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Landon Lempke, Rebecca Wilkinson, Caitlin Murray and Justin Stanek

Clinical Scenario: Stretching is applied for the purposes of injury prevention, increasing joint range of motion (ROM), and increasing muscle extensibility. Many researchers have investigated various methods and techniques to determine the most effective way to increase joint ROM and muscle extensibility. Despite the numerous studies conducted, controversy still remains within clinical practice and the literature regarding the best methods and techniques for stretching. Focused Clinical Question: Is proprioceptive neuromuscular facilitation (PNF) stretching more effective than static stretching for increasing hamstring muscle extensibility through increased hip ROM or increased knee extension angle (KEA) in a physically active population? Summary of Key Findings: Five studies met the inclusion criteria and were included. All 5 studies were randomized control trials examining mobility of the hamstring group. The studies measured hamstring ROM in a variety of ways. Three studies measured active KEA, 1 study measured passive KEA, and 1 study measured hip ROM via the single-leg raise test. Of the 5 studies, 1 study found greater improvements using PNF over static stretching for increasing hip flexion, and the remaining 4 studies found no significant difference between PNF stretching and static stretching in increasing muscle extensibility, active KEA, or hip ROM. Clinical Bottom Line: PNF stretching was not demonstrated to be more effective at increasing hamstring extensibility compared to static stretching. The literature reviewed suggests both are effective methods for increasing hip-flexion ROM. Strength of Recommendation: Using level 2 evidence and higher, the results show both static and PNF stretching effectively increase ROM; however, one does not appear to be more effective than the other.

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Angela Tate, Shana Harrington, Melissa Buness, Susan Murray, Caitlin Trout and Corinne Meisel

Context:

Youth- through masters-level competitive swimmers incur significant shoulder pain. Risk factors associated with shoulder pain include high swimming yardage, a lack of cross-training, decreased shoulder strength and reduced core endurance, and limited posterior shoulder and pectoral length. Since training, swimming exposure, and physical-performance measures have all been associated with shoulder pain, the methods used to train swimmers may influence the development of shoulder pain, yet studies delineating training methods are lacking.

Objectives:

To identify in-water and dry-land practices among youth- through masters-level swimmers in the United States (US) and describe the potential effects of training practices on swimmers’ shoulders.

Design:

A Web-based survey was developed to identify common training practices in 5 areas: quantification of swimming and dry-land training and in-water techniques such as kicking drills, upper-body stretching, shoulder and core strengthening, and cross-training.

Participants:

156 swim-team coaches or captains of youth, high school, and college swim teams and 196 masters swimmers participated (N = 352). There was geographic representation from across the US.

Results:

Responses indicated diverse training practices. However, most respondents used kicking drills, which may provoke shoulder pain due to prolonged poor positioning. High yardage swum by high school and college teams increases their risk of shoulder tendinopathy. Stretching and strengthening exercises and dosages commonly used were inconsistent with current research recommendations and lacked specificity in terms of addressing typical mobility restrictions and muscle weaknesses described in the swimming literature. Core strengthening and cross-training are frequently performed.

Conclusions:

Several areas of in-water and dry-land practice were identified that may put swimmers’ shoulders at risk for injury. Further research regarding the safety and efficacy of training programs is recommended to determine optimal methods of injury prevention and performance enhancement.