Effects of Contract–Relax, Static Stretching, and Isometric Contractions on Muscle–Tendon Mechanics

Foam rolling and stretching do not provide superior acute flexibility and stiffness improvements compared to any other warm-up intervention: A systematic review with meta-analysis

BACKGROUND

Acute improvement in range of motion (ROM) is a widely reported effect of stretching and foam rolling, which is commonly explained by changes in pain threshold and/or musculotendinous stiffness. Interestingly, these effects were also reported in response to various other active and passive interventions that induce responses such as enhanced muscle temperature. Therefore, we hypothesized that acute ROM enhancements could be induced by a wide variety of interventions other than stretching or foam rolling that promote an increase in muscle temperature.

METHODS

After a systematic search in PubMed, Web of Science, and SPORTDiscus databases, 38 studies comparing the effects of stretching and foam rolling with several other interventions on ROM and passive properties were included. These studies had 1134 participants in total, and the data analysis resulted in 140 effect sizes (ESs). ES calculations were performed using robust variance estimation model with R-package.

RESULTS

Study quality of the included studies was classified as fair (PEDro score = 4.58) with low to moderate certainty of evidence. Results showed no significant differences in ROM (ES = 0.01, p = 0.88), stiffness (ES = 0.09, p = 0.67), or passive peak torque (ES = -0.30, p = 0.14) between stretching or foam rolling and the other identified activities. Funnel plots revealed no publication bias.

CONCLUSION

Based on current literature, our results challenge the established view on stretching and foam rolling as a recommended component of warm-up programs. The lack of significant difference between interventions suggests there is no need to emphasize stretching or foam rolling to induce acute ROM, passive peak torque increases, or stiffness reductions.

Discussing Conflicting Explanatory Approaches in Flexibility Training Under Consideration of Physiology: A Narrative Review

The mechanisms underlying range of motion enhancements via flexibility training discussed in the literature show high heterogeneity in research methodology and study findings. In addition, scientific conclusions are mostly based on functional observations while studies considering the underlying physiology are less common. However, understanding the underlying mechanisms that contribute to an improved range of motion through stretching is crucial for conducting comparable studies with sound designs, optimising training routines and accurately interpreting resulting outcomes. While there seems to be no evidence to attribute acute range of motion increases as well as changes in muscle and tendon stiffness and pain perception specifically to stretching or foam rolling, the role of general warm-up effects is discussed in this paper. Additionally, the role of mechanical tension applied to greater muscle lengths for range of motion improvement will be discussed. Thus, it is suggested that physical training stressors can be seen as external stimuli that control gene expression via the targeted stimulation of transcription factors, leading to structural adaptations due to enhanced protein synthesis. Hence, the possible role of serial sarcomerogenesis in altering pain perception, reducing muscle stiffness and passive torque, or changes in the optimal joint angle for force development is considered as well as alternative interventions with a potential impact on anabolic pathways. As there are limited possibilities to directly measure serial sarcomere number, longitudinal muscle hypertrophy remains without direct evidence. The available literature does not demonstrate the necessity of only using specific flexibility training routines such as stretching to enhance acute or chronic range of motion.

Cross-Education Effects of Isokinetic Eccentric Plantarflexor Training on Flexibility, Strength, and Muscle-Tendon Mechanics

INTRODUCTION

Large increases in joint range of motion (ROM) have been reported after eccentric resistance training; however, limited data exist describing the associated mechanisms or potential cross-education effects in the contralateral limb. Therefore, the effects of a 6-wk isokinetic eccentric plantarflexor training program were examined in 26 participants.

METHODS

Before and after the training program, dorsiflexion ROM, plantarflexor strength, and muscle-tendon unit (MTU) morphology and mechanics were measured in control ( n = 13) and experimental ( n = 13) young adult groups. Training consisted of 5 sets of 12 maximal isokinetic eccentric plantarflexor contractions twice weekly on the right limb.

RESULTS

Significant ( P < 0.05) increases in dorsiflexion ROM (4.0-9.5°), stretch tolerance (40.3-95.9%), passive elastic energy storage (47.5-161.3%), and isometric (38.1-40.6%) and eccentric (46.7-67.0%) peak plantarflexor torques were detected in both trained and contralateral limbs in the experimental group. Significant increases in gastrocnemius medialis and soleus thickness (5.4-6.1%), gastrocnemius medialis fascicle length (7.6 ± 8.5%), passive plantarflexor MTU stiffness (30.1 ± 35.5%), and Achilles tendon stiffness (5.3 ± 4.9%) were observed in the trained limb only. Significant correlations were detected between the changes in trained and contralateral limbs for dorsiflexion ROM ( r = 0.59) and both isometric ( r = 0.79) and eccentric ( r = 0.73) peak torques. No significant changes in any metric were detected in the control group.

CONCLUSIONS

Large ROM increases in the trained limb were associated with neurological, mechanical, and structural adaptations, with evidence of a cross-education effect in the contralateral limb being primarily driven by neurological adaptation (stretch tolerance). The large improvements in ROM, muscle size, and strength confirm that isokinetic eccentric training is a highly effective training tool, with potential for use in athletic and clinical populations where MTU function is impaired and current therapies are ineffective.

Stretching exercises in managing spasticity: effectiveness, risks, and adjunct therapies

Spasticity is a component of upper motor neuron disorders and can be seen in neurological conditions like stroke and multiple sclerosis. Although the incidence rate of spasticity is unknown, it can put pressure on the health condition of those with spasticity, and there is no absolute effective way to control it. In the past, stretching exercises were an accessible tool for physical therapists to manage and control spasticity, but opinions on the optimal dose, aftereffects, and mechanism of effects were controversial. Therefore, this article tries to provide an overview of the effectiveness and risks of stretching exercises. Furthermore, there are several adjunct therapies, such as brain stimulation and botulinum injection, that can increase the effectiveness of a simple stretch by increasing cortical excitability and reducing muscle tone and their role is evaluated in this regard. The results of this study propose that several prospective and case studies have demonstrated the benefits of stretching to control spasticity, but it seems that other methods such as casting can be more effective than a simple stretch. Therefore, it is better to use stretching in combination with other therapeutic regimes to increase its effectivity of it.

Acute effects of static and proprioceptive neuromuscular facilitation stretching on hamstrings muscle stiffness and range of motion: a randomized cross-over study

This study aimed to compare the acute effects of static stretching (SS) and proprioceptive neuromuscular facilitation (PNF) stretching on hamstrings flexibility and shear modulus. Sixteen recreationally active young volunteers participated in a randomized cross-over study. Participants underwent an aerobic warm-up (WU), followed by either SS or PNF stretching. Range of motion (RoM) during passive straight leg raise and active knee extension, as well as shear modulus of the biceps femoris (BF) and semitendinosus (ST) muscles, were measured at baseline, post-WU, and post-stretching. Both stretching techniques significantly increased RoM, with no differences observed between SS and PNF (p < 0.001; η2 = 0.59-0.68). However, only PNF stretching resulted in a significant decrease in BF shear modulus (time×stretching type interaction: p = 0.045; η2 = 0.19), indicating reduced muscle stiffness. No changes in ST shear modulus were observed after either stretching technique. There was no significant correlation between changes in RoM and shear modulus, suggesting that the increase in RoM was predominantly due to changes in stretch tolerance rather than mechanical properties of the muscles. These findings suggest that both SS and PNF stretching can effectively improve hamstring flexibility, but PNF stretching may additionally reduce BF muscle stiffness. The study highlights the importance of considering individual muscle-specific responses to stretching techniques and provides insights into the mechanisms underpinning acute increases in RoM.

