Written By: Oxenford Physiotherapist, Chris Stack. 

In the Physiotherapy clinic, we are commonly asked questions regarding stretching and what the best techniques are. Whether it is a warm-up, cool-down or simply a stretch to improve flexibility; this blog aims to highlight the different types of stretching techniques and when they are best utilised.

Static stretching (StS)

What is it?
StS is a type of stretching exercise which causes elongation of muscle with application of low force and long duration (up to 60 seconds).

StS has a relaxation, elongation effect on muscle, improving range of motion, decreasing stiffness through the muscle and tendon and reduces the risk of acute muscle strain injuries. It is a slow controlled movement with emphasis on postural awareness and body alignment.

When to apply it?
In general, it appears that StS prior to sports is most beneficial for athletes requiring flexibility for their sports e.g., gymnastics and dance. However, literature shows it’s best used post physical activity to maintain and improve muscle flexibility.

There is evidence suggesting that StS causes only trivial negative effects on subsequent strength and power performances if the accumulated duration per muscle group does not exceed 60 seconds (Chaabene et al., 2019).

Overall, coaches are advised to consider short-duration StS as an important warm-up component in recreational sports due to its potentially positive effect on flexibility and musculotendinous injury prevention.  

Dynamic stretching (DS)

What is it?
DS involves stretching your muscles whilst moving, either by leg swings or by performing sports-specific drills such as high knee walking for hip mobility.

It works ‘with’ sensors in the muscle called muscle spindles. Muscle spindles are sensors within the muscle that sense the speed a muscle is being stretched. A muscle can be flexible with sufficient length. However, if it is suddenly asked to move at speed then sensors called muscle spindles may kick in to prevent it overstretching. This is how stretch related muscle strains/ tears can occur.

When to apply it?
DS may be better suited prior to sports for athletes requiring optimal running or jumping performance during their sport such as basketball players or sprinters.

A study by Iwata et al., 2019 found that 10 x  30 second sets / 15 repetitions of DS increased knee extension ROM which is consistent with the results of previous studies (Chen et al., 2018a; Herda et al., 2013). Both the duration and intensity of stretching have been shown to influence passive stiffness of the muscle-tendon unit (Opplert et al., 2018). A higher number of repetitions and addition of resistance to the primary muscles have both been shown to increase range of movement following DS (Mizuno, 2017).

Proprioceptive Neuromuscular Facilitation (PNF) Stretching

What is it?
PNF can take on several forms including hold-relax; contract-relax; and rhythmic initiation.

PNF can be either completely passive (meaning the therapist moves the limb through its range of motion) or active-assisted, in which the athlete plays a role in the treatment. In this case, it requires an isometric contraction before the stretch.

PNF works on the theories of reciprocal inhibition (or innervation) and post-isometric relaxation. Reciprocal inhibition is based on a reflex loop, controlled by the muscle spindles. When an agonist muscle contracts (for example the quads, causing knee extension), the antagonist’s muscle is inhibited, causing it to relax (in this example the hamstrings), allowing the full movement of the antagonist muscle (knee extension). Post-isometric relaxation is thought to be controlled by the Golgi tendon organs, sensors within the muscle that are sensitive to muscle tension. When a muscle is contracted isometrically for a period of time, this results in an inhibition of the muscle, resulting in relaxation.

When to apply it?
PNF stretching has been proven to decrease strength and power when done prior to high intensity and maximal effort exercises, such as jumping, plyometrics, sprinting, cutting, and other similar movements. These effects can last longer than ninety minutes. PNF is effective if completed after exercise and done at least twice a week to ensure lasting ROM and sustained beneficial effects similar top static stretching.

Neural Stretching

What is it?
Neural stretching refers to stretching the structures of the nervous system. This is necessary for injuries where there is excess neural tension, for example, muscle-related sciatic pain or thoracic outlet syndrome. Symptoms such as pins and needles, numbness, weakness, and sensation deficits may indicate if neural stretching is required. Neural stretches are adaptations of neural tension tests, such as the slump test and the upper limb tension test.

The limb is taken to the point of stretch and held for a maximum of 10 seconds, although initially, this may be as little as 3-4 seconds to avoid causing nerve irritation.

When to apply it?
Neural stretches are usually prescribed by a Physiotherapist as these techniques can cause irritation to nerves and worsen symptoms if they are not appropriate for the pathology and performed ineffectively. They are usually prescribed at a symptom management dosage; so they are performed until symptoms reduce or even dissipate.

Ballistic stretching

What is it?
This type of stretching is where you stretch the muscle as far as it is comfortable to do so. Then, at the end range of movement, you bounce or force the joint that little bit further.

This stretch is often utilised in sports where athletes need to access extreme joint range of motion such as Martial arts and Ballet.

It may also be used in rehabilitation to increase joint range of movement.

An example of this would be performing a lunge taken to full range and then applying a small bounce movement at the end of range.

When to apply it?
Ballistic stretching should be applied with caution post static, PNF and dynamic stretching techniques. Ballistic stretching may result in injury if the athlete has not been exposed sufficiently to stretching at these end of range positions.

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References:

Chaabene H, Behm DG, Negra Y, Granacher U. Acute Effects of Static Stretching on Muscle Strength and Power: An Attempt to Clarify Previous Caveats. Front Physiol. 2019 Nov 29;10:1468. doi: 10.3389/fphys.2019.01468. PMID: 31849713; PMCID: PMC6895680.

Hindle KB, Whitcomb TJ, Briggs WO, Hong J. Proprioceptive Neuromuscular Facilitation (PNF): Its Mechanisms and Effects on Range of Motion and Muscular Function. J Hum Kinet. 2012 Mar;31:105-13. doi: 10.2478/v10078-012-0011-y. Epub 2012 Apr 3. PMID: 23487249; PMCID: PMC3588663.

Iwata M, Yamamoto A, Matsuo S, Hatano G, Miyazaki M, Fukaya T, Fujiwara M, Asai Y, Suzuki S. Dynamic Stretching Has Sustained Effects on Range of Motion and Passive Stiffness of the Hamstring Muscles. J Sports Sci Med. 2019 Feb 11;18(1):13-20. PMID: 30787647; PMCID: PMC6370952.