Range of motion, neuromechanical, and architectural adaptations to plantar flexor stretch training in humans

The acute effects of dynamic stretching on the neuromuscular system are independent of the velocity

This study examined the acute effects of dynamic stretching at different velocities on the neuromuscular system. Fourteen participants underwent four experimental sessions in random order: (1) control (lying at rest with the ankle in a neutral position); (2) slow velocity dynamic stretching (50 beats/min; SLOWDS); (3) moderate velocity dynamic stretching (70 beats/min; MODDS); and (4) fast velocity dynamic stretching (90 beats/min; FASTDS). The stretching protocols consisted of four sets of 10 repetitions and targeted the plantar flexor muscles of the right ankle. Assessments included corticospinal excitability (via motor-evoked potential-MEP/Mmax), spinal reflex activity (via H-reflex-Hmax/Mmax), muscle contractile properties (peak twitch torque; PTT), maximal voluntary contraction (MVC), and maximal range of motion (ROMmax). Dynamic stretching did not affect MEP/Mmax and MVC of the plantar flexor muscles (P > 0.05). All stretching protocols similarly reduced soleus Hmax/Mmax (P < 0.05), and increased PTT (P < 0.05). Additionally, all conditions, including control, similarly increase ROMmax (P < 0.05, and Cohen's d value of -0.39, -0.28, -0.38 and -0.29 for CON, SLOWDS, MODDS and FASTDS, respectively). Therefore, dynamic stretching reduces spinal reflex activity and enhances muscle contractile properties irrespective of movement velocity without impairing corticospinal excitability and MVC.

Influence of Stretch Speed and Arousal State on Passive Ankle Joint Mechanics

Studies investigating the mechanisms influencing maximum passive joint range of motion (ROMmax) and stiffness have not objectively assessed the possible influence of stretch speed and/or arousal state. The purpose of this study was to assess the effects of arousal state and stretch speed on healthy individuals ROMmax, stiffness, gastrocnemius medialis, and soleus electromyographic activity (EMG). Fourteen participants performed one familiarization and then one testing session on separate days in the laboratory. In the familiarization (Session 1), participants practiced fast (30°/s ankle dorsiflexion) and slow (5°/s) plantar flexor stretches on an isokinetic dynamometer with the knee extended. In the experimental session (Session 2), they performed two slow, then two fast, stretches under three randomized arousal conditions: control (no music), arousing, and relaxing music. Dorsiflexion ROMmax, ankle joint stiffness, muscle activity during stretch, mean heart rate, and perception of arousal were measured. Perception of arousal was greater in the arousing than relaxing condition (p = 0.001). ROMmax was greater during fast (69.1° ± 7.8°) than slow stretches (64.9° ± 10.8°; p = 0.002) with no effect of arousal. Stiffness and EMG were higher at faster speeds, with a significantly greater percentage of stiffness observed in the arousing than the other conditions during faster stretches (p = 0.04). ROMmax was greater at the faster stretch speed despite greater stiffness and muscle activities being produced during the stretch. Thus, despite reflexive muscle activity and viscosity being higher during faster stretches, a greater, not lesser, ROMmax was observed. Arousal state, at least when altered by music, did not seem to affect ROMmax but somewhat influenced stiffness in the faster stretches.

Optimising the Dose of Static Stretching to Improve Flexibility: A Systematic Review, Meta-analysis and Multivariate Meta-regression

BACKGROUND

Static stretching is widely used to increase flexibility. However, there is no consensus regarding the optimal dosage parameters for increasing flexibility.

OBJECTIVES

We aimed to determine the optimal frequency, intensity and volume to maximise flexibility through static stretching, and to investigate whether this is moderated by muscle group, age, sex, training status and baseline level of flexibility.

METHODS

Seven databases (CINAHL Complete, Cochrane CENTRAL, Embase, Emcare, MEDLINE, Scopus, and SPORTDiscus) were systematically searched up to June 2024. Randomised and non-randomised controlled trials investigating the effects of a single session (acute) or multiple sessions (chronic) of static stretching on one or more flexibility outcomes (compared to non-stretching passive controls) among adults (aged ≥ 18 years) were included. A multi-level meta-analysis examined the effect of acute and chronic static stretching on flexibility outcomes, while multivariate meta-regression was used to determine the volume at which increases in flexibility were maximised.

RESULTS

Data from 189 studies representing 6654 adults (61% male; mean [standard deviation] age = 26.8 ± 11.4 years) were included. We found a moderate positive effect of acute static stretching on flexibility (summary Hedges' g = 0.63, 95% confidence interval 0.52-0.75, p < 0.001) and a large positive effect of chronic static stretching on flexibility (summary Hedges' g = 0.96, 95% confidence interval 0.84-1.09, p < 0.001). Neither effect was moderated by stretching intensity, age, sex or training status, or weekly session frequency and intervention length (chronic static stretching only) [p > 0.05]. However, larger improvements were found for adults with poor baseline flexibility compared with adults with average baseline flexibility (p = 0.01). Furthermore, larger improvements in flexibility were found in the hamstrings compared with the spine following acute static stretching (p = 0.04). Improvements in flexibility were maximised by a cumulative stretching volume of 4 min per session (acute) and 10 min per week (chronic).

CONCLUSIONS

Static stretching improves flexibility in adults, with no additional benefit observed beyond 4 min per session or 10 min per week. Although intensity, frequency, age, sex and training status do not influence improvements in flexibility, lower flexibility levels are associated with greater improvement following both acute and chronic static stretching. These guidelines for static stretching can be used by coaches and therapists to improve flexibility.

CLINICAL TRIAL REGISTRATION

PROSPERO CRD42023420168.

Chronic Effects of Static Stretching Exercises on Skeletal Muscle Hypertrophy in Healthy Individuals: A Systematic Review and Multilevel Meta-Analysis

BACKGROUND

The chronic effect of static stretching (SS) on muscle hypertrophy is still unclear. This study aimed to examine the chronic effects of SS exercises on skeletal muscle hypertrophy in healthy individuals.

METHODS

A systematic literature search was conducted in the PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases up to July 2023. Included studies examined chronic effects of SS exercise compared to an active/passive control group or the contralateral leg (i.e., utilizing between- or within-study designs, respectively) and assessed at least one outcome of skeletal muscle hypertrophy in healthy individuals with no age restriction.

RESULTS

Twenty-five studies met the inclusion criteria. Overall, findings indicated an unclear effect of chronic SS exercises on skeletal muscle hypertrophy with a trivial point estimate (standardised mean difference [SMD] = 0.118 [95% prediction interval [95% PI] = - 0.233 to 0.469; p = 0.017]) and low heterogeneity (I2 = 24%). Subgroup analyses revealed that trained individuals (β = 0.424; 95% PI = 0.095 to 0.753) displayed larger effects compared to recreationally trained (β = 0.115; 95% PI = - 0.195 to 0.425) and sedentary individuals (β = - 0.081; 95% PI = - 0.399 to 0.236). Subanalysis suggested the potential for greater skeletal muscle hypertrophy in samples with higher percentages of females (β = 0.003, [95% confidence interval [95% CI] = - 0.000 to 0.005]). However, the practical significance of this finding is questionable. Furthermore, a greater variety of stretching exercises elicited larger increases in muscle hypertrophy (β = 0.069, [95% CI = 0.041 to 0.097]). Longer durations of single stretching exercises (β = 0.006, [95% CI = 0.002 to 0.010]), time under stretching per session (β = 0.006, [95% CI = 0.003 to 0.009]), per week (β = 0.001, [95% CI = 0.000 to 0.001]) and in total (β = 0.008, [95% CI = 0.003 to 0.013]) induced larger muscle hypertrophy. Regarding joint range of motion, there was a clear positive effect with a moderate point estimate (β = 0.698; 95% PI = 0.147 to 1.249; p < 0.001) and moderate heterogeneity (I2 = 43%). Moreover, findings indicated no significant association between the gains in joint range of motion and the increase in muscle hypertrophy (β = 0.036, [95% CI = - 0.123 to 0.196]; p = 0.638).

CONCLUSIONS

This study revealed an overall unclear chronic effect of SS on skeletal muscle hypertrophy, although interpretation across the range of PI suggests a potential modest beneficial effect. Subgroup analysis indicated larger stretching-induced muscle gains in trained individuals, a more varied selection of SS exercises, longer mean duration of single stretching exercise, increased time under SS per session, week, and in total, and possibly in samples with a higher proportion of females. From a practical perspective, it appears that SS exercises may not be highly effective in promoting skeletal muscle hypertrophy unless a higher duration of training is utilized. PROSPERO registration number: CRD42022331762.

The effect of six-week regular stretching exercises on regional and distant pain sensitivity: an experimental longitudinal study on healthy adults

BACKGROUND

Stretching exercises are widely used for pain relief and show positive effects on musculoskeletal, nociplastic and neuropathic pain; the magnitude of altered pain sensitivity responses following regular stretching is currently unknown. This study aimed to investigate the effect of six weeks of regular stretching exercise on regional and widespread pain sensitivity and range of motion and the effect of stretching cessation on regional and widespread pain sensitivity and range of motion.

METHODS

An experimental single-blind longitudinal repeated measures study. Twenty-six healthy adults were recruited. Regional and distant pressure pain thresholds and passive knee extension range of motion were measured at three points: before (baseline) and after six weeks (post-stretch) of daily bilateral hamstring stretching exercises and following four weeks of cessation (post-cessation) from stretching exercises.

