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Tuesday, June 6, 2023

To stretch or not to stretch

Brent Brookbush

Brent Brookbush


Rober Taylor - … Recently I had a conversation about stretching an the how, when and what questions came up. We discussed practice plans and program design while looking at a bunch of scenarios other schools are using. It confused me and I am sure it confuses others too. Check out what this research says about stretching and potential performance outcomes. Do you or your athletes stretch before activities? Dynamic, static, PNF or myofascilal release? How much time do you set aside for performance flexibility training on a daily or weekly basis?

Discussion started in the Linkedin Group - Senior Level Fitness Industry Professionals

Marina Aagaard, MFT • The answer: To stretch! Poor flexibility/mobility hinders optimal performance and health.

However, the question is: Who, what (goal), which muscles, how, how long, when???

6 days ago• Like

Robert Taylor • Hello Marina. Thank you for contributing to the discussion. The term "flexibility" is interpreted MANY ways now a days. It used to mean "sit and stretch" and was done at the beginning of a "practice" as a "warm-up." The field has moved considerably away from this definition and the questions you indicated are even more appropriate. Do you have any research to share as to the "Who, what, which muscles, how, how long, and when" questions?

Marina Aagaard, MFT • Hi Robert,

Yes, many interpretations and uses (for): Warm-up, sports preparation, cool-down, relaxation, rehabilitation, etc. With specific stretches: Active, passive, dynamic, static.

No research handy at present; I am in the process of collecting data and will share later.

Robert Taylor • Hello again Marina. Thanks for the reply. I look forward to reading what you share later. Bummer that if you are in the process of collecting, you couldn't share some information on the topic. Hopefully it is worth waiting for and I get a chance to read it.

Brent Brookbush • Great questions Marina,

And thanks for bringing this topic to the forefront again Robert… here is an article I wrote on the topic "Refined Static Stretching Protocol: Consideration of Selected Research" - https://brentbrookbush.com/online-courses/articles/flexibility/refined-static-stretching-protocol/

I hope you enjoy… feel free to comment, question, or critique on the blog, or in this discussion.

Robert Taylor • Interesting article Brent. Thanks for sharing. I will look up some of your references as well.

Freddie Wolner • This is the best article I have found to date on stretching. http://saveyourself.ca/articles/stretching.php

Robert Taylor • Hello Freddie. The first thing that drew my eye was "published 8/20/00, updated 11/02/18." Am I reading this correctly that the update shouldn't even be published yet or is the date written differently then mm/dd/yy? I did enjoy the read. Nice article. I have not seen that one before. I will certainly share that with others also. Good suggestion.

5 days ago• Like

Freddie Wolner • Not sure on the dates. Check with the author. He is fairly accessible…Bottom line is, even since 2000, I dont think you will find any definitive research on stretching. I just dont think it exists. Too many variables to manage. Let me know if you come across and meaningful material. Thanks.

5 days ago• Like

Robert Taylor • Thanks Freddie. I haven't come across anything conclusive either. Dr. Wayne Westcott has been sharing some interesting information on the combination of stretching and strength training. Just did a podcast with him which you can listen to here:http://www.spreaker.com/online-courses/online-courses/show/smarter_team_training

Brent Brookbush • Hey Freddie,

That article is more than a little rough around the edges… it continually references "tons of new research" but cites next to nothing, and starts in with a pretty biased view. The only thing I can say that I agree with is that stretching is an amazingly complicated topic. I am not sure I would recommend that article to anyone on the basis that it leaves them with nothing. No suggestions, no better stretching techniques, no specific techniques to look out for… Just confusion and dismay. If a muscle becomes clinically tight and assumes a shortened length due to changes in posture and arthrokinematics you will need to stretch that muscle to return it to its optimal length. If you do not stretch, you will continue to reinforce compensation patterns, set-up the cumulative injury cycle, end up in pain, and end up seeing a physical therapist who will…. stretch you… just food for thought.

