Does stretching reduce pain in non-stretched areas?

The capacity of our joints and muscles to adapt their shape profoundly shapes our strength, dictates the quality of our movement, and determines our ability to navigate the demands of daily life. This capacity - flexibility - forms a foundation for autonomy, allowing us to live on our own terms. Stretching, when practiced with intention and regularity, often proves to be the most effective tool for cultivating flexibility. Many seek out stretching to become more limber, to relieve muscle tension, or simply to enhance their overall well-being. In therapeutic settings, stretching transcends physical exercise; it becomes a method for alleviating pain. The evidence suggests that a good stretch can offer immediate relief, soothing both muscular and nerve-related discomfort [1-3]. Yet, in the context of routine stretching, questions persist about its impact on chronic, widespread pain and general bodily soreness. If stretching were shown to alleviate systemic, long-term pain, it would represent an accessible, low-cost intervention for those living with persistent discomfort. However, to leverage its potential fully and reach those who would benefit most, we must deepen our understanding of its mechanisms—how it mitigates pain and transforms our sensory experience.

Numerous studies have demonstrated that an individual can enhance their flexibility through consistent stretching, provided they maintain this practice for a minimum of four to six weeks. The essential factor lies both in the act of stretching and in the regularity, in the cumulative hours invested each month. Repetition is paramount: the more frequently you stretch, the greater the range you are likely to achieve. Yet, intriguingly, most of what changes over this period is not within the muscle fibres themselves but in your perception - the experience of tightness, the sensation of stretch, even the apprehension of pain [4]. It is this psychological adaptation that builds tolerance. To engage in stretching is to endure discomfort, a process through which tolerance itself becomes a reflection of your resilience. Researchers suggest that these incremental increases in flexibility may serve as a revealing metric for an individual's overall capacity to endure pain [5-7].

The alteration in stretch tolerance may derive from inhibitory processes - specifically, a dampening of the sensation of pain - that render the experience of strain more manageable. Stretching, it seems, has the capacity to diminish perceived pain not only at the site of the stretch but potentially throughout the body. Some researchers propose this effect hinges on the manner in which the central nervous system modulates pain signals. This might involve the dorsal horns of the spinal cord, which play a role in the Gate Control Theory, or the activation of endogenous pain inhibitory mechanisms, wherein the body itself mitigates pain. Empirical evidence indicates a correlation between your range of motion and pain tolerance post-stretching [8,9]. Nevertheless, the precise degree to which routine stretching could fundamentally recalibrate our sensitivity to pain remains elusive.

The transitory nature of flexibility gained through regular stretching underscores an important principle: the maintenance of increased stretch tolerance relies on consistency. In other words, the body requires repeated exposure to remain attuned to the expanded range of motion. This continuity is vital in preserving the "feel" of the stretch. Intriguingly, recent research delved into the effects of a structured six-week stretching regimen on pain sensitivity, examining both localised and more distant areas of the body, with a follow-up period of four weeks without stretching to observe any changes [10]. What they uncovered is notable: six weeks of consistent stretching led to a measurable decrease in pain sensitivity, not only in the stretched area but also in other, seemingly unrelated regions of the body. Remarkably, the alleviation of pain endured even after four weeks of no stretching. Put simply, the impact of stretching extended beyond localised relief, reducing pain perception in non-stretched areas as well, and this effect was retained long after the stretching had ceased.

Research consistently demonstrates that regular stretching induces a remarkable attenuation of pain sensitivity. You engage in the act of stretching, and, almost imperceptibly at first, a reduction in pain follows. This phenomenon isn’t confined to the precise muscle or joint being stretched; rather, it reverberates across the body, extending its effects to regions both proximate to and distant from the initial stretch site. This relief doesn’t dissipate quickly but instead lingers, contributing to an ongoing decrease in pain perception. What emerges here is an activation of a central, underlying mechanism. It's a physiological process that tempers pain in the immediate area and across multiple regions of the body Empirical studies support this broader connection between localised and widespread shifts in pain thresholds, pointing to a unified mechanism at play. Yet, the relief is most potent within the muscles directly involved in stretching; surrounding areas experience some relief, but to a lesser extent. In essence, while stretching triggers a far-reaching alleviation of pain, the most pronounced effect is reserved for the targeted muscles.

The relief that stretching provides is undeniable, potentially because it activates the body’s intrinsic mechanisms for alleviating discomfort. Yet, there is an intriguing and less understood dimension to this phenomenon, a mystery embedded in the nature of how our bodies handle pain. Some scientists suggest that stretching brings about a shift in our autonomic balance, toggling between the sympathetic and parasympathetic systems. They propose that this balance is influenced by the mechanical strain stretching places on the muscles, which press upon mechanosensitive receptors. This pressure, in turn, is thought to dampen the transmission of pain signals to the brain, offering an insight into why stretching feels so beneficial.

Moreover, it's been hypothesised that this shift towards parasympathetic activation may stimulate what are known as descending noradrenergic pathways, which are neural routes that traverse the central nervous system. These pathways originate in the brainstem, specifically from nuclei such as the locus coeruleus in the pons, and extend down through the spinal cord. They form a crucial part of our physiological architecture for moderating stress and discomfort, allowing us to adjust not just to physical pain but to emotionally trying experiences as well. When parasympathetic activity increases, bringing with it a sense of calm, the grip of pain loosens, offering reprieve not only to healthy individuals but to those suffering from chronic pain. Conversely, when sympathetic activation takes precedence, pain often sharpens, embedding itself with a relentless tenacity that becomes difficult to endure. The delicate balance between these systems reveals a complex interplay, hinting that our experience of pain may be as much a matter of perception as it is of sensation.

