Stretching - What, Where, When and How

author : AMSSM
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By Andrew Getzin, MD
Member AMSSM

I see many people in my office or fellow triathletes training and racing who confess their guilt because they are not stretching. We all seem to be brainwashed that stretching is essential. Flexibility assessment is even part of the annual school-age fitness test. Here is the truth: There is no data suggesting that stretching decreases the chance for injury or improves performance.   If your goal is to improve race performance, consider using time more wisely by increasing your running, swimming, or biking time. If you want to stay injury free, spend the time strength training. Triathletes who make their way into my office due to injury are more often too flexible resulting in instability as opposed to being too tight. For many, their bodies are unprepared to control the forces they apply. I encourage all endurance athletes to work hard on establishing a firm base that can successfully absorb the training load.

Studies looking at sub-elite runners found that those who were tighter were actually faster. It is not clear why, but perhaps the increased tightness creates a spring effect, which propels them faster. In addition, there is evidence that a single bout of stretching acutely impairs muscle strength with a lesser effect on power. This may have a negative affect on the bike. 

When stretching can improve performance

There are a couple of areas of triathlons where stretching can potentially improve performance. Stretching your chest and shoulders can potentially increase your swimming stroke length. However, swimming sufficient distances over time might also result in physiologic adaptation to accomplish the same thing. Alternatively, training all strokes instead of just freestyle might not only help your feel for the water but may also increase your shoulder range of motion.   Increasing back flexibility can allow a sustained aero position on the bike. The longer you can stay aero or the more aero you can get, the faster you will more likely be on the bike. Instead of stretching by back, I am just careful by limiting my time aero. I start early in the season with only a few minutes aero per ride and gradually work myself up to race time. I also gradually shift my bike seat up to a more aggressive position as the season progresses.

Stretching for rehabilitation

It is not uncommon to feel tight. It seems that people who are the most flexible seem to feel the tightest. I want to do a study where I ask people in my office if they feel tight or do they feel flexible, and then objectively measure their flexibility. I suspect we will see an inverse correlation. If you are someone who has been injured and has done stretching exercise as part of your physical therapy, you may have learned how valuable stretching can be with injury rehabilitation. Clearly, there is a role for altering movement patterns in the injured state, so don’t stop your home exercises. However, injured versus the non-injured state requires a different approach.

Dynamic stretching

If stretching makes you feel good, feel free to stretch. If you are not hypermobile, it is not going to hurt you. You can self-check for hypermobility by seeing if you can palm the floor or hyperextend your elbows. If this is you, try to abstain from excessive stretching. Probably the best way to stretch is via dynamic stretching after a warm up or at the end of the work out. The American College of Sports Medicine defines dynamic stretching as “a gradual transition from one body position to another, and a progressive increase in reach and range of motion as the movement is repeated several times.” It has been shown to be more effective than the classic static stretch, where you hold a position for 30 seconds to a minute. Ideally, stretching would be performed when the muscles are warm. However, don’t worry - you won’t tear your muscles if you stretch before exercise; it will just be less effective when the muscles are cold. 


 

Andrew Getzin, MD,
Clinical director of Sports Medicine and Athletic Performance Cayuga Medical Center Ithaca, NY
Director, Cayuga Medical Center Endurance Athlete Center, www.cayugamed.org/endurance.
Team physician for USA triathlon, USA Olympic Committee, and a USAT level 1 coach.
All-American USAT, 2012 Ironman world championship qualifier and competitor. 

Bibliography:

  1. McHugh, To Stretch or Not to stretch: role in injury prevention and performance, Scand J Med Sci Sports 2010;20:169
  2. Kay, Effect of acut static stretch on maximal muscle performance: a systematic review. Med Sci Sport Exerc 2012;44:154
  3. Garber, Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently health adults: Guidance for prescribing exercise. Med Sci Sport Exerc 2011; 1334
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date: June 8, 2014

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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