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Updates: 12 significant, 7 minor
Stretching is a pleasant ritual for many people, myself included. It’s simple, it feels good, and we believe — or hope — that it prevents and treats injuries. For many others, athletes and couch potatoes alike, stretching is also a bit of a drag: a duty that weighs on the conscience, one more thing to make time for. And yet they still do it, counting on the benefits.
Can all these people be barking up the wrong tree? Yes. This (large) article makes the scientific case against the typical stretching habit in detail. Stretching is not an important part of fitness. It’s primary goal — flexibility — does not correlate. And it’s also easily achieved with other kinds of exercise that are much more beneficial for fitness in other ways. Most stretching is simply a waste of time.
Unless you just enjoy it, of course. I stretch almost every day — hamstrings, lumbar erector spinae, and especially the deep gluteals are my favourites. I do it because it feels nice, but I don’t believe the habit is doing much more for me than a daily back scratch. I am just as stiff and inflexible and full of “knots” as I have ever been. I play sports the same way with or without it. I still get just as sore, whether I stretch or not.
I am hardly the only person to notice that stretching may not be all it’s cracked up to be, and there’s plenty of science on this. 1 This article is a detailed but readable review of the key arguments and some of the most interesting evidence. Warning: you may not “just enjoy” stretching quite so much once you realize how many myths there are about its benefits.
Flexibility has been researched for over 100 years. Its track record is unimpressive, particularly when viewed in light of other components of physical fitness. Flexibility lacks predictive and concurrent validity value with meaningful health and performance outcomes. Consequently, it should be retired as a major component of fitness.
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Berman BM, Langevin HH, Witt CM, Dubner R. Acupuncture for Chronic Low Back Pain. N Engl J Med. 2010 Jul 29;(363):454–461. PubMed #20818865 ❐ PainSci #54942 ❐
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TABLE OF CONTENTS
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Types of stretching (not just static)
This article is not just about the inadequacies of simple “static” stretching. Many stretching advocates are happy to join me in criticizing simple, old-school static stretching — that is, elongating a muscle and then holding still for a while. They are happy to do that because most of them decided long ago that some other method of stretching actually does work, and that’s where their allegiance lies. They feel no need to defend static stretching.
Unfortunately, there is no clear evidence that any method of stretching is a clear winner for any important therapeutic goal.
For instance, alternately stretching and contracting a muscle is a staple of “advanced” stretching. This is called the contract-relax (CR) method, which is part of a general strategy with the very advanced sounding name of “proprioceptive neuromuscular facilitation” (PNF). However, it’s really nothing fancy: CR just adds contraction. 3 It doesn’t increase flexibility any more than static stretching. 4 In 2011, researchers compared a normal CR stretch of the hamstring to a modified one without any hamstring contraction (instead, some other “uninvolved, distant” muscle was contracted). The effect of both stretches was the same — a “moderate increase in range of motion,” which is the one thing that stretching will achieve. It didn’t matter if the hamstring was contracted or not — with or without a contraction, the result was the same: a slight increase. This is a major blow to the central xclaim of CR-PNF stretching.
Things that sound too good to be true … still aren’t.
Some supposedly advanced stretching methods are not really “stretching” at all. There are only so many things that you can change about stretching before it really becomes something else. The classic example is dynamic joint mobility drills — repeatedly moving through a larger range of motion than usual (i.e. swinging your arms in a circle or walking lunges). Should we call that “stretching”? Perhaps. But I say no: although the kinship is clear, it already has its own name, and it’s a movement exercise, not “stretching.”
If an exercise doesn’t involve elongating muscles to the point of feeling significant tension for several seconds at least, it’s not stretching.
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There is no “truth” about stretching
There are too many mysteries in muscle and connective tissue physiology, too many different stretching methods, and too many and vague and overlapping goals for it to ever be possible to claim that stretching does or does not “work.” What kind of stretching? With what purpose?
However, plentiful recent research now shows that stretching as we know it — the kind of typical stretching that the average person does at the gym, and even the kind of stretching that most athletes do — is mostly a waste of time for most commonly identified goals. For instance, scientific reviews have concluded that there isn’t much evidence that any widely practiced form of stretching prevents injury or post-workout muscle soreness. 5 6 A major year 2000 clinical study of hundreds of soldiers showed no benefit and even some risks to stretching. 7 Some extremely popular rehab stretches are particularly futile, IT band stretching most notably, which is like trying to stretch an inch-thick steel cable.
Trainers, coaches, and health care professionals are starting to insist on making recommendations based on evidence, or at least on a really convincing physiological rationale … and stretching just has not held up well under that pressure. Nor is it even a new idea that stretching might not be all that helpful. Consider this 37-year-old passage from an excellent 1983
article about David Moorcroft, a British middle and long distance runner and 5,000 metres world record holder: 8
Stacked in a corner of Anderson’s [Moorcroft’s coach] office are bundles of scientific papers. “I’ve tried to interpret the findings of the best physiologists and translate them into sound practices,” says Anderson. “That’s made me a radical. We’ve turned some coaching sacred cows on their ear.”
For one, Anderson dismisses the stretching that most runners do. “It’s rubbish,” he says. “The received idea that by touching your toes you lengthen the fibers in your hamstrings is wrong. Soft tissue stretching like that is a learned skill and doesn’t carry over into running. Dave requires flexibility, and joint mobility, but running fast is the right kind of stretching for him.”
The world-record holder mutely demonstrates his suppleness by reaching toward his toes. His fingertips get down to about midshin.
treatment of sports injuries and chronic pain
And a fifth which I only hear occasionally, but it’s still out there:
“performance enhancement” (e.g. faster sprinting)
All of these overlapping goals for stretching have serious problems. Either they have long ago been proven to be impossible, 11 or they never made sense to begin with, or both, or worse. Certainly none of them is a slam dunk. They will all be critically analyzed below.
One final reason for stretching gets mentioned surprisingly infrequently. People prefer to give more “technical” and serious-sounding reasons for their stretching, I guess.
it feels great!
This may be the best reason for stretching. Just ask Murmel:
I stretch because it feels good. Just a couple seconds stretching this-a-way, then a couple more that-a-way, and I’m good to hop. Don’t overdo it! Holding stretches is over-rated.
