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Stretching: Acute and Chronic?The Potential ConsequencesMike Stone,PhD,Michael W. Ramsey, PhD, Ann M. Kinser

East Tennessee State University, Johnson City,Tennessee

Harold S.OBryant,PhD

Appalachian State University,Boone, North Carolina

Chris Ayers, MS

East Tennessee State University, Johnson City,Tennessee

William A. Sands,PhD

United States Olympic Committee, Colorado Springs,Colorado

National Strength and Conditioning Association

Volume 28, Number 6, pages 6674

Keywords: acute stretching; chronic stretching; range of motion

Introduction

Stretching can be defined as the actof applying tensile force tolengthen muscle and connective

tissue. Often stretching is performed as

part of a warm-up prior to physical exer-tion. Typically, stretching is used to en-hance the range of motion (ROM)about a joint (flexibility). The resultingenhancement may be viewed as acute(temporary) or chronic.

There are many different types of stretch-ing that can be performed. A quick lookat the internet (under stretching) of-

fers a variety of stretching types andmethods, including:

Ballistic stretching Dynamic stretching Active stretching Passive (or relaxed) stretching Static stretching Isometric stretching Proprioceptive neuromuscular facili-

tation stretching

Although in some cases the nature of

these methods is essentially the same,it gives the coach/athlete a wide varietyof methods from which to choosewhen acutely or chronica lly st ret ching.

Although, the exact timing and degreeof stretching varies somewhat fromsport to sport, there are basically 2forms of stretching taking place on a

regular basis among athletes: first isacute stretching (as part of a warm-upprocess), and second is chronic stretch-ing that is often quite extensive andusually occurs after a training session.Athletes and coaches commonly hold 2beliefs concerning these 2 forms ofstretching: (a) acute stretching (part ofwarm-up) may increase per formanceand will reduce the injury potential of

exercise; (b) chronic stretching will in-crease performance, reduce aches andpains, and reduce the injury potential ofexercise and sports performance.

However, data exist indicating that thesebeliefs may not be completely true. Thepurpose of this paper is to answer severalbasic questions concerning stretching andits relationship to sports performance,with a particular focus on gymnastics.

Will Warm-Up (Acute) Stretch-

ing Produce a Better Perfor-mance?Table 1 shows the results of studies deal-ing with the relationship of various ac-tivities and various performance charac-teristics that would have effects onsport. Although not all studies show adecrease in performance, the large ma-jority do indicate that acute stretching

s u m m a r y

Stretching is commonly used by

many athletes in different sports. Al-

though acute stretching, as part of a

warm-up, can enhance range of mo-

tion,it may also reduce performance.

Acute stretching can reduce peak

force, rate of force production, and

power output. Chronic stretching

may enhance performance,although

the mechanism is unclear. Acute

stretching has little effect on injury.

However,chronic stretching (not par t

of warm-up) may have some injury

reduction potential.

6 December 2006 Strength and Conditioning Journal


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can decrease subsequent performance,particularly for maximum strength andexplosive strengthrelated movements.So, for a sport such as gymnastics, inwhich explosive strength is quite impor-tant, such a loss of explosive capability

may reduce the ability to perform.

The underlying mechanisms that can re-duce performance subsequent to acutestretching are not necessarily apparentor easily understood. To begin to under-stand why acute stretching may reduceperformance, a brief discussion of howstretching affects ROM is in order.There are basically 2 mechanistic possi-bilities that may have an effect individu-ally or in combination: (a) stretching al-ters ROM by altering the structure and

properties of soft tissue (muscle andconnective tissue); (b) there is an in-crease in pain tolerance.

Tissue stiffness is the ability of a tissueto resist change in length and is repre-sented by a change in force per changein length (F/L). A decreased or in-creased stiffness may alter the stress-strain curve (changes in force whenmuscle or connective tissue is length-ened or shortened by stretching). Fig-

ure 1 (36) shows a passive stress-straincurve in which a tissue is beingstretched until failure. Note that to apoint, the greater the lengthening ofthe tissue the greater the force pro-duced. The amount of energy that isabsorbed by the tissue before failure isa function of its tensile strength.Therefore, the more energy absorbed,the stronger and the more stretch resis-tant the tissue. The stiffer the tissue,the more it resists the stretch, andthere are 2 possible results: (a) the rate

at which force rises is faster; (b) thefailure point of the tissue may bereached f aster.

