Does stretching prevent injury?

From the Guidelines

Stretching alone does not reliably prevent injury during physical activity. While stretching can improve flexibility and range of motion, research has not consistently shown that it reduces injury rates when used as the only preventive measure 1. A more effective approach combines dynamic warm-ups (moving stretches like leg swings or arm circles) before activity with static stretching (holding positions) after exercise. For injury prevention, incorporate a comprehensive routine that includes not just stretching but also strength training, proper technique training, gradual progression of activity intensity, and adequate rest between workouts.

The likely reason stretching alone isn't sufficient is that injuries typically result from multiple factors including muscle imbalances, poor movement patterns, overtraining, and inadequate preparation for specific activities. According to the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis, flexibility exercises, such as static stretching, should be performed 2-3 days a week, with each stretch held for 10-30 seconds 1. However, this should be part of a broader approach to injury prevention.

Key components of an effective injury prevention strategy include:

• Dynamic warm-ups before activity to increase blood flow and prepare muscles
• Static stretching after exercise to maintain flexibility
• Strength training to improve muscle balance and overall physical fitness
• Proper technique training to reduce the risk of overuse and traumatic injuries
• Gradual progression of activity intensity to avoid sudden spikes in physical demand
• Adequate rest and recovery between workouts to allow for muscle repair and rebuilding

As noted in a study on exercise-related injuries among women, the total amount of exercise, including frequency, duration, and intensity, is a significant predictor of injury risk 1. Therefore, it's crucial to tailor exercise programs to an individual's current level of fitness and previous physical activity to minimize the risk of injury. A comprehensive approach to injury prevention, rather than relying solely on stretching, is essential for reducing the risk of injury and improving overall physical fitness.

From the Research

Evidence on Stretching and Injury Prevention

• The relationship between stretching and injury prevention is complex and has been studied extensively 2, 3, 4, 5, 6.
• Some studies suggest that stretching may be beneficial for injury prevention in certain sports, such as those involving high-intensity stretch-shortening cycles (e.g. soccer, football) 2.
• However, other studies have found that stretching may not be effective in preventing injuries in sports with low-intensity or limited stretch-shortening cycles (e.g. jogging, cycling, swimming) 2, 3.
• A review of the literature found that stretching had no significant effect on reducing total injuries, including shin splints, tibial stress reaction, sprains/strains, and lower-extremity and -limb injuries 6.
• Another study found that increasing range of motion beyond function through stretching may not be beneficial and can actually cause injury and decrease performance 3.
• The effectiveness of stretching in preventing Achilles tendon injuries is also unclear, with some studies suggesting that stretching may increase the risk of injury 4.
• A review of warm-up and stretching techniques found that certain protocols may be effective in deterring muscular injury, but the evidence is contradictory 5.

Types of Sports and Stretching

• Sports involving high-intensity stretch-shortening cycles may benefit from stretching to increase the compliance of the muscle-tendon unit 2.
• Sports with low-intensity or limited stretch-shortening cycles may not require stretching, as the power generation is primarily through active muscle work 2.
• The type of sport and the specific demands on the muscle-tendon unit should be considered when determining the effectiveness of stretching for injury prevention 2, 3, 4.

Limitations of Current Evidence

• Many studies have methodological limitations, including conflicting definitions of warm-up and stretching, and variability in study design and protocols 5, 6.
• The quality of the evidence is often low, with few studies meeting the criteria for high-quality research 6.
• Further research is needed to fully understand the relationship between stretching and injury prevention, and to develop evidence-based guidelines for stretching protocols 2, 3, 4, 5, 6.