three months. They spend an hour working on both active and passive stretching. (Passive stretching is when someone else stretches you, perhaps past the limit you could stretch yourself.) "When I started, I would wake up very stiff in the morning and I was concerned about arthritis," Newman says. "Now I can almost do a split. I'm much more flexible and, of course, stretching feels good." In the past, when Newman has been training for marathons, he's always had an injury of some sort. This year he's had none. He attributes that to the fact that he has learned the correct ways to stretch and stretches before and after exercising.
It's ironic that just when the scientific evidence has begun to cast doubts on some of the perceived benefits of stretching, Pilates - an exercise program that incorporates a lot of stretching - and yoga - the ultimate in static stretching - are so much in vogue.
With various styles going in and out of favor, stretching has become complicated. There are various types: active, passive, ballistic (the oldfashioned bouncing stretches), isometric and PNF (which stands for "proprioceptive neuromuscular facilitation" and uses contractrelax techniques). Lynn Millar, a fellow of the American College of Sports Medicine and a professor of physical therapy in Michigan, says she stretches before exercising, but does what she calls "dynamic stretching" - which involves more motion than the traditional static stretch.
During the day, separate from her aerobic exercise, Millar also does gentle hamstring stretches and other stretching exercises for her back. "Right now, don't throw the baby out with the bathwater," she warns. "We know too much anecdotally of athletes who didn't stretch. The jury is still out - I tend to lean more to the `do it'. I don't think it will hurt." June Schneider, a sports massage therapist, agrees. Four times a week before a run she does 30 to 40 minutes of yoga and stretches five to 10 minutes after her run. She also stretches after strength training. "If you run and get enough injuries, you develop something that works," she says. "Stretching does that for me."