Review
Does pre-exercise static stretching inhibit maximal muscularperformance? A meta-analytical review
L. Simic1, N. Sarabon2, G. Markovic1
1Motor Control and Human Performance Laboratory, School of Kinesiology, University of Zagreb, Zagreb, Croatia, 2Institute forKinesiology Research, University of Primorska, Science and Research Center, Koper, SloveniaCorresponding author: Goran Markovic, Motor Control and Human Performance Laboratory, School of Kinesiology, University ofZagreb, Horvacanski zavoj 15, 10000 Zagreb, Croatia. Tel: +385 1 3658 606, Fax: +385 1 3634 146, E-mail: [email protected]
Accepted for publication 3 January 2012
We applied a meta-analytical approach to derive a robustestimate of the acute effects of pre-exercise static stretch-ing (SS) on strength, power, and explosive muscular per-formance. A computerized search of articles publishedbetween 1966 and December 2010 was performed usingPubMed, SCOPUS, and Web of Science databases. Atotal of 104 studies yielding 61 data points for strength, 12data points for power, and 57 data points for explosiveperformance met our inclusion criteria. The pooled esti-mate of the acute effects of SS on strength, power, andexplosive performance, expressed in standardized units aswell as in percentages, were -0.10 [95% confidence inter-
val (CI): -0.15 to -0.04], -0.04 (95% CI: -0.16 to 0.08),and -0.03 (95% CI: -0.07 to 0.01), or -5.4% (95% CI:-6.6% to -4.2%), -1.9% (95% CI: -4.0% to 0.2%), and-2.0% (95% CI: -2.8% to -1.3%). These effects were notrelated to subject’s age, gender, or fitness level; however,they were more pronounced in isometric vs dynamic tests,and were related to the total duration of stretch, withthe smallest negative acute effects being observed withstretch duration of �45 s. We conclude that the usage ofSS as the sole activity during warm-up routine shouldgenerally be avoided.
Static stretching (SS) is commonly performed prior toexercise (ACSM, 2000) and athletic events (Beaulieu,1981; Holcomb, 2000). It is generally believed that pre-exercise SS will promote better performances and reducethe risk of injury during exercise (Shellock & Prentice,1985; Smith, 1994). However, recent reviews have sug-gested that pre-exercise SS might reduce the incidenceof some (e.g., muscle strains) (McHugh & Cosgrave,2010), but not all injuries (Herbert & Gabriel, 2002;Thacker et al., 2004), and that it may actually reduceperformance (Shrier, 2004; Rubini et al., 2007; McHugh& Cosgrave, 2010; Behm & Chaouachi, 2011). Moreimportantly, stretch-induced reductions in performanceare particularly evident in maximal and explosive mus-cular efforts that play an essential role in a number ofindividual and team sports (Markovic & Mikulic, 2010;Cormie et al., 2011). These results have already made animpact on sports and exercise professionals who nowstart to recommend avoidance of SS during warm-up forsport and exercise (Pearson, 2001; Young & Behm,2002; Knudson, 2007).
Despite an increasing number of studies that demon-strated an acute reduction in muscular performance fol-lowing SS (for recent reviews, see Magnusson &Renstrom, 2006; Rubini et al., 2007; McHugh & Cos-grave, 2010; Behm & Chaouachi, 2011), it has to be
acknowledged that many studies reported no reductionin strength, power, or explosive muscular performancefollowing SS (Bazett-Jones et al., 2005; Burkett et al.,2005; Cramer et al., 2005, 2007b; Unick et al., 2005;Little & Williams, 2006; McMillian et al., 2006;O’Connor et al., 2006; Maisetti et al., 2007; Kinseret al., 2008; Torres et al., 2008; Wallmann et al., 2008;Di Cagno et al., 2010; Haag et al., 2010; Handrakiset al., 2010; Molacek et al., 2010; Murphy et al., 2010),while some of them even reported improvement in per-formance (O’Connor et al., 2006; Gonzalez-Rave et al.,2009; Haag et al., 2010). Moreover, we still do not knowa precise magnitude of stretch-induced acute changes inmuscular performance. Finally, the total duration ofmuscle stretching in most studies in this area was muchlonger than the ranges normally used in practice andrecommended in literature, i.e., 15–30 s per musclegroup (Rubini et al., 2007; Young, 2007). Given thewidespread use of SS in exercise and rehabilitation set-tings, it is of both scientific and practical relevance todetermine a precise estimate of acute effects of SS onmuscle function and exercise performance.
While two narrative reviews (McHugh & Cosgrave,2010; Behm & Chaouachi, 2011) and one systematicreview (Kay & Blazevich, 2011) have been recently pub-lished on this topic and reported average effects of acute
Scand J Med Sci Sports 2012: ••: ••–••doi: 10.1111/j.1600-0838.2012.01444.x
© 2012 John Wiley & Sons A/S
1
SS on various performance measures, none of thosestudies actually used an appropriate statistical tool forcombining and analyzing individual study findings in aquantitative manner. Thus, the precise magnitude ofstretch-induced acute changes in muscular performanceis still unknown. In the present study, we applied a meta-analytical approach to derive a robust estimate of theacute effects of SS on muscle strength, power, and explo-sive muscular performance. We also seek to understandwhether these effects (a) were specific with respect to thesubject characteristics (age, gender, and training status)and type of performance test, and (b) depend on the totalduration of SS per muscle group.
MethodsLiterature search and study selection
Searches of PubMed, SCOPUS, and Web of Science were per-formed for studies published in English up to and includingDecember 2010. We used the following search phase (static stretchOR static stretching OR acute stretch OR acute stretching ORpassive stretch OR warm-up) AND (strength OR force OR torqueOR jump OR sprint OR throw OR performance). Reference lists inreview and original research articles identified were also exam-ined. The present meta-analysis includes studies published in jour-nals that have presented original research data on healthy humansubjects. No age or gender restrictions were imposed at the searchstage. Abstracts and unpublished theses/dissertations wereexcluded from this analysis due to lack of methodological details.Inclusion criteria applied in this study were as follows: (a) crosso-ver, randomized, and non-randomized control trials; (b) studiesthat evaluated acute effects of SS on human muscular strength,power, and explosive muscular performance; (c) studies in whichSS lasted not longer than 30 min; and (d) English language studiespublished in peer-reviewed journals. Our search strategy retrieved1168 hits in PubMed, 285 hits in SCOPUS, and 216 hits in Web ofScience. Studies that examined the acute effects of SS on otherfitness qualities (e.g., muscular or cardiorespiratory endurance,flexibility, agility, balance, repeated-sprint ability, etc.; Zakaset al., 2003, 2006c, e; Knudson et al., 2004; Young et al., 2004;Nelson et al., 2005b; Beckett et al., 2009; Sim et al., 2009; Costaet al., 2009a; Amiri-Khorasani et al., 2010; Covert et al., 2010;Samogin Lopes et al., 2010; Wilson et al., 2010) were not includedin this meta-analytical review. Also, due to significant contralateraleffect of acute SS (Cramer et al., 2005), studies that used thecontralateral (unstretched) limb as a control were not considered inthis meta-analytical review. A total of 115 articles that studied theacute effects of SS (either active or passive) on maximal musclestrength [one repetition maximum (1 RM), isometric or isokineticforce or torque], muscle power, and explosive muscular perform-ance [rate of force or torque development (RFD), jumping, sprint-ing, and throwing performance] was identified. Note that weexcluded from this list several potentially relevant studies on thegrounds of having no control (i.e., prestretch) condition (Faigen-baum et al., 2005, 2006a, b; Thompsen et al., 2007; Taylor et al.,2009). Furthermore, some studies were excluded as they combinedSS with dynamic stretching (Fletcher & Anness, 2007; Sim et al.,2009; Taylor et al., 2009). Finally, some studies were excludedbecause SS lasted more than 30 min (Avela et al., 1999, 2004), orbecause they combined stretching and maximal voluntary contrac-tions (Kay & Blazevich, 2009a, 2010). Note also that numerousstudies met our inclusion criteria but failed to report all or some ofthe results in numerical format (Kokkonen et al., 1998; Fowleset al., 2000; Behm et al., 2001, 2004, 2006; Cornwell et al., 2001,2002; Nelson et al. 2001a, b; Siatras et al., 2003, 2008; Power
et al., 2004; Papadopoulos et al., 2005; Knudson & Noffal, 2005;Wallmann et al., 2005, 2008; Little & Williams, 2006; O’Connoret al., 2006; Behm & Kibele, 2007; Ogura et al., 2007; Bradleyet al., 2007; Maisetti et al., 2007; Herda et al., 2008, 2009, 2010;Holt & Lambourne, 2008; Samuel et al., 2008; Bacurau et al.,2009; Hough et al., 2009; Kay & Blazevich, 2009a; Pearce et al.,2009). In these cases, a personal contact was made with theauthors to retrieve appropriate information. However, severalauthors did not respond to our request; therefore, we manuallycalculated the results from the figures (in combination with datafrom articles). Only one study was partly excluded (i.e., for oneprimary outcome) for poor reporting of data (Winke et al., 2010).Thus, altogether, 104 studies met our inclusion criteria and wereincluded in this meta-analytical review.
