The Effect of Remote Myofascial Release on Chronic Nonspecific Low Back Pain With Hamstrings Tightness

CONTEXT

Anatomy trains theory states that performing techniques in any part of the superficial myofascial backline can remotely treat other parts of this pathway. Due to the connections of different parts of the superficial backline, it is possible to influence the hamstring by performing the technique in the lumbar area. As chronic nonspecific low back pain (LBP) may lead to or be caused by hamstring tightness, remote myofascial release (MFR) techniques using the superficial backline can help improve hamstring tightness.

OBJECTIVE

This study aimed to evaluate the effect of remote MFR on hamstring tightness for those with chronic nonspecific LBP.

DESIGN

Single-blind, parallel design.

SETTING

The present study was performed at the clinical setting of Tarbiat Modares University in Iran.

METHODS

This study included 40 participants (20 males and 20 females) who were 40.5 (5.3) years old with chronic nonspecific LBP and hamstring tightness.

INTERVENTIONS

Participants were randomly divided into the lumbar MFR (remote area) and hamstring MFR groups. Participants underwent 4 sessions of MFR for 2 weeks.

MAIN OUTCOME MEASURES

A passive knee-extension (PKE) test was used for muscle tightness evaluation 3 times.

RESULTS

Repeated-measure analysis of variance test showed that after the lumbar and hamstring MFR, the PKE was significantly reduced in both legs: lumbar MFR (right knee: from 61.04° [2.17°] to 51.01° [4.11°], P ≤ .003 and left knee: from 63.02° [3.12°] to 52.09° [2.48°], P ≤ .004) and hamstring MFR (right knee: from 62.01° [4.32°] to 50.50° [7.18°], P ≤ .001 and left knee: from 63.11° [2.56°] to 51.32° [5.31°], P ≤ .002). Least Significant Difference (LSD) post hoc test results showed that the 2 groups were not significantly different after the MFR (P ≥ .05). Also, the intraclass correlation coefficient index showed that the PKE test has excellent reliability (intraclass correlation coefficient, .910 for the right limb and .915 for the left limb). The minimal detectable change at the 95% confidence interval indicated that a change greater than or equal to 6° is required to exceed the threshold of the error PKE test, respectively.

CONCLUSION

The present study showed that the remote MFR technique to the lumbar region demonstrated the same significant results in decreasing hamstring tightness as was noted in hamstring MFR to both limbs in patients with chronic nonspecific LBP.

Evidence-Based Hamstring Injury Prevention and Risk Factor Management: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Hamstring injuries are common among athletes. Considering the potentially prolonged recovery and high rate of recurrence, effective methods of prevention and risk factor management are of great interest to athletes, trainers, coaches, and therapists, with substantial competitive and financial implications.

PURPOSE

To systematically review the literature concerning evidence-based hamstring training and quantitatively assess the effectiveness of training programs in (1) reducing injury incidence and (2) managing injury risk factors.

STUDY DESIGN

Systematic review and meta-analysis; Level of evidence, 1.

METHODS

A computerized search of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus with manual screening of selected reference lists was performed in October 2020. Randomized controlled trials investigating methods of hamstring injury prevention and risk factor management in recreational, semiprofessional, and professional adult athletes were included.

RESULTS

Of 2602 articles identified, 108 were included. Eccentric training reduced the incidence of hamstring injury by 56.8% to 70.0%. Concentric hamstring strength increased with eccentric (mean difference [MD], 14.29 N·m; 95% CI, 8.53-20.05 N·m), concentric, blood flow-restricted, whole-body vibration, heavy back squat, FIFA 11+ (Fédération Internationale de Football Association), and plyometric training methods, whereas eccentric strength benefited from eccentric (MD, 26.94 N·m; 95% CI, 15.59-38.30 N·m), concentric, and plyometric training. Static stretching produced greater flexibility gains (MD, 10.89°; 95% CI, 8.92°-12.86°) than proprioceptive neuromuscular facilitation (MD, 9.73°; 95% CI, 6.53°-12.93°) and dynamic stretching (MD, 6.25°; 95% CI, 2.84°-9.66°), although the effects of static techniques were more transient. Fascicle length increased with eccentric (MD, 0.90 cm; 95% CI, 0.53-1.27 cm) and sprint training and decreased with concentric training. Although the conventional hamstring/quadriceps (H/Q) ratio was unchanged (MD, 0.03; 95% CI, -0.01 to 0.06), the functional H/Q ratio significantly improved with eccentric training (MD, 0.10; 95% CI, 0.03-0.16). In addition, eccentric training reduced limb strength asymmetry, while H/Q ratio and flexibility imbalances were normalized via resistance training and static stretching.

