Stretching and Performance

[BAD KNEE 2]

I ran competitively for 30 years, at national levels during and 3 years after college, and can say emphatically that stretching is critical to performance. When to stretch a different question. I stretch before any athletic activiy, not to really stretch the muscles/connective tissue, but to find the tight spots, which I then warm up, not stretch out. I spend a good half hour every night before bed streching to be sure I wake up the next morning reasonably flexible (hey, it's static stretching and a glass of good red wine is in there somewhere, as is conversation with my wonderful wife of 29 years). Static stretching BEFORE competition does slow me down noticeably if I do it before a bout, and did slow me down when I was being beaten in the intermediate hurdles at the olympic qualifiers a few years ago. Static stretching AFTER the activity does keep me from pulling things and feeling overwound. My study sample is one, but I have NEVER pulled a muscle, even while competing in more than 600 track meets during my running days, running high and intermediate hurdles, and nearly 150 fencing tournaments Stretching is critical to my performance, but not before a bout.

[IvorDarcy]

Did anyone pay attention to the fact that the study was on the effect of ACUTE static stretching? I don't know about anyone else but I stretch everytime I am at the club but never to the point of discomfort. I do some light jogging/jumping jacks/push-ups prior to stretching and have never had a fencing injury in 30 years. I do light static stretching simply to let my body know it is about to be pushed hard and it's not such a shock to my poor old body/muscles. I have done the same routine for 30 years and as far as I am concerned "if it ain't broke, don't fix it."

[Timberwolf_CY]

"if it ain't broke, don't fix it."

Quoted for truth, as they say...

[darius]

Or is it:

"if it ain't broke, don't bother looking for something better."

Look, I know of acclaimed HS cross-country and swim coaches who still believe in over-distance training; after all, if you can run 6 miles, you must be able to run 2, right?

The best warmups and flexibility routines are the ones you actually do. If something works for you, that's great. But shouldn't we always searching for better methods of preparing our athletes?

darius

[finnfence]

I'd prefer Club Med, myself.

Yeah, you're doing warm-up lunges, you're making warm-up extensions and cuts, guess what? You're stretching.

But simply contorting yourself into various positions from the Kama Sutra is something else again.

Apparently, though, Finnfence is the single exception. Perhaps he's an alien, whose muscle fiber differs significantly from our human variety.

Tee hee. I do *not* recommend Power Yoga in the bedroom. But ashtanga yoga isn't contorting yourself - check out sun salutes here, and you'll see that it's just a combo of warm-up and mild stretching rolled into one, with interesting cardio effects to boot due to the breathing and blood flow: http://www.youtube.com/watch?v=gZbfQAMut9g.

I'm not an alien - I'm a woman. But you're right - girls do have different bits from guys

[finnfence]

Static stretching AFTER the activity does keep me from pulling things and feeling overwound.

Do you stretch right after, or do you find that it's possible to take a shower in between. Just wondering because for me, I can't let sweat dry on my skin or it breaks out. On the other hand, no injuries is more important than clear skin, at least in my job.

And congratulations - 29 years and still in love is a beautiful thing!

[Inquartata]

I absolutely must stretch before I undertake almost any fencing activity whatsoever. The few times I didn't stretch before practice or a tournament, I was sore for weeks. And I don't mean just "in pain" I mean like, "went to the doctor, 'Son, you've pulled all your quadriceps and hamstrings.'" So yeah, stretching every time, multiple ways. Jog if possible, but not a priority.

Heh. Poor, fragile foilists.

I ran competitively for 30 years, at national levels during and 3 years after college, and can say emphatically that stretching is critical to performance.

You can say it, but not with any authority. This is a variant of the argumentum ad verecundiam fallacy. Years as an athlete does not make you an expert physiologist, nor does opinion outweigh actual scientifically tested findings...


Here, watch this:

I have fenced competitively for 25 years, at national levels for about the last 10, and can say emphatically that stretching is completely unrelated to performance.

