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Impact of stretching on the performance and injury risk of long-distance runners



Stretching, either prior to exercise or at the end, or both, is typically carried out by all individuals undertaking sporting activity whether they be elite or recreational athletes. The many forms of stretching available to the athlete, either passive or active, have long been thought to improve performance, decrease injury and generally be advantageous to the athlete. This review examines the current state of the literature and evaluates what athletes can and should do with respect to this controversial topic.
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Research in Sports Medicine
An International Journal
ISSN: 1543-8627 (Print) 1543-8635 (Online) Journal homepage:
Impact of stretching on the performance and
injury risk of long-distance runners
Claire Baxter, Lars R. Mc Naughton, Andy Sparks, Lynda Norton & David
To cite this article: Claire Baxter, Lars R. Mc Naughton, Andy Sparks, Lynda Norton & David
Bentley (2017) Impact of stretching on the performance and injury risk of long-distance runners,
Research in Sports Medicine, 25:1, 78-90, DOI: 10.1080/15438627.2016.1258640
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Impact of stretching on the performance and injury risk of
long-distance runners
Claire Baxter
, Lars R. Mc Naughton
, Andy Sparks
, Lynda Norton
and David Bentley
School of Health Science, Flinders University, Adelaide, South Australia, Australia;
Sport and Physical
Activity, Edge Hill University, Ormskirk, United Kingdom
Stretching, either prior to exercise or at the end, or both, is
typically carried out by all individuals undertaking sporting activity
whether they be elite or recreational athletes. The many forms of
stretching available to the athlete, either passive or active, have
long been thought to improve performance, decrease injury and
generally be advantageous to the athlete. This review examines
the current state of the literature and evaluates what athletes can
and should do with respect to this controversial topic.
Received 8 May 2015
Accepted 17 August 2015
Performance; exibility;
Stretching has long been considered an integral part of the training routine for athletes
and is used across all disciplines as a tool of preparation, performance enhancement and
injury prevention (Trehearn & Buresh, 2009). In recent years, however, it has been
suggested that the tendency to incorporate stretching into the regimes of athletes
was based not on science but assumption (Herbert, de Noronha, & Kamper, 2011;
Shrier, 2004; Thacker, Gilchrist, Stroup, & Kimsey, 2003).
Stretching performed prior to exercise (acutely) or as a long-term intervention has
traditionally been thought to improve the performance of endurance runners (Herbert &
Gabriel, 2002). However, inconsistency across the literature has suggested this is not
necessarily the case and may have dierent implications for various sports disciplines.
Delayed onset muscle soreness (DOMS) can occur after single bouts of high-intensity
running and/or unfamiliar activity (Herbert et al., 2011). The occurrence of DOMS can
result in fatigue, pain and reduction in performance, eects usually lasting 2448 h
(Cheung, Hume, & Maxwell, 2003) and can be hindering for long-distance athletes.
Stretching has been considered to inuence the incidence of DOMS in endurance
runners. Chronic overuse injuries are also frequent and devastating for long-distance
athletes. Common running-related injuries include medial tibial stress syndrome, plantar
fasciitis, achilles tendonitis, stress fractures and various knee-related injuries (Gallo,
Plakke, & Silvis, 2012). Stretching has been considered a tool for reducing the risk of
CONTACT Lars R. Mc Naughton Edge Hill University, St Helens Road,
Ormskirk L39 4QP, United Kingdom
VOL. 25, NO. 1, 7890
© 2016 Informa UK Limited, trading as Taylor & Francis Group
injury for endurance athletes and is an additional reason stretching is often used by
endurance runners. This narrative review will report on the evidence available surround-
ing the eects of acute and chronic stretching in relation to its eects on performance,
DOMS and injury risk in endurance runners.
Does stretching improve exibility?
Stretching is a broad term used to describe an array of passive and active movements used
to increase exibility (Woods, Bishop, & Jones, 2007). Although there are various types of
stretching, this review primarily investigates static stretching. In contrast to the dynamic
movement associated with the other variations of stretching, static stretching involves
elongating a muscle to the point at which a gentle tension is felt and remaining in this
position for a given amount of time. Typically, multiple stretches are performed on a single
muscle group with a minimum of 30 s per stretch (Woods et al., 2007). Bandy and Irion
(1994) investigated the duration of static stretching and reported that 30 s is the optimal
period for static stretching and that increasing this duration provides no additional
advantage. It is largely unknown as to the optimal frequency (days per week) or dimen-
sions of stretching on improvements in range of motion of a joint. Each variation of
stretching has speculated to provide an assortment of advantages to athletes of varying
disciplines, however the literature has primarily examined the eects of static stretching as
this is the variation most commonly recommended to and performed by endurance
athletes (Shrier, 2004; Wallmann, Christensen, Perry, & Hoover, 2012). The second distinc-
tion in stretching referenced in this review is the acute or chronic nature of the activity.
Acute stretching refers to a temporary activity that is performed in a discrete capacity
immediately before exercise (Wallmann et al., 2012). In contrast, chronic stretching is
dened as that which is performed outside of the warm-up regime as a tool of increasing
long-term exibility (Stone, Ramsey, Kinser, & OBryant, 2006).
Flexibility is a recognized tness component and is considered a result of regular stretching
practices (Shrier, 2004; Wilson et al., 2010). However, a preliminary point to the stretching
debate is whether or not stretching does in fact improve exibility. This is a question that has
been raised to determine whether or not the dispute surrounding the relationship between
performance and injury for athletes is central to stretching or exibility. Is exibility the factor
that is under scrutiny or is it simply that the common stretching methods engaged by athletes
are not increasing exibility? The research has demonstrated that when simple static stretch-
ing is executed regularly over a minimum of 6 weeks, exibility is signicantly increased
(Bandy & Irion, 1994; Thacker et al., 2003). This leads to the distinction between acute
stretching (single bout immediately before exercise) and long-term chronic stretching (per-
formed regularly and exclusive to the warm-up regime of athletes). This is an important
dierence and as a result research has been conducted on both variations in relation to its
aect on performance, DOMS and chronic injury in endurance runners.
Are endurance runners exible?