CONCLUSION

Several strategies exist to prevent hamstring injury and address known risk factors. Eccentric strengthening reduces injury incidence and improves hamstring strength, fascicle length, H/Q ratio, and limb asymmetry, while stretching-based interventions can be implemented to improve flexibility. These results provide valuable insights to athletes, trainers, coaches, and therapists seeking to optimize hamstring training and prevent injury.

Comparison of Pelvic Tilt Before and After Hip Flexor Stretching in Healthy Adults

OBJECTIVE

The purpose of this study was to assess the association between hip flexor length and pelvic tilt or lumbar lordosis by quantifying the effect of stretching on pelvic tilt and lumbar lordosis.

METHODS

We quantified pelvic tilt and lumbar lordosis before and after a single session of passive hip flexor stretching in a sample of 23 male participants. Changes in hip flexor length were also characterized, using a Thomas test protocol to measure passive hip extension in supine lying. We investigated both the mean effect of the stretching protocol and potential correlations between changes in passive hip extension and changes in pelvic tilt or lumbar lordosis.

RESULTS

Following the stretching protocol, there was a mean increase of 2.6° (P < .001) in passive hip extension and a corresponding mean reduction of 1.2° (P < .001) in anterior pelvic tilt. However, there was no change in lumbar lordosis, nor were there any meaningful correlations between change in passive hip extension and change in pelvic tilt or lumbar lordosis.

CONCLUSION

The results suggest that hip muscle stretching may lead to immediate reductions in pelvic tilt during relaxed standing. Such stretching programs could play an important role in interventions designed to improve standing postural alignment.

Static Stretching Intensity Does Not Influence Acute Range of Motion, Passive Torque, and Muscle Architecture

CONTEXT

Although stretching exercises are commonly used in clinical and athletic practice, there is a lack of evidence regarding the methodological variables that guide the prescription of stretching programs, such as intensity.

OBJECTIVE

To investigate the acute effects of different stretching intensities on the range of motion (ROM), passive torque, and muscle architecture.

DESIGN

Two-group pretest-posttest design.

SETTING

Laboratory.

PARTICIPANTS

Twenty untrained men were allocated into the low- or high-intensity group.

MAIN OUTCOME MEASURES

Subjects were evaluated for initial (ROMinitial) and maximum (ROMmax) discomfort angle, stiffness, viscoelastic stress relaxation, muscle fascicle length, and pennation angle.

RESULTS

The ROM assessments showed significant changes, in both groups, in the preintervention and postintervention measures both for the ROMinitial (P < .01) and ROMmax angle (P = .02). There were no significant differences for stiffness and viscoelastic stress relaxation variables. The pennation angle and muscle fascicle length were different between the groups, but there was no significant interaction.

CONCLUSION

Performing stretching exercises at high or low intensity acutely promotes similar gains in flexibility, that is, there are short-term/immediate gains in ROM but does not modify passive torque and muscle architecture.

A single session with a roller massager improves hamstring flexibility in healthy athletes: a randomized placebo-controlled crossover study

Purpose

The aim of this randomized placebo-controlled crossover study was to compare the acute effect on young athletes of a single session of roller massager (RM) with that obtained from passive static stretching (PSS) and a placebo intervention (PL) on hamstring flexibility and on strength.

Methods

Twenty-nine (23 male, 6 female) young athletes completed the study. Maximal voluntary contraction (MVC) and two-leg sit-and-reach test were performed before and immediately after PL, PSS and RM on three different days.

Results

Results showed that all three interventions increased the flexibility of the hamstring muscles compared to the pre-test measurements (Wilcoxon signed-rank test, p < 0.05). Only the RM intervention was significantly higher than the PL intervention (sham ultrasound). Stretching intervention was not significantly different from either of the other two interventions. None of the three interventions significantly changed the muscle strength in the short term.

Conclusions

RM can be considered as an effective alternative to stretching to increase the flexibility of the hamstring. This could be meaningful when stretching is contraindicated or evokes pain.

The effects of stretching with cryotherapy, stretching with heat and stretching alone on hamstring flexibility in physically active females

Background/Aims

A pre- and post-intervention study was conducted to examine the effects of acute cryotherapy with stretching, heat with stretching, and stretching alone on hamstring flexibility.

Methods

Thirty female participants were randomly allocated into three groups: stretching with cryotherapy, stretching with heat, or stretching without an intervention. A sit and reach test and the 90/90 active knee extension test were conducted before and after a 20-minute stretching routine to measure hamstring flexibility.