Convinced by my authoritative statement? I thought not.

Maybe you're experiencing a sort of placebo effect from the stretching?

I have NEVER pulled a muscle

Me, either. And I don't stretch either before or after fencing.

Now, I do as an overall part of my fitness regimen. It becomes more and more necessary as I get older, just to keep from losing what flexibility I have left.

Or maybe that's just a placebo effect, too.

I'm not an alien - I'm a woman. But you're right - girls do have different bits from guys

Different...er...arrangements do not make us from different species. Muscle fibre is muscle fibre. Individuals have different amounts in different proportions, but it's all the same material. Saying that stretching may have been found by science to weaken male muscles but not female ones is like saying that female eyes see in a fundamentally different way than male eyes...

[the ancient one]

Interesting points above.

Here is another larger study about injury prevention and stretching. Basically it says that stretching is not effective.

http://www.bmj.com/cgi/reprint/325/7...urcetype=HWCIT

Really interesting summary in the discussion section such as "the average subject would need to stretch for 23 years to prevent one injury."

Lovely thing, the British Medical Journal, one of the few remaining quality peer-reviewed sources that gives free full access to all but the latest reports.

[finnfence]

The difficulty with "scientific" papers on medical subjects is that the range of variation across humans is so wide that you can't say very much meaningful on some topics. That's why in fact we do often go back to relying on word of mouth.

I've just recently had *another* doc tell me "your skin breakouts are not related to sugar consumption. That's been scientifically proven to be impossible." Well, no, it hasn't. What has been proven is that there is no statistically meaningful correlation between sugar consumption and acne in large groups. However, acne is a symptom, not a disease. The root causes of it are manifold, and lie in a complex interaction of hormonal balances, skin structure and sensitivities to hormones, immune system responses, digestive system and metabolism, personal hygiene, and a host of other factors. For each person, there's a particular set of stimuli that leads to breakouts. Some people break out from caffeine, some from stress, some from sugar, some from hormones run amok, some from a food but only when their stress levels or hormones are also out of whack, etc etc. Trying to run a "scientific" study by lumping all these people together and looking for correlations is kind of hopeless. If you're lucky, you'll find large enough blocks of people who share similar pathways that you'll be able to identify some root causes of breakouts. But that's it. You will certainly not be able to say that the study invalidates the other people's pathways. It just means there weren't enough people with that pathway for it to show up as statistically significant in a large group.

Medicine in general is like that, particularly since we humans haven't all been bred to be genetically similar, the way lab rats have. That's why, when we read that study X has shown Y, we need to experiment on our own bodies (gently, cautiously, with common sense) and see if this finding applies in our own case.

People generally accept this principle in fashion; I just want to make the point that it applies equally to all things related to the body. Including stretching.

So I guess I'm in violent agreement with Inquartata that one person's experience doesn't say squat about someone else's experience. At the same time, neither does a scientific study, necessarily, since it is just a larger collection of individual experiences, somewhat oversimplified and with a shiny statistical coating applied. To me, the value of everyone sharing their own experiences on medical subjects is that you get a better picture of all the possibilities, including the outlying bits of the bell curve. The value of the scientific study is, you get a picture of what the most statistically likely reaction is. Neither one disproves the other - they're both needed for balance.

And since people tend to have blind faith in studies and to discount personal experience in face of it, or to extrapolate the "average experience" as shown by the study to "everyone's experience must be X because it's scientifically proven", it's really important to hear from those whose experience does not conform to the study findings, just to remind people that the study isn't the whole story. Especially when we're dealing with a complex phenomenon, like the relationship between stretching, athletic performance, and injuries. In those cases, it's all too common for the studies to forget to take some key variables into account, and to come up with the wrong findings, the way the whole egg scare got propagated because the study designers didn't think to check for genetic factors. Turns out eating eggs does not lead to higher blood cholesterol - unless you have a certain genetic mutation, in which case they most certainly do. Now some people are saying cholesterol itself is not the bad guy, and is only a marker for inflammation, which is supposedly often caused by some of the very fats we thought were safe, but which become wicked little monsters when overheated...who knows where it'll all end. I'm personally going to keep one eye on the studies, and the other on people's personal stories, especially my own.