There is evidence to suggest that typically, elite endurance runners are less exible than
their non-elite counterparts (Saunders, Pyne, Telford, & Hawley, 2004). Posthumus,
Schwellnus and Collins (2011) completed a survey that investigated the presence of
the gene COL5A1 in endurance runners, a gene associated with inexibility, which
demonstrated that endurance runners who possess this gene had a considerably higher
running economy than the other athletes participating in the study. Running economy is
a recognized determinant of the performance of endurance runners and is measured by
the energy demand of a runner at a specied velocity (Nelson, Kokkonen, Eldredge,
Cornwell, & Glickman-Weiss, 2001). This gene also had a substantially greater presence
among the endurance athletes subgroup then is estimated across the general popula-
tion (Posthumus et al., 2011). It has also been postulated that hypertrophy of muscle can
reduce the range of motion of a joint and this also could contribute to the reduced
exibility seen in endurance runners (Wilson & Flanagan, 2008). Gleim, Stachenfeld and
Nicholas (1990) conducted a study on untrained individuals and found that the partici-
pants with the lowest exibility consistently had the most economical running styles.
These results were justied by demonstrating that the decrease in range of motion of
the transverse and frontal physiological planes led to stabilization in the pelvic region
when the foot connected with the ground. This resulted in a reduction in excessive
range of motion and therefore an increase in the energy required to stabilize muscular
activity. It was also suggested that tightness in the muscles and tendons could increase
elastic storage and therefore reduce the oxygen demand. Thacker et al. (2003) com-
mented that the likeliness of injury is also inuenced and that there is an optimal
exibility for endurance runners. The research proposes that inexibility can be com-
pared to that of hyperexibility when considering injury risk (Thacker et al., 2003). A base
range of exibility will neither improve nor decrease likeliness of developing running-
related injuries; however, extreme cases outside the normal range of exibility might be
problematic. Future research may be directed to quantifying this optimal level of
exibility for both performance and injury risk in the endurance running population
compared to athletes of other disciplines.
Stretching and performance
Long-distance runners, considered to be athletes that participate in events 5 km or
longer, (Cosca & Navazio, 2007) are a population that are heavily inuenced by the
outcome of the stretching debate (Wilson et al., 2010). The ability of endurance running
can be divided into two main subsections. Firstly, performance potential, which is
impacted by physiological parameters such as aerobic capacity (VO
max) and lactate
threshold (Godges, Macrae, Longdon, Tinberg, & Macrae, 1989; Joyner & Coyle, 2008;
Wilson et al., 2010). The VO
max represents a number of physiological aspects including
cardiac output (Spurway, Ekblom, Noakes, & Wagner, 2012), haemoglobin levels (Ferretti,
2014), blood ow and muscle oxygen extraction (Joyner & Coyle, 2008). Lactate thresh-
old is the percentage of the VO
max where lactic acid levels rise sharply in the blood
(Marcell, Hawkins, Tarpenning, Hyslop, & Wiswell, 2003). The higher the percentage of
the VO
max in which the lactate threshold occurs equates to the athletes increased
potential for performance. The second variable is eciency, which runs parallel to
performance and varies about 3040% among athletes (Joyner & Coyle, 2008).
Running eciency refers to how the body composition of an athlete impacts how
eective muscles are at using available energy (Saunders et al., 2004) and is dependent
on factors such as muscle morphology, elastic elements and joint mechanics (Engero,
Bernardi, Vogt, & Banzer, 2014). The eciency of movement is primarily due to anato-
mical and physiological factors of the body and methods to improve it are largely
unknown (Joyner & Coyle, 2008). The eciency variable of running ability is where
stretching practices have the potential to impact an athletes success (Barnes &
Kilding, 2015). This raises the question of whether acute or chronic stretching is inuen-
cing running eciency and whether it should remain an assumed aspect of training.
Running economy is a multifactorial determinant that results from a number of
metabolic, cardiorespiratory and biomechanical characteristics including VO
max, lac-
tate threshold and running eciency (Barnes & Kilding, 2015). Running economy is
dened as the steady state of oxygen consumption at a given running velocity, reect-
ing the energy demand of running at a constant submaximal speed (Allison, Bailey, &
Folland, 2008; Barnes & Kilding, 2015). It has been considered the standard measurement
for the overall competency of runners.
Over the past 20 years, the literature on stretching and performance has expanded
and argued three standpoints, some studies providing evidence that stretching
increases performance, some arguing it decreases performance, and some stating it
does not impact it at all. Running economy was the primary indicator of performance for
the studies investigating the eect of stretching on the performance of long-distance
runners (Allison et al., 2008; Barnes & Kilding, 2015; Joyner & Coyle, 2008; Saunders et al.,
2004; Wilson et al., 2010). The debate surrounding the eects of stretching surfaced after
it was suggested that acute stretching immediately before exercise had the ability to
signicantly inhibit performance on short, explosive events including the leg press one
repetition max (Bacurau et al., 2009), 20 m sprint performance (Nelson, Driscoll, Landin,
Young, & Schexnayder, 2005) and vertical jump height (Young et al., 2001) due to the
physiological changes seen in the muscle and the decreased ability to store elastic
energy (Wilson et al., 2010). As performance in long-distance running events relies on
factors such as VO
max, lactate threshold and biomechanical factors in contrast to the
explosive, power-oriented variables seen in anaerobic activities, a number of subsequent
studies analyzed the eects of acute stretching on endurance running (Gleim et al.,
1990; Kyrolainen & Komi, 1994; Wilson et al., 2010). Although some research demon-
strated that pre-exercise stretching has the potential to reduce explosive actions (Wilson
et al., 2010), a contrasting study reported that increased exibility meant a reduction in
musculotendinous stiness which by enhancing the use of elastic energy was able to
improve the results of rebound bench press (Wilson, Elliott, & Wood, 1992). However,
this study (Wilson et al., 1992) is not relevant to endurance running. No additional
studies have shown that acute stretching has the ability to improve the performance
of athletes and notably no studies have reported positive eects for endurance runners.
As a result, the debate has since evolved into whether stretching decreases running
economy for endurance runners or simply does not aect it.
Acute stretching and performance
Athletes commonly use acute stretching during their warm-up regime prior to both
training and competition (Shrier, 2004). However, the majority of the literature that has
investigated acute stretching and endurance running argues that stretching causes a
decrease in running economy (Saunders et al., 2004; Shrier, 2004; Thacker et al., 2003).
