physio cottingham

Does stretching actually prevent injury?

Our worst nightmare as a runner or athlete is getting injured. We often try all kinds of methods to prevent this…

What do we think actually causes injury?  

Do the traditional things we do to prevent injuries like stretching actually help?

A study carried out by Saragiotto et al, 2014 (SOURCE) found runners to believe that not stretching both before and after their run would leave them more likely to get injured. This is something that is  commonly discussed in the Consortium clinic with our clients. We therefore felt this to be an important topic for us to provide an evidence based opinion on to help our clients separate fact from fiction.

Can static stretching reduce my chances of getting injured?

Static stretching (holding a position to stretch a muscle for a sustained period of time) historically has been a routine of many runners/athletes prior to beginning their activities to prevent against injury. However.... more recent evidence has suggested it’s maybe not as worth your while as you first thought! Lauersen (2013) (SOURCE) found static stretching did not have any protective effects with no support found for stretching and preventing injury when carried out either before or after activity. In fact.... it has also been suggested it can instead have a negative impact on the level of your performance! Did you know static stretches held for 45 seconds or longer, prior to activity can reduce maximal strength, power and muscular explosive performance, such as when jumping and sprinting? (Simic, 2012) (SOURCE)

OK...... So 45 seconds is a long time to hold a static stretch…

So what if I stretch for a shorter time? 

Static stretching for shorter periods has been less associated with the previously mentioned negative effects but still has no benefit towards injury prevention, this may lead you to ask whether it is worth your time doing both before and after exercise? 

Should I continue to stretch? Or is there a better alternative?

One thing we do know is that gradual muscle strengthening has demonstrated the ability to reduce sporting injuries by 1/3 and over-use injuries by a 1/2 (Lauersen, 2013) (SOURCE). More recently, specific eccentric muscle strengthening (working the muscle as it lengthens) has also been shown to both improve and gain long standing muscle length through a process of ‘sarcomeregenesis’ (increasing amount of contractile units in the muscle) (O’Sullivan, 2012) (SOURCE)

So what does this actually mean? In essence, if we included and carried out a specific graded eccentric muscle strengthening routine as part of our weekly training schedule we can ‘kill two birds with one stone’. By not only improving strength, which is proven to reduce the likelihood of injuries, but also by improving your flexibility at the same time if this is one of your aims. An example of this has been demonstrated with studies around the hamstring muscles suggesting an increase in muscle fascicle length by 1/2cm by using eccentric strengthening can reduce the chances of injury by up to 70% (Askling, 2014) (SOURCE)

But I feel better after stretching… so Should I stop doing this or carry on? 

Often clients have carried out static stretches as part of their routines and ’rituals’ before races/competition/games for many years and it makes them feel good and ‘ready to go’… So if you feel happier continuing to do this it is perfectly O.K, although as we have discussed there is no evidence towards preventing injury and holding them less than 45 seconds should have no negative effects on your performance.

An alternative that you also may be aware of is dynamic stretching (using controlled movement and momentum of the body part e.g. whilst standing raising your knee towards your stomach then back to it's starting position repeatedly in a controlled manner to move the muscle from one end of its range to the other). Although this again has little evidence towards injury prevention. Instead, it may be more suited and is recommended to be included in a warm up to gradually prepare your body for the activity in hand (Behm, 2011) (SOURCE)

However, it is also worth mentioning that if your sport requires your joints to achieve sustained extremes of movement such as in Ballet or Kick boxing then static stretching is recommended to be carried out before in short duration to prevent impairment (Behm, 2011) (SOURCE).  

Summary…

To summarise, static stretching before activity is something we have done for many years with the feeling it would ‘stop us pulling a muscle’, but surprisingly the evidence towards this is in fact pretty poor. A better alternative to prevent injury is suggested to be a gradual eccentric strengthening routine included in your weekly training plan. But as mentioned above this is not to say you can’t ever carry out static stretches again… As even though this is maybe not doing what we thought it was to prevent injury, it is not going to do you much harm either.

Hope you’ve enjoyed reading our latest ‘blog’… If you have any questions or would like any further information such as, how to implement a specific eccentric strengthening routine please don’t hesitate to contact us via our Facebook page, Website or telephone and one of our team will be more than happy to help. Also if there are any specific topics you’d be keen for us to cover in our next installments of our blog please let us know.

