To Stretch or Not To Stretch: Should you waste your time?

By Emily Haglage, PT, DPT from Midwest Orthopaedics at Rush

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The American College of Sports Medicine states that adults should be getting at least 150 minutes of moderate-intensity exercise per week. That is about 20 minutes a day. Stretching is not considered to be a moderate-intensity exercise. So, do we need to add 5-10 minutes of stretching prior to our workout, like our coaches always told us? In recent years, there has been much debate over different ways to stretch and which way is the safest and most effective. There are many different types of stretching techniques, but today we are only considering two types: static and dynamic.


Static stretching is lengthening the muscle while holding a particular pose for an extended period of time, such as propping your leg up onto a chair, leaning forward, and stretching your hamstring for 30 seconds.

Dynamic stretching is elongating the muscle while completing a movement. For example, running with high knees or walking lunges. So, how do we know when to perform each type of stretching?


Static Stretching

A strong amount of research supports the effects of static stretching to be performed after a warm up, but prior to your full workout, especially if you do not have the full range of motion to complete the activity. However, there are many current research articles that raise the negative effects of static stretching. One study states, “A longer stretch duration (i.e. >60 s) are more likely to cause a small or moderate reduction in performance,” which could lead you to a higher risk of injury.

Another study looked at performance of collegiate sprinters with and without static stretching. That study found, “ significant slowing in performance with static stretching… Therefore, in strict terms of performance, it seems harmful to include static stretching in the warm-up protocol of collegiate male sprinters.” Looking at this from a broader perspective, if you are want to participate in a sport such as jogging, evidence supports that there is no need for a specific static stretching routine.

● Perform after a warm up, but prior to a full workout

● Hold stretch less than 45 seconds

● Decreases speed and power

● May have little effect on long-term flexibility, and could increase your risk for injury

Dynamic Stretching

Research seems to lean towards dynamic stretching as the most beneficial form of stretching prior to any type of exercise or sport routine. In fact, most studies found that it was beneficial to perform dynamic stretching in order to reverse negative effects of static stretching. One researcher group discovered, “ Athletes in sports requiring [leg] power should use dynamic stretching techniques in warm-up to enhance flexibility while improving performance”.

Another research article found that dynamically stretching your hamstrings can actually decrease tightness and improve flexibility over a period of 6 weeks, and therefore significantly decrease low back pain. Not only does dynamic stretching warm up your muscles, but it wakes up your central nervous system which can prepare your body for a tough workout.

● Perform after statically stretching (if you choose this modality of stretching)

● Beneficial for the athlete participating in a sport with less pivoting movements such as swimming or jogging

● Can decrease muscle tightness and improve flexibility

● Helps to decrease your risk of injury


Emily_Haglage.jpgEmily Haglage is a graduate of Saint Louis University where she received her bachelor’s of science degree in exercise science and doctorate in physical therapy. She treats a variety of orthopedic injuries with special interest in knee injuries including patellofemoral pain, meniscus injuries, ligamentous injuries, arthritis and post-operative total knee replacements. She enjoys working closely with athletes by performing Functional Sports Assessments (FSAs) which give physicians more assurance that their patients are safe to return to sports such as basketball, football, soccer, tennis and hockey.

Warming Up vs Cooling Down: Things To Know

By Matthew Buckley for Athletico Physical Therapy

warming up vs cooling down

Picture this – you walk into your local gym after carving out time in your day to  work out.. You come prepared with your headphones in, new favorite song turned up, and a game plan full of all the exercises you’re going to accomplish that day. You scan the gym and see your favorite machine with no one else on it calling your name. You scurry to it, get settled in, and just as you’re about to start you think to yourself, “I probably should warm up, shouldn’t I?”

We’ve all been here. Most people at one time or another have followed some sort of workout plan in hopes of becoming more physically fit, and yet so often these programs neglect any sort of warm up or cool down. All too often people end up in physical therapy with workout related injuries, many of which can be attributed to poor warm ups/cool downs. In fact, in 2012 roughly 500,000 people were injured while exercising or using exercise equipment. Gym-goers are not alone. A review of the incidence of running injuries shows that the average recreational runner has anywhere from a 37 to 56 percent chance of injuring themselves.