The central idea behind this phenomenon is that stretching before an endurance event
reduces mechanical eciency of the lower body (Kyrolainen & Komi, 1994) primarily
through the reduction of musculotendinous stiness (Thacker et al., 2003). A musculo-
tendinous unit is dened as the contractile muscle and the attached tendinous struc-
tures (McLachlan, Murphy, Watsford, & Rees, 2006), and musculotendinous stiness
refers specically refers to the units ability to resist an applied change in length
(Kuitunen, Komi, & Kyrolainen, 2002). Although this stiness has traditionally been
considered a factor that has the potential to increase the risk of injury and inhibit
athletes performance in the early stages of a race, it appears it is a desirable trait for
long-distance runners (Wilson & Flanagan, 2008). The reduction in mechanical eciency
stems directly from the decrement in muscle stiness that appears as a result of static
stretching. The specic reasoning behind why a decrease in musculotendinous stiness
leads to reduced mechanical eciency varied throughout the literature; however, all
reported that acute stretching before endurance-based events does not assist athletes
performance and in fact can diminish it (Craib et al., 1996; Kyrolainen & Komi, 1994;
Wilson et al., 2010). One study suggested that stier muscles surrounding the ankle and
knee joints causes an increase in force potentiation when transitioning from the braking
to push ophase of running (Kyrolainen & Komi, 1994) and proposed that stier
muscles provide the best running economy and results. Craib et al. (1996) investigated
the eect of short and rapid stretching on running economy and found that inexibility
in the hip and calf regions were associated with improved running economy as less
energy was required for muscle stabilization. The improved running economy may be a
result of increased pelvis stability and a reduction in required muscle activation at foot
strike to maintain stability. An additional study described that acute stretching may
result in an increase in the number of motor units recruited to perform the same
amount of mechanical work that is required without stretching. Activation of a larger
number of motor units means an increase in both oxygen consumption and energy
expenditure (Wilson et al., 2010). Additionally, Gleim et al. (1990) argue that ecient
elastic energy storage and return is favoured for endurance athletes with a tighter
musculotendinous system. Furthermore, acute stretching has the ability to strain the
muscle, causing a decrease in force development, and an increase in oxygen require-
ment within the hour following the stretching regime (Shrier, 2004).
Hayes and Walker (2007) suggested that a 10-min submaximal warm-up run prior to
performance testing could reverse the reduction in active peak force and rate of force
development while retaining the improved stretch-absorbing capacity and therefore not
impact running economy. Furthermore, Allison et al. (2008) reported that changes in
neuromuscular function due to stretching were evident in participants but had no eect
on running economy. However, no studies were able to suggest that stretching imme-
diately before an endurance running event could improve running economy (Shrier,
2004;Thacker et al., 2003). A small number of studies that investigated the performance
of isolated muscle groups demonstrated that stretching before performance testing can
increase the strength of that muscle group at specic isokinetic degrees (Akagi &
Takahashi, 2014; Godges et al., 1989), however these results did not provide evidence
to suggest that the same results could be applied to endurance running (Worrell, Smith,
& Winegardner, 1994). Furthermore, when Godges et al. (1989) conducted a follow-up
study on a larger population, it was reported that no eect on running economy was
seen (Bonacci, Chapman, Blanch, & Vicenzino, 2009).
In conclusion, stretching does not possess properties that warrant it a useful or
eective tool in the warm-up regime of long-distance runners. Although the data are
not entirely conclusive and the literature demonstrates some disparity, there is little to
suggest that acute stretching has properties that can enhance performance for endur-
ance athletes and in fact may have the opposite eect. This research suggests that
endurance athletes may be best reducing their warm-up routine to a low-intensity,
progressive run and removing stretching practices completely.
Chronic eects of stretching and performance
It has been argued that provided that stretching is not completed immediately before
exercise as is generally the case for athletes engaging in chronic stretching increased
exibility as a result of regular stretching will not inhibit performance or decrease
running economy (Godges, MacRae, & Engelke, 1993; Nelson et al., 2001). Nelson et al.
(2001) conducted a study involving 32 participants over 10 weeks and noted that
although exibility was signicantly increased over the study duration, it did not appear
to eect running economy. The study makes specic mention that the exercise was not
performed immediately following the stretching regime and although running economy
was not reduced it also did not show improvement. There was no studies found that
reported that running economy would either improve or decline from long-term
stretching programmes. However, as previously reported, the literature does suggest
that an increased running economy has a high association with inexibility in endurance
runners (Gleim et al., 1990; Posthumus et al., 2011; Saunders et al., 2004) As a result,
unless stretching possesses other health or performance-related benets, it appears to
have little purpose in an endurance runners preparation. The research suggests that
there may be an optimal level of exibility for running economy, in which a balance
between muscle stiness in order to maximize elastic energy storage and return is
achieved while allowing enough movement for optimal stride length at high running
speeds (Saunders et al., 2004).
The literature suggests acute stretching regimes do not help endurance runners
performance, and may in fact decrease running economy. Specically, by decreasing
musculotendinous stiness, acute stretching reduces stability and force production, in
turn decreasing mechanical eciency and increasing oxygen demand (Wilson &
Flanagan, 2008). Therefore, if individuals feel it necessary to include stretching in their
daily routine, it is suggested that it is not performed immediately before running.
Further research is required to clarify the eects of chronic stretching on endurance
running performance. Furthermore, the evidence on dynamic stretching is limited and
requires further examination. Although no studies were able to provide evidence that
acute stretching positively impacts performance for endurance runners the eects of
chronic stretching on endurance running performance is unknown and is an area
requiring further investigation. A notable weakness that is seen across all relevant
literature examining the relationship between stretching and performance is the lack
of explanation and are primarily speculative in nature. There are limited evidence-based
claims which describe why acute and chronic stretching aect performance.
Stretching and delayed onset muscle soreness
DOMS is common and debilitating for endurance runners (Cheung et al., 2003). DOMS
in subsequent exercise, decreased muscle strength and range of motion (High,
Howley, & Franks, 1989). The specic cause of DOMS is unknown; however, it is
thought to be triggered by a series of biochemical changes that occur as a result
of muscle damage (Fridén, 2002). It is often seen when individuals are exposed to
high force eccentric contractions repeatedly and/or unaccustomed exercise. Running
has a signicant eccentric component which has been implicated in the manifestation
of DOMS (Cheung et al., 2003). As a result, DOMS is prevalent following bouts of
high-intensity or downhill running exercise. Therefore, a reduction in the incidence of
DOMS and therefore an improvement in recovery would be such a quality to encou-
rage endurance athletes to leave stretching in their daily routine.
The use of stretching to prevent DOMS was supported by the idea that muscle
soreness was a result of unfamiliar exercise causing muscle spasm (de Vries, 1966).
