1
|
Afonso J, Andrade R, Rocha-Rodrigues S, Nakamura FY, Sarmento H, Freitas SR, Silva AF, Laporta L, Abarghoueinejad M, Akyildiz Z, Chen R, Pizarro A, Ramirez-Campillo R, Clemente FM. What We Do Not Know About Stretching in Healthy Athletes: A Scoping Review with Evidence Gap Map from 300 Trials. Sports Med 2024; 54:1517-1551. [PMID: 38457105 PMCID: PMC11239752 DOI: 10.1007/s40279-024-02002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Stretching has garnered significant attention in sports sciences, resulting in numerous studies. However, there is no comprehensive overview on investigation of stretching in healthy athletes. OBJECTIVES To perform a systematic scoping review with an evidence gap map of stretching studies in healthy athletes, identify current gaps in the literature, and provide stakeholders with priorities for future research. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and PRISMA-ScR guidelines were followed. We included studies comprising healthy athletes exposed to acute and/or chronic stretching interventions. Six databases were searched (CINAHL, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science) until 1 January 2023. The relevant data were narratively synthesized; quantitative data summaries were provided for key data items. An evidence gap map was developed to offer an overview of the existing research and relevant gaps. RESULTS Of ~ 220,000 screened records, we included 300 trials involving 7080 athletes [mostly males (~ 65% versus ~ 20% female, and ~ 15% unreported) under 36 years of age; tiers 2 and 3 of the Participant Classification Framework] across 43 sports. Sports requiring extreme range of motion (e.g., gymnastics) were underrepresented. Most trials assessed the acute effects of stretching, with chronic effects being scrutinized in less than 20% of trials. Chronic interventions averaged 7.4 ± 5.1 weeks and never exceeded 6 months. Most trials (~ 85%) implemented stretching within the warm-up, with other application timings (e.g., post-exercise) being under-researched. Most trials examined static active stretching (62.3%), followed by dynamic stretching (38.3%) and proprioceptive neuromuscular facilitation (PNF) stretching (12.0%), with scarce research on alternative methods (e.g., ballistic stretching). Comparators were mostly limited to passive controls, with ~ 25% of trials including active controls (e.g., strength training). The lower limbs were primarily targeted by interventions (~ 75%). Reporting of dose was heterogeneous in style (e.g., 10 repetitions versus 10 s for dynamic stretching) and completeness of information (i.e., with disparities in the comprehensiveness of the provided information). Most trials (~ 90%) reported performance-related outcomes (mainly strength/power and range of motion); sport-specific outcomes were collected in less than 15% of trials. Biomechanical, physiological, and neural/psychological outcomes were assessed sparsely and heterogeneously; only five trials investigated injury-related outcomes. CONCLUSIONS There is room for improvement, with many areas of research on stretching being underexplored and others currently too heterogeneous for reliable comparisons between studies. There is limited representation of elite-level athletes (~ 5% tier 4 and no tier 5) and underpowered sample sizes (≤ 20 participants). Research was biased toward adult male athletes of sports not requiring extreme ranges of motion, and mostly assessed the acute effects of static active stretching and dynamic stretching during the warm-up. Dose-response relationships remain largely underexplored. Outcomes were mostly limited to general performance testing. Injury prevention and other effects of stretching remain poorly investigated. These relevant research gaps should be prioritized by funding policies. REGISTRATION OSF project ( https://osf.io/6auyj/ ) and registration ( https://osf.io/gu8ya ).
Collapse
Affiliation(s)
- José Afonso
- Faculty of Sport, Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), University of Porto, Porto, Portugal.
| | - Renato Andrade
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - Sílvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Alvares, 4900-347, Viana do Castelo, Portugal
- Tumour and Microenvironment Interactions Group, INEB-Institute of Biomedical Engineering, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 4200-153, Porto, Portugal
- Sport Physical Activity and Health Research & Innovation Center, 4900-347, Viana do Castelo, Portugal
| | - Fábio Yuzo Nakamura
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
| | - Hugo Sarmento
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Sandro R Freitas
- Laboratório de Função Neuromuscular, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Ana Filipa Silva
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Alvares, 4900-347, Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, 4900-347, Viana do Castelo, Portugal
| | - Lorenzo Laporta
- Núcleo de Estudos em Performance Analysis Esportiva (NEPAE/UFSM), Universidade Federal de Santa Maria, Avenida Roraima, nº 1000, Cidade Universitária, Bairro Camobi, Santa Maria, RS, CEP: 97105-900, Brazil
| | | | - Zeki Akyildiz
- Sports Science Faculty, Department of Coaching Education, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Rongzhi Chen
- Faculty of Sport, Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), University of Porto, Porto, Portugal
| | - Andreia Pizarro
- Faculty of Sport, Research Center in Physical Activity, Health and Leisure (CIAFEL), University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas, 135, 4050-600, Porto, Portugal
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy. Faculty of Rehabilitation Sciences, Universidad Andres Bello, 7591538, Santiago, Chile
| | - Filipe Manuel Clemente
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Alvares, 4900-347, Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, 4900-347, Viana do Castelo, Portugal
- Gdańsk University of Physical Education and Sport, 80-336, Gdańsk, Poland
| |
Collapse
|
2
|