RESULTS

Participants had a mean ± standard deviation (range) age of 23.8 ± 2.1 (21-30) years. There was a 36.7% increase in regional (p = 0.003), an 18.7% increase in distant pressure pain thresholds (p = 0.042) and a 3.6% increase in range of motion (p = 0.002) between baseline and post-stretch measures. No statistically significant differences were found for regional (p = 1.000) or distant pressure pain thresholds (p = 1.000), or range of motion (p = 1.000) between post-stretch and post-cessation. A 41.2% increase in distant pressure pain thresholds (p = 0.001), a 15.4% increase in regional pressure pain thresholds from baseline to post-cessation (p = 0.127) and a 3.6% increase in passive knee extension range of motion (p = 0.005) were found from baseline to post-cessation.

CONCLUSIONS

Six weeks of regular stretching exercises significantly decreased regional and widespread pain sensitivity. Moreover, the results showed that the hypoalgesic effect of stretching on regional and widespread pain sensitivity persisted following four weeks of cessation. The results further support the rationale of adding stretching exercises to rehabilitation efforts for patients experiencing nociceptive, nociplastic, and neuropathic pain. However, further research is needed to investigate how the long-term effects of stretching exercises compare with no treatment in clinical populations.

TRIAL REGISTRATION

The trial was registered June 1st, 2021 at ClinicalTrials.gov (Trial registration number NCT04919681).

Static Stretch Training versus Foam Rolling Training Effects on Range of Motion: A Systematic Review and Meta-Analysis

BACKGROUND

Long-term static stretching as well as foam rolling training can increase a joint's range of motion (ROM). However, to date, it is not clear which method is the most effective for increasing ROM.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to compare the effects of static stretching and foam rolling training on ROM.

METHODS

The literature search was performed in PubMed, Scopus, and Web of Science to find the eligible studies. Eighty-five studies (72 on static stretching; and 13 on foam rolling) were found to be eligible with 204 effect sizes (ESs). For the main analyses, a random-effect meta-analysis was applied. To assess the difference between static stretching and foam rolling, subgroup analyses with a mixed-effect model were applied. Moderating variables were sex, total intervention duration, and weeks of intervention.

RESULTS

Static stretch (ES =  - 1.006; p < 0.001), as well as foam rolling training (ES =  - 0.729; p = 0.001), can increase joint ROM with a moderate magnitude compared with a control condition. However, we did not detect a significant difference between the two conditions in the subgroup analysis (p = 0.228). When the intervention duration was ≤ 4 weeks, however, a significant change in ROM was shown following static stretching (ES =  - 1.436; p < 0.001), but not following foam rolling (ES =  - 0.229; p = 0.248). Thus, a subgroup analysis indicated a significant favorable effect with static stretching for increasing ROM compared with foam rolling (p < 0.001) over a shorter term (≤ 4 weeks). Other moderator analyses showed no significant difference between static stretch and foam rolling training on ROM.

CONCLUSIONS

According to the results, both static stretching and foam rolling training can be similarly recommended to increase joint ROM, unless the training is scheduled for ≤ 4 weeks, in which case static stretching demonstrates a significant advantage. More studies are needed with a high-volume foam rolling training approach as well as foam rolling training in exclusively female participants.

Effect of resistance training on quadriceps femoris muscle thickness obtained by ultrasound: A systematic review with meta-analysis

OBJECTIVE

The present study aimed to determine the magnitude and intervention time of resistance training required to generate adaptations in the muscle thickness of the quadriceps muscle obtained by ultrasound in healthy adults.

METHOD

A systematic review with meta-analysis was conducted on studies recovered from Pubmed, Web of Science, and Scopus databases up to March 2022. The study selection process was carried out by two independent researchers, with the presence of a third researcher in case of disagreements. The methodological quality of the studies was determined with the TESTEX scale, and the risk of bias analysis was determined using Cochrane's RoB 2.0 tool. The meta-analysis used the inverse of the variance with a fixed model, and the effect size was reported by the standardized mean difference (SMD) with a confidence interval of 95%.

RESULTS

Ten studies were included in a meta-analysis. The overall analysis of the studies demonstrated an SMD = 0.35 [95% CI: 0.13-0.56] (P = 0.002), with a low heterogeneity of I2 = 0% (P = 0.52). No publication bias was detected using a funnel plot followed by Egger's test (P = 0.06). The degree of certainty of the meta-analysis was high using the GRADE tool.

CONCLUSION

We found that resistance training can generate significant average increases of 16.6% in muscle thickness obtained by ultrasound in the quadriceps femoris muscles of healthy adults. However, the subgroup analysis showed that significant effect sizes were only observed after eight weeks of training.

The relationship between muscle thickness and pennation angle is mediated by fascicle length in the muscles of the lower extremities

Muscle morphological architecture, a crucial determinant of muscle function, has fascinated researchers since the Renaissance. Imaging techniques enable the assessment of parameters such as muscle thickness (MT), pennation angle (PA), and fascicle length (FL), which may vary with growth, sex, and physical activity. Despite known interrelationships, robust mathematical models like causal mediation analysis have not been extensively applied to large population samples. We recruited 109 males and females, measuring knee flexor and extensor, and plantar flexor MT, PA, and FL using real-time ultrasound imaging at rest. A mixed-effects model explored sex, leg (dominant vs. non-dominant), and muscle region differences. Males exhibited greater MT in all muscles (0.1 to 2.1 cm, p < 0.01), with no sex differences in FL. Dominant legs showed greater rectus femoris (RF) MT (0.1 cm, p = 0.01) and PA (1.5°, p = 0.01), while vastus lateralis (VL) had greater FL (1.2 cm, p < 0.001) and PA (0.6°, p = 0.02). Regional differences were observed in VL, RF, and biceps femoris long head (BFlh). Causal mediation analyses highlighted MT's influence on PA, mediated by FL. Moderated mediation occurred in BFlh, with FL differences. Gastrocnemius medialis and lateralis exhibited FL-mediated MT and PA relationships. This study unveils the intricate interplay of MT, FL, and PA in muscle architecture.

What We Do Not Know About Stretching in Healthy Athletes: A Scoping Review with Evidence Gap Map from 300 Trials

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 ).

Proteomic Profiling of Muscular Adaptations to Short-Term Concentric Versus Eccentric Exercise Training in Humans

The molecular mechanisms underlying muscular adaptations to concentric (CON) and eccentric (ECC) exercise training have been extensively explored. However, most previous studies have focused on specifically selected proteins, thus, unable to provide a comprehensive protein profile and potentially missing the crucial mechanisms underlying muscular adaptation to exercise training. We herein aimed to investigate proteomic profiles of human skeletal muscle in response to short-term resistance training. Twenty young males were randomly and evenly assigned to two groups to complete a 4-week either ECC or CON training program. Measurements of body composition and physiological function of the quadriceps femoris were conducted both before and after the training. Muscle biopsies from the vastus lateralis of randomly selected participants (five in ECC and four in CON) of both before and after the training were analyzed using the liquid-chromatography tandem mass spectrometry in combination with bioinformatics analysis. Neither group presented a significant difference in body composition or leg muscle mass; however, muscle peak torque, total work, and maximal voluntary contraction were significantly increased after the training in both groups. Proteomics analysis revealed 122 differentially abundant proteins (DAPs; p value < 0.05 & fold change >1.5 or <0.67) in ECC, of which the increased DAPs were mainly related to skeletal muscle contraction and cytoskeleton and enriched specifically in the pentose phosphate pathway, extracellular matrix-receptor interaction, and PI3K-Akt signaling pathway, whereas the decreased DAPs were associated with the mitochondrial respiratory chain. One hundred one DAPs were identified in CON, of which the increased DAPs were primarily involved in translation/protein synthesis and the mitochondria respiratory, whereas the decreased DAPs were related to metabolic processes, cytoskeleton, and de-ubiquitination. In conclusion, the 4-week CON and ECC training resulted in distinctly different proteomic profiles, especially in proteins related to muscular structure and metabolism.

Chronic effects of stretching on range of motion with consideration of potential moderating variables: A systematic review with meta-analysis

BACKGROUND

It is well known that stretch training can induce prolonged increases in joint range of motion (ROM). However, to date more information is needed regarding which training variables might have greater influence on improvements in flexibility. Thus, the purpose of this meta-analysis was to investigate the effects of stretch training on ROM in healthy participants by considering potential moderating variables, such as stretching technique, intensity, duration, frequency, and muscles stretched, as well as sex-specific, age-specific, and/or trained state-specific adaptations to stretch training.

METHODS

We searched through PubMed, Scopus, Web of Science, and SportDiscus to find eligible studies and, finally, assessed the results from 77 studies and 186 effect sizes by applying a random-effect meta-analysis. Moreover, by applying a mixed-effect model, we performed the respective subgroup analyses. To find potential relationships between stretch duration or age and effect sizes, we performed a meta-regression.

RESULTS

We found a significant overall effect, indicating that stretch training can increase ROM with a moderate effect compared to the controls (effect size = -1.002; Z = -12.074; 95% confidence interval: -1.165 to -0.840; p < 0.001; I2 = 74.97). Subgroup analysis showed a significant difference between the stretching techniques (p = 0.01) indicating that proprioceptive neuromuscular facilitation and static stretching produced greater ROM than did ballistic/dynamic stretching. Moreover, there was a significant effect between the sexes (p = 0.04), indicating that females showed higher gains in ROM compared to males. However, further moderating analysis showed no significant relation or difference.

CONCLUSION

When the goal is to maximize ROM in the long term, proprioceptive neuromuscular facilitation or static stretching, rather than ballistic/dynamic stretching, should be applied. Something to consider in future research as well as sports practice is that neither volume, intensity, nor frequency of stretching were found to play a significant role in ROM yields.

Acute effects of static stretching on passive stiffness in older adults: A systematic review and meta-analysis

BACKGROUND

Static stretching has been demonstrated to improve the health of older adults. One of its goals is to decrease passive stiffness of the muscle-tendon unit (MTU) and/or muscles. Decreased passive stiffness in older adults could increase the range of motion and movement efficiency. Herein, we conducted a meta-analysis of the acute effects of static stretching on passive stiffness in older adults as well as a meta-analysis of differences in these effects between older and young adults.