Muscle spasm was thought to reduce blood ow to the muscle and conversely, stretch-
ing was thought to restore blood to the muscle, interrupting the painspasmpain cycle
(Herbert et al., 2011). High et al. (1989) conducted a study that investigated the eect of
stretching on DOMS of 62 healthy participants in order to investigate these claims.
Results were compared among the individuals in the experimental (static stretching) and
control (non-stretching) conditions and the results demonstrated that there was no
signicant dierence between muscle soreness over the following 5 days. These ndings
were supported by a number of additional studies, reporting that acute stretching does
not provide a signicant impact on DOMS following exhaustive exercise (Buroker &
Schwane, 1989; Johansson, Lindström, Sundelin, & Lindström, 1999; McGlynn, Laughlin,
& Rowe, 1979; Wessel & Wan, 1994). Furthermore, Herbert and Gabriel (2002) reported
that although a small amount of improvement may be seen in DOMS following stretch-
ing, it is too insignicant to warrant athletes including it into their warm-up regime.
Herbert et al. (2011) reported that there was no evidence that suggested static or
dynamic stretching performed before or after exercise or in an acute or chronic capacity
had the ability to reduce the severity or duration of DOMS. Jamtvedt et al. (2010)
supported these claims surveying over 2,000 individuals and concluding that no varia-
tion of stretching has the ability to alter DOMS.
Similarly to the eects on performance, there is no evidence found which suggests
that stretching has the ability to reduce either the presence of DOMS or the pre-
valence of chronic injury in long-distance runners. A number of studies have inves-
tigated the relationship between stretching and the presence of DOMS following
exercise and the unanimous response is that the duration and intensity of DOMS
cannot be inuenced by stretching (Dannecker, Koltyn, Riley, & Robinson, 2002;
Herbert et al., 2011). There was no evidence to suggest stretching could assist in
the reduction of DOMS across the literature for athletes of any discipline (Herbert
et al., 2011). It is recommended that athletes suering from DOMS investigate other
prevention methods, such as massaging, icing or hot and cold therapy (Sforzo, Ankita,
Stretching and chronic injury
The bulk of the literature investigating the relationship between stretching and injury for
long-distance runners has focused on chronic, long-term, degenerative injuries which
are seen most commonly in this population. Although competitive endurance runners
are most frequently in their 20s and 30s, the majority of participants are within the
3550 years bracket (Cosca & Navazio, 2007). As a result, this population is at a high risk
for running-related chronic injuries such as illiotibial band friction, achilles tendinopathy
and plantar fasciitis (Cosca & Navazio, 2007; Gallo et al., 2012). Marti, Vader, Minder, and
Abelin (1988) conducted a study on over 4,000 male runners and reported that 45%
sustained an injury over a 1 year period with inammation to the achilles tendon and
calf muscle injuries among the most common.
The majority of studies suggest that stretching has no impact of the risk of chronic
injury in endurance runners (Cosca & Navazio, 2007; Thacker et al., 2003; Witvrouw,
Mahieu, Danneels, & McNair, 2004). It has shown that long-term stretching can poten-
tially increase the compliance of the muscletendon unit (Toft, Espersen, Kalund,
Sinkjaer, & Hornemann, 1989) and may allow greater force production at longer muscle
lengths (McHugh & Nesse, 2008) which may be relevant to other sporting disciplines;
however, Witvrouw et al. (2004) highlight that for endurance running these potential
benets are not clinically benecial. When participating in a long-distance running
event, the lower limbs engage in a repetitive motion at a submaximal intensity. This
means the tendons in the legs are unlikely to require maximum energy absorption and
elastic stability to perform the exercise (Witvrouw et al., 2004). This applies to all
endurance events which include repetitive motion such as long-distance cycling and
swimming. As a result of this, the likeliness that the endurance athletes will encounter
muscle strain injuries is low in comparison to highly explosive sports which require
maximum eort out of the musculotendinous structures.
Dutch researchers (van Mechelen, Hlobil, Kemper, Voorn, & de Jongh, 1993) studied
the eect of stretching on injury over a 10-week programme and reported that stretch-
ing made no impact on the prevalence of overuse injuries. Furthermore, the study did
not report any muscle or tendon strain-related injuries supporting the idea that overuse
injuries are the most frequent for endurance runners. This also supports that although
there is potential advantages for a subset of sporting activities, due to the nature of the
injuries generally experienced by endurance runners, stretching provides no assistance
in reducing the risk of injury (McHugh & Cosgrave, 2010). Pope, Herbert, Kirwan, and
Graham (2000) conducted a study which reinforced these claims, surveying over 1,000
military recruits and concluding that stretching did not aect the prevalence of chronic
overuse injuries in their population.
Bonacci et al. (2009) have commented that although stretching has not demonstrated
any ability to reduce the risk of injury in endurance runners, it can be an important tool
in the maintenance and promotion of range of motion in hip, knee and ankle joints after
injury. An additional study investigated the eect of exibility on vertical jump techni-
que and suggested that stretching has both advantageous and disadvantageous proper-
ties depending on the activities that individuals are participating in and what the athlete
is trying to achieve (Hunter & Marshall, 2002). This highlights that the relationship
between the eects of stretching and sporting activities generally is not clear and
some athletes may benet from incorporating chronic stretching into their routine from
an injury risk standpoint.
When investigating the relationship between stretching and chronic injury, the
literature shows a higher degree of discrepancy. Stretching may possess qualities that
will help reduce the likeliness of muscle and tendon strain injuries; however, this is
unrelated to the subset of injuries most experienced by endurance runners (McHugh &
Cosgrave, 2010). As a result it can be concluded that stretching provides no signicant
assistance in the reduction of chronic overuse injuries and therefore is not a useful injury
preventative strategy for endurance athletes. Further research is required to determine
whether stretching has the ability to reduce the prevalence of muscle strain injuries and
should remain incorporated into the warm-up regime of athletes of dierent areas.