In vivo human medial gastrocnemius fascicle behaviour and belly gear during submaximal eccentric contractions are not affected by concentric fatiguing exercise

Changes in muscle geometry and belly gearing during eccentric contractions influence fibre strain and susceptibility to muscle damage. They are modulated by the interaction between connective tissues and intracellular-intrafascicular fluid pressures and external pressures from neighbouring structures. Fatiguing exercise triggers fluid shifts (muscle swelling) and muscle activation changes that may influence these modulators. Our purpose was to measure medial gastrocnemius (MG) geometric changes in vivo during eccentric contractions before and after maximal concentric muscle work to test the hypothesis that fatigue would reduce fascicle rotation and muscle gear and provoke greater fascicle strain. Submaximal eccentric plantar flexor contractions at 40% and 60% of maximal eccentric torque were performed on an isokinetic dynamometer at 5°.s-1 before and immediately after the fatiguing exercise. MG fascicles and muscle-tendon junction were captured using ultrasonography during contractions, allowing quantification of geometric changes, whole-MG length, and belly gear (Δmuscle length/Δfascicle length). Triceps surae (TS) activation was estimated using surface electromyography and the distribution of activations between synergistic muscles was then determined. After exercise, concentric torque decreased ∼39% and resting muscle thickness increased by 4%, indicating muscle fatigue and swelling, respectively. While soleus (Sol) activation and the Sol/TS ratio increased, no changes in MG, MG/TS ratio or fascicle rotation during the contraction were detected. Thus, fascicle lengthening and belly gear remained unaltered. Changes in muscle thickness during contraction was also similar before and after exercise, suggesting that changes in muscle shape were relatively unaffected by the exercise. Consequently, the muscle maintained mechanical integrity after the fatiguing muscle work.

Changes in echo intensity of the gastrocnemius muscle with passive ankle dorsiflexion: can echo intensity be used to assess muscle elongation?

Introduction: While shear modulus has been used as an index of muscle elongation, high costs prevent its general adoption. A more general indicator that can quantify muscle elongation non-invasively is needed to develop effective methods for stretching each muscle. The purpose of this study was to determine whether the echo intensity of the muscle changes with muscle elongation compared with the shear modulus. Methods: Sixteen healthy males (24.1 ± 2.8 years) participated in the study. Shear modulus and echo intensity of the medial gastrocnemius were assessed at 20° and 10° of ankle plantar-flexion, and 0°, 10°, and 20° of ankle dorsiflexion (presented as -20°, -10°, and 0°, +10°, +20°, respectively). Shear modulus was measured using ultrasound shear wave elastography. The echo intensity was quantified using the average grayscale value of a given region of interest (RoI) in longitudinal and transverse B-mode images. Grayscale analysis was performed using two RoIs: one which included as much of the muscle as possible (maximum RoI), and a rectangular one whose size and depth was identical for all images (rectangular RoI). Pearson's correlation coefficients between either the shear modulus or echo intensity and the ankle angle and between the echo intensity and shear modulus were calculated separately for each participant. Results: Average Pearson's correlation coefficient between shear modulus and ankle angle of the participants was 0.904. The average Pearson's correlation coefficients between the echo intensity and ankle angle were estimated to be 0.797 and 0.222 for the maximum RoI and 0.698 and 0.323 for the rectangular RoI in the longitudinal and transverse images, respectively. The average Pearson's correlation coefficients between the echo intensity and shear modulus were 0.684 and 0.514 for the maximum RoI, and 0.611 and 0.409 for rectangular RoI in the longitudinal and transverse images, respectively. Discussion: The results indicate that the echo intensity in the longitudinal image of the gastrocnemius, especially when assessed using the maximum RoI, increased with muscle elongation by passive ankle dorsiflexion. Therefore, assessment of the echo intensity using the maximum RoI in the longitudinal image might be useful for quantifying the muscle elongation.

Effects of patterned electrical sensory nerve stimulation and static stretching on joint range of motion and passive torque

Static stretching and proprioceptive neuromuscular facilitation stretching techniques can modulate specific neural mechanisms to improve the range of motion. However, the effects of modulation of these neural pathways on changes in the range of motion with static stretching remain unclear. Patterned electrical stimulation of the sensory nerve induces plastic changes in reciprocal Ia inhibition. The present study examined the effects of patterned electrical stimulation and static stretching on a range of motion and passive torque in plantarflexion muscles. The subjects were 14 young men (age 20.8 ± 1.3 years). The effects of patterned electrical stimulation (10 pulses at 100 Hz every 1.5 s) or uniform electrical stimulation (one pulse every 150 ms) to the common peroneal nerve for 20 min on reciprocal Ia inhibition of the Hoffman reflex (H-reflex) were examined. Reciprocal Ia inhibition was evaluated as short-latency suppression of the soleus H-reflex by conditioning stimulation of the common peroneal nerve. Then, the effects of transcutaneous electrical nerve stimulation (patterned electrical stimulation or uniform electrical stimulation) or prolonged resting (without electrical stimulation) and static 3-min stretching on the maximal dorsiflexion angle and passive torque were investigated. The passive ankle dorsiflexion test was performed on an isokinetic dynamometer. Stretch tolerance and stiffness of the muscle-tendon unit were evaluated by the peak and slope of passive torques, respectively. Patterned electrical stimulation significantly increased reciprocal Ia inhibition of soleus H-reflex amplitude (9.7 ± 6.1%), but uniform electrical stimulation decreased it significantly (19.5 ± 8.8%). The maximal dorsiflexion angle was significantly changed by patterned electrical stimulation (4.0 ± 1.4°), uniform electrical stimulation (3.8 ± 2.3°), and stretching without electrical stimulation (2.1 ± 3.3°). The increase in stretch tolerance was significantly greater after patterned electrical stimulation and uniform electrical stimulation than after stretching without electrical stimulation. Stiffness of the muscle-tendon unit was significantly decreased by patterned electrical stimulation, uniform electrical stimulation, and stretching without electrical stimulation. Transcutaneous electrical nerve stimulation and static stretching improve stretch tolerance regardless of the degree of reciprocal Ia inhibition.

Vertical Jumping Performance: Recording the Effects of Proprioceptive Neuromuscular Facilitation Stretching at Different Plantar Flexor Lengths

INTRODUCTION

Flexibility seems to be an essential part of both the training and rehabilitation processes. Several stretching techniques have been used to improve the range of motion (ROM) of the joints with the proprioceptive neuromuscular facilitation (PNF) method being the most effective one. Although plantar flexors are ideal to compare the acute effects of synergistic muscle groups on performance, it is not clear whether the PNF stretch at different muscle lengths could result in different alterations.

MATERIAL AND METHODS

Sixteen male students randomly performed 2 levels of stretching (PNF with bended knees, or PNFshort, and with extended knee, or PNFlong) and 3 types of jumps, separated by 48 hours (7 sessions in total). Jumping parameters were recorded by a force plate, and the final jumping height (H) and ground reaction forces (Fz) were analyzed. Furthermore, the ROM of the ankle joint was recorded before, right after, and 15 minutes after the stretches.  Results: The ankle joint's ROM joint was increased after both interventions. No significant changes were found in the jumping height of all jumps. The Fz, during the squat jump (SJ) and countermovement jump (CMJ), were increased after PNFshort. Similarly, a significant increase was found in Fz in drop jumps (DJ) right after the PNFshort.

CONCLUSION

Our findings demonstrated that PNF stretches of different lengths could potentially alter the stretch-shortening cycle's performance, possibly leading to a non-optimal muscle-tendon interaction.