Afonso J, Clemente FM, Nakamura FY, Morouço P, Sarmento H, Inman RA, Ramirez-Campillo R. The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Physiol 2021; 12:677581. [PMID: 34025459 PMCID: PMC8133317 DOI: 10.3389/fphys.2021.677581] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Post-exercise (i.e., cool-down) stretching is commonly prescribed for improving recovery of strength and range of motion (ROM) and diminishing delayed onset muscular soreness (DOMS) after physical exertion. However, the question remains if post-exercise stretching is better for recovery than other post-exercise modalities. Objective: To provide a systematic review and meta-analysis of supervised randomized-controlled trials (RCTs) on the effects of post-exercise stretching on short-term (≤1 h after exercise) and delayed (e.g., ≥24 h) recovery makers (i.e., DOMS, strength, ROM) in comparison with passive recovery or alternative recovery methods (e.g., low-intensity cycling). Methods: This systematic review followed PRISMA guidelines (PROSPERO CRD42020222091). RCTs published in any language or date were eligible, according to P.I.C.O.S. criteria. Searches were performed in eight databases. Risk of bias was assessed using Cochrane RoB 2. Meta-analyses used the inverse variance random-effects model. GRADE was used to assess the methodological quality of the studies. Results: From 17,050 records retrieved, 11 RCTs were included for qualitative analyses and 10 for meta-analysis (n = 229 participants; 17–38 years, mostly males). The exercise protocols varied between studies (e.g., cycling, strength training). Post-exercise stretching included static stretching, passive stretching, and proprioceptive neuromuscular facilitation. Passive recovery (i.e., rest) was used as comparator in eight studies, with additional recovery protocols including low intensity cycling or running, massage, and cold-water immersion. Risk of bias was high in ~70% of the studies. Between-group comparisons showed no effect of post-exercise stretching on strength recovery (ES = −0.08; 95% CI = −0.54–0.39; p = 0.750; I2 = 0.0%; Egger's test p = 0.531) when compared to passive recovery. In addition, no effect of post-exercise stretching on 24, 48, or 72-h post-exercise DOMS was noted when compared to passive recovery (ES = −0.09 to −0.24; 95% CI = −0.70–0.28; p = 0.187–629; I2 = 0.0%; Egger's test p = 0.165–0.880). Conclusion: There wasn't sufficient statistical evidence to reject the null hypothesis that stretching and passive recovery have equivalent influence on recovery. Data is scarce, heterogeneous, and confidence in cumulative evidence is very low. Future research should address the limitations highlighted in our review, to allow for more informed recommendations. For now, evidence-based recommendations on whether post-exercise stretching should be applied for the purposes of recovery should be avoided, as the (insufficient) data that is available does not support related claims. Systematic Review Registration: PROSPERO, identifier: CRD42020222091.
Collapse
Affiliation(s)
- José Afonso
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sport of the University of Porto, Porto, Portugal
| | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Álvares, Viana do Castelo, Portugal.,Instituto de Telecomunicações, Delegação da Covilhã, Covilhã, Portugal
| | - Fábio Yuzo Nakamura
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University Institute of Maia (ISMAI), Maia, Portugal.,Associate Graduate Program in Physical Education Universidade de Pernambuco (UPE)/Universidade Federal da Paraíba (UFPB), João Pessoa, Brazil
| | - Pedro Morouço
- Superior School of Education and Social Sciences, Polytechnic of Leiria, Leiria, Portugal
| | - Hugo Sarmento
- Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Richard A Inman
- The Psychology for Positive Development Research Center (CIPD), Universidade Lusíada, Porto, Portugal
| | - Rodrigo Ramirez-Campillo
- Human Performance Laboratory, Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile.,Centro de Investigación en Fisiología del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| |
Collapse
|
3
|
Cooke MB, Nix CM, Greenwood LD, Greenwood MC. No Differences Between Alter G-Trainer and Active and Passive Recovery Strategies on Isokinetic Strength, Systemic Oxidative Stress and Perceived Muscle Soreness After Exercise-Induced Muscle Damage. J Strength Cond Res 2018; 32:736-747. [PMID: 27941488 DOI: 10.1519/jsc.0000000000001750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cooke, MB, Nix, C, Greenwood, L, and Greenwood, M. No Differences Between Alter G-Trainer and Active and Passive Recovery Strategies on Isokinetic Strength, Systemic Oxidative Stress and Perceived Muscle Soreness After Exercise-Induced Muscle Damage. J Strength Cond Res 32(3): 736-747, 2018-The incidence of muscle injuries is prevalent in elite sport athletes and weekend warriors and strategies that safely and effectively hasten recovery are highly desirable. The purpose of this study was to examine the differences between 3 recovery methods after eliciting muscle damage in recreationally active men relative to maximal isokinetic contractions, perceived muscle soreness, and psychological mood states. Twenty-five recreationally active men (22.15 ± 3.53 years, 75.75 ± 11.91 kg, 180.52 ± 7.3 cm) were randomly matched by V[Combining Dot Above]O2 peak (53.86 ± 6.65 ml·kg·min) and assigned to one of 3 recovery methods: anti-gravity treadmill (G-Trainer) (N = 8), conventional treadmill (N = 8) or static stretching (N = 9). Recovery methods were performed 30 minutes, 24, 48, and 72 hours after a 45-minute downhill run. Following eccentrically biased running, no significant differences were noted in isokinetic knee flexion and extension peak torque, systemic markers of muscle damage, oxidative stress and lipid peroxidation such as serum creatine kinase (CK), superoxide dismutase (SOD), and malondialdehyde (MDA), respectively, and subjective ratings of perceived muscle soreness between recovery methods. The G-Trainer group did however display a higher mood state as indicated by the Profile of Mood State global scores at 24 hours postexercise when compared to the conventional treadmill recovery group (p = 0.035). The improved mood state after the use of the anti-gravity treadmill may provide clinical relevance to other populations.
