Static Vs. Dynamic Stretching

When I was initially tasked to write about stretching, I got excited because as a former athlete and now physical therapist for more than 16 years, I thought I understood the evidence and rationale to easily address this topic. However, like the evidence-informed therapist that I am, I decided to first perform a literature search in order to check my preconceptions. This would prove to be pivotal in how I decided to tackle the subject matter.

What is Static Stretching?

Static stretching is when you take a body part to a point where a “stretch,” or pulling sensation, is felt and hold that position for a length of time, generally less than 60 seconds in duration (position based). ​An Example of a static stretch for the arm would be a cross body stretch – holding the arm directly across the chest.

What is Dynamic Stretching?

Dynamic Stretching can be classified as a large/gross movement pattern that involves multiple joints and muscles groups moving in and out of various ranges of motion (movement based). An example of a dynamic stretch on the arm would be performing arm circles – moving the arms forward and/or backwards in various degrees of motion.

What are the Benefits of Stretching?

For years it was thought that static stretching prior to activity would help decrease injury, prepare the body for activity, improve range of motion (ROM), and even enhance performance. However, does stretching do any of these things?

  1. Reduce Injury: Most of the recent data suggests that static stretching alone is inefficient at reducing the likelihood of sustaining an injury with a sporting activity. In fact, depending on the sport, in an article recently reviewed pertaining to golf, adding static stretching seemed to increase in the likelihood of injury. However, if static stretching is incorporated into a comprehensive warm-up program, it may actually help reduce musculotendinous injury in sports that require sprinting/making sharp cuts, i.e., soccer, football, basketball, etc.
  2. Prepare Body for Activity: The idea of a “warm-up” is to increase blood flow to the muscles that we intend to use for the given activity we are about to perform as well as increase the body’s core body temperature prior to competition. Static stretching alone does not satisfy these goals, which is why many professionals would recommend dynamic stretching.
  3. Improve ROM: It has been shown that static stretching does increase ROM of the hip and knee with hamstring stretching, but there are very few research studies that have shown the same amount of change in other body areas. To observe these changes in ROM, the static stretch needs to be done consistently for no more than 45 seconds at a time for no fewer than three reps for a minimum of eight weeks.
  4. Enhance Performance: Initially, I was confident that there was indeed research that supports the notion that static stretching had been shown to reduce strength, power, and muscle performance. While that is not entirely false, the evidence is not as consistent as I had once thought. a 2013 Systematic Review of 104 studies concluded that there was a decrease in strength, power, and explosive performance (to varying degrees). However, when looking at how they did the analysis the individual study designs and the tests they used to measure strength, power, and explosive performance varied greatly, which makes it much more difficult to make blanket statements with regards to performance deficits that may exist after static stretching.

What is the Goal or Purpose of Stretching?

If your goal is to gain range of motion in a specific muscle group or joint, keep the stretch to less than 45 seconds. Dynamic stretching is preferred as it is more efficient and better prepared the body for an activity or sport.

If you want to warm up before an activity, work, or to help reduce injury, consider a Comprehensive Warm-Up (CWU). A CWU should include light aerobic activity (walking, jogging, cycling, jumping rope/jacks, etc. in which you can still speak comfortably), dynamic stretching, and a sport/activity/job specific tasks. For a sport or activity that requires sprinting/quick changes in direction, adding static stretching of less than 45 seconds in a given position may help reduce musculotendinous injury.

 

Josh Anderson, PT, DPT has over 15 years of diverse experience in both the on-site and outpatient settings treating patients by providing Injury Prevention Services and Early Intervention Screens, as well as utilizing a variety of Physical Therapy techniques to get patients back to work as quickly as possible. His professional interests include Balance and Vestibular Orthopedics, Sports Physical Therapy, and Manual Therapy. Josh is certified in Sports PT through Evidence in Motion, Selective Functional Movement Assessment (SFMA), and Rocktape Level 1. He is also a Certified Clinical Instructor via the APTA.

