How Does Stretching Induce Gains in Hypertrophy and Strength? • Stronger by Science

Word: This text was the MASS Analysis Evaluation cowl story for October 2023 and is a overview of a recent paper by Warneke et al. In order for you extra content material like this, subscribe to MASS.

Key Factors 

1. This overview of human and animal knowledge explored the impression of long-duration stretching on hypertrophy and power. In animals, massive and constant will increase in power and hypertrophy happen throughout species with excessive (typically steady) stretching protocols.
2. There are fewer human research for moral and logistical causes, and so they use much less excessive protocols. Whereas greater intensities, frequencies, and durations of stretching seem to trigger larger beneficial properties in people, mechanisms have solely been studied in animals. 
3. Mechanical stress is the principle proposed mechanism, however stress is multifaceted and different mechanisms could also be concerned. Stretch-induced hypertrophy can happen with out lively contraction and leads to the addition of sarcomeres (in parallel and in collection) in animals. It’s attainable that stretching may present a stimulus that’s complementary to lifting. 

After I noticed this overview (1), I obtained excited. I’ve been taken with stretch-induced hypertrophy since MASS first covered the research by Warneke and colleagues demonstrating the sturdy potential of long-duration, high-frequency static stretching to induce hypertrophy and power beneficial properties in people (2). I’ve been holding an in depth eye on this analysis group’s work ever since. I’ve reviewed essential publications like their comparability of calf stretching to calf resistance coaching (3), and I made a video on all of the analysis this group printed thus far. Consider it or not, I’ve even gone so far as getting an identical ankle orthosis that this group used and tried it on myself for 12 weeks (we’re at the moment writing a case research about it). 

As an enormous nerd and aggressive bodybuilder (and one who has struggled to make calf beneficial properties), I discover this space fascinating. The massive query in my thoughts is, how does this work? Extra particularly, are stretch-induced beneficial properties in hypertrophy and power pushed by the identical physiological mechanisms as resistance coaching, or are they totally different? In the event that they differ, are they doubtlessly complementary? These are open questions, so I used to be excited to see Warneke and colleagues try to sort out a few of them within the current paper, which helps us get nearer to understanding what’s going on with stretch-induced hypertrophy and power beneficial properties.

Goal and Hypotheses

Goal

The aim of this narrative overview was “to debate the impression of stretch-induced mechanical stress as an underlying mechanism on muscle hypertrophy and power enhancements.” 

Speculation

The authors didn’t explicitly state any hypotheses, which is frequent for narrative overview papers.

Strategies

Evaluation Kind

Whereas narrative opinions are generally positioned as a decrease type of proof in comparison with systematic opinions and meta-analyses, many narrative opinions merely serve a special objective. Systematic opinions and meta-analyses are finest suited to subjects which have a strong physique of literature reporting end result knowledge that may be systematically gathered and summarized successfully. Because of this, they’ve particular pointers for inclusion and exclusion standards, database looking out, high quality management of research, and, if a meta-analysis is carried out, the statistical strategy. For instance, a scientific overview about HMB (with or with out meta evaluation) would focus on all the related research exploring numerous outcomes of curiosity in numerous populations over time. It could doubtless acknowledge the proposed mechanisms resulting in these outcomes, however it also needs to embody a qualitative or quantitative comparability of particular outcomes in response to consuming HMB versus placebos or controls.

You’ll often come throughout a story overview that would have been a scientific overview or meta-analysis, however authors extra often write narrative opinions to debate a possible mechanism, cowl a broad or multifaceted matter, make clear methodology, or all the above. The current overview is one such instance. 

Evaluation Technique

When writing a story overview, researchers have an excessive amount of latitude when figuring out their search technique and inclusion standards. The authors described their strategy as follows: 

“As this can be a narrative overview, the authors tried to mirror the important state of the literature by performing an prolonged research search. Nevertheless, as a result of there’s a huge variety of research, particularly relating to the consequences of stretching on flexibility in people and on hypertrophy in animals, it was essential to focus the literature search, which probably led to some research lacking within the overview article. To investigate research addressing our analysis query, we began by screening latest systematic overview articles addressing the subject (4, 5, 6, 7, 8). Subsequently, associated articles and reference lists have been screened to search out articles excluded within the aforementioned systematic opinions. Moreover, solely research investigating the consequences of stretching on power or strength-related parameters, resembling peak torque, maximal voluntary contractions (eccentric, isometric, or concentric), or muscle mass-related parameters, have been thought of on this overview. For a complete overview of the literature, systematic opinions are wanted, specializing in the consequences of stretching on totally different outcomes – flexibility, maximal power and muscle hypertrophy – individually.”