Acute Effects of Varied Back Squat Activation Protocols on Muscle-Tendon Stiffness and Jumping Performance

ABSTRACT

Krzysztofik, M, Wilk, M, Pisz, A, Kolinger, D, Tsoukos, A, Zając, A, Stastny, P, and Bogdanis, GC. Acute effects of varied back squat activation protocols on muscle-tendon stiffness and jumping performance. J Strength Cond Res 37(7): 1419-1427, 2023-Intensity, movement velocity, and volume are the principal factors to successfully use postactivation performance enhancement. Therefore, 15 resistance-trained volleyball players completed 3 different back squat configurations as a conditioning activity (CA) in randomized order: (a) 3 sets of 3 repetitions at 85% 1RM (HL); (b) a single set of back squats at 60% 1RM until 10% mean velocity loss (VB); (c) and 2 sets of back squats at 60% 1RM until 10% mean velocity loss (2VB) on subsequent countermovement jump performance, Achilles tendon, and vastus lateralis stiffness with concomitant front thigh skin surface temperature assessment. The measurements were performed 5 minutes before the CA and at 2, 4, 6, 8, and 10 minutes. The jump height was significantly increased in the second minute and at peak, post-CA compared with baseline for all conditions ( p = 0.049; ES = 0.23 and p < 0.001; ES = 0.37). Skin surface temperature was significantly increased for all post-CA time points compared with baseline in the 2VB condition ( p from <0.001-0.023; ES = 0.39-1.04) and in the fourth minute and at peak post-CA in HL condition ( p = 0.023; ES = 0.69 and p = 0.04; ES = 0.46), whereas for the VB condition, a significant decrease in peak post-CA was found ( p = 0.004; ES = -0.54). Achilles tendon stiffness was significantly decreased for second, fourth, eighth, 10th, and peak post-CA in comparison to baseline for all conditions ( p from p = 0.004-0.038; ES = -0.47 to -0.69). Vastus lateralis stiffness was significantly decreased for peak post-CA compared with baseline for all conditions ( p = 0.017; ES = -0.42). We recommend using a single set of barbell squats with a 10% velocity loss as a mechanism of fatigue control to acutely improve jump height performance and avoid unnecessary increases in training volume.

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.

Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients With Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial

Objective

The purpose of this study was to evaluate the effects of myofascial release technique of a remote area on lumbar elasticity and low back pain (LBP) in patients with chronic nonspecific LBP.

Methods

For this clinical trial, 32 participants with nonspecific LBP were assigned to a myofascial release group (n = 16) or a remote release group (n = 16). Participants in the myofascial release group received 4 sessions of myofascial release to the lumbar region. The remote release group received 4 myofascial release sessions to the crural and hamstring fascia of the lower limbs. Low back pain severity and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment by the Numeric Pain Scale and ultrasonography examinations.

Results

The mean pain and elastic coefficient in each group before and after myofascial release interventions were significantly different (P ≤ .0005). The results showed that the changes in mean pain and elastic coefficient of the 2 groups after myofascial release interventions were not significantly different from each other (F1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 = 1.48, P = .230, 95% confidence interval) (effect size = 0.22).

Conclusion

The improvements in the outcome measures for both groups suggest that remote myofascial release was effective in patients with chronic nonspecific LBP. The remote myofascial release of the lower limbs reduced the elastic modulus of the lumbar fascia and LBP.

Combined Static Stretching and Electrical Muscle Stimulation Induce Greater Changes in Range of Motion, Passive Torque, and Tendon Displacement Compared with Static Stretching

The purpose of this study was to determine the combined effects of static stretching and electrical muscle stimulation on maximal dorsiflexion angle and passive properties. Sixteen healthy subjects participated in three randomly ordered experimental trials: combined static stretching and electrical muscle stimulation, static stretching alone, and control. In combined trial, subjects performed 5 min of calf stretching while receiving electrical muscle stimulation of the gastrocnemius medialis. In static stretching trial, subjects performed calf stretching only. Maximal dorsiflexion angle, passive torque, and muscle displacement were measured before and after intervention. Tendon displacement was also calculated. The difference from pre- to post-intervention in maximal dorsiflexion angle in combined trial was greater compared with that in the control (p = 0.026), but the static stretching trial exhibited no significant difference (both p > 0.05). Passive torque at submaximal dorsiflexion angles was significantly decreased only after combined trial (all p < 0.05). Muscle displacement at maximal dorsiflexion angle was significantly increased in all conditions (all p < 0.05). Tendon displacement at maximal dorsiflexion angle was higher after combined trial compared with static stretching trial (p = 0.030). These results revealed additional effects of adding electrical muscle stimulation to static stretching on maximal dorsiflexion angle, passive torque, and tendon displacement.

Comparison Between Foam Rolling With and Without Vibration on Passive and Active Plantar Flexor Muscle Properties

Although foam rolling interventions with and without vibration have been used to increase flexibility in the field of sports, their effects on passive and active properties remain unclear. Hence, this study aimed to investigate the effects of foam rolling interventions on range of motion (ROM), shear elastic modulus, plantar flexor muscle strength, and jump performance. This randomized, controlled, crossover study included 16 healthy male participants who visited the laboratory three times (control condition, foam rolling condition, and vibration foam rolling condition), each with an interval of >72 h. In both foam rolling and vibration foam rolling conditions, participants were instructed to perform 60-s bouts of intervention for three sets, with 30-s rest between each set. In the vibration foam rolling condition, the intensity of vibration was set at a frequency of 48 Hz. Dorsiflexion (DF) ROM, shear elastic modulus, plantar flexor muscle strength, and drop jump height were determined before and after the rolling intervention. Our results showed a similar increase in DF ROM (p < 0.01, d = 0.51; p < 0.01, d = 0.65, respectively) and passive torque at DF ROM (p = 0.02, d = 0.51 and p < 0.01, d = 0.65, respectively) after foam rolling and vibration foam rolling. Medial gastrocnemius shear elastic modulus decreased only after vibration foam rolling (p < 0.01, d = 0.44). No significant main effects of time were observed in maximal voluntary isometric contraction torque (F = 2.0, p = 0.15, η_p² = 0.119) and drop jump height (F = 1.5, p = 0.24, η_p² = 0.091) after both interventions. Maximal voluntary concentric contraction torque showed a significant main effect of time (F = 7.59, p = 0.02, η_p² = 0.336). However, only after foam rolling, the maximal voluntary concentric contraction torque significantly decreased (p = 0.01, d = 0.39). Our results suggest that vibration foam rolling effectively alters passive muscle properties without decreasing muscle strength and performance.

Passive Muscle Stiffness of Biceps Femoris is Acutely Reduced after Eccentric Knee Flexion

Eccentric hamstring exercises reportedly prevent hamstring strain injury in the biceps femoris long head (BFlh). However, information on the favorable adaptive responses in the BFlh to eccentric hamstring exercises is limited. We aimed to examine the acute effect of maximal isokinetic eccentric knee flexion on passive BFlh stiffness as a potential risk factor for the hamstring strain injury using ultrasound shear wave elastography. Ten young participants randomly performed both tasks involving five consecutive repetitions of isokinetic concentric and eccentric knee flexion with maximal effort on different legs. Passive BFlh shear modulus was taken before and 30, 60, 90, and 120 s after each task. Passive BFlh shear modulus was significantly reduced at all time points after eccentric knee flexion, whereas there was no significant change in passive BFlh shear modulus after the concentric task. The present findings indicate that passive BFlh stiffness would reduce specifically after low-volume, slow-velocity eccentric knee flexion exercise. The findings may help provide practitioners with a basis to develop more effective exercise programs for preventing HSI.

Diurnal variation in Uchikomi fitness test performance: Influence of warm-up protocols

Performance is judged using a variety of methods to ensure uniformity between competitions. Uchikomi Fitness Test (UFT) could accomplished between morning qualifying and evening finals. The purpose of this study is to investigate the impact of different warm-up protocols on UFT at different times of the day in female judokas. Ten volunteer women who had been practising judo on a regular basis for more than 5 years and actively competed in international tournaments took part in this study. Judokas completed UFT, either after no-warm-up (NWU), specific warm-up (SWU), and linear+lateral warm-up (FWU) protocols for two times a day in the morning: 09:00-11:00 and in the evening: 16:00-18:00, on non-consecutive days. In conclusion, there was a significant increase in UFT scores (F = 9.89; p = 0.002), a + b (F = 4.42; p = 0.04) and heart rate (F = 28.99; p < 0.001) in the early evening compared to the morning. Increases in UFT performance were observed in the SWU protocol compared to the NWU and FWU protocols (p < 0.05). However, the interaction between time of day and warm protocol was not significant (p > 0.05). The UFT performance revealed diurnal variation, and the judokas' performances may be favourably affected more in the late hours, particularly following SWU procedures.

