Reproducibility and criterion-related validity of the sit and reach test and toe touch test for estimating hamstring flexibility in recreationally active young adults

Balance highly influences flexibility measured by the toe-touch test

Flexibility evaluation is a standard assessment in clinical and in sports settings. The Toe-touch test (TTT) is a common assessment tool to evaluate posterior muscular chain flexibility, but the test procedure implies a balance demand. The objective of the study was to verify the hypothesis that the balance demand during the TTT may affect the flexibility measured by the test. Twenty healthy, active young adults participated in the present study. Toe-touch test outcome (the linear finger to toe distance), Center of Pressure (CP) and sagittal plane joint angles were compared under two balance conditions: (1) standard TTT (ST) and (2) minimised postural demand (MPD) during TTT (using a device that restrained the participant against a forward fall). Then, ST was re-tested to verify a possible effect of motor learning on TTT outcome. Compared to ST, MPD showed an improvement of 73% in test outcome, greater flexion of the ankle, greater total body flexion, and a forward displacement of the CP. Re-test of ST showed indications of motor learning with a different balance strategy compared to the first trial in the same condition. The test outcome showed significant negative correlations with CP position in ST (weak correlation), in the re-test (strong correlation) and when the conditions were combined (moderate correlation). In conclusion, TTT outcome was highly affected by balance performance. Maximum range of motion during ST was a fraction of the range obtained when balance demand was minimized.

Comparison of a 12-Week Whole-Body Exergaming Program on Young Adults: Differentiation in Flexibility, Muscle Strength, Reaction Time, and Walking Speed Between Sexes

This study aimed to investigate the effects of exergaming on flexibility, muscle strength, reaction time, and walking speed of adults within sex differences. Fifty-four individuals participated in a 12-week exergaming program. Three 30-min sessions were conducted each week. Baseline and post-intervention assessments were done using the sit-and-reach and bend-over tests for flexibility, hand-held dynamometer for muscle strength, auditory and visual reaction time machine for reaction time, and 5-meter walk test for walking speed. There were no significant changes in the sit-and-reach, bend-over test, and auditory-visual reaction time for either gender ( p > .05) with the intervention. Walking speed and muscle strength improved after exergaming in both sexes ( p < .05). The study showed that the video gaming intervention led to significant and equal improvements in muscle strength and walking speed for both sexes; however, it had no impact on flexibility and auditory-visual reaction time.

Four Weeks of Nordic Hamstring Exercise Reduce Muscle Injury Risk Factors in Young Adults

Ribeiro-Alvares, JB, Marques, VB, Vaz, MA, and Baroni, BM. Four weeks of Nordic hamstring exercise reduce muscle injury risk factors in young adults. J Strength Cond Res 32(5): 1254-1262, 2018-The Nordic hamstring exercise (NHE) is a field-based exercise designed for knee-flexor eccentric strengthening, aimed at prevention of muscle strains. However, possible effects of NHE programs on other hamstring injury risk factors remain unclear. The purpose of this study was to investigate the effects of a NHE training program on multiple hamstring injury risk factors. Twenty physically active young adults were allocated into 2 equal-sized groups: control group (CG) and training group (TG). The TG was engaged in a 4-week NHE program, twice a week, 3 sets of 6-10 repetitions; while CG received no exercise intervention. The knee flexor and extensor strength were assessed through isokinetic dynamometry, the biceps femoris long head muscle architecture through ultrasound images, and the hamstring flexibility through sit-and-reach test. The results showed that CG subjects had no significant change in any outcome. TG presented higher percent changes than CG for hamstring isometric peak torque (9%; effect size [ES] = 0.27), eccentric peak torque (13%; ES = 0.60), eccentric work (18%; ES = 0.86), and functional hamstring-to-quadriceps torque ratio (13%; ES = 0.80). The NHE program led also to increased fascicle length (22%; ES = 2.77) and reduced pennation angle (-17%; ES = 1.27) in biceps femoris long head of the TG, without significant changes on muscle thickness. In conclusion, a short-term NHE training program (4 weeks; 8 training sessions) counteracts multiple hamstring injury risk factors in physically active young adults.

Effectiveness of low-frequency electrical stimulation in proprioceptive neuromuscular facilitation techniques in healthy males: a randomized controlled trial

BACKGROUND

Hamstring muscle injuries are common in the sports field, with lack of hamstring flexibility being a risk factor. Stretching the hamstring muscles is an important part of the training and rehabilitation programs used to prevent or treat injury and improve performance. We aim to compare the immediate and follow-up effect on hamstring muscle flexibility between 2 different stretching protocols, proprioceptive neuromuscular facilitation (PNF) stretching and PNF stretching combined with electrostimulation. A second aim is to determine whether physical activity level is related to flexibility.

