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Athletic Trainers: How to Use the Latest Data to Support Flexibility and Stretching

  • June 1, 2023
  • Preparation & Recovery
CoachesEducators

Michele LaBotz headshot.The past few decades have seen incredible shifts in recommendations regarding the benefits, and potential risks, of different stretching protocols for athletes. Unfortunately, individual studies can have highly variable protocols that may lead to conflicting results and confusion for practitioners and their athletes.

Several recent systematic reviews can help sort out some of these discrepancies, but determinations of “best practice” regarding stretching are certainly subject to some controversy and future change, and it can be incredibly difficult to figure out the best advice to give a young athlete. Here, Dr. Michele LaBotz, TrueSport Expert and sports medicine physician, shares what we know now about stretching.

Static stretching—where you stay in one position and hold a stretch for a specified amount of time—was the original standard for stretches done by athletes. The original static stretching logic back then was simple: if you did a lot of static stretching, you would prevent injury and perform better.

However, over the years, that concept was ‘debunked,’ and some research came out showing that static stretching could decrease performance and increase injury risk. “After that, static stretching, whether before working out or as part of a warm-up routine, fell out of favor,” says LaBotz. “That’s when dynamic stretching became more popular.” As the name suggests, dynamic stretching is more movement-based, with athletes actively moving through the range of motion. For instance, bending over to touch your toes and holding that position for 30 seconds would be a static stretch, while leg swings would be a dynamic stretch.

But then, a recent meta-analysis looking at a series of studies done on stretching found that the uproar against static stretching was a “little overblown,” according to LaBotz. As with many things in the health and fitness world, the studies that initially scared people away from doing static stretching were more nuanced than headlines made them seem. However, there are still important caveats for athletic trainers to be aware of.

“It turns out that, in some cases, static stretches may actually help prevent injury,” says LaBotz. “It may also help to increase range of motion, which can potentially help with performance in a lot of different sports. But it doesn’t mean every athlete should be doing static stretches every day.”

So, what does this mean for you as an athletic trainer?

 

Variable effects for endurance vs. non-endurance athletes

“For high-performance athletes in non-endurance sports, avoiding static stretches as part of the warm-up may still the best protocol,” LaBotz says. “There are some studies that show small decreases in speed and power immediately following a static stretch warm up. However, other studies in endurance athletes show some improvements in running economy and decreased perceived effort after a warm-up that included either static or dynamic stretches.”

 

Understand your athlete’s growth phase

Male coach helping young male athlete stretch quads.“Flexibility is particularly important for athletes who are in a rapid phase of growth,” says LaBotz. “As a young person grows, their bones grow first, and then the muscles and the tendons all stretch out to accommodate them before catching up. While they’re doing so, the athlete’s flexibility goes down, since there’s naturally more tension on the muscles and tendons.” So, if an athlete suddenly seems less flexible and has recently grown an inch or two, that’s not a cause for alarm. LaBotz explains, “Sometimes just maintaining flexibility requires dedicated effort during these growth phases.”

 

Understand what a ‘good stretch’ feels like

Stretching should never be painful, says LaBotz. Part of the reason stretching got a bad name was because athletes would sometimes be forced into stretches that were too intense. (You may be able to recall a physical education teacher pressing down on your upper back to ‘help you’ go further in a seated forward fold, taking the stretch from pleasant to painful.) “A good stretch feels like a bit of a pull, maybe a small amount of discomfort, but there should never be pain,” says LaBotz. Always err on the side of caution!

 

Find modalities that work for your athlete

LaBotz is a fan of combining different modes of stretching and improving flexibility and mobility, including static stretches, dynamic movements, equipment like foam rollers, and assisted methods like dynamic nerve glides, where the athletic trainer helps the athlete move through a range of motion that helps open up tight spots.

 

Incorporate static stretches at the right time

Young female soccer players stetching on the field.“Stretching is always best when the body is warm,” says LaBotz. “It’s great to do stretching as a cool down after practice—or if you want to do a stretch session before practice, still start with a warm up to get the blood flowing.” And when it comes to adding static stretches, especially around practice, aim for two holds of around 20 seconds each. “You don’t want to overdo it,” says LaBotz. “Too much of a good thing is not a good thing.” For rapidly growing kids, having some kind of stretching protocol most days of the week is ideal.

 

Skip stretching for more flexible athletes

The caveat to stretching for young athletes is that for naturally flexible kids, stretching isn’t the best use of their time. If an athlete is extremely flexible or even struggles with hypermobility, LaBotz notes that they need to spend that time working on stability and strength.