BACKGROUND

PubMed, Web of Science, and EBSCO were searched for studies published before June 28, 2023. Manual searches were performed to identify additional studies. All included studies were critically reviewed by five authors. Meta-analyses of muscle and tendon injuries were performed using a random effect model. Of 4643 identified studies, 6 studies were included in the systematic review.

RESULTS

The main meta-analysis in older adults showed that static stretching could decrease the passive stiffness of the MTU or muscles (effect size, 0.55; 95 % confidence interval, 0.27 to 0.84; p < 0.01; and I2 = 0.0 %). Moreover, for the comparison between young and old adults, three studies were included in the meta-analysis. The results revealed no significant difference in the effects of static stretching interventions on stiffness between older and young adults (effect size, 0.136; 95 % confidence interval, -0.301 to 0.5738; p = 0.541; and I2 = 17.4 %). Static stretching could decrease the passive stiffness of the MTU and/or muscles in older adults to a small magnitude, and the effects were comparable between older and young adults.

The effects of regional quadriceps architecture on angle-specific rapid force expression

Evaluating anatomical contributions to performance can increase understanding of muscle mechanics and guide physical preparation. While the impact of anatomy on muscular performance is well studied, the effects of regional quadriceps architecture on rapid torque or force expression are less clear. Regional (proximal, middle, and distal) quadriceps (vastus lateralis, rectus femoris, and vastus intermedius) thickness (MT), pennation angle (PA), and fascicle length (FL) of 24 males (48 limbs) were assessed via ultrasonography. Participants performed maximal isometric knee extensions at 40°, 70°, and 100° of knee flexion to evaluate rate of force development from 0 to 200 ms (RFD0-200). Measurements were repeated on three occasions with the greatest RFD0-200 and mean muscle architecture measures used for analysis. Linear regression models predicting angle-specific RFD0-200 from regional anatomy provided adjusted correlations (√adjR2) with bootstrapped compatibility limits. Mid-rectus femoris MT (√adjR2 = 0.41-0.51) and proximal vastus lateralis FL (√adjR2 = 0.42-0.48) were the best single predictors of RFD0-200, and the only measures to reach precision with 99% compatibility limits. Small simple correlations were found across all regions and joint angles between RFD0-200 and vastus lateralis MT (√adjR2 = 0.28 ± 0.13; mean ± SD), vastus lateralis FL (√adjR2 = 0.33 ± 0.10), rectus femoris MT (√adjR2 = 0.38 ± 0.10), and lateral vastus intermedius MT (√adjR2 = 0.24 ± 0.10). Between-correlation comparisons are reported within the article. Researchers should measure mid-region rectus femoris MT and vastus lateralis FL to efficiently and robustly evaluate potential anatomical contributions to rapid knee extension force changes, with distal and proximal measurements providing little additional value. However, correlations were generally small to moderate, suggesting that neurological factors may be critical in rapid force expression.

Hormonal, immune, and oxidative stress responses to blood flow-restricted exercise

INTRODUCTION

Heavy-load free-flow resistance exercise (HL-FFRE) is a widely used training modality. Recently, low-load blood-flow restricted resistance exercise (LL-BFRRE) has gained attention in both athletic and clinical settings as an alternative when conventional HL-FFRE is contraindicated or not tolerated. LL-BFRRE has been shown to result in physiological adaptations in muscle and connective tissue that are comparable to those induced by HL-FFRE. The underlying mechanisms remain unclear; however, evidence suggests that LL-BFRRE involves elevated metabolic stress compared to conventional free-flow resistance exercise (FFRE).

AIM

The aim was to evaluate the initial (<10 min post-exercise), intermediate (10-20 min), and late (>30 min) hormonal, immune, and oxidative stress responses observed following acute sessions of LL-BFRRE compared to FFRE in healthy adults.

METHODS

A systematic literature search of randomized and non-randomized studies was conducted in PubMed, Embase, Cochrane Central, CINAHL, and SPORTDiscus. The Cochrane Risk of Bias (RoB2, ROBINS-1) and TESTEX were used to evaluate risk of bias and study quality. Data extractions were based on mean change within groups.

RESULTS

A total of 12525 hits were identified, of which 29 articles were included. LL-BFRRE demonstrated greater acute increases in growth hormone responses when compared to overall FFRE at intermediate (SMD 2.04; 95% CI 0.87, 3.22) and late (SMD 2.64; 95% CI 1.13, 4.16) post-exercise phases. LL-BFRRE also demonstrated greater increase in testosterone responses compared to late LL-FFRE.

CONCLUSION

These results indicate that LL-BFRRE can induce increased or similar hormone and immune responses compared to LL-FFRE and HL-FFRE along with attenuated oxidative stress responses compared to HL-FFRE.

Acute and Long-Term Effects of Static Stretching on Muscle-Tendon Unit Stiffness: A Systematic Review and Meta-Analysis

Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in the range of motion after static stretching. However, to date, the effects of acute and long-term static stretching on MTS are not well understood. The purpose of this meta-analysis was to investigate the effects of acute and long-term static stretching training on MTS, in young healthy participants. PubMed, Web of Science, and EBSCO published before January 6, 2023, were searched and finally, 17 papers were included in the meta-analysis. Main meta-analysis was performed with a random-effect model and subgroup analyses, which included comparisons of sex (male vs. mixed sex and female) and muscle (hamstrings vs. plantar flexors) were also performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on MTS. For acute static stretching, the result of the meta-analysis showed a moderate decrease in MTS (effect size = -0.772, Z = -2.374, 95% confidence interval = -1.409 - -0.325, p = 0.018, I2 = 79.098). For long-term static stretching, there is no significant change in MTS (effect size = -0.608, Z = -1.761, 95% CI = -1.284 - 0.069, p = 0.078, I2 = 83.061). Subgroup analyses revealed no significant differences between sex (long-term, p = 0.209) or muscle (acute, p =0.295; long-term, p = 0.427). Moreover, there was a significant relationship between total stretching duration and MTS in acute static stretching (p = 0.011, R2 = 0.28), but not in long-term stretching (p = 0.085, R2 < 0.01). Whilst MTS decreased after acute static stretching, only a tendency of a decrease was seen after long-term stretching.

Long-term static stretching can decrease muscle stiffness: A systematic review and meta-analysis

Stretch training increases the range of motion of a joint. However, to date, the mechanisms behind such a stretching effect are not well understood. An earlier meta-analysis on several studies reported no changes in the passive properties of a muscle (i.e., muscle stiffness) following long-term stretch training with various types of stretching (static, dynamic, and proprioceptive neuromuscular stretching). However, in recent years, an increasing number of papers have reported the effects of long-term static stretching on muscle stiffness. The purpose of the present study was to examine the long-term (≥2 weeks) effect of static stretching training on muscle stiffness. PubMed, Web of Science, and EBSCO published before December 28, 2022, were searched and 10 papers met the inclusion criteria for meta-analysis. By applying a mixed-effect model, subgroup analyses, which included comparisons of sex (male vs. mixed sex) and type of muscle stiffness assessment (calculated from the muscle-tendon junction vs. shear modulus), were performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on muscle stiffness. The result of the meta-analysis showed a moderate decrease in muscle stiffness after 3-12 weeks of static stretch training compared to a control condition (effect size = -0.749, p < 0.001, I2  = 56.245). Subgroup analyses revealed no significant differences between sex (p = 0.131) and type of muscle stiffness assessment (p = 0.813). Moreover, there was no significant relationship between total stretching duration and muscle stiffness (p = 0.881).

Muscle Architecture Adaptations to Static Stretching Training: A Systematic Review with Meta-Analysis

BACKGROUND

Long-term stretching of human skeletal muscles increases joint range of motion through altered stretch perception and decreased resistance to stretch. There is also some evidence that stretching induces changes in muscle morphology. However, research is limited and inconclusive.

OBJECTIVE

To examine the effect of static stretching training on muscle architecture (i.e., fascicle length and fascicle angle, muscle thickness and cross-sectional area) in healthy participants.

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed Central, Web of Science, Scopus, and SPORTDiscus were searched. Randomized controlled trials and controlled trials without randomization were included. No restrictions on language or date of publication were applied. Risk of bias was assessed using Cochrane RoB2 and ROBINS-I tools. Subgroup analyses and random-effects meta-regressions were also performed using total stretching volume and intensity as covariates. Quality of evidence was determined by GRADE analysis.

RESULTS

From the 2946 records retrieved, 19 studies were included in the systematic review and meta-analysis (n = 467 participants). Risk of bias was low in 83.9% of all criteria. Confidence in cumulative evidence was high. Stretching training induces trivial increases in fascicle length at rest (SMD = 0.17; 95% CI 0.01-0.33; p = 0.042) and small increases in fascicle length during stretching (SMD = 0.39; 95% CI 0.05 to 0.74; p = 0.026). No increases were observed in fascicle angle or muscle thickness (p = 0.30 and p = 0.18, respectively). Subgroup analyses showed that fascicle length increased when high stretching volumes were used (p < 0.004), while no changes were found for low stretching volumes (p = 0.60; subgroup difference: p = 0.025). High stretching intensities induced fascicle length increases (p < 0.006), while low stretching intensities did not have an effect (p = 0.72; subgroup difference: p = 0.042). Also, high intensity stretching resulted in increased muscle thickness (p = 0.021). Meta-regression analyses showed that longitudinal fascicle growth was positively associated with stretching volume (p < 0.02) and intensity (p < 0.04).

CONCLUSIONS

Static stretching training increases fascicle length at rest and during stretching in healthy participants. High, but not low, stretching volumes and intensities induce longitudinal fascicle growth, while high stretching intensities result in increased muscle thickness.

REGISTRATION

PROSPERO, registration number: CRD42021289884.

