Does stretching actually prevent injury?

Our worst nightmare as a runner or athlete is getting injured. We often try all kinds of methods to prevent this…

What do we think actually causes injury?  

Do the traditional things we do to prevent injuries like stretching actually help?

A study carried out by Saragiotto et al, 2014 (SOURCE) found runners to believe that not stretching both before and after their run would leave them more likely to get injured. This is something that is  commonly discussed in the Consortium clinic with our clients. We therefore felt this to be an important topic for us to provide an evidence based opinion on to help our clients separate fact from fiction.

Can static stretching reduce my chances of getting injured?

Static stretching (holding a position to stretch a muscle for a sustained period of time) historically has been a routine of many runners/athletes prior to beginning their activities to prevent against injury. However.... more recent evidence has suggested it’s maybe not as worth your while as you first thought! Lauersen (2013) (SOURCE) found static stretching did not have any protective effects with no support found for stretching and preventing injury when carried out either before or after activity. In fact.... it has also been suggested it can instead have a negative impact on the level of your performance! Did you know static stretches held for 45 seconds or longer, prior to activity can reduce maximal strength, power and muscular explosive performance, such as when jumping and sprinting? (Simic, 2012) (SOURCE). 

OK...... So 45 seconds is a long time to hold a static stretch…

So what if I stretch for a shorter time? 

Static stretching for shorter periods has been less associated with the previously mentioned negative effects but still has no benefit towards injury prevention, this may lead you to ask whether it is worth your time doing both before and after exercise? 

Should I continue to stretch? Or is there a better alternative?

One thing we do know is that gradual muscle strengthening has demonstrated the ability to reduce sporting injuries by 1/3 and over-use injuries by a 1/2 (Lauersen, 2013) (SOURCE). More recently, specific eccentric muscle strengthening (working the muscle as it lengthens) has also been shown to both improve and gain long standing muscle length through a process of ‘sarcomeregenesis’ (increasing amount of contractile units in the muscle) (O’Sullivan, 2012) (SOURCE). 

So what does this actually mean? In essence, if we included and carried out a specific graded eccentric muscle strengthening routine as part of our weekly training schedule we can ‘kill two birds with one stone’. By not only improving strength, which is proven to reduce the likelihood of injuries, but also by improving your flexibility at the same time if this is one of your aims. An example of this has been demonstrated with studies around the hamstring muscles suggesting an increase in muscle fascicle length by 1/2cm by using eccentric strengthening can reduce the chances of injury by up to 70% (Askling, 2014) (SOURCE). 

But I feel better after stretching… so Should I stop doing this or carry on? 

Often clients have carried out static stretches as part of their routines and ’rituals’ before races/competition/games for many years and it makes them feel good and ‘ready to go’… So if you feel happier continuing to do this it is perfectly O.K, although as we have discussed there is no evidence towards preventing injury and holding them less than 45 seconds should have no negative effects on your performance.

An alternative that you also may be aware of is dynamic stretching (using controlled movement and momentum of the body part e.g. whilst standing raising your knee towards your stomach then back to it's starting position repeatedly in a controlled manner to move the muscle from one end of its range to the other). Although this again has little evidence towards injury prevention. Instead, it may be more suited and is recommended to be included in a warm up to gradually prepare your body for the activity in hand (Behm, 2011) (SOURCE). 

However, it is also worth mentioning that if your sport requires your joints to achieve sustained extremes of movement such as in Ballet or Kick boxing then static stretching is recommended to be carried out before in short duration to prevent impairment (Behm, 2011) (SOURCE).  

Summary…

To summarise, static stretching before activity is something we have done for many years with the feeling it would ‘stop us pulling a muscle’, but surprisingly the evidence towards this is in fact pretty poor. A better alternative to prevent injury is suggested to be a gradual eccentric strengthening routine included in your weekly training plan. But as mentioned above this is not to say you can’t ever carry out static stretches again… As even though this is maybe not doing what we thought it was to prevent injury, it is not going to do you much harm either.