 

Check posture and mobility

“There are a couple of patterns that I’m noticing in young athletes now,” says LaBotz. “Many now have the ‘head forward’ position, often from being on phones or computers for most of the day. It sets these kids up for increased risk of back pain, as well as shoulder injury because it puts the shoulder in a bad position. Make sure that they’re doing some stretches across the front of their chests to open up that area.”

 

Individualize recommendations to your athlete’s specific sport

Woman coach stretching younger woman on mat.After assessing general posture, mobility, and flexibility concerns for an athlete, consider the sport-specific stretches that would be performance-enhancing. LaBotz reports, “A thrower, for instance, should focus on stretching out the posterior capsule in their shoulder, but for a swimmer, you would do the opposite and stretch out the anterior.”

She also encourages athletic trainers to think beyond the basics and consider less-common stretches, such as hip stretches for a thrower since lower body rotation is important. “Pay attention to the whole kinetic chain,” she says. “Every athlete is going to come in with a different set of strengths and limitations, meaning they need to build up certain aspects to improve performance in their specific sport.”

 ___________________

Takeaway

Based on the latest research, athletic trainers can feel comfortable recommending both static and dynamic stretching after analyzing what will best serve an athlete based on their sport, body type, existing flexibility, and injury history.

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Hi. I’m Trevon, Trey, Jennifer. Team USA wheelchair basketball player, paralympian, and true sport athlete. Today, I want to talk to you about goal setting. And there are three things that I would like you to know. First, successful athletes set goals and a planned roadmap. Second, goals should be written down, assessed over time, and changed if necessary. And third, goals need to be challenging in order to be worthwhile. As a freshmen at Edinboro University, I was a part of a team that made the national championship game. And at that time I recognized I was the low man on the totem pole, but I felt in my heart that I knew my dreams were so much bigger than winning a national title. I wanted to make Team USA. I knew what achieving my lofty goal was not going to be easy and that I would need to work hard every day.

So, as a reminder, I created a pyramid of goals that I kept right above my bed. This pyramid reminded me of the accomplishments that I was working towards and visually represented my need to create a solid foundation underneath me before reaching the top. In the bottom roll of my pyramid of goals I listed goals such as obtaining my bachelor’s degree, becoming a scholar athlete award recipient, and becoming an All-American. The middle row listed winning a national title and playing for a professional team. And at the top row, the most challenging of them all, I listed becoming a gold medalist for Team USA.

By understanding that there are smaller stepping stones to achieving my ultimate goal of being on Team USA, I was able to stay motivated and to stay focused on completing the smaller stepping stones fully before moving onto the next one. Now I’ll be the first to admit that not every goal that I listed on my pyramid was accomplished, but seeing my goals every day when I went to bed, I was able to push through the days that I felt like doing nothing in hopes of achieving the bigger picture. Remember, create a clear goal roadmap, assess your goals often, and continue to challenge yourself. I hope that you never stopped dreaming big or reaching for the stars. And I look forward to seeing where your roadmap takes you.

Body Image Lesson Video Transcript

Hi, I’m Kara Winger, Olympic javelin thrower, and true sport athlete. Today I want to talk to you about body image and I have three things I’d like you to know. First, healthy thoughts often lead to healthier bodies. Second, there are varying body types and no one’s body is exactly like another. And third, true beauty goes deeper than the skin. As a multi-time Olympian, I’ve experienced a lot of variation and progression in my training. My coaches and I adapt to my training frequently, all with the goal of supporting my long-term success and health in the sport of javelin. I’m talking to you about body image today because sometimes even with the best of intentions and a common goal in mind, the changes you make to your training habits can prove to be detrimental if made for the wrong reasons. In the lead up to the 2012 Olympic trials, I was told in order to improve my performance on the field, I should try to become a leaner, skinnier version of myself.

So I changed my diet. I went along with what I was being told to do, even though I’d had great success at a slightly heavier weight and higher body fat percentage, and became much leaner than ever before. It seemed like a successful change at first, but I didn’t have nearly the results I’d had before. And I believe becoming leaner than my body naturally wanted to be was what caused my ACL to tear. In the end, it cost me heavily going into the 2012 London games. The takeaway for me, and hopefully for you, is that it’s important to know what works for you and your body and to not compare yourself to others. You should do your research and experiment with your diet to find what makes you feel the best, rather than focusing on what you look like. Today, if I feel like having a chocolate chip cookie, I have one, just not every day.

I’ve learned what a properly balanced meal for my body looks like and I recognize food as the fuel that keeps me throwing. I hydrate and allow myself time to recover. And I listen to and communicate with my body so that I can be the best version of myself. In the end, you are in control of how you see, treat, and respond to your body. We only get one and it’s amazing to discover how many things our bodies can do. Be a true sport athlete. Love who you are in this moment and get excited for all the places your body will take you.

