Determinants of musculoskeletal flexibility: viscoelastic properties, cross-sectional area, EMG and stretch tolerance

Factors contributing to lumbar region passive tissue characteristics in people with and people without low back pain

BACKGROUND

Previously, we demonstrated that people in the Rotation with Extension low back pain subgroup display greater asymmetry of passive tissue characteristics during trunk lateral bending than people without low back pain. The purpose of this secondary analysis is to examine factors that explain the group differences.

METHODS

Twenty-two people in the Rotation with Extension subgroup, and 19 people without low back pain were examined. Torque, lumbar region kinematics, and trunk muscle activity were measured during passive and isometric resisted trunk lateral bending. The dependent variables were lumbar region passive elastic energy to each side; the independent variables included group, gender, anthropometrics, trunk muscle characteristics, and an interaction factor of group and trunk muscle characteristics. Multiple linear regression was used for the analysis.

FINDINGS

Anthropometrics explained passive measures to the left (P=.03). Anthropometrics (P<.01), trunk muscle characteristics (P<.01), and the interaction of group and trunk muscle characteristics (P=.01) explained passive measures to the right. After accounting for gender and anthropometrics, 43.7% of the variance in passive measures to the right was uniquely accounted for by trunk muscle characteristics for the Rotation with Extension subgroup, compared to 0.5% for the group without low back pain.

INTERPRETATION

Anthropometrics explained passive measures with trunk lateral bending to both sides, in both groups. For people in the Rotation with Extension subgroup, there was a direct relationship between trunk muscle performance and passive measures to the right. Muscle is an important contributing factor to asymmetry in this subgroup and should be considered in treatment.

Neuromuscular factors influencing the maximum stretch limit of the human plantar flexors

Maximum joint range of motion is an important parameter influencing functional performance and musculoskeletal injury risk. Nonetheless, a complete description of the muscle architectural and tendon changes that occur during stretch and the factors influencing maximum range of motion is lacking. We measured muscle-tendon elongation and fascicle lengthening and rotation sonographically during maximal plantar flexor stretches in 21 healthy men. Electromyogram (EMG) recordings were obtained synchronously with ultrasound and joint moment data, and H-reflex measurements were made with the ankle at neutral (0°) and dorsiflexed (50% maximal passive joint moment) positions; the maximum H amplitude (normalized to maximum M-wave amplitude; M(max)) and H-amplitude elicited at a stimulation intensity that evoked 10% M(max) were obtained. Maximal stretch was accomplished through significant muscle (14.9%; 30 mm) and tendon lengthening (8.4%; 22 mm). There were similar relative changes in fascicle length and angle, but planimetric modeling indicated that the contribution of fascicle rotation to muscle lengthening was small (<4 mm). Subjects with a greater range of motion showed less resistance to stretch and a greater passive joint moment at stretch termination than less flexible subjects (i.e., greater stretch tolerance). Also, greater fascicle rotation accompanied muscle elongation (9.7 vs. 5.9%) and there was a greater tendon length at stretch termination in more flexible subjects. Finally, a moderate correlation between the angle of EMG onset and maximum range of motion was obtained (r = 0.60, P < 0.05), despite there being no difference in H-reflex magnitudes between the groups. Thus clear differences in the neuromuscular responses to stretch were observed between "flexible" and "inflexible" subjects.

The time course of the effects of constant-angle and constant-torque stretching on the muscle-tendon unit

The purpose of the present study was to examine the time course of passive range of motion (PROM), passive torque (PASTQ), and musculo-tendinous stiffness (MTS) responses during constant-angle (CA) and constant-torque (CT) stretching of the leg flexors. Eleven healthy men [mean ± standard deviation (SD): age = 21.5 ± 2.3 years] performed 16 30-s bouts of CA and CT stretching of the leg flexors. PROM, PASTQ , and MTS were measured during stretches 1, 2, 4, 8, and 16. For PROM and PASTQ , there were no differences between CA and CT stretching treatments (P > 0.05); however, there were stretch-related differences (P < 0.001). PROM increased following one 30-s bout of stretching (collapsed across CA and CT stretching) with additional increases up to 8 min of stretching. PASTQ decreased following one 30-s bout of stretching (collapsed across CA and CT stretching) and continued to decrease up to 4 min of stretching. In contrast, only the CT stretching treatment resulted in changes to MTS (P < 0.001). MTS decreased after one 30-s bout of CT stretching, with subsequent decreases in MTS up to 6 min of stretching. These results suggested that CT stretching may be more appropriate than a stretch held at a constant muscle length for decreasing MTS.