Assessment of study quality
Methodological quality was assessed with the PEDro scale (Maheret al., 2003). The quality of the included studies was assessedindependently by two assessors, and disagreements were resolvedby a third independent assessor.
Coding and classifying variables
Each study that met our inclusion criteria was recorded on acoding sheet. The major categories coded included (a) study char-acteristics; (b) subject characteristics; (c) intervention characteris-tics; and (d) primary outcome characteristics. The studycharacteristics that were coded included author(s) name, journal,year of publication, and the number of subjects. Subject charac-teristics that were coded included age, gender, and fitness level.Gender was coded as a variable representing the proportion of menin the sample (e.g., 1 for all men; 0.5 for five women and five men;and 0 for all women). Fitness level was coded as “non-athletes”(physically inactive persons and recreationally trained individuals)and “athletes” (competitive level). Intervention characteristics thatwere coded included stretched muscles and total duration ofstretching per muscle group per limb. Note that in several cases,the total duration of SS per muscle group per limb was not explic-itly defined; in these cases, we calculated it from the available data(i.e., total duration of SS, number of sets, and/or exercises). Fur-thermore, in several cases, researchers applied different number ofstretching exercises per selected muscle groups. This resulted inlarge variation in mean duration of SS per muscle group. In thesecases, we reported mean duration of SS of primary musclegroup(s) (with respect to primary outcome), together with therespective range of duration of SS per muscle group per limb.Finally, primary outcome characteristics that were coded includedtype of exercise test applied for the assessment of maximal musclestrength (1RM, isometric peak force/torque, or isokinetic peaktorque), muscle power (mean or peak power), and explosive mus-cular performance (RFD, jumping, sprinting, or throwing perform-ance). Note that many of the included studies applied a one-grouprepeated-measure design (i.e., no stretch and SS condition).Although it is possible to perform a meta-analysis on studies thatapplied different study designs (i.e., independent groups vsmatched groups; Borenstein et al., 2009), we decided to treat eachstudy included in this meta-analysis as a one-group pre-/posttestintervention (Peterson et al., 2010). Therefore, coding of perform-ance change was only carried out for groups receiving the SStreatment. Specifically, for all studies, means and standard devia-tion (SD) for pre- and poststretching condition were extracted. Incases where the author(s) measured >1 poststretching condition(i.e., time course of changes in performance after static stretching;e.g., Fowles et al., 2000; Brandenburg et al., 2007), only the firstpoststretching condition was considered.
Simic et al.
2
Data extraction and data analyses
Given that each treatment group was considered a one-group pre-/posttest intervention, the study estimate for the acute effect of SSon muscle strength, muscle power, and explosive muscular per-formance is given by the difference between the post- and pre-stretching results in primary outcomes divided by a within-groupSD (SDwithin; Borenstein et al., 2009), i.e., the standardized meandifference d. The within-group SD (SDwithin) was obtained usingthe following formula:
SDS
rwithin
diff=× −( )2 1
where Sdiff is the standard deviation of the difference scores and ris the correlation between pairs of observation (i.e., the pretest–posttest correlation of performance measures). Note that many ofthe studies did not report Sdiff. Rather, the majority of studiesobtained for this analysis included the SDs for the pre- and post-stretching performance outcomes, or sometimes the standarderrors of the mean. For all other studies, Sdiff was calculated usingthe pre- and poststretching SDs, as well as pretest–posttest corre-lation of performance measures r using the following equation(Follmann et al., 1992; Peterson et al., 2010):
SD SD SD r SD SDdiff pre post pre post= + − × × ×[ ]2 2 2
For the purpose of this meta-analysis, pretest–posttest corre-lation of performance measures r was 0.9. Note that changing rto 0.8 or to 0.7 had a little effect on pooled estimates and wouldnot change the main conclusion of this meta-analytical review.The standard error (SEd) of d is given by (Borenstein et al.,2009):
SEn
d
nrd = +
×⎛⎝⎜
⎞⎠⎟
× × −( )1
22 1
2
where n is the number of pairs.We also expressed the study estimates relative to the pre-
stretching mean value, that is, in percentage values. Percentageeffects were converted to factors (= 1 + effect/100), log trans-formed for the analysis, and then back transformed to percent-ages (Bonetti & Hopkins, 2009). In this case, the standard error(SEd) of d was approximated by the following equation (Petersonet al., 2010):
SER CV CV r CV CV
nd =
× + − × × ×[ ]pre post pre post2 2 2
where R represents the ratio of post- and prestretch performancemeasures, CV denotes the coefficient of variation equaling theratio of SD and mean at the respective time (i.e., pre- and post-stretching), r is pretest–posttest correlation of performance meas-ures, and n represents the number of participants.
A random-effects model was chosen for meta-analysis toaccount for heterogeneity in effect d among trials. The weightfactor by which the study estimates were weighted was
12 2SEd + τ
where t is the between-study variation (Borenstein et al., 2009).Separate meta-analyses were performed for maximum musclestrength (peak isometric force or torque, 1RM, concentric oreccentric isokinetic peak torque), muscle power (mean and peakpower), and explosive muscular performance (RFD, jumping per-formance, sprinting performance, and throwing performance).Furthermore, within the maximal muscle strength and explosivemuscular performance category, separate meta-analyses were per-
formed for isometric vs dynamic maximal strength, and for rate offorce/torque development vs jumping performance (vertical jumpheight and horizontal jump distance) vs sprinting performance(sprint velocity or sprint time over distances between 5 and 100 m)vs throwing performance (throwing velocity or throwing distance).Note that a number of studies reported >1 primary outcome owingto >1 performance test measured. In cases where multiple out-comes belonged to the same performance category being meta-analyzed, we computed the composite effect and the respective SEaccording to Borenstein et al. (2009). For all pooled estimates, wecalculated the 95% confidence intervals (95% CI), and we madeprobabilistic magnitude-based inferences about the true values ofthe effects, as suggested by Hopkins and co-workers (Batterham &Hopkins, 2006; Bonetti & Hopkins, 2009; Hopkins et al., 2009).An effect was deemed unclear if its 95% CI overlapped the thresh-olds for smallest positive and negative effects; equivalently, theeffect was unclear if chances of the true value being substantiallypositive and negative were both >5% (Batterham & Hopkins,2006). The probabilities for each meta-analyzed effect werederived using a published spreadsheet (Hopkins, 2007). An esti-mate of the smallest substantial change in performance is requiredto make these inferences. Based on variability in competitive ath-letic performance reported by Hopkins and co-workers (Hopkins,2004, 2005; Bonetti & Hopkins, 2010; Smith & Hopkins, 2011),we defined the threshold change in performance for benefit andharm for field-based explosive performance tests (i.e., jumping,sprinting, and throwing performance) and muscle power as 1%.For strength performance [i.e., maximal muscle strength andRFD], the corresponding threshold change were derived from thewithin-individual variability in strength performance, expressed ascoefficient of variation. The within-individual variation in musclestrength and RFD varies considerably due to the well-knownfactors like type of test, type and velocity of contraction, musclegroup being tested, subject’s characteristics, etc. (Abernethy et al.,1995; Wilson & Murphy, 1996). However, it usually rangesbetween 3% and 15%. If we conservatively take 3% as a typicalwithin-individual variation in strength performance, we mayapproximate the smallest substantial change by multiplying thisvalue with the factor of 1.5 or 2 (Hopkins, 2000). We thereforedefined this threshold change as 5%.
Heterogeneity of effects for each meta-analysis was assessedusing the quantity I2, as suggested by Higgins and co-workers(Higgins et al., 2003). In brief, I2 was calculated as follows:I2 = 100% · (Q – d.f.)/Q, where Q is Cochran’s c2 heterogeneitystatistic and d.f. is the degrees of freedom. The Cochran’s Q iscalculated by summing the squared deviations of each trial’s esti-mate from the overall meta-analytical estimate. I2 describes thepercentage of variability in point estimates which is due to hetero-geneity rather than sampling error. I2 values of 25%, 50%, and75% represent low, moderate, and high statistical heterogeneity,respectively (Higgins et al., 2003).
Publication bias, as well as evidence of outliers, was examinedby funnel plots of standard errors of the estimate of the acute effectvs calculated study estimates d. In addition, publication bias wasalso statistically evaluated by calculating rank correlationsbetween effect estimates and their standard errors (i.e., Kendall’st statistic; Begg & Mazumdar, 1994). A significant result wasconsidered to be suggestive of publication bias.
