Using a practical approach for determining the most effective stretching strategy in female college division I volleyball players

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

BACKGROUND

Stretching has garnered significant attention in sports sciences, resulting in numerous studies. However, there is no comprehensive overview on investigation of stretching in healthy athletes.

OBJECTIVES

To perform a systematic scoping review with an evidence gap map of stretching studies in healthy athletes, identify current gaps in the literature, and provide stakeholders with priorities for future research.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and PRISMA-ScR guidelines were followed. We included studies comprising healthy athletes exposed to acute and/or chronic stretching interventions. Six databases were searched (CINAHL, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science) until 1 January 2023. The relevant data were narratively synthesized; quantitative data summaries were provided for key data items. An evidence gap map was developed to offer an overview of the existing research and relevant gaps.

RESULTS

Of ~ 220,000 screened records, we included 300 trials involving 7080 athletes [mostly males (~ 65% versus ~ 20% female, and ~ 15% unreported) under 36 years of age; tiers 2 and 3 of the Participant Classification Framework] across 43 sports. Sports requiring extreme range of motion (e.g., gymnastics) were underrepresented. Most trials assessed the acute effects of stretching, with chronic effects being scrutinized in less than 20% of trials. Chronic interventions averaged 7.4 ± 5.1 weeks and never exceeded 6 months. Most trials (~ 85%) implemented stretching within the warm-up, with other application timings (e.g., post-exercise) being under-researched. Most trials examined static active stretching (62.3%), followed by dynamic stretching (38.3%) and proprioceptive neuromuscular facilitation (PNF) stretching (12.0%), with scarce research on alternative methods (e.g., ballistic stretching). Comparators were mostly limited to passive controls, with ~ 25% of trials including active controls (e.g., strength training). The lower limbs were primarily targeted by interventions (~ 75%). Reporting of dose was heterogeneous in style (e.g., 10 repetitions versus 10 s for dynamic stretching) and completeness of information (i.e., with disparities in the comprehensiveness of the provided information). Most trials (~ 90%) reported performance-related outcomes (mainly strength/power and range of motion); sport-specific outcomes were collected in less than 15% of trials. Biomechanical, physiological, and neural/psychological outcomes were assessed sparsely and heterogeneously; only five trials investigated injury-related outcomes.

CONCLUSIONS

There is room for improvement, with many areas of research on stretching being underexplored and others currently too heterogeneous for reliable comparisons between studies. There is limited representation of elite-level athletes (~ 5% tier 4 and no tier 5) and underpowered sample sizes (≤ 20 participants). Research was biased toward adult male athletes of sports not requiring extreme ranges of motion, and mostly assessed the acute effects of static active stretching and dynamic stretching during the warm-up. Dose-response relationships remain largely underexplored. Outcomes were mostly limited to general performance testing. Injury prevention and other effects of stretching remain poorly investigated. These relevant research gaps should be prioritized by funding policies.

REGISTRATION

OSF project ( https://osf.io/6auyj/ ) and registration ( https://osf.io/gu8ya ).

Four minutes of capacitive and resistive electric transfer therapy increased jump performance

Capacitive and resistive electric transfer (CRET) therapy can improve flexibility and increase muscle activity and may be useful as a warm-up technique. This study examined the effects of short-time CRET on jump performance. Thirty healthy men (age range, 20-40 years) were randomly divided into passive (n = 15) and active (n = 15) warm-up groups. The participants and statisticians were blinded to the participant allocation. The passive warm-up group underwent 4 min of CRET therapy on their posterior lower legs. The active warm-up group performed stretching and jogging for 4 min. Calf muscle temperature and rebound jump (RJ) index were measured before and after the intervention. The mean (± standard deviation) muscle temperature increased by 2.0 ± 0.5°C and 1.4 ± 0.6°C in the passive and active warm-up groups, respectively (p < 0.05). RJ index increased significantly in both groups (p < 0.05). Therefore, passive warm-up using CRET may help avoid energy loss while increasing the muscle temperature in a short time when compared with traditional active warm-up techniques.

A systematic review and net meta-analysis of the effects of different warm-up methods on the acute effects of lower limb explosive strength

OBJECTIVE

To evaluate the effects of different warm-up methods on the acute effect of lower limb explosive strength with the help of a reticulated meta-analysis system and to track the optimal method.

METHODS

R software combined with Stata software, version 13.0, was used to analyse the outcome metrics of the 35 included papers. Mean differences (MD) were pooled using a random effects model.

