Flexibility | Exercise Tool Kit

Static Stretching A Flexibility Mainstay

Posted on 02.10.13

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In general, different groups of people have different stretching needs. For example, weight trainers may present with patterns of tightness that may vary from a runner. A gymnast may need greater than “normal” hamstring flexibility but hamstrings that are too flexible may be a detriment to the athlete trying to avoid ACL injury.¹

It is important that within groups there will also be individual variation. One size does not fit all when deciding how to incorporate static stretching into an exercise program.

The intention of this article is to provide a very general introduction to static stretching which is an effective way to improve and maintain flexibility.

Acute versus Chronic Static Stretching

For the purpose of this article I will define acute stretching as a single bout of stretching, let’s say 1-3 sets of 30 second holds. This may be performed before or after an activity.

Chronic stretching would be a series of acute bouts of stretching accumulated over weeks/months. An example would be stretching tight hamstrings every day for 2 months.

Acute stretching before activity: Performance, Injury Risk, Muscle Soreness

Effect on Performance: Some literature suggests that stretching before activity may be detrimental to force and power production.²This is true for longer durations of stretch >60s. Experimental studies show that shorter duration of stretching (approximately 30s or less) probably do not have a profound negative OR positive effect on these markers of performance.^2,3

Effect on Injury/Muscle Soreness: Acute static stretching by itself does not seem to decrease overall injury risk or muscle soreness.^4,5There is some evidence that it may reduce muscle strain injuries.⁶

Should I static stretch before activity? I would say that this depends. If you are a gymnast or ballet dancer it may be appropriate to warm-up with static stretching. The gymnast/dancer will need to be prepared to passively stretch during their actual event.

If you are involved in a traditional team sport I do not see an issue performing a shorter duration of stretch as part of a comprehensive warm-up. Sample recommendation:⁷

light jog–>static stretching (30 seconds)–>dynamic/skill warm-up–>sport

Skipping the static stretch pre-exercise and performing post-exercise probably wouldn’t be an issue either.

If you are relying on power and strength it is probably not advisable to static stretch immediately prior to the event. For example, stretching (>60s) right before a high jump, or sprint has been shown to decrease performance.^{8, 9} Stretching in the racing blocks for a few seconds before a sprint will probably not have much of an impact.³

Chronic stretching: Performance, Injury Risk

Performance: A gymnast who is unable to do a split is probably not performing as well as they could. Utilizing static stretching is a good tool to improve and maintain flexibility for sports such as gymnastics.

Regular stretching is associated with improvements in force and power which are markers of performance.¹⁰Chronic stretching seems to have a positive effect on force and power production while acutely performing static stretching prior to an event tends to have a negative effect.

Injury Risk: In a study of military recruits that stretched their tight hamstrings multiple times a day over 13 weeks there were significantly reduced lower extremity overuse injuries when compared to a control group.¹¹This is a demonstration of how addressing muscle tightness through chronic stretching may be helpful for injury reduction.

Bottom Line

Acute Static Stretching
Shorter duration static stretching before activity may not necessarily increase or decrease performance. There may be benefit in some cases for decreasing muscle strain injuries. It is probably not in the athletes best interest to static stretch immediately before a task requiring power such as a sprint or high jump.

Chronic Static Stretching
The culmination of many bouts of acute stretching over time or chronic stretching, may help performance and decrease risk of injury when targeted to tight musculature. Relative tightness is individual and flexibility exercise should be tailored accordingly. There are normal values of flexibility established but keep in mind that gymnasts have different requirements than a runner.
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Author: Christopher (C.J.) Eberley, PT, DPT

Board Certified Orthopedic Physical Therapist

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Disclaimer: The views discussed on this website are for educational purposes only. Should you have any questions please consult your physician or physical therapist. Copyright© Kinesis Physical Therapy. All Rights Reserved.