[BAD KNEE 2]

Do you stretch right after, or do you find that it's possible to take a shower in between. Just wondering because for me, I can't let sweat dry on my skin or it breaks out. On the other hand, no injuries is more important than clear skin, at least in my job.

And congratulations - 29 years and still in love is a beautiful thing!

I do the static stretching immediately before bed. I generally walk about a bit to cool down after fencing, but don't do any stretching unless I have a really noticeable tight spot, and if so I do some light stretching.

[BAD KNEE 2]

You can say it, but not with any authority. This is a variant of the argumentum ad verecundiam fallacy. Years as an athlete does not make you an expert physiologist, nor does opinion outweigh actual scientifically tested findings...

OK, critical to MY performance. That I can say with authority.

[darius]

I'm personally going to keep one eye on the studies, and the other on people's personal stories, especially my own.

I also suspect that science lags behind what people are doing in the gym. Given that fencing is an inherent athletic pastime, I make sure to seek out sources who are involved in athletic preparation at a high level.

Granted, fencers don't need to move massive amounts of iron, run a 4.3 second 40, or have a 30 inch vertical leap, but in my mind it's wise to steal methods from people whose livelihoods depend on that.

darius

[Nolano]

Before tournaments I usually jog around a bit, then do a little stretching. Mainly the legs. if I don't stretch and get warmed up, I usually feel like my legs are like lead and I have difficulty moving quickly. Not helpful.


Stretching afterwards is also important. I went a week of fencing and a tournament without stretching. I couldn't even get within a few inches of touching my toes.

[Aussie_Fencer]

I do pretty much the same things that nolano does. I find that if I don't stretch out (especially my back and legs) I end up being very slow and usually pull a muscle(especially if I don't stretch my back). I also like to go on a little jog after fencing just to let my muscles cool down, then I stretch out some more.

[Inquartata]

The rationalizations continue. Ah, human nature!

Perhaps we need a War on Cognitive Dissonance, to keep us all safe from...you know...science and evidence and stuff...

[finnfence]

Inquartata, are you just trolling here, or do you actually believe that the Foundation trilogy is a documentary? There's a fundamental difference in science as applied to physics and science as applied to medicine. In physics (at least some parts of physics) you are dealing with pretty well-defined problems, and you can isolate the thing you want to study, and set up an experiment in which the variables you're trying to study are either independent of each other, or related in ways that follow well-known rules, like PV=nRT. You can repeat the experiment and get the same result every time. In medicine, it isn't like that at all. Medical studies attempt to apply the scientific method to systems which are poorly understood, in which there are complicated and not-well understood feedback systems galore, the variables aren't independent, and if they follow 100% repeatable rules about how they interact, we haven't figured them out yet. The subjects of the experiment are usually non-homogenous, not really that similar to each other (unlike electrons). All medical studies generally do is try to do their best to set up a faintly controlled system, and then try to lay out a bell curve, so doctors can guess how a patient is most likely to react. That's it. (Of course, there are also studies that attempt to identify specific mechanisms of action, like the pathway for a particular type of inflammation, but this is not the kind of study that you are referring to with your stretching study, so I'm going to leave it to the side for the moment). It gets easier if you're studying a relatively well-defined medical problem, like malaria, and much more difficult if you're studying entire body systems or overlapping systems, like when you do a study on stretching or plaque deposition in arteries. That's why you get repeatability in medical studies more often when you're studying the simple stuff than the complex stuff - too many variables, too poorly understood. But in any case, because medicine does not test laws, like E=mc2, but only checks where the peak of the bell curve is, you can't say that the finding of a medical study is "science" or "evidence" the way that the finding of a physics experiment is. And the human population doesn't fit tidily under the bell curve, so that you can say, "well, 99% of us are going to fit with the study and only aliens won't". Medical researchers are well aware of the limitations of medicine (although doctors are under a lot of pressure from patients not to talk about it, because it's scary). Just check out the literature on "idiosyncratic" (= code for "does not fit the predicted reaction found from studies"), for example here: http://www.blackwell-synergy.com/doi...ournalCode=epi (abstract below). What it means is, we can use medical studies as possible pointers, but we have to all put on our big-boy undies or big-girl thongs, and take responsibility for maintaining our own health. We have to observe closely what works for us, we have to be unafraid to say "the emperor has no clothes" when confronted by medical studies that don't seem to line up with experience, and we have to go out there and gather information from as many places as we can, including word of mouth.