RESULTS

1) Static combined with dynamic stretching [MD = 1.80, 95% CI: (0.43, 3.20)] and dynamic stretching [MD = 1.60, 95% CI: (0.67, 2.60)] were significantly better than controls in terms of improving countermovement jump height (cm), and the effect of dynamic stretching was influenced by the duration of stretching (I2 = 80.4%), study population (I2 = 77.2%) and age (I2 = 75.6%) as moderating variables, with the most significant effect size for dynamic stretching time of 7-10min. 2) Only dynamic stretching [MD = -0.08, 95% CI: (-0.15, -0.008)] was significantly better than the control group in terms of improving sprint time (s), while static stretching [MD = 0.07, 95% CI: (0.002, 0.13)] showed a significant, negative effect. 3) No results were available to demonstrate a significant difference between other methods, such as foam axis rolling, and the control group.

CONCLUSION

The results of this review indicate that static stretching reduced explosive performance, while the 2 warm-up methods, namely dynamic stretching and static combined with dynamic stretching, were able to significantly improve explosive performance, with dynamic stretching being the most stable and moderated by multiple variables and dynamic stretching for 7-10min producing the best explosive performance. In the future, high-quality studies should be added based on strict adherence to test specifications.

Effects of Dynamic Stretching Combined With Static Stretching, Foam Rolling, or Vibration Rolling as a Warm-Up Exercise on Athletic Performance in Elite Table Tennis Players

CONTEXT

Warm-up exercise is an essential preexercise routine for athletes to optimize performance. However, the benefits of combined warm-up protocols remain unclear.

OBJECTIVE

This comparative study investigated the acute effects of dynamic stretching (DS) followed by static stretching (SS), self-myofascial release using a foam rolling (FR) device, or vibration foam rolling (VFR) as a warm-up exercise to improve flexibility, power, agility, and specific skills in elite table tennis players.

DESIGN

A crossover study.

SETTING

University.

PARTICIPANTS

Twenty-three elite table tennis players.

INTERVENTIONS

Players completed 3 different interventions in a random order (DS + SS, DS + FR, and DS + VFR). The target muscle groups included the bilateral posterior calf, posterior thigh, anterior thigh, back, and shoulder.

MAIN OUTCOME MEASURES

Sit-and-reach test for flexibility, board jump test for lower-extremity power, medicine ball throw test for upper-extremity power, Edgren Side Step Test for agility, and ball speed of table tennis was assessed before and after intervention.

RESULTS

After intervention, significant increases in flexibility (15.2%, 20.4%, and 23.8%); lower-limb power (4.5%, 6.6%, and 6.3%); upper-limb power (9.6%, 8.5%, and 9.1%); and ball speed (7.4%, 7.6%, and 7.7%) were observed for DS + SS, DS + FR, and DS + VFR, respectively (all P < .001). In addition, only DS coupled with FR (5.1%) and DS in conjunction with VFR (2.7%) significantly improved agility (P < .001). However, no significant improvements in agility were observed after DS + SS. In addition, no one protocol was superior to the other in all outcomes.

CONCLUSION

The authors suggest that a combination of DS with FR or VFR as warm-up exercises significantly improved flexibility, power, ball speed, in addition to agility in elite table tennis players. Coach and athletic professionals may take this information into account for choosing more effective warm-up protocols to enhance performance.

Combined Effects of Self-Myofascial Release and Dynamic Stretching on Range of Motion, Jump, Sprint, and Agility Performance

Richman, ED, Tyo, BM, and Nicks, CR. Combined effects of self-myofascial release and dynamic stretching on range of motion, jump, sprint, and agility performance. J Strength Cond Res 33(7): 1795-1803, 2019-Massage has been used as both a pre- and post-exercise modality with purported benefits to flexibility and athletic performance. This study was designed to determine the effect of a 6-minute protocol of self massage known as self-myofascial release (SMR) using a foam rolling device in conjunction with a general warm-up and sport-specific dynamic stretching (DS) session on flexibility and explosive athletic performance in a sample of 14 female collegiate athletes. After familiarization, participants completed 2 testing sessions that began with 5 minutes of jogging at a self-selected pace, followed by either a 6-minute foam rolling session (SMR) or 6 minutes of light walking (LW) and a subsequent 6-minute period of sport-specific DS. Sit-and-reach (SR) was measured after a general warm-up, the SMR, or LW session, and following DS, after which participants performed 3 trials each of squat jump (SJ), countermovement jump (CMJ), and drop jump (DJ). Two additional tests, the agility T-Test (TT) and a 10-yd short sprint (SP), were then performed. The change in SR after SMR was significantly greater than the change seen in SR after LW, although the total changes seen in each condition were not statistically different after the addition of DS. Squat jump and CMJ improved by 1.72 ± 2.47 cm and 2.63 ± 3.74 cm (p = 0.070, p = 0.070), with no significant change to DJ, SP, and TT. Self-myofascial release in the form of foam rolling after a general warm-up and preceding a DS session seems to improve SJ and CMJ with no detriment to flexibility, DJ, sprint, and agility performance in comparison with LW and DS.