METHODS

Design of study: Single-blind, randomized controlled trial; Participants: 30 healthy volunteers (30 men, 18-39 years old); Intervention: A 6-session intervention program spanning over 2 weeks and 1-week and 3-week follow-up. The control group underwent PNF stretching with a voluntary contraction. The experimental group underwent PNF stretching but the muscle contraction was triggered with an electrical stimulation device (TENS); Main outcome measu: Hamstring muscles flexibility was assessed using the Modified Sit and Reach (MSR) and the Back Saver Sit and Reach (BSSR) tests. Physical activity level was evaluated with the short form of the International Physical Activity Questionnaire (IPAQ).

RESULTS

Both groups showed an overall increase in hamstring muscle flexibility. However, when comparing flexibility gain between baseline and the end of the stretching program (session 6), and at the 1-week and 3-week follow-ups, only the experimental group showed significant differences. No correlation between the IPAQ score and the degree of hamstring muscle flexibility was observed.

CONCLUSIONS

Hamstring muscle PNF stretching combined with electrical stimulation to trigger muscle contraction during the muscle contraction phase of the stretch achieves better flexibility results when compared to PNF alone.

Evaluation of Fitness and the Balance Levels of Children with a Diagnosis of Juvenile Idiopathic Arthritis: A Pilot Study

Background: Juvenile idiopathic arthritis is a main cause of physical disability and has high economic costs for society. The purpose of this study was to assess the fitness levels and the postural and balance deficits with a specific test battery. Methods: Fifty-six subjects were enrolled in this study. Thirty-nine healthy subjects were included in the control group and seventeen in the juvenile idiopathic arthritis group. All subjects were evaluated using a posturography system. The fitness level was evaluated with a battery of tests (Abalakov test, sit-up test, hand grip test, backsaver sit and reach, the toe touch test). An unpaired t-test was used to determine differences. Pearson’s correlation coefficient was used to evaluate the correlation between the tests. Results: The battery of tests demonstrated that subjects in the juvenile idiopathic arthritis group have lower fitness levels compared to the control group. The juvenile idiopathic arthritis group showed low postural control with respect to the control group. Pearson analysis of the juvenile idiopathic arthritis group data showed significant correlations between variables. Pearson’s results from the control group data showed a similar trend. Conclusions: The results suggest that the battery of tests used could be an appropriate tool. However, we highlight that these conclusions need to be supported by other studies with a larger population scale.

Immediate and Short-Term Effects of Kinesio Taping Tightness in Mechanical Low Back Pain: A Randomized Controlled Trial

BACKGROUND

There is controversy regarding the best technique for applying Kinesio Taping (KT), and the theory supporting that skin convolutions may explain its efficacy has recently been challenged.

OBJECTIVE

To compare the immediate and short-term effectiveness of KT tightness on mechanosensitivity and spinal mobility in nonspecific low back pain (LBP), and to observe the influence of gender in the outcome measures.

DESIGN

Double-blind, randomized, controlled trial.

SETTING

University-based clinical research center.

PARTICIPANTS

A total of 75 individuals with a mean age of 33 years (±7.4 years), 60% female and 40% male, with nonspecific LBP were recruited and randomly assigned to 1 of the following study groups: standard KT tension (n = 26), increased KT tension (n = 25), and no KT tension (n = 24).

INTERVENTIONS

All participants received a two I-strip taping over the paravertebral muscles for 24 hours. Paper-off tension (15%-25% of the available stretch) was used in the standard KT group, which was increased to 40% in the increased KT tension group. The rest of participants received a taping procedure with no KT tension. Measurements were taken at baseline, immediately after the taping, 24 hours after the taping, and after KT removal.

MAIN OUTCOME MEASURES

The primary outcome included pressure pain thresholds over the erector spinae and gluteus medius muscles. The secondary outcome was lumbar mobility (assessed with a digital inclinometer, and back-saver sit-and-reach, finger-to-floor, and sit-and-reach tests).

RESULTS

In the between-groups analysis of the mean score changes after baseline assessment, no significant differences were found for any of the outcome measures (P > .05) except the left back-saver sit-and-reach test (P = .03). A statistically significant interaction group × gender × time was observed only for mechanosensitivity values (P = .02 for the gluteus and P = .01 for the erector spinae).

CONCLUSION

KT tightness does not seem to influence pain sensitivity and lumbar mobility in chronic LBP in either the immediate or short term.

LEVEL OF EVIDENCE

II.