Findings and Interpretation

As this was a story overview with out a particular qualitative or quantitative comparability, I’ll focus on their findings and my interpretations on this mixed part. 

Animal Findings 

First, the animal knowledge are eye-opening, for each an excellent and a nasty purpose. The nice purpose is the actually astounding magnitude of hypertrophy reported. The unhealthy purpose is that the protocols are excessive (as is commonly the case with animal analysis); I’m certain none of those animals loved them (to skip studying in regards to the protocols, go to the following paragraph). In many of the animal research the researchers hooked up a weight or utilized resistance to at least one wing of a rooster or a quail by way of a stretching equipment. Generally, 10-35% of the wing’s weight was used and the non-weighted wing was used because the comparator. Intermittent protocols have been utilized in some instances (as brief as two rounds of quarter-hour of stretching per day), however normally the wing was weighted repeatedly (24 hours a day) for so long as 5 weeks straight. 

The authors reported the findings of all of the animal stretching research within the current narrative overview in a extremely huge, three-page desk. However, additionally they printed a meta-analysis on hypertrophy final 12 months (6) on simply the 16 highest high quality animal research which met their inclusion standards, which is much simpler to summarize. In that meta-analysis they reported will increase in muscle fiber cross-sectional space as excessive as +141.6%, will increase in fiber variety of as much as +82.2% (indicating hyperplasia), and will increase in fiber size as excessive as +50% in rooster and quails, following interventions lasting now not than 5 weeks! 

To place this in perspective, Tables 1 and a couple of show the forest plots from that meta-analysis for each the muscle- and fiber-level hypertrophy knowledge exhibiting the standardized imply adjustments in stretched wings relative to regulate wings. As a reminder, standardized imply variations are the impact dimension generally reported in meta-analysis and signify proportional will increase in a imply relative to their customary deviation. So, if a complement was related to an impact dimension of 0.3 for 1RM power, the typical 1RM enhance after supplementation was about 30% of the pre-study customary deviation. Additional, 0.2 is the brink that researchers typically use to separate a “small” impact from a trivial one, and an impact dimension of 0.8 or greater is usually thought of “massive.” You’ll see standardized imply distinction values starting from 4.62 to eight.55 in Tables 1 and a couple of. At first look, it seems that stretching protocols routinely produced impact sizes 5-10x larger than the standard threshold for a “massive” impact dimension. Nevertheless, Dr. Trexler spot-checked a number of the unique research to confirm the impact dimension calculations. Whereas he solely checked just a few, all the impact sizes he spot-checked have been calculated utilizing customary error values as an alternative of normal deviations, which dramatically inflates the impact dimension metric. We must always take the calculated values in these tables with a giant grain of salt, however the uncooked values and p.c change values clearly inform us that the impact sizes have been very substantial nonetheless (certainly, as will likely be mentioned, the will increase in muscle dimension are roughly 10-fold what’s been noticed in people).

Whereas these findings are bonkers, the human knowledge are promising however much less excessive in magnitude. It’s because the applicability of animal knowledge to people is all the time restricted. For one, any time you evaluate two totally different species (like people and birds) you must anticipate totally different responses as a result of…nicely, they’re totally different species. Secondly, the moral constraints for stretching protocols allowed in animal research are far more liberal than the moral constraints governing human research. Thus, human trials merely can’t replicate the intervention or the identical stimulus normally, and it’s additionally tougher to precisely measure adjustments in hypertrophy (animal research will be extra exact, because the precise mass tissue is commonly weighted post-intervention). Within the current instance, each limitations apply: these birds have been doing much more excessive stretching protocols than people would ever (willingly) do. 

To cross the species hole a little bit, we will have a look at the findings in non-human mammals. This space consists of simply 4 stretching research in rabbits and rats (9, 10, 11, 12), the place just like the human knowledge, the protocols consisted of intermittent stretching. Maybe unsurprisingly, the findings are extra much like the human knowledge, with smaller magnitudes of change which have been solely noticed when extra frequent stretching occurred. Particularly, two of the 4 research reported vital hypertrophy, one doing intermittent day by day stretches in rats for 3 weeks (12) and the opposite stretching rabbits 3 times per week for 4 weeks reporting the very best muscle mass enhance in non-human mammals of +13.4% (9). 

