Words:
Danny Coyle / Gary Carr
Does the right warm up really help injury avoidance or is the idea simply stretching the truth?Is your pre-run stretch the only thing between you and a four-hour wait in A&E? One recent study says not. Its author, Daniel Pereles, orthopaedic surgeon from Montgomery Orthopedics, Washington, DC, says: “As a runner myself, I thought stretching before a run would help to prevent injury. However, we found that the risk for injury was the same for men and women, whether or not they were high or low mileage runners, and across all age groups.
“But, the more mileage run or the heavier and older the runner was, the more likely he or she was to get injured, and previous injury within four months predisposed to even further injury.”
Pereles’ study included 2,729 runners who ran 10 or more miles per week. Of these runners, 1,366 were placed at random into a stretching group, and 1,363 formed a non-stretching group before running.
Runners in the stretch group stretched their quadriceps, hamstrings, and gastrocnemius/soleus muscle groups. The entire routine took approximately three to five minutes and was performed immediately before running.
The results suggested that stretching before running neither prevents nor causes injury, and, surprisingly, that the most significant risk factors for injury included the following:
- history of chronic injury or injury in the past four months
- higher body mass index (BMI)
- switching pre-run stretching routines (runners who normally stretch stopping and those who didn’t, starting to stretch before running)
The most common injuries sustained were groin pulls, foot/ankle injuries, and knee injuries and the study found no significant difference in injury rates between the runners who stretched and the runners who didn’t for any specific injury location or diagnosis. So if you don’t stretch, should you bother starting? And if you do, are you just as vulnerable to injury as the rest of us?
MR asked Gary Carr, lead Chartered Physiotherapist at Excel Physiotherapy and Acupuncture in Upminster, Essex for a second opinion.
“Only in recent times have the advantages of flexibility in sport been questioned such as in the above study,” he says.
“It has always been accepted that a warm (increased blood flow/oxygenation) and flexible (elongated fibres) muscle would be less susceptible to injury.
Indeed, ask any of Arsene Wenger’s ageing back four in the Arsenal football team of the late 90s about the elongation of their careers through his newly introduced conditioning and, particularly, flexibility programmes - quite radical for the time - and they will strongly argue in the affirmative.”
Carr continues: “In reality - and certainly from my clinical exposure treating a broad spectrum of runners - it all very much depends on the individual. I have known 56-year-olds who still put in 2hrs 14mins marathons and can’t touch their knees and, conversely, others who have actually injured themselves over-stretching because of being told of the magical benefits of flexibility to runners.
“In my experience, on the whole, it is not the inflexible runners who end up on the physio’s table, but those with running-induced injuries secondary to what is termed ‘muscle imbalance’.
Chain reaction
“Ideally in both lower limbs the ‘kinetic chain’ should be fully functional. To put this in its simplest terms, every component of the leg must be functioning to its best ability i.e the pelvis/hip, the knee and the ankle joint.
“All muscle groups acting on these joints should have optimum strength to provide endurance and all joints should have adequate flexibility (not necessarily excessive) to enable movement through at least the range required for running.
“Muscle imbalance-related injuries - often commonly and incorrectly termed ‘overuse’ injuries - occur primarily when a strength deficit is present (in the kinetic chain) and then unwanted overstrain will be placed on other structures which, unless able to compensate, will eventually lead to injury.
Achilles heel
“The classic example in runners is ‘Achilles tendonitis.’ This is often insufficiently treated with strengthening and orthotic inserts in running shoes, particularly where it occurs on just one side. Most therapy is aimed at progressive strength work for the tendon together with stretching to return adequate flexibility. This is appropriate but not on its own.
“The often-predominating factor in an Achilles injury is the weakness in the gluteal region and more predominantly the hip abductor/rotator mechanisms. This can lead to unwanted inward turning of both the femur (the thigh bone) and the tibia (the main shin bone), compensatory over-pronation of the foot and, in turn, overstrain on the Achilles.
Strengthening of only the Achilles component of the chain no matter how efficient the programme, will more often than not only allow temporary return to running and eventually, with the weak component of the chain still evident, the injury will return.
“Flexibility does play a part but only in the need to be able to move a joint sufficiently through its range. I’m not advocating ceasing all reference to stretching in your programme. Indeed, muscle elongation after exercise has for a long time been shown to aid quicker recovery particularly with heavy programmes. BUT, in the world of running injuries, muscle imbalance is more than likely to be the killer component.
The answer
“Consult a clinician who can assess the WHOLE of the kinetic chain to ensure that ALL COMPONENTS are working to their optimum ability, paying particular regard to strength and endurance of all lower limb muscle groups. This will go a long way to preventing injuries and aiding recovery of long term niggles, which can so often blight your season.”