Confiabilidade intra-avaliador da medida de amplitude de movimento da flexão e extensão do joelho pelo método de fotogrametria

Apesar de existirem diversos métodos para a determinação da amplitude de movimento (ADM), a baixa confiabilidade, a pouca sensibilidade, a subjetividade ou a ausência de valores do erro típico da medida (ETM) de alguns desses métodos comprometem a interpretação adequada dos resultados. O objetivo deste estudo foi determinar a confiabilidade intra-avaliador da medida e do método de fotogrametria para a ADM de extensão ativa e flexão passiva do joelho (FPJ), realizada no mesmo dia (consistência interna) e em dias diferentes (estabilidade). Participaram 18 sujeitos do sexo masculino (24,5±3,7 anos, 79,3±10,1 kg e 174,8±4,2 cm). Após a marcação dos pontos anatômicos de referência, a angulação dos movimentos foi registrada em fotografia, por meio da ferramenta de dimensão angular no software CorelDRAW®. A confiabilidade da medida e do instrumento foi estabelecida pelo coeficiente de correlação intraclasse (CCI) e pelo cálculo do ETM. A distribuição dos erros dos dados foi verificada pela representação gráfica de Bland e Altman. O método apresentou confiabilidade perfeita (ETM=0,01 e CCI=1,0) para ambos os movimentos. Para a confiabilidade da medida, foram encontrados os valores 0,97 e 0,93 para consistência interna e 0,96 e 0,83 para estabilidade (ETM=2,9 e 4,0%; p<0,001) na extensão e flexão do joelho, respectivamente. O método mostrou excelente confiabilidade e baixo erro na determinação da ADM de extensão e flexão do joelho, sendo assim, adequado para a aplicação em dimensão clínica e de pesquisa.

The COL5A1 Gene, Ultra-Marathon Running Performance, and Range of Motion

Purpose:

Endurance running performance is a multifactorial phenotype that is strongly associated with running economy. Sit and reach range of motion (SR ROM) is negatively associated with running economy, suggesting that reduced SR ROM is advantageous for endurance running performance. The COL5A1 gene has been associated with both endurance running performance and SR ROM in separate cohorts. The aim of this study was to investigate whether COL5A1 is associated with ultra-marathon running performance and whether this relationship could be partly explained by prerace SR ROM.

Methods:

Seventy-two runners (52 male, 20 female) were recruited from the 56 km Two Oceans ultra-marathon and were assessed for prerace SR ROM. The cohort was genotyped for the COL5A1 BsfUI restriction fragment length polymorphism, and race times were collected after the event.

Results:

Participants with a TT genotype (341 ± 41 min, N = 21) completed the 56 km Two Oceans ultra-marathon significantly (P = 0.014) faster than participants with TC and CC genotypes (365 ± 39 min, N = 50). The COL5A1 genotype and age accounted for 19% of performance variance. When the cohort was divided into performance and flexibility quadrants, the T allele was significantly (P = 0.044) over-represented within the fast and inflexible quadrant.

Conclusion:

The COL5A1 genotype was found to be significantly associated with performance in a 56 km ultra-endurance run. This study confirms previous findings and it furthers our understanding of the relationships among ROM, COL5A1, and endurance running performance. We continue to speculate that the COL5A1 gene alters muscle-tendon stiffness.

Influência da Escola de Postura na qualidade de vida, capacidade funcional, intensidade de dor e flexibilidade de trabalhadores administrativos