 

Bibliography:

1. K Small, et al. A Systematic Review into the Efficacy of Static Stretching as Part of a Warm-up for the Prevention of Exercise Related Injury. Research in Sports Medicine, 16:213-23, 2008
2. A Ehlert and PB Wilson. A Systematic Review of Golf Warm-ups: Behaviors, Injury and Performance. Journal of Strength and Conditioning Research, 33(12): 3444-3462, 2019
3. DG Behm, A Chaouachi. A Review of the Acute Effects of Static and Dynamic Stretching on Performance. European Journal of Applied Physiology, 111: 2633-2651, 2011
4. DM Medeiros, et al. Influence of Static Stretching on Hamstring Flexibility in Health Young Adults: Systematic Review and Meta-analysis. Physiotherapy Theory and Practice, 32(6): 438-445, 2016
5. DG Behm, et al. Mechanisms Underlying Performance Impairments Following Prolonged Static Stretching Without a Comprehensive Warm Up. European Journal of Applied Physiology, 121: 67-84, 2021
6. L Simic, et al. Does Stretching Improve Performance: A Systematic and Critical Review of the Literature.Scandinavian Journal of Medicine and Science in Sports, 23(2): 131-148, April 2013
7. Yamagichi, et al. Effects of Static Stretching for 30 seconds and Dynamic Stretching on Leg Extension Power. Journal of Strength and Conditioning Research, 19(3): 677-683, Aug 2005
8. DG Behm, et al. Effect of Acute Static Stretching on Force, Balance, Reaction Time and Movement Time. Med Sci Sports Exercise, 36(8): 1397-1402, 2004
9. AD Kay, AJ Blazevich. The Effect of Acute Static Stretch on Maximal Muscle Performance: A Systematic Review. Medicine & Science in Sport and Exercise, 44(1):154-164, 2012
10. I Shrier. Does Stretching Improve Performance: A Systematic and Critical Review of the Literature.Clinical Journal of Sports Medicine, 14(1): 267-273, 2004
11. DG Behm, A Chaouachi. A Review of the Acute Effects of Static and Dynamic Stretching on Performance. European Journal of Applied Physiology, 111: 2633-2651, 2011
12. H Chaabene, et al. Acute Effects of Static Stretching on Muscle Strength and Power: An Attempt to Clarify Previous Caveats. Frontiers in Physiology, 10 (1468): 1-10, 2019

Female Athletes and ACL Prevalence

As a former female division 1 gymnast, I personally experienced and witnessed many types of injuries. I had a few teammates who had recurring injuries that impacted their ability to continue the sport they loved. Seeing the sub-par rehabilitation process in a college setting without physical therapy interventions available, re-injury was extremely common. Many of these recurring injuries involved the knee and internal knee structures such as the ACL, PCL, MCL, and LCL. 

ACL injuries are becoming more and more common in the young athlete, but did you know that female athletes are up to 10 times more likely to experience an ACL injury compared to men? This may be due to the anatomy and biomechanics of the female knee joint. Often due to wider hips and a smaller groove at the bottom of the femur where the ACL inserts, the ACL in the female knee may experience greater stress and further restriction during twisting, jumping, changing direction, and landing movements compared to men. Other contributors to increased risk of injury include weakness of the posterior chain musculature (glutes and hamstrings) and ligament laxity during hormone cycles. Recent studies have found that woman may be more susceptible to ACL injury just prior to ovulation compared to the follicular phase due to increased ligament laxity.

The most common form of treatment following ACL injury is a reconstructive surgery using a graft from either the patient’s own patellar tendon, hamstring, or an ACL from a cadaver. Although an athlete may go through ACL reconstruction, it does not guarantee normal functions of the knee or prevention of subsequent knee injury. In recent studies, it has shown that about half of athletes who underwent ACL reconstruction return to high level sports, and only about 20% of these younger athletes will return to higher level sports in the first year following injury. Given these findings, it is extremely important that ACL rehabilitation encompasses deficits related to surgical interventions as well as initial cause of injury occurring prior to surgery.

Current generalized ACL rehabilitations programs may not have all-inclusive motor training, and neuromuscular re-education needed to safely allow return to sport within one year’s time. It has been statistically proven that proper recruitment and strength of the posterior chain as well as muscles that stabilize the knee will decrease risk of  re-injury in the young athlete with a prior ACL tear. Physical therapists have the training and knowledge to specifically pinpoint weakness and instability within the hip and knee complex, analyze gait and movements patterns, and build sport specific training programs to assist in injury prevention of the young athlete. 

