Replace Stretching with Strengthening

You see a soccer player who reports of recurrent hamstring strains. He feels that he has “short” hamstrings and asks for your professional opinion on the best method of lengthening his hamstring muscles for preventing injuries. Would you suggest stretching or strengthening?

A study on 30 elite Norwegian soccer teams demonstrated no difference in the incidence of hamstring strains between the teams that used a flexibility training program and those who did not (Arnason et al 2008).

Thus far, 3 systematic reviews have all reached the same conclusion; static stretching exercises are proven to be not beneficial for sports injury prevention (Lauersen et al 2014).

Based on the above-mentioned study on the Norwegian soccer teams, although static stretching failed to work, they demonstrated significantly lower incidences of hamstring strains in teams who used an eccentric training program when compared to the teams that did not use the program. Thus, eccentric strengthening was an effective method of reducing the risk of hamstring injuries (Arnason et al 2008).

A recent study (Bourne et al 2016) demonstrated that compared to a control group, the subjects who performed strengthening exercises such as the Nordic hamstring exercises and hip extensions achieved a significant increase in fascicle length after 5 weeks. Biceps femoris long head length was measured using 2D ultrasound.

Could we extrapolate these finding to those who report of upper fibers of trapezius “tightness”?

Case study: I recently saw a patient who reported of having >5 years of neck pain and “tightness”. She proudly assured me that she was doing her self-stretches as instructed by her previous PTs on a daily basis; in fact several times a day. Although the stretching felt good, the benefits did not seem to last. She was also able to self “crack” her neck while doing her neck stretches which also felt good …temporary of course.

She reported of seeing an RMT once a week for the past 2 years which also provided her with at least one day of relief.

Following my assessment I realized that she had no loss of cervical mobility and in fact she was hypermobile in her cervical ROM in every direction.

I concluded that instead of massaging and stretching the cervical muscles, I would focus on neck proprioception and strengthening exercises.

Treatments

1) Avoid all neck stretches for 6 weeks and avoid the temptation of “cracking” neck (self-manip)

2) Replace the temptation to stretch the trapezius with figure 8 exercises. Close your eyes and SLOWLY draw a figure 8 with the tip of your nose.

3) Perform shoulder press exercises 3 sets of 10 on a daily basis using 5lbs dumbbells or with a band placed under the feet.

Guess what? After only 2 weeks she felt dramatically better!

Moral of the studies & case study: Sometimes we need to get over our obsession with stretching “tight” muscles and focus on strengthening.

References: 1) Arnason et al Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports 2008; 18:40-48.

2) Bourne M et al Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention. Br J Sports Med. 2017 Mar;51(5):469-477.

3) Lauersen et al The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2014; 48:871-877