National Strength and Conditioning Association Volume 28, Number 6, pages 6674

Keywords: acute stretching; chronic stretching; range of motion

Stretching: Acute and Chronic? The Potential Consequences

Mike Stone, PhD, Michael W. Ramsey, PhD, Ann M. Kinser East Tennessee State University, Johnson City,Tennessee Harold S. OBryant, PhD Appalachian State University, Boone, North Carolina Chris Ayers, MS East Tennessee State University, Johnson City,Tennessee William A. Sands, PhD United States Olympic Committee, Colorado Springs, Colorado part of a warm-up prior to physical exertion. Typically, stretching is used to enhance the range of motion (ROM) about a joint (flexibility). The resulting enhancement may be viewed as acute (temporary) or chronic. There are many different types of stretching that can be performed. A quick look at the internet (under stretching) offers a variety of stretching types and methods, including: Ballistic stretching Dynamic stretching Active stretching Passive (or relaxed) stretching Static stretching Isometric stretching Proprioceptive neuromuscular facilitation stretching regular basis among athletes: first is acute stretching (as part of a warm-up process), and second is chronic stretching that is often quite extensive and usually occurs after a training session. Athletes and coaches commonly hold 2 beliefs concerning these 2 forms of stretching: (a) acute stretching (part of warm-up) may increase performance and will reduce the injury potential of exercise; (b) chronic stretching will increase performance, reduce aches and pains, and reduce the injury potential of exercise and sports performance. However, data exist indicating that these beliefs may not be completely true. The purpose of this paper is to answer several basic questions concerning stretching and its relationship to sports performance, with a particular focus on gymnastics.

summary
Stretching is commonly used by many athletes in different sports. Although acute stretching, as part of a warm-up, can enhance range of motion, it may also reduce performance. Acute stretching can reduce peak force, rate of force production, and power output. Chronic stretching may enhance performance, although the mechanism is unclear. Acute

stretching has little effect on injury. However,chronic stretching (not part of warm-up) may have some injury reduction potential.

Although in some cases the nature of these methods is essentially the same, it gives the coach/athlete a wide variety of methods from which to choose when acutely or chronically stretching. Although, the exact timing and degree of stretching varies somewhat from sport to sport, there are basically 2 forms of stretching taking place on a

Will Warm-Up (Acute) Stretching Produce a Better Performance?

Table 1 shows the results of studies dealing with the relationship of various activities and various performance characteristics that would have effects on sport. Although not all studies show a decrease in performance, the large majority do indicate that acute stretching

Introduction
tretching can be defined as the act of applying tensile force to lengthen muscle and connective tissue. Often stretching is performed as

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can decrease subsequent performance, particularly for maximum strength and explosive strengthrelated movements. So, for a sport such as gymnastics, in which explosive strength is quite important, such a loss of explosive capability may reduce the ability to perform. The underlying mechanisms that can reduce performance subsequent to acute stretching are not necessarily apparent or easily understood. To begin to understand why acute stretching may reduce performance, a brief discussion of how stretching affects ROM is in order. There are basically 2 mechanistic possibilities that may have an effect individually or in combination: (a) stretching alters ROM by altering the structure and properties of soft tissue (muscle and connective tissue); (b) there is an increase in pain tolerance. Tissue stiffness is the ability of a tissue to resist change in length and is represented by a change in force per change in length ( F/ L). A decreased or increased stiffness may alter the stressstrain curve (changes in force when muscle or connective tissue is lengthened or shortened by stretching). Figure 1 (36) shows a passive stress-strain curve in which a tissue is being stretched until failure. Note that to a point, the greater the lengthening of the tissue the greater the force produced. The amount of energy that is absorbed by the tissue before failure is a function of its tensile strength. Therefore, the more energy absorbed, the stronger and the more stretch resistant the tissue. The stiffer the tissue, the more it resists the stretch, and there are 2 possible results: (a) the rate at which force rises is faster; (b) the failure point of the tissue may be reached faster. Muscle can also be activated to resist a stretching load (e.g., eccentric contractions). Thus, muscle tissue has active stiffness properties. Contraction during stretching can take up the slack in the

Table 1
The Effects of Acute Stretching (Warm-Up) on Performance Variables Performance Sprinting Study Nelson et al. (47) McBride et al. (39) Koch et al. (30) Cornwell et al. (11) Knudson et al. (33) McNeal and Sands (42) Young et al. (69) Cornwell et al. (11) Fry et al. (16) Kokkenen et al. (31) Nelson et al. (46) Behm et al. (8) Avela et al. (7) Nelson et al. (47) Nelson et al. (46) Result Decrease Decrease ND Decrease ND Decrease Decrease ND Decrease Decrease Decrease Decrease Decrease Decrease Decrease

Standing long jump Counter movement jump

Static jump

Dynamic strength

Isometric strength

Strength endurance

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

series elastic elements faster and result in a faster rate of force production and an increased amount of force before failure (36).