Muscle can also be activated to resist astretching load (e.g., eccentric contrac-tions). Thus, muscle tissue has activestiffness properties. Contraction duringstretching can take up the slack in the

series elastic elements faster and resultin a faster rate of force production andan increased amount of force beforefailure (36).

A ver y stiff tissue would require moreforce to stretch it to a given length. Sotissue stiffness could (theoretically) inhibit flexibility. Therefore, an acute ex

December 2006 Strength and Conditioning Journal

Table 1The Effects of Acute Stretching (Warm-Up) on Performance Variables

Performance Study Result

Sprinting Nelson et al. (47)

McBride et al. (39)

Decrease

Decrease

Standing long jump Koch et al. (30) ND

Counter movement jump Cornwell et al . (11)

Knudson et al. (33)

McNeal and Sands (42)

Decrease

ND

Decrease

Static jump Young et al. (69)

Cornwell et al. (11)

Decrease

ND

Dynamic strength Fry et al. (16)

Kokkenen et al. (31)

Decrease

Decrease

Isometric strength Nelson et al. (46)Behm et al. (8)

Avela et al. (7)

DecreaseDecrease

Decrease

Strength endurance Nelson et al. (47)

Nelson et al. (46)

Decrease

Decrease

Summary:Explosive performance can be compromised by acute stretching.ND=no difference

Figure 1. A force-length or stress-strain curve.1 = elastic region:region of stretch in

which the elastic properties of the tissue increase the force by resisting

(pulling back against the stretch). 2 = nonelastic region: region of stretch in

which the elastic properties of the muscle are stretched to their limit and

nonelastic elements resist the stretch.


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ercise reducing tissue stiffness couldenhance flexibility. However, in the

normal intact human, changes in thelength of a muscle (or muscles) alsoalter the feedback to the nervous sys-tem. For example, a less stiff musclewould produce less force at a givenlength, and the nervous system sensesthis difference. Thus, alterations inmuscle stiffness (active or passive)

could change how the nervous systemreacts to a given muscle length. There-

fore, a change in active or passive mus-cle stiffness could also effect thestretch reflex characteristics and tissueelastic properties (less energy storedfor elastic recoil) such that force trans-mission is disrupted/muted, decreas-ing force magnitude, rate of force de-velopment, and power output.

Some evidence indicates that an in-creased ROM as a result of stretching isrelated to reduced tissue stiffness (20).However, the majority of studies indi-cate that although tissue viscosity maybe altered, muscle stiffness and elastic-

ity are largely unaffected by acutestretching as part of a warm-up (11) orchronic stretching over a 3- to 4-weekperiod (21, 34, 37) and that alterationsin ROM after stretching are more re-lated to increased pain tolerance (21,37). On the other hand, repeated andprolonged stretching for 1 hour (7) ad-versely affected active and passive mus-cle stiffness, and 30 sessions of staticstretching produced a decrease in pas-sive muscle stiffness (20). The decreasein active tissue stiffness as a result of

prolonged stretching could be a fa-tigue-induced phenomenon ratherthan simply a stretch result (5, 24).Thus, increased ROMs as a result ofstretching may result from decreasedmuscle stiffness but this appears to bemore likely caused by altered tissue vis-cosity and pain tolerance.


Figure 2. If muscle stiffness is a key,then stiffness can be increased and performance

should also increase (modified from J. McBride [39]).ROM=range of motion.

Table 2Effects of Chronic (Weeks) Stretching on Performance

Study Subject Description Result

Positive effect

Dintiman (14) Trained (n = 145, 4 groups) Faster running speed*

Handel et al. (22) Various athletes (n = 8) Increased force

Kerrigan et al. (29) Elderly (n = 47E, 49C) Improved gait

Wilson et al. (64) Powerlifters (n = 9E, 7C) Enhanced stretch-shortening cycle

Hunter and Marshall (26) Various athletes (n = 60, 3 groups) Improved vertical jump

Worrell et al. (67) Active students (n = 19) Increased hamstring force

Hortobagyi et al. (25) Active students (n = 12) Increased knee extension force

No effect

Nelson et al. (46) Physically active No effect running performance

Godges et al. (18) Physically active No effect on gait economy

*Augmented strength + sprint training.E = experimental;C = control.


