CRITICAL REVIEW

Does Stretching Improve Performance?

A Systematic and Critical Review of the Literature
Ian Shrier, MD, PhD
Objective: The purpose of this article was to evaluate the clinical
and basic science evidence surrounding the hypothesis that stretching
improves performance.
Data Sources and Selection: MEDLINE and Sport Discus were
searched using MeSH and textwords for English-language and
French-language articles related to stretching and performance (or
performance tests). Additional references were reviewed from the
bibliographies and from citation searches on key articles. All articles
related to stretching and performance (or performance tests) were re-
viewed.
Main Results: Of the 23 articles examining the effects of an acute
bout of stretching, 22 articles suggested that there was no benefit for
the outcomes isometric force, isokinetic torque, or jumping height.
There was 1 article that suggested improved running economy. Of 4
articles examining running speed, 1 suggested that stretching was
beneficial, 1 suggested that it was detrimental, and 2 had equivocal
results. Of the 9 studies examining the effects of regular stretching, 7
suggested that it was beneficial, and the 2 showing no effect examined
only the performance test of running economy. There were none that
suggested that it was detrimental.
Conclusions: An acute bout of stretching does not improve force or
jump height, and the results for running speed are contradictory.
Regular stretching improves force, jump height, and speed, although
there is no evidence that it improves running economy.
(Clin J Sport Med 2004;14:267273)
A
lthough many clinicians and authors currently advise that
stretching prevents injury,
13
recent reviews
4,5
have sug-
gested that stretching immediately prior to exercise does not
prevent injury. However, there is some weak evidence that
stretching at other times may indeed prevent injury.
6
Although clinicians are now generally aware of the is-
sues related to stretching and injury, many authors also recom-
mend stretching to improve performance.
79
If stretching de-
creases muscle stiffness (via changes in passive visco-elastic
properties), less energy is required to move the limb, and
force/speed of contraction may be increased. Alternatively, de-
creased stiffness may decrease storage of recoil energy, which
would lead to greater energy requirements. If performance is
enhanced, the issue of increased risk of injury may be moot for
some persons.
Because of the nature of research, we can never test ac-
tual competition performance with appropriate scientific rigor.
Therefore, we rely on tests of performance that relate directly
or indirectly to sport performance. The closer the test is to the
performance required, the more relevant the test. For example,
running speed over 50 m would be considered very relevant if
the race distance interested in was 50 m, and less relevant if the
race distance interested in was 1000 m. In addition, running
speed in a race is dependent on force generated, speed of con-
traction, running economy, and psychology. Therefore, results
from tests of only 1 of these (e.g., only force, only running
economy) have to be interpreted with caution. That being said,
some sports can often be categorized as a combination of
single activities. In basketball, both speed and jump height are
direct skills that affect the ability to perform, and in this case,
results of performance tests become very relevant measures on
their own.
Therefore, this article reviews the evidence on whether
acute or regular long-term stretching affects tests of sport per-
formance. For brevity, performance is used instead of tests of
performance throughout the article.
METHODS
MEDLINE and Sport Discus were searched for all clini-
cal articles related to stretching and performance using the
strategy outlined in Table 1.* All pertinent articles from the
bibliographies of these clinical articles were reviewed. A cita-
tion search was performed on the key articles found in each
search. Articles were separated into those that investigated the
effects froman acute bout of stretching (i.e., within 60 minutes
of stretching) and those that investigated the effects of regular
long-term stretching over days to weeks. Study designs in-
Received for publication July 2003; accepted April 2004.
From the Centre for Clinical Epidemiology and Community Studies, SMBD-
Jewish General Hospital, Montreal, Quebec, Canada.
*Tables 1 to 4 cited within the text are available via the Article Plus feature at
www.cjsportmed.com. Please go to the September/October issue and click
on the Article Plus link posted with the article in the Table of Contents.
Reprints: Ian Shrier, MD, PhD, Centre for Clinical Epidemiology and Com-
munity Studies, SMBD-Jewish General Hospital, 3755 Cote Sainte-
Catherine Road, Montreal, Quebec H3T 1E2, Canada (e-mail:
ian.shrier@mcgill.ca).
Copyright 2004 by Lippincott Williams & Wilkins
Clin J Sport Med Volume 14, Number 5, September 2004 267
cluded only randomized controlled trials, cross-over trials
(each subject is used as his/her own control), and repeated-
measures studies.
