SPORT SCIENCE & MEDICINE TEAM
FLEXIBILITY PROTOCOL
INTRODUCTION
This protocol has been written to provide up to date evidence-based information on best practice. It
sets out to establish the justification for stretching and how it should be implemented. Much of the
evidence at the moment is contradictory. Therefore at times decisions should be made based on
clinical expertise and experience.
Definition of Terms
ACTIVE STRETCHING – an unassisted movement that requires voluntary muscle contractions to
move the joint to its maximal range [Hartley O’Brien, 1980].
PASSIVE STRETCHING – an assisted movement occurring in a relaxed state; the assistance can be an
external force such as gravity, body momentum or manual assistance [Hartley O’Brien, 1980].
‘NORMAL’/FUNCTIONAL FLEXIBILITY – muscle length is considered to be sufficient to allow the
specific sport or activity to be performed without restriction.
DYNAMIC WARM UP – soft tissues and joints are taken through their ‘normal’ range of movement.
Movements are functional to the forthcoming task, i.e. skill rehearsal. It is preceded by aerobic activity
and followed by skill rehearsal. [See warm-up, cool down policy]
STATIC STRETCHING – the antagonist muscle is positioned at the end of its available range, where
there is some resistance, and held for a sustained period of time - 30 seconds is recommended as the
optimum.
BALLISTIC STRETCHING – repetitive contractions of the agonist muscle gives sudden rapid
stretches to the antagonist muscle at the end of range. There is little control during this type of
stretching and therefore it is not recommended.
HIGH INTENSITY TRAINING – when there is a conditioning/overload element to training e.g.
running, hockey or weights. Athletes are considered to be training at high intensity if their VO2 max
is 85% or more.
PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF)
PASSIVE PNF (HOLD RELAX) – the antagonist muscle is taken to its end of range. An
isometric contraction of the antagonist is performed against an external resistance (usually
another person) for 5 -30 secs. On relaxation of the contraction, an external force (another
person) stretches the muscle further.
ACTIVE PNF (MODIFIED SLOW REVERSAL - HOLD RELAX) – the antagonist muscle is
taken to its end of range. An isometric contraction of the antagonist is performed against an
external resistance (usually another person) for 5 -30 secs. On relaxation of the contraction,
the athlete contracts the agonist muscle to stretch the antagonist muscle further.
Maintenance of joint and muscle flexibility can be achieved by a variety of means, including static
stretching, PNF, and dynamic warm-up. Ballistic stretching is not recommended.
INDICATIONS FOR THE USE OF STATIC STRETCHING
Static stretching may be used to INCREASE muscle length or to RETURN muscle length to NORMAL
following high intensity training. It is very important that the reason for stretching is clear.
SPORT SCIENCE & MEDICINE TEAM
Static stretching has not been proven to reduce acute muscle injuries [Pope, 2000], but it may reduce
injuries of a biomechanical nature. Injury statistics from English Hockey’s elite squads identifies that
the majority of injuries are biomechanical in nature rather than due to acute trauma.
Stretching may enhance performance in athletes with insufficient range to perform a given task with
maximum efficiency.
Static stretching has been proven to increase muscle length, [Kibler, 1993]. The effectiveness appears
to be related to the period of time it is practised, i.e. weeks/month, rather than the number of
repetitions per day.
It is vital that any programme aiming to increase flexibility ensures that the athletes have muscle
strength and control throughout the whole of the new range.
Athletes who are deemed to have ‘normal’ flexibility or are considered to be hypermobile do not
need to stretch to increase range. However their flexibility should be monitored on a regular basis
though.
However, it is important that following high intensity training all athletes [whether hypomobile,
normal or hypermobile] should stretch to regain normal muscle resting length.
Static stretching does not reduce the effect of the DOMS, [Herbert 2003].
INDICATIONS FOR DYNAMIC WARM-UP
As part of the warm up in preparation for activity [see warm up, cool down protocol]
INDICATIONS FOR PNF
In its truest form, PNF incorporates rotation. As functional movement is rarely uniplanar this uses
more realistic patterns of movement than other types of stretches.
Some research claims that working a muscle or its antagonist maximally results in increased relaxation
and therefore enhances the opportunity to increase muscle length.
Active PNF is seen as the safest method as the individual has maximum control.
PNF can be used either to return muscle length to its original resting length following high intensity
training or as a means of increasing muscle length.
IMPLEMENTATION
o
Following high intensity training all athletes [whether hypomobile, normal or hypermobile]
should stretch to return resting muscle length to normal.
o
Athletes who are identified as having reduced flexibility [this will be highlighted in the
screening process, including specific muscles that are tight] need to stretch regularly to
increase muscle length. Funded athletes will therefore have an individualised stretching
programme.
o
It is recommended that athletes warm up before they stretch. This would involve 5 mins of
aerobic activity e.g. jogging, cycling, or by artificial means e.g. hot bath. However it is better
that athletes stretch when cold than not at all.