Collapse
Affiliation(s)
- Matthew B Cooke
- College of Health and Biomedicine, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia
| | - Carrie M Nix
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas
| | - Lori D Greenwood
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A & M University, College Station, Texas
| | - Mike C Greenwood
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A & M University, College Station, Texas
| |
Collapse
|
4
|
Van Hooren B, Peake JM. Do We Need a Cool-Down After Exercise? A Narrative Review of the Psychophysiological Effects and the Effects on Performance, Injuries and the Long-Term Adaptive Response. Sports Med 2018; 48:1575-1595. [PMID: 29663142 PMCID: PMC5999142 DOI: 10.1007/s40279-018-0916-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It is widely believed that an active cool-down is more effective for promoting post-exercise recovery than a passive cool-down involving no activity. However, research on this topic has never been synthesized and it therefore remains largely unknown whether this belief is correct. This review compares the effects of various types of active cool-downs with passive cool-downs on sports performance, injuries, long-term adaptive responses, and psychophysiological markers of post-exercise recovery. An active cool-down is largely ineffective with respect to enhancing same-day and next-day(s) sports performance, but some beneficial effects on next-day(s) performance have been reported. Active cool-downs do not appear to prevent injuries, and preliminary evidence suggests that performing an active cool-down on a regular basis does not attenuate the long-term adaptive response. Active cool-downs accelerate recovery of lactate in blood, but not necessarily in muscle tissue. Performing active cool-downs may partially prevent immune system depression and promote faster recovery of the cardiovascular and respiratory systems. However, it is unknown whether this reduces the likelihood of post-exercise illnesses, syncope, and cardiovascular complications. Most evidence indicates that active cool-downs do not significantly reduce muscle soreness, or improve the recovery of indirect markers of muscle damage, neuromuscular contractile properties, musculotendinous stiffness, range of motion, systemic hormonal concentrations, or measures of psychological recovery. It can also interfere with muscle glycogen resynthesis. In summary, based on the empirical evidence currently available, active cool-downs are largely ineffective for improving most psychophysiological markers of post-exercise recovery, but may nevertheless offer some benefits compared with a passive cool-down.
Collapse
Affiliation(s)
- Bas Van Hooren
- Department of Nutrition and Movement Sciences, Maastricht University Medical Centre+, NUTRIM School of Nutrition and Translational Research in Metabolism, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
- Institute of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
| | - Jonathan M Peake
- School of Biomedical Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Sport Performance Innovation and Knowledge Excellence, Queensland Academy of Sport, Brisbane, Australia
| |
Collapse
|
5
|
Bae HI, Kim DY, Sung YH. Effects of a static stretch using a load on low back pain patients with shortened tensor fascia lata. J Exerc Rehabil 2017; 13:227-231. [PMID: 28503538 PMCID: PMC5412499 DOI: 10.12965/jer.1734910.455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/02/2017] [Indexed: 11/22/2022] Open
Abstract
Stretch of tensor fascia lata (TFL) improves range of motion on hip and pelvis and it reported to help reduce low back pain. Accordingly, the purpose of this study was to investigate effects of static stretching using a load on TFL in patients with low back pain. Twenty three subjects were recruited according to the selection criteria. The subjects were randomly assigned to static stretching group (control, n=12), and a static stretching using a load group (experimental, n=11). All group performed stretching for 15 min (side for 50 sec per time and a rest for 30 sec) per day in the left side and the right, respectively, for 2 weeks. Before and after the intervention, all groups measured visual analogue scale (VAS), stand and reach test, and the Oswestry disability index (ODI). In the present results, we found that the experimental group showed significant differences in VAS, stand and reach test, and the ODI (P<0.05) in before and after the intervention. Therefore, static stretching using a load can be actively utilized for low back pain patients with shortened TFL.
Collapse
Affiliation(s)
- Hae-In Bae
- Department of Physical Theraphy, Graduate School of Industry & Business Administration of Kyungnam University, Changwon, Korea
| | - Dae-Young Kim
- Department of Sports Healthcare, College of Humanities & Social Sciences, Inje University, Gimhae, Korea
| | - Yun-Hee Sung
- Department of Physical Theraphy, Graduate School of Industry & Business Administration of Kyungnam University, Changwon, Korea
| |
Collapse
|