TRAINING, PREVENTION, AND REHABILITATION

The Effects of Stretching on Performance Evan Peck, MD1; Greg Chomko, DPT2; Dan V. Gaz, MS3; and Ann M. Farrell, MLS4 stretching on performance in three categories of sport: strength and power dominant, speed and agility dominant, and endurance dominant. We categorized strength- and power-dominant activities as those involving a brief and maximal effort, such as a countermovement jump for maximum height or a one-repetition maximum (1RM) in resistance exercises such as the bench press. We categorized speed-and agilitydominant activities as either cyclical, short-duration, fast muscular contraction events such as sprinting (100 m or less), or agility tasks that involved repeated quick and multidirectional movements. We categorized endurance-dominant activities as either cyclical, longer-duration (200 m or greater) tasks such as distance running or cycling or submaximal muscular endurance performance in resistance exercises such as the bench press. This categorization is acknowledged as subjective and has significant limitations, as many sports involve some degree of all three components. However the authors believe that this categorization helped define the results of the literature better and may assist athletes, coaches, and sports medicine providers in making decisions regarding the implementation of stretching in a training program.

Abstract Stretching long has been commonplace in the training programs of recreational and competitive athletes. Its role in performance enhancement has been debated. This review discusses the literature concerning the effects of static, dynamic, and proprioceptive neuromuscular facilitation stretching on performance in three categories of sporting activity: strength- and powerdominant, speed- and agility-dominant, and endurance-dominant activities.

Introduction The use of stretching in the training programs of recreational and competitive athletes has been historically commonplace. The role of stretching in enhancing athletic performance has been debated (49). The purpose of this review was to examine the literature regarding the effect of stretching on performance, without regard to any of the other purported effects of stretching, including improvements in joint range of motion, muscle length, or recovery from or susceptibility to injury. There are three primary types of stretching, although numerous subtypes exist. For the purposes of this review, we categorized the type of stretching utilized in a study into one or more of the following: static stretching, dynamic stretching, and proprioceptive neuromuscular facilitation (PNF) stretching. Static stretching involves lengthening a muscle and holding it in a mildly uncomfortable position for a period, usually somewhere between 10 and 30 s. Dynamic stretching uses momentum and active muscular effort to lengthen a muscle, but the end position is not held. PNF stretching typically involves a contraction of the opposing muscle to stretch the target muscle, followed by an isometric contraction of the target muscle. In 2004, Shrier (49) published a review of stretching and performance. We examined the literature published since around the time of that review, assessing the effect of 1 Sports Health, Department of Orthopaedic Surgery, Cleveland Clinic Florida, West Palm Beach, FL; 2CORA Rehabilitation Services, Palm Beach Gardens, FL; 3Sports Medicine Center, Mayo Clinic, Rochester, MN; and 4Plummer Library, Mayo Clinic, Rochester, MN

Address for correspondence: Evan Peck, MD, Sports Health, Department of Orthopaedic Surgery, Cleveland Clinic Florida, 525 Okeechobee Blvd Ste 1400, West Palm Beach, FL 33401; E-mail: [email protected]. 1537-890X/1303/179Y185 Current Sports Medicine Reports Copyright * 2014 by the American College of Sports Medicine

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Methods The MEDLINE database was searched using the Ovid interface for relevant original research articles published in English between 2003 and June 2013. Keywords included stretching, prestretching, performance, preperformance, exertion, and exercise. We excluded articles that solely examined the role of stretching on joint range of motion, muscle length, injury treatment, or injury prevention. Studies were excluded if they did not examine the effect of stretching on a subsequent sporting performance task directly. We excluded studies that examined the long-term effect of stretching on performance, as we believed these studies to be measuring a distinct and potentially more complex process than that in studies included in this review. We identified 154 potentially relevant articles. Of these, 62 met the inclusion and exclusion criteria and were included in this review. These are summarized in Tables 1, 2, and 3, which categorize the primary study outcomes for each domain of sports performance and type of stretching. Current Sports Medicine Reports

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Table 1. Summary of studies examining the effect of stretching on strength- and power-dominant activities.