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Interestingly, maximum strength andstrength training effects appear to be as-sociated with increased active and pas-sive muscle stiffness that is independentof ROM alterations (17, 34, 37, 55). Anincrease in muscle stiffness appears to be

associated with enhanced strength (66)and various types of performances, in-cluding the vertical jump and improvedrunning (i.e., enhance running econo-my; Figure 2). Thus, a loss of perfor-mance associated with acute stretchingcould be associated with a decrease inmuscle stiffness.

Stretching has also been associatedwith muscle damage. In mice, Blackand Stevens (9) found that acutelystretching muscle fibers 5 % beyond

resting resulted in a 5% loss of isomet-ric force production. Strains (stretch-ing), as low as 20% beyond restinglength, have been related to muscledamage and decreased force in humans(38). So vigorous stretching could in-duce enough muscle damage to reducemaximum strength and explosivestrength. However, in the authorsopinion, it is unlikely that chronicstretching in well-trained athleteswould continue to induce tissue dam-

age. Otherwise, one would expectchronic muscle soreness among ad-vanced and elite athletes, and thisclearly is not the case.

A finding noted in most of the perfor-mance studies indicates that acutestretching as a part of warm-up reducesmaximum strength (force magnitude)and several associated variables, such asrate of force development and poweroutput (8, 46, 53). Additionally, a de-creased H-reflex has been noted (6, 7,

20). The H-reflex is a monosynapticreflex elicited by stimulating a nerve,particularly the tibial nerve, with anelectric shock. Thus, it appears thatstretching acutely as part of a warm-upcan negatively alter force production,power output, and stretch-shorteningcycle characteristics such that strengthand performance, including such explo-

sive performances as gymnastics, can becompromised. This compromise may beassociated with alterations in musclestiffness (Figure 2).

Will Chronic Stretching

(NonWarm-Up) ImprovePerformance?Many athletes stretch after a trainingsession. The belief is that over the longterm, this practice may reduce injuryand perhaps enhance performance.Table 2 shows studies that have investi-gated long-term stretching and perfor-mance. These studies generally showthat performance, particularly maxi-mum strength and explosive strengthperformances, were enhanced. Whenthe studies are taken as a whole, the de-

gree of enhancement appears to besmall, perhaps 3 to 4 %. However, itshould be remembered that in high-levelsports, a small percentage of improve-ment can actually be a lot. For example,in the last 2 Olympics, the difference be-tween first and fourth place (for mostsports) was less than 1.5 %. The mecha-nisms underlying enhanced perfor-mance, as a result of chronic stretching,are unclear at best.

Due to position requirements forsome sports, such as weightlifting,diving, and particularly gymnastics, itbecomes obvious that an increasedROM would be advantageous. If tis-sue stiffness could be reduced, onemight argue that movement economywould be enhanced. In this contex t,Godges et al. (19) noted that amongvery inflexible patients, stretchingcould produce performance (gait) en-hancements. However, the primary al-teration (3- to 4-week studies) appears

to be stretch-pain-tolerance and notchange in visco-elasticity (21, 37).Thus, it is doubtful that muscle stiff-ness and movement economy wouldbe substantially altered as a result ofstretching.

Another possibi lity is that stretching in-duces additional hypertrophy. Chronic

stretch (24 h/d) causes some muscledamage and chronic reflexive activityand results in muscle hypertrophy inanimals. Acute stretching (5% of initial length) can cause some muscledamage (at least in untrained animals

and result in a force deficit (9). However, it is doubtful that the stretchingused in training athletes would beenough to cause sufficient damage totissue to increase hypertrophy andforce-producing capability, especiallyin well-trained strength/power athletes. Therefore, the exact mechanismthat underlie the small but positiveperformance improvements that oftenaccompany increased flexibility remainelusive. Perhaps the underlying mechanism explaining increased perfor

mance is simply a greater ROM resulting from greater pain tolerance.