~ Murmel the bunny, master stretcher
Stretching in an athletic context
A lot of stretching happens in an athletic context: stretching to warm up and prevent injury and post-exercise soreness, stretching to facilitate rehab from injuries, and maybe increase performance. The more general assumption, usually unstated, is that stretching is a major component of fitness, on par with strength and endurance.
I’ll start with these goals and beliefs because they are the easiest to debunk.
But no matter how effective that debunking, nearly everyone will continue to assume that it’s different for “serious” athletes or athletes who seem to need more flexibility: gymnastics, dance, martial arts, circus arts, and so on. It’s likely that even there stretching is not actually anywhere near as important as we have believed, and maybe not even important at all. If all the information below is taken to heart, it should be clear that a “serious” athlete might actually want to avoid stretching. They have a lot of other training to do that is definitely more important — and which will also achieve flexibility.
Until fairly recently, there were few major examples of elite athletes rejecting stretching, but that's changing. The best recent example I know of is that the Australian Ballet has purged stretching; instead, it’s all about training for strength throughout the full joint range. The Australian Ballet has written about their experience with this: same or better performance, fewer injuries. Wow.
Dogma is powerful. When there’s a long tradition of doing things a certain way, it can be extremely difficult for people to accept that it might not be necessary. For years, I have regularly gotten angry email from martial artists, always sneering smugly about how I obviously know nothing because, clearly, elite martial artists know that they have to stretch. Maybe. I doubt it, and I can see which way the wind is blowing on this, but I honestly don’t know.
I do know the power of dogma. I know how many times in sports history traditional practices have been overturned and replaced by updated beliefs that were required to break new records.
And in fact I do have some personal experience with martial arts, and I know that not every martial artist is flexible or thinks they need to be. My most memorable example was a grizzled old practitioner of Aikido — the most formidable martial artist I ever met, and also the least flexible. He seemed flexible, but it was all in how he used the rather stunted range of motion he had. He worked within his limitations like an artist — a martial artist — and you would never even haved guessed he was so stiff unless you spent time with him in training. 12 We never stretched much in that dojo, and an MMA club — with some very competitive members — also never did any stretching.
As the years tick by, I predict that there will be more and more stories about elite athletes who no longer stretch — but still kick ass.
Why is it that many Kenyans don’t stretch? Why was legendary coach Arthur Lydiard not a fan of stretching? Why does Galloway say, “In my experience runners who stretch are injured more often, and when they stop stretching, the injuries often go away”?
~ Bob Cooper,
I am a soccer referee, and mostly by happy accident began substituting what you call “ mobilizing ” for various stretches prior to my matches, and I find this does an excellent job of stimulating the muscles, whereas after only stretching I still seem to be tight for the first several minutes. Then I read this article, which corroborates what I have found in practice!
~ Carlos Di Stefano, soccer referee (reader feedback)
Stretching research clearly shows that stretching is not an effective warmup
You cannot “warm up” your muscles by stretching them: it’s like trying to cook a steak by pulling on it. Instead, the best way to warm up is probably to start by doing a kinder, gentler version of the activity you have in mind (i.e. walk before you run). The metabolic activity involved in muscle contraction does literally warm up your muscles, an inevitable side effect of all the activity that actually makes warm up effective for injury prevention.
Nothing about static stretching is more clear than this failure. Your basic quick (static) stretch warmup is one of the most studied topics in all of musculoskeletal health care and exercise science. For instance, a huge 2011 review of all the research found “overwhelming evidence that stretch durations of 30-45 seconds … imparted no significant effect” and even some evidence of harm. 14
Um, harm? Slight harm, yes: a 2014 test found that a nice pre-run stretch causes “a reduced capacity of the skeletal muscle to produce explosive force.” Yikes. As Alex Hutchinson put it for Runner’s World , “I can’t see anything good about something that makes me go slower but feel like I’m trying harder.” 15 And there’s more like that. 16
Metaphorically, “warming up” also refers to readiness for activity or body awareness. You are “warm” in this sense when you are neurologically responsive and coordinated: when your reflexes are sensitive and some adrenalin is pumping. Warmup for its own sake (i.e., without following it up with more intense exercise) is fairly pointless — the goal is to prevent injury and enhance performance. And those goals may be realistic. For instance, research has shown that a warmup routine focused on these goals actually does provide decent insurance against the number and severity of both accidents and over-use injuries. 17 18
So, warmups in this second sense is probably helpful … but does stretching warm you up in this sense? No, probably not much — certainly no more than a bunch of other exercises you could do — and quite possibly not at all. One of the most-studied warmup regimens (including one of the studies just cited), FIFA’s “The 11+” programme , notably does not include stretching. The most compelling evidence that stretching doesn’t warm you up is the evidence that shows that it doesn’t prevent injury or enhance performance (discussed below). Static stretch is somewhat stimulating to tissue, but in ways that are quite different from most actual activities.
A large study of girls’ soccer teams showed warming up can cut injury rates by about a third. Notably, the warmup that was studied, FIFA’s “11+” warmup, did not include stretching!
Because of all this, stretching to warm up does not even qualify as “official” exercise dogma anymore — most professionals actually gave up on it many years ago, and it is passé even in the opinion of a great many more informed joggers and weekend warriors. It simply doesn’t work, and it’s hard to imagine a common fitness practice more thoroughly contradicted by the evidence and by many professionals. And yet …
And yet I still see it all the time in the wild. I live and play on Vancouver’s famous “sea wall” — one of the best and most popular running routes in the world. I am able to constantly observe runners in their natural habitat, doing what runners do, and a great many of them participating in structured training programs and running groups, clearly being instructed by experts and coaches.
And they stretch to warm up. In droves. So despite the evolution of professional opinion, this practice clearly still needs to be debunked. There are still far too many people out there stretching before they run and play sports, trying to “warm up” almost exclusively by standing still and elongating muscles!
Once again, the best way to prepare for an activity is probably just to start it slowly.