Strength and Power Performance Effects Static stretching

Positive Effect

Negative Effect

No Effect

Pacheco et al., 2011

Barroso et al., 2012

Knudson et al., 2004

Behm and Kibele, 2007

Holt and Lambourne, 2008

Behm et al., 2011

Little and Williams, 2006

Bradley et al., 2007

Molacek et al., 2010

Brandenburg, 2006

Taylor et al. 2009

Carvalho et al., 2012

Wallmann et al., 2008

Cramer et al., 2004 Curry et al., 2009 Fletcher and Monte-Colombo, 2010 Gergley, 2009 Herda et al., 2008 La Torre et al., 2010 Pearce et al., 2009 Power et al., 2004 Robbins and Scheuermann, 2008 Sim et al., 2009 Taylor et al., 2009 Winchester et al., 2009 Young and Behm, 2003 Dynamic stretching

Behm et al., 2011

Barroso et al., 2012

Dalrymple et al., 2010

Carvalho et al., 2012

Bradley et al., 2007

Little and Williams, 2006

Curry et al., 2009

Christensen and Nordstrom, 2008

Fletcher, 2010

Herda et al., 2008

Fletcher and Monte-

Jaggers et al, 2008

Colombo, 2010

Torres et al., 2008

Holt and Lambourne, 2008 Moran et al., 2009 Needham et al., 2009 Pearce et al., 2009 Perrier et al., 2011 Turki et al., 2011 Yamaguchi et al., 2007 PNF stretching

Pacheco et al., 2011

Barroso et al., 2012

Christensen and Nordstrom, 2008

Bradley et al., 2007

Molacek et al., 2010

PNF, proprioceptive neuromuscular facilitation.

Static Stretching for Strength- and Power-Dominant Sports A considerable body of literature indicates that static stretching performed prior to strength- and power-dominant activities results in performance deficits, including such tasks as countermovement jump height, 1RM in the bench press, and peak torque output (2Y7,11,13,20,22,28,34,42,44,45, 180

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50,52,59,62). When examining the countermovement jump, the detrimental effect of static stretching may be pronounced more at knee angles closer to extension (34). Gergley et al. (22) showed that passive static stretching during warm-up in young competitive male golfers caused decreased club head speed, distance, and accuracy. Little and Williams (35) conversely found that static stretching did not impair countermovement Stretching and Performance

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Table 2. Summary of studies examining the effect of stretching on speed- and agility-dominant activities.

Speed and Agility Performance Effects

Static stretching

Positive Effect

Negative Effect

No Effect

Favero et al., 2009

Amiri-Khorasani et al., 2010

Amiri-Khorasani et al., 2010

Chaouachi et al., 2010

Chaouachi et al., 2010

Chaouachi et al., 2008

Chaouachi et al., 2008

Fletcher and Jones, 2004

Favero et al., 2009

Fletcher and Anness, 2007

Sim et al., 2009

Fletcher and Monte-Colombo, 2010

Taylor et al., 2009

Kistler et al., 2010 Little and Williams, 2006 Sayers et al., 2008 Sim et al., 2009 Stewart et al., 2007 Taylor et al., 2009 Dynamic stretching

Amiri-Khorasani et al., 2010

None

Chaouachi et al., 2010

None

None

Fletcher and Anness, 2007 Fletcher and Jones, 2004 Fletcher and Monte-Colombo, 2010 Little and Williams, 2006 Needham et al., 2009 Turki et al., 2012 Van Gelder and Bartz, 2011 PNF stretching

None

PNF, proprioceptive neuromuscular facilitation.

jump performance. Moran et al. (38) found that static stretching did not affect club head or ball speeds in golfers, while Knudson et al. (33) likewise found that static stretching had no effect on tennis serving speed and accuracy.

When static stretching is performed prior to a general warm-up or dynamic stretching, performance deficits may be reversed partially or completely (29,37,52,57). However when static stretching was performed after a general warm-up

Table 3. Summary of studies examining the effect of stretching on endurance-dominant activities.

