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Stretching and Its Effects
on Recovery: A Review
William A. Sands, PhD, CSCS,
1
Jeni R. McNeal, PhD, CSCS*D,
2
Steven R. Murray, DA,
3
Michael W. Ramsey, PhD,
1
Kimitake Sato, PhD,
1
Satoshi Mizuguchi, PhD,
1
and Michael H. Stone, PhD, FNSCA
1
1
Department of Exercise and Sport Science, East Tennessee State University, Johnson City, Tennessee;
2
Department of Physical Education, Health, and Recreation, Eastern Washington University, Cheney, Washington; and
3
Department of Kinesiology, Colorado Mesa University, Grand Junction, Colorado
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided
in the HTML and PDF versions of this article on the journal’s Web site (http://journals.lww.com/nsca-scj).
ABSTRACT
STRETCHING IS A COMMONLY
PRESCRIBED EXERCISE ACTIVITY
THAT HAS BEEN APPLIED TO
WARM-UP, INCREASING RANGE OF
MOTION (ROM), AND RECOVERY
FROM TRAINING. THE PRACTI-
TIONER SHOULD UNDERSTAND
THE EFFECTS OF STRETCHING
EXERCISE AND THE INHERENT DIF-
FERENCES BETWEEN TYPES OF
STRETCHING EXERCISES AND
ACTIVITIES DESIGNED TO
ENHANCE "LOOSENESS" AND
FREEDOM OF MOTION. STRETCH-
ING TO ENHANCE ROM MAY BE
CONTRAINDICATED WHEN
APPLIED TO RECOVERY ACTIVITIES.
STRETCHING FOR RECOVERY
SHOULD BE PAIN-FREE MOTION
WITHIN THE CONSTRAINTS OF
MAXIMUM ROM OF A JOINT.
FOR A VIDEO ABSTRACT OF THIS
ARTICLE, SEE SUPPLEMENTAL
DIGITAL CONTENT 1 (SEE VIDEO,
http://links.lww.com/SCJ/A119).
STRETCHING
Stretching has long been a part of
athlete training, defined as “.
the application of force to mus-
culotendinous structures in order to
achieve a change in their length, usu-
ally for the purposes of improving joint
range of motion (ROM), reducing stiff-
ness or soreness, or preparing for
(physical) activity” (3, p. 3). Flexibility
is the ROM of a joint or a related series
of joints, such as the spine (61,84).
Stretching for increased flexibility
tends to be uncomfortable, seeking to
enhance stretch tolerance by relatively
extreme body positions that put mus-
cles and tendons under unaccustomed
tensile stresses (51,53). Stretching as
a preparatory activity (i.e., warm-up)
is clearly not intended to help an ath-
lete “recover” because the stretching
precedes the bulk of the training lesson.
Stretching to reduce stiffness and sore-
ness is a therapeutic aspect of stretch-
ing that is distinct from the other
concepts listed above (87). Thus, the
term “stretching” can be somewhat
paradoxical by application to several
diverse purposes. For example, Kisner
and Colby (44, p. 187) differentiate
between stretching and “ROM exerci-
ses,” with stretching involving tissue
tensions and lengths beyond those nor-
mally available, whereas ROM exerci-
ses seek to keep movements within the
current boundaries of tissue extensibil-
ity (2, p. 5).
There are a number of confusing
notions about stretching, flexibility,
and recovery. For example, the ROM
of a joint almost always is determined
statically or passively, whereas the
actual expression of ROM in sport is
usually dynamic (87, p. 311). As a desir-
able property of movement, and the link
between stretching and flexibility, Siff
(81, p. 123), has commented that move-
ment proficiency is based on a balance
of static and dynamic positions and
motions and that tissues must be con-
ditioned to withstand deformations and
shocks. In terms of recovery, stretching
seeks to achieve motion that is pain free,
unencumbered, and coordinated.
However, other activities and modal-
ities can enhance ROM in the short
term. Heat, cold, vibration, massage,
hydrotherapy, anesthetics, and other
modalities have been shown to
reduce pain and enhance ROM
(41,47,61,73–75).
Stretching can be categorized as active
or passive, static or dynamic, and acute
or chronic (61). Active stretching refers
to a limb position that places a joint at its
extreme ROM by virtue of the tension
obtained from agonist muscles (e.g.,
while standing, raising a straight leg
from the hip in flexion using the tension
from hip flexors). Active stretching po-
sitions are opposed by the antagonist
muscles’ elastic and viscous resistances
(e.g., while standing, raising a straight leg
from the hip in flexion is resisted by hip
extensor muscles and resistive properties
of tendons, ligaments, skin, and fascia).