Subgroup analyses for each primary outcome included sub-ject’s training status (athletes vs non-athletes), SS categoriesformed according to stretch duration per muscle (�45 s vs 46 s to90 s vs >90 s), and type of muscular performance test (isometric vsdynamic test for maximal muscle strength; RFD vs jumping per-formance vs sprinting performance vs throwing performance forexplosive muscular performance), and were performed using aQ-test based on analysis of variance (Borenstein et al., 2009). Incases where the total duration of stretching was different amongstretched muscle groups, the average stretch duration was used in
Acute static stretching and performance
3
further analyses. Similarly, for studies that reported acute effectsof SS of different durations on a particular primary outcome (e.g.,Zakas et al. 2006a; Zakas et al. 2006b; Zakas et al. 2006d; Oguraet al., 2007; Kay & Blazevich, 2008; Ryan et al. 2008b; Winches-ter et al., 2009), along with calculation of the composite effect (seeprevious text), we averaged the total duration of stretching permuscle group. Meta-regression was used for analyzing the rela-tionship between study estimates and the selected subject or train-ing characteristics: subject’s age, gender, and total duration ofstretching per muscle (Borenstein et al., 2009). The level of sig-nificance was set to P < 0.05.
ResultsDescriptive statistics
Altogether, 104 published investigations were includedin the meta-analyses, giving 61 study estimates formaximal muscle strength, 12 study estimates for musclepower, and 57 study estimates for explosive muscularperformance. Tables 1–3 summarize the characteristicsof the included studies. Altogether, 962 subjects (593males and 369 females) were included in the meta-analysis of maximal muscle strength, 195 subjects (125males and 70 females) were included in the meta-analysis of muscle power, and 1072 subjects (719 malesand 353 females) were included in the meta-analysis ofexplosive muscular performance. The average durationof pre-exercise SS per muscle group per limb formaximal muscle strength, muscle power, and explosivemuscular performance tests was 314, 255, and 86 s,respectively.
Methodological quality of included studies
The range of quality scores was 2–5 (median 4) out of10. Often a report did not clearly specify that a criterionwas met, and, consequently, we scored the study as notsatisfying the criterion. Note that all studies failed tosatisfy the following five methodological criteria: treat-ment allocation concealment, blinding of all subjects,blinding of all therapists, blinding of all assessors, andintention to treat analyses (i.e., items 3, 5, 6, 7, and 9,respectively).
Primary outcomes
Tables 1–3 report individual changes in the primary out-comes and summarize the pooled estimates of the acuteeffects of SS on maximal muscle strength, musclepower, and explosive muscular performance.
Maximal muscle strength
For the maximal muscle strength (i.e., peak force,torque, or 1RM), pooled estimate of the acute effect ofSS, expressed in standardized units, was d = -0.10(95% CI: -0.15 to -0.04). When expressed in percent-ages, the respective pooled estimate was -5.4% (95%CI: -6.6% to -4.2%), indicating a likely negative acute
effect. The statistical heterogeneity of the acute effectof SS on muscle strength was low (I2 = 5%). Theinspection of the funnel plot as well as Kendall’s t sta-tistic (r = -0.11; P = 0.20) suggests no presence of pub-lication bias in maximal muscle strength tests. Notably,one study could be defined as outlying (Behm et al.,2001); however, its exclusion from the meta-analysisdid not affect the pooled estimate. Subgroup analysesshowed similar acute effect of SS on maximal musclestrength in both athletes and non-athletes (P = 0.97).With respect to the type of test applied, significantlylarger (P = 0.012) pooled negative acute effect of SSwas observed for isometric vs dynamic strength tests(Fig. 1(a)), although the average stretch duration permuscle group did not differ significantly between thetwo groups of tests (333 s vs 290 s; P > 0.05). Specifi-cally, pooled estimates for the acute effect of SS onisometric and dynamic strength tests were -6.5% (95%CI: -8.3% to -4.6%; almost certainly negative effect)and -3.9% (95% CI: -4.8% to -2.9%; most likelytrivial effect), respectively. With respect to the stretchduration, we observed a trend (P = 0.18) toward dimin-ishing the negative acute effect of SS on maximalmuscle strength with shorter stretch duration (Fig. 2(a)).In particular, pooled estimates for the acute effect of SSlasting �45 s, 46–90 s, and >90 s per muscle group onmaximal muscle strength were -3.2% (95% CI: -5.6%to -0.8%; most likely trivial effect), -5.6% (95% CI:-7.3% to -3.8%; likely negative effect), and -6.1%(95% CI: -7.9% to -4.3%; almost certainly negativeeffect), respectively.
Muscle power
Pooled estimate of the acute effect of SS on musclepower was d = -0.04 (95% CI: -0.16 to 0.08). Whenexpressed in percentages, the respective pooled estimatewas -1.9% (95% CI: -4.0% to 0.2%), indicating anunclear acute effect of SS on muscle power. We alsoobserved very low heterogeneity of acute effects of SSon muscle power (I2 = 3.6%). Note also that both funnelplot and Kendall’s t statistic (r = -0.36; P = 0.09)showed no evidence of publication bias in muscle powertests. Subgroup analyses showed similar acute effect ofSS on muscle power in both athletes and non-athletes(P = 0.7). Although limited by the number of studies,subgroup analysis related to stretch duration showed atrend (P = 0.10) toward reduction of the negative acuteeffect of SS on muscle power with shorter stretch dura-tion (Fig. 2(b)). Specifically, pooled estimates for theacute effect of SS lasting �45, 46–90, and >90 s permuscle group on muscle power were 0.4% (95% CI:-5.8% to 6.6%; an unclear effect), -1.7% (95% CI:-5.1% to 1.6%; possibly negative effect), and -3.3%(95% CI: -7.2% to 0.6%; a likely negative effect),respectively.
Simic et al.
4
Tabl
e1.
Sum
mar
yof
the
inve
stig
atio
nsin
clud
edin
the
met
a-an
alys
esof
acut
eef
fect
sof
stat
icst
retc
hing
onm
axim
alm
uscl
est
reng
th
Stud
yAg
e(y
ears
)Fi
tnes
sle
vel
Sam
ple
size
M/F
Dura
tion
ofst
retc
h(s
)St
retc
hed
mus
cle
grou
psPe
rfor
man
cem
easu
reEf
fect
size
(SE)
95%
CI%
chan
ge(S
E)95
%CI
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2008
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1448
0KE
T(6
0/30
0°/s
)-0
.12
(0.2
0)-0
.51
to0.
27-3
.6(1
.0)
-5.5
to-1
.6Cr
amer
etal
.(20
06)*
23N-
A0/
1348
0KE
T(6
0/30
0°/s
)-0
.95
(0.9
4)-2
.79
to0.
89-2
.5(1
.5)
-5.4
to0.
3Cr
amer
etal
.(20
07b)
*23
.4N-
A8/
1048
0KE
T(-
60/-
180°
/s)
-0.0
3(0
.17)
-0.3
7to
0.31
-0.4
(2.5
)-5
.2to
4.4
Cram
eret
al.(
2007
b)*
21.5
N-A
7/14
480
KET
(60/
240°
/s)
-0.1
2(0
.20)
-0.5
1to
0.27
-3.5
(2.6
)-8
.5to
1.6
Egan
etal
.(20
06)*
20A
0/11
480
KET
(60/
300°
/s)
0.06
(0.2
4)-0
.42
to0.
541.
0(2
.7)
-4.4
to6.
3Ev
etov
ich
etal
.(20
10)
19.9
A0/
1548
0KE
T(6
0°/s
)-0
.24
(0.3
2)-0
.86
to0.
38-7
.1(2
.9)
-12.
8to
-1.4
Evet
ovic
het
al.(
2010
)21
A0/
1448
0KE
T(6
0°/s
)-0
.21
(0.2
6)-0
.73
to0.
31-5
.3(3
.6)
-12.
4to
1.9
Evet
ovic
het
al.(
2003
)*22
.7N-
A10
/836
0EF
T(3
0/27
0°/s
)-0
.14
(0.2
2)-0
.58
to0.
30-6
.2(4
.0)
-14.
1to
1.7
Flet
cher
and
Mon
te-C
olom
bo(2
010a
)20
.8A
21/0
30(3
0–60
)PF
,KE,
KF,H
E,HF
T(3
0°/s
)-0
.14
(0.1
7)-0
.48
to0.
20-3
.6(1
.8)
-7.2
to0.
0Fo
wle
set
al.(
2000
)21
N-A
8/4
1755
PFT
-1.2
7(1
.40)
-4.0
1to
1.47
-27.
7(3
.0)
-33.
5to
-21.
9Gu
rjao
etal
.(20
09)
64.6
N-A
0/23
90KE
,KF,
HET
-1.3
1(1
.99)
-5.2
1to
2.59
-7.6
(0.6
)-8
.7to
-6.6
Herd
aet
al.(
2010
)23
N-A
11/0
360
PFT
-0.6
0(0
.64)
-1.8
5to
0.65
-9.4
(2.1
)-1
3.5
to-5
.2He
rda
etal
.(20
09)
24N-
A15
/012
00PF
T-0
.52
(0.6
4)-1
.77
to0.
73-1
0.2
(2.1
)-1
4.4
to-6
.1He
rda
etal
.(20
08)*
25N-
A14
/012
15KF
T-0
.25
(0.3
0)-0
.84
to0.
34-6
.5(2
.4)
-11.