In early rehabilitation, it is crucial to protect the graft site, and begin regenerating the quad musculature. Research shows that following knee injury or surgical interventions there is a reflex response to inhibit muscle activation called Arthrogenic Muscle inhibition (AMI). Physical therapy can assist in targeting the muscles that have been affected during this reflex inhibition process. Some examples include quad setting, resisted terminal knee extension, straight leg raises with a knee extension brace until the patient can complete a straight leg raise without knee flexion. Other exercises to assist overall hip and knee stability include closed chain activity such as partial squats, step ups, single leg balance activities, and bridges. It is critical for the physical therapist to ensure the patient is completing exercises without compensatory strategies and progressing toward proper movement patterns. 

Due to the high prevalence of re-injury, as well as muscular inhibition following knee injury, it is highly recommended that athletes, specifically women receive intensive rehabilitative care following ACL repair. Without specific neuromuscular re-education, proper movement pattern restoration, and addressing pre-injury mechanical deficits, young athletes are at risk for re-injury or significant time lapses as they attempt to return to sport. Physical therapy can provide young athletes with the education and tools they need for success as they return to the sports they love. 

Amanda Lievendag, DPT, CMTPT is a Physical Therapist in the outpatient setting at Frederick Health Physical Therapy & Sports Rehab. Amanda’s professional interests are Sports Orthopedics, Sports Rehab, Trigger Point Dry Needling, and Spine Rehabilitation. She is a high energy physical therapist who has specialized experience with post-op, sports injuries, return-to-sport training, overuse injuries, and general wellness with athletes and patients of all ages.

 

The Weekend Warrior and Olympian Champs All Rely on Physical Therapy

The Winter Olympics are starting! For an Olympic athlete, training is a year-round activity.  But many of us non-Olympians go to the gym, work hard, and participate in recreational activities we love.

Olympians put a lot of stress and strain on their bodies. And so do we as weekend warriors. Odds are when you incur an injury, much like the Olympians, you will start a rehabilitation program.  What are the differences?  Not many!  Your physical therapist is most times using the same treatment strategies that are used on Olympic athletes

Evaluation

Your therapist will evaluate your current status and work with you to develop a treatment plan based on your goals. They will ask you questions about your current lifestyle, routines, and history to customize an individualized plan unique to you.  At each visit, your progress and treatment plan are reviewed and your therapist may ask you additional questions and adjust your goals to help you reach maximum success.

Remember, no matter your level, all athletes set goals.

Treatment Plans

Your physical therapist will take in account your current limitations and devise a plan to slowly and methodically reach your short and long-term goals. They will be careful to push you just enough so that you see progress without overusing those areas that you are seeking treatment.  Just as Olympic trainers push their athletes to reach success.

Participation

When Olympians stop participating in the recovery plans, their chances of success diminish. Your active participation in your rehabilitation recovery is crucial.  Communicating with your Physical Therapist about your daily routine, exercise habits, work schedule, and other obligations can help ensure you accomplish as much as possible during your Physical Therapy session.  And they will always ask you about your Home Exercise Program so be sure you are keeping up with your plan.  Your Physical Therapist expects you to reach self-management – actively maintain the strength, range of motion, and flexibility you have achieved.

Whether you’re a professional athlete, weekend warrior, or recovering from a recent fall, a sprain, or surgery, you can benefit from the same rehab strategies that help Olympians climb on top of that podium and achieve gold!

Avoiding Sports Specialization to Preserve our Young Athletes’ Health

Nicholas, Harbaugh, PTA

Sports Specialization has led to a trend over the past couple of years involving our young athletes: the increase in cases of injuries ranging from simple overuse to breaks and/or sprains. This increase in rate and number of injuries seen in young athletes, according to multiple studies, can be linked to the increase of sport specialization in children.  Sport specialization is defined as “year-round intensive training in a single sport at the exclusion of other sports.”