Passive stretching involves placing a joint
KEY WORDS:
recovery; stretching; flexibility; range of
motion; extensibility; stiffness
VOLUME 35 | NUMBER 5 | OCTOBER 2013 Copyrig ht ÓNational Strength and Conditioning Association
30
in an extreme ROM position by the use
of gravity or inertia (e.g., a gymnast or
dancer sitting in a split position or
swinging a limb to an extreme position).
Static stretching is the most commonly
prescribed type of stretching involving
placement of the body and limbs in an
extreme ROM position and holding this
position for a period by gravity, partner
assistance, or agonist muscle tension.
Dynamic stretching moves joints
through extreme ROM movements
without long pauses or holds and
momentarily taking a limb to an extreme
position (e.g., swinging the leg at the hip,
forward and backward in the sagittal
plane, momentarily stretching hip flex-
ors and extensors). Acute stretching
referstoasingleexerciseorstretching
for a relatively short duration, usually 30
seconds or less (6,68). Chronic stretch-
ing refers to repeated stretching exer-
cises or sets of exercises over days and
weeks.
Stretching to develop semipermanent
ROM improvements relies largely on
the achievement of “stretch tolerance”
(50,52,54). Achievement of stretch toler-
ance requires focused practice in extreme
and uncomfortable ROM positions.
Stretching discomfort is difficult to quan-
tify but relates directly to stretching
intensity and pain tolerance (11, p. 2,
18,30). The presence of discomfort or
pain in an effort to achieve recovery
appears contradictory to the concept of
recovery. However, the discomfort level
of stretching often has been pre-
scribed as tension remaining below
a pain threshold (2, pp. 58, 145),
without considering that an optimal
discomfort and tension level may be
obtained in a different position that
results in the more effective achieve-
ment of a new ROM. Moreover, the
inducement of pain also appears to
contradict the concept of recovery-
relaxation (2, p. 5, 62,71).
RECOVERY
Recovery is usually defined as the pro-
cess of returning something that was
lost (85, pp. 260–261). “Mostly, recov-
ery is defined as the compensation of
deficit states of an organism (e.g.,
fatigue or decrease in performance)
and, according to the homeostatic
principle, a reestablishment of the ini-
tial state” (39, p. 6). However, recovery
in sport is a 2-stage process: returning
what was lost (i.e., reducing fatigue)
and adapting or supercompensating
to training demands (85, pp. 260–
261). Adaptation results from the inter-
play of work and recovery. Recovery is
not, and should not be, considered
complete or effective unless the athlete
reaches a higher state of fitness after
recovery (61,85, pp. 260–261). Thus,
simply reducing fatigue or returning
to a nonfatigued state represents in-
complete recovery. Moreover, the ulti-
mate test of recovery-adaptation lies
in the transfer of newly acquired
fitness and/or skill to actual sport
performance (10, pp. 1–21, 14,87,
pp. 173–174).
ARE STRETCHING AND RECOVERY
COMPATIBLE?
In terms of recovery, the primary
objective of stretching should be to
achieve enhanced ROM and/or
reduced stiffness and soreness. The
acute effects of stretching are short-
lived, from seconds to minutes
(21,22,28,43,45,82,93). Supporting
Wolff’s law (function determines
structure), semipermanent changes
in ROM require focused training for
days to months (13,23,46,65). Acute
therapeutic stretching may return
ROM after immobilization from
injury (55,58,72) and quasi-therapeu-
tically in dynamic "loosening" activi-
ties to promote ease of motion after
warm-up and/or cooldown activities
(1,15,38,89), as a means of developing
concentration control (27,42) and the
ability to cope with chronic pain
(78,79,91). The difference in stretch-
ing and ROM exercise concepts, as
described above, has been noted by
Verkhoshansky and Siff (87, pp. 173–
174), who have attributed some gains
in ROM to changes in muscle and
tendon stiffness and neuromuscular
properties. If stretching is included
in recovery efforts, the movements
should be dynamic and pain free,
contraindicating stretching positions
that elicit discomfort and pain.
The role of stretching and recovery
has a relatively long, and somewhat
confusing, history. As early as 1961,
de Vries (19) observed reduced mus-
cle distress after static stretching.
Static stretching has been shown to
reduce electromyographic median
frequency fatigue of back extensor
muscles and thereby enhanced cop-
ing with chronic pain (24). Smaller
decreases and more rapid return of
strength after delayed onset muscle
soreness (DOMS) were observed
using static and proprioceptive neu-
romuscular facilitation stretching
(16). Stretching via pain-free motions
with minimal resistance may enhance
postexercise strength, ROM, and
recovery (62). Heat-shock protein
incursion of immobilized rat gastroc-
nemius muscle was reduced after
static stretching and was thought to
protect the muscle against reloading
injury after immobilization (34). Cold
combined with stretching was supe-
rior to either alone or heat in reduc-
ing postexertional pain (67).