Evidence-based post-exercise recovery strategies in rugby: a narrative review

In the sport of rugby, athletes need a multitude of sport-specific skills along with endurance, power, and speed to optimize performance. Further, it is not unusual for athletes to play several competitive matches with insufficient recovery time. Rugby requires repeated bouts of high-intensity actions intermixed with brief periods of low-to-moderate active recovery or passive rest. Specifically, a match is characterized by repeated explosive activities, such as jumps, shuffles, and rapid changes of direction. To facilitate adequate recovery, it is necessary to understand the type of fatigue induced and, if possible, its underlying mechanisms. Common approaches to recovery may include nutritional strategies as well as active (active recovery) and passive recovery (water immersions, stretching, and massage) methods. However, limited research exists to support the effectiveness of each strategy as it related to recovery from the sport of rugby. Therefore, the main aim of the current brief review is to present the relevant literature that pertains to recovery strategies in rugby.

Acute Effects of Dynamic Stretching on Muscle Flexibility and Performance: An Analysis of the Current Literature

Stretching has long been used in many physical activities to increase range of motion (ROM) around a joint. Stretching also has other acute effects on the neuromuscular system. For instance, significant reductions in maximal voluntary strength, muscle power or evoked contractile properties have been recorded immediately after a single bout of static stretching, raising interest in other stretching modalities. Thus, the effects of dynamic stretching on subsequent muscular performance have been questioned. This review aimed to investigate performance and physiological alterations following dynamic stretching. There is a substantial amount of evidence pointing out the positive effects on ROM and subsequent performance (force, power, sprint and jump). The larger ROM would be mainly attributable to reduced stiffness of the muscle-tendon unit, while the improved muscular performance to temperature and potentiation-related mechanisms caused by the voluntary contraction associated with dynamic stretching. Therefore, if the goal of a warm-up is to increase joint ROM and to enhance muscle force and/or power, dynamic stretching seems to be a suitable alternative to static stretching. Nevertheless, numerous studies reporting no alteration or even performance impairment have highlighted possible mitigating factors (such as stretch duration, amplitude or velocity). Accordingly, ballistic stretching, a form of dynamic stretching with greater velocities, would be less beneficial than controlled dynamic stretching. Notwithstanding, the literature shows that inconsistent description of stretch procedures has been an important deterrent to reaching a clear consensus. In this review, we highlight the need for future studies reporting homogeneous, clearly described stretching protocols, and propose a clarified stretching terminology and methodology.

Acute Effect of Foam Rolling and Dynamic Stretching on Flexibility and Jump Height

Smith, JC, Pridgeon, B, and Hall, MC. Acute effect of foam rolling and dynamic stretching on flexibility and jump height. J Strength Cond Res 32(8): 2209-2215, 2018-Dynamic stretching (DS) can acutely improve vertical jump (VJ) performance but its effect lasts no more than 5 minutes. Foam rolling (FR), a form of self-myofascial release, can acutely increase range of motion (ROM) with this effect lasting less than 10 minutes. Therefore, the purpose of this study was to evaluate the time course of these effects, separately and combined, on VJ height and ROM. Twenty-nine university students completed 4 different sessions (control, FR, DS, and combo) in a randomized order. After a warm-up and baseline assessments of VJ height and sit-and-reach, participants rested (control) and performed FR, DS, and the combination of FR and DS (combo). Vertical jump height and ROM were assessed every 5 minutes for 20 minutes after treatment. Mean scores at each time point were expressed as a percent change from baseline scores. Immediately after FR, sit-and-reach was significantly greater than control (p = 0.003). Vertical jump height immediately after treatment for DS and combo was significantly greater than the control and FR counterparts (p ≤ 0.002). Vertical jump height for DS and combo was also significantly greater than the control counterpart at 5 minutes after treatment (p < 0.001). At 15 minutes after treatment, the percent change in VJ height for the combo was significantly greater than the control counterpart (p = 0.002). Although FR has no effect on VJ performance, it can acutely increase ROM, but its effect was quickly dissipated. Foam rolling does not seem to enhance VJ height either alone or in combination with DS.