Practical implications
The available research suggests neither acute nor chronic static stretching has clinically
benecial eects for endurance runners on performance, incidence of DOMS or to
prevent injury. Therefore, other strategies could be used to assist a runner with pre-
paration and recovery. Bazyler et al. (2011) conducted a study to investigate the benet
of a submaximal warm-up for endurance performance and found no signicant
improvements in performance. Similarly, investigations involving dynamic stretching
techniques have shown little evidence to suggest it provides any advantage to endur-
ance athletes (Dalleck, Janot, & Reyment, 2007). However, the research outside of static
stretching is limited (Dalleck et al., 2007) and is an area requiring further research. From
the current literature, it can be concluded that stretching is an ineective way of altering
performance or injury risk and endurance athletes are advised to direct their eorts to
other strategies. In terms of pre-exercise activities, this may include a progressive warm-
up prior to exercise which incorporates graded intensity. Athletes are also recom-
mended to individualize their training programmes in order to promote performance
responses and reduce injury risk. Aside from the improvement of athletes lactate thresh-
old and VO
max, supplementary eorts such as resistance training (Dean, Lamb, Ceri, &
Twist, 2013) have reported to assist in the performance of endurance runners and may
be a useful incorporation into the training schedule of athletes. Endurance runners
experiencing common overuse injuries are advised to treat each injury individually
and acknowledge that risk factors such as extensive mileage can impact the risk of
developing a chronic injury in the lower limbs (Warden, Davis, & Fredericson, 2014).
Therefore, progressive and planned training in combination with over recovery mod-
alities may be the most eective way to reduce injury risk and promote recovery during
period of high running volume. Cross and interval training may be techniques used to
reduce weekly mileage and the likeliness of overuse injuries (Millet, Vleck, & Bentley,
In conclusion, the literature suggests that stretching poses no signicant advantage to
endurance runners. Acute stretching can reduce running economy and performance for
up to an hour by diminishing the musculotendinous stiness and elastic energy
potential. Chronic stretching additionally appears to have no advantageous eects. In
regards to DOMS, it has been reported consistently in the literature that stretching
cannot reduce its longevity or intensity. In relation to injury risk, stretching shows little
signicance for endurance runners to chronic injury. Endurance athletes are at high risk
of overuse injuries such as illiotibial band syndrome, stress fractures and plantar fasciitis,
and the literature suggests that stretching cannot reduce the prevalence of these
injuries. It appears stretching may hold signicance for certain exercise disciplines;
however, it can be concluded that it holds no advantage for endurance runners and is
not the solution to improving performance or reducing injury prevalence.
Disclosure statement
No potential conict of interest was reported by the authors.
Lars R. Mc Naughton
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... Regarding the effects induced by SS on physical performance, some studies showed an increase in ROM around the joint, and a significant decrease in the risk of muscle injuries [10,11]. However, when investigating the relationship between stretching and injury, some studies showed contrasting data, reporting that SS was not a useful prevention strategy for endurance athletes, as it was unable to reduce the prevalence of muscularskeletal injuries [12]. ...
... A single bout of SS during warm-up has been demonstrated to both impair running performance and running economy [3,12,13], and to reduce maximal voluntary strength and muscle power [8,14], whereas some studies reported no effect on running economy and performance following SS exercises [15][16][17][18][19][20]. Given the contrasting literature about the effects of SS on performance, an alternative modality, namely, DS, has been proposed. ...
... Finally, in line with previous studies [9,12,13,20,28,53], in which longer-lasting stretching protocols were applied, our findings showed no effect either on physiological and metabolic responses or on running performance, following a few minutes of stretching exercises within the warm-up, in any of the experimental sessions tested. In particular, we showed that the time to exhaustion at the power output corresponding to VO 2max , which is considered to be a key factor in determining running performance [15,17,32], was not significantly prolonged, and TRD was not significantly increased by pre-exercise stretching, confirming the ineffectiveness of short-duration pre-exercise stretching in improving running performance. ...
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This randomized crossover counterbalanced study investigated, in recreational runners, the acute effects of pre-exercise stretching on physiological and metabolic responses, endurance performance, and perception of effort. Eight male endurance runners (age 36 ± 11 years) performed three running-until-exhaustion tests, preceded by three warm-ups, including the following different stretching protocols: static (SS), dynamic (DS), and no-stretching (NS). During the SS and DS sessions, the warm-up consisted of 10 min of running plus 5 min of SS or DS, respectively, while during the NS session, the warm-up consisted of 15 min of running. Physiological and metabolic responses, and endurance running performance parameters, were evaluated. The perception of effort was derived from the rating of perceived exertion (RPE). Running economy significantly improved after SS (p < 0.05) and DS (p < 0.01), and RPE values were significantly lower in SS (p < 0.05) and DS (p < 0.01), compared to NS. No differences in physiological and metabolic responses among the sessions were found. This study showed that including SS and DS within the warm-up ameliorated running economy and decreased the perception of effort during a running-until-exhaustion test, highlighting the benefits of stretching on endurance performance. These results should encourage recreational runners to insert stretching during warm-up, to optimize the running energy costs, reducing the perception of effort and making the training sessions more enjoyable.
... Stretching also improves the blood flow throughout the body or toward the muscles involved in performing activities (Wickeet al., 2014). Stretching on regular basis not only enhanced the performance but pooled the blood circulation efficiently along with nutrients throughout the body and assisted to remove the harmful waste(metabolites) from the body, which eventually accelerate recovery time (Baxter et al., 2017). Thus, range of motion elevated with stretching, which enabled athletes to perform more dynamic tasks and boosts the techniques in sport-specific areas (Reese and Bandy, 2016). ...
... Flexibility boosts through stretching exercises is one of the basic tenets of physical fitness (Napoli, 2016). Stretching is the process of placing particular parts of the body into a position that will lengthen the muscles and their associated soft tissue (Baxter et al., 2017). The athletes have normal routine to make a habit of stretching before and after sessions,in addition correct exercises in order reduce risk of injury and increase performance (McHugh et al., 2010). ...
... The athletes have normal routine to make a habit of stretching before and after sessions,in addition correct exercises in order reduce risk of injury and increase performance (McHugh et al., 2010). Stretching keeps the muscles flexible, strong, and healthy, and we need that flexibility to maintain a range of motion in the joints, the muscles reduce range of motion and become less elastic (Baxter et al., 2017). The athletes, who did not perform any sort of flexibility and stretching exercises, have risk of joint pain, strains, and muscle damage (Shah &Bhalara, 2012). ...
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This study investigated that the effects of stretching exercise on the flexibility of male athletes. A sample size of (N=30) selected through a simple random sampling method from the population. The intervention group comprised of (N=20) subjects. The population of the study was male athletes of Punjab University Lahore. A control group of (N=10) also maintained for comparison. The selected subjects were undertaking pre and post exercises of sit and reach test performed for checking the effect of stretching exercises on the flexibility of male athletes. After the 6 weeks training sessions, the post-test conducted for the measurements of the flexibility of the same athletes. The subjects followed for 4 months after the completion of research to check the recurrence and resulted that intervention group has less injury. The study is very beneficial for male athletes as their tough and tight schedule and found less time for recovery and relaxation. Stretching of any kind helped sportspersons to ease their brain and body within a short duration.