O objetivo do estudo foi analisar os efeitos de um programa "Escola de Postura" em relação à qualidade de vida, capacidade funcional, intensidade de dor e flexibilidade em trabalhadores com dor lombar inespecífica. Participaram 33 trabalhadores do setor administrativo. O programa foi realizado em sete encontros com quatro grupos (com sete ou oito participantes), uma vez por semana, com duração de uma hora cada. Antes e após a intervenção, os voluntários responderam ao questionário de qualidade de vida Short-Form Health Survey (SF-36) e ao questionário de incapacidade funcional Roland-Morris, realizaram o teste sentar e alcançar com o banco de Wells e assinalaram a intensidade de dor na escala visual analógica. O teste estatístico de Shapiro-Wilk foi usado para analisar a normalidade de distribuição dos dados. Os dados foram analisados pelo teste Wilcoxon e pelo teste t de Student, com nível de significância de 5% (p<0,05). Foi observada melhora da qualidade de vida em sete domínios do SF-36 (p<0,005), da incapacidade funcional (p<0,005), da intensidade de dor (p<0,005) e da flexibilidade (p<0,005). O índice de adesão foi de 58,93%. O programa "Escola de Postura" proposto melhorou significativamente a qualidade de vida, capacidade funcional, flexibilidade e intensidade de dor de adultos trabalhadores de setores administrativos.

Age-sex differences in the hip abductor muscle properties

AIM

Elderly women are reported to have worse postural balance in the mediolateral direction than elderly men, which may be related to hip lateral muscle properties. The purpose of this study was to investigate the effects of sex, age and their interactions on hip abductor muscle properties.

METHODS

Thirty elderly and 30 young healthy subjects were recruited in this study. Subjects were instructed to abduct their leg as forcefully and quickly as possible under isometric condition, in response to audible beeps. Electromyogram was measured on the gluteus medius muscle and abduction torque was measured. Investigated muscle properties included torque amplitudes and muscle contraction timings. Muscle contraction timings were designated as premotor time, electromechanical delay and total reaction time. The effects of sex, age and their interactions on muscle properties were analyzed.

RESULTS

Women showed smaller torque amplitudes, longer electromechanical delay and longer total reaction time than men (P < 0.01), whereas no sex difference was observed in association with premotor time (P = 0.15). Age-sex interaction was significant in torque amplitudes and in electromechanical delay (P < 0.01). Post-hoc test revealed that torque amplitude differed between sexes only in the young (P < 0.001). In contrast, the electromechanical delay differed between sexes only in the elderly and the age-related elongation of electromechanical delay was significant only in women (P < 0.001).

CONCLUSION

Both a sex difference and a sex difference of age-related change in hip abductor muscle properties were demonstrated. These sex differences may contribute to the sex difference in lateral balance performance.

The effect of soft tissue mobilisation techniques on flexibility and passive resistance in the hamstring muscle-tendon unit: a pilot investigation

The growing evidence suggests that physiological mobilisation techniques influence the passive properties of the muscle-tendon unit (MTU). Techniques that combine a transverse directed force to the physiological technique attempt greater influence on biomechanical properties. No research has investigated the biomechanical effects of a technique with addition of a transverse directed force. This pilot study aimed to explore preliminary data of effectiveness of two techniques on longitudinal load (extensibility and passive resistance) in the hamstring MTU. A counterbalanced quasi-experimental same subject design using fifteen healthy subjects compared two conditions: physiological technique and a technique with addition of a transverse directed force. Passive resistance (torque, Nm) and extensibility (knee extension range of movement) of the hamstring MTU were recorded during and following both conditions. Paired t tests explored within and across condition comparisons, with Bonferroni adjustment to account for multiple analyses. Passive resistance demonstrated a significant reduction for the technique with addition of a transverse directed force (t = 4.26, p < 0.05) that may have contributed to the significant increase in extensibility (t = 8.48, p < 0.05). The data suggest that longitudinal load through the hamstring MTU during a physiological mobilisation can be increased by the application of a transverse directed force. This merits further research.

Analyzing glenohumeral torque-rotation response in vivo

BACKGROUND

Because the human shoulder has many degrees of freedom that allow redundant means of producing the same net humerothoracic motion, there are many impediments to objective, repeatable assessment of shoulder function in vivo. Devices designed to date have suffered from poor reliability. In this study we introduce a new device and methods to evaluate human shoulder kinematics and evaluate its reproducibility from subject to subject and from day to day.

METHODS

This was a controlled laboratory study. Using electromagnetic motion sensors to record the position and orientation of the thorax, scapula, and humerus, we quantified the kinematic response of twenty four normal shoulders in response to known internal-external torque application. A four-parameter logistic function was selected to characterize the strident features of the torque-rotation relationship.

