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Warneke K, Behm DG, Alizadeh S, Hillebrecht M, Konrad A, Wirth K. Discussing Conflicting Explanatory Approaches in Flexibility Training Under Consideration of Physiology: A Narrative Review. Sports Med 2024; 54:1785-1799. [PMID: 38819597 PMCID: PMC11258068 DOI: 10.1007/s40279-024-02043-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
The mechanisms underlying range of motion enhancements via flexibility training discussed in the literature show high heterogeneity in research methodology and study findings. In addition, scientific conclusions are mostly based on functional observations while studies considering the underlying physiology are less common. However, understanding the underlying mechanisms that contribute to an improved range of motion through stretching is crucial for conducting comparable studies with sound designs, optimising training routines and accurately interpreting resulting outcomes. While there seems to be no evidence to attribute acute range of motion increases as well as changes in muscle and tendon stiffness and pain perception specifically to stretching or foam rolling, the role of general warm-up effects is discussed in this paper. Additionally, the role of mechanical tension applied to greater muscle lengths for range of motion improvement will be discussed. Thus, it is suggested that physical training stressors can be seen as external stimuli that control gene expression via the targeted stimulation of transcription factors, leading to structural adaptations due to enhanced protein synthesis. Hence, the possible role of serial sarcomerogenesis in altering pain perception, reducing muscle stiffness and passive torque, or changes in the optimal joint angle for force development is considered as well as alternative interventions with a potential impact on anabolic pathways. As there are limited possibilities to directly measure serial sarcomere number, longitudinal muscle hypertrophy remains without direct evidence. The available literature does not demonstrate the necessity of only using specific flexibility training routines such as stretching to enhance acute or chronic range of motion.
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Affiliation(s)
- Konstantin Warneke
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.
- Department of Movement Sciences, Institute of Sport Science, University of Klagenfurt, Universitatsstraße 65, 9020, Klagenfurt Am Wörthersee, Austria.
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
- Human Performance Lab, Department of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Martin Hillebrecht
- University Sports Center, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Andreas Konrad
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
- University Sports Center, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Klaus Wirth
- University of Applied Sciences Wiener Neustadt, Vienna, Austria
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Shaikh AA, Quraishi MF, Chitapure T, Joshi PA, Shaikh SA, Nandgaonkar N, Sable K. A Comparison of the Effectiveness of Neurodynamic Sliding Technique and Self-Myofascial Release Technique for Reducing Hamstring Tightness in Healthy Individuals: A Prospective Study. Cureus 2023; 15:e40613. [PMID: 37476106 PMCID: PMC10354375 DOI: 10.7759/cureus.40613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Hamstring tightness is prevalent among college-going students aged 18-25 years, leading to an increased risk of recurrent injury, reduced athletic performance, post-exercise soreness, and decreased coordination. Myofascial release and neurodynamic sliding technique are two interventions used to alleviate this issue. Myofascial release is a concept that involves pain originating from the muscle and fascia. The neurodynamic sliding technique is a method of producing sliding movement of neural structures relative to their mechanical interfaces. METHODS This study involved 70 individuals with hamstring tightness who met the inclusion and exclusion criteria. Participants were assigned to Group A or Group B using a convenient sampling method. Group A received neurodynamic sliding technique treatment, while Group B received a self-myofascial release. Both interventions were administered for two months. The outcome measures used in this study were active knee extension and lower extremity functional scale, which were evaluated before and after the intervention. RESULTS AND IMPLICATIONS Within-group comparisons indicated that both Group A and Group B showed significant improvements in hamstring flexibility. Between-group comparisons of active knee extension (AKE) and lower extremity functional scale (LEFS) immediately after the intervention showed statistically significant results. These findings suggest that both the neurodynamic sliding technique and self-myofascial release are effective in improving hamstring flexibility. This study has implications for clinical practice, as both interventions may be used to address hamstring tightness. CONCLUSION Our study found that both the neurodynamic sliding technique and self-myofascial release can improve hamstring flexibility. However, the neurodynamic sliding technique was found to be more effective than self-myofascial release. Further research is necessary to determine the optimal protocol for these interventions and their effectiveness in clinical populations with hamstring tightness or injury.