Eight weeks of proprioceptive neuromuscular facilitation stretching and static stretching do not affect muscle-tendon properties, muscle strength, and joint function in children with spastic cerebral palsy

BACKGROUND

While the effect of static stretching for individuals with cerebral palsy is questionable, recent results suggest that the combination with activation seems promising to improve muscle-tendon properties and function. Therefore, this study analyzed the effects of 8-week proprioceptive neuromuscular facilitation stretching on the gastrocnemius medialis muscle-tendon properties, muscle strength, and the ankle joint in children with spastic cerebral palsy in comparison to static stretching.

METHODS

Initially, 24 children with spastic cerebral palsy were randomly assigned to a static stretching (10.7 ± 1.8 years) or proprioceptive neuromuscular facilitation stretching group (10.9 ± 2.6 years). Plantar flexors were manually stretched at home for 300 s and ∼ 250-270 s per day four times a week for eight weeks, respectively. Assessments of ankle joint function (e.g., range of motion), muscle-tendon properties, and isometric muscle strength were conducted using 3D motion capture, 2D ultrasound, dynamometry, and electromyography. A mixed analysis of variance was used for the statistical analysis.

FINDINGS

Stretching adherence was high in the proprioceptive neuromuscular facilitation stretching (93.1%) and static stretching group (94.4%). No significant changes (p > 0.05) were observed in ankle joint function, muscle-tendon properties, and isometric muscle strength after both interventions. Moreover, no differences (p > 0.05) were found between the stretching techniques.

INTERPRETATION

The findings support the idea that manual stretching (neither proprioceptive neuromuscular facilitation stretching nor static stretching) performed in isolation for eight weeks may not be appropriate to evoke significant changes in muscle-tendon properties, voluntary muscle strength, or joint function in children with spastic cerebral palsy.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04570358.

Effects of Eccentric Resistance Training on Lower-Limb Passive Joint Range of Motion: A Systematic Review and Meta-analysis

INTRODUCTION

Substantial increases in joint range of motion (ROM) have been reported after eccentric resistance training; however, between-study variability and sample size issues complicate the interpretation of the magnitude of effect.

METHODS

PubMed, Medline, and SPORTDiscus databases were searched for studies examining the effects of eccentric training on lower-limb passive joint ROM in healthy human participants. Meta-analysis used an inverse-variance random-effects model to calculate the pooled standardized difference (Hedge's g ) with 95% confidence intervals.

RESULTS

Meta-analysis of 22 ROM outcomes (17 studies, 376 participants) revealed a large increase in lower-limb passive joint ROM ( g = 0.86 (95% confidence intervals, 0.65-1.08)). Subgroup analyses revealed a moderate increase after 4-5 wk ( g = 0.63 (0.27-0.98)), large increase after 6-8 wk ( g = 0.98 (0.73-1.24)), and moderate increase after 9-14 wk ( g = 0.75 (0.03, 1.46)) of training. Large increases were found in dorsiflexion ( g = 1.12 (0.78-1.47)) and knee extension ( g = 0.82 (0.48-1.17)), but a small increase in knee flexion was observed ( g = 0.41 (0.05-0.77)). A large increase was found after isokinetic ( g = 1.07 (0.59-1.54)) and moderate increase after isotonic ( g = 0.77 (0.56-0.99)) training.

CONCLUSIONS

These findings demonstrate the potential of eccentric training as an effective flexibility training intervention and provide evidence for "best practice" guidelines. The larger effect after isokinetic training despite <50% training sessions being performed is suggestive of a more effective exercise mode, although further research is needed to determine the influence of contraction intensity and to confirm the efficacy of eccentric training in clinical populations.

Architectural and Mechanical Changes after Five Weeks of Intermittent Static Stretch Training on the Medial Gastrocnemius Muscle of Active Adults

We investigated the effects of intermittent long-term stretch training (5 weeks) on the architectural and mechanical properties of the muscle–tendon unit (MTU) in healthy humans. MTU’s viscoelastic and architectural properties in the human medial gastrocnemius (MG) muscle and the contribution of muscle and tendon structures to the MTU lengthening were analyzed. Ten healthy volunteers participated in the study (four females and six males). The passive stretch of the plantar flexor muscles was achieved from 0° (neutral ankle position) to 25° of dorsiflexion. Measurements were obtained during a single passive stretch before and after the completion of the stretching protocol. During the stretch, the architectural parameters of the MG muscle were measured via ultrasonography, and the passive torque was recorded by means of a strain-gauge transducer. Repeated-measure ANOVA was applied for all parameters. When expressed as a percentage for all dorsiflexion angles, the relative torque values decreased (p < 0.001). In the same way, architectural parameters (pennation angle and fascicle length) were compared for covariance and showed a significant difference between the slopes (ANCOVA p < 0.0001 and p < 0.001, respectively) suggesting a modification in the mechanical behavior after stretch training. Furthermore, the values for passive stiffness decreased (p < 0.05). The maximum ankle range of motion (ROM) (p < 0.01) and the maximum passive torque (p < 0.05) increased. Lastly, the contribution of the free tendon increased more than fascicle elongation to the total lengthening of the MTU (ANCOVA p < 0.001). Our results suggest that five weeks of intermittent static stretch training significantly change the behavior of the MTU. Specifically, it can increase flexibility and increase tendon contribution during MTU lengthening.

Effects of daily static stretch training over 6 weeks on maximal strength, muscle thickness, contraction properties, and flexibility

Purpose

Static stretch training (SST) with long stretching durations seems to be sufficient to increase flexibility, maximum strength (MSt) and muscle thickness (MTh). However, changes in contraction properties and effects on muscle damage remain unclear. Consequently, the objective of the study was to investigate the effects of a 6-week self-performed SST on MSt, MTh, contractile properties, flexibility, and acute response of creatine kinase (CK) 3 days after SST.

Methods

Forty-four participants were divided into a control (CG, n = 22) and an intervention group (IG, n = 22), who performed a daily SST for 5 min for the lower limb muscle group. While isometric MSt was measured in leg press, MTh was examined via sonography and flexibility by functional tests. Muscle stiffness and contraction time were measured by tensiomyography on the rectus femoris. Additionally, capillary blood samples were taken in the pretest and in the first 3 days after starting SST to measure CK.

Results

A significant increase was found for MSt (p < 0.001, η ² = 0.195) and flexibility in all functional tests (p < 0.001, η ² > 0.310). Scheffé post hoc test did not show significant differences between the rectus femoris muscle inter- and intragroup comparisons for MTh nor for muscle stiffness and contraction time (p > 0.05, η ² < 0.100). Moreover, CK was not significantly different between IG and CG with p > 0.05, η ² = 0.032.

Discussion

In conclusion, the increase in MSt cannot be exclusively explained by muscular hypertrophy or the increased CK-related repair mechanism after acute stretching. Rather, neuronal adaptations have to be considered. Furthermore, daily 5-min SST over 6 weeks does not seem sufficient to change muscle stiffness or contraction time. Increases in flexibility tests could be attributed to a stretch-induced change in the muscle-tendon complex.

Effects of Different Long-Term Exercise Modalities on Tissue Stiffness

Stiffness is a fundamental property of living tissues, which may be modified by pathologies or traumatic events but also by nutritional, pharmacological and exercise interventions. This review aimed to understand if specific forms of exercise are able to determine specific forms of tissue stiffness adaptations. A literature search was performed on PubMed, Scopus and Web of Science databases to identify manuscripts addressing adaptations of tissue stiffness as a consequence of long-term exercise. Muscular, connective, peripheral nerve and arterial stiffness were considered for the purpose of this review. Resistance training, aerobic training, plyometric training and stretching were retrieved as exercise modalities responsible for tissue stiffness adaptations. Differences were observed related to each specific modality. When exercise was applied to pathological cohorts (i.e. tendinopathy or hypertension), stiffness changed towards a physiological condition. Exercise interventions are able to determine tissue stiffness adaptations. These should be considered for specific exercise prescriptions. Future studies should concentrate on identifying the effects of exercise on the stiffness of specific tissues in a broader spectrum of pathological populations, in which a tendency for increased stiffness is observed.

The influence of longitudinal muscle fascicle growth on mechanical function

Skeletal muscle has the remarkable ability to remodel and adapt, such as the increase in serial sarcomere number (SSN) or fascicle length (FL) observed after overstretching a muscle. This type of remodelling is termed longitudinal muscle fascicle growth, and its impact on biomechanical function has been of interest since the 1960s due to its clinical applications in muscle strain injury, muscle spasticity, and sarcopenia. Despite simplified hypotheses on how longitudinal muscle fascicle growth might influence mechanical function, existing literature presents conflicting results partly due to a breadth of methodologies. The purpose of this review is to outline what is currently known about the influence of longitudinal muscle fascicle growth on mechanical function and suggest future directions to address current knowledge gaps and methodological limitations. Various interventions indicate longitudinal muscle fascicle growth can increase the optimal muscle length for active force, but whether the whole force-length relationship widens has been less investigated. Future research should also explore the ability for longitudinal fascicle growth to broaden the torque-angle relationship's plateau region, and the relation to increased force during shortening. Without a concurrent increase in intramuscular collagen, longitudinal muscle fascicle growth also reduces passive tension at long muscle lengths; further research is required to understand whether this translates to increased joint range of motion. Lastly, some evidence suggests longitudinal fascicle growth can increase maximum shortening velocity and peak isotonic power, however, there has yet to be direct assessment of these measures in a neurologically intact model of longitudinal muscle fascicle growth.

Chronic and Residual Effects of a Two-Week Foam Rolling Intervention on Ankle Flexibility and Dynamic Balance

Background

Foam rolling has been shown to acutely improve joint range of motion (ROM). However, limited knowledge exists on the chronic and residual effects. The primary purpose of this study was to examine the chronic and residual effects of a 2-week roller–massager intervention on ankle dorsiflexion ROM and dynamic balance.