Human Findings

I needed to go over the animal knowledge first, even though we’ve got human knowledge, as a result of the findings are simply so loopy. The easy magnitudes of hypertrophy reported within the animal analysis give purpose to why this matter is value exploring in people. Additional, as we’ll focus on in a bit, the findings additionally push again towards a number of the reductionist statements about stretch-induced hypertrophy mechanisms I’ve seen (extra on that to come back). This part will likely be transient, as a result of we’ve already coated these knowledge in MASS (Research Brief; video). 

Whereas the primary human stretching analysis was performed many years in the past, the primary systematic overview on the subject of stretching to induce hypertrophy in people was printed in 2020 (4). Notably, the reviewed research’ protocols have been largely short-term, low-intensity, and short-duration in nature, with the longest particular person stretching bouts lasting 4.5 minutes, and the very best quantity being 36 minutes of stretching per week. The authors of this systematic overview concluded that “passive, low-intensity stretch doesn’t seem to confer helpful adjustments in muscle dimension and structure; alternatively, albeit restricted proof means that when stretching is finished with a sure diploma of tensile pressure (significantly when loaded, or added between lively muscle contractions) could elicit muscle hypertrophy.” 

In 2022 and 2023, the primary human research utilizing longer-duration, higher-frequency, higher-intensity protocols resembling a number of the much less excessive (however nonetheless efficient) animal protocols have been printed by the authors of the current overview, on the identical muscle group (the calves), utilizing the identical protocol of day by day stretching with a calf orthosis for an hour per day for as much as six weeks in all however two instances, and at an 8/10 stretch ache tolerance. Whereas I need to deal with mechanisms, I summarized these findings in a Quantity 7 video in Subject 2 and a Research Brief in Subject 5. For comfort, I’ll restate the principle findings right here:

• Power: +6.2-14.2% following 1hr/day orthosis stretching and +22.3% within the one 2hr/day research, and +10.5% within the one research utilizing a calf board 10min/day, in six weeks. 
• Muscle thickness: +4.5-15.2% following 1hr/day orthosis stretching for six weeks, with bigger will increase amongst males and within the medial versus lateral gastrocnemius. 

Whereas the information earlier than this level have been unimpressive, these findings are in line with the non-human mammal knowledge, fairly spectacular, and truly akin to what’s been noticed in resistance coaching trials of an identical size within the calves. The notable variations of the latest stretching knowledge in comparison with resistance coaching, are for one, that in contrast to in resistance coaching trials (13), in response to stretching ladies appear to reply proportionally much less in magnitude for each power and hypertrophy, doubtless as a result of at baseline ladies are extra versatile on common, so the mechanical stress from stretching is decrease (14). Moreover, as I discussed, 7 hours of steady, painful stretching per week is much much less logistically possible than doing 45 minutes of whole calf coaching per week (three days of 5 units of 10-12 reps to failure) to get a comparable magnitude of hypertrophy or power change (3). Thus, for most individuals, stepping into the weeds on this matter might be not value it. The one purpose one would possibly contemplate participating in such an excessive protocol is that if they 1) had an excessive aim (say, aggressive bodybuilding) and if 2) stretching seems to be a doubtlessly complementary stimulus to resistance coaching based mostly on its mechanism(s) of motion.   

Mechanical Rigidity as a Mechanism

Now that we’ve gone by way of the findings, let’s discuss in regards to the proposed main mechanism of stretch-induced hypertrophy: mechanical stress. Studying that mechanical stress is the proposed main mechanism might need simply taken the wind out of your sails in case you have been hoping that resistance coaching and stretching would have totally different main mechanisms. Nevertheless, mechanical stress isn’t just one factor. Nowadays, “mechanical stress” will get thrown round rather a lot in evidence-based circles when discussing hypertrophy mechanisms, however generally I’m wondering if everybody actually understands what that truly means. So, to begin, let’s get into the weeds a bit on what precisely mechanical stress is.