Acute effects of combined isometric and plyometric conditioning activities on sports performance and tendon stiffness in female volleyball players

This study aimed to compare the effects of bilateral and unilateral conditioning activities (CA; combined isometric and plyometric) on countermovement jump performance, modified t-agility test, Achilles tendon stiffness and skin surface temperature. Thirteen female semi-professional volleyball players performed two CAs in random order: 1) bilateral isometric half back squats followed by bilateral drop jumps (BI-CA); and 2) unilateral isometric half back squats followed by unilateral drop jumps (UNI-CA). To assess the effects of CAs, countermovement jump, modified t-agility test, Achilles tendon stiffness and skin surface temperature measurements were performed 5 min before and 6 min after the CA. Both CAs significantly increased thigh skin surface temperature from pre- to post-CA (BI-CA, p < 0.001; effect size [ES] = 1.41 and UNI-CA, p = 0.001; ES = 1.39) but none of them influenced modified t-agility test time (interaction: p = 0.338, main effect of time: p = 0.121 and condition: p = 0.819). The countermovement jump height and modified reactive strength index significantly increased from pre-to post-CA during the BI-CA condition (p = 0.003, ES = 0.45, and p = 0.008, ES = 0.48) but not for UNI-CA (p = 0.061, ES = 0.18 and p = 0.065, ES = 0.26). No significant impact has been found for countermovement depth (interaction: p = 0.054, main effect of time: 0.097, and condition: p = 0.41) as well as for contraction time (interaction: p = 0.536, main effect of time: p = 0.224, and condition: p = 0.807). Moreover, stronger and weaker limb CMJ relative peak force significantly decreased from pre-to post-CA (p = 0.014, ES = −0.31, and p = 0.027, ES = −0.26; respectively) during UNI-CA condition but not for BI-CA (p = 0.096, ES = 0.23, and p = 1.41, ES = 0.18). The stronger and weaker limb Achilles tendon stiffness significantly increased from pre-to post-CA during the UNI-CA condition (p = 0.013, ES = 0.60 and p < 0.001, ES = 0.79; respectively) but not for BI-CA (p = 0.66; ES = 0.15 and p = 0.265; ES = 0.42). Furthermore, the post-CA stronger limb Achilles tendon stiffness during the UNI-CA was significantly higher than that noted during the BI-CA (p = 0.006, ES = 0.7). The present study showed that combined isometric and plyometric bilateral CA effectively improved the countermovement jump but did not enhance the t-agility test performance. These findings indicate that exercise combinations could effectively produce a post-activation performance enhancement effect but should replicate the following explosive task as much as possible.

Quadriceps or triceps surae proprioceptive neuromuscular facilitation stretching with post-stretching dynamic activities does not induce acute changes in running economy

Previous studies reported that both a more compliant quadriceps tendon and a stiffer Achilles tendon are associated with better running economy. While tendon stiffness can be decreased by a single bout of proprioceptive neuromuscular facilitation (PNF), post-stretching dynamic activities (PSA) can counteract the potential stretch-induced force loss. Thus, the purpose of this study was to investigate if a single, moderate duration, (4 × 15 s), bout of PNF stretching of either the quadriceps or triceps surae muscles followed each by PSA, causes either an improvement or impairment in running economy. Eighteen trained male runners/triathletes visited the laboratory five times. The first two visits were to familiarize the participants and to test for maximal oxygen consumption (VO₂max) respectively. The further three appointments were randomly assigned to either 1.) quadriceps PNF stretching + PSA or 2.) triceps surae PNF stretching + PSA or 3.) no stretching + PSA. Following the interventions, participants performed a 15-min run on the treadmill with a speed reflecting a velocity of 70% VO₂max to assess oxygen consumption (i.e., running economy) and running biomechanics. Our results showed neither a difference in oxygen consumption (p = 0.15) nor a change in any variable of the running biomechanics (p > 0.33) during the steady-state (i.e., last 5 min) of the 15-min run. Athletes can perform moderate duration PNF stretching of the quadriceps or triceps surae + PSA prior to a running event, without affecting running economy. Future studies should emphasize long-term training effects on tendon stiffness adaptations and running economy.

Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching of the Plantar Flexors on Ankle Range of Motion and Muscle-Tendon Behavior in Children with Spastic Cerebral Palsy-A Randomized Clinical Trial

Stretching is considered a clinically effective way to prevent muscle contracture development in children with spastic cerebral palsy (CP). Therefore, in this study, we assessed the effects of a single session of proprioceptive neuromuscular facilitation (PNF) or static stretching (SS) on ankle joint range of motion (RoM) and gastrocnemius muscle-tendon behavior in children with CP. During the SS (n = 8), the ankle joint was held in maximum dorsiflexion (30 s). During the PNF stretching (n = 10), an isometric contraction (3-5 s) was performed, followed by stretching (~25 s). Ten stretches were applied in total. We collected data via dynamometry, 3D motion capture, 2D ultrasound, and electromyography, before and after the stretching sessions. A mixed ANOVA was used for the statistical analysis. Both ankle RoM and maximum dorsiflexion increased over time (F(1,16) = 7.261, p < 0.05, η² = 0.312; and F(1,16) = 4.900, p < 0.05, η² = 0.234, respectively), without any difference between groups. An interaction effect (F(1,12) = 4.768, p = 0.05, η² = 0.284) was observed for muscle-tendon unit elongation (PNF: -8.8%; SS: +14.6%). These findings suggest a positive acute effect of stretching on ankle function. However, SS acutely increased muscle-tendon unit elongation, while this decreased after PNF stretching, indicating different effects on the spastic muscles. Whether PNF stretching has the potential to cause positive alterations in individuals with CP should be elucidated in future studies.

Changes in stiffness of the specific regions of knee extensor mechanism after static stretching

Decreased muscle stiffness could reduce musculotendinous injury risk in sports and rehabilitation settings. Static stretching (SS) has been used to increase the flexibility of muscles and reduce muscle stiffness, but the effects of SS on the stiffness of specific regions of the knee extensor mechanism are unclear. The quadriceps femoris and patellar tendon are essential components of the knee extensor mechanism and play an important role in knee motion. Therefore, we explored the acute and prolonged effects of SS on the stiffness of the quadriceps femoris and patellar tendon and knee flexion range of motion (ROM). Thirty healthy male subjects participated in the study. Three 60-s SS with 30-s intervals were conducted in right knee flexion with 30° hip extension. We measured the ROM and stiffness of the vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) and the proximal-(PPT), middle-(MPT), and distal-(DPT) region stiffness of the patellar tendon before and immediately after SS intervention, or 5 and 10 min after SS. The stiffness of the quadriceps muscle and patellar tendon were measured using MyotonPRO, and the knee flexion ROM was evaluated using a medical goniometer. Our outcomes showed that the ROM was increased after SS intervention in all-time conditions (p < 0.01). Additionally, the results showed that the stiffness of RF (p < 0.01) and PPT (p = 0.03) were decreased immediately after SS intervention. These results suggested that SS intervention could be useful to increase knee flexion ROM and temporarily reduce the stiffness of specific regions of the knee extensor mechanism.