Recovery in volleyball

INTRODUCTION

In current team sports (including volleyball), the players have to play numerous competitive matches without time to recover. Volleyball can be defined as a moderate duration exercise including repeated bouts of high-intensity activity interspersed with brief periods of low to moderate active recovery or passive rest. A match is characterized by repeated explosive activities, such as: jumps, shuffles and rapid changes in direction.

EVIDENCE ACQUISITION

To guarantee adequate recovery after matches, it is necessary to know the type of fatigue induced and if possible its underlying mechanisms. Recovery strategies are commonly utilized in volleyball despite limited scientific confirmation to support their effectiveness to facilitating optimal recovery.

EVIDENCE SYNTHESIS

It is particularly important to optimize recovery because players spend a much greater proportion of their time recovering than they do in training.

CONCLUSIONS

Therefore, the main aim of this brief review is to facilitate useful information for practical application, based on the scientific evidence and applied knowledge specifically in volleyball.

The biomechanical effect of warm-up stretching strategies on landing mechanics in female volleyball athletes

Female volleyball athletes incorporate dynamic and static stretching into a warm-up, with evidence generally supporting dynamic stretching to improve performance. However, the effects of these stretching practices on injury risk during subsequent volleyball manoeuvres have yet to be fully elucidated in the warm-up literature. Three-dimensional kinematic data associated with non-contact, lower extremity injury were recorded on 12 female collegiate club volleyball athletes during unilateral landing tasks on the dominant and non-dominant limb. Participants performed landings as part of a volleyball-simulated manoeuvre prior to and post-dynamic (DWU) and combined dynamic-static (CDS) warm-ups. A significant reduction in non-dominant hip adduction angle was found at 15 min post CDS warm-up (p = 0.016; d = 0.38), however, no other warm-up differences were detected. The non-dominant limb demonstrated greater knee abduction (p = 0.006; d = 0.69) and internal rotation angle (p = 0.004; d = 0.88), suggesting that this limb demonstrates more risky landing patterns that are potentially due to altered trunk positioning upon landing. The results show that the majority of selected landing kinematics are unaffected by additional static stretching to a dynamic warm-up and that the non-dominant limb may be at a higher injury risk in female volleyball athletes.

Kinetic Analysis of Unilateral Landings in Female Volleyball Players After a Dynamic and Combined Dynamic-Static Warm-up

Avedesian, JM, Judge, LW, Wang, H, and Dickin, DC. Kinetic analysis of unilateral landings in female volleyball players after a dynamic and combined dynamic-static warm-up. J Strength Cond Res 33(6): 1524-1533, 2019-A warm-up is an important period before training or competition to prepare an athlete for the physical demands of subsequent activity. Previous research has extensively focused on the effects of warm-up in relation to various jumping performance attributes; however, limited research has examined the biomechanical nature of landings after common warm-up practices. Twelve female, collegiate-level volleyball players performed unilateral landings on the dominant and nondominant limb before and after dynamic warm-ups and combined dynamic-static (CDS) warm-ups. Kinetic variables of interest were measured at the hip and knee during the landing phase of a volleyball-simulated jump-landing maneuver. A significant 3-way interaction (warm-up × limb × time) for peak internal knee adduction moment was observed, as this kinetic parameter significantly increased (p = 0.01; d = 0.79) in the nondominant limb at 1-minute post-CDS warm-up. No other warm-up differences were detected; however, significant main effects of limb were determined for dominant-limb internal hip abduction moment (p < 0.01; d = 1.32), dominant-knee internal rotation moment (p < 0.01; d = 1.88), and nondominant-knee external rotation moment (p < 0.01; d = 1.86), which may be due to altered hip and trunk mechanics during the jump landings. This information provides strength and conditioning professionals with biomechanical information to determine warm-up protocols that reduce the risk of injury in female volleyball athletes.