Endurance Performance Effects

Static stretching

Positive Effect

Negative Effect

No Effect

None

Esposito et al., 2012

Esposito et al., 2012

Franco et al., 2008

Gomes et al., 2011

Nelson et al., 2005

Hayes and Walker, 2007

Wilson et al., 2010

Mojock et al., 2011

Wolfe et al., 2011

Samogin Lopes et al., 2010 Hayes and Walker, 2007

Dynamic stretching

None

None

PNF stretching

None

Barroso et al., 2012

Zourdos et al., 2010 None

Franco et al., 2008 Gomes et al., 2011 PNF, proprioceptive neuromuscular facilitation. www.acsm-csmr.org

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(5 min of treadmill running), Holt and Lambourne (29) found that increases in countermovement jump performance were less than those when performing a general warm-up alone. Pearce et al. (42) likewise found that with a warm-up period after a static stretching session, the strength and power performance deficits created by static stretching persisted. Provided that the static stretch is performed for at least 15 s, further increases in duration of stretch do not appear to alter the effect on performance (6). However Winchester et al. (59) found that while a single 30-s static stretch inhibited maximal voluntary strength, additional sets of 30-s static stretching further diminished strength. Pacheco et al. (41) uniquely found that static stretching enhanced squat jump, countermovement jump, and drop jump performance, while other studies have demonstrated that static stretching prior to activity has no effect on strength and power (8,12,14,16,24Y26,31,37,46,53). Bradley et al. (5) found that static stretching induces a decrease in countermovement jump performance that persists for 5 min but returns to baseline at 15 min. Gonzalez-Rave et al. (24) found no differences in countermovement jump performance between groups performing static stretching alone, heavy-load exercises alone, and a combination of static stretching and heavy-load exercises prior to activity. Although evidence is conflicting, a preponderance of the evidence suggests that static stretching immediately prior to strength and power activities diminishes performance. However it also appears that if static stretching is performed with adequate time (e.g., 15 min) prior to the event or is combined with a subsequent general warm-up, it has no effect on strength and power performance. Static Stretching for Speed- and Agility-Dominant Sports Static stretching prior to activity also appears to affect speed and agility negatively (1,8,9,19,20,32,48,50,51,52). Kistler et al. (32) found that static stretching decreased sprint speed, with slowing between 20 and 40 m in both 60and 100-m sprints. Static stretching also has been shown to produce slower 20-, 30-, and 40-m sprint times (19,48,51). Fletcher and Monte-Colombo (20) found both 20-m sprint times and Balsom agility tests to be affected negatively by static stretching prior to activity. However Amiri-Khorasani et al. (1) found that static stretching had no effect on the Illinois agility test in professional soccer players. When static stretching is followed by dynamic stretching or a general warm-up prior to speed- and agility-dominant activities, impairments related to static stretching may be reversed (1,8,9,16,35,50,52). Conversely Fletcher and Anness (18) found that the combination of static stretching followed by dynamic stretching decreased sprint performance. Furthermore Chaouachi et al. (8) found that dynamic stretching followed by static stretching also decreased sprint performance. The baseline level of flexibility of the athlete may impact the performance effect of stretching in speed and agility tasks. Favero et al. (16) showed that subjects with low baseline flexibility scores had a performance benefit from static stretching, with an improvement in 40-m sprint time, whereas those subjects that had higher baseline flexibility scores were affected adversely by static stretching, with slower sprint times. 182

