Injury Prevention 101 - Flexibility

by Dr. Josh Sandell
Spine and Sports Institute

[also see part 1 on Strength Training]

Flexibility

The Australian triathlon team was screened in November 2003 prior to the World Championships in New Zealand, and found two main predisposing factors to injury: thoracic spine stiffness and tight hip flexors.

This pattern is extremely common in cyclists. Cycling training is one potential cause of thoracic stiffness because of the time spent in the time-trial position. If good spinal posture is not maintained on the bike, the thoracic spine can become excessively hunched when the cyclist becomes fatigued. If this posture is not corrected and the mid-spine is not regularly stretched, stiffness can develop and a drop in cycling performance may follow as a result of the athlete adopting a less efficient aerodynamic position.

The thoracic spine's mobility can be improved with laying on your back over a physio ball or lying on one’s back with a towel on the floor.

Tight hip flexors are a major injury risk factor and are a common problem because of the length of time cyclists spend with the hip bent in the time-trial position while cycling. Low back injuries, hamstring strains, hip flexor strains and most lower limb overuse injuries can be linked to tight hip flexors. Hip flexor and quadriceps stretching are essential to prevent this pattern from developing.

The muscle groups should be stretched daily, before and after activity (especially after cycling). Stretches should be held for approximately 30 seconds to one minute without bouncing, performed gently and slowly to the point of tension but never pain.

While an effective stretching program may reduce injuries, many athletes look to stretching as the answer to injuries. Athletes do become injured because of overflexibility. Be consistent with your stretching, but don’t go to extremes and don’t look to it as the injury cure-all.

STRETCHING YES, STRETCHING NO…

Fernando A Pena, MD – TRIA Orthopaedic Center

In spite of scientists’ best efforts, we are still missing the scientific evidence that regular stretching prevents injuries. At the most, there is some suggestion that it may help to recover from an injury, like a muscle strain or pulled groin, but still it is a very soft correlation.

The benefit from stretching comes from preparing a muscle group for an athletic activity and sending the proper “signals” to get ready. The benefit is believed to be related to the increased blood flow to the muscle fibers as well as the connective tissue surrounding the muscle. Excessive stretching may be counterproductive, as it may create some degree of instability to a specific joint and therefore make it more susceptible to injuries.

The human body has to get ready to exercise. Similarly, it has also to get ready for something apparently as trivial as stretching. Something as simple as a brisk walk or a light vertical jumping for a few minutes would help to get the blood flow going and therefore it will facilitate the stretching program.

The golden rule for stretching is to avoid pain. To stretch until the rider feels pain it is considered to be excessive and definitely not beneficial. It is recommended to feel tension and a “stretch” but not necessarily pain. A good stretch should be held under tension for 10 to 30 seconds. Beyond that point it does not seem to be of an extra benefit either.

It is very important to avoid any “bouncing” of the muscle group while stretching. The “bouncing” will generate neurological signals at the level of the spinal cord which will be transmitted to the muscle and prevent further stretching, making the rest of the session useless and in some cases even injury prone.

In the case of a cyclist, the muscle groups, to benefit from stretching will include the lumbosacral spine (lower back) and lower extremities. The cervical spine (neck) and upper extremities will be positioned almost completely static during a ride. Regular stretching of those areas while riding will be of benefit to avoid overload injuries to tendons and ligaments of the neck and upper extremities.

Regarding the lower extremities, special attention has to be paid to the iliotibial band also known as the IT band (a ligament that stretches from the hip to the knee along the outside of your thigh). Both at the level of the hip and the knee joint, the IT band is prone to irritation. When the pain is felt at the hip level, it is also called the “snapping hip” as the IT band “jumps” over the bony prominence of the hip area with every flexion-extension of the hip joint. At the knee level, it is very unlikely to feel any snapping, but still it may be of significant discomfort after long rides in the presence of a tight IT band. Proper stretching of the IT band is the best initial remedy to avoid those conditions as well as a very diligent program of icing to the affected area.