2to
-1.8
Kay
and
Blaz
evic
h(2
008)
*25
.5N-
A4/
330
(5–6
0)PF
T(1
80°/
s)-0
.31
(0.2
6)-0
.83
to0.
21-7
.0(3
.1)
-13.
0to
-1.0
Kay
and
Blaz
evic
h(2
009b
)20
.2N-
A8/
718
0PF
T(5
°/s)
--
-5.0
(1.2
)-7
.3to
-2.7
Knud
son
and
Noffa
l(20
05)*
N/A
N-A
33/2
410
WF
F-0
.31
(0.4
1)-1
.12
to0.
50-8
.5(1
.45)
-11.
3to
-5.6
Kokk
onen
etal
.(19
98)*
22N-
A15
/15
90PF
,KE,
KF,H
F1R
M-0
.25
(0.4
4)-1
.1to
0.60
-7.9
(2.4
)-1
2.5
to-3
.3Ku
boet
al.(
2001
)25
.3N-
A7/
060
0PF
T-0
.17
(0.2
2)-0
.61
to0.
27-1
.9(1
.9)
-5.6
to1.
9
Acute static stretching and performance
5
Tabl
e1.
(con
tinue
d)
Stud
yAg
e(y
ears
)Fi
tnes
sle
vel
Sam
ple
size
M/F
Dura
tion
ofst
retc
h(s
)St
retc
hed
mus
cle
grou
psPe
rfor
man
cem
easu
reEf
fect
size
(SE)
95%
CI%
chan
ge(S
E)95
%CI
Mai
setti
etal
.(20
07)
25N-
A0/
1175
PFT
-0.5
4(0
.58)
-1.6
8to
0.60
-8.5
(2.0
)-1
2.3
to-4
.6M
arek
etal
.(20
05)*
23N-
A9/
1048
0KE
T(6
0/30
0°/s
)-0
.02
(0.1
0)-0
.22
to0.
18-0
.9(4
.3)
-9.3
to7.
4M
cBrid
eet
al.(
2007
)*21
.4N-
A8/
027
0KE
F-0
.50
(0.4
7)-1
.42
to0.
42-1
1.9
(3.5
)-1
8.7
to-5
.0M
olac
eket
al.(
2010
)*19
.9A
15/0
95(4
0–15
0)UB
1RM
-0.0
5(0
.14)
-0.3
3to
0.23
-0.6
(1.2
)-3
.0to
1.8
Nels
onet
al.(
2005
c)*
22N-
A18
/13
360
PF,K
E,KF
,HF
1RM
-0.1
4(0
.24)
-0.6
2to
0.34
-4.4
(2.4
)-9
.0to
0.3
Nels
onet
al.(
2001
a)*
22N-
A25
/30
480
KET
-0.0
3(0
.10)
-0.2
3to
0.17
-1.3
(1.9
)-5
.0to
2.4
Nels
onet
al.(
2001
b)*
24N-
A10
/590
KET
-0.3
9(0
.50)
-1.3
7to
0.59
-9.2
(2.4
)-1
3.9
to-4
.5Og
ura
etal
.(20
07)*
20A
10/0
30KF
F-0
.43
(0.4
5)-1
.31
to0.
45-5
.4(1
.6)
-8.5
to-2
.3Pa
pado
poul
oset
al.(
2005
)20
.7N-
A32
/018
0(9
0–18
0)KE
,KF
T(3
0°/s
)-0
.31
(0.4
2)- 1
.14
to0.
52-4
.5(0
.9)
-6.2
to-2
.8Pa
pado
poul
oset
al.(
2006
)19
.7N-
A10
/090
PF,K
E,KF
,HF
F-0
.03
(0.1
4)-0
.31
to0.
25-0
.8(3
.8)
-8.3
to6.
7Po
wer
etal
.(20
04)
32N-
A12
/027
0PF
,KE,
KFF
-0.4
9(0
.55)
-1.5
6to
0.58
-9.0
(2.5
)-1
3.9
to-4
.0Ry
anet
al.(
2008
b)*
22N-
A7/
612
0PF
T-0
.30
(0.3
3)-0
.95
to0.
35-4
.7(3
.2)
-10.
9to
1.6
Seki
ret
al.(
2010
)*20
A0/
1080
KE,K
FT
(60/
180°
/s)
-0.4
2(0
.32)
-1.0
4to
0.20
-9.8
(2.2
)-1
4.2
to-5
.4Si
atra
set
al.(
2008
)*22
.1N-
A20
/010
KET
0.06
(0.1
7)-0
.28
to0.
401.
4(1
.9)
-2.4
to5.
2Si
atra
set
al.(
2008
)*21
N-A
20/0
20KE
T-0
.14
(0.1
7)-0
.48
to0.
20-2
.9(2
.2)
-7.1
to1.
4Si
atra
set
al.(
2008
)*21
.1N-
A20
/030
KET
-0.7
1(0
.59)
-1.8
7to
0.45
-6.6
(1.2
)-8
.9to
-4.3
Siat
ras
etal
.(20
08)*
21.1
N-A
20/0
60KE
T-0
.82
(0.6
7)-2
.13
to0.
49-1
2.5
(1.8
)-1
6.0
to-8
.9Th
igpe
n(1
989)
*27
.3N-
A12
/12
90KF
T(6
0/15
0/24
0°/s
)-0
.01
(0.1
0)-0
.21
to0.
19-0
.2(1
.42)
-3.0
to2.
6To
rres
etal
.(20
08)
19.6
A11
/030
UBF
0.21
(0.2
6)-0
.31
to0.
733.
2(2
.2)
-1.0
to7.
5Vi
ale
etal
.(20
07)
23.1
N-A
7/1
390
KET
-0.4
6(0
.45)
- 1.3
4to
0.42
-8.0
(2.6
)-1
3.2
to-2
.9W
eir
etal
.(20
05)
23.1
N-A
0/15
600
PFT
-0.4
2(0
.53)
-1.4
6to
0.62
-7.1
(1.9
)-1
0.8
to-3
.3W
inch
este
ret
al.(
2009
)*22
.5N-
A10
/810
5(3
0–18
0)KF
1RM
-0.2
5(0
.26)
-0.7
7to
0.27
-8.9
(2.6
)-1
3.9
to-3
.8Ya
mag
uchi
etal
.(20
06)*
23.8
N-A
12/0
720
KE,H
FT
-0.0
2(0
.20)
-0.4
1to
0.37
-0.7
(1.4
)-3
.4to
2.1
Zaka
set
al.(
2006
b)*
18.5
A14
/017
2(4
5–30
0)KE
T(6
0/90
/150
/210
/270
°/s)
-0.3
1(0
.24)
-0.7
9to
0.17
-4.3
(1.3
)-6
.8to
-1.9
Zaka
set
al.(
2006
a)*
13A
16/0
60KE
T(3
0/60
/120
/180
/300
°/s)
-0.2
9(0
.30)
-0.8
8to
0.30
-4.2
(1.1
)-6
.5to
-2.0
Zaka
set
al.(
2006
d)*
25A
15/0
270
(30–
480)
KET
(60/
90/1
50/2
10/2
70°/
s)-0
.25
(0.2
6)-0
.77
to0.
27-3
.5(1
.2)
-5.9
to-1
.2Ov
eral
lmea
n(a
ll)22
.9–
10/6
314
––
-0.1
0(0
.03)
-0.1
5to
-0.0
4-5
.4(0
.6)
-6.6
to-4
.2
*Stu
dyth
atre
porte
dm
ore
than
one
prim
ary
outc
ome.
A,at
hlet
es;N
-A,n
on-a
thle
tes;
PF,a
nkle
plan
tarfl
exor
s;KE
,kne
eex
tens
ors;
KF,k
nee
flexo
rs;H
E,hi
pex
tens
ors;
HF,h
ipfle
xors
;UB,
uppe
rbod
y;W
F,w
ristfl
exor
s;1
RM,o
nere
petit
ion
max
imum
;F,p
eak
forc
e;T,
peak
torq
ue;C
I,co
nfide
nce
inte
rval
;SE,
stan
dard
erro
r.
Simic et al.
6
Explosive muscular performance
For all explosive muscular performance tests, pooledestimate of the acute effect of SS was d = -0.03 (95%CI: -0.07 to 0.01). When expressed in percentages, therespective pooled estimate was -2.0% (95% CI: -2.8%to -1.3%), indicating a very likely negative acute effectof SS on explosive muscular performance. We alsoobserved very low heterogeneity of acute effects of SSon muscle power (I2 = 1.7%). Kendall’s t statistic(r = -0.03; P = 0.71) suggests no presence of publica-tion bias in this performance category. However, a closeinspection of the funnel plot recognized one study thathad unrealistically large negative acute effect of SS onexplosive performance (d = -1.1; percent change =-38.4%; McBride et al., 2007). Although its exclusiondid not change the overall acute effect of SS on explosivemuscular performance, it did affect two subgroup meta-analyses (i.e., groups based on the type of test and stretchduration, respectively). We therefore removed that studyfrom those analyses. Subgroup analyses showed similaracute effect of SS on explosive muscular performance inboth athletes and non-athletes (P = 0.81). With respect tothe type of test applied, significant differences (P < 0.05)Ta
ble
2.Su
mm
ary
ofth
ein
vest
igat
ions
incl
uded
inth
em
eta-
anal
yses
ofac
ute
effe
cts
ofst
atic
stre
tchi
ngon
mus
cle
pow
er
Stud
yAg
e(y
ears
)Fi
tnes
sle
vel
Sam
ple
size
M/F
Dura
tion
ofst
retc
h(s
)St
retc
hed
mus
cle
grou
psPe
rfor
man
cem
easu
reEf
fect
size
(SE)
95%
CI%
chan
ge(S
E)95
%CI
Mus
cle
pow
erCh
aoua
chie
tal.