Results in the tables are presented as they were in the
original articles. To compare results across studies in a figure,
the relative effect (e.g., MVC
stretch
/MVC
control
; maximumvol-
untary contraction) is also reported. Where not given in
the article, the relative effect was estimated as (mean
post
stretch
)/(mean post
control
), which is not equivalent to the true
relative effect (i.e., the relative effect should be calculated for
each individual, and then the mean should be taken). In simple
pre-post studies, the relative effect is simply (post-pre)/pre.
Because it is not possible to calculate the confidence intervals
without the raw data, the figures display only point estimates.
RESULTS
There were 23 studies (24 articles; 1 study published re-
sults in 2 articles) that investigated the effects of an acute bout
of stretching and 9 studies that investigated the effects of re-
peated stretching after days to weeks.
Does Pre-Exercise Stretching
Improve Performance?
A detailed summary of each study examining the acute
effects of stretching on force, torque, and jump can be found in
Table 2,* and those examining running can be found in Table
3.* Figures 1, 2, and 3 illustrate the effects of an acute bout of
stretching for MVC, jump height, and isokinetic torque, re-
spectively. The results of the effects on isometric force, isoki-
netic torque, and jump height are summarized below. The ef-
fects on running are discussed separately because the studies
present conflicting results.
Force, Torque, and Jump: Positive Studies
There were no studies that suggested that stretching is
beneficial for these aspects of performance.
Force, Torque, and Jump: Negative Studies
There were 20 studies (21 articles; 1 study reported re-
sults in 2 separate articles
10,11
) that found that an acute stretch-
ing session diminished performance.
1029
The measures in-
cluded MVC, power, jump height, jump force, and jump ve-
locity. One of these studies found static stretching detrimental
for jumping, whereas dynamic stretching had no effect.
29
If stretching increases compliance, it is possible that the
muscles length-tension curve is shifted. This might lead to
changes in MVC when the muscle is in a short position but not
when tested in a position of tension (i.e., still on the plateau of
the length-tension curve). Stretching decreased MVC only
when the muscle was not on tension in 1 study on knee exten-
sion.
23
In the only other study looking at joint positions, this
did not occur.
12
In this latter study, the plantar flexors were
tested with the knee at 90 flexion and the ankle at 0, 10, and
20 dorsiflexion. The object of the study was to test the soleus
muscle (on/off tension at different positions used). However,
FIGURE 1. Isometric MVC or 1 repetition maximum (1RM) of
the stretched leg as a percentage of the unstretched leg is
plotted for all studies investigating an acute bout of stretching
for which it could be calculated. Studies are divided according
to whether the muscle was on stretch at the time it was being
tested. In studies in which the results were not presented as a
percentage of the unstretched leg, the means were used to
estimate the true value (i.e., the mean of the individual subject
percentages is not mathematically equivalent to the percent-
age calculated based on the mean changes across individuals).
FIGURE 2. Isokinetic torque of the stretched leg as a percent-
age of the unstretched leg is plotted for all studies investigat-
ing an acute bout of stretching for which it could be calcu-
lated. Studies are divided according to whether the isokinetic
testing speed was slow or fast. In studies in which the results
were not presented as a percentage of the unstretched leg, the
means were used to estimate the true value (i.e., the mean of
the individual subject percentages is not mathematically
equivalent to the percentage calculated based on the mean
changes across individuals).
Shrier Clin J Sport Med Volume 14, Number 5, September 2004
268 2004 Lippincott Williams & Wilkins
the gastrocnemius muscle was not on tension at any position,
and therefore, its force production would have been decreased
at all ankle angles.
One study reported that the diminished performance was
limited to slow contraction speeds during isokinetic testing,
24
but another study found the effect at multiple joint velocities.
27
Both studies used similar ranges of velocities (results at very
high velocities demonstrate more variability
30
), and there was
no apparent methodological difference that would explain this
discrepancy.
There was a decrease in the EMG in 4 studies
12,21,22,26
but not in a fifth.
19
The time spent stretching in the study with-
out a decreased EMG was similar to some of the studies that
showed a decrease in EMG, suggesting that this was not the
reason for the difference. The duration of the effect on the
EMGwas variable. Where only 1 limb was stretched, the EMG
decreased in the unstretched leg with knee isokinetic testing
27
but not in the study measuring MVC of the plantar flexors.
26
Force, Torque, and Jump: Equivocal Studies
There was 1 study
31
suggesting equivocal results. The
measured outcomes included isometric force and isokinetic
torque.
