We agree with Ian Shrier that the finding of an effect of stretching\u00a0on risk of muscle, ligament and tendon injuries should be interpreted with\u00a0caution. That is why we wrote “The finding of an effect of stretching on\u00a0muscle, ligament and tendon injury risk needs to be considered cautiously\u00a0because muscle, ligament and tendon injury risk was a secondary outcome,\u00a0and there was no evidence of an effect of stretching on the primary\u00a0outcome of all-injury risk. If stretching had reduced the risk of muscle,\u00a0ligament and tendon injuries without increasing the risk of other\u00a0injuries, we would expect a reduction in all-injury risk.” Nonetheless,\u00a0after a prolonged discussion of this issue we decided that the finding\u00a0could not be totally dismissed. We believe that it was appropriate to\u00a0report the observed effect on muscle, ligament and tendon injuries with an\u00a0explicit acknowledgement of the uncertainty associated with this finding.<\/p>\n
Regardless of whether one accepts the finding that stretching reduces\u00a0risk of muscle, tendon and ligament injuries, the implications would\u00a0appear to be the same. Even if the effect is real, it is quite small in\u00a0absolute terms (even in this population, at quite a high risk of injury,\u00a0only “one injury to muscle, ligament or tendon was prevented for every 20\u00a0people who stretched for 12 weeks”). For this reason the data from this\u00a0study do not appear to provide support for the practice of stretching, at\u00a0least in so far as the aim is to reduce injury risk. The stronger\u00a0justification for stretching, though still a marginal one in our view, is\u00a0provided by the clear evidence of a very small effect of stretching on\u00a0soreness. For other outcomes, such as performance or range of motion our\u00a0study did not provide any data.<\/p>\n
It is not yet known whether stretching is best carried out before\u00a0exercise, after exercise, or both before and after exercise. We were\u00a0surprised, when planning this study, to learn that most Australian stretch\u00a0before exercise but not after, and most Norwegians stretch after exercise\u00a0but not before! It was for that reason we designed a trial in which\u00a0participants stretched both before and after exercise. We do not agree\u00a0with Ian Shrier’s suggestion to conduct an unplanned post-hoc comparison\u00a0of the non-randomised subgroups that chose to stretch only before, only\u00a0after, or both before and after exercise. Such an analysis would almost\u00a0certainly be seriously confounded and would probably be uninterpretable;\u00a0at any rate it hardly seems consistent with his disapproval of our much\u00a0more disciplined pre-planned secondary comparison between randomised\u00a0groups. The only truly satisfactory way to resolve the issue of whether it\u00a0is better to stretch before or after exercise is to conduct a further\u00a0randomised trial in which participants are randomised to those two\u00a0conditions.<\/p>\n
Conflict of Interest: None declared<\/p>\n","protected":false},"excerpt":{"rendered":"
We agree with Ian Shrier that the finding of an effect of stretching\u00a0on risk of muscle, ligament and tendon injuries should be interpreted with\u00a0caution. That is why we wrote “The finding of an effect of stretching on\u00a0muscle, ligament and tendon injury risk needs to be considered cautiously\u00a0because muscle, ligament and tendon injury risk was a […]<\/p>\n