FINDINGS

Our analysis in conjunction with the measurement technique described herein, allowed the passive glenohumeral internal-external range of motion to be differentiated from other motion components and was determined to within 9.6% of full scale over three repeated trials. Range of motion was the most reliable biomechanical outcome, more so than computed indices of glenohumeral flexibility and hysteresis. The exact profile of the torque-rotation response, and therefore the repeatability of the calculated outcomes, was unique from shoulder to shoulder.

INTERPRETATION

The development of the capacity for precise, non-invasive measurement of shoulder biomechanics over time is a requisite step towards optimizing treatment of shoulder injury and disease. Our current methods are superior to previous attempts at trying to non-invasively evaluate the biomechanics of the glenohumeral joint.

Increasing muscle extensibility: a matter of increasing length or modifying sensation?

Various theories have been proposed to explain increases in muscle extensibility observed after intermittent stretching. Most of these theories advocate a mechanical increase in length of the stretched muscle. More recently, a sensory theory has been proposed suggesting instead that increases in muscle extensibility are due to a modification of sensation only. Studies that evaluated the biomechanical effect of stretching showed that muscle length does increase during stretch application due to the viscoelastic properties of muscle. However, this length increase is transient, its magnitude and duration being dependent upon the duration and type of stretching applied. Most of these studies suggest that increases in muscle extensibility observed after a single stretching session and after short-term (3- to 8-week) stretching programs are due to modified sensation. The biomechanical effects of long-term (>8 weeks) and chronic stretching programs have not yet been evaluated. The purposes of this article are to review each of these proposed theories and to discuss the implications for research and clinical practice.

Vibration as an exercise modality: how it may work, and what its potential might be

Whilst exposure to vibration is traditionally regarded as perilous, recent research has focussed on potential benefits. Here, the physical principles of forced oscillations are discussed in relation to vibration as an exercise modality. Acute physiological responses to isolated tendon and muscle vibration and to whole body vibration exercise are reviewed, as well as the training effects upon the musculature, bone mineral density and posture. Possible applications in sports and medicine are discussed. Evidence suggests that acute vibration exercise seems to elicit a specific warm-up effect, and that vibration training seems to improve muscle power, although the potential benefits over traditional forms of resistive exercise are still unclear. Vibration training also seems to improve balance in sub-populations prone to fall, such as frail elderly people. Moreover, literature suggests that vibration is beneficial to reduce chronic lower back pain and other types of pain. Other future indications are perceivable.

Rapid torque development in older female fallers and nonfallers: a comparison across lower-extremity muscles

The objective of this study was to compare reaction time, joint torque, rate of torque development, and magnitude of neuromuscular activation of lower-extremity muscles in elderly female fallers and nonfallers. Participants included 11, elderly, female fallers (71.3+/-5.4 years) and twelve nonfallers (71.3+/-6.2 years) who completed a fall risk questionnaire. Then, maximal, voluntary, isometric contractions of the knee and ankle muscles were performed in reaction to a visual cue to determine joint torque, rate of torque development, reaction time, and nervous activation of agonists and antagonists. Results indicated that significantly more fallers reported "dizziness upon rising", "use of balance altering medications", "stress or depression", "not enough sleep", "arthritis in lower body", "chronic pain in lower body", and "tiring easily while walking" (all P<0.05). Normalized dorsiflexion and plantarflexion strength scores (summation of peak torque, rate of torque development and impulse) were lower in fallers than in nonfallers (P<0.05). When summed across lower-extremity muscle groups, fallers demonstrated 19% lower peak torque and 29% longer motor time (P<0.05). In conclusion, comprehensive fall risk screening and prevention programs should address both neuromuscular and non-muscular factors, and, weakness of the ankle dorsiflexors and plantarflexors should be further studied as potential contributors to falls in older adults.

Passive properties of the muscle-tendon unit: the influence of muscle cross-sectional area

The purpose of the present study was to examine the relationships among the passive properties of the muscle-tendon unit and muscle cross-sectional area (CSA). Our findings indicated significant relationships between muscle CSA and passive stiffness (P < 0.05; r = 0.830) and muscle CSA and passive energy absorption (P < 0.05; r = 0.765). Since passive stiffness and the ability to absorb passive energy decreases with many diseases, these findings may support the need to maintain or increase muscle CSA.

