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ACSM'S Health & Fitness Journal:
doi: 10.1249/FIT.0b013e31817bf75b
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You Asked For It: Question Authority

Nieman, David C. Dr.P.H., FACSM

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David C. Nieman, Dr.P.H., FACSM, is professor and director of the Human Performance Laboratory, Appalachian State University in Boone, North Carolina. He is an active researcher and author of several textbooks on health and fitness. Send your questions to


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A: The merits and methods of stretching cause much debate among experts too. Many claims have been made for the performance-, fitness-, and health-related benefits of regular stretching. Stretching is a vital component of several types of sports including martial arts, gymnastics, ballet, swimming, wrestling, and yoga, and typically the rationale is linked more to performance than anything else.

Stretching for enhanced performance in some types of sports makes sense, but the health and fitness value of stretching regimens does not have a strong scientific basis. No consistent link, for example, has been shown between regular flexibility exercise and prevention of low back pain, injury, or delayed onset of muscle soreness (1,2). And contrary to common belief, recent evidence shows that vertical jump, muscle strength and endurance, and sprint performance may be reduced when individuals stretch intensely just before exercise (3). Thus, intensive stretching should be scheduled after aerobic exercise or as a stand-alone session for athletes involved in sports where jumping and muscular strength, power, and endurance are important for performance.

Don't get me wrong-stretching does have its place in a total fitness program. Many people stretch simply because it makes them feel better (4). The relationship between injury and flexibility exercise may vary between sports, and regular stretching may have more value than pre-event stretching. Flexibility exercise is a valuable component of rehabilitation programs from injury (5). Of all age groups, the elderly have the most to gain through regular flexibility exercise, with several studies showing improved range of motion and capacity for daily activities of living (6).

Flexibility can be developed through several different types of stretching techniques. The most common and popular form, static stretching, involves slowly applying a stretch to the muscle and tendon group and then holding the stretched position for a period, often 10 to 30 seconds (7). Static stretching can be active or passive (7). Active static stretching is defined as holding the stretched position with no assistance other than using the strength of the agonist muscle as common in many forms of yoga. Passive static stretching involves assuming the stretched position while holding some part of the body or with the assistance of a partner or piece of apparatus.

The goal of a flexibility program is to develop range of motion in the major joints. You should pay attention to certain minimum standards when performing static stretching

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Duration of stretched position: Hold the stretch for 10 to 30 seconds at the point of discomfort (8). Limited evidence suggests that 60-second compared with 15- to 30-second static stretches confer greater range of motion gains for the elderly (9).

Repetitions: Repeat the flexibility exercise for 2 to 4 repetitions. Most studies showing gains in joint range of motion over 3 to 12 weeks have used 2 to 4 repetitions per flexibility exercise (7,8). Aim for 60 seconds of total stretching time per flexibility exercise by adjusting duration and repetitions according to individual desires. For example, 60 seconds of stretch time can be met by two 30-second stretches or four 15-second stretches (8).

Frequency: Engage in stretching exercises at least 2 to 3 days per week (7,8). Greater gains in joint range of motion can be measured with near-daily flexibility exercise (8,9). Improvements in joint range of motion can be measured within the first month of flexibility exercise but just as quickly be reversed upon cessation of stretching (9). Thus, flexibility exercise needs to be engaged in regularly to experience and maintain increased joint range of motion.

Types of flexibility exercises: Use at least eight different exercises for the major muscle-tendon units, including the shoulder girdle, front of chest, and neck (two different exercises), lower back, hips, posterior thighs, and trunk (three exercises), anterior thigh (one exercise), and posterior legs and ankles (two exercises). For most individuals, this routine can be completed within 10 minutes.

When to stretch: Flexibility exercise is most effective when the muscle is warmed through light-to-moderate aerobic activity or passively through external methods such as moist heat packs or hot baths, although this benefit may vary across muscle-tendon units. A pre-event warm-up that includes both aerobic activity and flexibility exercise has benefits for specific athletes such as gymnasts and ballet dancers. However, for most adults, a dynamic warm-up is superior to flexibility exercise for aerobic or resistive exercise performance (10). Flexibility exercise, especially an intensive regimen with high duration and repetitions, is generally recommended after aerobic or resistive exercise, or as a stand-alone program.

I recommend stretching after your run. Aim for two 30-second static stretches of eight different exercises, with an emphasis on your lower back and legs. This stretching program will probably have no effect (positive or negative) on your running performance, muscle soreness after tough workouts, or the likelihood of injury. You will feel better after you stretch and maintain a superior range of joint motion as you get older.

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1. Herbert R., and M. de Noronha. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database Systematic Reviews 2007 Oct 17;(4):CD004577.

2. Witvrouw E., N. Mahieu, P. Roosen, et al. The role of stretching in tendon injuries. British Journal of Sports Medicine 41(4):224-226, 2007.

3. Rubini E.C., A.L. Costa, and P.S. Gomes. The effects of stretching on strength performance. Sports Medicine 37(3):213-224, 2007.

4. Parente D. Influence of aerobic and stretching exercise on anxiety and sensation-seeking mood state. Perceptual and Motor Skills. 90(1):347-348, 2000.

5. Kofotolis N., and E. Kellis. Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Physical Therapy 86(7):1001-1012, 2006.

6. Nelson M.E., W.J. Rejeski, S.N. Blair, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Medicine & Science in Sports & Exercise® 39(8):1435-1445, 2007.

7. Kokkonen J., A.G. Nelson, C. Eldredge, et al. Chronic static stretching improves exercise performance. Medicine & Science in Sports & Exercise® 39(10):1825-1831, 2007.

8. Decoster L.C., J. Cleland, C. Altieri, et al. The effects of hamstring stretching on range of motion: a systematic literature review. The Journal of Orthopaedic and Sports Physical Therapy 35(6):377-387, 2005.

9. Feland J.B., J.W. Myrer, S.S. Schulthies, et al. The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Physical Therapy 81(5):1110-1117, 2001.

10. McMillian D.J., J.H. Moore, B.S. Hatler, et al. Dynamic vs. static-stretching warm up: the effect on power and agility performance. Journal of Strength and Conditioning Research 20(3):492-499, 2006.

© 2008 American College of Sports Medicine


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