Randomized controlled trial of multidisciplinary rehabilitation therapy using mobile applications in cases of ankle fractures

A multidisciplinary approach to rehabilitation in patients with ankle fractures is needed to return to their daily activities. Mobile health applications can improve or optimize the rehabilitation process. The purpose of this study is to monitor the efficiency of a modified and validated rehabilitation scheme for the functional rehabilitation of the lower limbs. The subjects of the study are patients in the post-immobilization and post-operative period. The algorithm of procedures administered to the patients were performed by physiotherapists and monitored via mobile apps. The results show a reduction of the swelling and the pain, overcoming the muscular imbalance, enhanced stabilization, correct way of walking, and an improved quality of life of the patients with ankle fractures. Despite a certain trend towards residual deficit, the implementation of kinesitherapeutic means creates the necessary background on the basis of which specialized methods can be applied - joint-mobilizing techniques and passive stretching, for the purpose of the full recovery of the functions of the lower extremity. The application of mobile apps optimizes the recovery process and increases access to rehabilitation.

Judo specific fitness test performance variation from morning to evening: specific warm-ups impacts performance and its diurnal amplitude in female judokas

BACKGROUND

A number of specific tests are used to standardize competition performance. Specific Judo fitness test (SJFT) can be applied by considering the start of the competition qualifiers in the morning and the continuation of the final competitions in the evening. The improvement of test performances can be achieved with warm-up for elevating heart rate (HR) and muscle temperature such as raise, activate, mobilise, potentiate (RAMP) protocols.

PURPOSE

The aim of this study is to evaluate the effects of different warm-up protocols on SJFT at different times of the day in female judokas.

METHODS

Ten volunteer women participated in this study, who regularly participated in judo training for more than 5 years and actively competed in international competitions. Judokas completed SJFT, either after no warm-up, or RAMP protocols like specific warm-up (SWU), and dynamic warm-up for two times a day in the morning: 09:00-10:00 and in the evening: 16:00-17:00, with at least 2 days between test sessions. The following variables were recorded: throws performed during series A, B, and C; the total number of throws; HR immediately and 1 min after the test, and test index after different warm-ups.

RESULTS

When analyzed evening compared to the morning without discriminating three warm-up protocols, evening results statistically significant number of total throws performed during series A, B, and C, the total number of throws; HR immediately and 1 min after the test, and test index than morning results (p < 0.01). Moreover, RAMP protocols interaction with time have demonstrated an impact on SJFT for index [F₍₂₎ = 4.15, p = 0.024, η_p²: 0.19] and changes after 1 min HR [F_(1.370)= 7.16, p = 0.008, η_p²: 0.29]. HR after 1 min and test index results were statistically significant in favor of SWU (p < 0.05).

CONCLUSIONS

In conclusion, SJFT performance showed diurnal variation and judo performances of the judokas can be affected more positively in the evening hours especially after RAMP protocols.

What to stretch? - Isolated proprioceptive neuromuscular facilitation stretching of either quadriceps or triceps surae followed by post-stretching activities alters tissue stiffness and jump performance

To overcome a possible drop in performance following longer stretch durations (>60 s), post-stretching dynamic activities (PSA) can be applied. However, it is not clear if this is true for isolated proprioceptive neuromuscular facilitation (PNF) stretching of different muscle groups (e.g., triceps surae and quadriceps). Thus, 16 participants performed both interventions (triceps surae PNF + PSA; quadriceps PNF + PSA) in random order, separated by 48 h. Jump performance was assessed with a force plate, and tissue stiffness was assessed with a MyotonPro device. While no changes were detected in the countermovement jump performance, the PNF + PSA interventions resulted in a decrease in drop jump performance which led to a large magnitude of change following the triceps surae PNF + PSA and a small-to-medium magnitude of change following the quadriceps PNF + PSA. Moreover, in the triceps surae PNF + PSA intervention, a decrease in Achilles tendon stiffness was seen, while in the quadriceps PNF + PSA intervention, a decrease in the overall quadriceps muscle stiffness was seen. According to our results, we recommend that especially triceps surae stretching is avoided during warm-up (also when PSA is included) when the goal is to optimise explosive or reactive muscle contractions.

Immediate effects of static and proprioceptive neuromuscular facilitation stretching of hamstring muscles on straight leg raise, craniovertebral angle, and cervical spine range of motion in neck pain patients with hamstring tightness: A prospective randomized controlled trial

BACKGROUND

The cranio-cervical flexion exercise and sub-occipital muscle inhibition technique have been used to improve a forward head posture among neck pain patients with straight leg raise (SLR) limitation. However, little is known about the cranio-vertebral angle (CVA) and cervical spine range of motion (CROM) after applying stretching methods to the hamstring muscle.

OBJECTIVE

To compare the immediate effects of static stretching and proprioceptive neuromuscular facilitation stretching on SLR, CVA, and CROM in neck pain patients with hamstring tightness.

METHODS

64 subjects were randomly allocated to the static stretching (n1= 32) or proprioceptive neuromuscular facilitation (n2= 32) stretching group. The SLR test was performed to measure the hamstring muscle's flexibility and tightness between the two groups, with CROM and CVA also being measured. The paired t-test was used to compare all the variables within each group before and after the intervention. The independent t-test was used to compare the two groups before and after the stretching exercise.

RESULTS

There were no between-group effects for any outcome variables (P> 0.05). However, all SLR, CVA, and CROM outcome variables were significantly improved within-group (P< 0.05).

CONCLUSIONS

There were no between-group effects for any outcome variable; however, SLR, CVA, and CROM significantly improved within-group after the one-session intervention in neck pain patients with hamstring tightness.

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.

A comparison of a single bout of stretching or foam rolling on range of motion in healthy adults

PURPOSE

Stretching and foam rolling are common warm-up exercises and can acutely increase the range of motion (ROM) of a joint. However, possible differences in the magnitude of change on ROM between these two interventions on the immediate and prolonged effects (e.g., 10 min after the intervention) are not yet well understood. Thus, the purpose of this review was to compare the immediate and prolonged effects of a single bout of foam rolling with a single bout of stretching on ROM in healthy participants.

METHODS

In total, 20 studies with overall 38 effect sizes were found to be eligible for a meta-analysis. For the main analysis, subgroup analysis, we applied a random-effect meta-analysis, mixed-effect model, respectively. The subgroup analyses included age groups, sex, and activity levels of the participants, as well as the tested muscles, the duration of the application, and the study design.

RESULTS

Meta-analyses revealed no significant differences between a single stretching and foam rolling exercise immediately after the interventions (ES = 0.079; P = 0.39) nor a difference 10 min (ES =  - 0.051; P = 0.65), 15 min (ES =  - 0.011; P = 0.93), and 20 min (ES =  - 0.161; P = 0.275) post-intervention. Moreover, subgroup analyses revealed no other significant differences between the acute effects of stretching and foam rolling (P > 0.05).

CONCLUSION

If the goal is to increase the ROM acutely, both interventions can be considered as equally effective. Likely, similar mechanisms are responsible for the acute and prolonged ROM increases such as increased stretch tolerance or increased soft-tissue compliance.

Tissue flossing of the thigh increases isometric strength acutely but has no effects on flexibility or jump height

The purpose of this study was to investigate the effects of a single floss band treatment of the thigh on hip and knee range of motion (ROM), knee extensor passive resistive torque (PRT), knee extensor maximum voluntary contraction (MVC) torque, and countermovement jump (CMJ) height.Sixteen healthy male volunteers were tested before and after both the flossing treatment and the control condition, in random order. For the flossing treatment, the floss band was wound around both thighs for 120 s, and the subject was then asked to perform 20 squats. During the control treatment, only the 20 squats were performed. Before and after the treatments, knee and hip ROM were assessed using a Thomas test with 3D motion caption. The PRT and MVC of the knee extensors were measured with a dynamometer, and the electromyographic (EMG) signal was collected from the vastus lateralis. CMJs were performed on a force plate.Compared to the control condition, the flossing treatment showed a positive effect on the MVC of the knee extensors (P = 0.01); however, no effects on hip ROM (P = 0.58), knee ROM (P = 0.37), CMJ height (P = 0.75), or PRT (P = 0.22) were observed. Correlation analyses revealed that the increase in MVC was not significantly related to changes in the tension of the muscle-tendon unit (rP = -0.13; P = 0.64) or vastus lateralis EMG (rS = 0.44; P = 0.10). Since the increase in MVC cannot be explained by changes of the mechanical (PRT) or neuromuscular (EMG) properties, we speculate that an enhancement of growth hormone and norepinephrine levels following the compression release is instead responsible for the increase in MVC.