5 days ago

Freddie Wolner • I totally agree about the article. That said, it is conventional wisdom to stretch with no evidence to support it. Not sure I know what clinically tight means or if stretching can help that and you can prove that works. No evidence to support injury preventing stretches either. Having said that, clients love to be stretched and it can feel great. Our job is to proomote partcipation and make people feel good through exercise. So I wont say dont do it. But know that there is limited evidence to support ts efficacy.

Brent Brookbush • It is a bit unfair to say that there is limited efficacy in stretching and limited proof in research. Although this is a common assertion it is a falsehood. The problem, as mentioned above, is that flexibility is a complicated topic involving muscular adaptation and physiology, fascial adaptation and physiology, neuromuscular reflex, arthrokinematic, neural control of human movement, and postural dysfunction.

Any single research study is limited to a couple of yes or no answers to direct questions (a hypothesis). This is not to say that the research is poorly designed, but that this is inherent limitation in the research method. Although it remains our purest form of evidence it takes dozens of research studies to paint a picture of what is actually occurring. In essence, research plays 20 questions. You are trying to get to the right answer with only yes's and no's. I like to think of research like a single dot on the Seurat piece entitled Sunday Afternoon on the Island of La Grande Jatte -http://en.wikipedia.org/wiki/Georges_Seurat… If you get so close that you can only see one dot (one research study) you can tell virtually nothing about the big picture. You have to step back and look at all the dots to understand the picture.

I did my Master research project on Flexibility training, have published several articles and a chapter on flexibility is included in my book "Fitness or Fiction" - http://www.amazon.com/Fitness-Fiction-Volume-Truth-Exercise/dp/0615503012

To answer the most basic questions about stretching I ended up citing 143 research studies and textbooks, and since I finished writing the book, dozens more research studies have been done.

Stretching short/tight muscles to improve length tension relationships and optimize posture will improve performance and reduce the risk of injury… You don't have to believe me, but to get an accurate picture of flexibility research requires a ton of reading. I am more than happy to send you a bibliography if anyone wishes to start creating there own position statement. You can see some of my articles on flexibility here -https://brentbrookbush.com/online-courses/online-courses/category/flexibility/ and of course you can pick up my book at Amazon (paperback, e-book, or rent it with Amazon Prime)

Some of my favorite books that address the topic are:

The 3 NASM texts (Essentials of Personal Training, Essentials of Sports Performance Training, and Essentials of Corrective Exercise Training)

The Science of Flexibility

Diagnoses and Treatment of Movement Impairment Syndromes

PNF in Practice

Muscle Energy Techniques

Kinesiology of the Musculoskeletal System

Marina Aagaard, MFT • I second that. Thank you very much an evidencebased answer. I will quote.

3 days ago• Like

Max Morton PhD, LPT, ATC(retired) • My PhD dissertation was about joint looseness as it relates to knee injuries in junior high & high school football players.

After reviewing the literature from 1920;s to the present, one should not accepted much of the research from then to now on flexibility and stretching.! At best what is out there is still biased on more myth than good research. Most the research is very poorly designed. Books that have been published are usually from the author's bias and for their pocketbook. Be a critical reader!

At best stretching is controversial and at worst nothing but myth past down for thw ages.

When the New York Jets did research on using 5 joint looseness tests and came to the decision that at least if a pro-football player was classified as

loose" (watch how you interpret that term) they were at higher risk for joint injuries. My education as a physical therapist and experience as an athletic trainer did not match what the Jet's MDs reported. Therefore I did my own study. Over 200 senior high & junior high school football players were measured. Then we followed them for two seasons and evaluated data about their knee, ankle, shoulder injuries or muscle strains.

There was no significant difference in the frequency of injuries between tight and loosed jointed athletes. I was subjected to rigorous review by academics.

How ever I did observed young males that had all 5 tight or all 5 loose characteristics.

I spent one year repeating the same measurements on the two groups parents and one or both of the parents had similar traits.

One has to wonder if it is inherited?