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Affiliation(s)
- Amreen Afsarpatel Shaikh
- Clinical Physiotherapy, Musculoskeletal Department, MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences (MGMIHS), Aurangabad, IND
| | - Maliha Fatima Quraishi
- Physiotherapy, Musculoskeletal Department, MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences (MGMIHS), Aurangabad, IND
| | - Tajuddin Chitapure
- Musculoskeletal Physiotherapy, Musculoskeletal Department, MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences (MGMIHS), Aurangabad, IND
| | - Priyanka Abhay Joshi
- Physiotherapy, Musculoskeletal Department, MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences (MGMIHS), Aurangabad, IND
| | - Saba Afsar Shaikh
- Physiotherapy, Musculoskeletal Department, MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences (MGMIHS), Aurangabad, IND
| | - Nikita Nandgaonkar
- Physiotherapy, Musculoskeletal Department, MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences (MGMIHS), Aurangabad, IND
| | - Komal Sable
- Physiotherapy, Musculoskeletal Department, MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences (MGMIHS), Aurangabad, IND
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Gutierrez-Coronado J, López-Bueno L, Cardero-Durán MDLA, Albornoz-Cabello M, Toledo-Marhuenda JV, Hernández-Sánchez S, Dueñas L, Marques-Sule E, Morral A, Espejo-Antúnez L. The Clinical Benefits of a Dynamic vs. Static Component as Part of a Comprehensive Warm-Up for Recreational Sports Players with Clinical Histories of Hamstring Injuries: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:744. [PMID: 36613065 PMCID: PMC9819227 DOI: 10.3390/ijerph20010744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Background: Few previous studies have analyzed the effects of certain specific static and dynamic warm-up components on recreational sports players with a previous hamstring injury. Therefore, the aim of this study was to analyze changes in some modifiable and external risk factors after (immediately and in a follow-up assessment after 10 min) a static or dynamic warm-up program on recreational sports players with a previous hamstring injury. Methods: A total of 62 participants were randomized into 2 groups: static warm-up (SW) (n = 31) or dynamic warm-up (DW) (n = 31). Range of movement (RoM), perceived pain, the pressure−pain threshold, and joint position sense were assessed at baseline, immediately after the intervention and 10 min afterwards. The intervention for the SW (hot pack procedures in both hamstring muscles) lasted 20 min. The DW intervention consisted of a running exercise performed on a treadmill for 10 min. Results: Both groups showed statistically significant changes (p ≤ 0.05) in the primary outcomes (perceived pain and the pressure−pain threshold) at the three measurement times (this was also true for RoM for the SW group, with statistically significant differences only between times from the baseline to the 10-min follow-up; p ≤ 0.05, d = 0.23). The intra-group secondary outcome showed no statistically significant changes (p > 0.05) in both groups (except for the period from the baseline−immediately after in the DW group; p ≤ 0.05, d = 0.53). The comparison between groups showed no statistically significant differences for any of the variables analyzed. (p ≥ 0.05). Conclusion: The present findings suggest that both specific warm-up modalities seem to positively influence perceived pain on stretching and the pressure threshold; however, the significant reduction in the joint repositioning error and the larger effect sizes observed in the DW group suggest that this method has a greater beneficial impact in recreational sports players with clinical histories of hamstring injuries.
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Affiliation(s)
- Javier Gutierrez-Coronado
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, Av. Elvas, s/n, 06006 Badajoz, Spain
| | - Laura López-Bueno
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010 Valencia, Spain
| | - María de los Angeles Cardero-Durán
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, Av. Elvas, s/n, 06006 Badajoz, Spain
| | - Manuel Albornoz-Cabello
- Department of Physical Therapy, Faculty of Nursing, Physical Therapy and Podiatry, University of Seville, C/Avicena, 6, 41009 Seville, Spain
| | - Jose Vicente Toledo-Marhuenda
- Department of Pathology and Surgery (Area of Physiotherapy), Medicine Faculty, Miguel Hernández University, Ctra Alicante-Valencia Km 8,7—N 332, 03550 Alicante, Spain
| | - Sergio Hernández-Sánchez
- Department of Pathology and Surgery (Area of Physiotherapy), Medicine Faculty, Miguel Hernández University, Ctra Alicante-Valencia Km 8,7—N 332, 03550 Alicante, Spain
| | - Lirios Dueñas
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010 Valencia, Spain
- Physiotherapy in Motion, Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Elena Marques-Sule
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010 Valencia, Spain
| | - Antoni Morral
- Blanquerna School of Health Sciences, Ramon Llull University, Carrer de Claravall, 1, 3, 08022 Barcelona, Spain
| | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, Av. Elvas, s/n, 06006 Badajoz, Spain