No Relationship Between Hamstring Flexibility and Hamstring Injuries in Male Amateur Soccer Players: A Prospective Study

BACKGROUND

In soccer, although hamstring flexibility is thought to play a major role in preventing hamstring injuries, the relationship between hamstring flexibility and hamstring injuries remains unclear.

PURPOSE

To investigate the relationship between hamstring flexibility and hamstring injuries in male amateur soccer players.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

This study included 450 male first-class amateur soccer players (mean age, 24.5 years). Hamstring flexibility was measured by performing the sit-and-reach test (SRT). The relationship between hamstring flexibility and the occurrence of hamstring injuries in the following year, while adjusting for the possible confounding effects of age and previous hamstring injuries, was determined with a multivariate logistic regression analysis.

RESULTS

Of the 450 soccer players, 21.8% reported a hamstring injury in the previous year. The mean (±SD) baseline score for the SRT was 21.2 ± 9.2 cm. During the 1-year follow-up period, 23 participants (5.1%) suffered a hamstring injury. In the multivariate analysis, while adjusting for age and previous injuries, no significant relationship was found between hamstring flexibility and hamstring injuries ( P = .493).

CONCLUSION

In this group of soccer players, hamstring flexibility (measured with the SRT) was not related to hamstring injuries. Age and previous hamstring injuries as possible confounders did not appear to influence this relationship. Other etiological factors need to be examined to further elucidate the mechanism of hamstring injuries.

Hamstring-and-Lower-Back Flexibility in Male Amateur Soccer Players

OBJECTIVE

This study investigated the hamstring-and-lower-back flexibility (HLBF) of male adult amateur soccer players, using the sit-and-reach test (SRT), with a view to obtaining population-based reference values and to determining whether SRT scores are associated with player characteristics.

DESIGN

Cross-sectional cohort study.

SETTING

Teams from high-level Dutch amateur soccer competitions were recruited for participation.

PARTICIPANTS

Dutch male high-level amateur field soccer players (n = 449) of age 18 to 40 years. Players with a hamstring injury at the moment of SRT-measurement or any other injury that prevented them from following the SRT protocol were excluded.

MAIN OUTCOME MEASURES

Sit-and-reach test scores were measured and then population-based reference values were calculated as follows: >2SD below mean (defining "very low" HLBF), 1SD-2SD below mean ("low" HLBF), 1SD below mean to 1SD above mean ("normal" HLBF), 1SD-2SD above mean ("high" HLBF), and >2SD above mean ("very high" HLBF). Whether SRT scores were correlated with player characteristics was determined using a Pearson correlation coefficient or Spearman rho.

RESULTS

Sit-and-reach test scores ranged from 0 to 43.5 cm (mean 22.0 cm, SD 9.2). The cutoff points for population-based reference values were <3.5 cm for "very low", 3.5 to 13.0 cm for "low", 13.0 to 31.0 cm for "normal", 31.0 to 40.5 cm for "high", and >40.5 cm for "very high". Sit-and-reach test scores were significantly associated with players' height (ρ = -0.132, P = 0.005), body mass index (r = 0.114, P = 0.016), and history of anterior cruciate ligament surgery (P < 0.001).

CONCLUSIONS

This study is the first to describe the HLBF of amateur soccer players. The SRT reference values with cutoff points may facilitate evidence-based decision making regarding HLBF, and the SRT might be a useful tool to assess injury risk, performance, or for diagnostic purposes.

Difference in Agility, Strength, and Flexibility in Competitive Figure Skaters Based on Level of Expertise and Skating Discipline

Slater, LV, Vriner, M, Zapalo, P, Arbour, K, and Hart, JM. Difference in agility, strength, and flexibility in competitive figure skaters based on level of expertise and skating discipline. J Strength Cond Res 30(12): 3321-3328, 2016-Figure skating is an extremely difficult sport that requires a combination of grace, artistry, flexibility, speed, and power. Although many skaters are involved with strength and conditioning programs, there is no current information about differences in off-ice performance measures based on skating discipline and level. The purpose of this study was to compare agility, strength, and flexibility performance based on skating discipline and level. A total of 343 figure skaters from 4 different disciplines (singles, dance, pair, and synchronized skating) and 3 different levels (novice, junior, and senior) completed combine testing with the United States Figure Skating Association. All subjects completed the hexagon agility test, t-test, triple bound jumps, vertical jump, timed tuck jumps, push-ups, v-ups, hand press, front split, seated reach, and stork pose. A multivariate analysis of variance with Scheffe's post hoc was used to identify differences in performance based on skating discipline and level. Mean differences, Cohen's d effect sizes, and 95% confidence intervals were reported for all significant differences. Senior and junior skaters tended to be faster and stronger than novice skaters. Singles, dance, and pair skaters tended to be more agile, stronger, and flexible than synchronized skaters, however, senior synchronized skaters tended to perform better than senior skaters in other disciplines. These results indicate that strength and conditioning professionals should consider skating discipline and level when designing strengthening programs for figure skaters.