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Stretching research shows that it does not prevent exercise soreness
Another extremely popular idea about stretching is that it prevents a specific type of soreness: the deep soreness that follows a hard workout. That phenomenon is called “ delayed-onset muscle soreness ” (DOMS) or sometimes just “post-exercise soreness.” Many people believe that stretching can help DOMS. Some seem to believe it like it’s their religion, and it’s amazing how determined people can be to ignore evidence that contradicts it. 19
Recently (2016), decades after this faith first got entrenched, science finally coughed up a specific reason why it might be based on something: evidence that stretching reduces inflammation in connective tissue. 20 (Exercise in general is anti-inflammatory, 21 and maybe this is partly why.) Surely this is relevant! It sure sounds like great science factoid to explain why people think stretching helps soreness after exercise. Practically a slam dunk! It is interesting evidence for sure, and I’ll return to it later.
But there are many problems with leaping to that conclusion. 22 It’s a classic mistake to assume that a scrap of biological relevance translates into a clear benefit in the real world. Unfortunately, the evidence strongly suggests that stretching does not prevent DOMS. Many studies have shown that nothing short of amputation can prevent DOMS 23 24 25 — and certainly not stretching. 26 Whatever effect stretching has on inflammation in connective tissue, it does not add up to a DOMS cure.
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Stretching research shows that stretching does not prevent injury
The commonly accepted idea that increased ROM and stretching prior to activity prevents injuries has been challenged and found to be on the shakiest of scientific foundations, or to come from such a paucity of data that no reasonable conclusions can be drawn.
~ Flexibility , by William Sands, p. 389
According to the evidence, stretching probably does not prevent injury. As I mentioned above, this has been suggested by a combination of recent literature reviews and large clinical studies, some of which I have already cited. Here’s some more.
In 2005, the
Clinical Journal of Sports Medicine
published a review of the scientific evidence to date, and found that the (admittedly limited) evidence “showed stretching had no effect in reducing injuries.” 27 Neither poor quality nor higher quality studies reported any injury prevention effect. Regardless of whether stretching was of individual muscles or entire groups, there was no reduction in injury rates.
More experimental research has been done since. For instance, a 2008 study published in the
American Journal of Sports Medicine
showed “no significant differences in incidence of injury” in soldiers doing preventative exercises. 28 Half of them participated in an exercise program including 5 exercises for strength, flexibility, and coordination of the lower limbs, and 50 of those soldiers sustained overuse injuries in the lower leg, either knee pain or shin splints. The other 500 soldiers were doing nothing at all to prevent injury in the lower limbs — no specific stretching, strengthening or coordination exercises — and only 48 of them had similar injuries. There were “no significant differences in incidence of injury between the prevention group and the placebo group,” and the authors concluded that the exercises “did not influence the risk of developing overuse knee injuries or medial tibial stress syndrome in subjects undergoing an increase in physical activity.”
However, what is clear is that the exercise regimen certainly included static stretching, and it certainly did not work any prevention miracles for some of the most common athletic injuries from the knees down. If stretching performs that poorly in such an experiment, how good can it possibly be at preventing other injuries? Probably not very.
Here in Vancouver — a running Mecca — researchers at Simon Fraser University have done an unusually large study of pre-run stretching, with more than 2700 participants. They found “no statistically significant difference in injury risk between the pre-run stretching and non-stretching groups.” 29 Injury rates for all kinds of injuries were the same, with or without stretching. It’s almost as though stretching made no difference at all. But make up your own mind!
I’m never surprised by such findings, because I’ve never heard a sensible explanation for how stretching can generally prevent injury. Usually, advocates have a vague notion that “longer” muscles are less likely to get strained: even if garden-variety stretching made muscles longer (which is doubtful in itself), and even if we knew exactly what kind of stretching to do (we don’t), and even if we had the time to stretch every significant muscle group, the benefits would still be relevant to only a small fraction of common sports injuries. An ankle sprain, for instance, or a blown knee — two of the most common of all injuries — probably have nothing to do with muscle length.
Not convinced yet? A 2014 review of exercise therapy for injury prevention in the
British Journal of Sports Medicine
was completely negative about stretching 30 — even though the authors were obviously a bit too optimistic about everything else! 31 “Consistently favourable estimates were obtained for all injury prevention measures except for stretching.” Ouch.
There may be some injury prevention powers to stretching — muscle strains seem like the most likely candidate 32 — but probably quite specific and missed by many basic, general pre-event stretching regimens. 33 For injury prevention, I can think of Sports Injury Prevention Tips that are probably more effective/efficient than stretching.
An opinion overheard at the gym…
“These kids, you know, they workout out like kids, they don’t stretch, they get hurt, they pull a groin, and they’re like, why, how did this happen? Well, maybe if you knew that stretching prevents injury, like a grown up, you wouldn’t have gotten hurt! Adults know that you have to stretch.”
Adults know? I love the implication that stretching to prevent injury is such locked-in wisdom that, in this guy’s mind, it’s synonymous with maturity: to be an adult is to know that stretching prevents injury! I came so close to interjecting: “And adults with more education know that the stretching to prevent injury is based on faith and received wisdom, and the scientific evidence clearly contradicts it.” I doubt that would have resulted in a productive conversation.
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Stretching research shows that stretch does not treat injury
That which prevents injury often treats it as well, and vice versa, and that’s the basic rationale for stretching as a treatment for injury. People believe that stretching prevents injury, so they believe that it can treat it as well — in a better-late-than-never way. Unfortunately, we already know that stretching doesn’t prevent injury, so it’s unlikely that it can treat it either.
But there are some more elaborate rationalizations for stretching as a treatment, chiefly that it corrects something.
Exercise is the closest thing there is to a general miracle drug, 34 35 and strength training is one of the best types of exercise, practically like magic: healthier and more efficient than most people realize. 36 It’s also widely accepted as a major part of injury rehab, and stretching goes along for that ride. Although it’s not taken anywhere near as seriously as strengthening, millions of athletes, trainers, coaches, and healthcare professionals still consider it to be a staple of rehab.
Tedious and specific “corrective” or “therapeutic” exercises are a tired cliché of rehab and physical therapy, both strengthening and stretching. It’s what everyone (athletes and non-athletes alike) imagines their training montage will look like if they are ever hurt.
Unfortunately, corrective exercise isn’t a great reason to build strength, and its an even poorer justification for stretching. This style of rehab is largely based on the flawed and even harmful assumption that there is something in-correct about injured patients — fragile, weak, uneven — which must be fixed by sufficiently expert and precise exercise prescription.