Results

Differences were observed pre- and post-test in the sit and reach test and knee 90/90 extension tasks (P<0.05) within all three groups. However, there were no significant differences (P>0.05) between the three intervention groups.

Conclusions

Combining stretching with cryotherapy or heat application potentially provides no additional benefit to stretching alone in short-term enhancements to hamstring muscle flexibility in physically active females.

Comparison between 4 weeks passive static stretching and proprioceptive neuromuscular facilitation programmes on neuromuscular properties of hamstring muscles: a randomised clinical trial

Background/aims

Studies have shown the efficacy of stretching to increase the hip flexion range of motion but studies regarding its effects are not unanimous about the most efficient technique. The aim of this study was to compare the effect of two stretching techniques on the neuromuscular properties of the hamstring muscles.

Methods

A total of 18 women (aged 24 ± 2.52 years old) participated, and were divided into three groups: a control group, a passive static stretching group and a propioceptive neuromuscular facilitation stretching group. Evaluations of variables of the hamstring muscles were performed before and after the training period. The intervention was carried out for 30 seconds, three times a week for a total of 4 weeks.

Results

A significant difference was found in the range of motion in the passive static stretching group (pre=80.8° [±11.0] and post=94.5° [±10.2]; t(5)=−3.755; P=0.013) and in concentric torque (passive static stretching group – pre=66.3 Nm [±12.9] and post=70.0 Nm [±8.1]; t(5)=−1.267; P=0.023; propioceptive neuromuscular facilitation stretching group – pre=79.1 Nm [±12.7] and post=83.5 Nm [±11.6]; t(5)=−1.917; P=0.014; control group – pre=71.1 Nm [±10.1] and post=74.1 Nm [±14.6]; t(5)=−1.275; P=0.003).

Conclusions

Passive static stretching was superior to propioceptive neuromuscular facilitation when comparing the increase range of motion in hip flexion, even without neural and structural changes in hamstring muscles after a 4-week period.

Effects of a 12-Week Chronic Stretch Training Program at Different Intensities on Joint and Muscle Mechanical Responses: A Randomized Clinical Trial

CONTEXT

Stretching intensity is an important variable that can be manipulated with flexibility training. However, there is a lack of evidence regarding this variable and its prescription in stretching programs.

OBJECTIVE

To investigate the effects of 12 weeks of knee flexor static stretching at different intensities on joint and muscle mechanical properties.

DESIGN

A randomized clinical trial.

SETTING

Laboratory.

PARTICIPANTS

A total of 14 untrained men were allocated into the low- or high-intensity group.

MAIN OUTCOME MEASURES

Assessments were performed before, at 6 week, and after intervention (12 wk) for biceps femoris long head architecture (resting fascicle length and angle), knee maximal range of motion (ROM) at the beginning and maximal discomfort angle, knee maximal tolerated passive torque, joint passive stiffness, viscoelastic stress relaxation, knee passive torque at a given angle, and affective responses to training.

RESULTS

No significant differences were observed between groups for any variable. ROM at the beginning and maximal discomfort angle increased at 6 and 12 weeks, respectively. ROM significantly increased with the initial angle of discomfort (P < .001, effect size = 1.38) over the pretest measures by 13.4% and 14.6% at the 6- and 12-week assessments, respectively, and significantly improved with the maximal discomfort angle (P < .001, effect size = 1.25) by 15.6% and 18.8% from the pretest to the 6- and 12-week assessments, respectively. No significant effects were seen for muscle architecture and affective responses. Initial viscoelastic relaxation for the low-intensity group was lower than ending viscoelastic relaxation.

CONCLUSION

These results suggest that stretching with either low or high discomfort intensities are effective in increasing joint maximal ROM, and that does not impact on ROM, stiffness, fascicle angle and length, or affective response differences.

A comparison between two educational methods in the rehabilitation of the microstomia in systemic sclerosis: a randomized controlled trial

OBJECTIVE

To test the effectiveness of an educational intervention including "face to face" training, compared to a standard information program, to reduce microstomia in women with systemic sclerosis.

DESIGN

Single-blind, two-arm, randomized controlled study with a 12-month follow-up period.

SETTING

Hospital wards of a large Italian dermatological reference center.

SUBJECTS

Female inpatients with diagnosis of systemic sclerosis.

INTERVENTIONS

For both groups an information brochure and an audio-visual DVD were developed specifically for the study. The control group was assigned to educational materials alone (i.e. brochures and DVD), while the experimental group, in addition to the same educational materials, received specific "face-to-face" interventions, repeated at each follow-up visit.

