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Nathaly Gaudreault, Alex Fuentes, Neila Mezghani, Virginie O. Gauthier and Katia Turcot

Context:

Decreased flexibility in muscles and joints of lower extremities is commonly observed in runners. Understanding the effect of decreased flexibility on knee walking kinematics in runners is important because, over time, altered gait patterns can make runners vulnerable to overuse injuries or degenerative pathologies.

Objectives:

To compare hamstring and iliotibial-band (ITB) flexibility and knee kinematics in runners and nonrunners.

Design:

A descriptive, comparative laboratory study.

Setting:

Hamstring and ITB flexibility were measured with the active knee-extension test and the modified Ober test, respectively, in both groups of participants. Three-dimensional (3D) walking kinematic data were then recorded at the knee using a motiontracking system.

Participants:

18 runners and 16 nonrunners.

Main Outcome Measures:

Knee-extension angle (hamstring flexibility) and hip-adduction angle (ITB flexibility). Knee kinematic parameters of interest included knee angle at initial contact, peak knee angles, and knee-angle range in all planes of movement.

Results:

The runners had a significantly less flexible ITB than the nonrunners (hip adduction [−] and adduction [+] angles, 3.1° ± 5.6° vs −6.4° ± 4.5°; P < .001). The runners demonstrated a greater mean tibial external-rotation angle at initial contact (7.3° ± 5.8° vs 2.0° ± 4.0°; P = .01) and a smaller mean peak tibial internal-rotation angle (−1.6° ± 3.0° vs −4.2° ± 3.2°; P = .04) than the nonrunners.

Conclusion:

This study provides new insight into the relationship between muscle flexibility and 3D knee kinematics in runners. This supports the premise that there is an association between muscle flexibility and transverse-plane knee kinematics in this population.

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Kosuke Fujita, Masatoshi Nakamura, Hiroki Umegaki, Takuya Kobayashi, Satoru Nishishita, Hiroki Tanaka, Satoko Ibuki and Noriaki Ichihashi

The effect of thermal agents on muscle flexibility has been well studied using various methods of heat interventions. 1 – 6 Most of these studies have supported the use of heat intervention for increasing range of motion (ROM). 1 , 2 , 5 , 7 A recent review of research with human participants has

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Teddy W. Worrell, Michael K. Sullivan and Joseph J. DeJulia

This study examined the intratester and intertester reliability of an active-knee-extension test (AKET) for determining hamstring muscle length (flexibility). Three testers performed repeated AKET measurements on 22 subjects. Intraclass correlation coefficients (ICC were used to calculate intratester and intertester reliability. Also, standard error of measurements (SEM) were calculated. The ICC and SEM were .96 and 1.82°, respectively, for Tester 1, .99 and 1.75° for Tester 2, and .99 and 1.80° for Tester 3. Intratester 95% confidence intervals ranged from 60.54 to 69.82°. Intertester ICC and SEM for two testers were .93 and 4.81°, respectively. A 95% intertester confidence interval ranged from 56.35 to 75.21 °; this reveals that intertester AKET values contained more error and suggests that only intratester AKET values should be used when comparing hamstring flexibility values. The AKET may provide a more accurate method for determining hamstring flexibility and quantifying changes that occur as a result of injury and stretching procedures.

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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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Che-Hsiu Chen, Trevor C. Chen, Mei-Hwa Jan and Jiu-Jenq Lin

Objectives:

To examine whether an acute bout of active or dynamic hamstring-stretching exercises would reduce the amount of muscle damage observed after a strenuous eccentric task and to determine whether the stretching protocols elicit similar responses.

Design:

A randomized controlled clinical trial.

Methods:

Thirty-six young male students performed 5 min of jogging as a warm-up and were allocated to 1 of 3 groups: 3 min of static active stretching (SAS), 3 min of dynamic active stretching (DAS), or control (CON). All subjects performed eccentric exercise immediately after stretching. Heart rate, core temperature, maximal voluntary isometric contraction, passive hip flexion, passive hamstring stiffness (PHS), plasma creatine kinase activity, and myoglobin were recorded at prestretching, at poststretching, and every day after the eccentric exercises for 5 d.

Results:

After stretching, the change in hip flexion was significantly higher in the SAS (5°) and DAS (10.8°) groups than in the CON (–4.1°) group. The change in PHS was significantly higher in the DAS (5.6%) group than in the CON (–5.7%) and SAS (–6.7%) groups. Furthermore, changes in muscle-damage markers were smaller in the SAS group than in the DAS and CON groups.

Conclusions:

Prior active stretching could be useful for attenuating the symptoms of muscle damage after eccentric exercise. SAS is recommended over DAS as a stretching protocol in terms of strength, hamstring range of motion, and damage markers.

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Noureddin Nakhostin Ansari, Parisa Alaei, Soofia Naghdi, Zahra Fakhari, Shiva Komesh and Jan Dommerholt

. Routinely, physiotherapists use stretching techniques to prevent contractures and increase muscle flexibility. 7 , 8 Although hamstring stretching is regularly included in exercise programs and as an appropriate strategy for the prevention and the treatment of hamstring length deficits, there are

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Sheri A. Hale

Objective:

To review the etiology of patellar tendinopathy as it relates to clinical management of chronic patellar-tendon disease in athletes.

