Finally, after a long delay and rehab, I'm about to take my first tentative steps back on the court. Monday morning, 6:30 AM, I'll have a racket in hand and a ball in the air, just hitting by myself and doing some light ghosting. Next week I'll go back to match play.
Part of my rehab has involved stretching, and stretching, it turns out, ain't all it appears to be. For most people it would appear to be axiomatic that stretching before and after physical exertion is clearly beneficial to injury prevention and whatever sport you are playing. But a note of caution to all you out there who contort your limbs before the big squash match: unequivocal proof that stretching is beneficial does not exist.
I've been interested in this for years because, historically, stretching before a match has never been helpful to me, and when I did it -- mostly because everyone else waiting for their matches seemed to be doing it -- my injury rate increased. (I know what you're thinking: I didn't stretch in the correct way. Trust me though, I did.)
I found in particular lower limb injuries increased when I stretched, so I finally got the message: For years I haven't stretched before a match. After a match I will do light stretching for a brief period of time, and I find that helps recover from the match.
But enough about me, what do the experts say? They say they're stumped. One study (Am J Sports Med. 1993;21(5):711-9) split male runners into two groups: one group of 159 runners would use a standardized warm-up, cool-down, and stretching regimen; the other group of 167 runners acted as controls and did not use the regimen. The study found no beneficial effect among the stretchers, who experienced more injuries per 1000 hours of running.
A more extensive review of injuries in runners was performed by the Cochrane Collaboration, an independent medical group that exhaustively reviews the effectiveness and appropriateness of treatments and medical interventions. Physicians know that a Cochrane Review is the most thorough approach to understanding in an unbiased way what is the best approach to a medical problem.
One Cochrane Review looked at various interventions for preventing lower limb injuries in runners (Cochrane Database Syst Rev.2001;(3):CD001256). This was the first major review on the subject. The review looked at any appropriately randomized trial that touched on the subject, and found 12 trials with 8,806 participants. Of these, 5 trials with 1944 participants and 3159 controls looked at the effectiveness of stretching. Their conclusion: "There is insufficient evidence to determine the effectiveness of stretching exercises for major lower limb muscle groups in reducing lower limb soft-tissue running injuries."
Other studies have not only found no benefit but have found injury rates that, as in my personal experience, increase with pre-workout stretching. One study (see it here: To Stretch or Not To Stretch?) found that runners who stretched before running were about one third more likely to be injured compared to non-stretchers. The study also found that stretching after a workout helped lower the risk of injury. Here's another study that had the same result in exercisers in general, not just runners: Res Sports Med. 2008;16:213-31.
The best study on stretching was done several years ago at West Point Military Academy (I'm sorry but I can't find the reference). Half the incoming freshmen were given a stretching regimen to do before physical exertion of any kind ("And that's an order!") and the other half were told to not stretch. Injury rates were then watched for their entire 4 years at the academy. You guessed it: The stretchers were injured more often than the non-stretchers.
So what's the take-home? I think the truth is that stretching after exertion is always good for you. None of these studies has found anything wrong with that. However, in some people -- and judging by these studies it may be more than 50% of us -- stretching before exertion may permit your muscles to stretch beyond what they should, thereby encouraging injury. Furthermore, I think those who are naturally fairly limber and loose-limbed, myself among them (and that's a description of an awful lot of squash players), are the ones who are likely not benefited by pre-workout stretching. Finally, there is an age quotient to this. As you get older you become a little less limber. Whereas stretching in my 20s and 30s increased my injury rate, as I've advanced in age (and wisdom) I am naturally less limber, and stretching naturally becomes more and more a beneficial thing.
Which is why come Monday morning, I'll stretch. A little....