MAIN MEASURES

Primary outcome was measurement of the opening of the mouth. Secondary outcomes was the self-reported mouth disability.

RESULTS

The intention-to-treat analysis included 63 patients. Compared to the baseline measurement, we observed an increase of the mouth opening of 0.31 cm (95% confidence interval: 0.13-0.49), P = 0.003; in the control group, the increase was 0.13 cm (95% confidence interval: 0.01-0.25), P = 0.06. The difference in improvement between the two groups was not statistically significant (P = 0.10); however, it reached statistical significance in the per-protocol analysis (39 patients, P = 0.02).

CONCLUSION

Face-to-face nursing rehabilitation training seems to improve microstomia to a greater extent, when compared to a standard intervention based only on written and audio-visual materials.

Range of Motion Adaptations in Powerlifters

Gadomski, SJ, Ratamess, NA, and Cutrufello, PT. Range of motion adaptations in powerlifters. J Strength Cond Res 32(11): 3020-3028, 2018-The aim of this study was to investigate range of motion (ROM) and training patterns in powerlifters. Upper- and lower-extremity passive ROMs were assessed through goniometry in 15 male powerlifters (35.3 ± 13.7 years) and 15 age-matched controls (34.9 ± 14.6 years). The Apley scratch test and modified Thomas test were used to assess ROM across multiple joints. Training frequency, stretching frequency, and exercise selection were recorded using questionnaires. Passive glenohumeral (GH) extension, internal rotation, and external rotation ROM were significantly decreased in powerlifters (p < 0.050). Powerlifters displayed decreased ROM in the Apley scratch test in both dominant (p = 0.015) and nondominant (p = 0.025) arms. However, knee extension angle was markedly improved in powerlifters (20.3 ± 7.3°) compared with controls (29.9 ± 6.2°; p < 0.001). Bench press and bench press variations accounted for 74.8% of all upper-body exercises, whereas back squat and deadlift accounted for 79.7% of all lower-body exercises in powerlifters' training programs. To determine whether existing ROM adaptations were seen in elite powerlifters, the powerlifting cohort was split into 3 groups based on Wilks score: <400 (low), 400-500 (intermediate), and >500 (high). GH ROM limitations were more pronounced in elite powerlifters (Wilks >500), who had more powerlifting experience (p = 0.048) and greater lean body mass (p = 0.040). Overall, powerlifters displayed decreased GH ROM, but increased hamstring ROM, after training programs that were heavily focused on the bench press, back squat, and deadlift.

Adaptations in the passive mechanical properties of skeletal muscle to altered patterns of use

The aim of this mini-review is to describe the present state of knowledge regarding the effects of chronic changes in the patterns of muscle use (defined as changes lasting >1 wk), including muscle stretching, strengthening, and others, on the passive mechanical properties of healthy human skeletal muscles. Various forms of muscle stretch training and some forms of strength training (especially eccentric training) are known to strongly impact the maximum elongation capacity of muscles in vivo (i.e., maximum joint range of motion), largely by increasing our ability to tolerate higher stretch loads. However, only small effects are observed in the passive stiffness of the muscle-tendon unit (MTU) or the muscle itself, although a reduction in muscle stiffness has been observed in the plantar flexors after both stretching and eccentric exercise interventions. No changes have yet been observed in viscoelastic properties such as the MTU stress-relaxation response, although a minimum of evidence indicates that hysteresis during passive stretch-relaxation cycles may be reduced by muscle stretching training. Importantly, data exist for relatively few muscle groups, and little is known about the effects of age and sex on the adaptive process of passive mechanical properties. Despite the significant research effort afforded to understanding the effects of altered physical activity patterns on the maximum range of motion at some joints, further information is needed before it will be possible to develop targeted physical activity interventions with the aim of evoking specific changes in passive mechanical properties in individuals or in specific muscles and muscle groups.