(201
0)*
20.6
A22
/060
PF,K
E,KF
,HE,
HFM
P0.
17(0
.27)
-0.3
5to
0.70
1.6
(0.9
)-0
.1to
3.3
Corn
wel
leta
l.(2
001)
*20
.6N-
A10
/090
KE,H
EPP
-0.1
8(0
.22)
-0.6
1to
0.26
-2.9
(2.2
)-7
.1to
1.4
Cram
eret
al.(
2007
b)*
23.4
N-A
15/0
480
KEM
P-0
.03
(0.1
7)-0
.36
to0.
30-0
.4(2
.5)
-5.2
to4.
4Cr
amer
etal
.(20
05)*
21.5
N-A
7/14
480
KEM
P-0
.12
(0.3
0)-0
.71
to0.
46-2
.7(3
.0)
-8.7
to3.
2Eg
anet
al.(
2006
)*20
.0A
0/11
480
KEM
P-0
.04
(0.2
2)-0
.46
to0.
380.
2(5
.0)
-9.6
to10
.1M
anoe
leta
l.(2
008)
*24
.0N-
A0/
1290
KEM
P-0
.13
(0.1
9)-0
.49
to0.
24-2
.9(2
.8)
-8.5
to2.
7M
arek
etal
.(20
05)*
22.0
N-A
9/10
480
KEM
P-0
.04
(0.1
1)-0
.26
to0.
19-1
.5(4
.0)
-9.3
to6.
23O’
Conn
oret
al.(
2006
)21
.4N-
A16
/11
30(2
0–40
)PF
,KE,
KF,H
E,HF
MP
0.13
(0.2
3)-0
.32
to0.
576.
1(4
.5)
-2.7
to14
.8Sa
mue
leta
l.(2
008)
22.0
N-A
12/1
290
KE,K
FM
P-1
.89
(2.9
3)-7
.63
to3.
85-3
.4(0
.2)
-3.7
to-3
.1To
rres
etal
.(20
08)
19.6
A11
/030
UBPP
0.14
(0.2
0)-0
.25
to0.
532.
2(2
.2)
-2.1
to6.
5Ya
mag
uchi
and
Ishi
i(20
05)
22.8
N-A
11/0
30PF
,KE,
KF,H
E,HF
MP
-0.2
7(0
.31)
-0.8
9to
0.35
-5.1
(2.4
)-9
.8to
-0.5
Yam
aguc
hiet
al.(
2006
)*23
.8N-
A12
/072
0KE
,HF
PP-0
.44
(0.4
0)-1
.23
to0.
35-8
.2(1
.7)
-11.
6to
-4.8
Over
allm
ean
21.8
–10
/625
5–
–-0
.04
(0.0
6)-0
.16
to0.
08-1
.9(1
.1)
-4.0
to0.
2
*Stu
dyth
atre
porte
dm
ore
than
one
prim
ary
outc
ome.
A,at
hlet
es;N
-A,n
on-a
thle
tes;
PF,a
nkle
plan
tarfl
exor
s;KE
,kne
eex
tens
ors;
KF,k
nee
flexo
rs;H
E,hi
pex
tens
ors;
HF,h
ipfle
xors
;UB,
uppe
rbod
y.;M
P,m
ean
pow
er;P
P,pe
akpo
wer
;CI,
confi
denc
ein
terv
al;S
E,st
anda
rder
ror.
Fig. 1. Meta-analyzed acute effects of static stretching onmaximal muscle strength tests (a) and explosive muscular per-formance tests (b). ISOM, isometric muscle strength; DYN,dynamic muscle strength; RFD, rate of force or torque develop-ment; JUMP, jumping performance; SPRINT, sprinting per-formance; THROW, throwing performance.
Acute static stretching and performance
7
Tabl
e3.
Sum
mar
yof
the
inve
stig
atio
nsin
clud
edin
the
met
a-an
alys
esof
acut
eef
fect
sof
stat
icst
retc
hing
onex
plos
ive
mus
cula
rpe
rfor
man
ce
Stud
yAg
e(y
ears
)Fi
tnes
sle
vel
Sam
ple
size
M/F
Dura
tion
ofst
retc
h(s
)St
retc
hed
mus
cle
grou
psPe
rfor
man
cete
stEf
fect
size
(SE)
95%
CI%
chan
ge(S
E)95
%CI
Jum
pAl
lison
etal
.(20
08)
25.0
A10
/024
0(2
40–3
60)
PF,K
E,KF
,HF
CMJ
-0.5
0(0
.52)
-1.5
2to
0.52
-5.4
(1.5
)-8
.3to
-2.5
Behm
and
Kibe
le(2
007)
27.6
N-A
7/3
120
PF,K
E,KF
SJ,D
J,CM
J-0
.29
(0.2
4)-0
.76
to0.
19-4
.7(1
.7)
-8.0
to-1
.3Be
hmet
al.(
2006
)25
.0N-
A9/
990
PF,K
E,KF
DJ-0
.08
(0.1
5)-0
.36
to0.
21-2
.0(2
.7)
-7.3
to3.
3Be
hmet
al.(
2006
)21
.9N-
A12
/090
PF,K
E,KF
DJ,C
MJ
-0.0
2(0
.31)
-0.6
3to
0.60
1.1
(3.3
4)-5
.5to
7.8
Brad
ley
etal
.(20
07)
24.3
N-A
18/0
120
(120
–240
)PF
,KE,
KFCM
J,SJ
-0.1
2(0
.19)
-0.4
9to
0.26
-4.0
(3.3
)-1
0.6
to2.
6Br
ande
nbur
get
al.(
2007
)22
.3N-
A8/
890
PF,K
E,KF
CMJ
-0.1
5(0
.22)
-0.5
7to
0.28
-3.0
(2.2
)-7
.3to
1.4
Burk
ette
tal.
(200
5)20
.0A
29/0
60PF
,KE,
KF,H
E,HF
CMJ
0.08
(0.1
5)-0
.22
to0.
380.
7(0
.8)
-0.8
to2.
3Ch
aoua
chie
tal.
(201
0)*
20.6
A22
/060
PF,K
E,KF
,HE,
HFHJ
,CM
J0.
01(0
.11)
-0.2
0to
0.22
0.2
(0.7
)-1
.3to
1.6
Chur
chet
al.(
2001
)20
.3A
0/40
n-a
KE,K
F,HE
,HF
CMJ
-1.3
1(7
.73)
-16.
46to
13.8
3-1
.2(1
.1)
-3.5
to1.
0Co
rnw
elle
tal.
(200
1)*
20.6
N-A
10/0
90KE
,HE
CMJ,
SJ-0
.50
(0.5
1)-1
.49
to0.
49-4
.4(1
.2)
- 6.8
to-2
.0Co
rnw
elle
tal.
(200
2)*
22.5
N-A
10/0
180
PFCM
J,SJ
-0.1
5(0
.24)
-0.6
1to
0.31
-4.1
(4.0
)-1
1.9
to3.
8Cr
onin
etal
.(20
08)
22.7
A10
/090
KFCM
J0.
00(0
.14)
-0.2
8to
0.28
0.0
(3.9
)-7
.7to
7.7
Curr
yet
al.(
2009
)26
.0N-
A0/
2336
PF,K
E,KF
,HE,
HFCM
J-0
.18
(0.3
0)-0
.76
to0.
40-2
.9(1
.4)
-5.6
to-0
.1Da
lrym
ple
etal
.(20
10)
19.5
A0/
1245
PF,K
E,KF
,HE
CMJ
-0.2
0(0
.25)
-0.7
0to
0.30
-3.2
(2.1
)-7
.3to
0.8
DiCa
gno
etal
.(20
10)
14.1
A0/
3890
(90–
180)
PF,K
E,KF
SJ0.
00(0
.05)
-0.1
0to
0.10
0.0
(0.3
)-0
.5to
0.5
Flet
cher
and
Mon
te-C
olom
bo(2
010a
)20
.8A
21/0
30(3
0–60
)PF
,KE,
KF,H
E,HF
CMJ
-0.3
7(0
.52)
-1.3
9to
0.66
-4.3
(1.1
)-6
.4to
-2.2
Flet
cher
and
Mon
te-C
olom
bo(2
010b
)20
.5A
27/0
30(3
0–60
)PF
,KE,
KF,H
E,HF
CMJ
-0.3
8(0
.64)
-1.6
4to
0.87
-4.1
(0.9
)-5
.8to
-2.3
Gonz
alez
-Rav
eet
al.(
2009
)*21
.8N-
A8/
045
PF,K
E,KF
CMJ,
SJ0.
