To Stretch Or To Strengthen? That Is The Question.
Mick Hughes
Co-Author Melbourne ACL Rehab Guide / Sports & Exercise Physiotherapist / Founder and Director at Learn.Physio
I often get asked by my patients how to best manage their injuries at home or in the gym. The question that they often ask is:
Should I stretch? Or should I strengthen?
Now to be honest it's not an easy answer, because every musculoskeletal complaint can present very differently between patients, and certainly things are very different between different stages of recovery that the injury is in. A perfect example of this is avoiding stretching for a reactive insertional Achilles enthesopathy vs stretching being ok as part of the ongoing management of chronic mid-portion Achilles tendinopathy.
However, although stretching has a role to play in most injuries, a large body of good-quality evidence suggests that strengthening-alone is by far and away the best way to manage injuries from your neck, all the way down to your feet. Here is a small snap-shot of what has been published:
- The most robust of all the evidence that supports strength training over stretching is from a 2014 systematic review and meta-analysis of 26600 subjects and 3464 injuries. This review concluded that strength training-alone was able to reduce the likelihood of acute sporting injuries by 33% and overuse sporting injuries by 50%, whereas stretching-alone was not found to be effective (reference).
- One of the most common complaints I treat in the clinic is chronic low back pain (CLBP), and there is strong evidence that suggests that resistance training is very effective in reducing pain, improving function and quality of life in patients with CLBP (reference).
- Not far behind CLBP seen in the clinic is chronic neck pain and neck-related headaches (cervicogenic headaches). Once again, strong evidence points towards strength training of the neck, scapula and shoulder muscles rather than stretching of the neck for the management of both conditions (reference).
- In what I personally feel is one of the most trickiest conditions to treat, strengthening-alone has been shown to be superior to stretching-alone at the 3-month mark in regards to pain and function for the treatment of plantar fascia pain (reference).
- For my older patients out there, although stretching and strengthening improve outcomes in the treatment of hip osteoarthritis, it was strengthening-alone that yielded the best results in terms of reducing pain, improving function, decreasing disability within 2-6 months of starting the strengthening intervention (reference).
- For my soccer and AFL players out there (or weekend warriors over 30 years old), adding in Nordic Hamstring Curls into training sessions, significantly reduces the incidence of hamstring injuries in the subsequent season when compared to other players who don't perform the exercise (reference).
- Finally, and this is my favourite because I meet so many recreational runners who don't do any strength training because they believe that all they need to do is foam roll their ITB's; Adding in strength training 2x per week for 6 weeks significantly improves 5km run time when compared against those runners who didn't perform strength training (reference).
So there you have it, a very comprehensive list of evidence that shows that strengthening-alone is far superior to stretching-alone in the treatment and prevention of injury, and improvement of running performance.
In addition to these studies, I generally choose strengthening over stretching for the management of injuries because of the "2-for-the-price-of-1" effect that eccentric strength training has on muscle. Research shows that not only do eccentric strength exercises improve strength, they also improve length of the muscle and tendon being exercised (reference). This is a win-win situation, for those patients that are time-poor.
Before I sign off and piss-off my yoga buddies out there. Please don't get me wrong - I'm not throwing the baby out with the bath water!
Stretching is very useful and certainly has a role to play in managing musculoskeletal complaints. In fact, I have many patients who all I do is give them stretches because I know they're sedentary, and I know that's the only thing that they'll do to help manage their pain. What I am saying is that if you're injured, or if you like to participate in sports/vigorous exercise, stretching-alone is not going to help with your rehabilitation or improve your performance. Stretching should however be part of a complete strengthening and conditioning plan, and is a great training tool on recovery days.
As always, please feel free to share my blogs with your patients and colleagues and feel free to comment if you think I've missed the mark, or have a different opinion about stretching vs strengthening.
I hope you're all having a great week!
Kinésiologue - Réadaptation en contexte de douleur persistante
5 年Thank you for this review of the evidence, especially for?plantar fasciitis ! In the article: "In fact, I have many patients who all I do is give them stretches because I know they're sedentary, and I know that's the only thing that they'll do to help manage their pain." Are these patients aware of your belief that "if you're injured [...] stretching-alone is not going to help with your rehabilitation [...]" ?? I think that stretching alone is of little value. Sedentary clients can be informed of the evidence for strengthening exercices, and such exercises can be prescribed at relatively low intensities initially so that the difficulty level will be not significantly higher, and in some cases lower, than stretching exercices.
Anecdotally, my soccer players perform strength exercises through just more than the ROM expected of their sport and we have had no no-contact injuries in many years. We do not stretch per se but perform strength worth through their expected range of motion for their sport. As to Nordic hamstrings, I prefer GHR, reverse hypers, gerrard deadlifts and sprint/skipping variations. I do not like players lying on their knees pushing them into the ground. We also avoid lying on turf fields as they are generally not cleaned. For time efficiency we attempt to make strength work similar to the sport demands but never prior to skill work.
Co-Author Melbourne ACL Rehab Guide / Sports & Exercise Physiotherapist / Founder and Director at Learn.Physio
8 年Spot on Paul! ????
? International High Performance Sports Consultant ? Strength & Conditioning Coach ? Clinical Sports Nutritionist ? Holistic Periodisation Specialist ? Performance Mentor ? Workshop Facilitator
8 年That's great that you keep pushing the message out there far and wide as it's what's needed and the only way to slowly turn the tide on the amateur athletes and weekend warriors. LinkedIn Blogs is a great format to utilise but you have the beauty of being at the coal face in your professional capacities. To me it's pretty sad and must be frustrating for these athletes to continually battle injuries many of which are simply soft tissue injuries of the kinetic chain. As you mention strengthening doesn't have to involve using the gym or anything expensive. I know many athletes get a niggle which they compensate for which overloads another group further down the posterior chain creating another injury. There are many simple dynamic exercises that can be done to strengthen the areas from the hips, groin, knees and ankles e.g. Carioca, High Knees, High Heels, Sideways Shuffle, Ice-skater, Jumping forward from static position and most of these in reverse etc. These all work the full range of movement of the chain and strengthen the soft tissue ligaments and muscles, raise blood temp ready for exercise as well as the heart rate into the aerobic zone ready for action while being low impact and reducing the likelihood of injury. For any athletes unaware many leg or posterior chain injuries occur as a result of under-strength hamstrings being overpowered in exercise by dominant quadriceps muscles. The starting point in strengthening should ideally be with dynamic movements strengthening a good base of the soft tissue areas from the pelvis/hips to your feet. This automatically begins a strengthening of your scapular, erectus spinae, gluteus maximus, core and hamstrings which provide the stability and posture to enjoy your sporting pursuits with a result of injury being unlikely. Once soft tissue areas of the posterior chain have been strengthened the next vital cab off the rank is strengthening of your hamstrings. Although they are 1 of the 3 largest muscle groups along with Quads and Gluteus Maximus as you don't see them they tend to be overlooked "Out of sight, out of mind". Unfortunately, that is a big mistake which will lead to numerous issues in and around the knees and/or ankles. It's not a matter of if it will happen but when! Unless you enjoy time out of sport, participating with niggles or time with Physios & Exercise Physiologists it's worth investing some time and $ in getting a program made up for you that is unique to you, your sport/s and even positions played. Just take your time to suss out someone that really knows what they are doing! As a last tip the best way to strengthen your lower leg and specifically your ankle tendons and ligaments is to train a mixture of dynamic movements and jogging at low velocity and impact with a heart rate no higher than 110 BPM in bare feet. Mick only intention is to add to your important message and assist you to get the correct message out there far and wide. I don't always have much time to do this but would love to help you more in the future.