If what I'm saying still seems like cognitive dissonance, then just try designing a study that would actually prove with 99% accuracy whether stretching helps or doesn't help athletic performance, pop it up on the forum. It would be interesting to see what you come up with. Remember, the point is not to prove whether it helps lab rats or people in a lab over a study period of an hour or two, but rather whether it helps everyday athletes in real sporting events.

Accepted December 23, 2006.
Home > List of Issues > Table of Contents > Article Abstract
Epilepsia
Volume 48 Issue 7 Page 1223-1244, July 2007

To cite this article: Gaetano Zaccara, Diego Franciotta, Emilio Perucca (2007) Idiosyncratic Adverse Reactions to Antiepileptic Drugs
Epilepsia 48 (7) , 1223–1244 doi:10.1111/j.1528-1167.2007.01041.x

Idiosyncratic Adverse Reactions to Antiepileptic Drugs
**Neurology Unit, ASL 10, FirenzeGaetano Zaccara, ††Laboratory of NeuroimmunologyDiego Franciotta, and ‡§‡Laboratories of Diagnostics and Applied Biological Research, Institute of Neurology, I.R.C.C.S. C. Mondino Foundation§Clinical Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, ItalyEmilio Perucca*Neurology Unit, ASL 10, Firenze; †Laboratory of Neuroimmunology; ‡Laboratories of Diagnostics and Applied Biological Research, Institute of Neurology, I.R.C.C.S. C. Mondino Foundation; and §Clinical Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
Address correspondence and reprint requests to Dr. Emilio Perucca, Clinical Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Piazza Botta 10, 27100 Pavia, Italy. E-mail: perucca@unipv.it
Abstract
Summary: Idiosyncratic drug reactions may be defined as adverse effects that cannot be explained by the known mechanisms of action of the offending agent, do not occur at any dose in most patients, and develop mostly unpredictably in susceptible individuals only. These reactions are generally thought to account for up to 10% of all adverse drug reactions, but their frequency may be higher depending on the definition adopted. Idiosyncratic reactions are a major source of concern because they encompass most life-threatening effects of antiepileptic drugs (AEDs), as well as many other reactions requiring discontinuation of treatment. Based on the underlying mechanisms, idiosyncratic reactions can be differentiated into (1) immune-mediated hypersensitivity reactions, which may range from benign skin rashes to serious conditions such as drug-related rash with eosinophilia and systemic symptoms; (2) reactions involving unusual nonimmune-mediated individual susceptibility, often related to abnormal production or defective detoxification of reactive cytotoxic metabolites (as in valproate-induced liver toxicity); and (3) off-target pharmacology, whereby a drug interacts directly with a system other than that for which it is intended, an example being some types of AED-induced dyskinesias. Although no AED is free from the potential of inducing idiosyncratic reactions, the magnitude of risk and the most common manifestations vary from one drug to another, a consideration that impacts on treatment choices. Serious consequences of idiosyncratic reactions can be minimized by knowledge of risk factors, avoidance of specific AEDs in subpopulations at risk, cautious dose titration, and careful monitoring of clinical response.