Effectiveness of active stretching during training for injury prevention and performance enhancement in sports: A systematic review and meta-analysis

Stretching, usually done during warm-up to lengthen the musculotendinous unit, aims to reduce injuries and improve performance, but evidence for active stretching (AS) remains conflicting. This review aims to evaluate the literature assessing the effectiveness of AS, defined here as stretching techniques involving active muscle engagement by the individual, defined as stretching techniques involving voluntary muscle engagement by the individual, including both dynamic and active static stretching, in reducing injuries and enhancing performance in athletes. Randomized controlled trials (RCTs) of AS interventions, including dynamic and active static stretching, were searched in databases: PubMed, Web of Science, and SciVerse Scopus from 2015 to 2024. A meta-analysis was conducted to evaluate the impact of AS on sports performance using RevMan 5.4 software. Nine RCTs were included in this review. The ages of the athletes participating in the studies ranged from 13.5 to 27 years, with sample sizes varying from 8 to 148 across soccer, handball, volleyball, and resistance training. Individualized static stretching for tight muscles was more effective than routine exercises in reducing lower extremity and trunk injuries. The meta-analysis revealed a significant increase in maximal isometric strength (MIS) by 3.6 N (95% CI, 0.28-6.93, p = 0.01) and an increase of 1.79 cm in ankle dorsiflexion range of motion (DF ROM) in the intervention group compared to controls (95% CI, 0.85-2.73, p < 0.001). AS appears to be effective in reducing injuries and enhancing performance parameters, including MIS and ankle DF ROM, among athletes from a variety of sports disciplines.