Data Sources:

Information was gathered from a MEDLINE search of literature in English using the key words patellar tendinitis, patellar tendonitis, patellar tendinosis, patellar tendinopathy, and jumper’s knee.

Study Selection:

All relevant peer-reviewed literature in English was reviewed.

Data Synthesis:

The etiology of patellar tendinopathy is multifactorial, incorporating both intrinsic and extrinsic factors. Age, muscle flexibility, training program, and knee-joint dynamics have all been associated with patellar tendinopathy. The roles of gender, body morphology, and patellar mobility in patellar tendinopathy are unclear.

Conclusions:

The pathoetiology of patellar tendinopathy is a complex process that results from both an inflammatory response and degenerative changes. There is a tremendous need for research to improve our understanding of the pathoetiology of patellar tendinopathy and its clinical management.

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Tarik Ozmen, Mert Aydogmus, Hanife Dogan, Derya Acar, Tuba Zoroglu and Mark Willems

Context:

Kinesio taping (KT) is a taping technique extensively used in rehabilitation of sports injuries; however, the effect of KT on delayed-onset muscle soreness is not entirely clear.

Objectives:

To investigate the effect of kinesio tape on the quadriceps femoris on muscle pain, flexibility, and sprint performance after squat exercise.

Design:

Crossover study.

Setting:

University research laboratory.

Participants:

19 female university students (age 21.0 ± 1.2 y, weight 53.0 ± 4.6 kg, height 164 ± 4 cm).

Main Outcome Measures:

Pressure-pain threshold for quadriceps femoris was recorded using pressure algometry. Quadriceps femoris flexibility was measured as the range of motion of knee flexion with a stainless steel goniometer. Sprint-speed measurements were conducted using photocells placed at 0 and 20 m. All participants completed both conditions (KT application and no KT application) after a 1-wk washout period. Measurements were taken at baseline and 48 h postexercise. For the KT condition, KT was applied immediately before the exercise protocol and remained on the skin for 48 h.

Results:

Squat exercise reduced flexibility and increased pain and sprint time compared with baseline. KT application resulted in similar sprint time and muscle pain as the no-KT condition but maintained flexibility compared with baseline.

Conclusions:

KT application immediately before squat exercise has no effect on muscle pain and short sprint performance but maintains muscle flexibility at 2 days of recovery.

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Bradley T. Hayes, Rod A. Harter, Jeffrey J. Widrick, Daniel P. Williams, Mark A. Hoffman and Charlie A. Hicks-Little

Context:

Static stretching is commonly used during the treatment and rehabilitation of orthopedic injuries to increase joint range of motion (ROM) and muscle flexibility. Understanding the physiological adaptations that occur in the neuromuscular system as a result of long-term stretching may provide insight into the mechanisms responsible for changes in flexibility.

Objective:

To examine possible neurological origins and adaptations in the Ia-reflex pathway that allow for increases in flexibility in ankle ROM, by evaluating the reduction in the synaptic transmission of Ia afferents to the motoneuron pool.

Design:

Repeated-measures, case-controlled study.

Setting:

Sports medicine research laboratory.

Participants:

40 healthy volunteers with no history of cognitive impairment, neurological impairment, or lower extremity surgery or injury within the previous 12 mo.

Intervention:

Presynaptic and postsynaptic mechanisms were evaluated with a chronic stretching protocol. Twenty subjects stretched 5 times a wk for 6 wk. All subjects were measured at baseline, 3 wk, and 6 wk.

Main Outcome Measures:

Ankle-dorsiflexion ROM, Hmax:Mmax, presynaptic inhibition, and disynaptic reciprocal inhibition.

Results:

Only ROM had a significant interaction between group and time, whereas the other dependent variables did not show significant differences. The experimental group had significantly improved ROM from baseline to 3 wk (mean 6.2 ± 0.9, P < .001), 3 wk to 6 wk (mean 5.0 ± 0.8, P < .001), and baseline to 6 wk (mean 11.2 ±0.9, P < .001).

Conclusions:

Ankle dorsiflexion increased by 42.25% after 6 wk of static stretching, but no significant neurological changes resulted at any point of the study, contrasting current literature. Significant neuromuscular origins of adaptation do not exist in the Ia-reflex-pathway components after a long-term stretching program as currently understood. Thus, any increases in flexibility are the result of other factors, potentially mechanical changes or stretch tolerance.

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Whitney Williams and Noelle M. Selkow

.1123/jsr.17.4.432 19160916 24. Stecco C , Schleip R . A fascia and the fascial system . J Bodyw Mov Ther . 2016 ; 20 ( 1 ): 139 – 140 . PubMed ID: 26891649 doi: 10.1016/j.jbmt.2015.11.012 26891649 25. Kalichman L , Ben David C . Effect of self-myofascial release on myofascial pain, muscle