For instance, there is often an alleged “imbalance” that consists of both overstretched and weak muscles that need to be toughened and tightened up, and tight and overworked muscles that need to be loosened and stretched. 37 It’s surprising how much that single idea has boosted the perceived importance of stretching in the rehab equation.
This kind of thinking has been called the “trap” of corrective exercise, for pros and patients. 38 (You can read much more about “the trap” in my main strength training article .)
Most of rehab is (or should be) just “load management” — that is, doing not too much or too little at each phase of recovery, taking baby steps back to normal function.
This is doubly true for the overuse injuries, which account for a huge percentage of all athletic injuries.
Stretching obviously doesn’t have much to contribute to load management. At best, it could be considered a form of light exercise that could be used for some stimulation in the early stages… but you could and probably should mostly just stick to dynamic joint mobility drills and very easy strength training instead.
If there’s any other justification for stretching in rehab, it has to live in the much smaller neighbourhood of rehab that isn’t all about load management.
Protecting or restoring range of motion after injury
This is the most reasonable reason to stretch for rehab: not because it helps the injury itself to heal, but to prevent any related loss of range of motion, or to restore it. As explained in detail later , there is no doubt that stretching can improve range of motion. But more ROM does not have clear value in general. Many factors restrict its importance even further in a rehab context.
Stiffness is the sensation that inspires stretching in rehab, but injury stiffness — the stiffness that typically afflicts the joints near an injury — usually has nothing to do with “tight” muscles and tendons. It’s mainly just a neurologically imposed inhibition of movement, a kind of pain, a warning about movement rather than a lack of it. To the extent that it actually does involve any shortening of muscle, it’s probably either minor and temporary and things will get back to normal on their own… or it’s more serious and cannot actually be affected by stretching in any case. 39
I think there are some clinical scenarios where a little stretching to maintain or restore post-traumatic ROM is probably worthwhile, but they are minor and rare.
Specific stretching for specific injuries
If not to maintain and restore range of motion, why else would you stretch an injury? What else could stretching do for an injury? Most people imagine that it’s about restoring balance: fixing things that are “too tight” and holding back recovery in some way, probably by constantly irritating the injury. In many cases, this hypothetical restriction is considered the root cause of the injury in the first place, which must be addressed to allow healing to proceed.
Stretching itself is not generally rehabilitative, because a limited range of motion does not usually cause or sustain injuries. Every kind of injury has to be considered separately, because there are all kinds of specific ideas about why one should stretch to fix different injuries. But if you go through a list of injuries and their presumed mechanisms, not many of them cannot clearly be blamed on anything that stretching can fix. Maybe none.
For instance, people believe that the reason they get iliotibial band syndrome , one of the two common kinds of runners’ knee is because the iliotibial band is “too tight.” Unfortunately, that almost certainly isn’t the problem, and the IT band is much too tough a structure to stretch in any case. 40
A calf-stretching gadget, one of many on the market that are sold with claims that they can treat plantar fasciitis. Science isn’t so sure.
But the arguments for and against stretching for ITBS are completely different than they are for, say, muscle strains or low back pain . Different kinds of injuries, different arguments about stretching. My plantar fasciitis book goes on for three chapters about the possible role of stretching in treating that condition, but the bottom line is that it either doesn’t work, or not all that well. 41
Over time, I will expand on a few other major examples. For now, suffice it to say that
there isn’t a single clear example of specific stretching’s superiority to any other approach to rehab. Not a single one. Prove me wrong!
I welcome counter-examples, with citations. Good luck finding those.
There are a handful that might be in the “promising” category, where it’s probably worth giving it a try. It’s not like stretching is expensive or risky. But even in those cases, it’s always arguable that dynamic joint mobility drills and strengthening would be better choices. For instance, in the case of muscle strain (tear), stretching may help cue the healing mechanisms in your muscle to lay down new connective tissue in a tidy way, and there’s even evidence to support that 42 … but so will gentle contractions. Simply using the muscle almost certainly does the same thing, or does it better.
You can go back and forth like this with almost any injury, but the bottom line is that stretching has never been found to make a significant difference in anyone’s rehab.
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In fact, stretching can actually cause injuries
Ironically, stretching can actually cause some of the injuries it is thought to prevent or treat. Although, stretching is mostly a safe activity, especially if practiced with a modicum of caution, there are (at least) four potential types of stretching hazards:
Stretching as a warmup may modestly impair athletic performance, as discussed above .
Overt injury (sprains and strains) from over-stretching, fairly common in yoga, dance, martial arts, and so on. People just overdo it.
Overt injury to people who should never stretch because of medical vulnerabilities directly related to flexibility, like the hypermobility spectrum disorders and connective tissue diseases (e.g. Ehlers–Danlos syndrome, Marfan syndrome).
Unexplained body pain may be worsened by attempts to stretch, for a variety of reasons, probably mostly related to aggravating pre-existing conditions.
Hypermobility and Ehlers-Danlos syndrome
Some people are much more flexible than average — pathologically flexible. “ Hypermobility spectrum disorders ” (HSD) are a group of conditions defined by joint hypermobility — unexplained joint looseness. 43 Ehlers–Danlos syndrome (EDS) is a closely related group with known genetic causes 44 that includes hypermobility along with fragile tissues that heal poorly, especially skin, with many consequences. All of these conditions together are quite common, and chronic pain is a routine complication. 45
Most people don’t need to stretch, but people with HSD/EDS really should not stretch … and they may not know it. HSD/EDS is often undiagnosed and mistreated; it is clinically important and yet often non-obvious. So lots of people are probably suffering without having any idea why or that they shouldn’t be stretching. Consider this story from a 75-year-old reader:
Upon continued strong urging by my physical therapist, I engaged in “glute” and “quad” stretches — quickly to my detriment and horror. MRI survey confirmed gluteal minimus and medius tendinitis and partial thickness tendon tears.
After a year of seeking help and ineffective treatment I was just this month diagnosed by a rheumatologist with hypermobility joint syndrome.
This condition does not seem to be on the “radar” of most docs or PT’s. As a kid, I delighted in acrobatics, some said I was “double-jointed”; and in high school and college, modern dance (which included acrobatics). I was still dancing and hiking up until a year ago, but this injury has been devastating!