Effects on muscle strength, maximal jump height, flexibility and postural sway after soccer and Zumba exercise among female hospital employees: a 9-month randomised controlled trial

This 9-month randomised controlled workplace physical activity trial investigated the effects of soccer and Zumba exercise, respectively, on muscle strength, maximal jump height, sit-and-reach flexibility and postural sway among female workers. A total of 107 female hospital employees aged 25-63 were cluster-randomised to a soccer group, a Zumba group or a control group. Training was conducted outside working hours as two to three 1-h weekly sessions the first 3 months and once a week the last 6 months. Tests were conducted at baseline, after 3 and 9 months. The soccer group improved maximal neck extension strength both after 3 (1.2 kg; P < 0.05) and 9 months (1.7 kg; P < 0.01) compared to the control group. The Zumba group improved maximal trunk extension strength (3.1 kg; P = 0.04) after 3 months, with improvements in postural sway velocity moment (-9.2 mm(2)/s; P < 0.05) and lower limb lean mass (0.4 kg; P < 0.05) after 9 months. No significant intervention effects were revealed in vertical jump height or sit-and-reach flexibility. The present study indicates that workplace-initiated soccer and Zumba exercise may be beneficial for improvement of the neck and trunk strength, which may have preventive effects with regard to future perceived muscle pain in the respective body regions. Furthermore, the Zumba group revealed positive effects on lower limb lean mass and postural sway compared to the control group.

The relevance of stretch intensity and position-a systematic review

Stretching exercises to increase the range of motion (ROM) of joints have been used by sports coaches and medical professionals for improving performance and rehabilitation. The ability of connective and muscular tissues to change their architecture in response to stretching is important for their proper function, repair, and performance. Given the dearth of relevant data in the literature, this review examined two key elements of stretching: stretch intensity and stretch position; and their significance to ROM, delayed onset muscle soreness (DOMS), and inflammation in different populations. A search of three databases, Pub-Med, Google Scholar, and Cochrane Reviews, identified 152 articles, which were subsequently categorized into four groups: athletes (24), clinical (29), elderly (12), and general population (87). The use of different populations facilitated a wider examination of the stretching components and their effects. All 152 articles incorporated information regarding duration, frequency and stretch position, whereas only 79 referred to the intensity of stretching and 22 of these 79 studies were deemed high quality. It appears that the intensity of stretching is relatively under-researched, and the importance of body position and its influence on stretch intensity, is largely unknown. In conclusion, this review has highlighted areas for future research, including stretch intensity and position and their effect on musculo-tendinous tissue, in relation to the sensation of pain, delayed onset muscle soreness, inflammation, as well as muscle health and performance.

Immediate Effects of Combining Local Techniques in the Craniomandibular Area and Hamstring Muscle Stretching in Subjects with Temporomandibular Disorders: A Randomized Controlled Study

OBJECTIVE

To assess the immediate effects on vertical mouth opening, orofacial mechanosensitivity, and lumbar and suboccipital mobility after adding a myofascial induction technique to a multimodal protocol in subjects with temporomandibular disorders (TMD).

DESIGN

A randomized and double-blind controlled trial was carried out.

SETTINGS/LOCATION

University-based physical therapy research clinic.

SUBJECTS

Sixty subjects (35±11.22 years) with TMD, and restricted mobility of the mandibular condyles and the first cervical vertebrae, were recruited and randomized to either a control group (CG) (n=30) or an experimental group (EG) (n=30).

INTERVENTIONS

The CG underwent a neuromuscular technique over the masseter muscles and passive hamstring muscle stretching. A suboccipital muscle inhibition technique was added to this protocol in the EG.

OUTCOME MEASURES

Primary measurements were made of vertical mouth opening and pressure pain threshold of the masseter muscles. Secondary outcome measures included pressure algometry of the trigeminal nerve, suboccipital range of motion, and lumbar spine mobility, assessed with the sit-and-reach (SAR) test and lumbar forward bending. All evaluations were collected at baseline and immediately after intervention.

RESULTS

In the intragroup comparison, the EG observed an increase in suboccipital flexion (p<0.001; F1,29=14.47; R(2)=0.33) and the SAR test (p=0.009; F1,29=7.89; R(2)=0.21). No significant differences were found in the between-group comparison for any variable (p>0.05).