Effect of acute static stretching on the passive mechanical properties of the Achilles tendon: a systematic review and meta-analysis

Background/Aims

Little is known about the effectiveness of static stretching on the tendinous structures. The aim of this study was to verify the effect of acute static stretching on the passive mechanical properties of the Achilles tendon.

Methods

Databases were searched with the descriptors ‘muscle stretching exercises,’ ‘adult’ and ‘Achilles tendon’ with a sample consisting of physically active young adults. Two blind reviewers performed the review.

Results

A total of four studies were selected. After the meta-analysis, no significant difference was observed for range of motion (−0.73; 95% confidence interval −2.18–0.71; I2=0%), muscle-tendon unit (−0.02; 95% confidence interval −0.23–0.19; I2= 83%), muscle (−0.43; 95% confidence interval −0.92–0.06; I2= 0%) and tendon stiffness (3.70; 95% confidence interval 1.57–5,83; I2=0%; P=0.0007) and passive torque (−1.35; 95% confidence interval −4.75–2.05; I2= 0%). Maximum voluntary isometric contraction showed an alteration with a longer stretching time (1215 seconds).

Conclusions

Passive static stretching (60–1215 seconds) does not significantly alter the analysed variables.

A Comparison of the Effects of Foam Rolling and Stretching on Physical Performance. A Systematic Review and Meta-Analysis

Foam rolling and stretching with its various techniques are frequently used as a warm-up routine to increase the range of motion of a joint. While the magnitude of the changes in range of motion between foam rolling and stretching (static and dynamic techniques) is similar, it is not clear if this also holds true for performance parameters (e.g., strength, jump height). The purpose of this meta-analysis was to compare the effects of an acute bout of foam rolling (with and without vibration) with an acute bout of stretching (with all techniques included) on performance parameters in healthy participants. We assessed the results from 13 studies and 35 effect sizes by applying a random-effect meta-analysis. Moreover, by applying a mixed-effect model, we performed subgroup analyses with the stretching technique, type of foam rolling, tested muscle, treatment duration, and type of task. We found no significant overall effect, and the analysis revealed only a trend of the performance parameters in favor of foam rolling when compared to stretching (when considering all techniques). Significantly favorable effects of foam rolling on performance were detected with subgroup analyses when compared to static stretching, when applied to some muscles (e.g., quadriceps) or some tasks (e.g., strength), when applied for longer than 60 s, or when the foam rolling included vibration. When foam rolling was compared to dynamic stretching or applied in the non-vibration mode, the same magnitude of effect was observed. While the present meta-analysis revealed no significantly different effect between foam rolling and stretching (including all techniques) prior to exercise, differences could be observed under specific conditions.

Effects of a Single Proprioceptive Neuromuscular Facilitation Stretching Exercise With and Without Post-stretching Activation on the Muscle Function and Mechanical Properties of the Plantar Flexor Muscles

A single proprioceptive neuromuscular facilitation (PNF) stretching exercise can increase the range of motion (ROM) of a joint but can lead to a decrease in performance immediately after the stretching exercise. Post-stretching activation (PSA) exercises are known as a possible way to counteract such a drop in performance following a single stretching exercise. However, to date, no study has investigated the combination of PNF stretching with PSA. Thus, the aim of this study was to compare the effects of a PNF stretching exercise with and without PSA on the muscle function (e.g., ROM) and mechanical properties of the plantar flexor muscles. Eighteen physically active males volunteered in the study, which had a crossover design and a random order. The passive shear modulus of the gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) was measured in a neutral position with shear wave elastography, both pre- and post-intervention. Maximum voluntary isometric contraction (MVIC) peak torque, maximum voluntary dynamic contraction peak torque, dorsiflexion ROM, and passive resistive torque (PRT) were also measured with a dynamometer. The interventions were 4×30s of PNF stretching (5s of contraction) and two sets of three exercises with 20 or 40 fast ground contacts (PNF stretching+PSA) and PNF stretching only. ROM was found to have increased in both groups (+4%). In addition, the PNF stretching+PSA group showed a decrease in PRT at a given angle (-7%) and a decrease in GM and mean shear modulus (GM+GL; -6%). Moreover, the MVIC peak torque decreased (-4%) only in the PNF stretching group (without PSA). Therefore, we conclude that, if PNF stretching is used as a warm-up exercise, target-muscle-specific PSA should follow to keep the performance output at the same level while maintaining the benefit of a greater ROM.

The Accumulated Effects of Foam Rolling Combined with Stretching on Range of Motion and Physical Performance: A Systematic Review and Meta-Analysis

Although it is well known that both stretching and foam rolling can acutely increase the range of motion (ROM) and affect performance, the effects of a combined treatment (foam rolling and stretching) are not yet clear. Hence, the purpose of this meta-analysis was to compare the combined effect to that of stretching or foam rolling alone on both ROM and performance. We assessed the effect of a combined treatment on ROM and compared it to the effect of stretching, foam rolling, and a control condition by applying a random-effect meta-analysis. We also applied the same model to compare the effect of the combined treatment on performance. Moreover, by applying a mixed-effect model, we performed subgroup analyses with the stretching technique, type of foam rolling, tested muscles, type of task, and the order of the combined treatment. We found a significant overall effect on ROM change when comparing the combined treatment with the control condition (effect size (ES) = -0.332); however, no significant effect was found when comparing it to stretching (ES = 0.032) or foam rolling alone (ES = -0.225). The meta-analysis revealed no significant overall effect on performance when the combined treatment was compared to stretching alone (ES = -0.029). However, the subgroup analysis for performance revealed a superior effect for the combined treatment compared to stretching alone, but only if foam rolling was followed by stretching (ES = -0.17), and not vice versa. Athletes do not have to combine stretching with foam rolling since no additional effect was observed. However, to increase performance, the combination of foam rolling followed by stretching can lead to greater improvements.

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.

Assessment of the Maximal Range of Motion from Initial Sensation of Stretching to the Limits of Tolerance

The aim of this study was to determine whether the first sensation of stretching (ROM_FSS) may predict the maximum range of motion (ROM_MAX) in male (N = 37) and female (N = 32) volunteer subjects, and to assess the reliability of the ROM perceived by subjects in relation to a pre-determined ROM (ROM_50%). Subjects attempted three experimental sessions with 48 hours between sessions 1 and 2 and 28 days between sessions 1 and 3. Within each session, five trials were performed with isokinetic equipment to assess posterior thigh muscle flexibility. The results revealed a strong and significant correlation between ROM_MAX and ROM_FSS for both sexes, females (r = 0.96, p < 0.001, R ² = 0.92) and males (r = 0.91, p < 0.001; R ² = 0.82). The accuracy of the model verified by the standard error of estimate (SEE) was high in the equations proposed for both female (SEE = 4.53%) and male (SEE = 5.45%). Our results revealed that ROM_FSS may predict the ROM_MAX for both male and female subjects. The ROM_FSS may contribute to the development of evaluation methods that do not subject the individuals to conditions that may include unnecessary risk of injury and is well suited to monitor the training process of stretching exercises with submaximal loads.

Triceps surae muscle-tendon unit mechanical property changes during 10 minutes of streching

OBJECTIVE

To verify the effect of 10-min static stretching on the triceps surae mechanical properties.

DESIGN

Quasi-experimental one-group pre test-post test study compared the time points of before, after, and minute by minute of one session of triceps surae passive static stretching.