Methods

Forty-two participants (24.3 ± 2.5 years, 33 males, 9 females) were randomly assigned to either roller-massage (RM) or control group (= no intervention). Ankle ROM was assessed with the weight-bearing lunge test (WBLT) and dynamic balance with the Y-Balance test for both limbs. The RM group was instructed to roll their calf muscles for three sets of 60 s per leg on 6 days a week over 2 weeks. Acute effects were measured during baseline testing for dorsiflexion ROM and dynamic balance immediately after foam rolling. Chronic and residual effects were measured 1 day and 7 days after the intervention period. Multivariate ANOVA was performed for post-hoc comparisons to determine acute, chronic, and residual effects.

Results

Significant acute and chronic foam rolling effects (p <0.05) were found for ankle dorsiflexion ROM. The chronic increase in ROM slightly decreased 7 days post-intervention but remained significantly above baseline (p < 0.05). Regarding dynamic balance, there were no acute but chronic (p < 0.05) and residual (p < 0.05) effects.

Conclusion

Using a roller–massager for a 2-week period chronically increases ROM and dynamic balance. These increases are still significant 7 days post-intervention emphasizing the sustainability of foam rolling effects.

Comparison Between Contract-Relax Stretching and Antagonist Contract-Relax Stretching on Gastrocnemius Medialis Passive Properties

Antagonist contract-relax stretching and contract-relax stretching is commonly used in sports practice and rehabilitation settings. To date, no study has compared these modalities regarding muscle stiffness and stretch tolerance. This study aimed to investigate the effects of contract-relax and antagonist contract-relax stretching on dorsiflexion range of motion (ROM), stretch tolerance, and shear elastic modulus. Forty healthy participants (24 men and 16 women) took part in the study. Participants were randomly assigned to perform either contract-relax stretching or antagonist contract-relax stretching for 2 min. Outcomes were assessed on ROM, stretch tolerance, and shear elastic modulus before and after stretching. The ROM and stretch tolerance significantly increased after both contract-relax stretching (+ 5.4 ± 5.8°, p < 0.05; + 3.5 ± 8.0 Nm, p < 0.05) and antagonist contract-relax stretching (+ 6.1 ± 4.9°, p < 0.05; + 4.2 ± 6.4 Nm, p < 0.05); however, no significant difference was found between the two groups. Alternatively, the shear elastic modulus significantly decreased after both contract-relax (-31.1 ± 22.6 kPa, p < 0.05) and antagonist contract-relax stretching (-11.1 ± 22.3 kPa, p < 0.05); however, contract-relax stretching (-41.9 ± 19.6%) was more effective than antagonist contract-relax stretching (-12.5 ± 61.6%). The results of this study suggest that contract-relax stretching instead of antagonist contract-relax stretching should be conducted to decrease muscle stiffness. However, either contract-relax or antagonist contract-relax stretching can increase ROM.

Comparison Between High- and Low-Intensity Static Stretching Training Program on Active and Passive Properties of Plantar Flexors

The purpose of this study was to compare two static stretching (SS) training programs at high-intensity (HI-SS) and low-intensity (LI-SS) on passive and active properties of the plantar flexor muscles. Forty healthy young men were randomly allocated into three groups: HI-SS intervention group (n = 14), LI-SS intervention group (n = 13), and non-intervention control group (n = 13). An 11-point numerical scale (0–10; none to very painful stretching) was used to determine SS intensity. HI-SS and LI-SS stretched at 6–7 and 0–1 intensities, respectively, both in 3 sets of 60 s, 3×/week, for 4 weeks. Dorsiflexion range of motion (ROM), gastrocnemius muscle stiffness, muscle strength, drop jump height, and muscle architecture were assessed before and after SS training program. The HI-SS group improved more than LI-SS in ROM (40 vs. 15%) and decreased muscle stiffness (−57 vs. −24%), while no significant change was observed for muscle strength, drop jump height, and muscle architecture in both groups. The control group presented no significant change in any variable. Performing HI-SS is more effective than LI-SS for increasing ROM and decreasing muscle stiffness of plantar flexor muscles following a 4-week training period in young men. However, SS may not increase muscle strength or hypertrophy, regardless of the stretching discomfort intensity.

Sex Differences in the Mechanical and Neurophysiological Response to Roller Massage of the Plantar Flexors

Self-massage using foam rollers, sticks, or balls has become a popular technique to enhance joint range of motion (ROM). Although increases are reported to be larger in females than males, the mechanisms of this observation are unclear. The present study aimed to investigate the effect of roller massage (RM) on ROM, passive tissue stiffness, and neurophysiological markers as a function of sex. Males (n = 15, 22.8 ± 2.9 yrs.) and females (n = 14, 21.1 ± 0.7 yrs.) performed three 60-second bouts of calf RM. Outcomes assessed pre-, and post-intervention included passive dorsiflexion (DF) ROM, passive tissue stiffness, passive torque, DF angle at the first stretch sensation, shear elastic modulus, and spinal excitability. DF ROM (+35.9 %), passive torque at DF ROM (+46.4 %), DF angle at first stretch sensation (+32.9 %), and pain pressure threshold (+25.2 %) increased in both groups (p<.05) with no differences between males and females (p > 0.05). No changes were observed for passive stiffness, shear elastic modulus, and spinal excitability (p > 0.05). Roller massage may increase ROM independently of sex, which, in the present study, could not be ascribed to alterations in passive stiffness or neurophysiological markers. Future studies may further elucidate the role of sensory alterations as possible factors driving RM-induced changes in flexibility.

Stimuli for Adaptations in Muscle Length and the Length Range of Active Force Exertion-A Narrative Review

Treatment strategies and training regimens, which induce longitudinal muscle growth and increase the muscles’ length range of active force exertion, are important to improve muscle function and to reduce muscle strain injuries in clinical populations and in athletes with limited muscle extensibility. Animal studies have shown several specific loading strategies resulting in longitudinal muscle fiber growth by addition of sarcomeres in series. Currently, such strategies are also applied to humans in order to induce similar adaptations. However, there is no clear scientific evidence that specific strategies result in longitudinal growth of human muscles. Therefore, the question remains what triggers longitudinal muscle growth in humans. The aim of this review was to identify strategies that induce longitudinal human muscle growth. For this purpose, literature was reviewed and summarized with regard to the following topics: (1) Key determinants of typical muscle length and the length range of active force exertion; (2) Information on typical muscle growth and the effects of mechanical loading on growth and adaptation of muscle and tendinous tissues in healthy animals and humans; (3) The current knowledge and research gaps on the regulation of longitudinal muscle growth; and (4) Potential strategies to induce longitudinal muscle growth. The following potential strategies and important aspects that may positively affect longitudinal muscle growth were deduced: (1) Muscle length at which the loading is performed seems to be decisive, i.e., greater elongations after active or passive mechanical loading at long muscle length are expected; (2) Concentric, isometric and eccentric exercises may induce longitudinal muscle growth by stimulating different muscular adaptations (i.e., increases in fiber cross-sectional area and/or fiber length). Mechanical loading intensity also plays an important role. All three training strategies may increase tendon stiffness, but whether and how these changes may influence muscle growth remains to be elucidated. (3) The approach to combine stretching with activation seems promising (e.g., static stretching and electrical stimulation, loaded inter-set stretching) and warrants further research. Finally, our work shows the need for detailed investigation of the mechanisms of growth of pennate muscles, as those may longitudinally grow by both trophy and addition of sarcomeres in series.

Altered Triceps Surae Muscle-Tendon Unit Properties after 6 Months of Static Stretching

INTRODUCTION

This study examined the effects of 24 wk of daily static stretching of the plantarflexors (unilateral 4 × 60-s stretching, whereas the contralateral leg served as a control; n = 26) on joint range of motion (ROM), muscle-tendon unit morphological and mechanical properties, neural activation, and contractile function.

METHODS

Torque-angle/velocity was obtained in passive and active conditions using isokinetic dynamometry, whereas muscle-tendon morphology and mechanical properties were examined using ultrasonography.

RESULTS

After the intervention, ROM increased (stretching, +11° ± 7°; control, 4° ± 8°), and passive torque (stretching, -10 ± 11 N·m; control, -7 ± 10 N·m) and normalized EMG amplitude (stretching, -3% ± 6%; control, -3% ± 4%) at a standardized dorsiflexion angle decreased. Increases were seen in passive tendon elongation at a standardized force (stretching, +1.3 ± 1.6 mm; control, +1.4 ± 2.1 mm) and in maximal passive muscle and tendon elongation. Angle of peak torque shifted toward dorsiflexion. No changes were seen in tendon stiffness, resting tendon length, or gastrocnemius medialis fascicle length. Conformable changes in ROM, passive dorsiflexion variables, tendon elongation, and angle of peak torque were observed in the nonstretched leg.

CONCLUSIONS

The present findings indicate that habitual stretching increases ROM and decreases passive torque, altering muscle-tendon behavior with the potential to modify contractile function.

