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Afonso J, Andrade R, Rocha-Rodrigues S, Nakamura FY, Sarmento H, Freitas SR, Silva AF, Laporta L, Abarghoueinejad M, Akyildiz Z, Chen R, Pizarro A, Ramirez-Campillo R, Clemente FM. What We Do Not Know About Stretching in Healthy Athletes: A Scoping Review with Evidence Gap Map from 300 Trials. Sports Med 2024; 54:1517-1551. [PMID: 38457105 PMCID: PMC11239752 DOI: 10.1007/s40279-024-02002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Stretching has garnered significant attention in sports sciences, resulting in numerous studies. However, there is no comprehensive overview on investigation of stretching in healthy athletes. OBJECTIVES To perform a systematic scoping review with an evidence gap map of stretching studies in healthy athletes, identify current gaps in the literature, and provide stakeholders with priorities for future research. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and PRISMA-ScR guidelines were followed. We included studies comprising healthy athletes exposed to acute and/or chronic stretching interventions. Six databases were searched (CINAHL, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science) until 1 January 2023. The relevant data were narratively synthesized; quantitative data summaries were provided for key data items. An evidence gap map was developed to offer an overview of the existing research and relevant gaps. RESULTS Of ~ 220,000 screened records, we included 300 trials involving 7080 athletes [mostly males (~ 65% versus ~ 20% female, and ~ 15% unreported) under 36 years of age; tiers 2 and 3 of the Participant Classification Framework] across 43 sports. Sports requiring extreme range of motion (e.g., gymnastics) were underrepresented. Most trials assessed the acute effects of stretching, with chronic effects being scrutinized in less than 20% of trials. Chronic interventions averaged 7.4 ± 5.1 weeks and never exceeded 6 months. Most trials (~ 85%) implemented stretching within the warm-up, with other application timings (e.g., post-exercise) being under-researched. Most trials examined static active stretching (62.3%), followed by dynamic stretching (38.3%) and proprioceptive neuromuscular facilitation (PNF) stretching (12.0%), with scarce research on alternative methods (e.g., ballistic stretching). Comparators were mostly limited to passive controls, with ~ 25% of trials including active controls (e.g., strength training). The lower limbs were primarily targeted by interventions (~ 75%). Reporting of dose was heterogeneous in style (e.g., 10 repetitions versus 10 s for dynamic stretching) and completeness of information (i.e., with disparities in the comprehensiveness of the provided information). Most trials (~ 90%) reported performance-related outcomes (mainly strength/power and range of motion); sport-specific outcomes were collected in less than 15% of trials. Biomechanical, physiological, and neural/psychological outcomes were assessed sparsely and heterogeneously; only five trials investigated injury-related outcomes. CONCLUSIONS There is room for improvement, with many areas of research on stretching being underexplored and others currently too heterogeneous for reliable comparisons between studies. There is limited representation of elite-level athletes (~ 5% tier 4 and no tier 5) and underpowered sample sizes (≤ 20 participants). Research was biased toward adult male athletes of sports not requiring extreme ranges of motion, and mostly assessed the acute effects of static active stretching and dynamic stretching during the warm-up. Dose-response relationships remain largely underexplored. Outcomes were mostly limited to general performance testing. Injury prevention and other effects of stretching remain poorly investigated. These relevant research gaps should be prioritized by funding policies. REGISTRATION OSF project ( https://osf.io/6auyj/ ) and registration ( https://osf.io/gu8ya ).
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Affiliation(s)
- José Afonso
- Faculty of Sport, Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), University of Porto, Porto, Portugal.