METHODS

15 participants performed a 10-min plantar flexor passive static stretching on the isokinetic dynamometer. We evaluated passive torque and myotendinous junction (MTJ) displacement before, minute by minute, and after the intervention. In contrast, we evaluated the range of motion (ROM), passive torque, MTJ displacement, and hysteresis before and after the intervention. Paired t-test compared pre and post-intervention time points. Passive torque and MTJ displacement in the minute-by-minute evaluations were compared by repeated measures one-way ANOVA with a Bonferroni post-hoc test.

RESULTS

ROM increased (effect size d = 0.56) and passive torque and muscle-tendon unit stiffness decreased (effect size d = 0.65 and d = 0.73, respectively) post-stretching. There was a reduction only in passive torque in the minute-by-minute evaluation, mainly at minutes five and seven.

CONCLUSIONS

passive torque decreased over a 10-min static stretching session of the ankle plantar flexors, followed by a ROM increase and muscle-tendon unit, a stiffness decrease.

Increased Ankle Range of Motion Reduces Knee Loads During Landing in Healthy Adults

Decreased dorsiflexion range of motion (DROM) can be modified using static stretching and joint mobilizations and may attenuate known knee anterior cruciate ligament injury risk factors. It is not known how these interventions compare to each other and how they improve knee landing mechanics. This study's purpose was to determine the immediate effects of static stretching and joint mobilization interventions on DROM measurement changes and right-leg drop jump knee landing mechanics. Eighteen females and 7 males, all recreationally active, completed 2 study sessions. Active and passive DROM, the weight-bearing lunge test, the anterior reach portion of the Star Excursion Balance Test, and a right-leg drop jump landing task were completed before and after the intervention. Change in DROM (ΔDROM) was calculated for DROM assessments between preintervention and postintervention. Pairwise dependent t tests determined no differences in ΔDROM between interventions, and statistical parametric mapping determined increased knee flexion (P = .004) and decreased anterior shear force (P = .015) during landing after both interventions. Increased DROM improves sagittal plane displacement and loading at the knee. Stretching may be a more feasible option in a healthy population for those wanting to maintain range of motion and decrease knee injury risk without physical therapist involvement.

Regional differential stretching of the pectoralis major muscle: An ultrasound elastography study

Pectoralis major (PMa) muscle injuries are becoming more prevalent, and their incidence differs among the PMa regions, i.e., the clavicular, sternal, and abdominal regions. Therefore, identifying the position for effectively lengthening each PMa region is critical in preventing PMa injuries. The purpose of this study was to determine the effective stretching position for each PMa region through shear wave elastography, which can indirectly assess individual muscle lengthening. Fifteen men participated in this study. Twelve stretching positions were compounded with shoulder abductions (45°, 90°, and 135°), pelvic rotation (with or without), shoulder external rotation (with or without), and shoulder horizontal abductions. The shear modulus of each PMa region was measured through shear wave elastography in the stretching positions mentioned above. At the clavicular region, the shear modulus was higher for three stretching positions: shoulder horizontal abduction at 45° abduction during pelvic rotation and shoulder external rotation, shoulder horizontal abduction at 90° abduction, and shoulder horizontal abduction at 90° abduction while considering shoulder external rotation. For the sternal region, the shear modulus was higher in two stretching positions: shoulder horizontal abduction at 90° abduction while adding external rotation, and combination of pelvic rotation and external rotation. For the abdominal region, the shear modulus was higher in the shoulder horizontal abduction at 135° abduction with pelvic and external rotation. These results indicated that the effective stretching position was different for each PMa region.

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.

Non-local acute stretching effects on strength performance in healthy young adults

BACKGROUND

Static stretching (SS) can impair performance and increase range of motion of a non-exercised or non-stretched muscle, respectively. An underdeveloped research area is the effect of unilateral stretching on non-local force output.

OBJECTIVE

The objective of this review was to describe the effects of unilateral SS on contralateral, non-stretched, muscle force and identify gaps in the literature.

METHODS

A systematic literature search following preferred reporting items for systematic review and meta-analyses Protocols guidelines was performed according to prescribed inclusion and exclusion criteria. Weighted means and ranges highlighted the non-local force output response to unilateral stretching. The physiotherapy evidence database scale was used to assess study risk of bias and methodological quality.

RESULTS

Unilateral stretching protocols from six studies involved 6.3 ± 2 repetitions of 36.3 ± 7.4 s with 19.3 ± 5.7 s recovery between stretches. The mean stretch-induced force deficits exhibited small magnitude effect sizes for both the stretched (-6.7 ± 7.1%, d = -0.35: 0.01 to -1.8) and contralateral, non-stretched, muscles (-4.0 ± 4.9%, d = , 0.22: 0.08 to 1.1). Control measures exhibited trivial deficits.

CONCLUSION

The limited literature examining non-local effects of prolonged SS revealed that both the stretched and contralateral, non-stretched, limbs of young adults demonstrate small magnitude force deficits. However, the frequency of studies with these effects were similar with three measures demonstrating deficits, and four measures showing trivial changes. These results highlight the possible global (non-local) effects of prolonged SS. Further research should investigate effects of lower intensity stretching, upper versus lower body stretching, different age groups, incorporate full warm-ups, and identify predominant mechanisms among others.

Postural Responses to Sudden Horizontal Perturbations in Tai Chi Practitioners

Tai Chi has been shown to elicit numerous positive effects on health and well-being. In this study, we examined reactive postural control after sudden unloading horizontal perturbations, which resembled situations encountered during Tai Chi. The study involved 20 participants, 10 in the Tai Chi group (age: 37.4 ± 7.8 years), who had been regularly training the push-hand technique for at least 7 years, and 10 in the control group, consisting of healthy adults (age: 28.8 ± 5.0). Perturbations were applied at three different positions (hips, shoulders, and arms) via the load-release paradigm. Twenty measurements were carried out for each perturbation position. We measured peak vertical and horizontal forces on the ground (expressed percentage of body mass (%BM)), peak center of pressure displacement and peak horizontal and vertical velocities at the knee, hip and shoulder joints. The Tai Chi group exhibited smaller increases in vertical ground reaction forces when perturbations were applied at the hips (11.5 ± 2.1 vs. 19.6 ± 5.5 %BW; p = 0.002) and the arms (14.1 ± 4.2 vs. 23.2 ± 8.4 %BW; p = 0.005). They also responded with higher horizontal force increase after hip perturbation (16.2 ± 3.2 vs. 13.1 ± 2.5 %BW; p < 0.001). Similar findings were found when observing various outcomes related to velocities of vertical movement. The Tai Chi group also showed lower speeds of backward movement of the knee (p = 0.005–0.009) after hip (0.49 ± 0.13 vs. 0.85 ± 0.14 m/s; p = 0.005) and arm perturbations (0.97 ± 0.18 vs. 1.71 ± 0.29 m/s; p = 0.005). Center of pressure displacements were similar between groups. Our study demonstrated that engaging in Tai Chi could be beneficial to reactive postural responses after sudden perturbations in a horizontal direction; however, future interventional studies are needed to directly confirm this. Moreover, because of the age difference between the groups, some confounding effects of age cannot be ruled out.

The Acute and Prolonged Effects of Different Durations of Foam Rolling on Range of Motion, Muscle Stiffness, and Muscle Strength

"Foam Rolling" has been used in sports settings to increase range of motion and decrease muscle stiffness without decreasing muscle strength and athletic performance. However, there has been no study investigating the acute and prolonged effect of different durations of foam rolling intervention on muscle stiffness, and the minimum foam rolling intervention duration required to decrease muscle stiffness is unclear. Therefore, the purpose of this study was to investigate the acute and prolonged effect of different durations of foam rolling intervention on ROM, muscle stiffness, and muscle strength. The 45 participants were randomly allocated to 1 of 3 groups (30 s × 1 times group vs 30 s × 3 times group vs 30 s× 10 times group). The outcome measures were dorsiflexion range of motion, shear elastic modulus of medial gastrocnemius, and muscle strength before, 2 min and 30 min after foam rolling intervention. There were no significant differences before and 2 min after foam rolling intervention in 30 s×1 time group, whereas dorsiflexion range of motion was increased in both 30 s×3 times group (p = 0.042, d = 0.26) and 30 s× 10 times group (p < 0.01, d = 0.33). However, the increase in dorsiflexion range of motion was returned to baseline value after 30 minutes in both 30 s × 3 times group and 30 s × 10 times group. In addition, there were no significant changes in shear elastic modulus and muscle strength in all groups. This study suggested that foam rolling for more than 90 s or more of foam rolling was effective in order to increase the range of motion immediately without changing muscle stiffness and muscle strength.