In contrast to the previous para-
graph, an acute reduction in muscu-
lar strength after fatiguing exercise
has been shown to continue after
static stretching for recovery (25).
Maximal voluntary contraction force
remained unchanged, whereas reflex
and stretch-shortening parameters
were reduced after fast, repeated
muscle stretching (5). Pre-exercise
stretching was not effective in reduc-
ing postexercise soreness and
reduced force abilities (36). In a study
of active exercise, passive resting, and
stretching for recovery from isoki-
netic knee extensions at 50% maximal
voluntary contractions to fatigue,
active recovery (i.e., light exercise,
cycling with no resistance) showed
better return to baseline recovery
(62). Active recovery was better in
returning strength-endurance perfor-
mance than either passive recovery
or stretching, which did not differ
from each other (62). Cold-water
immersion was better than carbohy-
drate supplementation and stretching
on recovery of basketball players
Strength and Conditioning Journal | www.nsca-scj.com 31
participating in a 3-day tournament
(62). Heat, cold, and stretching
groups performing stair running did
not achieve enhanced recovery over
a control group (69). Rat sciatic nerve
axonal retrograde transport (i.e.,
intracellular material movement
toward the cell body from the termi-
nal ending) was inhibited by 6% strain
(10% neuron lengthening) stretching.
This rodent study showed that
stretching caused ischemia and
increased neuron tensile forces (86).
The reduction of pain via stretching
is a laudable goal for recovery activ-
ities. However, perceived muscle
pain was not relieved by static
stretching (59). Stretching pre- and
posteccentric exercise did not reduce
DOMS (90). Inconsistent results
were obtained using warm-up,
stretching, and massage treatments
to reduce soreness after eccentric
exercise (70). Recovering from trau-
matic muscular injury usually seeks to
ensure rapid return of ROM within
the constraints of tissue healing.
However, more recent work has
shownthatreturntoactivityshould
be based on full recovery of the
muscle and tendon unit and that
programs based solely on stretching
and strengthening result in poorer
outcomes (35). A review of DOMS
and effective treatments concluded
that cold therapy, stretching, hom-
eopathic remedies, ultrasound, and
electrical modalities had little
or no influence on the alleviation of
muscle soreness or other DOMS
symptoms (17).
CAN STRETCHING FOR RECOVERY
BE QUANTIFIED?
A serious problem permeates nearly
all studies of stretching—how does
one measure stretching intensity?
How does one determine if the
stretching activity elicited slightly
uncomfortable, moderately uncom-
fortable or painful sensations during
stretching? Individual athletes have
idiosyncratic tolerances for pain.
Moreover, discomfort and pain may
be exercise specific (61). Soreness and
stiffness may elicit pain and reduced
ROM that inhibits the use of even small
ROM movements thereby presenting
a new stress rather than the reduction
of stress. There does not appear to be
a single metric ever proposed to ascer-
tain the level, intensity, or magnitude of
stretching, short of static measurements
of maximum ROM positions (e.g., sit-
and-reach tests) that are too often
completely lacking in a conceptual
framework and sport specificity (33).
As such, how can any judgment of
the effectiveness of stretching on
recovery be determined? The subject
or athlete is usually directed to per-
form movements that are pain free,
butthelinebetweenmerediscom-
fort and pain is not clear (11,
p. 2,18,30). Moreover, the tolerance
of discomfort and pain is likely to be
greater during short duration expo-
sures as opposed to those of longer
duration (4,63,76). Some athletes
may perform extreme positions more
zealously and achieve greater ROM or
incur and endure greater discomfort
than studymates (63). Stretching studies
are inherently incomparable if there is
no standard means of measuring the
stretching effort.
CAN STRETCHING PREVENT
RECOVERY AND ADAPTATION?
There is a consensus that serious stretch-
ing (i.e., flexibility-related stretching that
is uncomfortable and intended to
enhance ROM rather than relaxation
through acquisition of stretch tolerance,
54) results in reduced strength and
power after stretching exercises. The del-
eterious effects may not be reversed by
transitional exercises, and the effect can
last up to an hour (8,9,12,37,56,60,88).
Unskilled, reckless, and unsupervised
use of ballistic stretching (e.g., powerful
jerking-type stretch) actually causes mus-
cle soreness and stiffness and is therefore
contrary to the idea of enhancement and
maintenance of relaxation and pain-free,
fluid motion (87).