Sex comparison of hamstring structural and material properties

BACKGROUND

Musculotendinous stiffness provides an estimate of resistance to joint perturbation, thus contributing to joint stability. Females demonstrate lesser hamstring stiffness than males, potentially contributing to the sex discrepancy in anterior cruciate ligament injury risk. However, it is unclear if the sex difference in hamstring stiffness is due to differences in muscle size or to inherent/material properties of the musculotendinous unit. It was hypothesized that hamstring stiffness, stress, strain, and elastic modulus would be greater in males than in females, and that hamstring stiffness would be positively correlated with muscle size.

METHODS

Stiffness was assessed in 20 males and 20 females from the damping effect imposed by the hamstrings on oscillatory knee flexion/extension following joint perturbation. Hamstring length and change in length were estimated via motion capture, and hamstring cross-sectional area was estimated using ultrasound imaging. These characteristics were used to calculate hamstring material properties (i.e., stress, strain, and elastic modulus).

FINDINGS

Stiffness was significantly greater in males than in females (P<0.001). However, stress, strain, and elastic modulus did not differ across sex (P>0.05). Stiffness was significantly correlated with cross-sectional area (r=0.395, P=0.039) and the linear combination of cross-sectional area and resting length (R(2)=0.156, P=0.043).

INTERPRETATION

Male's hamstrings possess a greater capacity for resisting changes in length imposed via joint perturbation from a structural perspective, but this property is similar across sex from a material perspective. Females demonstrate lesser hamstring stiffness compared to males in response to standardized loading conditions, indicating a compromised ability to resist changes in length associated with joint perturbation, and potentially contributing to the higher female ACL injury risk. However, the difference in hamstring stiffness is attributable in large part to differences in muscle size.

The acute effect of stretching on the passive stiffness of the human gastrocnemius muscle tendon unit

Passive stretching is commonly used to increase limb range of movement prior to athletic performance but it is unclear which component of the muscle-tendon unit (MTU) is affected by this procedure. Movement of the myotendinous junction (MTJ) of the gastrocnemius medialis muscle was measured by ultrasonography in eight male participants (20.5 +/- 0.9 years) during a standard stretch in which the ankle was passively dorsiflexed at 1 deg s(-1) from 0 deg (the foot at right angles to the tibia) to the participants' volitional end range of motion (ROM). Passive torque, muscle fascicle length and pennation angle were also measured. Standard stretch measurements were made before (pre-) and after (post-) five passive conditioning stretches. During each conditioning stretch the MTU was taken to the end ROM and held for 1 min. Pre-conditioning the extension of the MTU during stretch was taken up almost equally by muscle and tendon. Following conditioning, ROM increased by 4.6 +/- 1.5 deg (17%) and the passive stiffness of the MTU was reduced (between 20 and 25 deg) by 47% from 16.0 +/- 3.6 to 10.2 +/- 2.0 Nm deg(-1). Distal MTJ displacement (between 0 and 25 deg) increased from 0.92 +/- 0.06 to 1.16 +/- 0.05 cm, accounting for all the additional MTU elongation and indicating that there was no change in tendon properties. Muscle extension pre-conditioning was explicable by change in length and pennation angle of the fascicles but post-conditioning this was not the case suggesting that at least part of the change in muscle with conditioning stretches was due to altered properties of connective tissue.

Passive knee joint range of motion is unrelated to the mechanical properties of the patellar tendon

The physiological factors that govern passive joint range of motion (ROM) are poorly understood. The present study investigated the relation between passive knee joint ROM and the mechanical properties of the patellar tendon. Knee joint ROM was assessed in 43 individuals, and the subjects with the greatest ROM (flexible group, n=10) and lowest ROM (inflexible group, n=10) were selected for further analysis. In these groups an overall "lower extremity joint ROM score" was determined with 11 clinical tests. The elongation of the patellar tendon was assessed during graded maximal isometric knee extensor contractions using ultrasonography, and the mechanical properties of the patellar tendon were determined from corresponding load and tendon deformation data. The two groups were similar with respect to weight, height, tendon cross-sectional area and length, and were, furthermore, equally physically active. The knee joint ROM and lower extremity joint ROM score was significantly different between the groups (flexible: 136+/-7 degrees vs inflexible: 76+/-16 degrees , P<0.001 and flexible: -4.7+/-1.3 vs inflexible: 3.1+/-4.1, P<0.001). There was no difference between groups in maximal knee extensor force or the corresponding tendon deformation. The tendon stiffness (flexible: 3269+/-1591 vs inflexible: 3185+/-1457 N/mm), stress (flexible: 22.4+/-6.5 vs inflexible: 34.0+/-17.6 N/mm(2)), strain (flexible; 6.5+/-1.6 vs inflexible: 7.2+/-1.9%) and Young's modulus (flexible: 0.81+/-0.35 vs inflexible: 1.22+/-0.52 GPa) were not different between the two groups of subjects. These data suggest that differences in knee joint ROM cannot be explained by the mechanical properties of the patellar tendon.

