Done With The Run – Do I stretch? How Much? How Hard?
Wasn’t this past weekend awesome? My family and I headed to one of the local greenways to soak in the warm sunshine. Since we go at toddler speed, we watch many weekend warriors go speeding by, enjoying their weekend runs. When we got back to the parking lot, we stopped for our traditional post-tricycle-ride snack. While the kids were enjoying some well-deserved fruit snacks, I noticed a runner who had passed us on the greenway, finishing off their weekend workout. I winced when I saw them keep up a pretty fast pace all the way to the car, then stop for several minutes of static stretching. Why would I wince? Seeing this stretching after running made me think of a number of my patients who were struggling with tendinopathy and had been stretching it forcefully at the end of a run because that’s what they’d always heard they should do, or even been told to do by a health provider. But research is starting to show that static stretching probably isn’t really helpful for runners, and especially where tendinopathy is involved, may even be harmful. How can this be?
In my practice, I see a lot of runners who are struggling with various degrees of tendinopathy, which has traditionally been called ‘tendonitis’. I’ve blogged about this common condition before, and about why the name we use for it matters: basically, ‘itis‘ means ‘inflammation’ – which tends to make us (doctors included!) want to treat it like an inflammation that needs to be reduced using common treatments like ice, medications, or steroid injections – and static stretching!
But the latest research is showing that tendinopathy is actually NOT primarily an inflammatory condition, but a degenerative one – which means that it needs relative rest and appropriate strengthening exercises. (Also – did you know that you can use exercises to actually relieve the pain of tendinopathy? I think that is great news! It’s a completely natural, healthy way for patients to relieve pain on their own – no office visits, medications, needles, or co-pays required! It’s called isometric exercise, and it’s one of my favorite treatments to teach my tendinopathy patients!)
Back to running and static stretching: if you’re experiencing pain during or after runs, there is a good possibility it is tendon pain. If this is the case, static stretching may be doing more harm than good by exacerbating the degenerative condition and further weakening the tendon. I’ve had multiple tendinopathy patients who were faithfully following the traditional advice and static stretching their painful tendons, without relief. Once we started them on a program of relative rest and appropriate strengthening, their condition, and pain, finally began to improve!
So, when is static stretching ok? Well, the truth is that unless you’re doing gymnastics or some other sport that truly requires a large range of motion, static stretching may not really be required. What you definitely DO want to do is a good dynamic warm-up routine (like the one here), and a gentle cool-down – so, for a runner, just a nice slow jog, and then a walk, for 5-10 minutes at the end of your workout. After your cool-down, if you have a specific muscle that feels tight, or if you just like it, go ahead and do some (gentle!) static stretching, holding the stretch for 20-30 seconds. (Some research shows that holding stretches for longer than 60-seconds actually begins to reduce muscle performance, so don’t hold for too long!)
The key is to listen to your body – if you’re experiencing any pain in your body (during workouts or otherwise) that lasts longer than a week, if your pain with activity is greater than 5 out of 10, or if you have a flare-up that lasts more than 24 hours, seek medical advice before self-treating or continuing the activity. If you’re experiencing any musculoskeletal pain, a physical therapist is a great place to start, since this is the type of problem we specialize in! Please DON’T just keep trying stretches, foam rolling, or different workout gear; depending on the cause of your pain these things may do more harm than good. The longer pain persists, the longer it can take to recover from. If your workout is causing you pain, please feel free to e-mail, message, or call me to discuss, and I will be happy to help you figure out what steps you can take to resolve the problem and get back on track as quickly as possible.
Check out the 2018 update video on stretching!
Your Running PT got Injured!
Runners Need Strength Training! Or Do They?!
The Female Athlete Triad
Boots For Stress Fractures and What Exercises Help The Most?
Blood Flow Restriction Training
Tendon Compression – Important to Consider For Some Tendons!
Thanks Andrew! This give me hope. I’ve been dealing with moderate to severe elbow pain, and my natural tendency is to stretch, stretch, stretch. But I’ve had no relief. I’ll pursue some rest and strengthening to see if that helps. Should I also treat the inflammation with medication (ibuprofen), or is that counter-productive? Thanks again!
Hey Mitch! Pleased you found some interest. There are quite a number of diagnoses around the elbow, with the most prominent tendinopathy being tennis elbow. If you follow the link in this post you will see about tendinopathy in general. However, there is still much research being done and we also are seeing that there may be some differences in certain tendons. This blog by one of the leading tendon researchers does a great job unpacking some research on this: http://www.tendinopathyrehab.com/blog/tendinopathy-updates/isometrics-for-tendon-pain-is-the-hype-justified
If you are up in Huntsville, stop by and I’d be happy to take a look! Or perhaps we can catch you when we are down that way!