Running
Of the 5 studies on running (Table 3;* 2 of these also
reported on force, torque, or jump), 1 examined running
economy, and 4 examined running speed. Although stretching
improved running economy, the study population was limited
to subjects with tight hip flexor or extensor muscles.
32
Because
running speed is dependent on economy and force, this is only
indirectly related to athletic performance.
Of the 4 studies that directly examined running speed, 2
studies had equivocal results. In 1 study, the numbers were
very small (only 4 subjects in the study by de Vries
33
), and the
results fromthe Pyke
34
study were reported only as not signifi-
cant, without giving the actual numbers.
The 2 remaining studies contradicted each other. In the
study showing a detrimental effect, stretching was 30 seconds,
repeated twice,
28
compared with 30 seconds once for the study
showing a beneficial effect.
29
Electronic timing was used in
both studies. One study measured professional soccer players,
and the other measured varsity athletes. Finally, the study
showing that stretching was detrimental used static stretching,
and the study showing that stretching was beneficial showed
greater benefits with dynamic stretching compared with static
stretching. Of note, although not statistically significant, the
study that showed that stretching was beneficial for running
had also showed that static stretching decreased jump height
by 2.5% (P = 0.07), which is the same magnitude found in
other studies. Dynamic stretching had resulted in only a 0.5%
decrease in jump height.
Summary of Clinical Evidence
All but 1 study found that an acute bout of stretching
diminished performance tests of force, torque, or jumping, or
that there was no clinically relevant difference. The effects
were observed for (1) static, ballistic, and proprioceptive neu-
romuscular facilitation (PNF) stretches; (2) males and females;
(3) competitive and recreational athletes; (4) children and
adults; (5) trained or untrained subjects; and (6) with or with-
out warm-up. Similar results were found across study designs.
There was limited research on the effect of the muscles pre-
exercise tension and of contraction velocity.
With regard to running speed, the results are conflicting.
Variables that differed between studies included stretch time
and dynamic versus static stretching.
Does Regular Stretching
Improve Performance?
A detailed summary of each study examining the effects
of repeated stretching over days to weeks can be found in Table
4.* Figures 4 and 5 illustrate the effects of regular stretching
for MVC and isokinetic torque, respectively.
Positive Studies
There were 7 studies suggesting that regular stretching
improves performance.
30,3540
The measures of performance
FIGURE 3. Jump height of the stretched leg as a percentage of
the unstretched leg is plotted for all studies investigating an
acute bout of stretching for which it could be calculated. Stud-
ies are divided according to whether the authors tested static
jump height (i.e., jump from a stationary position) or counter-
movement jump height (i.e., subjects lower themselves to-
ward the floor and then jump in 1 smooth motion). Tests that
measured drop jump height (i.e., jump height after jumping
down from a small height) were considered countermovement
jumps for presentation on this graph. In studies in which the
results were not presented as a percentage of the unstretched
leg, the means were used to estimate the true value (i.e., the
mean of the individual subject percentages is not mathemati-
cally equivalent to the percentage calculated based on the
mean changes across individuals).
Clin J Sport Med Volume 14, Number 5, September 2004 Does Stretching Improve Performance?
2004 Lippincott Williams & Wilkins 269
included MVC, contraction velocity, both eccentric and con-
centric contraction force, counter-movement jump height, and
50-yard dash.
Negative Studies
There were no studies that suggested that regular stretch-
ing diminishes performance.
Equivocal Studies
There were 2 studies suggesting neither an improvement
nor a diminished performance.
41,42
Both of these studies were
randomized cross-over studies, and both examined economy
of motion. A third study that had found an increase in force
also did not find an increase in running or walking economy.
35
Summary of Clinical Evidence
Overall, the evidence strongly suggested that regular
stretching increases isometric force production and velocity of
contraction. The 3 studies investigating running economy
found no effect. In the 1 study measuring 50-yard dash time,
regular stretching improved performance. This suggests that
contraction velocity or force is more important than running
economy for short sprints. Whether this is also true for longer
distances remains to be determined. The wide variety of pa-
tients and measures suggests that the performance benefits of
regular stretching are robust. Populations included high school
students to seniors, competitive athletes, recreational athletes,
and males and females. Similar results were found across study
designs.