SPORT SCIENCE & MEDICINE TEAM
o
As it is more effective to stretch when warm, stretching after a training session is a good
opportunity.
o
It is recognised that microtrauma may result when athletes stretch to increase range
immediately after a high intensity session. Currently no research has been found to prove
that this is a problem, particularly as the nature of training is overload, and therefore
microtrauma is to be expected. Providing the athletes are in a training, rather than a
competition, phase, it is felt that the benefits of stretching outweigh the risks.
o
It is accepted that muscles will have an increased tendency to tighten as training volume/load
increases. By stretching immediately after training it is easy to ensure that the amount of
stretching meets the requirements at that time.
o
There is no contraindication to athletes following an upper body weights with lower body
stretches and visa versa.
o
Athletes may choose to work on increasing flexibility as a separate session but it is
recommended that they are warm first.
o
Numerous studies have been unable to prove that static stretching prior to training reduces
the risk of injury in that training session. It is therefore not recommended to stretch prior to
training, unless it is for injury management purposes.
o
Static stretching may well reduce muscle power generation prior to training. It is not
recommended to statically stretch prior to competing, or training where power/strength is
key e.g. prior to weights.
o
However, individual athletes who are known to have specific overactive or tight muscles that
affect correct movement patterns may stretch these specific muscles prior to or during
power/strength training or competition.
o
Three repetitions have been identified as the optimum number of repetitions – further
repetitions do not give further improvement. Hold times vary considerably from 10-60 secs
but 30 secs seems to have the highest consensus. This is therefore what we recommend.
CONCLUSION
o
All athletes should stretch following high intensity training, in order to return muscles to
normal resting length.
o
Athletes who have been identified as having poor flexibility should stretch those individual
muscle groups to increase range.
o
It is vital to ensure that full strength/control in the new range follows increased flexibility.
o
Flexibility training may vary according to what training phase athletes are in.
SPORT SCIENCE & MEDICINE TEAM
References
Amako, M., Oda T., Masuoka K., Yokoi H., Campisi P. [2003] Effect of static stretching on prevention
of injuries for military recruits. Military Medicine. 168:442-6.
Bandy W.D., Irion J.M. [1994] The effect of time on static stretch on the flexibility of the hamstring
muscles. Physical Therapy. 74:845-50.
Bandy W.D., Irion J.M. [1998] The effect of static stretch and dynamic range of motion training on
the flexibility of the hamstring muscles. Orthopaedic Sports Physical Therapy. 27:295-300.
Crowther G. [2000] Stretching the truth. Runner Magazine. July issue.
Dadebo B., White J., George K.P. [2004] A survey of flexibility training protocols and hamstring strain
in professional football clubs in England. British Journal of Sports Medicine 38:388-94.
Gleim G.W., McHugh M.P. [1997] Flexibility and its effects on sports injury and performance. Sports
Medicine. 24:289-99.
Hartig, D.E. and Henderson, J.M. (1999) Increasing hamstring flexibility decreases lower extremity
overuse injuries in military trainees. Am. J. Sports Med. 27(2):173-176.
Hartley O’Brien, S (1980) Six mobilization exercises for active range of hip flexion. Research
Quarterly for Exercise and Sport, 51 (4): 625-635.
Herbert , R.D., and Gabriel, M. (2002) Effects of stretching before and after exercising on muscle
soreness and risk of injury: systematic review. British Medical Journal. 325(31):1-5.
Kibler W.B., Chandler T.J. [2003] Range of motion in junior tennis players participating in an injury
risk modification program. J Sci Med Sport 6:51-62.
Knapik J., Jones B., Connie L., Bauman, Harris J. [1992] Strength, flexibility and athletic injuries. Sports
Medicine 14:277-288.
Mohr K. J., Pink M.M., Elsner C., Kvitne R.S. [1998] Electromyographic investigation of stretching: the
effect of warm up. Clin J Sport Med. 8:215-220.
Pope, R., Herbert, R., Kirwan, J., and Graham, B. (1999) Does pre-exercise muscle stretching prevent
injury ?. Proceedings of ‘The Muscle Symposium’, A.I.S.:31-32.
Pope, R.P., Herbert, R.D., and Kirwan, J.D. (2000) A randomised trial of pre-exercise stretching for
prevention of lower limb injury. Med. Sci. Sports Exerc. 32:271-277.
Rosenbaum D., Hennig E. M., [1995] The influence of stretching and warm up exercises on Achilles
tendon reflex activity. J Sports Sci. 13:481-90.
Schilling, B.K. and Stone, M.H. (2000) Stretching : Acute effects on strength and power performance.
Strength and Conditioning Journal 22(1):44-47.
Shrier, I. (1999) Stretching before exercise does not reduce the risk of local muscle injury: A critical
review of the clinical and basic science literature. Clin. J. Sports Med. 9:221-227.
Shrier, I. (2000) Stretching before exercise:an evidence based approach. Br. J. Sports Med.
34(10):324-325.
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Shrier, I. and Gossal, K. (2000) Myths and Truths of Stretching. Phys. and Sports Med. 28(8)
Taylor, D.C., Dalton, J.D., Seaber, A.V. et al. (1990) Viscoelastic properties of muscle-tendon
units:the biomechanical effects of stretching. Am. J. Sports Med. 18(3):300-309.
Thacker S.B. Gilchrist J., Stroup D. F. Kimsey C.D. [2004] The impact of stretching on sports injury
risk: a systemic review of the literature. Med Sci Sports Exerc. 36:371-8.
Winters M., Blake C., Trost J., Marcello-Brinker T, Lowe L., Garber M., Waiiner R. [2004] Passive
versus active stretching of hip flexor muscles in subjects with limited hip extension: a randomized
clinical trail. Phys Ther. 84:800-7.
Witvrouw E., Danneels L., Asselman P., D’Have T., Cambier D. [2003] Muscle flexibility as a risk
factor for developing muscle injuries in male professional soccer players. A prospective study. Am J
Sports Med. 31:41-6.
Witvrouw E., Mahieu N., Daneels L., McNair P. [2004] Stretching and injury prevention: an obscure
relationship. Sports Med 34:443-9.
Young, W.B., and Behm, D.G. (2002) Should static stretching be used during a warm-up for strength
and power activities?. Strength and Conditioning Journal 24(6):33-37.