Muscle Architectural and Functional Adaptations Following 12-Weeks of Stretching in Adolescent Female Athletes

This study examined the effects of high-volume static stretching training on gastrocnemius muscle architecture, ankle angle and jump height in 21 female adolescent volleyball players. Static stretching of the plantar flexors of one leg (STR) was performed five times/week for 12 weeks, in addition to volleyball training, with the contra-lateral leg used as control (CON). Total duration of stretching per session increased from 540 s (week 1) to 900 s (week 12). At baseline, week 12 and after 3 weeks of detraining, muscle architecture at the middle and the distal part of both gastrocnemius heads (medialis and lateralis) and ankle angle were examined at rest and at maximum dorsiflexion. At the same time-points gastrocnemius cross-sectional area (CSA) was also assessed, while jumping height was measured at baseline and week 12. Following intervention, ankle dorsiflexion increased in both legs with a greater increase in STR than CON (22 ± 20% vs. 8 ± 17%, p < 0.001). Fascicle length at the middle part of gastrocnemius medialis increased only in the STR, at rest (6 ± 7%, p = 0.006) and at maximum dorsiflexion (11 ± 7%, p < 0.001). Fascicle length at maximum dorsiflexion also increased at the distal part of gastrocnemius lateralis of STR (15 ± 13%, p < 0.001). A greater increase in CSA (23 ± 14% vs. 13 ± 14%, p < 0.001) and in one-leg jumping height (27 ± 30% vs. 17 ± 23%, p < 0.001) was found in STR than CON. Changes in ankle angle, fascicle length and CSA were maintained following detraining. High-volume stretching training for 12 weeks results in ankle dorsiflexion, fascicle length and muscle cross sectional area increases in adolescent female volleyball players. These adaptations may partly explain improvements in jump performance.

Local and Non-local Effects of Foam Rolling on Passive Soft Tissue Properties and Spinal Excitability

In sports and clinical settings, roller massage (RM) interventions are used to acutely increase range of motion (ROM); however, the underlying mechanisms are unclear. Apart from changes in soft tissue properties (i.e., reduced passive stiffness), neurophysiological alterations such as decreased spinal excitability have been described. However, to date, no study has investigated both jointly. The purpose of this trial was to examine RM’s effects on neurophysiological markers and passive tissue properties of the plantar flexors in the treated (ROLL) and non-treated (NO-ROLL) leg. Fifteen healthy individuals (23 ± 3 years, eight females) performed three unilateral 60-s bouts of calf RM. This procedure was repeated four times on separate days to allow independent assessments of the following outcomes without reciprocal interactions: dorsiflexion ROM, passive torque during passive dorsiflexion, shear elastic modulus of the medial gastrocnemius muscle, and spinal excitability. Following RM, dorsiflexion ROM increased in both ROLL (+19.7%) and NO-ROLL (+13.9%). Similarly, also passive torque at dorsiflexion ROM increased in ROLL (+15.0%) and NO-ROLL (+15.2%). However, there were no significant changes in shear elastic modulus and spinal excitability (p > 0.05). Moreover, significant correlations were observed between the changes in DF ROM and passive torque at DF ROM in both ROLL and NO-ROLL. Changes in ROM after RM appear to be the result of sensory changes (e.g., passive torque at DF ROM), affecting both rolled and non-rolled body regions. Thus, therapists and exercise professionals may consider applying remote treatments if local loading is contraindicated.

Strength Training versus Stretching for Improving Range of Motion: A Systematic Review and Meta-Analysis

(1) Background: Stretching is known to improve range of motion (ROM), and evidence has suggested that strength training (ST) is effective too. However, it is unclear whether its efficacy is comparable to stretching. The goal was to systematically review and meta-analyze randomized controlled trials (RCTs) assessing the effects of ST and stretching on ROM (INPLASY 10.37766/inplasy2020.9.0098). (2) Methods: Cochrane Library, EBSCO, PubMed, Scielo, Scopus, and Web of Science were consulted in October 2020 and updated in March 2021, followed by search within reference lists and expert suggestions (no constraints on language or year). Eligibility criteria: (P) Humans of any condition; (I) ST interventions; (C) stretching (O) ROM; (S) supervised RCTs. (3) Results: Eleven articles (n = 452 participants) were included. Pooled data showed no differences between ST and stretching on ROM (ES = -0.22; 95% CI = -0.55 to 0.12; p = 0.206). Sub-group analyses based on risk of bias, active vs. passive ROM, and movement-per-joint analyses showed no between-protocol differences in ROM gains. (4) Conclusions: ST and stretching were not different in their effects on ROM, but the studies were highly heterogeneous in terms of design, protocols and populations, and so further research is warranted. However, the qualitative effects of all the studies were quite homogeneous.

Training and Detraining Effects Following a Static Stretching Program on Medial Gastrocnemius Passive Properties

A stretching intervention program is performed to maintain and improve range of motion (ROM) in sports and rehabilitation settings. However, there is no consensus on the effects of stretching programs on muscle stiffness, likely due to short stretching durations used in each session. Therefore, a longer stretching exercise session may be required to decrease muscle stiffness in the long-term. Moreover, until now, the retention effect (detraining) of such an intervention program is not clear yet. The purpose of this study was to investigate the training (5-week) and detraining effects (5-week) of a high-volume stretching intervention on ankle dorsiflexion ROM (DF ROM) and medial gastrocnemius muscle stiffness. Fifteen males participated in this study and the plantarflexors of the dominant limb were evaluated. Static stretching intervention was performed using a stretching board for 1,800 s at 2 days per week for 5 weeks. DF ROM was assessed, and muscle stiffness was calculated from passive torque and muscle elongation during passive dorsiflexion test. The results showed significant changes in DF ROM and muscle stiffness after the stretching intervention program, but the values returned to baseline after the detraining period. Our results indicate that high-volume stretching intervention (3,600 s per week) may be beneficial for DF ROM and muscle stiffness, but the training effects are dismissed after a detraining period with the same duration of the intervention.

Effects of a high-volume static stretching programme on plantar-flexor muscle strength and architecture

PURPOSE

Static stretching (SS) is performed in various settings, but there is no consensus about the effects of SS programmes on changes in muscle morphofunction. This study aimed to investigate the effects of a high-volume SS programme on muscle strength and architecture.

METHODS

Sixteen healthy young male adults participated, and the dominant leg was defined as the intervention side, with the non-dominant leg as the control side. Stretching exercises were performed two times per week (6 sets of 5 min, totally 30 min per session,) for 5-week using a stretching board under the supervision of the research team. Before and after SS intervention programme, plantar-flexor strength (maximum voluntary isometric contraction, MVC-ISO; maximum voluntary concentric contraction, MVC-CON) and architecture (muscle thickness, pennation angle, and fascicle length) were measured via dynamometer and ultrasound, respectively.

RESULTS

Following the SS-training programme, significant increases were observed for stretching side in MVIC-ISO at neutral ankle position (p = 0.02, d = 0.31, Δ = 6.4 ± 9.9%) and MVC-CON at 120°/s (p = 0.02, d = 0.30, Δ = 7.8 ± 9.1%), with no significant change on the control side. There was no significant change in any measure of muscle architecture for both intervention and control sides.

CONCLUSION

Five-week high-volume SS induced positive changes on some measures of muscle strength but not hypertrophy of plantar-flexor muscles. Even with a volume much greater than already tested, the low strain offered by the SS per set seems be insufficient to induce architectural changes on skeletal muscle.

The effects of 12 weeks of static stretch training on the functional, mechanical, and architectural characteristics of the triceps surae muscle-tendon complex

PURPOSE

We investigated the effects of 12 weeks of passive static stretching training (PST) on force-generating capacity, passive stiffness, muscle architecture of plantarflexor muscles.

METHODS

Thirty healthy adults participated in the study. Fifteen participants (STR, 6 women, 9 men) underwent 12-week plantarflexor muscles PST [(5 × 45 s-on/15 s-off) × 2exercises] × 5times/week (duration: 2250 s/week), while 15 participants (CTRL, 6 women, 9 men) served as control (no PST). Range of motion (ROM), maximum passive resistive torque (PRT_max), triceps surae architecture [fascicle length, fascicle angle, and thickness], passive stiffness [muscle-tendon complex (MTC) and muscle stiffness], and plantarflexors maximun force-generating capacity variables (maximum voluntary contraction, maximum muscle activation, rate of torque development, electromechanical delay) were calculated Pre, at the 6th (Wk6), and the 12th week (Wk12) of the protocol in both groups.

RESULTS

Compared to Pre, STR ROM increased (P < 0.05) at Wk6 (8%) and Wk12 (23%). PRT_max increased at Wk12 (30%, P < 0.05), while MTC stiffness decreased (16%, P < 0.05). Muscle stiffness decreased (P < 0.05) at Wk6 (11%) and Wk12 (16%). No changes in triceps surae architecture and plantarflexors maximum force-generating capacity variables were found in STR (P > 0.05). Percentage changes in ROM correlated with percentage changes in PRT_max (ρ = 0.62, P = 0.01) and MTC stiffness (ρ = - 0.78, P = 0.001). In CTRL, no changes (P > 0.05) occurred in any variables at any time point.

CONCLUSION

The expected long-term PST-induced changes in ROM were associated with modifications in the whole passive mechanical properties of the ankle joint, while maximum force-generating capacity characteristics were preserved. 12 weeks of PST do not seem a sufficient stimulus to induce triceps surae architectural changes.

Effects of 6-Week Static Stretching of Knee Extensors on Flexibility, Muscle Strength, Jump Performance, and Muscle Endurance

ABSTRACT

Ikeda, N and Ryushi, T. Effects of 6-week static stretching of knee extensors on flexibility, muscle strength, jump performance, and muscle endurance. J Strength Cond Res 35(3): 715-723, 2021-The purpose of this study was to evaluate the changes in flexibility and muscular performance after stretching training for 6 weeks. Twelve healthy young men were assigned to a stretching group and 13 to a control group. The subjects of the stretching group performed static stretching of knee extensors for 6 weeks. Knee flexion range of motion (KFROM), leg extension strength, rate of force development (RFD) in leg extension, jump performance (squat and countermovement jump height, and index of rebound jump), and strength decrement index of 50 repetitions of isokinetic knee extension (muscle endurance) were measured before and after the interventions. In the stretching group, KFROM significantly increased from 145.2 ± 17.3 to 158.7 ± 6.3° (p < 0.05), whereas RFD significantly improved from 10,173 ± 2,401 to 11,883 ± 2,494 N·s-1 (p < 0.05). By contrast, leg extension strength and jump performance of each jump type did not improve significantly. Furthermore, muscle endurance decreased significantly. All variables remained unchanged in the control group. In conclusion, 6 weeks of stretching training of knee extensors improved KFROM and RFD in leg extension, but not leg extension strength and jump performance; moreover, muscle endurance decreased. These findings indicate that this stretching training protocol can be used by athletes in sports who require high flexibility and those who require high-power exertion.