| | - Renato Andrade
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - Sílvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Alvares, 4900-347, Viana do Castelo, Portugal
- Tumour and Microenvironment Interactions Group, INEB-Institute of Biomedical Engineering, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 4200-153, Porto, Portugal
- Sport Physical Activity and Health Research & Innovation Center, 4900-347, Viana do Castelo, Portugal
| | - Fábio Yuzo Nakamura
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
| | - Hugo Sarmento
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Sandro R Freitas
- Laboratório de Função Neuromuscular, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Ana Filipa Silva
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Alvares, 4900-347, Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, 4900-347, Viana do Castelo, Portugal
| | - Lorenzo Laporta
- Núcleo de Estudos em Performance Analysis Esportiva (NEPAE/UFSM), Universidade Federal de Santa Maria, Avenida Roraima, nº 1000, Cidade Universitária, Bairro Camobi, Santa Maria, RS, CEP: 97105-900, Brazil
| | | | - Zeki Akyildiz
- Sports Science Faculty, Department of Coaching Education, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Rongzhi Chen
- Faculty of Sport, Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), University of Porto, Porto, Portugal
| | - Andreia Pizarro
- Faculty of Sport, Research Center in Physical Activity, Health and Leisure (CIAFEL), University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas, 135, 4050-600, Porto, Portugal
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy. Faculty of Rehabilitation Sciences, Universidad Andres Bello, 7591538, Santiago, Chile
| | - Filipe Manuel Clemente
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Alvares, 4900-347, Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, 4900-347, Viana do Castelo, Portugal
- Gdańsk University of Physical Education and Sport, 80-336, Gdańsk, Poland
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Chen CH, Chiu CH, Tseng WC, Wu CY, Su HH, Chang CK, Ye X. Acute Effects of Combining Dynamic Stretching and Vibration Foam Rolling Warm-up on Lower-Limb Muscle Performance and Functions in Female Handball Players. J Strength Cond Res 2023; 37:1277-1283. [PMID: 33651738 DOI: 10.1519/jsc.0000000000003998] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Chen, CH, Chiu, CH, Tseng, WC, Wu, CY, Su, HH, Chang, CK, and Ye, X. Acute effects of combining dynamic stretching and vibration foam rolling warm-up on lower-limb muscle performance and functions in female handball players. J Strength Cond Res 36(4): 920-926, 2022-The purpose of this study was to compare the acute effects of 3 warm-up protocols on knee flexor and extensor muscles performance in elite female collegiate handball players. Ten female handball players with poor hamstring flexibility completed 3 randomly sequenced experimental visits. During each visit, a different warm-up protocol (general running warm-up [GW], dynamic stretching [DS], or DS combined with vibration foam rolling [DS + VR]) was delivered before the subsequent tests: quadriceps and hamstring muscle stiffness, knee extension and flexion range of motion (ROM), knee joint position sense, knee extension and flexion isokinetic strength with hamstring-quadriceps strength ratio, and muscle endurance during fatiguing exercise. Relative to the GW, the DS + VR protocol resulted in significantly greater knee flexion ROM (mean ± SD : DS + VR = 79.4° ± 7.7°; GW = 69.3° ± 9.6°) and lower hamstring muscle stiffness (DS + VR = 253.33 ± 36.20 N·m -1 ; GW = 292.89 ± 24.28 N·m -1 ). In addition, the DS + VR protocol also yielded greater hamstring muscle endurance than the other 2 protocols did (fatigue percentage: DS + VR = 30.24% ± 10.84%; GW = 41.40% ± 8.98%; DS = 42.22% ± 9.42%). Therefore, the results of this experiment suggest that it can be more beneficial for the female handball players to warm-up with the DS + VR, rather than the GW and DS protocols.