Chronic pain often stems from a phenomenon called central sensitisation, a process where repeated encounters with pain heighten the nervous system’s reactivity, rendering it more prone to excitation. In cases where an individual regularly engages in stretching, there’s a potential for the brain’s pain pathways to undergo gradual changes. This could alleviate the entrenched grip of central sensitisation, thereby easing hyperalgesia (the heightened response to pain) and reducing allodynia (pain triggered by otherwise benign stimuli). Over time, this practice of stretching could, in effect, “rewire” neural circuits involved in the perception of pain, diminishing its sting and the oppressive weight it can carry.

Key regions within the brain, including the anterior cingulate cortex (ACC) and the prefrontal cortex (PFC), are integral in this process, governing both the experience of pain and our emotional response to it. The practice of stretching has the unique potential not only to influence these areas but also to strengthen the connection between them. This reconfiguration may shift how pain is perceived and managed, reshaping the mental and emotional responses that often accompany it. The ACC and PFC guide us in interpreting the intensity of pain, enabling a refined assessment of its impact. Consistent stretching could potentially strengthen the link between these regions, allowing the brain to mitigate pain by fostering a form of mental resilience. Moreover, the insula and the primary somatosensory cortex, which handle the sensory dimensions of pain, are also involved in this transformative process. Through regular stretching, the activity in these areas may be dampened, leading to a softened perception of pain. This nuanced interaction suggests that the habitual practice of stretching recalibrates the mind’s relationship with pain, subtly shifting its contours and offering a new avenue for relief.

Stretching, over time, has shown itself to be surprisingly effective in alleviating both acute and chronic pain - not only in the muscles being actively worked but, curiously, in other areas left untouched by the stretch itself. Yet as straightforward as it may sound, using stretching as a method to combat chronic pain presents a set of paradoxical challenges. Stretching, as a process, is uncomfortable. To gain any degree of relief and freedom within the joints, you must first face the sting and resistance inherent in the stretch. It’s essentially a form of exposure therapy, gradually confronting the body with the very sensations it would rather avoid.

And here lies the catch: most people simply do not find this pleasant. Frankly, I’m no different. Though I’ve been called a steadfast advocate of static stretching, the truth is, I’m as averse to it as anyone. I don’t endorse it because I enjoy it; I endorse it because it works, and the scientific data support its efficacy. Despite this, I experience the same boredom and discomfort that comes with each session as everyone else. As someone familiar with the ongoing problems of chronic pain, inviting further discomfort seems counterintuitive. Yet, we must admit that pain tolerance, like anything else, can be trained, incrementally and methodically. We each have our unique cognitive barriers around pain and discomfort, and therefore, we need individualised strategies for cultivating flexibility, approaches we’re likely to adhere to in the long run.

Stretching to alleviate pain now competes with resistance training, a method increasingly recommended for its multitude of benefits, pain relief chief among them. Resistance training offers relief for muscle and bone discomfort, targeting areas like the neck and shoulders where tension often resides. Doing some resistance training even briefly each day can bring tangible improvements. For those enduring persistent pain, be it lower back issues, arthritic knees, or tendinitis, resistance training has shown significant promise. Animal studies even suggest that lifting weights may dull pain by activating certain receptors linked to muscle strength, offering insight into why it benefits us as it does. Yet the question remains: which method is superior, stretching or resistance training? A definitive answer still eludes us. Emerging evidence, however, underscores the potential of combining both approaches. Increasingly, coaches advocate for resistance training, noting recent findings that suggest both methods are roughly equivalent in enhancing flexibility. Resistance training, however, provides broader health advantages, leading many trainers to favour it as a strategy not only for pain relief but also for flexibility gains. Ultimately, the choice between stretching, lifting, or blending both approaches is deeply personal, resting with each of us to discover which path best aligns with our bodies and goals.

References

[1] Behm, D. et al. (2021) 'Effects of acute and chronic stretching on pain control.' Journal of Clinical Exercise Physiology, volume 10, pages 150-159

[2] Zhang, Y. et al. (2021) 'Exercise for neuropathic pain: A systematic review and expert consensus.' Frontiers in Medicine, volume 8.

[3] Ferro Moura Franco, K. et al. (2020) 'Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: A systematic review with meta-analysis.' European Journal of Pain, volume 25, pages 51-70.

[4] Herbert, R. et al. (2007) 'Stretching to prevent or reduce muscle soreness after exercise.' Cochrane Database of Systematic Reviews, Article CD004577.

[5] Støve, M. et al. (2019) 'Muscle stretching - the potential role of endogenous pain inhibitory modulation on stretch tolerance.' Scandinavian Journal of Pain, volume 19, pages 415–422.

[6] Bishop, M. & George, S. (2017) 'Pain sensitivity and torque used during measurement predicts change in range of motion at the knee.' Journal of Pain Research, volume 10, pages 2711-2716.

[7] Støve, M. et al. (2021) 'The tolerance to stretch is linked with endogenous modulation of pain.' Scandinavian Journal of Pain, volume 21, pages 355–363.

[8] Magnusson, S. et al. (1996) 'Mechanical and physical responses to stretching with and without preisometric contraction in human skeletal muscle.' Archives of Physical and Medical Rehabilitation, volume 77, pages 373-378.

[9] Støve, M. et al. (2024) 'Regional and widespread pain sensitivity decreases following stretching in both men and women – Indications of stretch-induced hypoalgesia.' Journal of Bodywork and Movement Therapies, volume 39, pages 32-37.

[10] Støve, M. et al. (2024) 'The effect of six-week regular stretching exercises on regional pain sensitivity: An experimental longitudinal study on healthy adults.' BMC Sports Science, Medicine, and Rehabilitation, volume 16, article 202.