At this point my recommendation is; keep what flexibility you have as long as you can as it does decrease slightly as one ages or has been injured or by disuse and disease.

I often ask these two questions: who are the most flexible athletes and who are the strongest pound for pound?

Robert Taylor • Interesting details Dr. Morton. Thanks for sharing. As for your question, is it rhetorical or is there a clearly defined answer?

Freddie Wolner • Thanks to both Brent and Max. I will keep searching. I am always looking for new information to help me confirm and question my own beliefs.

Max Morton PhD, LPT, ATC(retired) • I have , like many, some beliefs from neuro-muscular physiology but from genetics only an educated guess. My research as most can not be apply to the total population.

I have no answer to my own questions.

Another question might be "How much can we modify joint looseness (flexibility) by focused activity, 1% -10%.

Some of my research has been in the cause if and the rehab of hamstring injuries. Most current practices are based on the wrong beliefs.

Brent Brookbush • Hey Dr. Max,

I appreciate the other side of this debate, but you do make several assertions that seem to replace one bias with another. You make the assertion that most research and texts are biased by the author… this is true of any publication, however, it is unfair to propose this to any consumer of information as an argument against said research. It quite literally is such a general statement that it even debases your research, as you yourself, are biased against stretching. Further to throw out why stretching may be effective is to also throw out concepts like "relative flexibility", the davis principle, and possibly assertions about recipricol inhibition and the gamma afferent system.

Second, If research on flexibility is based on faulty assumptions (a position I do agree with) than lets build a better model and set of assumptions, not just ditch the whole thing. I do challenge much of flexibility research in this article https://brentbrookbush.com/online-courses/articles/flexibility/what-can-we-learn-from-static-stretching-research/ -

The biggest assumption we need to reset is why we stretch - if the muscle is not short/tight/overactive - as in, if we do not have reason to believe that a muscle has adopted a short position and adapted to that length, than don't stretch it. This is a major problem in research - most studies are on the hamstrings, and although the hamstrings may be hyper-tonic they are in a lengthened position for most individuals due to postural dysfunction at the LPHC.

Which brings me to your research - Why the knee? - a joint that research is showing to be a victim of hip and ankle mechanics. If you want to reduce knee injury, you should not focus on the knee, but rather improve hip and ankle kinematics. And why was the focus joint laxity and how do you measure that?

Last, stretching is a solution to a problem and not a genre unto itself. Stretching is a tool used by many to affect the resting length of muscles - in my case muscles that have adaptively shortened in response to postural dysfunction or injury. I don't stretch long muscles, or muscles of a normal resting length. I don't stretch because I'm sore and certainly don't stretch because it feels good. But, at the end of the day if you take stretching out of your tool box, you simply have one less tool to work with. A tool that does have some significant benefits when used appropriately.

Just some more food for thought… thanks for the lively debate.

Max Morton PhD, LPT, ATC(retired) • Why the knee? Because that was at a time when many in athletics were using the Jet's research as the standard. My research used the Jets' 5 measures of joint "looseness". "Victim of hip and ankle mechanics, is an interesting concept if you remove trauma. All five of the Jet's test demonstrate chains of joints not one joint but see above as to why I focused on the knee and ankle.I would be glad to share the tests with you if you are interested. Was I biased when I started? Somewhat because in my practice in athletic training and physical therapy the old concepts did not fit what i had come to know nor did they work in many cases. I was always looking for a better way.

When I started I was not convinced that you could apply those results on adult male pro-football players to high school and junior high school players.

I had also done the sit and reach test on every male track and field participant at the old WAC conference meet. We took the history of hamstring injuries to the flexibility of the sit and reach test (which measures the muscles of the low back, hip, knee and ankle). The track and field participants had no significant relationship between the sit and reach test but the significance was with speed events. The probability of injuring a hamstring muscle was related to the speed required in the event.

Also some research that came out of Brazil had demonstrated that strained or ruptured muscle improved much more rapidly with no stretching until 4-6 weeks post injury.