... Stretching performed prior to exercise (acutely) or as a long-term intervention has traditionally been thought to improve the performance of endurance runners (Baxter et al., 2017). Stretching has been considered a tool to reduce the risk of injury for endurance athletes and is an additional reason why stretching is often used by endurance runners (Baxter et al., 2017). ...
... Stretching performed prior to exercise (acutely) or as a long-term intervention has traditionally been thought to improve the performance of endurance runners (Baxter et al., 2017). Stretching has been considered a tool to reduce the risk of injury for endurance athletes and is an additional reason why stretching is often used by endurance runners (Baxter et al., 2017). ...
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Flexibility is an important basic component in sports activities, which supports the achievement of the maximum performance of an athlete. Exercises are needed for stretching proper this study aimed to determine: (1) the effect of passive static stretching on shoulder flexibility, (2) the effect of Proprioceptive Neuromuscular Facilitation (PNF) stretching on shoulder flexibility (3) determine which exercise is better on shoulder flexibility between stretching and PNF. the method used is experimental with pretest and post-test design. The research sample was 16 students of the Sport Coaching Education study program, Faculty of Sport, Sebelas Maret University, Surakarta. research data was obtained using the sit and reach test. Data analysis using an independent sample test with the help of the SPSS 22.0 program. The results of the study (1) passive static stretching effect on togok flexibility, the test results show the value of sig. 0.00 < 0.05. (2) practice PNF affects the flexibility of stakes. The study results show that both passive tactical stretching exercises and PNF exercises have a significant effect on increasing flexibility, but empirical data states that PNF exercise is more effective in increasing flexibility.
... The obtained results may allow to suggest that the use of exercises aimed at stretching and relaxing the muscles does not significantly affect the prevention of injuries. As noted by Baxter et al. [23], the benefits of stretching among long-distance runners is not indicated in literature on the subject, both in terms of performance and the occurrence of delayed onset muscle soreness (DOMS), as well as a reduction in the risk of trauma development. Overload changes, such as iliotibial band syndrome, plantar fasciitis or fractures caused by overload, are the most common in runners. ...
... The researchers concluded that this type of exercise may have significant impact on athletes in other sports, but it is doubtful that long-distance runners could benefit significantly from it, and doing so is not a solution to the problem of injury prevention. This is certainly an issue that requires further research [23]. ...
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Aim: The aim of this study was to evaluate the relationship between the results achieved in the Functional Movement Screen test and various aspects of training as well as injury history in long-distance runners. Basic procedures: The study involved 30 long-distance runners aged 20 to 45 years, training regularly from two to seven days a week and covering a total distance from 10 to 100 km. The subjects completed a questionnaire containing queries about training and past injuries. The Functional Movement Screen test was used to assess the quality of movement patterns. Results: The mean total score in the FMS test was 16.03 points. Results within the range from 18 to 21 points were achieved by 6 subjects, 3 of the subjects suffering injuries in the past. Results in the range from 14 to 17 points were obtained by22 subjects, 14 subjects having a history of injury. Ascore below 14 points was reachedby 2 subjects, both of them suffering injuries in the past. Conclusions: The results of this study indicate that a lower FMS score is associated with a greater number of injuries in the past. Warming up before training is a good way to prevent injury, while stretching after training does not seem reduce the incidence of injury.
... Systematic reviews to date have generally shown that RE improves running economy [34]; however, most of the recent reviews focused only on the effects of strength training in highly trained runners [35], such as concurrent heavy weight and explosive training [36]. Existing reviews on running biomechanics and injury-risk typically focus on multiple interventions or interventions other than RE [37][38][39][40]. The purpose of this paper is to summarize, in a narrative manner, the available evidence on effects of different RE modalities for different domains of application related to running. ...
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It is well-accepted that at least a certain amount of resistance exercise (RE) is recommended for most endurance athletes. In this review, we aim to summarize the evidence regarding the effects of RE on running economy, running biomechanics, and running-related injury risk in endurance runners. The evidence robustly shows that lower limb RE is effective for improving running economy and performance, with a combination of strength and plyometric training being recommended to improve RE. Isometric training is also emerging as a possible alternative to implement during periods of high overall training load. Lower limb RE may change some aspects of joint kinematics during running; however, the evidence regarding the effects on kinetics is limited. Lower limb RE may help reduce running-related injury risk, but further evidence is needed.
... Assim, o alongamento pode ter sido um fator protetor contra as lesões, corroborando o estudo de Roth et al. (2021), que também demonstrou baixos índices de lesões nos corredores de rua amadores. Contudo, Baxter et al. (2017) relatam que o alongamento não pode reduzir a prevalência destas lesões e nem melhorar o desempenho dos corredores, mas ainda há poucas evidências. ...
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OBJETIVO: Avaliar a função musculoesquelética e prevalência de lesões musculoesqueléticas em corredores amadores de rua. MÉTODOS: Selecionados 70 corredores amadores de rua, do sexo masculino, com idade entre 18 e 49 anos, divididos em G10km e G21km. Para identificar as lesões musculoesqueléticas foram avaliados por meio de um questionário semiesetruturado e a função musculoesquelética pelos seguintes testes: força de preensão manual (FPM)para estimar a força muscular global, fleximetria, teste de elevação da perna retificada, teste de sentar e alcançar, mensuração do comprimento de membro inferior, Functional Movement Screen (FMS), Crossover Hop Test for Distance (CHT), Y test, posição de primeira resistência detectada, weight bearing lunge test (WBLT) e flexibilidade da banda iliotibial. RESULTADOS: Em ambos os grupos encontrou-se baixa frequência de lesões, FPM adequada, amplitude de movimento (ADM) de flexão de joelho (fleximetria) e de dorsiflexão (WBLT) diminuídas, encurtamento de músculos isquiotibiais, discrepância de comprimento de membro inferior. Além desses achados, no G21km verificou-se equilíbrio dinâmico alterado e risco de lesão (Y test). CONCLUSÃO: Os corredores de rua apresentaram função musculoesquelética adequada, corroborando com a baixa prevalência de lesões musculoesqueléticas observada.