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Affiliation(s)
- Che-Hsiu Chen
- Department of Sport Performance, National Taiwan University of Sport, Taichung, Taiwan
| | - Chih-Hui Chiu
- Department of Exercise and Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Wei-Chin Tseng
- Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan
| | - Chun-Yen Wu
- Department of Rehabilitation, Feng Yuan Hospital of the Ministry of Health and Welfare, Taichung, Taiwan
| | - Hsi-Hsun Su
- Department of Rehabilitation, Feng Yuan Hospital of the Ministry of Health and Welfare, Taichung, Taiwan
| | - Chien-Km Chang
- Department of Ball Sports, National Taiwan University of Sport, Taichung, Taiwan; and
| | - Xin Ye
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut
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The Effect of Static and Dynamic Stretching during Warm-Up on Running Economy and Perception of Effort in Recreational Endurance Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168386. [PMID: 34444136 PMCID: PMC8391672 DOI: 10.3390/ijerph18168386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Abstract
This randomized crossover counterbalanced study investigated, in recreational runners, the acute effects of pre-exercise stretching on physiological and metabolic responses, endurance performance, and perception of effort. Eight male endurance runners (age 36 ± 11 years) performed three running-until-exhaustion tests, preceded by three warm-ups, including the following different stretching protocols: static (SS), dynamic (DS), and no-stretching (NS). During the SS and DS sessions, the warm-up consisted of 10 min of running plus 5 min of SS or DS, respectively, while during the NS session, the warm-up consisted of 15 min of running. Physiological and metabolic responses, and endurance running performance parameters, were evaluated. The perception of effort was derived from the rating of perceived exertion (RPE). Running economy significantly improved after SS (p < 0.05) and DS (p < 0.01), and RPE values were significantly lower in SS (p < 0.05) and DS (p < 0.01), compared to NS. No differences in physiological and metabolic responses among the sessions were found. This study showed that including SS and DS within the warm-up ameliorated running economy and decreased the perception of effort during a running-until-exhaustion test, highlighting the benefits of stretching on endurance performance. These results should encourage recreational runners to insert stretching during warm-up, to optimize the running energy costs, reducing the perception of effort and making the training sessions more enjoyable.
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Classic sports massage vs. Chinese self-massage. Which one is more effective in warm-up? BIOMEDICAL HUMAN KINETICS 2021. [DOI: 10.2478/bhk-2021-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Study aim: Warm-up is an indispensable element of sports training. The aim of the study was to determine the effect of warm-up exercises with Swedish, classic sports massage and Chinese self-massage on functional limitations of the locomotive system.
Materials and methods: The study included 42 women and 13 men aged 19 to 22. They all performed the Functional Movement Screen (FMS) test, without a warm-up, and then (after a week) performed it again after either a standard warm-up with sports massage (Group 1) or a warm-up with Chinese self-massage (Group 2).
Results: Both groups obtained significantly higher results in the second measurement (FMS test), preceded by a standard warm-up with sports massage (Group 1, p = 0.003) and warm-up with Chinese self-massage (Group 2, p = 0.000). In Group 1, statistically significant differences were observed in the results of the exercises: hurdle step and push-ups. In Group 2, the difference was significant in the attempts to sit down deep, walk over the fence and pump.
Conclusion: There were no significant differences between the groups that used massage and self-massage. Both methods can improve movement functionality.
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Naczk M, Kowalewska A, Naczk A. The risk of injuries and physiological benefits of pole dancing. J Sports Med Phys Fitness 2020; 60:883-888. [PMID: 32162500 DOI: 10.23736/s0022-4707.20.10379-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to evaluate the positive and negative aspects of pole dance training. METHODS We included 30 women trained in pole dancing and 30 untrained young women. We measured maximal hand strength, lower back and hamstring muscle flexibility, and body composition. Participants also completed an anonymous questionnaire, which mainly asked about injuries. RESULTS The pole dancers possessed significantly greater muscle strength and lower back and hamstring muscle flexibility compared to untrained controls. Pole dancers had significantly less body fat and significantly more muscle mass in the upper limbs compared to untrained controls. During two years of pole dance training, 36.7% of the dancers had sustained acute injuries (mainly muscle, shoulder joint, and wrist injuries) and 80% of the dancers had sustained a chronic injury. Most injuries occurred during handsprings, twines, and carousel performances. Moreover, pole dancers experienced more menstrual irregularities than the controls. CONCLUSIONS Pole dancing had many positive physiological effects, but pole dancers should be aware that pole dancing and behavior associated with training significantly increased the risk of injury. The most important factors which can protect pole dancers by acute injuries are well performed warm-up and balanced diet. Results indicate that many attempts at weight loss are connected with high risk of acute injury.
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Affiliation(s)
- Mariusz Naczk
- Faculty of Medicine and Health Sciences, University of Zielona Gora, Zielona Gora, Poland -
| | - Agnieszka Kowalewska
- Faculty of Medicine and Health Sciences, University of Zielona Gora, Zielona Gora, Poland
| | - Alicja Naczk
- Department of Individual Sports, Faculty of Physical Culture in Gorzow Wielkopolski, University School of Physical Education in Poznan, Poznan, Poland
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