58(0
.41)
-0.2
2to
1.39
8.3
(1.7
)4.
9to
11.6
Hand
raki
set
al.(
2010
)*49
.9N-
A6/
490
PF,K
E,KF
,HE
HJ0.
00(0
.14)
-0.2
7to
0.26
-0.1
(1.9
)-3
.8to
3.6
Holt
and
Lam
bour
ne(2
008)
20.7
A64
/015
KE,K
F,HE,
HFCM
J0.
13(0
.20)
-0.2
6to
0.53
1.6
(1.4
)-1
.1to
4.3
Houg
het
al.(
2009
)21
.0A
11/0
30PF
,KE,
KF,H
E,HF
SJ-0
.25
(0.2
9)-0
.82
to0.
32-4
.3(2
.2)
-8.7
to0.
1Ki
nser
etal
.(20
08)*
11.3
A0/
840
HF,H
E,KF
CMJ,
SJ-0
.34
(0.3
4)-1
.00
to0.
32-6
.0(2
.4)
-10.
6to
-1.3
Knud
son
etal
.(20
01)
23.7
A10
/10
135
PF,K
E,KF
CMJ
- 0.3
0(0
.44)
-1.1
6to
0.56
-4.2
(1.4
)-7
.0to
-1.4
Koch
etal
.(20
03)
20.0
A16
/16
160
KE,K
FHJ
0.00
(0.0
8)-0
.15
to0.
150.
0(2
.1)
-4.1
to4.
1La
Torr
eet
al.(
2010
)*23
.0A
17/0
120
PF,K
ESJ
-0.2
2(0
.27)
-0.7
5to
0.31
-7.4
(2.3
)-1
2.0
to-2
.9Li
ttle
and
Will
iam
s(2
006)
n/a
A18
/030
PF,K
E,KF
,HE,
HFCM
J-0
.21
(0.3
0)-0
.80
to0.
38-2
.5(1
.2)
-4.9
to-0
.1M
cmill
ian
etal
.(20
06)
20.2
N-A
16/1
430
UB,P
F,KE
,KF,
HE,H
FHJ
0.26
(0.4
5)-0
.63
to1.
143.
2(1
.0)
1.2
to5.
1M
cNea
land
Sand
s(2
003)
13.3
A0/
1390
(60–
90)
PF,K
FDJ
-0.5
6(0
.69)
-1.9
2to
0.80
-9.6
(2.7
)4.
2to
15.0
Mur
phy
etal
.(20
10)
26.0
N-A
11/0
36PF
,KE,
HECM
J0.
37(0
.41)
-0.4
4to
1.18
4.2
(1.5
)1.
2to
7.1
Pear
ceet
al.(
2009
)22
.5N-
A11
/260
PF,K
E,KF
,HE,
HFCM
J-0
.37
(0.4
3)-1
.22
to0.
49-7
.8(2
.5)
-12.
7to
-2.9
Robb
ins
and
Sche
uerm
ann
(200
8)*
20.3
A10
/10
60(3
0–90
)PF
,KE,
KFSJ
-0.1
2(0
.16)
-0.4
4to
0.20
-2.1
(1.4
)-4
.7to
0.6
Sam
uele
tal.
(200
8)22
.0N-
A12
/12
90KE
,KF
CMJ
-0.0
7(0
.17)
-0.4
0to
0.26
--
Unic
ket
al.(
2005
)*19
.2A
0/16
90(4
5–90
)PF
,KE,
KFCM
J,DJ
0.13
(0.1
9)-0
.25
to0.
511.
9(1
.6)
-1.2
to4.
9Ve
tter
(200
7)22
.3N-
A14
/12
30PF
,KE,
KF,H
ECM
J-0
.10
(0.1
9)-0
.47
to0.
27-0
.8(0
.7)
-2.2
to0.
5W
allm
anet
al.(
2005
)26
.0N-
A8/
690
PFCM
J-0
.23
(0.2
9)-0
.80
to0.
35-5
.6(2
.9)
-11.
4to
0.1
Wal
lman
etal
.(20
08)
26.0
N-A
7/6
90PF
CMJ
0.09
(0.1
6)-0
.23
to0.
412.
9(3
.8)
-4.6
to10
.4Yo
ung
and
Behm
(200
3)*
26.0
N-A
13/4
120
PF,K
ESJ
,DJ
-0.2
1(0
.29)
-0.7
7to
0.35
-3.2
(1.8
)-6
.7to
0.3
Youn
gan
dEl
liott
(200
1)22
.0A
14/0
45PF
,KE,
HESJ
-0.1
9(0
.26)
-0.7
0to
0.31
-1.9
(1.2
)-4
.2to
0.4
Youn
get
al.(
2006
)*22
.8N-
A12
/860
PFDJ
-0.1
7(0
.21)
-0.5
8to
0.24
-3.5
(1.5
)-6
.5to
-0.5
Over
allj
ump
22.5
–12
/779
––
-0.0
3(0
.03)
-0.0
8to
0.02
-1.6
(1.5
)-2
.5to
-0.7
Simic et al.
8
Tabl
e3.
(con
tinue
d)
Stud
yAg
e(y
ears
)Fi
tnes
sle
vel
Sam
ple
size
M/F
Dura
tion
ofst
retc
h(s
)St
retc
hed
mus
cle
grou
psPe
rfor
man
cete
stEf
fect
size
(SE)
95%
CI%
chan
ge(S
E)95
%CI
RFD
Alpk
aya
and
Koce
ja(2
007)
25.1
N-A
14/1
90PF
RFD
0.12
(0.1
9)-0
.25
to0.
493.
9(3
.9)
-3.8
to11
.6Ba
zett-
Jone
set
al.(
2005
)20
.6A
10/0
90KE
,KF,
HFRF
D0.
04(0
.15)
-0.2
5to
0.32
0.9
(3.6
)-6
.2to
8.0
Gurja
oet
al.(
2009
)64
.6N-
A0/
2390
(90–
180)
KE,K
F,HE
RFD
-1.2
8(1
.94)
-5.0
8to
2.52
-14.
1(1
.1)
-16.
2to
-11.
9M
aise
ttiet
al.(
2007
)*25
.0N-
A0/
1175
PFRF
D0.
09(0
.13)
-0.1
6to
0.34
4.1
(5.0
)-5
.8to
14.0
McB
ride
etal
.(20
07)
21.4
N-A
8/0
99KE
RFD
-1.0
7(0
.97)
-2.9
7to
0.83
-38.
4(5
.5)
-49.
2to
-27.
5Pa
pado
poul
oset
al.(
2006
)19
.7N-
A10
/018
0(9
0–18
0)PF
,KE,
KF,H
FRF
D-0
.13
(0.1
9)-0
.51
to0.
25-3
.6(3
.7)
-10.
8to
3.6
Yam
aguc
hiet
al.(
2006
)*23
.8N-
A12
/072
0KE
,HF
RFD
-0.4
1(0
.37)
-1.1
3to
0.32
-16.
4(3
.2)
-22.
7to
-10.
1Yo
ung
and
Behm
(200
3)26
.0N-
A13
/412
0PF
,KE
RFD
-0.0
8(0
.15)
-0.3
7to
0.21
-2.7
(3.8
)-1
0.2
to4.
8Yo
ung
and
Ellio
tt(2
001)
22.0
A14
/045
PF,K
E,HE
RFD
-0.2
3(0
.30)
-0.8
3to
0.36
-6.1
(3.0
)-1
1.9
to-0
.3Yo
ung
etal
.(20
06)*
22.8
N-A
12/8
60PF
RFD
-0.0
9(0
.17)
-0.4
3to
0.25
- 2.3
(2.2
)-6
.6to
2.0
Over
allR
FD27
.1–
9/5
157
––
-0.0
2(0
.06)
-0.1
4to
0.10
-4.5
(2.7
)-9
.8to
0.9
Sprin
t§
Chao
uach
ieta
l.(2
010)
20.6
A22
/060
PF,K
E,KF
,HE,
HFSp
rint5
,10,
30m
-0.4
2(0
.53)
-1.4
5to
0.62
-2.4
(0.5
)-3
.3to
-1.4
Chao
uach
ieta
l.(2
008)
14.0
N-A
24/2
440
KE,K
FSp
rint1
0m
-0.1
2(0
.26)
-0.6
3to
0.39
-0.8
(0.4
)-1
.7to
0.1
Fave
roet
al.(
2009
)*22
.0A
10/0
90PF
,KE,
KF,H
E,HF
Sprin
t10,
40m
-0.1
0(0
.19)
-0.4
7to
0.27
-0.6
(0.8
)-2
.1to
0.9
Flet
cher
and
Jone
s(2
004)
23.0
A28
/020
PF,K
E,KF
,HE,
HFSp
rint2
0m
-0.2
4(0
.40)
-1.0
0to
0.52
-1.2
(0.4
5)-2
.1to
-0.3
Flet
cher
and
Jone
s(2
004)
23.0
A24
/020
PF,K
E,KF
,HE,
HFSp
rint2
0m
-0.2
6(0
.41)
-1.0
6to
0.54
-1.5
(0.5
5)-2
.6to
-0.4
Flet
cher
and
Mon
te-C
olom
bo(2
010a
)20
.8A
21/0
30PF
,KE,
KF,H
E,HF
ADD,
ABD
Sprin
t20
m0.