Pre- and Post-Activity Stretching Practices of Collegiate Athletic Trainers in the United States

Popp, JK, Bellar, DM, Hoover, DL, Craig, BW, Leitzelar, BN, Wanless, EA, and Judge, LW. Pre- and post-activity stretching practices of collegiate athletic trainers in the United States. J Strength Cond Res 31(9): 2347-2354, 2017-The aim of the study was to investigate the knowledge and practices of collegiate-certified athletic trainers (ATs) in the United States. Participants (n = 521) were provided an overview of the study and a hyperlink to a web-based survey. The "pre- and post-activity practices in athletic training questionnaire" consisted of demographic items and elements to measure knowledge and practices related to pre- and post-activity stretching routines. In previous studies, the survey demonstrated construct validity, α = 0.722. Pearson chi-square test was used to evaluate goodness of fit, and kappa was calculated to measure agreement between items. Only 32.2% of ATs recommended dynamic stretching (DS) to be performed pre-activity, whereas a larger percentage (42.2%) recommended a combination of static stretching (SS) and DS. Athletic trainers reported that only 28.0% of athletes are performing DS before activity. Conversely, 60.6% of collegiate ATs recommended SS postexercise, and 61.0% of athletes agree and perform after workout SS (κ = 0.761, p < 0.001). Collegiate ATs seem to underuse the current research evidence, which indicates that DS is more beneficial than SS when used pre-activity, and ATs continue to regularly incorporate SS in their pre-activity routines. However, there is evidence that collegiate ATs in the United States emphasize SS postactivity in a manner consistent with current research.

Personal Trainer Demographics, Current Practice Trends and Common Trainee Injuries

Increasing emphasis on maintaining a healthy lifestyle has led many individuals to seek advice on exercise from personal trainers. There are few studies to date that evaluate personal trainer education, practice trends, and injuries they have seen while training clients. A survey was distributed to personal trainers using Survey Monkey® (Palo Alto, CA, USA) with 605 personal trainers accessing the survey. An exercise related bachelor’s degree was held by 64.2% of survey participants and a certification in personal training by 89.0%. The most common personal trainer certifications were from American College of Sports Medicine (59.2%) and National Strength and Conditioning Association (28.9%). Only 2.9% of all personal trainers surveyed had no exercise-related bachelor’s degree and no personal trainer certification. The most common injuries seen by personal trainers during sessions were lumbar muscle strain (10.7%), rotator cuff tear/tendonitis (8.9%), shin splints (8.1%), ankle sprain (7.5%), and cervical muscle strain (7.4%). There is variability in the practices between different personal trainers when analyzing differences in collegiate education, personal trainer certifications, and strength and conditioning certifications. The clinical implication of the differences in practices is unknown as to the impact on injuries or exercise prescription effectiveness.

Enhancing physical performance in male volleyball players with a caffeine-containing energy drink

There are no scientific data about the effects of caffeine intake on volleyball performance. The aim of this study was to investigate the effect of a caffeine-containing energy drink to enhance physical performance in male volleyball players. A double-blind, placebo-controlled, randomized experimental design was used. In 2 different sessions separated by 1 wk, 15 college volleyball players ingested 3 mg of caffeine per kg of body mass in the form of an energy drink or the same drink without caffeine (placebo). After 60 min, participants performed volleyball-specific tests: standing spike test, maximal squat jump (SJ), maximal countermovement jump (CMJ), 15-s rebound jump test (15RJ), and agility T-test. Later, a simulated volleyball match was played and recorded. In comparison with the placebo drink, the ingestion of the caffeinated energy drink increased ball velocity in the spike test (73 ± 9 vs 75 ± 10 km/h, P < .05) and the mean jump height in SJ (31.1 ± 4.3 vs 32.7 ± 4.2 cm, P < .05), CMJ (35.9 ± 4.6 vs 37.7 ± 4.4 cm, P < .05), and 15RJ (29.0 ± 4.0 vs 30.5 ± 4.6 cm, P < .05). The time to complete the agility test was significantly reduced with the caffeinated energy drink (10.8 ± 0.7 vs 10.3 ± 0.4 s, P < .05). In addition, players performed successful volleyball actions more frequently (24.6% ± 14.3% vs 34.3% ± 16.5%, P < .05) with the ingestion of the caffeinated energy drink than with the placebo drink during the simulated game. A caffeine-containing energy drink, with a dose equivalent to 3 mg of caffeine per kg body mass, might be an effective ergogenic aid to improve physical performance and accuracy in male volleyball players.