Sports Medicine

, Volume 34, Issue 7, pp 443–449 | Cite as

Stretching and Injury Prevention

An Obscure Relationship
  • Erik WitvrouwEmail author
  • Nele Mahieu
  • Lieven Danneels
  • Peter McNair
Review Article


It is generally accepted that increasing the flexibility of a muscle-tendon unit promotes better performances and decreases the number of injuries. Stretching exercises are regularly included in warm-up and cooling-down exercises; however, contradictory findings have been reported in the literature. Several authors have suggested that stretching has a beneficial effect on injury prevention. In contrast, clinical evidence suggesting that stretching before exercise does not prevent injuries has also been reported. Apparently, no scientifically based prescription for stretching exercises exists and no conclusive statements can be made about the relationship of stretching and athletic injuries. Stretching recommendations are clouded by misconceptions and conflicting research reports. We believe that part of these contradictions can be explained by considering the type of sports activity in which an individual is participating. Sports involving bouncing and jumping activities with a high intensity of stretch-shortening cycles (SSCs) [e.g. soccer and football] require a muscle-tendon unit that is compliant enough to store and release the high amount of elastic energy that benefits performance in such sports. If the participants of these sports have an insufficient compliant muscle-tendon unit, the demands in energy absorption and release may rapidly exceed the capacity of the muscle-tendon unit. This may lead to an increased risk for injury of this structure. Consequently, the rationale for injury prevention in these sports is to increase the compliance of the muscle-tendon unit.

Recent studies have shown that stretching programmes can significantly influence the viscosity of the tendon and make it significantly more compliant, and when a sport demands SSCs of high intensity, stretching may be important for injury prevention. This conjecture is in agreement with the available scientific clinical evidence from these types of sports activities. In contrast, when the type of sports activity contains low-intensity, or limited SSCs (e.g. jogging, cycling and swimming) there is no need for a very compliant muscle-tendon unit since most of its power generation is a consequence of active (contractile) muscle work that needs to be directly transferred (by the tendon) to the articular system to generate motion. Therefore, stretching (and thus making the tendon more compliant) may not be advantageous. This conjecture is supported by the literature, where strong evidence exists that stretching has no beneficial effect on injury prevention in these sports. If this point of view is used when examining research findings concerning stretching and injuries, the reasons for the contrasting findings in the literature are in many instances resolved.


Sport Activity Injury Prevention Patellar Tendinopathy Stiff Tendon Athletic Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors have provided no information on sources of funding or on conflicts of interest directly relevant to the content of this review.