Will Stretching (Acute or Chron-ic) Affect Injury Rates?Although flexibil ity is often believedto be related to injury, particularlymuscular injury, it is not clear as tohow it is related (57). The mechanismthat is usually associated with the roleof flexibility in musculo-tendinous injury deals with stret ching the ti ssue

beyond its normal active limits. Foexample, in sports movements inwhich the tissue does not have enoughelasticity to compensate for additionastretch, the tissue will tear. If the average person jumped into a fore-aft splittypical of gymnastics, most often therewould be considerable injury to themusculo-tendinous tissues (not tomention a few other items). If highlevels of flexibility are gained throughstretching, such as takes place amonggymnasts, this position can typically

be achieved without problems. Although this example is likely related toflexibility and is a good reason to enhance flexibility, not all injuries can beattributed to ROM characteristics. Foexample, the majority of pulled (tornmuscles, such as those affected when asprinter pulls a hamstring, do not appear to occur as a result of overexten



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sion of the tissues. Many of thesenonlimit-stretching injuries appearto occur during eccentric loading butwithin normal ROMs (58, 62). Fur-thermore, the injury potential appearsto rise as the eccentric loading pro-duces faster strain rates (61). Thus,some other mechanism must be re-sponsible for the nonlimit-stretch

induced injuries.

One mechanistic possibility responsi-ble for nonlimit-stretch injuries is in-creased muscle stiffness, particularlywhen the muscle i s active, such as dur-ing eccentric loading (54, 58). It ispossible that as external eccentricforces are imposed upon stiff musculo-

tendinous units that are less compli-ant, less force can be absorbed beforeinjury occurs. So a more compliant tis-sue system has a cushioning effect, re-ducing the trauma on the muscle fibersand resulting in less damage (65).Some evidence indicates that greaterpassive muscle stiffness, as measuredby flexibility, is associated with more

muscle damage and subsequent loss ofstrength and degree of delayed sorenessas a result of eccentric contractions(41). Thus, a stiffer tissue may increasethe potential for injury. Becausestrength training can increase musclestiffness, it is possible that the strongermuscle is now more susceptible to in-jury. However, the ava ilabl e data do

not completely support this idea; al-though strength training increasesmuscle stiffness, it can also reduce in-jur y potential. As tis sue is stretched itabsorbs energy, and active muscles arecapable of absorbing more energy thanpassive muscles (36). A stronger mus-cle would have a greater energy ab-sorbance reserve before tearing during

eccentric actions (35). Thus, strengthtraining, particularly eccentric train-ing, may actually reduce rather thanincrease injury to the musculo-tendi-nous unit.

Table 3 shows studies that deal withfactors related to injury and injury re-duction during physical activity. Sev-


Table 3Potential Injury Reduction

Injury and Rate of Motion

Study Injury site Result

Nattress et al. (44) Lumbar spine No relation

Zuberbier (70) Low back No relation

Emery and Meeuwisse (15) Groin (hockey) No relation

Watson (63) Soccer injuries No relation

Some Determinates of Injury

Study Variables Result

Stewart and Burden (60) Extreme rate of motion Increased injury risk

Konradsen and Vioght (32) Excessive rate of motion/poor stability Increased injury risk

Orchard (48, 49) Previous injury or defect Increased injury risk

Emery and Meeuwisse (15) Previous injury Increased injury risk

Orchard (48, 49) Fatigue Increased injury risk

Almeida et al. (1) Volume of training/fatigue Increased risk potential

Yamamoto (68) Relative strength Decreased injury risk

McCarthy et al. (40) Strength Decreased injury risk

Orchard et al. (49) Strength Decreased injury risk

Nadler et al. (43) Strength Decreased injury risk

Crosier et al. (13) Strength (eccentric) Decreased injury risk

Askling et al. (2) Strength Decreased injury risk


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eral factors appear to predispose oneto increased injury, such as previousinjury. Interestingly, with the excep-tion of joints showing extreme ROMs,most studies indicate that reducedflexibility shows little relationship to

typical sports injuries. Neither acute(50) nor chronic (23) stretching ap-pears to effect a significant reductionin physical activityrelated injuries.Indeed, Thacker et al. (62), in an ex-tensive review of the flexibility litera-ture that included 361 articles datingback into the 1950s, concluded thatthere is little relationship betweenstretching (e.g., increased ROM) andinjury. Thus, there is little evidencethat stretching and improved ROM ef-fects a lower injury rate.