Now I understand the problem, so my rehab routine is strengthening within a normal range of motion. Feel-good, easy whole-body stretching only. Swimming has been a great help, along with careful exercising with weights at the gym.
It’s awful that this patient, with a long history of hypermobility, was convinced to overstretch by “strong urging” from a healthcare professional. This is a perfect example of clinical ignorance of hypermobility and the consequences of unjustified enthusiasm for stretching. Most people, even healthcare professionals, are simply oblivious to how common and serious hypermobility is — but it’s highly relevant to the value and safety of stretching.
Hypermobility is a common vulnerability that is directly related to stretching. There are many other medical conditions that have nothing obvious to do with stretching, but can be aggravated by stretching. A simple example: back pain has many possible causes, several of which might be aggravated by stretching, even severely.
And yet people routinely attempt to self-treat back pain with stretching, more or less oblivious to the possibility that it will do more harm than good in some cases.
Here’s the story of my own ill-fated attempt to treat some neck pain with stretching:
Stretching Injury How I almost ripped my own head off! A cautionary tale about the risks of injury while stretching ~ 1,200 words
Stretching research shows that stretching probably doesn’t enhance performance (and it definitely doesn’t make you sprint faster)
The most flexible athletes are not necessarily the most successful.
~ Flexibility , by William Sands, p. 389
You don’t hear this argument for stretching as often as your hear the others. And yet it comes up, especially with runners, and with athletes who play sprinty team sports. It’s a common practice to stretch when you’re off the field. The habit is probably usually rationalized as an injury prevention method, but many of those athletes will also insist that it enhances their performance — that the muscles “spring back” from the stretch and make them run faster. 46
I’ve already mentioned a huge 2011 scientific review by Kay et al that found “overwhelming evidence” that pre-exercise stretching has “no significant effect.” That was not a surprise. What is a little surprising is that the same review showed the opposite of a benefit — that pre-exercise stretching might reduce muscle strength. 47 I wouldn’t take the danger too seriously, but it certainly emphasizes the lack of benefit: if anything, it swings the other way. Yikes!
Similarly, research has shown that stretching does not improve sprinting … but it gets worse. What really happens to your sprint if you stretch first? It turns out that, all other things being equal, the athlete who didn’t stretch is actually going to leave you behind! An Australian research group in Perth did this experiment in early 2009. They rounded up a few athletes and tested their sprinting with and without a stretching regimen between sprints. 48 The results of the tests were clear: “There was a consistent tendency for repeated sprint … times to be slower after the static stretching.” In other words, if you want to perform in a sprinty sport, you might not want to stretch right before getting your cleats dirty.
There are many possible mitigating factors here. 49 However, the complexities only emphasize the absurdity of the legions of people who have an oversimplified faith that stretching is important. The evidence is clear that stretching is generally pointless for enhancing performance, and possibly worse. Scientific reviews keep reporting the same conclusion. 50 Maybe eventually this news will reach amateur athletes? But don’t hold your breath.
In the face of so much discouraging evidence, it makes sense to assume that sport itself provides all the “stretching” one needs. The late Mel Siff:
It is almost heretical to question this stretching doctrine, yet it is important to disclose that there is no research which proves categorically that there is any need for separate stretching sessions, phases or exercises to be conducted to improve performance and safety. To appreciate this fact, it is useful to return to one of the clinical definitions of flexibility, namely that flexibility refers to the range of movement of a specific joint or group of anatomical tissues. Moreover, flexibility cannot be considered separate from other fitness factors such as strength and stamina. There is no real need to prescribe separate stretching exercises or sessions, since logically structured training should take every joint progressively through its full range of static and dynamic movement. In other words every movement should be performed to enhance flexibility, strength, speed, local muscular endurance and skill, so that separate stretching sessions then become largely redundant.
~ Facts and fallacies of fitness , by Mel Siff, p. 123
Siff’s sensible minimalism — from 1988 — stands in stark contrast to a much more common and marketable “flexibility first” approach, an approach that just happens (coincidence, I’m sure!) to give coaches, trainers and therapists something to be expert about: the idea that athletes must make a point of increasing flexibility first (by whatever stretching method), and then train for the strength and coordination to exploit this marvelous new range of motion. That picture is quite likely to be exactly backwards.
Stretching for pain (and for pleasure)
Stretching as rehab for injury has already been covered. The next few sections are loosely about stretching as therapy for unexplained chronic pain problems where the role of injury is unclear. This part of the article is undergoing some renovations, and may be a bit disjointed and incomplete for a while.
The anecdotal evidence that stretching “works” for miscellaneous body pain and stiff and aching muscles is substantial. (So is the anecdotal evidence that it can backfire .) There is also some scientific evidence suggesting that stretching is helpful for common stubborn pain problems, such as neck and back pain, 51 52 but it’s also a complicated, incomplete, underwhelming mess, and there are also popular stretching practices that are clearly a waste of time. One of the best examples is the idea that tight hamstrings cause back pain, and therefore stretching them is good back pain therapy. But they really don’t, and it’s really not. 53 And yet that belief probably accounts for at least 50% of all the stretching people do for back pain!
In general, stretching doesn’t seem to come close to “curing” anyone, but darned if it doesn’t also sometimes seem “take the edge off” enough to make it worth trying. So people in pain stretch, and sometimes they feel better. A little bit. For a while.
People who feel stiff and tight usually assume their range of motion is limited by literally short muscles, but this is rarely the case, despite how it feels. Stiffness isn’t the same as being inflexible; they aren’t even really related.
Most stiffness is a sensation, a symptom, a kind of mild pain with movement rather than an actual limitation of movement.
Even hypermobile people often feel stiff! Genuinely abnormal muscle tightness (dystonia) is much less common than the symptom of stiffness, but some milder dystonias probably do blend right in with other common aches and pains.
There are many possible causes of soreness and stiffness that stretching has little to do with: central sensitization , and positional cervical cord compression and multiple level radiculopathy, vitamin D and magnesium deficiency, and non-obvious entrapment of nerves (neuropathy) and bloods vessels (claudication). Several hard-to-diagnose diseases can involve long-term excessive aches and pains as a major symptom, such as the hypermobility disorders, facioscapulohumeral muscular dystrophy (FSHD), and multiple sclerosis. And then there’s drug side effects, too! 54
That is just a sampling; all of these and more are summarized in 34 Surprising Causes of Pain . If you have pain from any of these sources, stretching is quite unlikely to help. In some cases, it might be useful for symptom control, at best.