  1. 1.
    Bixler B, Jones RL. High-school football injuries: effects of a post-halftime warm-up and stretching routine. Fam Pract Res J 1992 Jun; 12(2): 131–9PubMedGoogle Scholar
  2. 2.
    Ekstrand J, Gillquist J, Moller M, et al. Incidence of soccer injuries and their relation to training and team success. Am J Sports Med 1983; 11(2): 63–7PubMedCrossRefGoogle Scholar
  3. 3.
    Ekstrand J, Gillquist J, Liljedahl SO. Prevention of soccer injuries. Supervision by doctor and physiotherapist. Am J Sports Med 1983; 11(3): 116–20PubMedCrossRefGoogle Scholar
  4. 4.
    Hartig DE, Henderson JM. Increasing hamstrings flexibility decreases lower extremity overuse injuries in Military Basic Trainees. Am J Sports Med 1999; 27(2): 173–6PubMedGoogle Scholar
  5. 5.
    Witvrouw E, Bellemans J, Lysens R, et al. Intrinsic risk factors for the development of patellar tendinitis in an athletic population: a two years prospective study. Am J Sports Med 2001; 29(2): 190–5PubMedGoogle Scholar
  6. 6.
    Witvrouw E, Danneels L, Asselman P, et al. Muscle flexibility as a risk factor of developing muscle injuries in professional male soccer players. Am J Sports Med 2003; 31(1): 41–6PubMedGoogle Scholar
  7. 7.
    Griffiths RI. The mechanics of medial gastrocnemius muscle in the freely hopping wallaby (Thylogale billardierri). J Exp Biol 1989; 147: 439–56Google Scholar
  8. 8.
    Biewener AA, Corning WR, Tobalske BW. In vivo pectoralis muscle force-length behavior during level flight in pigeons (Columba livia). J Exp Biol 1998; 201: 3293–307PubMedGoogle Scholar
  9. 9.
    Bijker KE, De Groot G, Hollander AP. Differences in leg muscle activity during running and cycling humans. Eur J Appl Physiol 2002; 87(6): 556–61PubMedCrossRefGoogle Scholar
  10. 10.
    Cornwell A, Nelson AG, Sidaway B. Acute effects of stretching on the neuromechanical properties of the triceps surae muscle complex. Eur J Appl Physiol 2002; 86: 428–34PubMedCrossRefGoogle Scholar
  11. 11.
    Ettema GJC. Mechanical efficiency and efficiency of storage and release of series elastic energy in skeletal muscle during stretch-shortening cycles. J Exp Biol 1996; 199: 1983–97PubMedGoogle Scholar
  12. 12.
    Ettema GJC. Muscle efficiency: the controversial role of elasticity and mechanical energy conversion in stretch-shortening cycles. Eur J Appl Physiol 2001; 85: 457–65PubMedCrossRefGoogle Scholar
  13. 13.
    Finni T, Komi PV, Lepola V. In vivo human triceps surae and quadriceps femoris muscle function in a squat and counter movement jump. Eur J Appl Physiol 2000; 83: 416–26PubMedCrossRefGoogle Scholar
  14. 14.
    Finni T, Komi PV, Lepola V. In vivo muscle mechanics during locomotion depend on movement amplitude and contraction intensity. Eur J Appl Physiol 2001; 85: 170–6PubMedCrossRefGoogle Scholar
  15. 15.
    Fukunaga T, Kurokawa S, Fukashiro S, et al. Muscle fiber behavior during drop jump in human. J Appl Physiol 1996; 80: 158–65PubMedGoogle Scholar
  16. 16.
    Kubo K, Kanehisa H, Kawakami Y, et al. Elasticity of tendon structures of the lower limbs in sprinters. Acta Physiol Scand 2000; 168: 327–35PubMedCrossRefGoogle Scholar
  17. 17.
    Kuitunen S, Komi PV, Kyröläinen H. Knee and ankle joint stiffness in sprint running. Med Sci Sports Exerc 2002; 34(1): 166–73PubMedCrossRefGoogle Scholar
  18. 18.
    Maganaris CN, Paul JP. In vivo human tendon mechanical properties. J Physiol 1999; 521(1): 307–13PubMedCrossRefGoogle Scholar
  19. 19.
    van Ingen Schenau GJ, Bobbert MF, de Haan A. Does elastic energy enhance work and efficiency in the stretch-shortening cycle? J Appl Biomech 1997; 13: 389–415Google Scholar
  20. 20.
    Biewener AA, Dial KP, Goslow GE. Pectoralis muscle force and power output during flight in the starling. J Exp Biol 1992; 164: 1–18CrossRefGoogle Scholar
  21. 21.
    Rome LC, Swank D, Corda D. How fish power swimming. Science 1993; 261: 340–3PubMedCrossRefGoogle Scholar
  22. 22.
    Wilson GJ, Murphy AJ, Pryor JF. Musculotendinous stiffness: its relationship to eccentric, isometric and concentric performance. J Appl Physiol 1994; 76(6): 2714–9PubMedGoogle Scholar
  23. 23.
    Wilson GJ, Elliott BC, Wood GA. Stretch-shortening cycle performance enhancement through flexibility training. Med Sci Sports Exerc 1992; 24: 116–23PubMedGoogle Scholar
