The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.
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Do Triathletes Really Need to Stretch?
Studies looking at stretching have had mixed results. It is a difficult to examine because stretching is ingrained in the psyche of so many athletes that they are unwilling to participate as controls.
By Andrew Getzin, MD
It is accepted lore by most athletes and coaches that stretching before vigorous activity is essential. This idea has been promoted for years by sports medicine and exercise specialists who believed that if an athlete did not stretch properly he would have an increased risk for injury. According to Shehab et al. 1, 95% of Michigan high school coaches advised their athletes to stretch and felt that stretching decreased injury risk.
Wikipedia defines stretching as the deliberate act of lengthening muscles to increase muscle flexibility and/or joint range of motion. There is strong evidence in the medical literature that stretching does increase muscle length when done consistently. Increased muscle length can translate into improved joint function.
As people age there is a physiologic decrease in flexibility and joint range of motion. Many older people can improve their functioning and quality of life by stretching. In addition, I am reminded every time I watch my daughter’s gymnastics team practice that there are some sports one cannot do if one doesn’t have sufficient flexibility. However, in my sports medicine practice, I increasingly see many patients who are too flexible and their joints have become unstable. When the joint becomes unstable (as we often see in swimmer’s shoulder) there is an increased risk of overuse injury or dislocation because joint motion is excessively increased.
Studies looking at stretching have had mixed results. It is a difficult intervention to examine because stretching is ingrained in the psyche of so many athletes that they are unwilling to act as a control group. Most studies that have been done have been compromised by both the control and stretching groups doing warm-ups. Thacker et al. 2, in a 2004 review on stretching from the CDC, found only six studies that met their inclusion criteria. The pooled data from these studies showed that the group that stretched is not injured less frequently. Herbet et al. 3, in another meta-analysis, found that stretching does not decrease post-exercise soreness. And Craib et al. 4 showed in a group of sub-elite distance runners that a lack of flexibility correlates with an increase in running efficiency.
Some people love to stretch because it makes them feel good. I am not trying to discourage people from doing things they enjoy. I tell the extremely flexible triathletes whom I see in my practice that they would benefit more from time spent weight training (especially if they are 40 years or older, when muscle mass loss tends to increase) and I discourage flexibility work. It is better to spend their limited time doing things that have been shown to improve performance (such as plyometrics or working on swim form) and to decrease injury (such as weight training).
For this triathlon season, I personally plan to spend only a few minutes weekly doing dynamic flexibility exercises and to spend more time in the pool, so that my shoulders’ physiology adapt and increase their range of motion.
Andrew Getzin, MD
USA Triathlon Physician
Cayuga Sports Medicine
310 Taughannock Blvd.
Ithaca, NY 14850
Shehab, et al., “Pre-exercise Stretching and Sports Related Injuries: Knowledge, Attitudes, and Practices,” Clin. J. Sport Med. 2006;16:228-231
Thacker, et al., “The Impact of Stretching on Sports Injury Risk: A systemic Review of the Literature,” Med. Sci. Sports Exerc. 2004;36(3):371-378
Herbert, et al., “Effects of Stretching on Muscle Soreness and Risk of Injury: A Meta-Analysis,” BMJ 2002;325:468-471
Craib, et al., “The Association between Flexibility and Running Economy in Sub-elite Male Distance Runners,” Med. Sci. Sports Exerc. 1996;28(6):737-743
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