Of course, there could be reasons why stretching is good for pain that we don’t understand, or are only just barely starting to understand. In the next sections, I’ll get into some of the causes of stiffness that stretching might be more relevant to: inflammation, trigger points, and contracture. But — spoiler alert — there’s literally not one clear promising example of stretching as effective medicine for anything painful. Not one.
Stretching, inflammation, and aging
Why do we so clearly get stiffer as we age? Even in people who have nothing in particular wrong with them, none of the many causes of aches and pains discussed above?
If there’s one thing most responsible for the feeling of needing to stretch, it’s probably the most common cause of aches and pains: “ inflammaging .” Chronic low-grade inflammation that gradually escalates over the years, for all kinds of poorly understood reasons. 55 This kind of stiffness is basically a form of mild pain that limits range of motion basically by making it uncomfortable. Our brains are more reluctant to allow free, quick movement of sore tissues. Stiffness is probably mainly a form of inhibition, then.
Unfortunately, systemic inflammation cannot be diagnosed or treated reliably by any means: it is simply too complicated and mysterious. Nevertheless, it is a trendy bogeyman, and allegedly anti-inflammatory diets in particular are extremely popular. But the best defense is simply to be as fit and healthy as possible.
And stretching? That seems like a long shot. But it’s worth discussing, at least.
Stretch your inflammation away?
A 2016 study produced one scrap of evidence that stretching reduces inflammation in connective tissues. 56 It’s not clear how much “inflammation in connective tissue” is related to inflammaging — maybe none, maybe lots — but obviously there could be a connection.
We do also have some relevant evidence that inflamed connective tissue is associated with back pain, 57 which is of course the epicentre of stiffness as we age (although back pain actually backs off quite a bit on the far side of middle-age).
That evidence is all there is, and it’s too scanty to trust yet. In fact, I am confident that these isolated research clues are probably misleading, and I don’t really buy that stretching reduces inflammation any more than I believe that massage reduces inflammation (a popular idea based on one over-hyped study 58 ). But let’s keep our minds open.
If stretching does help some inflammation resolve, obviously that would be good for us. It wouldn’t even have to be a large or consistent effect (neither are the benefits of pain meds). “Taking the edge off” sometimes would be enough to explain the reputation stretching has for relieving stiffness and soreness.
Chances are strong that inflammaging is a steamroller that stretching cannot really touch, however. There are several high plausible mechanisms for inflammaging that are quite unlikely to be affected by stretching. The best hope is that stretching is somehow mildly anti-inflammatory, regardless of what caused the inflammation, but it’s more likely that fitness is much more “anti-inflammatory” than stretching specifically. Practically any functional stimulation of the same tissue — not just stretching — might have the same modest anti-inflammatory effect.
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Stretching for trigger points
There is one kind of soreness that is common and might be responsive to stretching: the stiffness and aching associated with those sensitive spots in muscles commonly known as “muscle knots” or trigger points.
The story goes like this: trigger points are isolated regions of contracted muscle fibres, basically micro cramps. If that’s how they actually work, then stretching might be a viable treatment method. Unfortunately, how they work is highly debatable, and basically unknown.
Stretching as a treatment for trigger points has some expert endorsements. In the weighty text
, researchers Dr. David Simons and Dr. Siegfried Mense wrote that stretching “by almost any means is beneficial.” This depends on chain of assumptions and theories about how trigger points work: the micro-cramp is metabolically exhausting, like an engine revving in the red, producing waste metabolites that pollute and irritate the surrounding tissues, causing pain and more contraction. In theory, a trigger point cannot burn fuel if it is fully elongated, which would give the energy crisis a chance to abate — a vicious cycle breaker.
If they are right, then stretching works about the same way that stretching out a calf cramp works: you win the tug-of-war with spasming muscle, just on a smaller scale. This sounds great on paper, but there are several major problems in both theory and practice. Simons and Mense also emphasize that it has “not been firmly established” that stretching trigger points is helpful, and that stretch works primarily for “newly activated, single-muscle” trigger points … leaving out a lot of trigger points that are serious problems. There are many circumstances in which you cannot realistically hope to win a tug-of-war with a strong one, because it would be too anatomically awkward and/or too painful.
How can we pull apart a powerful contraction knot — a tiny segment of muscle fibres in full spasm — with anything less than pliers, a vice, and a glass of bourbon? We almost certainly do not have the leverage or pain tolerance required, especially if the muscle fights back with a defensive contraction (which may account for the cases that backfire). That trigger point is like a knot in a bungie cord: all we’re going to do is stretch the hell out of the bungie cord on either side of the knot. If it works at all, it probably mostly only works on the milder cases that don’t matter much in the first place.
And then there’s the possibility that Simons and Mense were just wrong, and a trigger point is not like a tiny cramp at all. If there is no metabolic “revving,” no energy crisis to interrupt by pulling muscle proteins apart like kids fighting on a playground, then it’s back to the drawing board: either stretching doesn’t work at all, or we just have no idea how it works. Which is possible.
This topic is covered in much greater detail (about 10x the length of this section) in my trigger points book .
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Is stretching good for tendons? Can it align their fibres?
Muscle and tendon, although they are distinct tissues, blend together quite seamlessly. Much of what we think of as mucle is an extension of tendinous tissue, and vice versa. It’s impossible to draw a line where tendon stops and muscle starts, and if stretching doesn’t do much to muscles, it probably doesn’t do much to tendons either.
And so most likely a positive effect of stretching on tendons is minimal or nil. Digging a little deeper …
In general, tissues are stimulated to growth and repair by the same forces that they normally have to deal with (and also the same forces that occasionally overload and overwhelm them and cause overuse injury or trauma). That stimulus is dished up far more efficiently and thoroughly by normal (and athletic) activity than by any isolated deliberate exercise therapy.
Cells inside of tendons generate collagenous fibres and absorb others as needed in response to stresses, constantly remodelling and tweaking the tendon so that it is optimized to cope with the actual stresses it encounters all day, every day. (Organisms always act on the assumption that the immediate future will probably be similar to the immediate past — that doesn’t always work out, but it’s a pretty good rule of thumb.)