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References

1.Blackburn, J. T., Norcross, M. F., & Padua, D. A. (2011). Influences of hamstring stiffness and strength on anterior knee joint stability. Clinical Biomechanics, 26(3), 278-283.
2. Kay, A. D., & Blazevich, A. J. (2012). Effect of acute static stretch on maximal muscle performance: a systematic review. Medicine and science in sports and exercise, 44(1), 154-164.
3.Cannavan, D., Coleman, D. R., & Blazevich, A. J. (2011). Lack of effect of moderate-duration static stretching on plantar flexor force production and series compliance. Clinical Biomechanics.
4. Herbert, R. D., & De Noronha, M. (2007). Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database Syst Rev, 4.
5.Thacker, S. B., Gilchrist, J., Stroup, D. F., & Kimsey Jr, C. D. (2004). The impact of stretching on sports injury risk: a systematic review of the literature.Medicine & Science in Sports & Exercise, 36(3), 371-378.
6. Small, K., Mc Naughton, L., & Matthews, M. (2008). 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(3), 213-231.
7.Taylor, Kristie-Lee, et al. “Negative effect of static stretching restored when combined with a sport specific warm-up component.” Journal of Science and Medicine in Sport 12.6 (2009): 657-661.
8. Winchester, Jason B., et al. “Static stretching impairs sprint performance in collegiate track and field athletes.” The Journal of Strength & Conditioning Research 22.1 (2008): 13-19.
9.Bradley, Paul S., Peter D. Olsen, and Matthew D. Portas. “The effect of static, ballistic, and proprioceptive neuromuscular facilitation stretching on vertical jump performance.” Journal of Strength and Conditioning Research, The 21.1 (2007): 223.
10. Shrier, Ian. “Does stretching improve performance?: a systematic and critical review of the literature.” Clinical Journal of Sport Medicine 14.5 (2004): 267-273.
11. Hartig, Donald E., and John M. Henderson. “Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees.” The American Journal of Sports Medicine 27.2 (1999): 173-176.

Static Hip Flexor Stretching

Posted on 10.14.12

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The hip flexors are responsible for lifting the leg at the hip. Functionally they help when advancing the leg during walking and running. When we sit they are put into a shortened position and when extending the hip they are put into a position of greater stretch.

Many of us sit for hours putting the hip flexors into shortened positions. Tightness in the hips may decrease the efficiency of how we perform activities such as walking and running.1,2

Static Hip Flexor Stretches

Kneeling Hip Flexor Stretch

This stretch is to be performed as shown leaning the trunk forward until a mild pull or stretch is felt in the front of the hip. One study showed improvement in flexibility when this stretch was held for 10 sets of 30 second counts daily for 6 weeks.² This may be more of an investment in time than some of us may be able to give. Performing 3 sets of 30 seconds most days of the week would likely be sufficient for improving tightness in the hip flexors.

Standing Hip Flexor Stretch

This is a variation on the kneeling stretch which should help to minimize the stretch of the longer hip flexor (rectus femoris), while focusing more specifically on the shorter hip flexors. The stretch can be performed as shown leaning the trunk forward until a mild pull or stretch is felt in the front of the hip. Performing 3 sets of 30 second holds most days of the week should be beneficial for improving and maintaining flexibility in the hip flexors.
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Author: Christopher (C.J.) Eberley, PT, DPT

Board Certified Orthopedic Physical Therapist

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References

1. Godges JJ, MacRae H, Longdon C, et al. Effects of two stretching procedures on hip range of motion and gait economy. J Orthop Sports Phys Ther. 1989;March:350–357.
2. Winters MV, Blake CG, Trost JS, et al. Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: a randomized clinical trial. Phys Ther. 2004;84(9):800–7

Deep Squat

Posted on 10.5.12

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Our lifestyle, culture and history of injury can contribute to our ability to move. Many people of various cultures are able to squat rather deeply even as older adults, but in the United States this seems less common. Tight hips, decreased knee range of motion and tightness in the calves can all make squatting with depth difficult.