DISCUSSION
A review of the clinical evidence strongly suggests that
pre-exercise stretching decreases force production and veloc-
ity of contraction for at least part of the range of motion
(ROM), and that running economy is improved. The effect on
running speed remains to be determined, with 1 study suggest-
ing that stretching is beneficial, 1 suggesting that stretching is
detrimental, and 2 equivocal small studies. The effects of regu-
lar stretching are exactly opposite: regular stretching improves
force production and velocity of contraction but has no effect
on economy of motion. These results are consistent with the
basic science evidence and mirror the results observed with
respect to stretching and injury.
Acute Stretching
An acute bout of stretching decreases the visco-elastic
behavior of muscle and tendon.
4346
Because the stiffness is
decreased, it requires less energy to move the muscle. This is
consistent with the clinical finding that running economy is
improved with an acute bout of stretching.
The mechanismby which stretching would be detrimen-
tal in tests of performance related to force produced is most
likely related to damage caused at the time of the stretch. The
basic science literature suggests that strains as little as 20%
FIGURE 5. Isokinetic torque of the stretched leg as a percent-
age of the unstretched leg is plotted for all studies investigat-
ing a regular stretching over a period of days to weeks for
which it could be calculated. Studies are divided according to
whether the isokinetic testing speed was slow or fast. In studies
in which the results were not presented as a percentage of the
unstretched leg, the means were used to estimate the true
value (i.e., the mean of the individual subject percentages is
not mathematically equivalent to the percentage calculated
based on the mean changes across individuals).
FIGURE 4. Isometric MVC or 1 repetition maximum (1RM) of
the stretched leg as a percentage of the unstretched leg is
plotted for all studies investigating a regular stretching over a
period of days to weeks in all studies for which it could be
calculated. Studies are divided according to whether the per-
son performed PNF or static stretching. In studies in which the
results were not presented as a percentage of the unstretched
leg, the means were used to estimate the true value (i.e., the
mean of the individual subject percentages is not mathemati-
cally equivalent to the percentage calculated based on the
mean changes across individuals).
Shrier Clin J Sport Med Volume 14, Number 5, September 2004
270 2004 Lippincott Williams & Wilkins
beyond resting fiber length can cause muscle damage, result-
ing in decreased force. A 20% strain occurs in some sarco-
meres with regular walking
47
and therefore is certainly to be
exceeded by normal stretching routines. Further, Black and
Stevens
48
found that an acute bout of stretching (5% beyond
resting length) in mice results in approximately 5% decline in
isometric force (control group). However, there was no work
deficit when the muscles were stimulated to contract and al-
lowed to shorten. Finally, EMG was affected in most studies,
and this may suggest that a neurologic mechanism is possible.
More experiments using similar methodology and varying the
parameters are needed.
The mechanism by which stretching would affect run-
ning speed is more complicated. Running speed is dependent
on running economy, force produced, and velocity of contrac-
tion. This review found that running economy is improved
(most likely due to decrease in visco-elasticity
43,49
), but force
and velocity of contraction are decreased (most likely due to
minor muscle damage
47,48
). The overall effect on running
speed is therefore likely to be dependent on the balance of
these factors within any particular individual. That being said,
the 1 article that found that stretching improved running speed
found that dynamic stretching was superior to static stretch-
ing.
29
Although the authors of this study did not measure
ROM, previous studies found that dynamic stretching in-
creased ROM much less than static stretching (4.3 vs.
11.4).
50
This strongly suggests that the effects seen were not
due to increased ROM and therefore were not due to improved
visco-elastic properties or running economy. Because dy-
namic stretching also requires the muscles to contract, other
possible mechanisms include central programming of muscle
contraction/coordination and decreased fatigue through in-
creased warm-up activity.
Regular Long-Term Stretching
Although the immediate effects of stretching decrease
visco-elasticity and increase stretch tolerance, the effect of
stretching over 3 to 4 weeks appears to affect only stretch tol-
erance, with no change in visco-elasticity.
51,52
Therefore, one
would not expect to see a change in running economy; the
clinical evidence supports the basic science evidence.
The mechanism by which regular long-term stretching
improves performance is likely related to stretch-induced hy-
pertrophy. When a muscle is stretched 24 hours per day, some
hypertrophy occurs even though the muscle has not been con-
tracting.
5355
If stretching a muscle group for 30 to 60 s/d over
months also results in hypertrophy, one would predict an in-
crease in force and contraction velocity; this was observed in
every study that investigated these outcomes. That being said,
Black et al
56
stretched mouse hindlimbs for 1 minute every
second day for 12 days and did not find any difference in peak
force between stretched and unstretched legs (data obtained
prior to the eccentric contraction-induced injury in the study).