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Based on the available literature, static stretching prior to speed- and agility-dominant activities appears to be detrimental to performance. Dynamic stretching or a general warm-up after static stretching may reverse this effect. It also appears that static stretching may affect speed and agility performance differently based on the athlete’s baseline level of flexibility. Static Stretching for Endurance-Dominant Sports In longer-duration activities (200 m or greater) such as running or cycling, static stretching prior to activity has been found to be detrimental to performance (15,58,60). However other data indicate that static stretching has no effect on endurance performance (27,36,47). Samogin Lopes et al. (47) found changes in metabolic measures after static stretching, such as improvement in blood lactate accumulation time and oxygen deficit; however performance improvements were not seen. The effect of static stretching on submaximal muscular endurance performance is unclear. Nelson et al. (40) found that static stretching prior to activity decreased the number of repetitions that could be performed in a knee flexion exercise with an external resistance of both 40% and 60% of body mass. Conversely Gomes et al. (23) found that static stretching prior to activity did not affect the number of repetitions performed at 40%, 60%, and 80% of 1RM in the bench press or a knee extension exercise. Franco et al. (21) found that a static stretch of 40 s prior to activity reduced the number of repetitions that could be performed at 85% of 1RM in the bench press, but a static stretch of 20 s prior to activity did not affect this performance. A consensus statement regarding the effects of static stretching on endurance activities is difficult to make from the current literature. It is unclear whether static stretching impairs either longer-duration (200 m or greater) cyclic activity or submaximal muscular endurance, but it is notable that no study shows a performance benefit from static stretching performed prior to these activities. Dynamic Stretching for Strength- and Power-Dominant Sports Dynamic stretching has been shown to enhance performance when instituted prior to strength and power activities (4,7,13,17,20,29,38,39,42,43,55,61). Moran et al. (38) found that dynamic stretching prior to golf improved club head speeds and ball speeds. Fletcher (17) found that a dynamic stretch performed with faster speed may affect performance more positively. Dynamic stretching in conjunction with a general warm-up has been shown to improve countermovement jump performance further (7,29,43). Needham et al. (39) also found that athletes combining dynamic stretching and front squats (using external resistance of 20% of body mass) had higher countermovement jump than that of athletes performing either dynamic stretching alone or static stretching alone, while dynamic stretching alone produced better performances than those produced by static stretching alone. However Turki et al. (55) found that dynamic stretching combined with heavy dead lifts, maximal isometric squats, tuck jumps, and drop jumps did not benefit countermovement jump performance versus dynamic stretching alone. Stretching and Performance

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Fewer studies have shown either no difference or a detrimental effect of dynamic stretching on strength and power performance (2,5,10,28,30,35,53). Jaggers et al. (30) found that dynamic stretching did not improve countermovement jump performance. Dalrymple et al. (14) found that among collegiate female volleyball players, there were no differences in countermovement jump performance between static stretching, dynamic stretching, and no stretching protocols. It appears from the preponderance of evidence that dynamic stretching improves strength and power performance when performed immediately prior to the event. Whether a combination of dynamic stretching and heavy-load exercises prior to an activity such as the countermovement jump further improves performance is unclear. Dynamic Stretching for Speed- and Agility-Dominant Sports There is literature supporting the benefit of dynamic stretching on speed- and agility-dominant activities (1,18, 19,20,35,39,54,56). Little and Williams (35) demonstrated that dynamic stretching during a warm-up for professional soccer players improved both sprint and agility performance. Fletcher and Anness (18) found that dynamic stretching combined with an 800-m jog led to faster 50-m sprint times. Needham et al. (39) found, similar to their findings with the countermovement jump, that athletes combining dynamic stretching and front squats had improved sprint times versus those of athletes performing dynamic stretching alone, and both of these groups sprinted faster than a static stretching group. Dynamic stretching also has been shown to improve 20-m sprint times (20), and one or two sets of dynamic stretching within the warm-up each improved 20-m sprint times (19). However three or more sets of dynamic stretching induced fatigue and impaired 10- and 20-m sprint times (54). Chaouachi et al. (8) found that dynamic stretching performed either alone, with static stretching, or with a general warm-up all had no effect on sprint performance. Regarding agility test times, dynamic stretching has been found to produce faster 505 agility test, Balsom agility test, and Illinois agility test times (1,20,56). It appears, however, that more experienced athletes may have less of an improvement (1). The limited available evidence appears to indicate that speed and agility performance are improved by dynamic stretching prior to activity. However excessive volume may induce fatigue and affect speed and agility performance adversely. Dynamic Stretching for Endurance-Dominant Sports There is insufficient evidence either to support or refute the practice of dynamic stretching prior to endurance activity (27,63). Further research is needed in this area. PNF Stretching for All Sports There is limited research on PNF stretching within the scope of this review, so these findings are summarized in one section. Molacek et al. (37) found that PNF stretching had no effect on 1RM bench press in highly trained individuals. Pacheco et al. (41) found that PNF stretching www.acsm-csmr.org

