When Should I Stretch, When Should I Strengthen?

When Should I Stretch, When Should I Strengthen?

When I first sat down to write this piece, I considered the question above. I thought, a weak muscle is tight and a stronger muscle is not. This may be a quick blog article and I might get out to enjoy the sunshine!!! 

Rarely, in physiotherapy will an easy answer appear. Often I see similar musculoskeletal complaints presenting very differently between patients. When considering the different stages of recovery the injury is in, different approaches need to be rationalised and decided upon. A perfect example of this is avoiding stretching for an Achilles tendon injury still in stretchingit’s inflammatory stage versus stretching being ok as part of the ongoing management of a chronic Achilles tendon injury not in it’s inflammatory stage.

Strength Training vs Stretching

From playing sports in school, to playing high level sports as we grow up, to working out in the gym. We have for years, on the most part, been advised to stretch, stretch, stretch! However, although stretching has a role to play in managing most injuries, a large body of good-quality evidence suggests that strengthening-alone is by far and away the best way to manage injuries from your neck, all the way down to your feet. Here is a small snap-shot of what has been published:

  • The most robust of all the evidence that supports strength training vs stretching is from a 2014 systematic review and meta-analysis of 26600 subjects and 3464 injuries. This review concluded that strength training-alone was able to reduce the likelihood of acute sporting injuries by 33% and overuse sporting injuries by 50%, whereas stretching-alone was not found to be effective (reference).

 

  • One of the most common complaints I treat in the clinic is chronic low back pain (CLBP), and there is strong evidence that suggests that resistance training is very effective in reducing pain, improving function and quality of life in patients with CLBP (reference).

 

  • Not far behind CLBP seen in the clinic is chronic neck pain and neck-related headaches (cervicogenic headaches). Once again, strong evidence points towards strength training of the neck, scapula and shoulder muscles rather than stretching of the neck for the management of both conditions (reference).

 

  • In what I personally feel is one of the trickiest conditions to treat, gradual appropriate strengthening-alone has been shown to be superior to stretching-alone at the 3-month mark in regards to pain and function for the treatment of plantar fascia pain (reference).

 

  • For my older patients out there, (and many retired GAELIC players!) although stretching and strengthening improve outcomes in the treatment of hip osteoarthritis, it was strengthening-alone that yielded the best results in terms of reducing pain, improving function, decreasing disability within 2-6 months of starting the strengthening intervention (reference).

 

  • For my soccer players out there (or weekend warriors over 30 years old), adding in Nordic Hamstring Curls into training sessions, significantly reduces the incidence of hamstring injuries in the subsequent season when compared to other players who don’t perform the exercise (reference).

 

  • Finally, and this is my favourite because I meet so many recreational runners who don’t do any strength training because they believe that all they need to do is foam roll their ITB’s (think why is this tight in the first place!) ; Adding in strength training 2x per week for 6 weeks significantly improves 5km run time when compared against those runners who didn’t perform strength training (reference).

 

So there you have it, a very comprehensive list of evidence that shows that strengthening-alone is lifting weightsfar superior to stretching-alone in the treatment and prevention of injury, and improvement of running performance.

In addition to these studies, I generally choose strengthening over stretching for the management of injuries because of the “2-for-the-price-of-1” effect that eccentric strength training has on muscle. Research shows that not only do eccentric strength exercises improve strength, they also improve length of the muscle and tendon being exercised (reference). This is a win-win situation, for those patients that are time-poor.

Stretching is very useful and certainly has a role to play in managing musculoskeletal complaints. In fact, I have many patients who all I do is give them stretches. Knowing what is appropriate and when it is appropriate is key. Stretching should be part of a complete strengthening and conditioning plan, and is a great training tool on recovery days.

 

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IMG_0129Patrick Mc Carrick MISCP

 

2 thoughts on ““When Should I Stretch, When Should I Strengthen?”

  • Esthela Trevino

    Is it better to do stretching exercises AFTER doing strengthening exercises? Or the other way around? During the same session, that is.
    Thank you a lot

  • Bo BreitReed

    Hi there,
    First off, thank you for this article and needed information. My question is now that I know to prioritize strengthening over stretching, how do I know which muscles to strengthen. For example, I have extremely tight hip flexors that fatigue now very easily and I’m wondering if this is because they are taking over for larger muscles that aren’t activating/engaging when they’re supposed to, such as my core or quads. I have done the test where, standing, you hug your knee into your chest and then release it to see if you can hold your leg at that angle without your arms. My knee does drop back down to being perpendicular — so I can’t. But the tightness in my hip flexors also started when I reintroduced weighted squats and lunges into my workouts and so I’m thinking my hip flexors aren’t weak, but over-trained. I do also have tightness in my glutes and my lower back/oblique muscles as well. I guess I just don’t know in what direction to move forward. Thank you for any advice you can give.

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