Mechanical stress is normally induced with resistance coaching (however will also be induced with stretching) which stimulates the underlying mobile signaling pathways to boost protein synthesis, leading to muscle hypertrophy (15). This happens by way of mechanotransduction, the method of an exterior bodily stimuli (resembling stress) being sensed by mechanosensors (of which there are a lot of sorts within the physique which sense numerous exterior stimuli) in a (muscle) cell that are then translated into biochemical alerts – on this case anabolic and anti-catabolic alerts which management muscle protein steadiness and thus, the corresponding web protein synthesis price (16). The related mechanosensors to muscular adaptation are diverse and positioned at a number of websites in skeletal muscle. Particular sensors are higher positioned and suited to sensing passive (stretch) and lively (contractile) forces. It’s not absolutely clear which mechanosensors are most impacted by totally different coaching modalities (stretching versus resistance coaching, concentric versus eccentric muscle actions, and so forth.), how every mechanosensor influences mobile signaling in response to drive sensing, and the diploma to which every impacts downstream adaptation. With that mentioned, a lot of potential mechanosensors that could be concerned in stimulating muscular adaptation in response to mechanical stress have been recognized and proposed. 

Costameres, for instance (17), are protein assemblies positioned beneath the sarcolemma which hyperlink the extracellular matrix to the contractile part of muscle fibers (Determine 1). Costameres transmit contractile drive laterally throughout muscle fibers to the extracellular matrix and are additionally proposed to sense compression forces, like muscle swelling, in addition to adjustments within the stiffness of the extracellular matrix in response to coaching, doubtlessly resulting in the activation of anabolic signaling pathways (15, 18). 

Titin, the biggest protein within the human physique, is one other proposed mechanosensor with elastic properties (Determine 2). It connects the z-disk (the anchoring plate for actin filaments within the sarcomere) to the central m-line (the attachment level for myosin) and serves the useful function of offering elasticity to muscle on the sarcomere degree, appearing as a “molecular spring,” producing passive drive when stretched (20). Titin truly goes slack throughout concentric contractions, however at lengthy muscle lengths it stretches and unfolds, doubtlessly activating anabolic signaling cascades (15).

Filamins are one other class of proteins that act as mechanosensors, with filamin-c particularly positioned on the z-disk. This v-shaped, hinge-like protein cross hyperlinks actin filaments and deforms throughout contraction (22). Such deformation is assumed to provoke signaling that would result in hypertrophy (15). One other intriguing discovering is that myonuclei themselves could act as mechanosensors (23). As myonuclei flatten and deform in response to muscle stretch, the protein desmin positioned beneath the sarcolemma acts as a mechanosensor detecting nuclear deformation (24), which can result in downstream anabolic signaling (18). Lastly, stretch-activated ion channels are one other mechanosensor positioned within the membrane of muscle cells. These gate-like buildings reply to stretch, which might happen attributable to eccentric contraction or muscle stretching, permitting ions to move into the cell, doubtlessly leading to signaling cascades associated to muscle harm and hypertrophy (18, 25). Thus, as proven in Determine 3, a number of mechanosensors could possibly sense and reply to muscle stretching (a few of them can also sense and reply to dynamic contraction) doubtlessly resulting in hypertrophic signaling.   

As soon as stress is sensed, hypertrophic signaling pathways are activated, a number of of which have been recognized (e.g., mTOR/p70s6K/PI3K) and all of that are extremely advanced, contain anabolic and/or anti-catabolic cascades, and are doubtless not absolutely elucidated. Additional, there could also be different pathways (and mechanosensors) not but recognized (15, 26).

Thus, at the same time as a main mechanism, it’s essential to grasp that mechanical stress will not be a singular idea. Totally different types of mechanical stress will be sensed by totally different mechanosensors and should result in totally different diversifications. Certainly, one scorching take I’ve seen on the web is that stretching will solely enhance the variety of sarcomeres in collection, however not in parallel. The declare posits that rising sarcomeres in collection is unlikely to meaningfully impression muscle thickness or cross-sectional space, thus having a minimal or negligible impression on the looks of bigger muscular tissues. Earlier than refuting this declare, it’s essential to notice that molecular-level adjustments (e.g., measuring sarcomere adjustments in parallel or collection) are hardly ever measured in human research and haven’t been particularly measured in people in response to high-intensity, long-duration, and high-frequency stretching protocols. So, any definitive assertion on this matter is arguably untimely, because it’s essentially based mostly on animal knowledge or oblique human knowledge. 

