Dossier étirements 1ere partie: Revue partielle de la littérature existante

Le présent article se veut une revue partielle de littérature existante sur le sujet des étirements. Le but est de centraliser certaines références sélectionnées au hasard, afin de supporter une entrevue à venir avec la physiothérapeute Marie-Claude St-Amour, phd, récemment interviewée sur la question (lire la 2e partie).

Il est difficile d’envisager un jour un consensus sur le sujet des étirements en général. Ils sont utilisés à plusieurs sauces, selon diverses recettes certaines plus originales que d’autres. La perspective qui m’intéresse dans le présent dossier se limite aux étirements utilisés comme méthode de prévention et traitement des blessures, surtout liées à la course à pieds. J’ai recherché sur l’efficacité des étirements en prévention du syndrome fémoro-rotulien, de la fasciite plantaire, du syndrome de la bandelette ilion-tibiale, etc, évitant les généralités et espérant ainsi découvrir des textes en ligne avec à mon angle de recherche.

Références: En faveur

Blessures de course les plus fréquentes (papier proposé par un Podiatre)

According to Tomas Best, md (sports medicine), PhD (biomedical engineering)
Once pain has subsided, strengthening and stretching exercises should be considered. Eccentric strength training (Figures 3a and 3b) is particularly effective in treating tendinopathies and helps promote the formation of new collagen.17,18 Eccentric contraction involves the lengthening of muscle fibers as the muscle contracts, preferentially loading the tendon. Eccentric exercise has proved beneficial in Achilles tendinosus17,18 and patellar tendinosus,19 and may be helpful in other tendinopathies. Stretching exercises generally are thought to be helpful and are widely accepted.

According to Robert Foster, Physiotherapist (Voted « Best Place to go for a Sports Injury » by the readers of Competitor Magazine in 2002, 2004, and 2007)
Stretching not only helps « wring » the waste products out of your muscles but helps the muscle and tendons « heal » with a functional scarring as they adapt to the stress placed on them in the workout. This is how to toughen your body against injury

Effects of dynamic and static stretching within general and activity specific warm-up protocols
Static stretching used in a separate training session can provide health related range of motion benefits. Generally, a warm-up to minimize impairments and enhance performance should be composed of a submaximal intensity aerobic activity followed by large amplitude dynamic stretching and then completed with sport-specific dynamic activities. Sports that necessitate a high degree of static flexibility should use short duration static stretches with lower intensity stretches in a trained population to minimize the possibilities of impairments.
A review of the acute effect of static and dynamic stretching on performance
Generally, a warm-up to minimize impairments and enhance performance should be composed of a submaximal intensity aerobic activity followed by large amplitude dynamic stretching and then completed with sport-specific dynamic activities. Sports that necessitate a high degree of static flexibility should use short duration static stretches with lower intensity stretches in a trained population to minimize the possibilities of impairments.

Effect of Acute Static Stretch on Maximal Muscle Performance: A Systematic Review
Conclusions: The detrimental effects of static stretch are mainly limited to longer durations (Q60 s), which may not be typically used during preexercise routines in clinical, healthy, or athletic populations. Shorter durations of stretch (G60 s) can be performed in a preexercise routine without compromising maximal muscle performance

There is some evidence of unintended adverse effects of stretching and/or increased flexibility. Stretching has been associated with a temporary strength deficit (up to 1 h) (24,57) and increased arterial blood pressure (13).

The role of stretching in tendon injuries
Therefore, findings have implications for the prevention and treatment of tendon injuries, and both ballistic and static stretching should be incorporated in the prevention and treatment programmes for tendon injuries.

Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors
Conclusion: To reduce the likelihood of developing PFPS, any individual, especially those with positive potential risk factors, can perform the proposed prehabilitation program.