Why deep squat?
When indicated, the deep squat can be utilized as a general lower body stretching exercise. In many cases, gaining the flexibility to get into a deep squat position may allow for a generally greater ease of movement. Carry over from improvements in hip mobility, calf flexibility and knee range of motion may result in improvements in activities such as the ability to kneel, stoop and play with children or pets.

Like other static stretches a mild to moderate stretch is appropriate. Pain should not be felt.

What does a deep squat look like?

Deep Squat

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Hip Crease is Below Level of Knee

Knees Not Tracking “Much” Beyond Toes

Heels on Ground

Upright Torso

Weight Through Heels

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The deep squat is a general way to screen for quality of movement, flexibility and injury.^1,2If the squat does not look somewhat like the pictures, there may be flexibility deficits in the hips, knees or calves. Simply getting into a squat position and holding for 30-60 seconds several times a day should help to increase mobility. After a couple of weeks significant changes in the ability to get into a deep squatting position should be noticed.

When squatting until the calves touch the thighs I recommend muscle tension in the front of the thighs so that the knees are not unnecessarily stressed.

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Author: Christopher (C.J.) Eberley, PT, DPT

Board Certified Orthopedic Physical Therapist

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References

1. Lamontagne M, Kennedy MJ, Beaulé PE. The effect of cam FAI on hip and pelvic motion during maximum squat. Clin Orthop Relat Res 2009;467:645e50
2. Butler RJ, Plisky PJ, Southers C, Scoma C, Kiesel KB. Biomechanical analysis of the different classifications of the Functional Movement Screen deep squat test. Sports Biomech. Nov 2010;9(4):270–279.

Static Quadriceps Stretching

Posted on 09.28.12

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The front of the thigh consists of 4 muscles called the quadriceps (quads). These muscles are primarily responsible for extending the knee, and are put on stretch when the hip is extended and knee is bent. Tightness in the quadriceps has the potential to put the athlete at risk for increased injury. In one study, male soccer players with tight hamstrings or quadriceps were more prone to straining their muscles.¹

Perhaps increasing the flexibility of the quadriceps will decrease the potential for a strain?

How can we improve quadriceps flexibility?

The following are two stretches that may improve the flexibility of the quadriceps:

Prone Quad Stretch (towel roll under thigh)

The stretch is performed lying facedown. The ankle can be grasped with the hand or if quad flexibility is not sufficient then a dog leash, stretch out strap or belt may be used to feel a stretch in the front of the thigh. The towel roll under the thigh is not required but may help facilitate a better stretch. A mild to moderate pull or stretch should be felt. I typically recommend 3 sets of 30s holds most days of the week to improve quadriceps flexibility.

Kneeling Quadriceps Stretch

This stretch addresses the Rectus Femoris which crosses both the hip and knee. The leg to be stretched is positioned as shown in the picture. Something soft can be placed under the knee to decrease stress on the knee cap. Keep the body upright and contract your buttock on the side to be stretched until a mild to moderate stretch is felt. Performing 3 sets of 30 seconds regularly should help improve tightness in the quadriceps.

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Author: Christopher (C.J.) Eberley, PT, DPT

Board Certified Orthopedic Physical Therapist

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References

1. Bradley PS, Portas MD. The relationship between preseason range of motion and muscle strain injury in elite soccer players. J Strength Cond Res 2007; 21 (4): 1155-60

Static IT Band Stretching

Posted on 09.11.12

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The illiotibial (IT) band is a dense strip of tissue that runs along the outside or lateral portion of the thigh. Many athletes may be familiar with the IT band, as tension in this structure is associated with illiotibial band syndrome, a common cause of pain in the outer portion of the knee.^1,²Decreasing tension through the IT band is believed to be a means of decreasing the risk of IT band syndrome and other hip and knee issues.