Kind regards,  

The Consortium Team

Consortium Steroid Injection Patient Information

If you are due to have a steroid injection at the Consortium clinic then following information will be useful reading for you

It is important that you are aware of the benefits and risks associated with having a steroid injection. Hopefully reading this will pre empt and answer the majority of your questions. You will be provided with your own printed copy to read in the clinic and take home. Should you have any questions that we don't cover here, then feel free to contact us and enquire. Clare manages the clinic and can be contacted on our enquiries line 01482 847705 seven days a week between 09.00 and 19.00.

What is a corticosteroid?

Steroid is anti-inflammatory medicine that can relieve swelling, stiffness and pain.

Why have an injection?

Quite simply, a injection will help reduce your pain and settle inflammation. In some rare cares, taking away your pain may be enough to allow you to return to your normal activities and naturally recondition your body and potentially solve your issue without any further input being needed. Unfortunately this is a rare occurrence, the majority of injections aim to provide a window of opportunity where we can rehabilitate patients without their pain preventing them from progressing. This often allows you to get better quicker.

Why have an injection? Why can i not take anti-inflammatory pills instead?

Oral anti-inflammatories will spread around your body systemically, therefore a smaller dose of the medication will reach the area of your pathology. The advantage of an injection is that the majority of the medication will be placed directly where it is needed. This makes for a far more efficient process.

Reasons not to inject

We would not consider injecting you if you are unwell on that particular day, have an active or suspected infection, under 18 yrs old, pregnant or have known allergies to steroid or local anaesthetic.

What are the possible side effects?

  • Flushing of the face for a few hours
  • Small area of fat loss or a change in colour of the skin around the injection site
  • Slight vaginal bleeding
  • Diabetic patients may notice a temporary increase in blood sugar levels
  • If you are taking blood thinning drugs there may be some temporary bruising
  • Infection from injection is extremely rare, however if the area becomes hot, swollen and painful for more than 24 hours you should contact your physiotherapist or doctor immediately.
  • Post injection pain is uncommon but it is possible that your symptoms may briefly worsen for a few hours after the injection. This does not affect the injection from working as normal
  • An allergic reaction to either local anaesthetic or steroid is an extremely rare side effect. You will be asked to wait 30 minutes after the injection to ensure there is no allergic reaction to the drug. Should a reaction occur, your physiotherapist is trained to manage this.

You will be asked to wait for 30 minutes after the injection to ensure no allergic reaction to the drug occurs.

How is the injection given?

The skin is first cleaned thoroughly with an antiseptic wipe. The injecting physiotherapist or orthopaedic consultant will insert a fine needle where there is access to the injured tissues. In certain injections the solution will be injected all in one go, in other types of injection the solution will be spread around the problem area in a technique we call peppering. The type of injection you will have will depend on your condition. This will be explained to you beforehand. After the procedure a small dressing is then placed on the skin over the site of the injection.

Is the injection painful?

Any procedure using needles will have some associated discomfort, however your physiotherapist/orthopaedic consultant has had intensive training in the techniques used to maximise comfort throughout.

How fast does the injection work?

The steroid usually starts to work within 24 - 48 hours but the steroid can continue to be absorbed into the tissues for 3-4 weeks.

What should I do after the injection?

It is advisable to avoid any strenuous or repetitive activity using the part of your body where you received the injection for 1-2 weeks. You can continue the majority of your daily activities during this period. If you have any doubts then do not worry as this will be discussed in detail with you prior to the injection being given.

When will I be seen again?

Following the injection it is likely that you will be advised to continue with physiotherapy. Once the injection has reduced the discomfort, the physiotherapist can address the underlying causes of the problem to provide a longer term solution.

How long does the injection work for?

This varies from person to person and for the condition that is being treated.

If an injection has been offered to you, you will be given both verbal and written information and will have plenty of time to ask questions. You will also be asked to sign a consent form to show you have received enough information and that you have understood it. The information you receive should explain your condition, the benefits and risks of injection, and the alternative options available to you.

If after your injection you have any concerns please contact our administrator Clare who will immediately pass a message onto one of the Physiotherapists/Consultants to contact you back, our enquiries line is open between 09.00 and 19.00 on 01482 847705. Outside of these hours you should seek advice from your GP or attend Accident and Emergency if needed.