00(0
.09)
-0.1
7to
0.17
0.0
(0.8
)-1
.5to
1.5
Gele
n(2
010)
23.3
A26
/050
PF,K
E,KF
,HE,
HF,A
DDSp
rint3
0m
-1.1
8(1
.90)
-4.9
0to
2.54
-8.5
(0.6
)-9
.7to
7.3
Kist
ler
etal
.(20
10)
20.3
A18
/018
0PF
,KE,
KFSp
rint4
0m
-0.6
1(0
.68)
-1.9
4to
0.72
-1.4
(0.2
)-1
.8to
-1.0
Littl
ean
dW
illia
ms
(200
6)*
n/a
A18
/030
PF,K
E,KF
,HE,
HFSp
rint1
0,20
m0.
00(0
.10)
-0.2
0to
0.20
0.0
(0.5
)-0
.9to
0.9
Nels
onet
al.(
2005
a)*
20.0
A11
/512
0PF
,KF,
HESp
rint2
0m
0.00
(0.0
9)-0
.17
to0.
170.
0(0
.1)
-0.2
to0.
2Sa
yers
etal
.(20
08)
19.4
A0/
2090
PF,K
E,KF
Sprin
t30
m-0
.37
(0.5
3)-1
.42
to0.
67-2
.1(0
.6)
-3.2
to1.
0Si
atra
set
al.(
2003
)*9.
8A
11/0
30PF
,DF,
KE,K
FSp
rint5
–15
m0.
18(0
.18)
-0.1
8to
0.54
3.2
(1.9
)-0
.5to
6.9
Vette
r(2
007)
22.3
N-A
14/1
230
PF,K
E,KF
,HE
Sprin
t30
m-0
.14
(0.2
5)-0
.63
to0.
34-2
.0(1
.3)
-4.5
to0.
5W
inch
este
ret
al.(
2008
)*20
.3A
11/1
190
PF,K
E,KF
,HE
Sprin
t20–
40m
-0.0
8(0
.16)
-0.4
0to
0.24
-0.6
(1.3
)-3
.2to
2.0
Over
alls
prin
t§19
.9–
16/6
63–
–-0
.04
(0.0
4)-0
.13
to0.
05-1
.6(0
.5)
-2.6
to-0
.5Th
row
ing
Haag
etal
.(20
10)
20.3
A12
/030
UBTh
row
ing
0.47
(0.5
3)-0
.57
to1.
521.
7(0
.5)
0.8
to2.
6M
cmill
ian
etal
.(20
06)
20.2
N-A
16/1
430
UB,P
F,KE
,KF,
HE,H
FTh
row
ing
-0.0
7(0
.14)
-0.3
5to
0.21
-2.1
(2.5
)-6
.9to
2.7
Torr
eset
al.(
2008
)*19
.6A
11/0
30UB
Thro
win
g-0
.13
(0.2
6)-0
.63
to0.
37-1
.2(1
.7)
-4.5
to2.
2Ov
eral
lthr
ow20
.0–
13/5
30–
–-0
.05
(0.1
2)-0
.29
to0.
190.
2(1
.3)
-2.3
to2.
7Ov
eral
lmea
n(a
llte
sts)
22.8
–12
/686
––
-0.0
3(0
.02)
-0.0
8to
0.01
-2.0
(0.4
)-2
.8to
-1.3
*Stu
dyth
atre
porte
dm
ore
than
one
prim
ary
outc
ome.
§ Sprin
ttim
e,an
inve
rsel
ysc
aled
varia
ble,
has
been
resc
aled
befo
rem
eta-
anal
ysis
.A,
athl
etes
;N-A
,non
-ath
lete
s;AD
D,hi
pad
duct
ors;
ABD,
hip
abdu
ctor
s;PF
,ank
lepl
anta
rflex
ors;
DF,a
nkle
dors
iflex
ors;
KE,k
nee
exte
nsor
s;KF
,kne
efle
xors
;HE,
hip
exte
nsor
s;HF
,hip
flexo
rs;U
B,up
perb
ody;
CMJ,
coun
term
ovem
entj
ump;
DJ,d
epth
jum
p;HJ
,hor
izont
alju
mp;
SJ,s
quat
jum
p;RF
D,ra
teof
forc
eor
torq
uede
velo
pmen
t;CI
,con
fiden
cein
terv
al;S
E,st
anda
rder
ror.
Acute static stretching and performance
9
in pooled negative acute effects of SS were observedamong four different explosive performance categories(Fig. 1(b)). Specifically, pooled estimates for the acuteeffect of SS on RFD, jump, sprint, and throw perform-ance were -4.5% (95% CI: -9.8% to 0.8%; possiblynegative effect), -1.6% (95% CI: -2.5% to -0.7%; alikely harmful effect), -1.6% (95% CI: -2.6% to -0.5%;a likely harmful effect), and 0.2% (95% CI: -2.3% to2.7%; an unclear effect), respectively. Note that theobserved magnitudes of stretch-induced changes, par-ticularly explosive muscular performance tests, are inagreement with the corresponding average stretch dura-tion per muscle group (i.e., 157, 79, 63, and 30 s forRFD, jump, sprint, and throw performance; see Table 3).With respect to the stretch duration, we observed a sig-
nificant (P = 0.0001) reduction in the negative acuteeffect of SS on explosive muscular performance withshorter stretch duration (Fig. 2(c)). In particular, pooledestimates for the acute effect of SS lasting �45, 46–90,and >90 s per muscle group on explosive performancewere -0.8% (95% CI: -2.0% to 0.5%; possibly negativeeffect), -2.5% (95% CI: -3.8% to -1.1%; almost cer-tainly negative effect), and -4.5% (95% CI: -7.3% to-1.7%; almost certainly negative effect), respectively.
Meta-regressions
Significant negative relationships (all P < 0.001) werefound between the total stretch duration per musclegroup and individual study estimates in all three catego-ries of muscular performance tests (Fig. 3). As men-tioned already, subject’s age and gender were notsignificantly related to study estimates in selectedprimary outcomes (all P > 0.05).
Discussion
This meta-analytical review provides clear evidencefrom 104 studies that (a) pre-exercise SS induces signifi-cant and practically relevant negative acute effects onmaximal muscle strength and explosive muscular per-formance, regardless of subject’s age, gender, or trainingstatus, while the corresponding acute effects of SS onmuscle power are still unclear; (b) the acute effects of SSon maximal muscular performance are task-specific,with type of muscle contraction (isometric vs dynamic)being an important factor; and (c) negative acute effectsof acute SS on maximal muscular performance tend todiminish with reduction of stretch duration. Prior to dis-cussing these main findings, some methodological issuesdeserve to be discussed.
While a meta-analysis will yield a mathematicallyaccurate synthesis of the studies included in the analysis,if these studies are a biased sample of all relevantstudies, the mean effect computed by the meta-analysiswill reflect this bias (Borenstein et al., 2009). In thepresent study, we found no evidence of publication biasin selected primary outcomes. Furthermore, there was alow heterogeneity of effect within each meta-analysis,suggesting that all trails generally examined the sameeffects. These issues generally support the robustness ofour results; however, we have to acknowledge that weselected only studies published in peer-reviewed jour-nals; thus, there is likelihood that some smaller studieswithout significant effects remained unpublished. Also,our meta-analytical review may have been biased byinclusion only of studies reported in English. In thatregard, some caution is still warranted regarding theprecise estimates of the acute effects of SS on selectedmuscular performance tests.
The major finding of this meta-analytical review isrelated to a precise quantitative estimate of the acute
Fig. 2. Meta-analyzed acute effects of different duration ofstatic stretching on maximal muscle strength (a), muscle power(b), and explosive muscular performance (c).