Recovery modalities, such as heat,
cold, hot/cold contrast, hydrotherapy,
massage, light exercise, electrical
stimulation, and nutritional supple-
mentation, rely heavily on increasing
overall blood flow to sore areas of the
body. Paradoxically, in a conceptual
model of recovery, it was postulated
that cooldown activities and stretch-
ing accelerate the elimination of
waste products, despite evidence that
stretching decreases blood flow.
Blood flow, capillary region oxygena-
tion, and velocity of red blood cells
decrease during stretching (57,66,83).
However, one study of ballet-trained
athletes and untrained controls indi-
cated that oxygenation during pain-
free stretching of the anterior tibialis
muscle was better maintained in the
ballet-trained athletes (64). Although
the fascicle lengths of the anterior ti-
bialis muscles were measured in both
groups, one wonders about the choice
of muscle in this study because of the
difficulty of stretching this muscle. In
this study, one could argue that
the anterior tibialis was simply length-
ened with little or no accompanying
discomfort.
Reduction of edema, both local and
systemic, are important objectives of
the recovery process but are poorly
understood by practitioners. More-
over, the new “frontier” in recovery
probably lies in the study and
control of training-induced infl-
ammation and associated edema
(20,26,29,32,48,49,77). Reduction of
edema is reliant on free lymphatic
fluid flow, and the accumulation of
cellular debris from exercise can
obstruct lymphatic uptake of fluids
(77). Herbert and Gabriel performed
a meta-analysis of the effects of
stretching on muscle soreness and
the risk of injury and found that
“Stretching before or after exercising
does not confer protection from mus-
cle soreness” (32, p. 468). However,
there may be a connection between
movements such as combinations of
stretching and contraction that may
mechanically aid lymphatic flow and
venous return and thereby help con-
trol sports-related edema and post-
training soreness (92).
CONCLUSIONS AND PRACTICAL
APPLICATIONS
The emphasis on dynamic movements
rather than static stretch positions is
Stretching and Recovery
VOLUME 35 | NUMBER 5 | OCTOBER 2013
32
important for recovery stretching. In
a review of recovery modalities, Barnett
wrote the following for athlete recovery
between events: “.there is no compel-
ling scientific evidence to support the
use of contrast temperature water
immersion therapy, hyperbaric oxygen
therapy, nonsteroidal anti-inflammatory
drugs, compression garments, stretching,
electromyostimulation, and combination
modalities” (emphasis added) (7, p. 781).
As we learn more about recovery, inves-
tigations may focus more light on many
modalities and some effectiveness may
yet be apparent. However, one would be
wise to question the relevance and effec-
tiveness of stretching in sport, particu-
larly stretching for recovery.
Possibly the most heretical remark to
make about stretching is to suggest that
the dedicated use of stretching sessions
may not even be necessary, especially
since many athletes dispense entirely with
special stretching or even warm-up ses-
sions before or after training without suf-
fering injury in training or competition.
The prescription of stretching and warm-
up or cooling down sessions has become
a well-accepted ritual, but that does not
imply that this is essential (87, p. 192).
Stretching exercises should be varied
under the same principle as strengthening
exercises, but rarely are (35,80). Light
training followed by pain-free stretching
is proposed as an effective means of
achieving an active recovery that was
superior to taking a day off from training
(40). Finally, a meta-analysis update of 12
studies, one including over 2,000 subjects,
showed that pre- and post-activity
stretching reduced muscle soreness from
1 to 3 days after exercise by one point in a
100-point scale. The authors concluded
that although the results were statistically
significant, the magnitude of effect was
not clinically significant (31). Practitioners
are encouraged to consider recovery
stretching carefully, that the activity is
not a panacea, and prescription of recov-
ery stretching should not be undertaken
blindly, unskillfully, and without careful
monitoring.
Conflicts of Interest and Source of Funding:
The authors report no conflicts of interest
and no source of funding.
William A.
Sands is a profes-
sor in the
Department of
Exercise and
Sport Science at
East Tennessee
State University.
Jeni R. McNeal
is a professor at
Eastern Wash-
ington University
and Strength and
Conditioning
Consultant for
United States
Diving.
Steven R.
Murray is a pro-
fessor at Colorado
Mesa University.
Michael W.
Ramsey is the
chair of the
Department of
Exercise and
Sport Science at
East Tennessee
State University.
Kimitake Sato
is an assistant
professor in the
Department of
Exercise and
Sport Science,
andanadjunct
faculty for Cen-
ter of Excellence
for Sport Science and Coach Education
at East Tennessee State University.
Satoshi
Mizuguchi is an
assistant profes-
sor in the
Department of
Exercise and
Sport Science at
East Tennessee
State University.
Michael H.
Stone is the lab-
oratory supervi-
sor, PhD
coordinator, and
a professor in the
Department of
Exercise and
Sport Science at
East Tennessee State University.
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