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Max Pietrzak and Niels B.J. Vollaard

Australian Football League players with HSI resulted in significantly faster return to play. Human in-vivo hamstring stretching studies in noninjured subjects strongly supports stretch tolerance as a primary mechanism responsible for lasting increases in hamstring extensibility utilizing intervention

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Genki Hatano, Shigeyuki Suzuki, Shingo Matsuo, Satoshi Kataura, Kazuaki Yokoi, Taizan Fukaya, Mitsuhiro Fujiwara, Yuji Asai and Masahiro Iwata

technique commonly used to acutely increase ROM. 11 – 14 The proposed mechanisms for this include an increased stretch tolerance due to altered sensation 12 , 14 , 15 and a change in the stiffness/viscoelastic properties of the muscle–tendon unit, 12 – 14 , 16 – 18 which result in improved movement and

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

. Secondary outcome measures included stretch tolerance and passive peak torque (PPT). Procedures The demographic characteristics were recorded including age, weight, and height. An experienced physiotherapist, who was blinded to the treatment given to the subjects, examined the subjects before (T0

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Masatoshi Nakamura, Tome Ikezoe, Hiroki Umegaki, Takuya Kobayashi, Satoru Nishishita and Noriaki Ichihashi

Context:

Static stretching (SS) is commonly performed in a warm-up routine to increase joint range of motion (ROM) and to decrease muscle stiffness. However, the time course of changes in ankle-dorsiflexion (DF) ROM and muscle stiffness during a routine SS program is unclear.

Objective:

To investigate changes in ankle-DF ROM, passive torque at DF ROM, and muscle stiffness during a routine SS program performed 3 times weekly for 4 wk.

Design:

A quasi-randomized controlled-trial design.

Participants:

The subjects comprised 24 male volunteers (age 23.8 ± 2.3 y, height 172.0 ± 4.3 cm, body mass 63.1 ± 4.5 kg) randomly assigned to either a group performing a 4-wk stretching program (SS group) or a control group.

Main Outcome Measures:

DF ROM, passive torque, and muscle stiffness were measured during passive ankle dorsiflexion in both groups using a dynamometer and ultrasonography once weekly during the 4-wk intervention period.

Results:

In the SS group, DF ROM and passive torque at DF ROM significantly increased after 2, 3, and 4 wk compared with the initial measurements. Muscle stiffness also decreased significantly after 3 and 4 wk in the SS group. However, there were no significant changes in the control group.

Conclusions:

Based on these results, the SS program effectively increased DF ROM and decreased muscle stiffness. Furthermore, an SS program of more than 2 wk duration effectively increased DF ROM and changed the stretch tolerance, and an SS program more than 3 wk in duration effectively decreased muscle stiffness.

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Masatoshi Nakamura, Tome Ikezoe, Takahiro Tokugawa and Noriaki Ichihashi

Context:

Hold–relax stretching (HRS) and static stretching (SS) are commonly used to increase joint range of motion (ROM) and decrease muscle stiffness. However, whether there are differences between acute effects of HRS and SS on end ROM, passive torque, and muscle stiffness is unclear. In addition, any differences between the mechanisms by which HRS and SS lead to an increase in end ROM are unclear.

Objective:

To compare the acute effects of HRS and SS on the passive properties of the gastrocnemius muscle–tendon unit (MTU), end ROM, passive torque, and muscle stiffness in vivo and to investigate the factors involved in increasing end ROM.

Design:

Crossover experimental design.

Participants:

30 healthy men (21.7 ± 1.2 y) with no history of neuromuscular disease or musculoskeletal injury involving the lower limbs.

Intervention:

Both HRS and SS of 30 s were repeated 4 times, lasting a total of 2 min.

Main Outcome Measures:

End ROM, passive torque, and muscle stiffness were measured during passive ankle dorsiflexion using a dynamometer and ultrasonography before and immediately after HRS and SS.

Results:

The results showed that end ROM and passive torque at end ROM significantly increased immediately after both HRS and SS, whereas muscle stiffness significantly decreased. In addition, the percentage change in passive torque at end ROM on use of the HRS technique was significantly higher than that after use of the SS technique. However, the percentage change in muscle stiffness after SS was significantly higher than that with HRS.

Conclusion:

These results suggest that both HRS and SS can effectively decrease muscle stiffness of the gastrocnemius MTU and that HRS induces a change in the passive torque at end ROM—ie, sensory perception—rather than changing muscle stiffness.