With a proper warm up and cool down prior to activity of any sort, these rates of injury can be decreased and the ever-dreaded soreness after exercise can be lessened.. A proper warm up is very different than a proper cool down, so it is important to understand what should be incorporated into each of these. Here are some tips to guide a safe, effective warm up, cool down and overall workout.


The Warm Up

Contrary to popular belief, static stretching is  not the best way to get ready for a workout. Static stretching helps to lengthen and relax muscles, which while important (see below), is not the most effective way to get your body ready for physical exertion. Instead, what is called a dynamic warm up is best for pre-exercise. These are movements designed to increase the mobility of muscles, tendons and ligaments surrounding the areas of the body you’ll be using for exercise, as well as increase the mobility of the joints themselves.

These movements help prime your body for more strenuous physical exertion, begin to get your heart rate up in preparation for activity, and increase blood flow to the areas to supply muscles and tendons with nutrients during the workout. All this effectively decreases the chances of causing injury to a muscle or joint that creates force to perform any type of workout movement. A few examples of these movements include:

  • Body weight squats
  • Forward and backward lunges
  • Sidestepping in a slight squat position with a band around your knees
  • Jumping jacks
  • High Knees
  • Jogging Butt Kickers
  • Forward and side planks

The Cool Down

Following a workout, muscles have exerted force for an amount of time and have the tendency to get tight. The cool down is essential to restore muscles to their proper flexibility to prevent tightness, muscle imbalances and decrease the risk of overuse injuries. Stretching is also a great way to gradually decrease your heart rate after a workout and can help decrease the amount of soreness felt later that day/the next day following exercise. A stretch should be performed for any muscle or muscle groups that were used during that workout. Stretches should be held for 30 seconds and should NOT be to the point of pain.

The use of foam rollers for warming up and cooling down has gotten much more popular over recent years, and for good reason. Using a foam roller can be beneficial for both warming up and cooling down, as well as in between workouts. The pressure of the roller may be a bit uncomfortable at the time, but no sharp pain should be felt. Foam roll use helps to mobilize the tissue making movement easier afterward and will also help work out any soreness that is felt through the muscles.

The proper use of warming up and cooling down has a variety of benefits in combination with a safe and effective workout routine of any kind. Using these methods will help improve workout function, decrease risk of injury while working out and improve recovery from workout to workout. As always, consult your physician and/or physical therapist with any pain you may be experiencing with activity.

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Recovery Modalities for Training

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In the search to maximize training and improvement performance, many are now looking at what is done during recovery as a component of the entire training/performance routine. Many recovery modalities have been touted as the answer to post-exercise fatigue and reduced performance. There are three potential benefits that may be considered: immediate recovery (right after the activity), short-term (between sets) and recovery between training bouts. We will focus on training recovery, as this is the most common question from athletes and those participating in recreational competition. Some of the modalities that have been used include vibration, whole body immersion (usually cold water or contrast; cold then warm, alternating), compression garments, massage, electrical stimulation, heat or stretching or pharmacologic measures, such as nonsteroidal anti-inflammatories (NSAIDs).

In general, most of these modalities provide little, if any, benefit to recovery. Whole body cryotherapy (cooling) reduced strength loss at one hour post activity, with less pain than a passive recovery group, but by 24 hours there was no difference in strength or pain between recovery modes. Similarly, another study noted that athletes said their legs felt “lighter” at 24 hours when having used active recovery and cold immersion, but physical tests between groups showed no difference. Alternating cold and warm water immersion (contrast water therapy) showed the greatest decreases in soreness, but, as with the others, there were no differences in specific components, such as strength or range of motion.

Electrical stimulation (e-stim) is being marketed for pain reduction, and while advertisements may identify other benefits, the research suggests otherwise. E-stim does not seem to aid “restoration” of traits that are usually altered following intense activity, such as strength or fatigue. Cooling was shown to have a positive effect on aerobic activity. However, it has been noted that the results are variable and partially dependent upon the length of cooling and individual responses to the modality. While the prolonged use of NSAIDs is not recommended due to the potential for gastric issues, most of the recovery modalities do not have major negative effects when used appropriately.