Non-local Acute Passive Stretching Effects on Range of Motion in Healthy Adults: A Systematic Review with Meta-analysis

BACKGROUND

Stretching a muscle not only increases the extensibility or range of motion (ROM) of the stretched muscle or joint but there is growing evidence of increased ROM of contralateral and other non-local muscles and joints.

OBJECTIVE

The objective of this meta-analysis was to quantify crossover or non-local changes in passive ROM following an acute bout of unilateral stretching and to examine potential dose-response relations.

METHODS

Eleven studies involving 14 independent measures met the inclusion criteria. The meta-analysis included moderating variables such as sex, trained state, stretching intensity and duration.

RESULTS

The analysis revealed that unilateral passive static stretching induced moderate magnitude (standard mean difference within studies: SMD: 0.86) increases in passive ROM with non-local, non-stretched joints. Moderating variables such as sex, trained state, stretching intensity, and duration did not moderate the results. Although stretching duration did not present statistically significant differences, greater than 240-s of stretching (SMD: 1.24) exhibited large magnitude increases in non-local ROM compared to moderate magnitude improvements with shorter (< 120-s: SMD: 0.72) durations of stretching.

CONCLUSION

Passive static stretching of one muscle group can induce moderate magnitude, global increases in ROM. Stretching durations greater than 240 s may have larger effects compared with shorter stretching durations.

Cardiovascular Responses to Muscle Stretching: A Systematic Review and Meta-analysis

The aim of this study will be to review the current body of literature to understand the effects of stretching on the responses of the cardiovascular system. A literature search was performed using the following databases: Scopus, NLM Pubmed and ScienceDirect. Studies regarding the effects of stretching on responses of the cardiovascular system were investigated. Outcomes regarded heart rate(HR), blood pressure, pulse wave velocity (PWV of which baPWV for brachial-ankle and cfPWV for carotid-femoral waveforms), heart rate variability and endothelial vascular function. Subsequently, the effects of each outcome were quantitatively synthetized using meta-analytic synthesis with random-effect models. A total of 16 studies were considered eligible and included in the quantitative synthesis. Groups were also stratified according to cross-sectional or longitudinal stretching interventions. Quality assessment through the NHLBI tools observed a "fair-to-good" quality of the studies. The meta-analytic synthesis showed a significant effect of d=0.38 concerning HR, d=2.04 regarding baPWV and d=0.46 for cfPWV. Stretching significantly reduces arterial stiffness and HR. The qualitative description of the studies was also supported by the meta-analytic synthesis. No adverse effects were reported, after stretching, in patients affected by cardiovascular disease on blood pressure. There is a lack of studies regarding vascular adaptations to stretching.

The tolerance to stretch is linked with endogenous modulation of pain

OBJECTIVES

The effect of stretching on joint range of motion is well documented, and although sensory perception has significance for changes in the tolerance to stretch following stretching the underlining mechanisms responsible for these changes is insufficiently understood. The aim of this study was to examine the influence of endogenous pain inhibitory mechanisms on stretch tolerance and to investigate the relationship between range of motion and changes in pain sensitivity.

METHODS

Nineteen healthy males participated in this randomized, repeated-measures crossover study, conducted on 2 separate days. Knee extension range of motion, passive resistive torque, and pressure pain thresholds were recorded before, after, and 10 min after each of four experimental conditions; (i) Exercise-induced hypoalgesia, (ii) two bouts of static stretching, (iii) resting, and (iv) a remote, painful stimulus induced by the cold pressor test.

RESULTS

Exercise-induced hypoalgesia and cold pressor test caused an increase in range of motion (p<0.034) and pressure pain thresholds (p<0.027). Moderate correlations in pressure pain thresholds were found between exercise-induced hypoalgesia and static stretch (Rho>0.507, p=0.01) and exercise-induced hypoalgesia and the cold pressor test (Rho=0.562, p=0.01). A weak correlation in pressure pain thresholds and changes in range of motion were found following the cold pressor test (Rho=0.460, p=0.047). However, a potential carryover hypoalgesic effect may have affected the results of the static stretch.

CONCLUSIONS

These results suggest that stretch tolerance may be linked with endogenous modulation of pain. Present results suggest, that stretch tolerance may merely be a marker for pain sensitivity which may have clinical significance given that stretching is often prescribed in the rehabilitation of different musculoskeletal pain conditions where reduced endogenous pain inhibition is frequently seen.

Acute effects of dynamic stretching on neuromechanical properties: an interaction between stretching, contraction, and movement

PURPOSE

The present study aimed to investigate the acute effects of dynamic stretching on neurophysiological and mechanical properties of plantar flexor muscles and to test the hypothesis that dynamic stretching resulted from an interaction between stretching, movement, and contraction.

METHODS

The dynamic stretching conditioning activity (DS) was compared to static stretching (SS), passive cyclic stretching (PCS), isometric contractions (IC), static stretching followed by isometric contractions (SSIC), and control (CO) conditions. Stretching amplitude (DS, SS, PCS and SSIC), contraction intensity (DS, IC and SSIC) and duration (all 6 conditions) were matched. Thirteen volunteers were included. Passive torque, fascicle length, and stiffness were evaluated from a dynamometer and ultrasonography during passive dorsiflexion. Neuromuscular electrical stimulation was used to investigate contractile properties [peak twitch torque (PTT), and rate of torque development (RTD)] and muscle voluntary activation (%VA). Gastrocnemius lateralis electromyographic activity (GL EMG/Mwave) was obtained during maximal voluntary contraction. All of these parameters were measured immediately before and 10 s after each experimental condition.

RESULTS

Peak twitch torque, RTD, %VA, GL EMG/Mwave remained unaltered, while passive torque was significantly reduced after DS (- 8.14 ± 2.21%). SS decreased GL EMG/Mwave (- 7.83 ± 12.01%) and passive torque (- 2.16 ± 7.25%). PCS decreased PTT (- 3.40 ± 6.03%), RTD (- 2.96 ± 5.16%), and passive torque (- 2.16 ± 2.05%). IC decreased passive torque (- 7.72 ± 1.97%) and enhanced PTT (+ 5.77 ± 5.19%) and RTD (+ 7.36 ± 8.35%). However, SSIC attenuated PTT and RTD improvements as compared to IC.

CONCLUSION

These results suggested that dynamic stretching is multi-component and would result from an interaction between stretching, contraction, and movement.

Comparison Between Contract-Relax Stretching and Antagonist Contract-Relax Stretching on Gastrocnemius Medialis Passive Properties

Antagonist contract-relax stretching and contract-relax stretching is commonly used in sports practice and rehabilitation settings. To date, no study has compared these modalities regarding muscle stiffness and stretch tolerance. This study aimed to investigate the effects of contract-relax and antagonist contract-relax stretching on dorsiflexion range of motion (ROM), stretch tolerance, and shear elastic modulus. Forty healthy participants (24 men and 16 women) took part in the study. Participants were randomly assigned to perform either contract-relax stretching or antagonist contract-relax stretching for 2 min. Outcomes were assessed on ROM, stretch tolerance, and shear elastic modulus before and after stretching. The ROM and stretch tolerance significantly increased after both contract-relax stretching (+ 5.4 ± 5.8°, p < 0.05; + 3.5 ± 8.0 Nm, p < 0.05) and antagonist contract-relax stretching (+ 6.1 ± 4.9°, p < 0.05; + 4.2 ± 6.4 Nm, p < 0.05); however, no significant difference was found between the two groups. Alternatively, the shear elastic modulus significantly decreased after both contract-relax (-31.1 ± 22.6 kPa, p < 0.05) and antagonist contract-relax stretching (-11.1 ± 22.3 kPa, p < 0.05); however, contract-relax stretching (-41.9 ± 19.6%) was more effective than antagonist contract-relax stretching (-12.5 ± 61.6%). The results of this study suggest that contract-relax stretching instead of antagonist contract-relax stretching should be conducted to decrease muscle stiffness. However, either contract-relax or antagonist contract-relax stretching can increase ROM.

Assessment methods of vastus lateralis muscle architecture using panoramic ultrasound: a new approach, test-retest reliability and measurement error

Abstract Extended-field-of-view ultrasonography is a valid alternative to determine the dimensions of the skeletal striated muscle; however, some factors may influence the final measurement. The aim of this study was to determine the test-retest reliability and measurement error of vastus lateralis muscle architecture variables through internal anatomical landmarks and to compare three fixed determined points using extended-field-of-view ultrasonography. Twelve young (24 ± 6 years) adult university male students participated in the study. Images were obtained through extended-field-of-view ultrasonography of the vastus lateralis muscle. Measurements were made for muscle thickness (MT), fascicle length (FL), and fascicle pennation angle (FA) using a method that identifies internal anatomical landmarks. MT was also measured at predetermined distances of 2 cm proximal, 6 cm proximal, and 2 cm distal. One-way ANOVA with repeated measures did not identify any test-retest significant differences for all variables measured. Typical measurement error in centimeters (cm) or degrees (º), coefficient of variation in percentage (%) and intraclass correlation coefficient were MT = 0.07 cm, 2.93%, 0.964; FL = 0.31 cm, 2.89%, 0.947; FA = 0.92°, 4.08%, 0.942; MT 2 cm proximal = 0.10 cm, 3.77%, 0.910; MT 6 cm proximal = 0.27 cm, 9.66%, 0.576; MT 2 cm distal = 0.35 cm, 19.76%, 0.564. MT, FL and FA showed high reliability and low measurement error. Internal anatomical landmarks proved to be more reliable and presented smaller measurement errors when compared to the predetermined distances method.