Balance highly influences flexibility measured by the toe-touch test

Flexibility evaluation is a standard assessment in clinical and in sports settings. The Toe-touch test (TTT) is a common assessment tool to evaluate posterior muscular chain flexibility, but the test procedure implies a balance demand. The objective of the study was to verify the hypothesis that the balance demand during the TTT may affect the flexibility measured by the test. Twenty healthy, active young adults participated in the present study. Toe-touch test outcome (the linear finger to toe distance), Center of Pressure (CP) and sagittal plane joint angles were compared under two balance conditions: (1) standard TTT (ST) and (2) minimised postural demand (MPD) during TTT (using a device that restrained the participant against a forward fall). Then, ST was re-tested to verify a possible effect of motor learning on TTT outcome. Compared to ST, MPD showed an improvement of 73% in test outcome, greater flexion of the ankle, greater total body flexion, and a forward displacement of the CP. Re-test of ST showed indications of motor learning with a different balance strategy compared to the first trial in the same condition. The test outcome showed significant negative correlations with CP position in ST (weak correlation), in the re-test (strong correlation) and when the conditions were combined (moderate correlation). In conclusion, TTT outcome was highly affected by balance performance. Maximum range of motion during ST was a fraction of the range obtained when balance demand was minimized.

Instrument-assisted soft tissue mobilization and proprioceptive neuromuscular facilitation techniques improve hamstring flexibility better than static stretching alone: a randomized clinical trial

Objectives: Tight hamstrings contribute to inefficiency of movement and increased risk for injury. Static stretching is the most common intervention for this problem, but the use of alternatives like instrument-assisted soft tissue mobilization (IASTM) and proprioceptive neuromuscular facilitation (PNF) is increasing among clinicians. This study examined two prospective studies with the common aim of demonstrating the effectiveness of IASTM or PNF over static stretching for improving hamstring tightness. Methods: Nondisabled adults were recruited on a university campus. IASTM study: N = 17 (11 males and 6 females). PNF study: N = 23 (7 males and 16 females). Hip flexion range of motion was measured with a passive straight leg raise (for IASTM) or active straight leg raise (for PNF) before and after stretching. Participants performed a self-static stretch on one leg and received the alternative intervention on the contralateral leg. The two studies were analyzed separately for reliability indices and significant differences between interventions. Results: Hip flexion measures showed good reliability in both studies (intraclass correlation coefficient = 0.97) with a minimal detectable change of <4.26. Both studies showed significant interactions between time and intervention (p < 0.05). Follow-up analyses revealed PNF and IASTM interventions resulted in greater increases in hip flexion range than static stretching. Discussion: These findings demonstrate the effectiveness of PNF and IASTM techniques over static stretching for hamstring flexibility. These interventions provide more efficient alternatives for improving flexibility in the clinic, allowing greater progress in a shorter period of time than an equivalent static stretching program. Level of Evidence: 1b.

Acute effect of different time periods of passive static stretching on the hamstring flexibility

BACKGROUND

Several factors are associated with the presence of chronic low back pain; one of them is the flexibility of the hamstring muscles that influences the posture of the pelvic spine.

OBJECTIVE

Investigate the influence of two different time periods of passive static stretching on the flexibility of the hamstring.

METHODS

Forty-six physiotherapy students were divided into two groups performing stretching exercises: 30 s and 60 s duration. The collections consisted of: (1) pre-test: evaluation of the flexibility of the hip and knee, using a manual goniometer by means of the following tests: Straight Leg Raise Test (SLR), Passive Hip Flexion Test (PHFT) and Modified Knee Extension Test (MKET), (2) intervention: stretching with different runtimes, (3) post-test: reappraisal of flexibility, conducted immediately after the intervention.

RESULTS

Significant difference was observed intra groups, group that did stretching exercises lasting 30 seconds (G30) (SLR p = 0.000. PHFT p = 0.003 and MKET p = 0.000) and group that did stretching exercises lasting 60 seconds (G60) (SLR p = 0.000. PHFT p = 0.001 and MKET p = 0.002). Comparing the groups, no significant difference was found (SLR p = 0.307; PHFT p = 0.904; MKET p = 0.132).

CONCLUSION

Thus it can be inferred that 30 seconds are sufficient for increased flexibility of young women. Therefore the time-treatment sessions can be optimized. Only the acute effect of stretching was observed; further investigation of the long-term effect is required.

Stretch for the treatment and prevention of contractures

BACKGROUND

Contractures are a common complication of neurological and non-neurological conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective. This review is an update of the original 2010 version of this review.

OBJECTIVES

The aim of this review was to determine the effects of stretch on contractures in people with, or at risk of developing, contractures.The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions, spasticity and adverse events.

SEARCH METHODS

In November 2015 we searched CENTRAL, DARE, HTA; MEDLINE; Embase; CINAHL; SCI-EXPANDED; PEDro and trials registries.

SELECTION CRITERIA

We included randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, extracted data, and assessed risk of bias. The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions and adverse events. We evaluated outcomes in the short term (up to one week after the last stretch) and in the long term (more than one week). We expressed effects as mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). We conducted meta-analyses with a random-effects model. We assessed the quality of the body of evidence for the main outcomes using GRADE.