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effects of SS on maximal muscular performance.Overall, our results indicate that an acute bout of SSdecreases maximal muscle strength, muscle power, andexplosive muscular performance by -5.4% (95% CI:-6.6% to -4.2%), -1.9% (95% CI: -4.0% to 0.2%), and-2.0% (95% CI: -2.8% to -1.3%), respectively. Basedon the corresponding 95% CI, and selected thresholdsfor minimal practically relevant change in athlete’s mus-cular performance (i.e., 5%, 1%, and 1%, respectively),we can conclude that these acute effects of SS werestatistically significant and practically relevant formaximal muscle strength (a likely negative acute effect)and explosive muscular performance (a very likely nega-tive acute effect), but not for muscle power (an uncleareffect). More studies are needed to clarify the acute
effects of SS on muscle power. More importantly, thisstudy shows that the observed stretch-induced reductionsin maximum muscular performance are generally inde-pendent of subject’s age, gender, and training status,suggesting that they could be generalized to young andadult athletic, but also non-athletic population of bothsexes. Obviously, factors other than age, sex, and train-ing status (e.g., stretch duration and intensity, task spe-cificity, etc.; see further paragraphs) are responsible forrelatively high variability in research results on this topic(see the first paragraph). Without considering thesefactors, the above-discussed results of meta-analysesstrongly suggest that the usage of SS as the sole activityduring warm-up routine should generally be avoided.Given that even a small reduction in maximum muscular
Fig. 3. Relationship between static stretch-induced change in performance (%) and the total duration of stretching in (a) maximalmuscle strength tests, (b) muscle power tests, and (c) explosive muscular performance tests.
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performance could be detrimental for competitive per-formance of high-level athletes in certain sports, thisconclusion particularly goes for the athletic population.Previous narrative and/or systematic reviews on thistopic also came to the same conclusion (Shrier, 2004;Magnusson & Renstrom, 2006; Rubini et al., 2007;McHugh & Cosgrave, 2010; Behm & Chaouachi, 2011;Kay & Blazevich, 2011), but without robust quantitativeevidence, obtained using an appropriate statisticalapproach.
An important factor to consider when studying theacute effects of SS on maximal muscular performance isthe type of performance test applied. In that regard, ourresults provide some new interesting findings related tothe type of contraction. First, we have demonstrated thatisometric maximal strength is significantly more nega-tively affected by an acute bout of SS compared withdynamic (concentric and eccentric) maximal strength.More interestingly, although not presented in the Resultssection, no evidence of contraction specificity in theacute effects of SS was found between the concentric vseccentric maximal strength tests. As there were no sig-nificant differences in average stretch duration permuscle group between isometric and dynamic maximalstrength tests, other factors are likely responsible for theobserved contraction-specific acute effects of SS onmaximal strength. We believe that the main candidatecould be stretch-induced transient reduction in stiffnessof the muscle-tendon complex (Weir et al., 2005; Ryanet al. 2008a). Specifically, a more compliant muscle-tendon complex would allow a less efficient transmissionof force to the skeleton (Markovic & Mikulic, 2010), andthis effect is likely to be more evident during isometriccompared with dynamic maximal contractions. Consist-ent with this notion is the fact that significantly highernegative acute effects of SS were observed in RFD (iso-metric contraction) than in jump, sprint, or throw per-formance (dynamic, high-velocity contractions). Indeed,reduced RFD and prolonged electromechanical delayhave been frequently associated with a reduction of mus-culotendinous stiffness (Costa et al., 2010; Herda et al.,2010). However, the above-mentioned difference couldalso be a result of noticeably higher mean stretch dura-tion per muscle group in RFD tests compared with theremaining explosive muscular performance tests. Thus,more studies are needed to clarify this issue. In theirrecent review article, Behm and Chaouachi (2011)argued that the negative acute effects of SS could belower in slow vs fast stretch-shortening cycle tasks. Wefound no evidence to support this viewpoint (seeTable 3), although detailed quantitative analysis in thisrespect has not been performed. Finally, pooled estimateof the acute effects of SS on throwing performance,although seriously limited by the total number of meta-analyzed studies, suggest that these effects could be lessharmful when compared with the corresponding acuteeffects on jumping and sprinting performance. Although
more studies are definitely needed in this area, we mayspeculate that the high-velocity movements that requirelarge operating ranges of motion (such as throwing) aremuch less adversely affected by an acute bout of SS.Theoretically speaking, for such movements, possiblenegative acute effects of SS on force-generating capacityof agonist muscle(s) could be counteracted by stretch-induced increase in active range of motion, therebyallowing muscles to perform similar amount of workduring propulsion in both cases (i.e., pre- and post-stretching). Alternatively, one could simply argue thatthrowing represents a complex ballistic movement thatrequires sequential action of numerous lower-body,trunk and upper-body muscles, and that the acute SS ofa particular upper-body muscle group has much lessimpact on performance. In that regard, it is interesting tonote that the most prominent negative acute effects of SSon throwing performance among selected studies is seenin a study that applied SS of both upper- and lower-bodymuscles (see Table 3). These conjectures require furtherexperimental verification.
Another important factor to consider when studyingthe acute effects of SS on maximal muscular perform-ance is the total stretch duration per muscle group. Intwo most recent review papers, the authors argued thatshorter-duration (<45 s per muscle group) pre-exerciseSS might not be detrimental to performance (Behm &Chaouachi, 2011; Kay & Blazevich, 2011). However,without the use of an appropriate statistical tool forpooling the data from available SS studies, suchconclusions lack firm scientific support. Results of ourmeta-analytical review indicate the existence of a dose–response relationship between stretch-induced perform-ance decrements and average stretch duration per musclegroup (see Figs 2 and 3), in line with the conclusions ofseveral research studies (Ogura et al., 2007; Kay &Blazevich, 2008; Ryan et al. 2008b) and reviews (Behm& Chaouachi, 2011; Kay & Blazevich, 2011). In particu-lar, stretch-induced negative acute effects on perform-ance diminished with the reduction of stretch duration inall three groups of muscular performance tests; however,they still remained negative for two muscular perform-ance categories. Thus, even short-duration pre-exerciseSS (i.e., <45 s per muscle group) could possibly beharmful to muscular performance. So, we now come toan important question for clinicians and practitioners:Should we completely exclude SS from warm-up routinesthat precede exercise or athletic events? An answer tothis question requires more than just acknowledging theresults of the performed meta-analyses. Namely, wehave to acknowledge that SS also has certain positiveacute effects during warm-up – increased range ofmotion (McHugh & Cosgrave, 2010; Behm & Cha-ouachi, 2011) and reduced incidence of muscle strains(McHugh & Cosgrave, 2010). Indeed, based on a com-prehensive literature review, McHugh and Cosgrave(McHugh & Cosgrave 2010) have recently concluded
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that pre-exercise SS is beneficial for reducing musclestrains. Thus, while the usage of SS (regardless of itsduration) as the sole activity during warm-up shouldgenerally be avoided, its incorporation into a compre-hensive warm-up could be a possible practical solutionthat would minimize the negative acute effects of SS onperformance, while still keeping its potentially positiveeffects. Related to that, Chaouachi et al. (2008) haverecently showed that the addition of short-duration (i.e.,20 s) SS of quadriceps and hamstring muscles into awarm-up routine for sprint training increased the rangeof motion and diminished the detrimental acute effectsof SS on sprint performance compared with a sprint-onlytraining program. Clearly, there is a need for additionalwell-designed studies that examine the acute effects ofshort-duration SS, incorporated into a comprehensivepre-exercise warm-up routine, on maximal muscularperformance.
This study has certain limitations. First, the PEDroscores of the studies included in the meta-analysessuggest that most studies are prone to subject and/orresearcher bias. Given that the ultimate quality of a meta-analysis depends of the quality of the primary studies onwhich it is based, our results need to be appreciated withan awareness of the limitations of the primary studies.However, we should take into account that blinding ofparticipants and therapists is impossible in exerciseinterventions. If these two items were deleted from thePEDro scale, the quality ratings of all the includedstudies would have changed substantially. Nonetheless,we recommend that future stretching studies improvetheir quality by randomizing subjects into groups, blind-ing the assessors, as well as by ensuring that treatmentallocation concealment and intention to treat analysesare performed. Second, our study did not address theeffects of several relevant factors related to acute SS,including the SS intensity, the time from cessation of thewarm-up to the performance test, the particular stretch-
ing exercises, and the time course of any stretch-inducedeffects (Young, 2007). These factors need to beaddressed in future well-designed SS studies.
Conclusions and recommendations
Our results clearly show that SS before exercise hassignificant and practically relevant negative acute effectson maximal muscle strength and explosive muscular per-formance, while the corresponding acute effects onmuscle power remain unclear. These findings are univer-sal, regardless of the subject’s age, gender, or trainingstatus. However, the magnitude of the static stretch-induced negative acute changes in performance wasmore pronounced in maximal isometric tests comparedwith maximal dynamic tests. Finally, the observedstretch-induced negative acute changes in selected mus-cular performance tests were related to the total durationof stretch, with the smallest negative acute effects beingobserved with stretch duration of �45 s, respectively.Based on the evidence from this study, we recommendthat the usage of SS as the sole activity during warm-uproutine should generally be avoided. Given the potentialpositive effect of pre-exercise SS on the reduction ofincidence of muscle strains, further studies shouldexamine the acute effects of SS of shorter duration (e.g.,15–30 s per muscle group), incorporated into a compre-hensive pre-exercise warm-up routine, on maximal mus-cular performance.
Key words: warm-up, stretch, performance, acuteeffects.
Acknowledgements
Goran Markovic was supported by the Croatian’s Ministry ofScience, Education and Sport Grant (no. 034-0342607-2623).
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