A very stiff tissue would require more force to stretch it to a given length. So tissue stiffness could (theoretically) inhibit flexibility. Therefore, an acute ex-

Figure 1. A force-length or stress-strain curve. 1 = elastic region: region of stretch in which the elastic properties of the tissue increase the force by resisting (pulling back against the stretch). 2 = nonelastic region: region of stretch in which the elastic properties of the muscle are stretched to their limit and nonelastic elements resist the stretch.

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Figure 2. If muscle stiffness is a key, then stiffness can be increased and performance should also increase (modied from J. McBride [39]). ROM=range of motion.

ercise reducing tissue stiffness could enhance flexibility. However, in the normal intact human, changes in the length of a muscle (or muscles) also alter the feedback to the nervous system. For example, a less stiff muscle would produce less force at a given length, and the nervous system senses this difference. Thus, alterations in muscle stiffness (active or passive)

could change how the nervous system reacts to a given muscle length. Therefore, a change in active or passive muscle stiffness could also effect the stretch reflex characteristics and tissue elastic properties (less energy stored for elastic recoil) such that force transmission is disrupted/muted, decreasing force magnitude, rate of force development, and power output.

Some evidence indicates that an increased ROM as a result of stretching is related to reduced tissue stiffness (20). However, the majority of studies indicate that although tissue viscosity may be altered, muscle stiffness and elasticity are largely unaffected by acute stretching as part of a warm-up (11) or chronic stretching over a 3- to 4-week period (21, 34, 37) and that alterations in ROM after stretching are more related to increased pain tolerance (21, 37). On the other hand, repeated and prolonged stretching for 1 hour (7) adversely affected active and passive muscle stiffness, and 30 sessions of static stretching produced a decrease in passive muscle stiffness (20). The decrease in active tissue stiffness as a result of prolonged stretching could be a fatigue-induced phenomenon rather than simply a stretch result (5, 24). Thus, increased ROMs as a result of stretching may result from decreased muscle stiffness but this appears to be more likely caused by altered tissue viscosity and pain tolerance.

Table 2
Effects of Chronic (Weeks) Stretching on Performance Study Positive effect Dintiman (14) Handel et al. (22) Kerrigan et al. (29) Wilson et al. (64) Hunter and Marshall (26) Worrell et al. (67) Hortobagyi et al. (25) No effect Nelson et al. (46) Godges et al. (18) Physically active Physically active No effect running performance No effect on gait economy Trained (n = 145, 4 groups) Various athletes (n = 8) Elderly (n = 47E, 49C) Powerlifters (n = 9E, 7C) Various athletes (n = 60, 3 groups) Active students (n = 19) Active students (n = 12) Faster running speed* Increased force Improved gait Enhanced stretch-shortening cycle Improved vertical jump Increased hamstring force Increased knee extension force Subject Description Result

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

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Interestingly, maximum strength and strength training effects appear to be associated with increased active and passive muscle stiffness that is independent of ROM alterations (17, 34, 37, 55). An increase in muscle stiffness appears to be associated with enhanced strength (66) and various types of performances, including the vertical jump and improved running (i.e., enhance running economy; Figure 2). Thus, a loss of performance associated with acute stretching could be associated with a decrease in muscle stiffness. Stretching has also been associated with muscle damage. In mice, Black and Stevens (9) found that acutely stretching muscle fibers 5 % beyond resting resulted in a 5% loss of isometric force production. Strains (stretching), as low as 20% beyond resting length, have been related to muscle damage and decreased force in humans (38). So vigorous stretching could induce enough muscle damage to reduce maximum strength and explosive strength. However, in the authors opinion, it is unlikely that chronic stretching in well-trained athletes would continue to induce tissue damage. Otherwise, one would expect chronic muscle soreness among advanced and elite athletes, and this clearly is not the case. A finding noted in most of the performance studies indicates that acute stretching as a part of warm-up reduces maximum strength (force magnitude) and several associated variables, such as rate of force development and power output (8, 46, 53). Additionally, a decreased H-reflex has been noted (6, 7, 20). The H-reflex is a monosynaptic reflex elicited by stimulating a nerve, particularly the tibial nerve, with an electric shock. Thus, it appears that stretching acutely as part of a warm-up can negatively alter force production, power output, and stretch-shortening cycle characteristics such that strength and performance, including such explo-

sive performances as gymnastics, can be compromised. This compromise may be associated with alterations in muscle stiffness (Figure 2).