MAIN RESULTS

Forty-nine studies with 2135 participants met the inclusion criteria. No study performed stretch for more than seven months. Just over half the studies (51%) were at low risk of selection bias; all studies were at risk of detection bias for self reported outcomes such as pain and at risk of performance bias due to difficulty of blinding the intervention. However, most studies were at low risk of detection bias for objective outcomes including range of motion, and the majority of studies were free from attrition and selective reporting biases. The effect of these biases were unlikely to be important, given that there was little benefit with treatment. There was high-quality evidence that stretch did not have clinically important short-term effects on joint mobility in people with neurological conditions (MD 2°; 95% CI 0° to 3°; 26 studies with 699 participants) or non-neurological conditions (SMD 0.2, 95% CI 0 to 0.3, 19 studies with 925 participants).In people with neurological conditions, it was uncertain whether stretch had clinically important short-term effects on pain (SMD 0.2; 95% CI -0.1 to 0.5; 5 studies with 174 participants) or activity limitations (SMD 0.2; 95% CI -0.1 to 0.5; 8 studies with 247 participants). No trials examined the short-term effects of stretch on quality of life or participation restrictions in people with neurological conditions. Five studies involving 145 participants reported eight adverse events including skin breakdown, bruising, blisters and pain but it was not possible to statistically analyse these data.In people with non-neurological conditions, there was high-quality evidence that stretch did not have clinically important short-term effects on pain (SMD -0.2, 95% CI -0.4 to 0.1; 7 studies with 422 participants) and moderate-quality evidence that stretch did not have clinically important short-term effects on quality of life (SMD 0.3, 95% CI -0.1 to 0.7; 2 studies with 97 participants). The short-term effect of stretch on activity limitations (SMD 0.1; 95% CI -0.2 to 0.3; 5 studies with 356 participants) and participation restrictions were uncertain (SMD -0.2; 95% CI -0.6 to 0.1; 2 studies with 192 participants). Nine studies involving 635 participants reported 41 adverse events including numbness, pain, Raynauds' phenomenon, venous thrombosis, need for manipulation under anaesthesia, wound infections, haematoma, flexion deficits and swelling but it was not possible to statistically analyse these data.

AUTHORS' CONCLUSIONS

There was high-quality evidence that stretch did not have clinically important effects on joint mobility in people with or without neurological conditions if performed for less than seven months. Sensitivity analyses indicate results were robust in studies at risk of selection and detection biases in comparison to studies at low risk of bias. Sub-group analyses also suggest the effect of stretch is consistent in people with different types of neurological or non-neurological conditions. The effects of stretch performed for periods longer than seven months have not been investigated. There was moderate- and high-quality evidence that stretch did not have clinically important short-term effects on quality of life or pain in people with non-neurological conditions, respectively. The short-term effects of stretch on quality of life and pain in people with neurological conditions, and the short-term effects of stretch on activity limitations and participation restrictions for people with and without neurological conditions are uncertain.

Influence of static stretching on hamstring flexibility in healthy young adults: Systematic review and meta-analysis

The aim of the current study was to investigate the influence of static stretching on hamstring flexibility in healthy young adults by means of systematic review and meta-analysis. The search strategy included MEDLINE, PEDro, Cochrane CENTRAL, EMBASE, LILACS, and manual search from inception to June 2015. Randomized and controlled clinical trials studies that have compared static stretching to control group, and evaluated range of motion (ROM), were included. On the other hand, studies that have worked with special population such as children, elderly people, athletes, and people with any dysfunction/disease were excluded, as well as articles that have used contralateral leg as control group or have not performed static stretching. The meta-analysis was divided according to three types of tests. Nineteen studies were included out of the 813 articles identified. In all tests, the results favored static stretching compared to control group: passive straight leg raise (12.04; 95% CI: 9.61 to 14.47), passive knee extension test (8.58; 95% CI: 6.31 to 10.84), and active knee extension test (8.35; 95% CI: 5.15 to 11.55). In conclusion, static stretching was effective in increasing hamstring flexibility in healthy young adults.

Effectiveness Analysis of Active Stretching Versus Active Stretching Plus Low-Frequency Electrical Stimulation in Children Who Play Soccer and Who Have the Short Hamstring Syndrome

OBJECTIVE

To determine the effectiveness of active stretching (AS) versus AS plus electrical stimulation (stretching + TENS) in young soccer players with the short hamstring syndrome (SHS).

