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CLINICAL SCIENCES Clinical Investigations

The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature STEPHEN B. THACKER1, JULIE GILCHRIST2, DONNA F. STROUP3, and C. DEXTER KIMSEY, JR.3 1

Epidemiology Program Office, 2National Center for Injury Prevention and Control, and 3National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA

ABSTRACT THACKER, S. B., J. GILCHRIST, D. F. STROUP, and C. D. KIMSEY, JR. The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature. Med. Sci. Sports Exerc., Vol. 36, No. 3, pp. 371–378, 2004. Purpose: We conducted a systematic review to assess the evidence for the effectiveness of stretching as a tool to prevent injuries in sports and to make recommendations for research and prevention. Methods: Without language limitations, we searched electronic data bases, including MEDLINE (1966 –2002), Current Contents (1997–2002), Biomedical Collection (1993–1999), the Cochrane Library, and SPORTDiscus, and then identified citations from papers retrieved and contacted experts in the field. Meta-analysis was limited to randomized trials or cohort studies for interventions that included stretching. Studies were excluded that lacked controls, in which stretching could not be assessed independently, or where studies did not include subjects in sporting or fitness activities. All articles were screened initially by one author. Six of 361 identified articles compared stretching with other methods to prevent injury. Data were abstracted by one author and then reviewed independently by three others. Data quality was assessed independently by three authors using a previously standardized instrument, and reviewers met to reconcile substantive differences in interpretation. We calculated weighted pooled odds ratios based on an intention-to-treat analysis as well as subgroup analyses by quality score and study design. Results: Stretching was not significantly associated with a reduction in total injuries (OR 0.93, CI 0.78 –1.11) and similar findings were seen in the subgroup analyses. Conclusion: There is not sufficient evidence to endorse or discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes. Further research, especially well-conducted randomized controlled trials, is urgently needed to determine the proper role of stretching in sports. Key Words: ATHLETES, CONDITIONING, META-ANALYSIS, SYNTHESIS

tretching before participation in athletic activities is standard practice for all levels of sports, competitive or recreational. Athletes, coaches, trainers, physiotherapists, and physicians recommend stretching in an effort to both prevent injury and enhance performance; numerous journal articles and textbooks are devoted to the topic, providing a variety of approaches directed to different parts of the body and for specific sporting activities (1). As more people participate in sports and other recreational activities through social changes (e.g., Title IX) and increased recognition that physical activity is part of a healthy lifestyle, injury prevention becomes more important. However, some

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Address for correspondence: Stephen B. Thacker, M.D., M.Sc., Director, Epidemiology Program Office, Centers for Disease Control and Prevention, MS C08, Atlanta, GA 30333; E-mail: sbt1@cdc.gov. Submitted for publication June 2003. Accepted for publication October 2003. 0195-9131/04/3603-0371 MEDICINE & SCIENCE IN SPORTS & EXERCISE® Copyright © 2004 by the American College of Sports Medicine DOI: 10.1249/01.MSS.0000117134.83018.F7

investigators have questioned the routine practice of stretching and contend that there is little evidence that stretching pre- or postparticipation prevents injury and that it might affect performance negatively (82,93). In particular, a recent systematic review (35) concluded that the best available...
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