The Role of Hip Muscle Function in the Treatment of Patellofemoral Pain Syndrome
« Conclusion: Improvements in hip flexion strength combined with increased iliotibial band and iliopsoas flexibility were associated with excellent results in patients with patellofemoral pain syndrome. »

Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study
Conclusion: A program of non-weight-bearing stretching exercises specific to the plantar fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of proximal plantar fasciitis. These findings provide an alternative option to the present standard of care in the nonoperative treatment of patients with chronic, disabling plantar heel pain.

Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up.
Conclusion: This study supports the use of the tissue-specific plantar fascia-stretching protocol as the key component of treatment for chronic plantar fasciitis. Long-term benefits of the stretch include a marked decrease in pain and functional limitations and a high rate of satisfaction. This approach can provide the health-care practitioner with an effective, inexpensive, and straightforward treatment protocol.

Static Progressive Stretch Brace as a Treatment of Pain and Functional Limitations Associated With Plantar Fasciitis (A Pilot Study)
Both interventions (static, exercise, and brace stretching) were beneficial for treating pain and functional limitations, suggesting that static progressive stretch brace is an effective alternative option to static stretching exercises for people with plantar fasciitis.

(Contre-la-Montre en Cyclisme) Jack-knife stretching promotes flexibility of tight hamstrings after 4 weeks: a pilot study
In adult volunteers, FFD was 14.1 ± 6.1 cm before the experiment and decreased to -8.1 ± 3.7 cm by the end of week 4, indicating a gain in flexibility of 22.2 cm. PFIA was 50.6 ± 8.2 before the experiment and 83.8 ± 5.8 degrees after. Before and after the experiment, the differences were significant (p < 0.05). For those aged under 18, FFD was 8.1 ± 8.0 and -9.6 ± 6.8, before and after the stretching, respectively. This difference was significant (p < 0.05). The jack-knife stretch is a useful active-static stretching technique to efficiently increase flexibility of tight hamstrings.

Références: En défaveur

A randomized trial of preexercise stretching for prevention of lower-limb injury.
Conclusion: A typical muscle stretching protocol performed during preexercise warm-ups does not produce clinically meaningful reductions in risk of exercise-related injury in army recruits. Fitness may be an important, modifiable risk factor.

Does Stretching Prevent Injuries?
For Dr. Thacker’s paper « The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature, » he and his colleagues pored over nearly 100 other published medical studies on the subject. Their key conclusions: stretching does increase flexibility; the highest-quality studies indicate that this increased flexibility doesn’t prevent injuries; few athletes need extreme flexibility to perform their best (perhaps just gymnasts and figure skaters); and more injuries would be prevented by better warmups, by strength training, and by balance exercises, than by stretching.

Stretching before exercise does not reduce the risk of local muscle injury: a critical review of the clinical and basic science literature.
The basic science literature supports the epidemiologic evidence that stretching before exercise does not reduce the risk of injury.

Quite a Stretch – Guest Post From Paul Ingraham
Plentiful recent research now shows that stretching as we know it — the kind of stretching that the average person does at the gym, or even the kind of stretching that athletes do — could very well be a waste of time. Articles published in recent years, reviewing hundreds of studies, have concluded that there isn’t much evidence that stretching prevents injury or muscle soreness.2, 3 Adding significantly to the credibility of those reviews, a major year 2000 clinical study of many hundreds of soldiers showed no sign of benefit from and even some risks to stretching.

Stretching vs. Non-Stretching
While the studies show that these abnormal changes induced in a stretched muscle can last for an hour, some clinicians have demonstrated that stretching can cause prolonged muscle problems that can last days and weeks.

A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) cohort.
Risk factors for the development of patellofemoral pain syndrome included decreased knee flexion angle, decreased vertical ground-reaction force, and increased hip internal rotation angle during the jump-landing task. Additionally, decreased quadriceps and hamstring strength, increased hip external rotator strength, and increased navicular drop were risk factors for the development of patellofemoral pain syndrome.
Prevention programs should focus on increasing strength of the lower extremity musculature along with instructing proper mechanics during dynamic movements to decrease the incidence of patellofemoral pain syndrome.

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