Hope you’ve enjoyed reading our latest ‘blog’… If you have any questions or would like any further information such as, how to implement a specific eccentric strengthening routine please don’t hesitate to contact us via our Facebook page, Website or telephone and one of our team will be more than happy to help. Also if there are any specific topics you’d be keen for us to cover in our next installments of our blog please let us know.

Kind regards,  

The Consortium Team

Are you in need of a modern approach to manage your persistent lower back pain?

Looking for a modern and revolutionary approach to treating lower back pain? Tried every treatment before with no improvement..?

Most people with severe non specific chronic lower back pain (back pain with no specific structural cause found) have two things in common, they usually have severe pain and also a lack of function. Many of them have undergone treatments including manual therapy, exercise therapy, core exercises, stabilising exercises, manipulation, electrotherapy, massage, pilates, yoga , medications, injections etc (the list goes on....). The evidence base for management of back pain has evolved immensely over the last decade but despite this many patients continue to be treated with all of these traditional therapies with little effect.

Even the latest national guidance from NICE (National Institute for Health and Care Excellence) clearly state that practitioners should not be offering acupuncture, injections and electrotherapy for treatment of lower back pain (source). 

Frustratingly, these types treatments are still marketed and sold to people in pain on a daily basis. There is therefore a clear need for physiotherapists, doctors, surgeons, osteopaths and chiropractors to improve the quality of what we offer for conservative management of non specific lower back pain and in the process move to a more contemporary approach. 

(USEFUL ARTICLE TO READ ON NEED FOR DRASTIC CHANGES IN CURRENT MANAGEMENT OF LOWER BACK PAIN)  

Since its inception, the Consortium clinic has always listed Cognitive Functional Therapy as a service provided for its patients. The research has shown this approach to be significantly more effective than any previous approaches we have traditionally used to manage back pain (source). This is exciting news for the future for those of you who suffer from severe disabling back pain. 

What is Cognitive Functional Therapy (CFT)?

When it comes to treating lower back pain - a one size fits all approach simply does not work.

CFT is most importantly patient centred. This means it is focused entirely around you as a person, your life and your goals. CFT looks at the way you move and analyses some of the strategies you have adopted as a result of living in pain. It targets the fears and beliefs that are associated with performing spinal movements and the movement behaviours you often display around your back. It will help you understand that pain will not necessarily cause your back any damage. We will look through your MRI scan with you and help you to dethreaten some of the worrying things you may have been told about it. CFT will try to get you out of the vicious circle that so many patients find themselves trapped within. Often all of these things lead to a significant increase in the tension around your back and this often drives the nervous system to be over sensitised.

CFT will look to undo and change many of these things to provide you with better strategies to ease your pain and lessen your disabilities. It will help empower you to get back to doing the things in life that are of value to you.

What does the research say that Cognitive functional therapy achieves?

The trials for CFT suggest that this approach is far more effective than the traditional management of being manipulated, mobilised or exercised. It has been shown to significantly reduce peoples levels of pain, disability and fear of movement. It often improves your mood and mental wellbeing. Patients who have had CFT often have less need for ongoing treatments or time off work (source).  

Is Cognitive Functional Therapy appropriate for everybody?

CFT can be applied to the majority of back pain. It is most appropriate for people with non specific back pain that is provoked by certain movements, postures or activities (85% of back pain). It is often even more appropriate for the more complex and disabled patients. It is also used successfully for those people with mild to moderate levels of back pain. However, CFT is not for everybody..... there are some patients (less than 15%) who have had a very specific structural cause of lower back pain identified, this approach is still beneficial but may focus on specific structural cause of symptoms aswell as all of the other contributing factors.

Want to learn more?

This video interviews one of the key researchers in CFT, it discusses what cognitive functional therapy actually is and the significant effects it can have....

Interested?

The Consortium clinic believes strongly in the use of the CFT approach for lower back pain. Should you wish to discuss with one of our clinicians then please contact our enquiries line on 01482 847705. We can always schedule one of our spinal specialists to ring you if needed. Alternatively you can email us at enquiries@consortiumphysio.co.uk