To Stretch Or To Strengthen? That Is The Question!

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 (1: Lauersen et al., 2014)

• 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 (2: Kristensen et al., 2012).

• 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 (3: Gross et al., 2015).

• 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 (4: Rathleff et al., 2015).

• 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 (5: Brosseau et al., 2015).

• 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 (6: van der Horst et al., 2015).

• 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 (7: Karsten et al., 2016).

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 (8: O'Sullivan et al., 2012). 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!

References:

1: http://www.ncbi.nlm.nih.gov/pubmed/24100287

2: http://www.ncbi.nlm.nih.gov/pubmed/21791457

3: http://www.ncbi.nlm.nih.gov/pubmed/25629215?dopt=Citation

4: http://www.ncbi.nlm.nih.gov/pubmed/25145882?dopt=Citation

5: http://www.ncbi.nlm.nih.gov/pubmed/26400851

6: http://www.ncbi.nlm.nih.gov/pubmed/25794868

7: http://www.ncbi.nlm.nih.gov/pubmed/25946163

8: http://www.ncbi.nlm.nih.gov/pubmed/22522590