... Post-exercise stretching is prescribed under the belief that it enhances recovery (American Heart Association, 2020; ACSM, 2021), but reviews do not support these claims (Herbert and Gabriel, 2002;Henschke and Lin, 2011;Herbert et al., 2011;Torres et al., 2012;Baxter et al., 2017;Van Hooren and Peake, 2018). A systematic review with meta-analysis including 11 randomized controlled trials (RCTs) assessed the effects of post-exercise stretching on short-term (≤1 h after exercise) and delayed (24, 48, 72 h) recovery markers including delayed onset muscular soreness (DOMS), strength and ROM (Afonso et al., 2021a). ...
... While the limitations in study designs used to examine the effects of pre-exercise SS (see appendix and supplement 7 in Behm et al. (2)) have sown some mistrust in the use of SS for pre-exercise preparation, there is also conflict and confusion regarding its efficacy for reducing musculotendinous injury incidence (2), overuse injuries (e.g., distance running) (33), or all-cause injury incidence (34)(35)(36). ...
Evidence for the effectiveness of acute and chronic stretching for improving range of motion is extensive. Improved flexibility can positively impact performances in activities of daily living and both physical and mental health. However, less is known about the effects of stretching on other aspects of health such as injury incidence and balance. The objective of this review is to examine the existing literature in these areas. The review highlights that both pre-exercise and chronic stretching can reduce musculotendinous injury incidence, particularly in running-based sports, which may be related to the increased force available at longer muscle lengths (altered force-length relationship) or reduced active musculotendinous stiffness, among other factors. Evidence regarding the acute effects of stretching on balance is equivocal. Longer-term stretch training can improve balance, which may contribute to a decreased incidence of falls and associated injuries and may thus be recommended as an important exercise modality in those with balance deficits. Hence, both acute and chronic stretching seem to have positive effects on injury incidence and balance, but optimum training plans are yet to be defined.
... Post-exercise stretching is prescribed under the belief that it enhances recovery (American Heart Association, 2020; ACSM, 2021), but reviews do not support these claims (Herbert and Gabriel, 2002;Henschke and Lin, 2011;Herbert et al., 2011;Torres et al., 2012;Baxter et al., 2017;Van Hooren and Peake, 2018). A systematic review with meta-analysis including 11 randomized controlled trials (RCTs) assessed the effects of post-exercise stretching on short-term (≤1 h after exercise) and delayed (24, 48, 72 h) recovery markers including delayed onset muscular soreness (DOMS), strength and ROM (Afonso et al., 2021a). ...
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Flexibility is the ability to move through full joint range of motion (ROM), while stretching is an intervention to improve flexibility and achieve other goals (e.g., post-exercise relaxation) (ACSM, 2021). Stretching has been promoted as mandatory in exercise programs (Behm, 2019; American Heart Association, 2020; ACSM, 2021), although this is changing toward an optional feature (Bull et al., 2020). There are different types of stretching, including active static stretching (SS—active lengthening of a muscle until the feeling of stretch or to the point of discomfort), passive static stretching (PS—where an external force is applied, e.g., by a coach or a colleague), dynamic stretching (DS –controlled movements through the joint ROM) and proprioceptive neuromuscular facilitation (PNF—combining PS with isometric contractions) (Behm, 2019). We will focus on SS and PS, since these methods are at the heart of most debates, with the pendulum swinging across the years (Behm et al., 2021b). The answer to “Can I perform a given exercise intervention?” is straightforward: when the benefits of an intervention outweigh its adverse effects or contra-indications, the answer is “yes.” Let us take the example of a study with 15 University students (Bengtsson et al., 2018), to illustrate the difference between the two questions: the negative acute effects of SS during a warm-up were restored if followed by isokinetic contractions, suggesting that SS can be included in a comprehensive warm-up protocol. University students are not representative of athletes, and a small sample does not warrant generalizations, but our point is that answering the first question (“Can I?”) does not answer the second question (“Do I have to?”). Focusing the research question and applicability on “Can I?” may be short-sighted. To date, we feel that research has focused more strongly on answering what stretching can do, while more information is required as to how stretching compares to alternative interventions. We will explore the differences between “Can I?” and “Do I have to?” stretch and their implications to warm-up, cool-down, ROM, and injury risk.
... Post-exercise stretching is prescribed under the belief that it enhances recovery (American Heart Association, 2020; ACSM, 2021), but reviews do not support these claims (Herbert and Gabriel, 2002;Henschke and Lin, 2011;Herbert et al., 2011;Torres et al., 2012;Baxter et al., 2017;Van Hooren and Peake, 2018). A systematic review with meta-analysis including 11 randomized controlled trials (RCTs) assessed the effects of post-exercise stretching on short-term (≤1 h after exercise) and delayed (24, 48, 72 h) recovery markers including delayed onset muscular soreness (DOMS), strength and ROM (Afonso et al., 2021a). ...
The effects and usefulness of active and passive static stretching have raised heated debates. Over the years, the pendulum has swung from a glorified vision to their vilification. As most of the times, the truth often lies somewhere in-between. But even if there was no controversy surrounding the effects of static and passive stretching (which there is), and even if their effects were homogeneously positive (which they are not), that would not be sufficient to make stretching mandatory for practicing physical exercise, for most populations. Amidst the many discussions, an important issue has remained underexplored: the prerequisites to answer the question “Can I?” are not sufficient to answer the question “Do I have to?”, especially when alternative interventions are available. In this current opinion paper, we address four potential applications of stretching: (i) warm-up; (ii) cool-down; (iii) range of motion; and (iv) injury risk. We argue that while stretching can be used in the warm-up and cool-down phases of the training, its inclusion is not mandatory, and its effectiveness is still questionable. Stretching can be used to improve range of motion, but alternative and effective interventions are available. The role of stretching in injury risk is also controversial, and the literature often misinterprets association with causation and assumes that stretching is the only intervention to improve flexibility and range of motion. Overall, the answer to the question “Can I stretch?” is “yes”. But the answer to the question “Do I have to?” is “no, not really”.