CONCLUSION

The inclusion of a myofascial induction maneuver in a protocol combining local (neuromuscular treatment) and distal techniques (hamstring stretching) in subjects with TMD has no impact on improving mouth opening, suboccipital and lumbar mobility, and orofacial sensitivity to mechanical pressure.

Relationship between Nutrition Knowledge and Physical Fitness in Semiprofessional Soccer Players

Whereas nutrition has a crucial role on sport performance, it is not clear to what extent nutrition knowledge is associated with physical fitness. The aim of this study was to examine the current level of nutrition knowledge of soccer players and whether this level is associated with physical fitness. Soccer players (n = 185, aged 21.3 ± 4.9 yr, weight 72.3 ± 8.4 kg, and height 177.5 ± 6.4 cm) performed a battery of physical fitness tests (sit-and-reach test, SAR; physical working capacity in heart rate 170, PWC170; and Wingate anaerobic test, WAnT) and completed an 11-item nutrition knowledge questionnaire (NKQ). Low to moderate Pearson correlations (0.15 < r < 0.34, p < 0.05) of NKQ with age, weight, height, fat free mass (FFM), SAR, peak power, and mean power of WAnT were observed. Soccer players with high score in NKQ were older (4.4 yr (2.2; 6.6), mean difference (95% confidence intervals)) and heavier (4.5 kg (0.6; 8.3)) with higher FFM (4.0 kg (1.1; 6.8)) and peak power (59 W (2; 116)) than their counterparts with low score. The moderate score in the NKQ suggests that soccer players should be targeted for nutrition education. Although the association between NKQ and physical fitness was low to moderate, there were indications that better nutrition knowledge might result in higher physical fitness and, consequently, soccer performance.

Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial

Objective:

To assess the effectiveness of pilates method on patients with chronic non-specific low back pain (LBP).

Method:

A randomized controlled trial was carried out in sixty patients with a diagnosis of chronic non-specific LBP. Patients were randomly assigned to one of two groups: Experimental Group (EG) that maintained medication treatment with use of NSAID and underwent treatment with the pilates method and Control Group (CG) that continue medication treatment with use of NSAID and did not undergo any other intervention. A blinded assessor performed all evaluations at baseline (T0), after 45, 90, and 180 days (T45, T90 and T180) for: pain (VAS), function (Roland Morris questionnaire), quality of life (SF-36), satisfaction with treatment (Likert scale), flexibility (sit and reach test) and NSAID intake.

Results:

The groups were homogeneous at baseline. Statistical differences favoring the EG were found with regard to pain ( P < 0.001), function ( P < 0.001) and the quality of life domains of functional capacity ( P < 0.046), pain ( P < 0.010) and vitality ( P < 0.029). Statistical differences were also found between groups regarding the use of pain medication at T45, T90 and T180 ( P < 0.010), with the EG taking fewer NSAIDs than the CG.

Conclusions:

The pilates method can be used by patients with LBP to improve pain, function and aspects related to quality of life (functional capacity, pain and vitality). Moreover, this method has no harmful effects on such patients.

The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: study protocol for a randomised controlled trial

BACKGROUND

Hamstring injuries are the most common muscle injury in male amateur soccer players and have a high rate of recurrence, often despite extensive treatment and long rehabilitation periods. Eccentric strength and flexibility are recognised as important modifiable risk factors, which have led to the development of eccentric hamstring exercises, such as the Nordic hamstring exercise. As the effectiveness of the Nordic hamstring exercise in reducing hamstring injuries has never been investigated in amateur soccer players, the aim of this study is to investigate the effect of this exercise on the incidence and severity of hamstring injuries in male amateur soccer players. An additional aim is to determine whether flexibility is associated with hamstring injuries.

STUDY DESIGN

Cluster-randomised controlled trial with soccer teams as the unit of cluster.

METHODS

Dutch male amateur soccer players, aged 18-40 years, were allocated to an intervention or control group. Both study groups continued regular soccer training during 2013, but the intervention group additionally performed the Nordic hamstring exercise (25 sessions over 13 weeks). Primary outcomes are the incidence of initial and recurrent hamstring injury and injury severity. Secondary outcomes are hamstring-and-lower-back flexibility and compliance. Compliance to the intervention protocol was also monitored.

DISCUSSION

Eccentric hamstring strength exercises are hypothesised to reduce the incidence of hamstring injury among male amateur soccer players by 70%. The prevention of such injuries will be beneficial to soccer players, clubs, football associations, health insurance companies and society.

TRIAL REGISTRATION

NTR3664.