However, tendons are quite static compared to other tissues, and remodelling is slow and “conservative” — they don’t do it quickly. Even a very strong stretch to a tendon constitutes an extremely brief input of stimulus relative to the context of an entire day or week of normal usage of the tendon. It probably takes months of regular, consistent, and significant new stresses for a tendon to change.
For comparison, consider how bone remodels — and bone is much more dynamic and responsive than tendons are. If bones are subjected to strong new stresses, they will change, slowly but steadily getting thicker and tougher in just the right way to cope with that stress. But it takes a lot! Now, how much do you suppose you could influence that process by deliberately applying a force to the bone? Even a fairly heroic twenty-minute application per day — far more than anyone would ever bother stretching a single tendon, or pair of tendons? And even if it could work, what are the chances that the deliberate application of force would be a good enough “simulation” of natural biomechanical stresses that it would elicit the desired, relevant adaptation? A simulation might be good enough in principle in some cases, but in general it’s just not going really be very much like the stresses that the tendon actually has to deal with in the real world — and therefore fundamentally inefficient way of preparing for it! If it works at all.
About alignment … the specific notion that tendon stretching will “align” its fibres is a particularly dubious and overly optimistic concept. Tendons are well nigh impervious, rupture only with extreme forces (and/or when already compromised), and change only in response to long term “just right” overloading. It’s relevant to understand that they are so tough that they are the strongest link in the chain, and in many cases they will tear away from their moorings on bone (avulsion fracture) before the “rope” breaks. For a mere stretch, collagen fibres don’t line up obediently any more than they already are — and tendons have impressively well-aligned microscopic orderliness to begin with.
It’s also extremely important to note that study after study after study has shown no injury prevention benefit to stretching — as covered above — and that includes tendon injuries. Tendons are not getting injured any less frequently in people who stretch a lot. If you want to reduce the chances of your tendons rupturing, then the way to do it is to expose them to a bunch of activities. Push the envelope just a little: enough that they are challenged, but not brutalized! Just the right amount of stimulation.
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Stretching does feel good, and maybe that is a kind of pain-killer
If stretching is mostly irrelevant to pain and injury, why is it that I feel like I have to stretch or I’m going to seize up like an old piece of leather? Why do I have this compulsion to stretch, and why does it feel so good, if it’s not actually doing anything? Why is this true for so many of us?
Because it is probably actually doing something! It’s just probably not doing what you thought it was doing. And we don’t really know for sure what it is doing. If we are intellectually honest, we simply have to admit that.
People routinely report that stretching feels good, that it reduces muscle soreness, or that they feel a strong urge to stretch. And I’m one of them. I have a stretching habit because it feels good, and because it feels like I’m going to “seize up” if I don’t. In particular, I stretch my hamstrings regularly and strongly, and it feels as pleasantly essential to my well-being as slipping into a hot bath — but the exact nature of the benefits are completely unclear to me, and I suspect it’s about as medically useful as a back scratch.
It’s the endorphins, stupid! A reader scolded me for not mentioning endorphins here, specifically that stretching releases endorphins.… but literally anything that feels good “releases endorphins,” by definition. That’s what endorphins do. They are how we feel good. A back scratch releases endorphins. So mentioning endorphins is just a science-y way of saying that stretching feels good.
It’s probably a stew of genuine but mysterious and subtle physiological benefits — like the heart rate regulatory effect noted in the last section — plus almost certainly some good placebo, too. I was raised on stretching. Despite my doubt about the conventional wisdom, I tend to emotionally “believe” in stretching just like everyone else — it’s deep in our culture, and, since stretching feels good, it’s easy for my mind to jump to the conclusion that it must be good. But of course that’s not really helpful at all — lots of things feel good without having any clear physiological benefits. Stretching might be like scratching: an undeniably strong impulse, but with almost no relevance to athletic performance or overall health.
I just don’t know. And based on the research to date, no one else does either.
If people believed that feeling good was the only thing that stretching was good for, most people — especially the athletes — would drop it from their exercise routine immediately. Most of us have better things to do. However, if someone firmly declared, “I stretch just to feel good,” I would applaud and say, “Hallelujah! That is an excellent reason to stretch! And one of the few that I can defend!”
And, then again, there may actually be real physiological benefits to stretching — just not the usual ones that get tossed around.
Scratching your inner itch: a feel-good theory
Is food an effective therapy because it tastes good?
Is music an effective therapy because it sounds good?
Essentially every pleasant sensation and experience has therapeutic qualities. These therapeutic qualities are not unimportant, but they’re not the same thing as an effective therapy. There’s a good reason why your physical therapist never prescribes ice cream. Here’s the last big stretching mystery I’d like to cover: how can stretching be so pleasant without (apparently) doing much measurable good? Look at this pattern:
Stretching feels great … but it’s over-rated and nowhere near as medically or athletically useful as most people think.
Massage feels even better … but its effects on pain are notoriously mild and fleeting.
Chiropractic “adjustments” can feel scrumptious, even addictive, especially in that cinder-block-rigid area between the shoulder blades … but in most cases you’ll be craving a re-do before long (which makes for a lovely business model for chiropractors).
The pattern is that of being “relieved” instead of “fixed.” Over many years of thinking about pain and therapy, it has been a stubborn mystery to me why these things can feel so good — really, really good — without making any large or lasting difference to most painful problems, most of the time.
Feeling good without working all that well causes no end of confusion and trouble. Wonderful and profound sensations are largely responsible for an epidemic of excessive optimism about their healing powers. It’s understandable that we would expect something that feels that good to work well, but a lot of testing has shown over and over again that stretching, massage and chiropractic are not exactly saving the world from its aches and pains.
It’s not hard to explain how something might feel good without curing pain. Sex feels great, but it does not cure pain. Back scratches, chocolate cake, sunshine, and hot baths: all wonderful, all mostly powerless to cure pain.
But stretching is where the gap between how it feels and how well it works is the most glaring, the best feeling but most useless of “treatments.” I’ve already mentioned that I do stretch regularly because I like it, but that doesn’t quite cover it: I actually stretch for pleasure almost every single day. I’m as inflexible and prone to aches and pains as ever, and I’ve never been able to justify the habit with anything except, “Because it feels good, dammit.” And that’s fine.