  24. 24.
    Shadwick R. Elastic energy storage in tendons: mechanical differences related to function and age. J Appl Physiol 1990; 68(3): 1033–40PubMedCrossRefGoogle Scholar
  25. 25.
    Bach T, Chapman A, Calvert T, et al. Mechanical resonance of the human body during voluntary oscillations about the ankle joint. J Biomech 1983; 16(1): 85–90PubMedCrossRefGoogle Scholar
  26. 26.
    Wilson G, Wood G, Elliott B. Optimal stiffness of the series elastic component in a stretch-shorten cycle activity. J Appl Physiol 1991 Feb; 70(2): 825–33PubMedGoogle Scholar
  27. 27.
    Safran MR, Seaber AV, Garrett Jr WE. Warm up and muscular injury prevention: an update. Sports Med 1989; 8: 239–49PubMedCrossRefGoogle Scholar
  28. 28.
    McHugh MP, Connolly DAJ, Eston RG, et al. The role of passive muscle stiffness in symptoms of exercise-induced muscle damage. Am J Sports Med 1999; 27: 594–9PubMedGoogle Scholar
  29. 29.
    Hawkins D, Bey M. Muscle and tendon force-length properties and their interactions in vivo. J Biomech 1997; 30: 63–70PubMedCrossRefGoogle Scholar
  30. 30.
    Noonan T, Best TM, Seaber AV, et al. Thermal effects on skeletal muscle tensile behavior. Am J Sports Med 1993; 21(4): 517–22PubMedCrossRefGoogle Scholar
  31. 31.
    Kubo K, Kanehisa H, Kawakami Y, et al. Influence of static stretching on viscoalstic properties of human tendon structures in vivo. J Appl Physiol 2001; 90: 511–9Google Scholar
  32. 32.
    Kubo K, Kanehisa H, Fukunaga T. Effects of resistance and stretching training programmes on the viscoelastic properties of human tendon structures in vivo. J Physiol 2002; 538: 219–26PubMedCrossRefGoogle Scholar
  33. 33.
    Frisen M, Magi M, Viidik A. Rhelogical analysis of collagenous tissue: part I. J Biomech 1969; 2: 13–20PubMedCrossRefGoogle Scholar
  34. 34.
    Viidik A. Simultaneous mechanical and light microscopic studies of collagen fibers. Z Anat Entwicklungsgesch 1972; 136: 204–12PubMedCrossRefGoogle Scholar
  35. 35.
    Wang XT, Ker R, Alexander RM. Fatigue rupture of wallaby tail tendons. J Exp Biol 1995; 198: 847–52PubMedGoogle Scholar
  36. 36.
    McNair P, Dombroski E, Hewson D, et al. Stretching at the ankle joint: viscoelastic responses to holds and continuous passive motion. Med Sci Sports Exerc 2001; 33: 354–8PubMedCrossRefGoogle Scholar
  37. 37.
    Proske V, Morgan DL. Tendon stiffness: methods of measurement and significance for the control of movement: a review. J Biomech 1987; 20: 75–80PubMedCrossRefGoogle Scholar
  38. 38.
    van Mechelen W, Hlobil H, Kemper HC, et al. Prevention of running injuries by warm-up, cool-down, and stretching exercises. Am J Sports Med 1993; 21(5): 711–9PubMedCrossRefGoogle Scholar
  39. 39.
    Yeung EW, Yeung SS. A systematic review of interventions to prevent lower limb soft tissue running injuries. Br J Sports Med 2001; 25: 383–9CrossRefGoogle Scholar
  40. 40.
    Andrish JT, Bergfield JA, Walheim J. A prospective study on the management of shin splints. J Bone Joint Surg 1974; 56: 1697–700PubMedGoogle Scholar
  41. 41.
    Pope RP, Herbert RD, Kirwan JD, et al. Effects of ankle dorsiflexion range and pre-exercise calf muscle on injury risk in army recruits. Aust J Physiother 1998; 44: 165–72PubMedGoogle Scholar
  42. 42.
    Pope RP, Herbert RD, Kirwan JD, et al. A randomized trial of preexercise stretching for prevention of lower-limb injury. Med Sci Sports Exerc 2000; 32(2): 271–7PubMedCrossRefGoogle Scholar
  43. 43.
    McFarland EG, Wasik M. Injuries in female collegiate swimmers due to swimming and cross training. Clin J Sports Med 1996; 6: 178–82CrossRefGoogle Scholar
  44. 44.
    Wilber CA, Holland GJ, Madison RE, et al. An epidemiological analysis of overuse injuries among recreational cyclists. Int J Sports Med 1995; 16: 201–6PubMedCrossRefGoogle Scholar
  45. 45.
    Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med 2002; 30: 126–51Google Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Erik Witvrouw
    • 1
    Email author
  • Nele Mahieu
    • 1
  • Lieven Danneels
    • 1
  • Peter McNair
    • 2
  1. 1.Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  2. 2.School of Physiotherapy, Physical Rehabilitation Research CentreAuckland University of TechnologyAucklandNew Zealand

Personalised recommendations