Recipricol inhibition and the gamma afferent system, reinforces my position that current practices of stretching and "massaging "muscle cramps" is not the "best practice" to relieve the muscle. The stretching I use today in practice is based on the above mention recipricol inhibition and the gamma system. Load the opposite muscle from the one your are treating with resistance and hold the contraction for 6-10 seconds, I have completely stopped static stretching (a lot of ACs & PTs still use it). At the time I got motivated to do much of this Bobby Anderson book was the bible for stretching. I know Bobby personally and while we have agreed to disagree we remain in professional respect of one another.

Why we stretch is a good question which I maintain is based on what the last coach did and the one before that and on & on. If an athlete has normal ROM why are we stretching them?

I currently am using eccentric progressive exercise as a successful method for me to treat most joint & muscle injuries including joint replacements, frozen shoulders, ACL post surgery and strained muscles.

If a client has significant soft tissue scaring post surgery or post injury I will do some stretching using activity movement.

Have you read the text book on EMGs "Muscles Alive: Their Functions Revealed by Electromyography" (9780683004144): John V. Basmajian, Carlo J. De Luca: Books, or Work Physiology by Per-Olof Åstrand? I have learned more about muscles and there function and neuro physiology than any other publications. I also used Per-Olof Astrand's book in the course I taught in advance exercise physiology.

I think I did indicate to you sometime ago that I had been part of the Arthur Jones Colorado Experiment in the early seventies. While Art and I disagreed on many issues he was a brilliant individual and I respect what he did for the strength industry.

Keep after me! And if you really want to go after a myth lets talk about % body fat!

Brent Brookbush • I'm not touching bodyfat %… I am not sure where I would even start (although the so called accuracy of many body-fat testing methods is likely enough to shake things up a bit). You did give me a good laugh with that last sentiment - and as far as myth busting I would love your thoughts on the book I published in September on myths titled "Fitness or Fiction." My goal was to write and evidence-based text for the fitness consumer, but I think as a professional you would appreciate my efforts.

After reading your last post, I think we agree more than we disagree on most issues. We both use lengthening techniques - Although I use static stretching and you use more of an active-isolated stretching technique (eccentric, and/or antagonist contraction), I think we would likely perform these techniques for similar reasons on similar muscle groups.

The sit-and-reach test is definitely a questionable test and I have done workshops where I have shown that release and stretch of the psoas, TFL, calves, adductor magnus, and even the piriformis will have a larger impact on the sit-and-reach than a hamstring stretch, and that's just self-administered techniques. Manual techniques, including SI joint and talus mobilizations, neurodynamic stretching, and any number of release techniques may return an individual to optimal without ever addressing the specific joint motions involved in the sit-and-reach - again without ever touching the hamstrings. My point is simple… we both agree on the most important sentiment of our discussion here… flexibility & ROM, as they relate to injury prevention & performance is a complicated and intricate relationship that cannot be simplified down to a single statement like "stretching doesn't work."

I need to check out the texts you've recommended (just what I needed… another book to read :-)~). I will add them to the short list.

As far as a model for new flexibility research I would also love your thoughts on an article I just wrote considering a "Predictive Model of Postural Dysfunction for the Upper-Body" - https://brentbrookbush.com/online-courses/online-courses/category/movement-impairmentpostural-dysfunction/ and exercise recommendations based on that model.

As this discussion is starting to wind down, I do want to thank you for all of your hard-work. This is an absolutely fantastic discussion that I would love to feature on my blog… if I can create a link to your blog, website, or whatever, please post the address.

Thanks again.

Max Morton PhD, LPT, ATC(retired) • You are to kind! I will give some thought to a blog, web site or what ever.

I will get to your book when I can (it will be a while but I will follow through.

If you are interested I would share my article on hamstring injury treatment.

Why because it works on most hamstring injuries and shortens the recover time by at least 50%.

Sorry you are not interested in body fat I have some real facts to share