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Rudisill SS, Varady NH, Kucharik MP, Eberlin CT, Martin SD. Evidence-Based Hamstring Injury Prevention and Risk Factor Management: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2022:3635465221083998. [PMID: 35384731 DOI: 10.1177/03635465221083998] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring injuries are common among athletes. Considering the potentially prolonged recovery and high rate of recurrence, effective methods of prevention and risk factor management are of great interest to athletes, trainers, coaches, and therapists, with substantial competitive and financial implications. PURPOSE To systematically review the literature concerning evidence-based hamstring training and quantitatively assess the effectiveness of training programs in (1) reducing injury incidence and (2) managing injury risk factors. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 1. METHODS A computerized search of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus with manual screening of selected reference lists was performed in October 2020. Randomized controlled trials investigating methods of hamstring injury prevention and risk factor management in recreational, semiprofessional, and professional adult athletes were included. RESULTS Of 2602 articles identified, 108 were included. Eccentric training reduced the incidence of hamstring injury by 56.8% to 70.0%. Concentric hamstring strength increased with eccentric (mean difference [MD], 14.29 N·m; 95% CI, 8.53-20.05 N·m), concentric, blood flow-restricted, whole-body vibration, heavy back squat, FIFA 11+ (Fédération Internationale de Football Association), and plyometric training methods, whereas eccentric strength benefited from eccentric (MD, 26.94 N·m; 95% CI, 15.59-38.30 N·m), concentric, and plyometric training. Static stretching produced greater flexibility gains (MD, 10.89°; 95% CI, 8.92°-12.86°) than proprioceptive neuromuscular facilitation (MD, 9.73°; 95% CI, 6.53°-12.93°) and dynamic stretching (MD, 6.25°; 95% CI, 2.84°-9.66°), although the effects of static techniques were more transient. Fascicle length increased with eccentric (MD, 0.90 cm; 95% CI, 0.53-1.27 cm) and sprint training and decreased with concentric training. Although the conventional hamstring/quadriceps (H/Q) ratio was unchanged (MD, 0.03; 95% CI, -0.01 to 0.06), the functional H/Q ratio significantly improved with eccentric training (MD, 0.10; 95% CI, 0.03-0.16). In addition, eccentric training reduced limb strength asymmetry, while H/Q ratio and flexibility imbalances were normalized via resistance training and static stretching. CONCLUSION Several strategies exist to prevent hamstring injury and address known risk factors. Eccentric strengthening reduces injury incidence and improves hamstring strength, fascicle length, H/Q ratio, and limb asymmetry, while stretching-based interventions can be implemented to improve flexibility. These results provide valuable insights to athletes, trainers, coaches, and therapists seeking to optimize hamstring training and prevent injury.
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Affiliation(s)
- Samuel S Rudisill
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA.,Rush Medical College of Rush University, Chicago, Illinois, USA
| | - Nathan H Varady
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA.,Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Michael P Kucharik
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA
| | - Christopher T Eberlin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA
| | - Scott D Martin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, USA
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Ankle-Injury Patients Perform More Microadjustments during Walking: Evidence from Velocity Profiles in Gait Analysis. Appl Bionics Biomech 2022; 2022:3057270. [PMID: 35035530 PMCID: PMC8758300 DOI: 10.1155/2022/3057270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/18/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction We evaluated the velocity profiles of patients with lateral collateral ligament (LCL) injuries of the ankle with a goal of understanding the control mechanism involved in walking. Methods We tracked motions of patients' legs and feet in 30 gait cycles recorded from patients with LCL injuries of the ankle and compared them to 50 gait cycles taken from normal control subjects. Seventeen markers were placed on the foot following the Heidelberg foot measurement model. Velocity profiles and microadjustments of the knee, ankle, and foot were calculated during different gait phases and compared between the patient and control groups. Results Patients had a smaller first rocker percentage and larger second rocker percentage in the gait cycle compared to controls. Patients also displayed shorter stride length and slower strides and performed more microadjustments in the second rocker phase than in other rocker/swing phases. Patients' mean velocities of the knee, ankle, and foot in the second rocker phase were also significantly higher than that in control subjects. Discussion. Evidence from velocity profiles suggested that patients with ligament injury necessitated more musculoskeletal microadjustments to maintain body balance, but these may also be due to secondary injury. Precise descriptions of the spatiotemporal gait characteristics are therefore crucial for our understanding of movement control during locomotion.
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