But why does it feel that good? “It’s stimulating” just doesn’t cut it. I can give a specific reason why each of the delicious things above feel so good. But stretching? I just don’t get it.
And then one day — while I was stretching, of course — I had an epiphany: stretching doesn’t just feel like scratching an itch, maybe it’s actually scratching an itch. A deep itch. In my experience, stretching feels best when I am sore from working out — which only deepens the mystery. Why would it feel so pleasant to pull on soft tissues that are incredibly sore?
That soreness is like an internal “rash” or any skin irritation. And we feel an incredible compulsion to scratch rashes, mosquito bites and other itchy, irritated things. Consider the mosquito bite: scratching it is certainly not going to “treat” it, and we know it. But the temporary relief of scratching is so great it almost transcends pleasure and degenerates into a nasty compulsion. As many pleasures do.
Could it be that exercise-induced soreness is kind of like a minor internal “rash”? And that stretching is just about as close as we can get to “scratching” it? To get a little fleeting relief? This is the best analogy I’ve come up with yet to describe how stretching feels to me.
There may be many reasons why stretching feels good without being particularly helpful, but this makes some serious sense to me. It’s specific and plausible. It achieves the difficult trick of simultaneously accounting for both the unusually pleasant sensation and the more or less total lack of any meaningful effect. And it nicely fits the way I like stretch best when my muscles feel the worst. And it makes even more sense if you extend the metaphor of the itch to include the even more common sensations of being stuck or stagnant, which I’ve written about in the past (guest posting for Todd Hargrove’s excellent blog, see The Bamboo Cage ).
I have often said that stretching and other relieving sensations of massage or spinal adjustment feel “like” scratching an itch. But I never went that extra step and considered that maybe they feel like that because, in a way, they actually are — because we can have genuine internal “itches,” vague sensory annoyances … and very limited and indirect ways of scratching them.
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Stretching for contracture: Thumbs down to static stretching as a treatment for seizing up
“Contracture” is the unlovely process of muscle and other soft tissues seizing up in response to neurological problems or prolonged immobilization. Your face can’t really “freeze like that” as your mother warned you, but if you could make an ugly face long enough — weeks — eventually contracture really would set in. This is pathology, mind. The tissue changes. For the worse.
Most people probably assume that long, intense stretches must be an effective prevention/treatment for contracture, perhaps the only viable option. It is not an assumption held with much conviction, but stretching always gets the benefit of the doubt, whether it deserves it or not, and it seems to make sense that stretching would be a cure for contracture.
Common sense fails again. As it so often does.
The Cochrane Collaboration
published a review of static stretch for the treatment and prevention of contractures. 59 The verdict? Thumbs way down. Based on “high quality evidence” they concluded that “stretch is not effective for the treatment and prevention of contractures.” I’m shocked. Shocked, I say!
Treatments are usually more obviously valuable to those who need them more. For example, the effect of acetaminophen is more obvious to someone with a headache. This very basic principle doesn’t always apply, but it usually does. This evidence shows that stretch does not meaningfully help even for a condition where the need for tissue elongation is dramatic.
So this is (yet another) great example of a “technical” reason to stretch that many or most people would assume to be effective. But no — probably not static stretch, anyway. 60
Pathologically seized up tissue cannot be meaningfully elongated. So what’s happening when healthy people seem to get flexible?
Stretching for flexibility
Beliefs about flexibility and the optimal means of stretching have often proceeded from assumptions that have never been tested and from an almost religious zeal regarding the perceived benefits of stretching by a few.
~ Flexibility , by William Sands, p. 389
There is really only one effect of stretching that seems to be clear and (almost) uncontroversial: it does actually increase flexibility. Even just plain old static stretching.
For whatever it’s worth, people do seem to be more flexible when they stretch regularly for a while. Meaningful improvement is elusive, but it can be done. The phenomenon is widely observed, and seems to have been confirmed by experiments. I previously cited Marshall et al — a decent, recent example — and there are more (cited and discussed below). Less than you’d think at this point in history, though! There’s hundreds of studies of anything these days, but not this.
So, you can get more flexible “for whatever it’s worth,” but what is it worth?
Is it actually even a benefit?
The American College of Sports Medicine believes that flexibility is “important in athletic performance (e.g., ballet, gymnastics) and in the ability to carry out activities of daily living.” It’s a "major component" of fitness, along with body composition, cardiovascular endurance, muscle endurance, and muscle strength. They recommend 2–3 days of stretching per week (2–4 repetitions of multiple stretches per day). 61
Personal trainers certainly buy into it. About 80% of American trainers prescribe static stretching — for all the reasons, but mainly for the flexibility. 62
I will start by arguing that is not worth much to most people, even athletes. To make that case more effectively, it’s also important to consider the nature of flexibility. When someone increases their flexibility, what changes, exactly? How does it work? Contrary to what nearly everyone believes, it’s probably not by actually making tissue “longer.” I’ll close the flexibility discussion by looking at plasticity versus neurological tolerance.
The value of flexibility
“I want to be more flexible,” people say. Even when they have normal range of motion in every joint. What’s this about? Why are people so determined to be more bendy? What is it you want to do with that super power?
The fact that there are actually several elastic superheroes speaks to our genuine craving for greater range of motion. We love the idea. But the reality is that hardly anyone actually needs to be more flexible. Most people have a normal range of motion — that’s why it’s normal! Unless you are specifically frustrated because you lack sufficient range of motion in a joint to perform a specific task, you probably don’t need to be more flexible.
What exactly are you planning to do with your flexibility?
Even abnormally poor flexibility is usually no big deal, as long as you are otherwise healthy. There just aren’t many functional limitations caused by being super stiff that actually matter much. A couple examples:
Toe touching is the ultimate in trivial flexibility goals. People can live their whole lives without being able to touch their toes without any practical consequences, for instance. This is one of the key points of the article: that flexibility should only matter if it can help us do something that actually matters to us. For the martial artist, flexibility enables performance goals that martial artists care about! Great! But if a dude doesn’t care if he can touch his toes ... so what?
Reaching bra buckles actually matters to women, of course, but — unless something is diagnosably wrong with that