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Hi, I’m Izy Isaksen, Team USA, Modern Pentathlon, Olympian, US Army Sergeant, and True Sport Ambassador. Today, I want to talk to you about being a good sport. There are three things I’d like you to know. First, real winners act the same toward their opponent, whether they win or lose. Second, follow the rules and be a gracious winner and respectful loser. And third, sportsmanship reveals your true character.

I started competing in Modern Pentathlon eight years after my older sister and three-time Olympian, Margaux Isaksen, began competing. I soon realized that people often compared the two of us. I would overhear spectators and teammates asking, “Who’s the better athlete,” and “Who’s going to beat the other.” Instead of letting outside pressures create a negative experience for us, I chose to practice winning and losing with grace and respect. I know that it would have been easy to let our hyper competitive mindset affect our relationship, but instead we decided to support and cheer for each other, regardless of our own performance. My experience of competing against and being compared to my older sister, taught me to focus on how to perform at my best, rather than putting wasted energy into wishing for others to fail.

I believe that sportsmanship reveals true character. So, no matter what situation I encounter during competition, I know it’s important to always treat people with respect and be a good sport. Remember, be a fierce competitor, find grace in all your victories and losses. And I hope to see you out there.

What Kind of Coach Do You Want to Be? Video Transcript

Edwin Moses: You’re a coach. Maybe what you want is very simple, for everyone to just run in the right direction, score for their own team, to try and try again and again. Maybe you want your athletes to become all stars. You want them to earn trophies, medals, win titles. You want them to reach the highest height their sport allows. And wanting all of that, of course, that’s good. But as every great coach discovers, developing a great athlete means nurturing, nurturing the even greater person within. Truth is, you have even more influence than you know.

You have the ability to affect even deeper change, to take what’s in your hands and do something even more extraordinary. You can be both the coach who provides the skills needed to win the game and the coach who helps them learn and succeed beyond the sport, to become all stars wherever they land in the future, and to enjoy their lives more now, because the confidence and courage they find working with you will stay with them when they need it the most. There are games to be won, lives to change. Coaches have the power to do both.

I’m Edwin Moses, and the lessons I’ve learned through sport have challenged me, guided me, and shaped my life forever. What kind of coach do you want to be?

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At first glance, dietary supplements look the same. They seem safe and healthy, but just because the label says a product is a dietary supplement, that doesn’t mean it’s safe. Unfortunately, you can’t tell whether a product is safe or not just by looking at the label. Most vitamins, minerals, fish oil, and other supplements containing nutrients are probably just fine, but supplements are not evaluated or approved by FDA before they are sold. Although it is rare for vitamins or minerals to be contaminated with drugs, there has been at least one case of a vitamin containing an anabolic steroid.

At the other extreme are products that contain drugs, stimulants, anabolic steroids, or other hormones. Even though these are not technically dietary supplements, many of them are labeled as supplements. For example, body-building products sometimes contain anabolic steroids or Selective Androgen Receptor Modulators, known as SARMs, or other hormones. Some pre-workout or energy products contain illegal stimulants like DMAA, ephedra, or other amphetamine-like stimulants. Weight loss products might contain prescription drugs like sibutramine, or hormones, like human chorionic gonadotropin, also known as hCG. All natural or herbal sexual enhancement products might contain hormones or Viagra-like drugs. Products like these can harm your health and career, but they’re for sale online, in some nutrition stores, and they’re labeled as dietary supplements.

When you pick up a supplement, especially one that promises performance enhancement, you don’t know if it belongs in the “Mostly O.K.” pile or in the “Dangerous” pile. After all, two products might look the same, but one might contain just amino acids and other legitimate ingredients, while the other also contains anabolic steroids. Because of this, FDA has issued a warning about certain categories of supplements: body building products, weight loss products, and sexual enhancement products. Be extremely careful when considering a supplement in one of these categories. We strongly recommend that you avoid products in these categories.

Even when FDA tests supplements and finds dangerous ingredients, companies sometimes refuse to recall them. Sometimes, they simply repackage their product and continue selling it under a new name. Just because a product is on a store shelf doesn’t mean it is safe. You need to do your research and be an informed consumer. The dietary supplement industry is enormous. Supplements that appear to be safe could actually be dangerous products in disguise. If you use dietary supplements without doing your research, you may be taking serious risks with your health and your career. Please visit USADA’s Supplement 411 for more information about dietary supplements.