However, let me take a step again to make sure I didn’t lose anybody. Sarcomeres are the useful, molecular-level items of muscle fibers. Sarcomeres are the place actin-myosin cross bridging happens and drive is produced. A muscle fiber is made up of hundreds of sarcomeres. When a muscle fiber grows it’s largely because of the addition of extra sarcomeres. Sarcomeres will be added subsequent to at least one one other, in parallel, or finish to finish, in collection. Hypertrophy by way of the addition of sarcomeres in collection is highest in response to stretch overload (as has been reported within the aforementioned animal research) in addition to eccentric coaching (offering overload whereas a muscle elongates). Importantly, muscular tissues produce extra drive when extra actin-myosin cross bridges can type, and thus, including sarcomeres in collection permits extra cross bridges to type at longer muscle lengths (27). Subsequently, the addition of sarcomeres in collection is a logical, useful adaptation in response to eccentric coaching or stretching, because it permits the muscle to higher resist elongation and produce drive when in a stretched place. Nevertheless, this doesn’t imply that hypertrophy in response to stretching solely consists of will increase within the variety of sarcomeres in collection. Certainly, whereas the muscle fiber size will increase in Desk 2 are large, so are the entire muscle and particular person muscle fiber cross-sectional will increase in Desk 1 and a couple of, respectively, indicating the sturdy addition of sarcomeres in parallel as nicely. Additional, going all the way in which again to the 1970’s, there are knowledge exhibiting that stretching can produce hypertrophy by way of will increase within the variety of sarcomeres in collection and in parallel. Intriguingly, this was documented in an animal mannequin the place the muscle was denervated (lower off from the nerve) to forestall lively contraction from doubtlessly inflicting the addition of sarcomeres in parallel (28).

As a ultimate be aware, adaptation within the human physique is commonly the consequence of a number of, advanced, generally redundant, typically complementary processes borne out of hundreds of thousands of years of evolution. Whereas it’s psychologically satisfying to search out the mechanism, as a rule there are a number of mechanisms, with one mechanism at finest being main. Certainly, along with the first mechanism of mechanical stress, the authors of the current overview famous that hypoxia could play a job in stretch-induced hypertrophy. In a single animal research, researchers assessed microvasculature adjustments in rat soleus muscle in response to a stretching protocol (29). The researchers famous that stretching induced greater levels of hypoxia and elevated the variety of microvascular connections and microvascular quantity of the rat soleus, attributable to each the extended deformation of blood vessels throughout stretch, in addition to ischemia (albeit to a lesser diploma). The authors of the current article concluded their overview by stating: “Given the totally different parameters influencing muscle morphology, additional components resembling hypoxia, fascial tissue in addition to neuronal mechanisms must be included in additional analysis to maximise potential indicated results.”

Subsequent Steps

I’ve mentioned the following steps relating to the purposes of stretch-induced hypertrophy beforehand. Try the final paragraph here. Finally, we’d like utilized analysis to see if stretching is additive or redundant to resistance coaching. Nevertheless, there are totally different subsequent steps if we need to uncover the underlying mechanisms as to how stretch-induced hypertrophy happens, which might inform us if it operates in a different way to resistance coaching induced hypertrophy. Future work must be achieved particularly wanting on the fiber- and molecular-level diversifications to stretching in comparison with resistance coaching. Does stretching end in conversion to slower muscle phenotypes than resistance coaching in people? Does stretching enhance muscle fascicle size by way of longer resting sarcomere lengths, or do precise will increase in sarcomeres in collection happen in people? How a lot ischemia happens within the stretching protocols which might be possible in people, and the way does this evaluate to resistance coaching? Additional, how does it evaluate to BFR and might we assess how a lot it contributes to the noticed hypertrophy? These are all open questions {that a} lowly utilized researcher like myself can’t reply, however would like to see answered.

Utility and Takeaways

If knowledge in birds are thought to have any relevance to people, large hypertrophy potential is feasible with long-duration, high-intensity, and high-frequency stretching. Certainly, in people, there’s a dose-response relationship between hypertrophy and power beneficial properties and the time and depth devoted to stretching. The first mechanism for these diversifications might be mechanical stress, however not essentially the identical kind of mechanical stress that happens throughout resistance coaching. Notably, these outcomes are all reported by the identical lab that has solely studied the calf musculature. The beneficial properties are akin to resistance coaching, however could require a painful and impractical hour of day by day stretching with an orthosis to attain. For some, that could be value it, however earlier than you dedicate your self to doing so, I’d advise ready till we perceive what’s happening mechanistically.

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References

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