Sport specialization has been associated with high volume training that can result is psychological and physiological stress in an athlete. This stress has been linked to an increased rate of burnout in athletes, as well as recurring and overuse injuries in multiple studies. Overuse injuries otherwise known as cumulative trauma disorders, are described as tissue damage that is a result from repetitive demand over the course of time. The term refers to a vast array of diagnoses: occupational, recreational, and habitual activities. Along with these studies the American Academy of Pediatrics (AAP) have released statements on their position against sport specialization to prevent these problems from arising.

sports specialization

Children were not always encouraged to specialize in a sport. A factor that may have contributed to this cultural change may be in part due to the increased pressure that coaches and parents place on their children to perform at a higher level to attain a collegiate scholarship or professional contract. In 1993, Ericsson and colleagues proposed a statement that in order for a musician to achieve mastery/expertise in that area you must practice for 10,000 hours. Parents and coaches have adopted this rule and applied it to sports to justify year-round intensive training. Many have adopted and applied this rule to athletes without realizing this was made primarily for musicians. These are high, sometimes costly, expectations for an athlete who performs repetitive, rigorous, sometimes high velocity movements and techniques year round without adequate rest time.

Some people ask “But doesn’t focusing on a sport make our youth excel at that particular sport?” Studies have shown that is not necessarily the case. Some studies have even shown that most multisport athletes (participating in 2-3 sports) show more promise to excel in a sport than a specialized athlete due to an increased overall athleticism and better gross motor function. Many professional and collegiate athletes were multisport athletes.

Examine the Ohio State varsity recruitment habits of coach Urban Myers as they depict a preference for the

young athlete

There have been statements from multiple coaches, along with Urban Meyer’s graph, pertaining to their preference of multisport athletes for example

multisport athlete.  According to Pete Carroll former USC and current Seattle Seahawks coach: “The first questions I’ll ask kids are; “What other sports does he play? Does he play ball? All of those things are important to me. I hate that kids don’t play 3 sports in high school…. I really don’t favor kids having to specialize in one sport.” Dan Starsia University of Virginia men’s lacrosse coach and Tim Corbin of Vanderbilt Baseball both concur with Carroll.

 

If this is the thought process of elite coaches, why, as parents, is ours so different? If the athletes goal is to play in college or to try and make it to a professional level, they need to have an all-around athleticism as most elite athletes do.

Examples of multisport athletes are:

  • Michael Jordan- Basketball and Baseball
  • Abby Wambach- Soccer and Basketball
  • Terry Bradshaw- Football and Baseball
  • Amy Rodriguez- Soccer, Swim, Softball, and Track
  • Tom Brady- Football and Baseball
  • Lauren Holiday- Soccer, Track, and Basketball
  • Babe Zaharias- Track and Field, Golf, Basketball, Tennis, Swimming and Volleyball
  • Wilt Chamberlain- basketball, volleyball and track

With many elite athletes being multisport, we need to get away from the thought process that sport specialization will make our children elite. In fact, sport specialization may be the reason a child does not get to that elite level. With burnout and overuse, reoccurring, and surgery required injuries, specializing in one specific sport may actually do more harm.

Year round training through a child’s growth spurt period places an increased work load on lengthening muscles and developing joints. During a growth spurt, performing consistent intensive training throughout the year will increase the stress that is placed on muscle attachments and the coinciding joints. This increased work load causes an increased risk of joint and ligamentous damage and injury. The more repetitive the motion…the more risk for overuse injuries.

Common overuse injuries associated with sport specialization are as follows with patellofemoral (knee) pain being the most prominent:

  • Osgood-schlatter disease
  • Sever’s disease
  • Medial epicondyle apophysitis
  • Distal radial physeal stress syndrome
  • Proximal humeral physiolysis
  • Stress fracture (e.g. spondylolysis)

A common overuse injury seen in pitchers, for example, is ulnar collateral ligament damage which can lead to having Tommy John surgery. This is the reason why we have pitch counts to limit the amount of stress placed on the elbow joint and the associated ligaments.

To allow proper rest time for the young athlete in organized sports, the AAP recommends

  • that children play multiple sports (2-3)
  • play no more than 8 months a year
  • play no more hours per week than the child’s age (13 year old =13 hours) with a maximum of 16 hours per week total.

You may ask: “What do I if my child is specializing in a sport or gets injured in that sport?” The first thing to do if a child is injured is to get them examined by an orthopedist or physician. Depending on the findings, the next step would be starting a physical therapy plan to address the injury and to examine the mechanics of the athlete and their sport. The physical therapist will help evaluate each athlete’s situation on an individual basis and help to prevent any further injury or re-injury.