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Benjamin S. Killen, Krista L. Zelizney and Xin Ye

improvement has also been reported in the contralateral 19 and nonlocal muscle group 20 after unilateral stretching and SAFR 21 interventions. The currently proposed mechanism potentially responsible for this increased ROM is the increased stretch tolerance rather than neural or mechanical factors, based

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Paul W.M. Marshall, Ric Lovell and Jason C. Siegler

Purpose:

Passive muscle tension is increased after damaging eccentric exercise. Hamstring-strain injury is associated with damaging eccentric muscle actions, but no research has examined changes in hamstring passive muscle tension throughout a simulated sport activity. The authors measured hamstring passive tension throughout a 90-min simulated soccer match (SAFT90), including the warm-up period and every 15 min throughout the 90-min simulation.

Methods:

Passive hamstring tension of 15 amateur male soccer players was measured using the instrumented straight-leg-raise test. Absolute torque (Nm) and slope (Nm/°) of the recorded torque-angular position curve were used for data analysis, in addition to total leg range of motion (ROM). Players performed a 15-min prematch warm-up, then performed the SAFT90 including a 15-min halftime rest period.

Results:

Reductions in passive stiffness of 20–50° of passive hip flexion of 22.1−29.2% (P < .05) were observed after the warm-up period. During the SAFT90, passive tension increased in the latter 20% of the range of motion of 10.1−10.9% (P < .05) concomitant to a 4.5% increase in total hamstring ROM (P = .0009).

Conclusions:

The findings of this study imply that hamstring passive tension is reduced after an active warm-up that includes dynamic stretching but does not increase in a pattern suggestive of eccentric induced muscle damage during soccer-specific intermittent exercise. Hamstring ROM and passive tension increases are best explained by improved stretch tolerance.

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Robert W. Morton, Sara Y. Oikawa, Stuart M. Phillips, Michaela C. Devries and Cameron J. Mitchell

Purpose:

Self–myofascial release (SMR) is a common exercise and therapeutic modality shown to induce acute improvements in joint range of motion (ROM) and recovery; however, no long-term studies have been conducted. Static stretching (SS) is the most common method used to increase joint ROM and decrease muscle stiffness. It was hypothesized that SMR paired with SS (SMR+SS) compared with SS alone over a 4-wk intervention would yield greater improvement in knee-extension ROM and hamstring stiffness.

Methods:

19 men (22 ± 3 y) with bilateral reduced hamstring ROM had each of their legs randomly assigned to either an SMR+SS or an SS-only group. The intervention consisted of 4 repetitions of SS each for 45 s or the identical amount of SS preceded by 4 repetitions of SMR each for 60 s and was performed on the respective leg twice daily for 4 wk. Passive ROM, hamstring stiffness, rate of torque development (RTD), and maximum voluntary contraction (MVC) were assessed pre- and postintervention.

Results:

Passive ROM (P < .001), RTD, and MVC (P < .05) all increased after the intervention. Hamstring stiffness toward end-ROM was reduced postintervention (P = .02). There were no differences between the intervention groups for any variable.

Conclusion:

The addition of SMR to SS did not enhance the efficacy of SS alone. SS increases joint ROM through a combination of decreased muscle stiffness and increased stretch tolerance.

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Ulrike H. Mitchell, J. William Myrer, J. Ty Hopkins, Iain Hunter, J. Brent Feland and Sterling C. Hilton

Context:

Some researchers have suggested that an alteration of stretch perception could be responsible for the success of the contract-relax (CR) stretch, a stretch technique derived from proprioceptive neuromuscular facilitation (PNF).

Objective:

This study was conducted to determine if the alteration of the stretch perception is a possible explanation for the range of motion (ROM) gains of the CR stretch.

Participants:

Eighteen subjects performed two stretches in randomized order: the slow stretch and the CR stretch.

Main Outcome Measure:

The stretch intensity was controlled. The stretch force was measured and compared between the slow stretch and CR stretch.

Results:

There was a significant difference between the stretch force that could be applied in the PNF stretch (126.0 N) and the slow stretch (108.4 N); P = 0.00086. The average stretch tolerance progressively increased with successive trials from 120.6 N in the first trial to 132.4 N in the fourth trial.

Conclusion:

The alteration of stretch perception plays a role in the success of the CR form of PNF stretching. At least four repetitions of the CR stretch are recommended to get the greatest ROM gain.

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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.