Will Chronic Stretching (NonWarm-Up) Improve Performance?

Many athletes stretch after a training session. The belief is that over the long term, this practice may reduce injury and perhaps enhance performance. Table 2 shows studies that have investigated long-term stretching and performance. These studies generally show that performance, particularly maximum strength and explosive strength performances, were enhanced. When the studies are taken as a whole, the degree of enhancement appears to be small, perhaps 3 to 4 %. However, it should be remembered that in high-level sports, a small percentage of improvement can actually be a lot. For example, in the last 2 Olympics, the difference between first and fourth place (for most sports) was less than 1.5 %. The mechanisms underlying enhanced performance, as a result of chronic stretching, are unclear at best. Due to position requirements for some sports, such as weightlifting, diving, and particularly gymnastics, it becomes obvious that an increased ROM would be advantageous. If tissue stiffness could be reduced, one might argue that movement economy would be enhanced. In this context, Godges et al. (19) noted that among very inflexible patients, stretching could produce performance (gait) enhancements. However, the primary alteration (3- to 4-week studies) appears to be stretch-pain-tolerance and not change in visco-elasticity (21, 37). Thus, it is doubtful that muscle stiffness and movement economy would be substantially altered as a result of stretching. Another possibility is that stretching induces additional hypertrophy. Chronic

stretch (24 h/d) causes some muscle damage and chronic reflexive activity and results in muscle hypertrophy in animals. Acute stretching (5% of initial length) can cause some muscle damage (at least in untrained animals) and result in a force deficit (9). However, it is doubtful that the stretching used in training athletes would be enough to cause sufficient damage to tissue to increase hypertrophy and force-producing capability, especially in well-trained strength/power athletes. Therefore, the exact mechanisms that underlie the small but positive performance improvements that often accompany increased flexibility remain elusive. Perhaps the underlying mechanism explaining increased performance is simply a greater ROM resulting from greater pain tolerance.

Will Stretching (Acute or Chronic) Affect Injury Rates?

Although flexibility is often believed to be related to injury, particularly muscular injury, it is not clear as to how it is related (57). The mechanism that is usually associated with the role of flexibility in musculo-tendinous injury deals with stretching the tissue beyond its normal active limits. For example, in sports movements in which the tissue does not have enough elasticity to compensate for additional stretch, the tissue will tear. If the average person jumped into a fore-aft split, typical of gymnastics, most often there would be considerable injury to the musculo-tendinous tissues (not to mention a few other items). If high levels of flexibility are gained through stretching, such as takes place among gymnasts, this position can typically be achieved without problems. Although this example is likely related to flexibility and is a good reason to enhance flexibility, not all injuries can be attributed to ROM characteristics. For example, the majority of pulled (torn) muscles, such as those affected when a sprinter pulls a hamstring, do not appear to occur as a result of overexten-

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Table 3
Potential Injury Reduction Injury and Rate of Motion Study Nattress et al. (44) Zuberbier (70) Emery and Meeuwisse (15) Watson (63) Lumbar spine Low back Groin (hockey) Soccer injuries Some Determinates of Injury Study Stewart and Burden (60) Konradsen and Vioght (32) Orchard (48, 49) Emery and Meeuwisse (15) Orchard (48, 49) Almeida et al. (1) Yamamoto (68) McCarthy et al. (40) Orchard et al. (49) Nadler et al. (43) Crosier et al. (13) Askling et al. (2) Variables Extreme rate of motion Excessive rate of motion/poor stability Previous injury or defect Previous injury Fatigue Volume of training/fatigue Relative strength Strength Strength Strength Strength (eccentric) Strength Result Increased injury risk Increased injury risk Increased injury risk Increased injury risk Increased injury risk Increased risk potential Decreased injury risk Decreased injury risk Decreased injury risk Decreased injury risk Decreased injury risk Decreased injury risk Injury site No relation No relation No relation No relation Result

sion of the tissues. Many of these nonlimit-stretching injuries appear to occur during eccentric loading but within normal ROMs (58, 62). Furthermore, the injury potential appears to rise as the eccentric loading produces faster strain rates (61). Thus, some other mechanism must be responsible for the nonlimit-stretch induced injuries. One mechanistic possibility responsible for nonlimit-stretch injuries is increased muscle stiffness, particularly when the muscle is active, such as during eccentric loading (54, 58). It is possible that as external eccentric forces are imposed upon stiff musculo-