Acute and Prolonged Effects of Stretching on Shear Modulus of the Pectoralis Minor Muscle

Increased muscle stiffness of the pectoralis minor (PMi) could deteriorate shoulder function. Stretching is useful for maintaining and improving muscle stiffness in rehabilitation and sport practice. However, the acute and prolonged effect of stretching on the PMi muscle stiffness is unclear due to limited methodology for assessing individual muscle stiffness. Using shear wave elastography, we explored the responses of shear modulus to stretching in the PMi over time. The first experiment (n = 20) aimed to clarify the acute change in the shear modulus during stretching. The shear modulus was measured at intervals of 30 s × 10 sets. The second experiment (n = 16) aimed to observe and compare the prolonged effect of different durations of stretching on the shear modulus. Short and long stretching duration groups underwent 30s × 1 set and 30s × 10 sets, respectively. The assessments of shear modulus were conducted before, immediately after, and at 5, 10, and 15 min post-stretching. In experiment I, the shear modulus decreased immediately after a bout (30 s) of stretching (p < 0.001, change: -2.3 kPa, effect size: r = 0.72) and further decreased after 3 repetitions (i.e., 90 s) of stretching (p = 0.03, change: -1.0 kPa, effect size: r = 0.53). In experiment II, the change in the shear modulus after stretching was greater in the long duration group than in the short duration group (p = 0.013, group mean difference: -2.5 kPa, partial η ² = 0.36). The shear modulus of PMi decreased immediately after stretching, and stretching for a long duration was promising to maintain the decreased shear modulus. The acute and prolonged effects on the PMi shear modulus provide information relevant to minimum and persistent stretching time in rehabilitation and sport practice.

Comparison of the Acute Effects of Hold-Relax and Static Stretching among Older Adults

Simple Summary

It is well known that stretching interventions are effective in improving age-related changes in range of motion (ROM) and muscle stiffness. We investigated the effects of various stretching interventions, such as static stretching and hold–relax stretching, on ROM and muscle stiffness in older adults to establish the most effective stretching technique. Our results showed that static stretching and hold–relax stretching increased ROM, which could be contributed by not change in muscle stiffness, but stretch tolerance. Conversely, medial gastrocnemius muscle stiffness decreased only after a static stretching intervention and not after hold–relax stretching. Our results indicated that static stretching intervention improved ROM and muscle stiffness in older adults.

Abstract

Various stretching techniques are generally recommended to counteract age-related declines in range of motion (ROM) and/or increased muscle stiffness. However, to date, an effective stretching technique has not yet been established for older adults. Consequently, we compared the acute effects of hold relax stretching (HRS) and static stretching (SS) on dorsiflexion (DF) ROM and muscle stiffness among older adults. Overall, 15 elderly men and nine elderly women (70.2 ± 3.9 years, 160.8 ± 7.8 cm, 59.6 ± 9.7 kg) were enrolled, and both legs were randomized to either HRS or SS stretching. We measured DF ROM and muscle stiffness using a dynamometer and ultrasonography before and after 120 s of HRS or SS interventions. Our multivariate analysis indicated no significant interaction effects, but a main effect for DF ROM. Post-hoc tests revealed that DF ROM was increased after both HRS and SS interventions. Moreover, multivariate analysis showed a significant interaction effect for muscle stiffness. Post-hoc tests revealed that muscle stiffness was decreased significantly after only SS intervention. Taken together, our results indicated that both HRS and SS interventions are recommended to increase ROM, and SS is recommended to decrease muscle stiffness in older adults.

The Impact of a Single Stretching Session on Running Performance and Running Economy: A Scoping Review

One determining factor for running performance is running economy (RE), which can be quantified as the steady-state oxygen consumption at a given running speed. Stretching is frequently applied in sports practice and has been widely investigated in recent years. However, the effect of stretching on RE and performance is not clear. Thus, the purpose of this scoping review is to investigate the effects of a single bout of stretching on RE and running performance in athletes (e.g., recreational and elites) and non-athletes. The online search was performed in PubMed, Scopus, and Web of Science databases. Only studies that explored the acute effects of stretching on RE (or similar variables) and/or running performance variables with healthy and adult participants, independent of activity level, were included in this review. Eleven studies met the inclusion criteria with a total of 44 parameters (14 performance-related/30 metabolic parameters) and 111 participants. Regardless of the stretching technique, there was an improvement both in performance variables (21.4%) and metabolic variables (13.3%) following an acute bout of stretching. However, detrimental effects in performance variables (28.5%) and metabolic variables (6.6%) were also reported, though the results were influenced by the stretching duration and technique. Although it was observed that a single static stretching exercise with a duration of up to 90 s per muscle group can lead to small improvements in RE (1.0%; 95% CI: -1.04 to 2.22), negative effects were reported in running performance (-1.4%; 95% CI: -3.07 to -0.17). It was also observed that a single bout of dynamic stretching only resulted in a negligible change in RE -0.79% (95% CI: -0.95 to 4.18) but a large increase in running performance (9.8%; 95% CI: -3.28 to 16.78), with an overall stretch duration (including all muscles) between 217 and 900 s. Therefore, if stretching is applied without additional warm-up, the results suggest applying dynamic stretching (for a short overall stretching duration of ≤220 s) rather than static stretching if the goal is to increase running performance. In general, only short static stretching durations of ≤60 s per muscle-tendon unit are advisable. One study reported that less flexible runners have greater benefits from stretching than athletes with normal flexibility. In addition, it can be suggested that less flexible runners should aim for an optimum amount of flexibility, which would likely result in a more economical run.

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.

Reliability of isokinetic tests of velocity- and contraction intensity-dependent plantar flexor mechanical properties

"Flexibility" tests are traditionally performed voluntarily relaxed by rotating a joint slowly; however, functional activities are performed rapidly with voluntary/reflexive muscle activity. Here, we describe the reliabilities and differences in maximum ankle range of motion (ROM_max ) and plantar flexor mechanical properties at several velocities and levels of voluntary force from a new test protocol on a commercially available dynamometer. Fifteen participants had their ankle joint dorsiflexed at 5, 30, and 60° s^-1 in two conditions: voluntarily relaxed and while producing 40% and 60% of maximal eccentric torque. Commonly reported variables describing ROM_max and resistance to stretch were subsequently calculated from torque and angle data. Absolute (coefficient of variation (CV%) and typical error) and relative (ICC_2,1 ) reliabilities were determined across two testing days (≥72 h). ROM_max relative reliability was good in voluntarily relaxed tests at 30 and 60° s^-1 and moderate at 5° s^-1 , despite CVs ≤ 10% for all velocities. Tests performed with voluntary muscle activity were only reliable when performed at 5° s^-1 , and ROM_max reliability was moderate and CV ≤ 8%. For most variables, the rank order of participants differed between the slow-velocity, relaxed test, and those performed at faster speeds or with voluntary activation, indicating different information. A person's flexibility status during voluntarily relaxed fast or active stretches tended to differ from their status in the traditional voluntarily relaxed, slow-velocity test. Thus, "flexibility" tests should be completed under conditions of different stretch velocity and levels of muscle force production, and clinicians and researchers should consider the slightly larger between-day variability from slow-velocity voluntarily relaxed tests.