Proprioceptive Neuromuscular Facilitation Stretching

Proprioceptive neuromuscular facilitation (PNF) stretching techniques are commonly used in the athletic and clinical environments to enhance both active and passive range of motion (ROM) with a view to optimising motor performance and rehabilitation. PNF stretching is positioned in the literature as the most effective stretching technique when the aim is to increase ROM, particularly in respect to short-term changes in ROM. With due consideration of the heterogeneity across the applied PNF stretching research, a summary of the findings suggests that an 'active' PNF stretching technique achieves the greatest gains in ROM, e.g. utilising a shortening contraction of the opposing muscle to place the target muscle on stretch, followed by a static contraction of the target muscle. The inclusion of a shortening contraction of the opposing muscle appears to have the greatest impact on enhancing ROM. When including a static contraction of the target muscle, this needs to be held for approximately 3 seconds at no more than 20% of a maximum voluntary contraction. The greatest changes in ROM generally occur after the first repetition and in order to achieve more lasting changes in ROM, PNF stretching needs to be performed once or twice per week. The superior changes in ROM that PNF stretching often produces compared with other stretching techniques has traditionally been attributed to autogenic and/or reciprocal inhibition, although the literature does not support this hypothesis. Instead, and in the absence of a biomechanical explanation, the contemporary view proposes that PNF stretching influences the point at which stretch is perceived or tolerated. The mechanism(s) underpinning the change in stretch perception or tolerance are not known, although pain modulation has been suggested.

Influence of a low-level contractile response from the soleus, gastrocnemius and tibialis anterior muscles on viscoelastic stress-relaxation of aged human calf muscle-tendon units

Measuring viscoelastic stress-relaxation (VSR) as the decline in passive tension over time when the skeletal muscle-tendon unit (MTU) is held in a lengthened position may be difficult in older people who may have difficulty relaxing. This study examined the VSR of the aged calf MTUs with a low-level involuntary contractile response from the soleus (S), gastrocnemius (G) and tibialis anterior (TA) muscles. Calf MTUs of 29 men and women (65-90 years) were stretched to maximal dorsiflexion and held for 60 s while torque (Nm) and surface electromyograms (SEMG) were recorded. Subjects with normalized SEMG (% of maximal voluntary contraction SEMG) of the S, G or TA <1% were assigned to Group 1 (n=14) and subjects with SEMG of the S or G > or =1% and <10%, or in the TA > or =1% were assigned to Group 2 (n=15). Although the mean total percent torque decline for Group 1 (17.9%) and Group 2 (16.6%) did not differ statistically, multiple regression analysis within Group 2 indicated that the G and TA SEMG accounted for 58% of its variation (R (2)=0.581). The G SEMG from 0-15 s accounted for 56% (r (2)=0.563) of the variation in the percent decline normalized to total percent decline (100%). From 15-30 s Group 2 had less percent decline (2%) than Group 1 (14%) (P=0.043) and the S and G SEMG accounted for 67% of its variation (R (2)=0.673). The results indicated that a low-level involuntary contractile response from the S, G and TA muscles may be related to the VSR process of aged calf MTUs. Measuring VSR within time intervals normalized to the total percent decline offers a new method to study VSR, which should be measured with SEMG in the muscles <1% MVC SEMG to ensure valid measurements.