Decreasing Tension on the IT Band

The actual IT band probably cannot be effectively stretched, but resting tension put on this dense structure has the potential to be decreased.²The muscles that put tension on the IT band include the tensor fascia latae and gluteus maximus. The tensor fascia latae is a muscle that is continuous with the IT band and lies on the outside of the hip. I believe this is where the focus of most IT band stretching should be felt. If structures of the hip such as the gluteus maximus and tensor fascia latae are more flexible, then the resting tension through the IT band should be diminished.

The following are two stretches that improve length of the IT band.³

Stretches

The first stretch begins by extending the leg to be stretched and crossing it behind the supporting leg. The trunk is slowly bent away from the leg to be stretched until a mild/moderate pull or stretch is felt in the outer portion of the hip. You might also feel some tightness in the trunk.

IT Band Stretch

The second stretch is performed the same way as the first, but with the arms held overhead. Both stretches are effective, bringing the arms overhead is more effective.³

IT Band Stretch: Arms Overhead

Three sets of 30-second holds most days of the week should be beneficial for increasing flexibility.

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Author: Christopher (C.J.) Eberley, PT, DPT

Board Certified Orthopedic Physical Therapist

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References

1. Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011 Dec;19(12):728-36.
2. Falvey, EC, Clark RA, Franklyn-Miller A, Bryant AL, Briggs C. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports. 2009 Aug 27.
3. Fredericson M, White JJ, MacMahon JM, Andriacchi TP. Quantitative analysis of the relative effectiveness of 3 iliotibial band stretches. Archives of Physical Medicine and Rehabilitation 2002;83:589–92.

Static Hamstring Stretching

Posted on 08.31.12

From the perspective of a physical therapist, I notice hamstring tightness in a large number of my patients. Seeing patients with tight hamstrings is probably not unusual considering tightness in these muscles is associated with a variety of injuries such as patellofemoral pain and hamstring strains.^1,2

This article will address static stretching of the hamstrings or the muscles located at the back of the thighs.

The Hamstrings

The bulk of the hamstring muscles run from the buttock region to just below the knee. If you sit on your hands, the bony portion you feel is where these muscles originate. The hamstrings can be felt running down the back of the thigh, and tendons can be felt as taut bands on each side of the back of the knee. When we sit with the knees bent, these muscles are shortened, which may lead to tightness over time.

Stretching the Hamstrings

Static stretching of the hamstrings is effective for improving flexibility, and it probably doesn’t matter what stretch is performed.³The following are three common stretches.

Lying Hamstring Stretch

Lie on your back with the leg stretched straight and the opposite knee bent. I recommend the opposite knee be bent to take some stress off the spine although the leg can lie straight if you prefer.
Use a strap, beach towel, dog leash, etc. to help raise the leg up while keeping the knee straight until a stretch is felt.

Seated Hamstring Stretch performed at Kinesis Physical Therapy

Seating Hamstring Stretch

Sit at the edge of a chair with the leg to be stretched held straight.
Lean forward at the hips.
There is no need to lean forward to touch your toes unless you are also working on increasing flexibility of the spine.
This picture depicts the end of the stretch.

Standing Hamstring Stretch with step at Kinesis Physical Therapy

Standing Hamstring Stretch W/ Step

Place your leg to be stretched on a step
Keep leg straight and lean from the hips until a pull or stretch is felt at the back of the thigh
This picture shows the end of the stretch

To effectively increase flexibility I would recommend picking one of the stretches and performing 1-3 sets of 30 seconds 5 days a week for about 6 weeks.^3,4To continue seeing improvements in flexibility or maintain hamstring flexibility, continue stretching at least 2-3 days per week ⁵.

