“I hurt my ____ the other day, what should I stretch?” Updated Guidance on Flexibility and Injuries. BOSTON PERFORMANCE PHYSICAL THERAPY

By Dr. Julia Muller, PT, DPT, CF-L1; Sharing thoughts on my years of experience working with active adults, coaching weightlifters, studying ballet, and working in sports medicine.

STRETCHING AND ACUTE INJURIES

We’ve all been there. You’re having a blast during a workout class or feeling great on a run when all of a sudden, a pain comes out of nowhere. When you wake up the next morning, it feels even worse. Friends, family, and coaches all around you are saying “just stretch it out, you’ll be fine!” Or worse, “you hurt yourself because you skipped stretching, get to it now!” 

In the presence of pain and injury, our brain’s primary job is to PROTECT us. The brain does a myriad of things to turn on the alarm bells so we stop doing threatening things and armor the injured area with temporary support. This most commonly manifests with feelings of tightness—called muscle guarding—in addition to pain sensations. Sometimes this guarding can even feel like a muscle spasm. 

First, take a moment to thank your body for always trying to protect you! Then, give the injury what it needs. While stretching may temporarily relieve that tightness, it may be sacrificing the body’s protective mechanisms if we just stop there. The key is to calm the threat by introducing some comfortable range of motion, engaging the muscles around the area with comfortable strengthening exercises, and doing some soft tissue work with hands or tools to help release tension without stressing the area of injury. These strategies help the body to feel more supported, calm the alarm bells down, and move us more in the direction of recovery rather than temporary relief. Sometimes, stretching a fresh injury can make us feel worse because we have disarmed the body’s initial protective mechanism, making us feel unsupported and vulnerable, yikes!

But did your lack of stretching CAUSE this injury? Likely not…

STRETCHING AND CHRONIC TIGHTNESS

Tight muscles are often weak muscles. I’m going to say it again differently: when a muscle feels tight, it often indicates that a muscle is unable to meet the strength demands we are asking of it and its next best strategy is to tighten up to support the body. We love testing this theory daily in the clinic when clients report less tightness after doing a strength exercise, similarly to how they feel after only stretching. However, the cool thing about strength training is that you get a temporary reduction in the tightness feeling as well as a steady reduction in the recurring tightness over time because we are addressing the root cause. 

We find the best solution to addressing a chronically tight muscle is two-fold: find an exercise that is muscularly challenging, that also utilizes the full range of motion of the muscle. When a muscle is challenged, it pulls more blood flow into that area which often gives feelings of relaxation, similar to how a nice heating pad feels on a tight muscle. The challenge of the exercise drives adaptations for the muscle to be stronger over time, leading to less reactive tightness. Using the full range of motion means that we are essentially stretching that muscle with every repetition and teaching the muscle how to be strong at all angles! The muscle is less likely to tighten up over time if we are regularly using that full range of motion in our strength training sessions. The muscle is ready to meet the demands we are asking of it. 

Two examples of this: 

• Swap a hamstring stretch for a Romanian deadlift, spending extra time in the descent

• Swap a calf stretch for a heel raise off of a step, spending extra time in the descent, and even pausing at the bottom to hold loaded tension in that stretch

To come back to the original question, did a lack of stretching cause the injury? Likely not, because the injury may have highlighted a window of vulnerability where muscles may have been underprepared for the task at hand. The tightness may have been a warning sign that they required more strength to do their jobs better.

However, there are some certain cases where flexibility work is crucial to performance…

Who really NEEDS to be doing this work and when?

I think we can all agree that having good flexibility across our lifespan is important to be able to do the things we need to do, like being able to stand up from a chair, bend over to put socks on, or be able to reach overhead to stock the top cabinet. If we are looking to participate in a sport or activity long term, we need to be able to comfortably achieve the required positions.

If you can comfortably (and regularly) access the positions you need to in life and in sport without much preparation or restriction, then you likely aren’t doing any harm by skipping the daily stretching. Many people have some muscles that feel sometimes tighter than others and get relief from doing some stretches, and there is no harm in that. Regularly incorporate the positions you need to achieve for your sport within a dynamic warm-up to ensure that you utilize your flexibility.

What if you can’t easily get into and utilize the positions you need? There are instances where a lack of flexibility may be a detriment to injury risk and performance. Two examples of this:

• A jumping athlete with stiff calves and ankles: This athlete needs to be able to absorb a lot of force through the ankle complex, and having enough range of motion to absorb force is key to not overloading the Achilles. This athlete needs strength AND mobility work of the calf. 

• A CrossFit athlete with stiff shoulders: This athlete needs to be able to stabilize weight overhead with the complete range of motion of the shoulder. If the shoulders can’t fully open up to get arms overhead, we start to see compensations at the back to balance the weight, causing further issues. This athlete needs strength AND mobility work of the shoulders and lats. 

If you find muscle groups becoming tighter over time or can’t achieve your sport specific positions, skip “just stretching and hoping for the best” and instead seek help from a performance PT to see what might be going on with your strength, mechanics, or training errors.