tendinous units that are less compliant, less force can be absorbed before injury occurs. So a more compliant tissue system has a cushioning effect, reducing the trauma on the muscle fibers and resulting in less damage (65). Some evidence indicates that greater passive muscle stiffness, as measured by flexibility, is associated with more muscle damage and subsequent loss of strength and degree of delayed soreness as a result of eccentric contractions (41). Thus, a stiffer tissue may increase the potential for injury. Because strength training can increase muscle stiffness, it is possible that the stronger muscle is now more susceptible to injury. However, the available data do

not completely support this idea; although strength training increases muscle stiffness, it can also reduce injury potential. As tissue is stretched it absorbs energy, and active muscles are capable of absorbing more energy than passive muscles (36). A stronger muscle would have a greater energy absorbance reserve before tearing during eccentric actions (35). Thus, strength training, particularly eccentric training, may actually reduce rather than increase injury to the musculo-tendinous unit. Table 3 shows studies that deal with factors related to injury and injury reduction during physical activity. Sev-

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eral factors appear to predispose one to increased injury, such as previous injury. Interestingly, with the exception of joints showing extreme ROMs, most studies indicate that reduced flexibility shows little relationship to typical sports injuries. Neither acute (50) nor chronic (23) stretching appears to effect a significant reduction in physical activityrelated injuries. Indeed, Thacker et al. (62), in an extensive review of the flexibility literature that included 361 articles dating back into the 1950s, concluded that there is little relationship between stretching (e.g., increased ROM) and injury. Thus, there is little evidence that stretching and improved ROM effects a lower injury rate. This discussion brings up an interesting dilemma: if acute (as part of a warm-up) stretching reduces performance and good flexibility is a necessity in performance, as in gymnastics, then: A. How long do you have to wait before the effect (reduce performance) wears off? Unfortunately, this problem has not been well studied. Obviously, the effect of reduced explosiveness does wear off, but exactly how long it takes is unknown. The authors observations suggest that the wear-off time may last as long as 1 to 2 hours and that differences in wear-off time may be individual characteristics. Part of the reason for differences in the wear-off time likely involves determining what type of stretching was used the degree of inhibition and the presence or absence of fatigue, as well as individual differences. B. What if there is an intervention between the acute flexibility exercise and the subsequent performance? This question deals with this idea: flexibility can be acutely enhanced by stretching as part of a warm-up; however, this reduces explosiveness during performance. What happens if some explosive

movement takes place between the stretching and the subsequent performance? Some data indicate that in fact the intervening exercise can reduce the negative effect of stretching on explosiveness, at least to an extent (69). However, it is not known to what extent the alterations in flexibility can be retained. C. Is there a warm-up method in which flexibility is gained but performance is either not adversely affected or enhanced? Vibration has been shown to acutely (and chronically) enhance explosive performance (28, 51, 52). Vibration has also been shown to acutely (and chronically) enhance flexibility resulting from stretching (3, 27, 56). When the 2 are combined, it may be possible to enhance flexibility without altering explosiveness. Cochrane and Stannard (10) found that women field hockey players using a vibration platform while in a stretched position for 5 minutes before exercise can increase both flexibility and explosiveness as measured by jumping.

ing seems to have little effect on injury. However, chronic stretching (not part of a warm-up) may have some injury reduction potential. Several questions concerning stretching remain to be answered. For example, how long do the negative effects of acute stretching on explosiveness last? Cooperative efforts between USOC Sports Science, East Tennessee State University, and Appalachian State University are currently under way to begin answering these questions.

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Conclusion
Stretching can alter the ROM about a joint and improve flexibility. However, stretching as part of a warm-up may reduce performance. It is unclear whether or not acute stretching reduces muscle stiffness or increases pain tolerance (or both). Indeed, most available data indicates acute performance reduction can occur and that it may be related to decreased tissue stiffness or alterations in nervous system components of the stretch-shortening cycle, such as the myototic reflex. These alterations in turn can result in a decreased maximum strength and explosiveness and inferior performances. Chronic stretching may enhance performance, although the mechanism is unclear. In such sports as gymnastics, in which great ranges of motion are clearly necessary for performance, it becomes obvious that flexibility is a primary ingredient. Acute stretch-

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Mike Stone is currently the Exercise and Sports Science Laboratory Director at East Tennessee State University. Michael Ramsey is Assistant Professor of Exercise Science at East Tennessee State University. Ann Kinser is currently finishing coursework for a Masters degree in Exercise and Sport Sciences at East Tennessee State University. Harold OBryant is a senior faculty member in the Health, Leisure, and Exercise Science Department at Appalachian State University. Chris Ayers is an Assistant Professor at East Tennessee University. William Sands is the head of Sports Biomechanics and Engineering for the United States Olympic Committee.

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