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Running economy (RE) is considered an important physiological measure for endurance athletes, especially distance runners. This review considers 1) how RE is defined and measured and 2) physiological and biomechanical factors that determine or influence RE. It is difficult to accurately ascertain what is good, average, and poor RE between athletes and studies due to variation in protocols, gas-analysis systems, and data averaging techniques. However, representative RE values for different caliber of male and female runners can be identified from existing literature with mostly clear delineations in oxygen uptake across a range of speeds in moderately and highly trained and elite runners. Despite being simple to measure and acceptably reliable, it is evident that RE is a complex, multifactorial concept that reflects the integrated composite of a variety of metabolic, cardiorespiratory, biomechanical and neuromuscular characteristics that are unique to the individual. Metabolic efficiency refers to the utilization of available energy to facilitate optimal performance, whereas cardiopulmonary efficiency refers to a reduced work output for the processes related to oxygen transport and utilization. Biomechanical and neuromuscular characteristics refer to the interaction between the neural and musculoskeletal systems and their ability to convert power output into translocation and therefore performance. Of the numerous metabolic, cardiopulmonary, biomechanical and neuromuscular characteristics contributing to RE, many of these are able to adapt through training or other interventions resulting in improved RE.
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Synopsis: Bone stress injury (BSI) represents the inability of bone to withstand repetitive loading, which results in structural fatigue and localized bone pain and tenderness. A BSI occurs along a pathology continuum that begins with a stress reaction, which can progress to a stress fracture and, ultimately, a complete bone fracture. Bone stress injuries are a source of concern in long-distance runners, not only because of their frequency and the morbidity they cause but also because of their tendency to recur. While most BSIs readily heal following a period of modified loading and a progressive return to running activities, the high recurrence rate of BSIs signals a need to address their underlying causative factors. A BSI results from disruption of the homeostasis between microdamage formation and its removal. Microdamage accumulation and subsequent risk for development of a BSI are related both to the load applied to a bone and to the ability of the bone to resist load. The former is more amenable to intervention and may be modified by interventions aimed at training-program design, reducing impact-related forces (eg, instructing an athlete to run "softer" or with a higher stride rate), and increasing the strength and/or endurance of local musculature (eg, strengthening the calf for tibial BSIs and the foot intrinsics for BSIs of the metatarsals). Similarly, malalignments and abnormal movement patterns should be explored and addressed. The current commentary discusses management and prevention of BSIs in runners. In doing so, information is provided on the pathophysiology, epidemiology, risk factors, clinical diagnosis, and classification of BSIs. Level of evidence: Therapy, level 5.
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Long-distance running (greater than 3000 m) is often recommended to maintain a healthy lifestyle. Running injury rates increase significantly when weekly mileage extends beyond 40 miles cumulatively. With the development of running analysis and other diagnostic tests, injuries to the leg secondary to bone, musculotendinous, and vascular causes can be diagnosed and successfully managed. Searches used the terms running, injuries, lower extremity, leg, medial tibial stress syndrome, compartment syndrome, stress fractures, popliteal artery entrapment, gastrocnemius soleus tears, and Achilles tendinopathy. Sources included Medline, Google Scholar, and Ovid from 1970 through January 2012. Tibial stress fractures and medial tibial stress syndrome can sometimes be prevented and/or treated by correcting biomechanical abnormalities. Exertional compartment syndrome and popliteal artery entrapment syndrome are caused by anatomic abnormalities and are difficult to treat without surgical correction. Leg pain due to bone, musculotendinous, and vascular causes is common among long-distance runners. Knowledge of the underlying biomechanical and/or anatomic abnormality is necessary to successfully treat these conditions.
It is generally accepted that increasing the flexibility of a muscle-tendon unit promotes better performances and decreases the number of injuries. Stretching exercises are regularly included in warm-up and cooling-down exercises; however, contradictory findings have been reported in the literature. Several authors have suggested that stretching has a beneficial effect on injury prevention. In contrast, clinical evidence suggesting that stretching before exercise does not prevent injuries has also been reported. Apparently, no scientifically based prescription for stretching exercises exists and no conclusive statements can be made about the relationship of stretching and athletic injuries. Stretching recommendations are clouded by misconceptions and conflicting research reports. We believe that part of these contradictions can be explained by considering the type of sports activity in which an individual is participating. Sports involving bouncing and jumping activities with a high intensity of stretch-shortening cycles (SSCs) [e.g. soccer and football] require a muscle-tendon unit that is compliant enough to store and release the high amount of elastic energy that benefits performance in such sports. If the participants of these sports have an insufficient compliant muscle-tendon unit, the demands in energy absorption and release may rapidly exceed the capacity of the muscle-tendon unit. This may lead to an increased risk for injury of this structure. Consequently, the rationale for injury prevention in these sports is to increase the compliance of the muscle-tendon unit. Recent studies have shown that stretching programmes can significantly influence the viscosity of the tendon and make it significantly more compliant, and when a sport demands SSCs of high intensity, stretching may be important for injury prevention. This conjecture is in agreement with the available scientific clinical evidence from these types of sports activities. In contrast, when the type of sports activity contains low-intensity, or limited SSCs (e.g. jogging, cycling and swimming) there is no need for a very compliant muscle-tendon unit since most of its power generation is a consequence of active (contractile) muscle work that needs to be directly transferred (by the tendon) to the articular system to generate motion. Therefore, stretching (and thus making the tendon more compliant) may not be advantageous. This conjecture is supported by the literature, where strong evidence exists that stretching has no beneficial effect on injury prevention in these sports. If this point of view is used when examining research findings concerning stretching and injuries, the reasons for the contrasting findings in the literature are in many instances resolved.
This article reviews the concept of maximal oxygen consumption ([Formula: see text]) from the perspective of multifactorial models of [Formula: see text] limitation. First, I discuss procedural aspects of [Formula: see text] measurement: the implications of ramp protocols are analysed within the theoretical work of Morton. Then I analyse the descriptive physiology of [Formula: see text], evidencing the path that led to the view of monofactorial cardiovascular or muscular [Formula: see text] limitation. Multifactorial models, generated by the theoretical work of di Prampero and Wagner around the oxygen conductance equation, represented a radical change of perspective. These models are presented in detail and criticized with respect to the ensuing experimental work. A synthesis between them is proposed, demonstrating how much these models coincide and converge on the same conclusions. Finally, I discuss the cases of hypoxia and bed rest, the former as an example of the pervasive effects of the shape of the oxygen equilibrium curve, the latter as a neat example of adaptive changes concerning the entire respiratory system. The conclusion is that the concept of cardiovascular [Formula: see text] limitation is reinforced by multifactorial models, since cardiovascular oxygen transport provides most of the [Formula: see text] limitation, at least in normoxia. However, the same models show that the role of peripheral resistances is significant and cannot be neglected. The role of peripheral factors is greater the smaller is the active muscle mass. In hypoxia, the intervention of lung resistances as limiting factors restricts the role played by cardiovascular and peripheral factors.