If an athlete does not suffer from an injury requiring immediate attention, it is recommended that he or she see a physical therapist to examine their movement patterns and form as well to prevent an injury from occurring and needing any further treatment. Before an athlete gets to that point though, the change must start at home with parents and coaches encouraging children to participate in multiple sports as well as decreasing the amount of pressure to play. After all, the main purpose of participating in sports is for overall physical activity and health and most importantly, fun, and enjoyment!

Talk to your children about their goals and encourage them to participate in more than one sport. Once you know their goals, you will know what they want to achieve! Encouraging diversity in sports can help to decrease the occurrence of overuse injuries.

Nicholas Harbaugh is a Physical Therapist Assistant at FMH Rehabilitation Aspen Ridge Outpatient Clinic.  Nick is experienced in treating orthopedic and sports-related injuries with  traditional land therapy techniques as well as aquatic therapy.

Aquatic Therapy Can Help Get You Back to…

There is no worse feeling than the aching pain that won’t go away, prevents you from accomplishing everyday tasks, and keeps you from doing the activities you love. If you have recently been injured or identified with having a debilitating diagnosis, aquatic therapy may be your answer to a pain-free lifestyle and get back to the activities you enjoy.

Diagnoses for Patients who benefit from Aquatic Rehabilitationaquatic therapy

Spinal Issues: Thoracic, Cervical, and Lumbar Spine Issues, Posture Issues, Spine Compression Fractures, Herniated Discs, and Spinal Stenosis

Imagine you are floating vertically in the pool using a floatation device. Since you are not touching the bottom, the water decreases the effect of gravity on the spine and creates traction. This process removes the pain you are feeling so you can now focus on learning the therapist’s exercises and doing them appropriately. Core stabilization will be the focal point of your exercises as it permits increased trunk/back movement with less pain due to the warmth, buoyancy, and pressure of the water.

Lymphedema Issues

If you have lymphedema issues, you may be experiencing swelling in your extremities. When you find yourself in the SwimEx Pool, you will notice a decrease in the swelling due to the hydrostatic pressure, making it easier and less painful to do strength exercises. This decrease in swelling will also make walking much easier.

Foot and Ankle Issues: Achilles Tendon Repairs or Tears and Toe, Foot, or Ankle Fractures

Typically, your doctor will give you weight bearing restrictions and you will most likely need a device to assist you while you walk and/or a boot. However, due to the anti-gravity properties of the water, you would not have to adhere to the restrictions. Other positive effects would be a decrease in swelling and less painful side effects. The pool helps you recover much faster because it allows you to work on balance in the early stages of recovery. Normally, patients have a hard time working on this if they are not in the pool due to the stress and pain of their foot or ankle.

Knee or Hip Replacements: ACL Repairs, Arthroscopic Repairs of Hip/Knee, and Patellar Tendon Repairs

The water provides a good environment to work on range of motion, stretching, and strengthen of these tender areas. An important distinction between aquatic and land therapy is the level of soreness associated with each, with aquatic causing much less soreness. Also, aquatic therapy allows you to perform most exercises sooner than on land with much less pain, getting you back to normal in much less time.

Fibromyalgia and Chronic Pain patients

Normally physical therapy is the last straw for this type of diagnosis. However, physical therapy in the pool should be one of the first choices since it will help you build stamina, endurance, and strength and manage your pain.

There are many more diagnoses that can be treated utilizing aquatic therapy. If you are not able to tolerate the pain associated with land therapy, aquatic therapy is an excellent alternative due to the anti-gravity environment. You will feel less pain and pressure in the pool and be able to make progress sooner than typical land therapy.

Get the therapy you need so that you can get back to your day-to-day routine and the actives you love. The goal of any rehabilitation team is to get you back to doing the activities you enjoy. Swinging a tennis racket. Walking through the woods. Peddling a bike around town. Pushing a cart down the grocery aisle. Even folding laundry! No matter the activity, enjoy life!

The ultimate goal of any therapy program is to get you back to _______ .   What is your blank?

Contributors: Morgan Thompson, Amelia Iams, DPT, Cynthia Brendle, PTA