Important components of recovery should include some relative rest, proper diet and rehydration. Diet and rehydration are especially necessary for longer activities and those in which the athlete is subject to high temperatures. In such cases, diet and hydration may help to restore energy resources to the muscle as well as restoration of electrolytes.


The evidence for physical benefits from recovery modalities is limited. However, many of the modalities appear to be useful for reduction of pain/muscle soreness. The noted reductions in pain/soreness may be temporary, but some have noted that this effect may allow an athlete to complete subsequent training, even if at a lower intensity. Furthermore, the psychological effect of any technique may be enough to promote improved performance or the ability to train at a desired level following previous intense bouts of training. Thus, the final decision regarding the use of a recovery modality will be based on your personal preference and the desired outcome. If pain/soreness reduction is important, then you may want to try a recovery modality. If the ability to do harder workouts in succession is the goal, a recovery modality will probably not help.

5 Ways to Maximize Triathlon Performance

5 ways to maximize triathlon performance

By Ryan Domeyer PT, DPT, CMPT for Athletico Physical Therapy

Participation in triathlons in the United States is at an all-time high according to USA Triathlon, the sport’s governing body in the United States. The group’s membership has swelled from around 100,000 in 1998 to 550,446 in 2013.1 What’s more, estimates from the Sports and Fitness Industry Associated show there were 2,498,000 road triathletes  in the United States in 2016.2

With the number of participants in triathlon races increasing, it is important to have a training plan in order to prevent injury and maximize performance on race day. There are numerous training plans and philosophies available to follow, but many are missing valuable components that can improve performance and decrease the risk of injury. Read below for five things to include in your training program in order to maximize triathlon performance.

1. Bicycle Fitting

Bicycles should be comfortable and fitted into a position that maximizes force output. There are multiple variables including saddle height, stem height and handlebar height that should be taken into consideration. Small changes in position on the bicycle can lead to large changes in muscle efficiency, which can help athletes maximize speed with less energy. For help with bike set up, athletes can seek out assistance from a local bicycle store or certified triathlon coach.

2. Running Form

Although most triathlon plans will include weekly running, few address proper form and how to run more efficiently to decrease force applied to the joints. Research shows that increasing cadence, or the number of steps taken, can decrease loading on the foot, knee and hip – which may lead to less overuse injuries.3  An easy way to track cadence is by using a metronome smartphone app. These apps can help to determine current steps per minute, and athletes can use this as a benchmark to start increasing their steps in 5 percent increments up to 170-190 steps per minute.

Another way to improve running form is by using Video Gait Analysis (VGA). This service can be used to analyze running under slow motion in order to identify areas of improvement that can help to prevent injuries and maximize performance. Physical therapists at Athletico Physical therapy are qualified to perform VGA and work with athletes to create plans for more efficient running through training and on race day.

3. Joint Mobility

Swimming, bicycling and running all utilize joints differently. Most training plans will outline the importance of stretching, but few people follow those recommendations. An easy way to prepare your joints for training is by utilizing a dynamic warm up to prepare the body for training. Learn more about the difference between stretching and a dynamic warm up by reading Athletico’s “Stretching Vs. Warming Up: What’s the Difference?

4. Strength Training

A  deficit in many triathlon training programs is the absence of strength training. Most programs include swimming, biking and running, but end up omitting ways to maintain or improve strength. The goal should not be to increase muscle size but rather to maintain strength to allow for maximum performance while training. Including bodyweight squats, lunges, planks and gluteal muscle strength is a great way to build a resilient body to prevent injuries while training.

5. Body Awareness

Triathlon training requires a large commitment in time and physical capacity. Being aware of when aches and pains are becoming injuries is vital to maximizing performance. Understanding of when to recover and when to push through aches is important to maximizing performance on race day. Physical therapists at Athletico are experts in musculoskeletal injuries and are available for complimentary injury screens to determine the best plan to prevent/treat injuries and maximize overall performance.

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