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Three Part Question

In [adults performing sport and exercise] does [a stretching routine] reduce prior to exercise reduce[injury]?

Clinical Scenario

A young adult who is keen on sport asks you about a suitable stretching routine for the lower limb in order to prevent injury. You are unsure which, if any, is effective and seek out the evidence.

Search Strategy

MEDLINE 1950 to week 1 May 2009, via OVID interphase
{[(stretch$.mp)] AND [(exp athletic injuries OR exp leg injuries OR exp sprains and strains OR exp soft tissue injuries or injur$.mp) LIMIT to "therapy (sensitivity)" and human and English language}.

Searches also conducted in CINAHL, AMED, SPORTDiscus, EMBASE, via the OVID interface, the Cochrane database and PEDro.

Search Outcome

The Medline search produced 341 studies. Several studies of varying quality were identified; however, a 2008 systematic review conducted a thorough search for all studies comparing stretch before exercise with a control. The review is detailed in the table

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Small et al, 2008, UK	3532 Soldiers + 421 recreational runners + 298 army trainees + 195 college football players + five school football teams, (number unknown) in seven studies. Subjects allocated to static stretching before exercise and control groups 1992–2003.	Systematic review	Rate of injury causing absence from training or competition	No significant difference in six of seven studies between stretch and control groupsOne study (298 army trainees, scoring 45/100 for methodology) found a significant difference (p = 0.02)	Well conducted reviewConsiderable heterogeneity between studiesExercise undertaken by soldiers may differ from that by an athlete in training

Comment(s)

The studies detailed above vary considerably in design, subjects and exercise.

Clinical Bottom Line

Stretching before exercise will not reduce the risk of injury.

References

1. Small K, Mc Naughton L, Matthews M. A systematic review into the efficacy of static stretching as part of a warm-up for the prevention of exercise-related injury. Res Sports Med 2008;16:213–31.