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Author: Christopher (C.J.) Eberley, PT, DPT

Board Certified Orthopedic Physical Therapist

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References

1. Heiderscheit BC, Sherry MA, Silder A, et al. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40:67–81.
2. Waryasz GR, et al. Patellofemoral pain syndrome (PFPS):a systematic review of anatomy and potential risk factors. Dyn Med, June 2008;26:7:9.
3. Decoster LC, Cleland J, Altieri C and Russell P (2005): The effects of hamstring stretching on range of motion: a systematic literature review. Journal of Orthopaedic and Sports Physical Therapy 5: 77–87
3. Bandy WD, Irion JM, Briggler M. The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles. J Orthop Sports Phys Ther. 1998;27:295-300.
4. Bandy WD, Irion JM, Briggler M. The effect of time and frequency of static stretching on flexibility of the hamstring muscles. Phys Ther. 1997;77:1090-1096.
5. Sainz de Baranda P, Ayala F. Chronic flexibility improvement after 12 week of stretching program utilizing the ACSM recommendations: hamstring flexibility. Int J Sports Med. 2010; 389–396.

Static Calf Stretching

Posted on 08.24.12

Our bodies adapt over time in response to being in fixed positions. If you have been in a cast for a period of time you may have noticed this in the form of stiffness and tightness and probably a loss of muscle mass. Imagine sitting in a chair for months on end. Theoretically our muscles, joints and ligaments would stiffen until we took on the shape of the chair. We would certainly not be able to function properly if we were not able to stand fully upright.

We might not be sitting for months straight but many of us sit for hours at a time. Students as well as people who work at desks are accustomed to the sitting posture. As we sit muscles, joints, and ligaments are provided with ideal conditions to tighten. Sit long enough for months and years on end and there is potential to become tight and weak.

One area that may become tight from excessive sitting are the calves. The gastrocnemius (gastroc) is a calf muscle which crosses the ankle and the knee. Since we bend the knee while sitting this muscle is put into a shortened position potentially leading to tightness. Now, if you are like me and lift your heels you are doing an even better job of shortening the gastroc but also contributing to tightness of another calf muscle called the soleus.

Why Stretch?

Why should you care that these muscles are tight? Well, tightness in the calf may be associated with conditions such as plantar fasciitis, achilles tendonitis and knee pain ¹. Ensuring that these muscles have sufficient flexibility may help serve a protective effect by allowing us to have the range of motion to move optimally. If we do not have enough motion at the ankle our bodies must find ways to compensate for this lost movement.

What can I do to stretch these muscles?

The following are two basic stretches that may help improve flexibilty of the calves ². To improve flexibility I recommend performing these stretches most days of the week for 3 sets of 30 seconds.

Standing Calf Stretch With Knee Straight to Stretch the Gastroc

This stretch can be performed with the hands against a wall or in the case of the picture a physical therapy table.

Extend the leg of the calf to be stretched with the foot flat and toes pointing forward
I recommend keeping the toe pointed forward in order to focus the stretch on the calf instead of other muscles (e.g. tibialis posterior)
Lean your weight forward until you feel a stretch in the calf.
Perform 3 sets holding each for 20-30 seconds

Calf Stretch With Knee Bent Performed at Kinesis Physical Therapy

Calf Stretch with Knee Bent to Stretch the Soleus

Perform as you would the first stretch but bend your knee keeping the heel pressed against the floor.
Lean your weight forward until you feel the stretch. If there are mobility issues in the ankle joint stiffness in the ankle may be felt.
Perform 3 sets holding each for 20-30 seconds

To add variety I like to also substitute the following stretch.

Calf Stretch From a Step at Kinesis Physical Therapy

Calf Stretch-Lowering Heels from a Step

With the forefoot on a step lower your heels until a stretch is felt
Hold for 3 sets of 20-30 second holds

References

1. Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C: Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med 2006, 40(10):870-875

2. Knight CA, Rutledge CR, Cox ME, et al. Effect of superficial heat, deep heat, and active exercise warm-up on the extensibility of the plantar flexors. Phys Ther 2001;81:1206–13.