enhanced squat jump, countermovement jump, and drop jump performance, whereas Christensen and Nordstrom (10) found that PNF stretching had no effect on countermovement jump performance. Bradley et al. (5) found that countermovement jump performance was affected negatively by PNF stretching. Barroso et al. (2) found that PNF stretching negatively affected 1RM leg press performance and decreased the total number of submaximal repetitions that could be performed. Franco et al. (21) found that PNF stretching prior to activity decreased submaximal repetitions in the bench press, and Gomes et al. (23) also found decreased submaximal bench press and knee extension performance following PNF stretching. Discussion Based on the available evidence, it is reasonable to recommend against static stretching immediately prior to strength and power activities (2Y7,11,13,20,22,28,34,42,44,45, 50,52,59,62). However if a general warm-up or dynamic stretching is performed after static stretching, any negative effect on strength and power performance may be reversed (29,37,52,57), although this contention has been disputed (29,42). Conversely the preponderance of evidence indicates that dynamic stretching prior to a strength- and power-dominant activity is beneficial (4,7,13,17,20,29,38,39,42,43,55,61). Fewer studies have shown no difference or a detriment to strength and power performance following dynamic stretching (2,5,10,28,30,35,53). The limited evidence regarding PNF stretching prior to strength- and power-dominant activities is principally neutral or negative (2,5,10,37), with only one study showing a performance benefit (41). The bulk of the literature suggests that static stretching prior to speed- and agility-dominant activities is detrimental to performance (1,9,19,20,32,48,50,51,52). However as with strength- and power-dominant activities, an intervening period of a general warm-up or dynamic stretching may reverse this negative effect (1,8,9,16,35,50,52). Similar with strength and power, the use of dynamic stretching in the period prior to speed- and agility-dominant activities appears to be beneficial (1,18,19,20,35,39,54,56). There is insufficient evidence to recommend for or against PNF stretching prior to speed- and agility-dominant activities. The available evidence shows static stretching to have either no effect or a detrimental effect on endurance performance (15,21,23,27,36,40,47,58,60). The effects of dynamic stretching on endurance performance are unclear (27,63). No recommendations can be made for or against PNF stretching prior to longer-duration cyclical endurance events, but the limited evidence regarding PNF stretching prior to submaximal muscular endurance activity is generally negative (2,21,23). Conclusions In summary, dynamic stretching generally can be recommended in the period immediately prior to activity for most athletes, and static stretching and PNF stretching probably are reserved best for the period after activity, if used. If static stretching or PNF are used prior to activity, they probably should be followed by an intervening sufficient period (e.g., 5 min), dynamic stretching session, or Current Sports Medicine Reports

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general warm-up prior to the activity to dissipate any potential negative effects on performance.

23. Gomes TM, Simao R, Marques MC, et al. Acute effects of two different stretching methods on local muscular endurance performance. J. Strength Cond. Res. 2011; 25:745Y52.

The authors declare no conflicts of interest and do not have any financial disclosures.

24. Gonzalez-Rave JM, Machado L, Navarro-Valdivielso F, Vilas-Boas JP. Acute effects of heavy-load exercises, stretching exercises, and heavy-load plus stretching exercises on squat jump and countermovement jump performance. J. Strength Cond. Res. 2009; 23:472Y9.

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Stretching and Performance

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49. Shrier I. Does stretching improve performance? A systematic and critical review of the literature. Clin. J. Sport Med. 2004; 14:267Y73. 50. Sim AY, Dawson BT, Guelfi KJ, et al. Effects of static stretching in warm-up on repeated sprint performance. J. Strength Cond. Res. 2009; 23:2155Y62. 51. Stewart M, Adams R, Alonso A, et al. Warm-up or stretch as preparation for sprint performance? J. Sci. Med. Sport. 2007; 10:403Y10. 52. Taylor KL, Sheppard JM, Lee H, Plummer N. Negative effect of static stretching restored when combined with a sport specific warm-up component. J. Sci. Med. Sport. 2009; 12:657Y61.

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The effects of stretching on performance.

Stretching long has been commonplace in the training programs of recreational and competitive athletes. Its role in performance enhancement has been d...
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