Effects of Static Stretching With High-Intensity and Short-Duration or Low-Intensity and Long-Duration on Range of Motion and Muscle Stiffness

This study investigated the effects of static stretching (SS) delivered with the same load but using two protocols – high-intensity and short-duration and low-intensity and long-duration – on range of motion (ROM) and muscle stiffness. A total of 18 healthy students participated in the study. They randomly performed high-intensity and short-duration (120% and 100 s) or low-intensity and long-duration (50% and 240 s) SS. Outcomes were assessed on ROM, passive torque at dorsiflexion ROM, and shear elastic modulus of the medial gastrocnemius before and after static stretching. The results showed that ROM increased significantly at post-stretching compared to that at pre-stretching in both high-intensity and short-duration [+6.1° ± 4.6° (Δ25.7 ± 19.9%)] and low-intensity and long-duration [+3.6° ± 2.3° (Δ16.0 ± 11.8%)]. Also, the ROM was significantly higher at post-stretching in high-intensity and short-duration conditions than that in low-intensity and long-duration. The passive torque at dorsiflexion ROM was significantly increased in both high-intensity and short-duration [+5.8 ± 12.8 Nm (Δ22.9 ± 40.5%)] and low-intensity and long-duration [+2.1 ± 3.4 Nm (Δ6.9 ± 10.8%)] conditions, but no significant differences were observed between both conditions. The shear elastic modulus was significantly decreased in both high-intensity and short-duration [−8.8 ± 6.1 kPa (Δ − 38.8 ± 14.5%)] and low-intensity and long-duration [−8.0 ± 12.8 kPa (Δ − 22.2 ± 33.8%)] conditions. Moreover, the relative change in shear elastic modulus in the high-intensity and short-duration SS was significantly greater than that in low-intensity and long-duration SS. Our results suggest that a higher intensity of the static stretching should be conducted to increase ROM and decrease muscle stiffness, even for a short time.

Acute and chronic effects of static stretching at 100% versus 120% intensity on flexibility

PURPOSE

The acute effects of static stretching have been frequently studied, but the chronic effects have not been studied concurrently. Thus, this study aimed to investigate both the acute and chronic effects of static stretching at different intensities on flexibility.

METHODS

Twenty-three healthy men were randomly assigned to perform 1 min of static stretching 3 days/week for 4 weeks at 100% intensity (n = 12) or 120% intensity (n = 11). The acute effects of stretching were assessed by measuring the range of motion (ROM), peak passive torque, and passive stiffness before and after every stretching session; the chronic effects of stretching were assessed by measuring these outcomes at baseline and after 2 and 4 weeks of stretching.

RESULTS

Compared with the 100% intensity group, the 120% intensity group had significantly greater acute increases in ROM after all 12 sessions, a significantly greater decrease in passive stiffness after 11 of 12 sessions, and a significantly greater increase in peak passive torque after six of 12 sessions. Regarding the chronic effects, ROM was significantly increased in both groups after 2 and 4 weeks of stretching. Peak passive torque significantly increased in the 100% intensity group after 2 and 4 weeks of stretching, and after 4 weeks in the 120% intensity group.

CONCLUSION

Stretching at 120% intensity resulted in significantly greater acute improvements in ROM, peak passive torque, and stiffness than stretching at 100% intensity. Four weeks of stretching increased ROM and peak passive torque but did not decrease passive stiffness, regardless of the stretching intensity.

Stretch-induced hypoalgesia: a pilot study

Objectives Stretching is an intervention often used in various kinds of rehabilitation protocols and the effects on pain sensitivity has sparsely been investigated, especially when addressing potential effects on pain. The objective is to investigate the immediate effects of an axial and peripheral prolonged stretch on pressure pain sensitivity (PPT) and temporal summation (TS) on local and distal sites in healthy subjects. Methods Twenty-two healthy volunteers were recruited to participate in this pilot study. Two prolonged stretching protocols were performed: low back and wrist extensors stretches. PPT and pinprick TS were measured pre- and post-intervention at local and remote sites. Repeated measures analysis of variance (ANOVA) was used to examine the effects and significance of the interventions. Results The low back stretch induced an increase in PPT for both local and remote sites, and the wrist stretch produced a PPT increase only at the local site. TS did not change. Conclusions Low back stretching induced an increase in PPT at both local and remote sites whereas the wrist stretch only increased PPT locally, suggesting hypoalgesia at these sites. Further studies are needed to confirm the effect and mechanisms using randomised, controlled and parallel study design. Considering that pain sensitivity is different than clinical pain, results are difficult to extrapolate to clinical practice. Future studies testing clinical pain are needed to better understand the clinical implication of these results.

Chronic effects of muscle and nerve-directed stretching on tissue mechanics

Tissue-directed stretching interventions can preferentially load muscular or nonmuscular structures such as peripheral nerves. How these tissues adapt mechanically to long-term stretching is poorly understood. This randomized, single-blind, controlled study used ultrasonography and dynamometry to compare the effects of 12-wk nerve-directed and muscle-directed stretching programs versus control on maximal ankle dorsiflexion range of motion (ROM) and passive torque, shear wave velocity (SWV; an index of stiffness), and architecture of triceps surae and sciatic nerve. Sixty healthy adults were randomized to receive nerve-directed stretching, muscle-directed stretching, or no intervention (control). The muscle-directed protocol was designed to primarily stretch the plantar flexor muscle group, whereas the nerve-directed intervention targeted the sciatic nerve tract. Compared with the control group [mean; 95% confidence interval (CI)], muscle-directed intervention showed increased ROM (+7.3°; 95% CI: 4.1-10.5), decreased SWV of triceps surae (varied from -0.8 to -2.3 m/s across muscles), decreased passive torque (-6.8 N·m; 95% CI: -11.9 to -1.7), and greater gastrocnemius medialis fascicle length (+0.4 cm; 95% CI: 0.1-0.8). Muscle-directed intervention did not affect the SWV and size of sciatic nerve. Participants in the nerve-directed group showed a significant increase in ROM (+9.9°; 95% CI: 6.2-13.6) and a significant decrease in sciatic nerve SWV (> -1.8 m/s across nerve regions) compared with the control group. Nerve-directed intervention had no effect on the main outcomes at muscle and joint levels. These findings provide new insights into the long-term mechanical effects of stretching interventions and have relevance to clinical conditions where change in mechanical properties has occurred.NEW & NOTEWORTHY This study demonstrates that the mechanical properties of plantar flexor muscles and sciatic nerve can adapt mechanically to long-term stretching programs. Although interventions targeting muscular or nonmuscular structures are both effective at increasing maximal range of motion, the changes in tissue mechanical properties (stiffness) are specific to the structure being preferentially stretched by each program. We provide the first in vivo evidence that stiffness of peripheral nerves adapts to long-term loading stimuli using appropriate nerve-directed stretching.

The effects of static stretching programs on muscle strength and muscle architecture of the medial gastrocnemius

Introduction

Static stretching (SS) program are widely used in clinical and athletic settings. Many previous studies investigate the effect of SS program on muscle strength and muscle architecture (muscle thickness, and pennation angleh). However, no consensus has been reached about the effect of SS programs on muscle strength and muscle architecture. The aim of this study was to investigate the effects of 6-week SS programs performed at different weekly frequencies on muscle strength, muscle thickness and pennation angle at different ankle joint positions.

Methods

A total of 24 healthy male volunteers were performed 6-week SS programs (2,160 s of SS: 360 s/week*6 weeks) and were randomized to a group that performed SS once a week, or a group that performed SS three times per week. Total time under stretching was equated between groups. The muscle strength (maximum voluntary isometric contraction) at three different ankle joints were assessed before and after the 6-week SS program. In addition, muscle thickness and pennation angle were assessed by ultrasonography before and after 6-week SS program.

Results

There were no significant changes in all variables before and after the 6-week SS program, regardless of weekly frequency (p > 0.05).

Conclusions

Our results suggest that 6-week SS programs do not increase muscle strength or muscle architecture at different ankle joint positions, regardless of stretching frequency; however, no negative effect on these outcomes was observed, contrary to evidence on the immediate, detrimental effects of SS.

Effects of Instrument-assisted Soft Tissue Mobilization on Musculoskeletal Properties

Purpose

Instrument-assisted soft tissue mobilization (IASTM) has been reported to improve joint range of motion (flexibility). However, it is not clear whether this change in the joint range of motion is accompanied by any alterations in the mechanical and/or neural properties. This study aimed to investigate the effects of IASTM in plantarflexors and Achilles tendon on the mechanical and neural properties of them.

Methods

This randomized, controlled, crossover study included 14 healthy volunteers (11 men and 3 women, 21–32 yr). IASTM was performed on the skin over the posterior part of the lower leg for 5 min and targeted the soft tissues (gastrocnemii, soleus, and tibialis posterior muscles; overlying deep fascia; and Achilles tendon). As a control condition, the same participants rested for 5 min between pre- and postmeasurements without IASTM on a separate day. The maximal ankle joint dorsiflexion angle (dorsiflexion range of motion), the peak passive torque (stretch tolerance), and the ankle joint stiffness (slope of the relationship between passive torque and ankle joint angle) during the measurement of the dorsiflexion range of motion and muscle stiffness of the triceps surae (using shear wave elastography) were measured before and immediately after the interventions.

Results

After IASTM, the dorsiflexion range of motion significantly increased by 10.7% ± 10.8% and ankle joint stiffness significantly decreased by −6.2% ± 10.1%. However, peak passive torque and muscle stiffness did not change. All variables remained unchanged in the repeated measurements of controls.

Conclusion

IASTM can improve joint range of motion, without affecting the mechanical and neural properties of the treated muscles.