DESIGN

Randomized, controlled, single-blind parallel clinical trial with 3 arms and a 2-month follow-up. The assignment ratio was 1:1:1.

SETTING

The study involved young federated soccer players in the town of Jumilla, in the region of Murcia (Spain), who were controlled in a physiotherapy office in 2012.

PARTICIPANTS

Fifty-one young soccer players (10-16 years) with SHS.

INTERVENTIONS

Stretching + TENS, AS, and conventional stretching.

MAIN OUTCOME MEASURES

Straight leg raise (SLR) test, popliteal angle with the passive knee extension (PKE) test, and the toe-touch test (TT).

RESULTS

Significant results (P < 0.05) were group 1 versus 2: (1) SLR, -5.5 degrees right; (2) PKE, +10.2 degrees right and +6.2 degrees left; and (3) range of values of clinically relevant parameters (RVCRP): relative risk (RR), 0.35 to 0.38; relative risk reduction (RRR), 0.62 to 0.65; absolute risk reduction (ARR), 0.32 to 0.39; number needed to treat (NNT), 3 to 4. Group 1 versus 3: (1) SLR, -12.3 degrees right and -10 degrees left; (2) PKE, +12.9 degrees right and +8.5 degrees left; (3) TT, -8.9 cm; and (4) RVCRP: RR, 0.12 to 0.28; RRR, 0.72 to 0.88; ARR, 0.60 to 0.83; NNT, 2 to 2. Group 2 versus 3: (1) SLR, -6.8 degrees right and -6.2 degrees left; (2) TT, -6.7 cm; (3) RVCRP: RR, 0.44 to 0.53; RRR, 0.47 to 0.56; ARR, 0.40 to 0.56; NNT, 2 to 3.

CONCLUSIONS

Stretching + TENS produces greater improvement than AS alone, and these are both better than conventional stretching.

CLINICAL RELEVANCE

The use of electrical stimulation combined with AS is a relevant technique for habitual clinical practice that should be systematically integrated in children aged 10 to 16 years who play soccer and who have the SHS.

The relevance of stretch intensity and position-a systematic review

Stretching exercises to increase the range of motion (ROM) of joints have been used by sports coaches and medical professionals for improving performance and rehabilitation. The ability of connective and muscular tissues to change their architecture in response to stretching is important for their proper function, repair, and performance. Given the dearth of relevant data in the literature, this review examined two key elements of stretching: stretch intensity and stretch position; and their significance to ROM, delayed onset muscle soreness (DOMS), and inflammation in different populations. A search of three databases, Pub-Med, Google Scholar, and Cochrane Reviews, identified 152 articles, which were subsequently categorized into four groups: athletes (24), clinical (29), elderly (12), and general population (87). The use of different populations facilitated a wider examination of the stretching components and their effects. All 152 articles incorporated information regarding duration, frequency and stretch position, whereas only 79 referred to the intensity of stretching and 22 of these 79 studies were deemed high quality. It appears that the intensity of stretching is relatively under-researched, and the importance of body position and its influence on stretch intensity, is largely unknown. In conclusion, this review has highlighted areas for future research, including stretch intensity and position and their effect on musculo-tendinous tissue, in relation to the sensation of pain, delayed onset muscle soreness, inflammation, as well as muscle health and performance.

Determination of the criterion-related validity of hip joint angle test for estimating hamstring flexibility using a contemporary statistical approach

OBJECTIVE

To examine the criterion-related validity of the horizontal hip joint angle (H-HJA) test and vertical hip joint angle (V-HJA) test for estimating hamstring flexibility measured through the passive straight-leg raise (PSLR) test using contemporary statistical measures.

DESIGN

Validity study.

SETTING

Controlled laboratory environment.

PARTICIPANTS

One hundred thirty-eight professional trampoline gymnasts (61 women and 77 men).

ASSESSMENT OF RISK FACTORS

Hamstring flexibility.

MAIN OUTCOME MEASURES

Each participant performed 2 trials of H-HJA, V-HJA, and PSLR tests in a randomized order. The criterion-related validity of H-HJA and V-HJA tests was measured through the estimation equation, typical error of the estimate (TEEST), validity correlation (β), and their respective confidence limits.

RESULTS

The findings from this study suggest that although H-HJA and V-HJA tests showed moderate to high validity scores for estimating hamstring flexibility (standardized TEEST = 0.63; β = 0.80), the TEEST statistic reported for both tests was not narrow enough for clinical purposes (H-HJA = 10.3 degrees; V-HJA = 9.5 degrees). Subsequently, the predicted likely thresholds for the true values that were generated were too wide (H-HJA = predicted value ± 13.2 degrees; V-HJA = predicted value ± 12.2 degrees).