This discussion brings up an interestingdilemma: if acute (as part of a warm-up)stretching reduces performance andgood flexibility is a necessity in perfor-mance, as in gymnastics, then:

A. How long do you have to wait be-fore the effect (reduce performance)wears off? Unfortunately, this prob-lem has not been well studied. Ob-viously, the effect of reduced explo-

siveness does wear off, but exactlyhow long it takes is unknown. Theauthors observations suggest thatthe wear-off time may last as long as1 to 2 hours and that differences inwear-off time may be individualcharacteristics. Part of the reasonfor differences in the wear-off timelikely involves determining whattype of stretching was used the de-gree of inhibition and the presenceor absence of fatigue, as well as indi-vidual differences.

B. What if there is an interventionbetween the acute flexibility exer-cise and the subsequent perfor-mance? This question deals withthis idea: flexibility can be acutelyenhanced by stretching as part of awarm-up; however, thi s reducesexplosiveness during performance.What happens if some explosive

movement takes place between thestretching and the subsequent per-formance? Some data indicate thatin fact the intervening exercise canreduce the negative effect ofstretching on explosiveness, at least

to an extent (69). However, it isnot known to what extent the al-terations in flexibility can be re-tained.

C. Is there a warm-up method in whichflexibility is gained but performanceis either not adversely affected or en-hanced? Vibration has been shownto acutely (and chronically) enhanceexplosive performance (28, 51, 52).Vibration has also been shown toacutely (and chronically) enhanceflexibility resulting from stretching

(3, 27, 56). When the 2 are com-bined, it may be possible to enhanceflexibility without altering explo-siveness. Cochrane and Stannard(10) found that women field hockeyplayers using a vibration platformwhile in a stretched position for 5minutes before exercise can increaseboth flexibility and explosiveness asmeasured by jumping.

Conclusion

Stretching can alter the ROM about ajoint and improve flexibi lity. However,stretching as part of a warm-up may re-duce performance. It is unclear whetheror not acute stretching reduces musclestiffness or increases pain tolerance (orboth). Indeed, most available data indi-cates acute performance reduction canoccur and that it may be related to de-creased tissue stiffness or alterations innervous system components of thestretch-shortening cycle, such as the my-ototic reflex. These alterations in turn

can result in a decreased maximumstrength and explosiveness and inferiorperformances. Chronic stretching mayenhance performance, although themechanism is unclear. In such sports asgymnastics, in which great ranges ofmotion are clearly necessary for perfor-mance, it becomes obvious that flexibili-ty is a primary ingredient. Acute stretch-

ing seems to have little effect on injuryHowever, chronic stretching (not part oa warm-up) may have some injury reduction potential.Several questions concerning stretchingremain to be answered. For example

how long do the negative effects of acutestretching on explosiveness last? Cooperative efforts between USOC SportScience, East Tennessee State Universityand Appalachian State University arecurrently under way to begin answeringthese questions.

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Acknowledgment: This paper was par-tially fund by a USECA grant.

Mike Stone is currently the Exercise and

Sports Science Laboratory Director at

East Tennessee State University.

Michael Ramsey is Assistant Professor of

Exercise Science at East Tennessee State

University.

Ann Kinser is currently finishing course-

work for a Masters degree in Exercise and

Sport Sciences at East Tennessee State

University.

Harold OBryant is a senior faculty mem-

ber in the Health, Leisure, and Exercise

Science Department at Appalachian StateUniversity.

Chris Ayers is an Assistant Professor at

East Tennessee University.

William Sands is the head of Sports Bio-

mechanics and Engineering for the Unit-

ed States Olympic Committee.


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