Strength training

Literature concerning the theoretical role of spinal reflex circuits and their sensorimotor signals in proprioceptive neuromuscular facilitation (PNF) muscle stretching techniques was examined. Reviewed data do not support the assertion commonly made in PNF literature that contraction of a stretched muscle prior to further stretch, or contraction of opposing muscles during muscle stretch, produces relaxation of the stretched muscle. Further, following contraction of a stretched muscle, inhibition of the stretch reflex response lasts only 1 s. Studies examined suggested that decreases in the response amplitude of the Hoffmann and muscle stretch reflexes following a contraction of a stretched muscle are not due to the activation of Golgi tendon organs, as commonly purported, but instead may be due to presynaptic inhibition of the muscle spindle sensory signal. The current view on the complex manner by which the spinal cord processes proprioceptive signals was discussed. The ability of acute PNF stretching procedures to often produce a joint range of motion greater than that observed with static stretching must be explained by mechanisms other than the spinal processing of proprioceptive information. Studies reviewed indicate that changes in the ability to tolerate stretch and/or the viscoelastic properties of the stretched muscle, induced by PNF procedures, are possible mechanisms.

The efficacy of stretching for prevention of exercise-related injury: a systematic review of the literature

The objective of this study was to conduct a systematic analysis of the literature to assess the efficacy of stretching for prevention of exercise-related injury. Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) investigating stretching as an injury prevention measure were selected. A computer-aided search of the literature was conducted for relevant articles, followed by assessment of the methods of the studies. The main outcome measures were scores for methodological quality based on four main categories (study population, interventions, measurement of effect, and data presentation and analysis) and main conclusions of authors with regard to stretching. One RCT (25%) and three CCTs (100%) concluded that stretching reduced the incidence of exercise-related injury. Three RCTs (75%) concluded that stretching did not reduce the incidence of exercise-related injury. Only two studies scored more than 50 points (maximum score=100 points) indicating that most of the studies selected were of poor quality. Neither of the two highest scoring RCTs showed positive effects for stretching. Due to the paucity, heterogeneity and poor quality of the available studies no definitive conclusions can be drawn as to the value of stretching for reducing the risk of exercise-related injury.

Neurophysiologic influences on hamstring flexibility: a pilot study

OBJECTIVE

To examine the potential contribution of neurologic influences on hamstring length during passive range of motion.

DESIGN

Prospective study.

SETTINGS

Academic sports medicine center.

PATIENTS

15 subjects undergoing arthroscopic surgery for unilateral knee injuries without previous injury to the contralateral knee.

INTERVENTIONS

Subjects received: 1) spinal anesthesia with bupivacaine, 2) epidural anesthesia with lidocaine, 3) general anesthesia, or 4) femoral nerve block of injured leg only.

MAIN OUTCOME MEASURES

Noninjured leg popliteal angle preoperatively, intraoperatively under anesthesia, and postoperatively after recovery from anesthesia.

RESULTS

The overall mean popliteal angle was 132.5 +/- 3.1 degrees preoperatively, 134.31 +/- 11.6 degrees intraoperatively, and 130.7 +/- 10.2 degrees postoperatively. Overall, the intraoperative angle was significantly greater than the postoperative angle (p = 0.02). The mean change in popliteal angle was 8.1 +/- 2.2 degrees (Group 1), -0.4 +/- 1.9 degrees (Group 2), 0.9 +/- 1.4 degrees (Group 3), and -2.4 +/- 3.8 degrees (Group 4). There was no significant change in pre- to postoperative popliteal angle in relation to postoperative pain. Females had a greater mean popliteal angle (139.84 degrees ) compared with males (128.84 degrees ) (p = 0.04).

CLINICAL RELEVANCE

Understanding the neuromuscular influences on muscle flexibility will assist in the development of new rehabilitative and injury preventative techniques.

CONCLUSION

The present pilot study implicates neural contributions to muscle flexibility. Further studies are needed to delineate the relative contributions of neural and muscular components and to facilitate new techniques in the rehabilitation and prevention of injury.