As the effect on running speed is a combination of force (in-
creased), velocity of contraction (increased), and running
economy (no change), the overall effect should be an increase
in running speed. This was observed in the 2 studies that used
running speed as the outcome.
Limitations
All of the studies in this review used human data. Al-
though most studies used a randomized cross-over design (the
strongest evidence of causality), some studies used a pre-post
design. Results were generally consistent across designs.
There are many different ways to stretch. Static stretch-
ing was used in most of the studies, but the effects were ob-
served with PNF stretching as well. Dynamic stretching is a
combination of both stretching and warm-up (i.e., muscle is
contracting). This reviewfound that the effects were consistent
across different modes of stretching for isometric force, isoki-
netic torque, and jump height. Although different modes of
stretching in running produced conflicting results, another
methodological difference was the duration of stretch, with the
longer stretch producing worse results.
It is not possible to blind a subject as to whether they
stretched or not. However, in the 1 study in which subjects
were asked, all believed that an acute bout of stretching would
improve performance.
14
Where the results were in the opposite
direction of the prior beliefs, lack of blinding could only mean
that the effect was even greater than we observed, and that it is
likely that an acute bout of stretching affects performance
through physiological and not psychologic mechanisms.
The subject population is a very important variable to
consider. These studies found similar results across gender,
age, and level of athletic talent. This also suggests the results
are due to basic physiological changes that occur in the muscle, a
hypothesis that is supported by the basic science evidence on
stretch-inducedmuscle damage andstretch-inducedhypertrophy.
There were no studies using injured subjects. An acute
stretch can produce an analgesic effect,
4446
which may in it-
self improve performance in injured athletes. For example, the
stretch-induced analgesia may minimize pain-induced muscu-
lar inhibition, and this could theoretically improve perfor-
mance in an injured athlete. However, the analgesic effect of
stretching may also affect other nerves aside from pain fibers
(e.g., proprioceptive nerves), and the overall effect of stretch-
ing in this population remains to be determined. Finally, the
improved performance, if it did occur, might be at the expense
of an increased risk of injury. The advantages and disadvan-
tages of stretching need to be weighed for each athlete, includ-
ing but not limited to competition level, competition timing
(e.g., early or late in the season), and nature of injury.
Although several measures of performance were used in
these studies, including isometric force, isokinetic torque,
jump height, jump velocity, and sprint speed, these do not
cover all aspects of performance. If a hurdler cannot get his or
Clin J Sport Med Volume 14, Number 5, September 2004 Does Stretching Improve Performance?
2004 Lippincott Williams & Wilkins 271
her leg over the hurdle without stretching, then an acute bout of
stretching will improve performance regardless of its effect on
force or sprint speed. In addition, stretching may be a mode of
relaxation for some subjects, and this may affect performance
within a competition. If this were a mechanism of improved
performance, then stretching should be compared with other
methods of relaxation for clinical effectiveness.
Finally, the author did not systematically review the
stretch-shorten cycle research. A muscle that contracts imme-
diately after a stretch (e.g., jumping up immediately after land-
ing from a short jump) produces more force than a muscle that
was not stretched. This is an important phenomenon but unre-
lated to the clinical effects of pre-exercise stretching. That be-
ing said, the effect of stretching on jump height was similar in
subjects who began from a stationary position (static jump
height) and those who used a stretch-shorten cycle (counter-
movement jump and drop-jump; Fig. 3).
In summary, the evidence suggests that stretching imme-
diately prior to exercise decreases the results on performance
tests that require isolated force or power. The effect on running
speed remains to be determined. On the other hand, regular
stretching will improve the results for all activities. This is
similar to the fact that stretching immediately prior to exercise
does not reduce the risk of injury, but that regular stretching
may reduce the risk of injury.
6
Therefore, if one stretches, one
should stretch after exercise, or at a time not related to exercise
(the relative benefit of each remains unstudied at the present
time). Future research should investigate the cellular and mo-
lecular mechanisms by which the effects of stretching occur,
whether the added benefit of regular stretching is as effective
as other types of performance-enhancement exercises being
promoted (e.g., plyometrics, increased weight training), and
whether the same effects are seen in the presence of injury.
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Clin J Sport Med Volume 14, Number 5, September 2004 Does Stretching Improve Performance?
2004 Lippincott Williams & Wilkins 273