CONCLUSIONS

The results suggest that although the HJA test showed moderate to high validity scores for estimating hamstring flexibility, the prediction intervals between the HJA and PSLR tests are not strong enough to suggest that clinicians and sport medicine practitioners should use the HJA and PSLR tests interchangeably as gold standard measurement tools to evaluate and detect short hamstring muscle flexibility.

Well-tolerated strategies for managing knee osteoarthritis: a manual physical therapist approach to activity, exercise, and advice

The orthopedic manual physical therapist approach to knee osteoarthritis (OA) is an effective, well-tolerated, and comprehensive strategy that provides a spectrum of intervention measures, which include guidance on activity selection, as well as selection of manual treatment and exercises to systematically address impairments and increase strength and movement in the knee and other related body regions. This approach integrates manually applied treatment while reinforcing exercise and functional activities that are tailored in scope and dose to each patient. Concepts used in the careful design of this exercise program include emphasizing minimal dosing, avoiding exacerbation, using exercises with multiple effects, effective functional positioning, emphasizing the importance of mid-range movements and end-range challenges, and strategic timing of exercises. Focusing on motion and strength gains through range of motion, along with functional or reinforcing activities, such as walking or biking to maintain motion and strength gains, are keys to long-term success. The overarching theme is that well-tolerated strategies using manual treatment, exercise, and activity require deliberate design and targeting of the most common impairments and functional limitations seen in the knee OA population and, more importantly, tailoring to the individual patient.

Reproducibility and criterion-related validity of the sit and reach test and toe touch test for estimating hamstring flexibility in recreationally active young adults

OBJECTIVE

1) to examine the test-retest reproducibility and criterion-related validity of the sit and reach test (SRT) and the toe touch test (TT) for estimating hamstring flexibility measured through the passive straight leg raise test (PSLR); and 2) to determine whether the SRT cut-off scores may be used for the TT test to identify participants in this sample of young healthy adults as having short hamstring flexibility.

DESIGN

Test-retest design.

SETTING

Controlled laboratory environment.

PARTICIPANTS

243 active recreationally young adults.

MAIN OUTCOME MEASURES

Participants performed the SRT, the TT test and PSLR twice in a randomized order with a 4-week interval between trials. Reproducibility was examined using typical percentage error (coefficient of variation [CV]) and intraclass correlation coefficient (ICC) as well as their respective confidence limits. Regression and Kappa correlation statistical analyses were performed to study the association of the SRT and TT test with the PSLR test and the 95% limits of agreement (LoA) between SRT and TT test were calculated to explore differences in the mean differences between these measurements.

RESULTS

The finding showed acceptable reproducibility measures for SRT (8.74% CV; 0.92 ICC), TT test (9.86% CV; 0.89 ICC) and PSLR (5.46% CV; 0.85 ICC). The SRT (R² = 0.63) and TT test (R² = 0.49) were significantly associated with PSLR. The 95% LoA between SRT and TT test reported systematic bias (2.84 cm) and wide 95% random error (±9.72 cm).

CONCLUSIONS

Reproducibility of SRT, TT test and PSLR is acceptable and the criterion-related validity of SRT and TT test is moderate. Furthermore, the SRT cut-off scores should not be used for TT test for the detection of short hamstring muscles.

Effect of orofacial exercises on oral aperture in adults with systemic sclerosis

PURPOSE

To examine the effect of a home orofacial exercise program on increasing oral aperture among adults with systemic sclerosis (SSc).

METHOD

Forty-eight adults with SSc were assigned randomly to the multifaceted oral-health intervention or usual dental care control group. Participants with an oral aperture of <40 mm in the intervention group received an orofacial exercise program, which included daily manual mouth-stretching and oral-augmentation exercises twice a day with a total of 6 minutes for 6 months. The outcome measure was oral aperture which was measured at baseline, 3-months, and 6-months intervals.

RESULTS

A significantly larger increase in oral aperture for participants received the orofacial exercise program was found when compared to those in the usual care at 3 months (P = 0.01), but not at 6-months evaluation. Participants' adherence rate to the exercise program was low (48.9%).

CONCLUSIONS

The orofacial exercise program intervention for adults with SSc and microstomia did not show significant improvement at 6 months. In addition to the low exercise adherence rate, insufficient frequencies, repetitions, and durations of the orofacial exercises may contribute to these results.