Passive extensibility of skeletal muscle: review of the literature with clinical implications

The purpose of this article was to review the literature on passive extensibility of skeletal muscle with reference to its anatomic and physiologic properties, mechanisms of adaptations and clinical implications. Studies with animal muscles have shown that passive extensibility is influenced by the size (mass) and length of muscle fibers, and the amount and arrangement of the connective tissues of the muscle belly. The resistance to passive lengthening is influenced by the readily adaptable amount of muscle tissue, including the contractile proteins and the non-contractile proteins of the sarcomere cytoskeletons. The relationship of adaptable changes in the muscle tissue and in the extracellular connective tissues remains unclear. Muscle length adaptations result from changes in the number of sarcomeres in series, which depend on the imposed length of muscles, not on the level of muscle activation and tension. This mechanism of muscle length adaptations, termed 'myogenic', has not been demonstrated in human muscles, but it has been intimated by therapeutic lengthening studies showing that both healthy and neurologically impaired human muscles can undergo increased length adaptations in the presence of muscle activations. Studies have suggested that optimal muscle function is probably achieved by increasing muscle length, length extensibility, passive elastic stiffness, mass and strength, but additional studies are needed to investigate these relationships, particularly for aged muscles and for muscles affected by clinical disorders, disease and injury. Such studies could contribute to the development of new intervention strategies designed to promote the passive muscle extensibility that enhances total muscle function, and ultimately improves the ability to complete functional activities and excel in athletic performances.

Passive energy absorption by human muscle-tendon unit is unaffected by increase in intramuscular temperature

The present study measured hamstring intramuscular temperature and muscle-tendon unit viscoelastic properties in healthy young men before and after 10 and 30 min of running with (day S) or without stretch (day NS). On day NS, passive energy absorption and intramuscular temperature were measured before running (Preex), after 10 min of running at 70% of maximum O(2) uptake (Postex10), and after 30 min of running at 75% of maximum O(2) uptake (Postex30). On day S, the protocol was repeated with three stretches (stretches 1-3) added after Postex10. Intramuscular temperature was elevated Postex10 (P < 0.01) and further Postex30 (P < 0.05). On day NS, the total energy absorbed Preex (14.3 +/- 2.3 J), Postex10 (14.5 +/- 3.2 J), and Postex30 (13.5 +/- 2.4 J) was not different. On day S, the total energy absorbed in stretch 3 (10.8 +/- 1.8 J) was lower than that Preex (14.5 +/- 1.7 J, P < 0.01) and Postex10 (13.5 +/- 1.9 J, P < 0.05) but not Postex30 (13.3 +/- 1.8 J). The total energy absorbed Postex30 did not differ from Preex. In conclusion, warm-up and continuous running elevated intramuscular temperature but did not affect the passive energy absorption. Repeated passive stretching reduced the energy absorption immediately; however, the effect did not remain after 30 min of running. These data suggest that passive energy absorption of the human skeletal muscle is insensitive to physiological increases in intramuscular temperature.

Passive properties of human skeletal muscle during stretch maneuvers. A review

Despite limited scientific knowledge, stretching of human skeletal muscle to improve flexibility is a widespread practice among athletes. This article reviews recent findings regarding passive properties of the hamstring muscle group during stretch based on a model that was developed which could synchronously and continuously measure passive hamstring resistance and electromyographic activity, while the velocity and angle of stretch was controlled. Resistance to stretch was defined as passive torque (Nm) offered by the hamstring muscle group during passive knee extension using an isokinetic dynamometer with a modified thigh pad. To simulate a clinical static stretch, the knee was passively extended to a pre-determined final position (0.0875 rad/s, dynamic phase) where it remained stationary for 90 s (static phase). Alternatively, the knee was extended to the point of discomfort (stretch tolerance). From the torque-angle curve of the dynamic phase of the static stretch, and in the stretch tolerance protocol, passive energy and stiffness were calculated. Torque decline in the static phase was considered to represent viscoelastic stress relaxation. Using the model, studies were conducted which demonstrated that a single static stretch resulted in a 30% viscoelastic stress relaxation. With repeated stretches muscle stiffness declined, but returned to baseline values within 1 h. Long-term stretching (3 weeks) increased joint range of motion as a result of a change in stretch tolerance rather than in the passive properties. Strength training resulted in increased muscle stiffness, which was unaffected by daily stretching. The effectiveness of different stretching techniques was attributed to a change in stretch tolerance rather than passive properties. Inflexible and older subjects have increased muscle stiffness, but a lower stretch tolerance compared to subjects with normal flexibility and younger subjects, respectively. Although far from all questions regarding the passive properties of humans skeletal muscle have been answered in these studies, the measurement technique permitted some initial important examinations of vicoelastic behavior of human skeletal muscle.