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Ingram LA, Tomkinson GR, d'Unienville NMA, Gower B, Gleadhill S, Boyle T, Bennett H. Optimising the Dose of Static Stretching to Improve Flexibility: A Systematic Review, Meta-analysis and Multivariate Meta-regression. Sports Med 2024:10.1007/s40279-024-02143-9. [PMID: 39614059 DOI: 10.1007/s40279-024-02143-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2024] [Indexed: 12/01/2024]
Abstract
BACKGROUND Static stretching is widely used to increase flexibility. However, there is no consensus regarding the optimal dosage parameters for increasing flexibility. OBJECTIVES We aimed to determine the optimal frequency, intensity and volume to maximise flexibility through static stretching, and to investigate whether this is moderated by muscle group, age, sex, training status and baseline level of flexibility. METHODS Seven databases (CINAHL Complete, Cochrane CENTRAL, Embase, Emcare, MEDLINE, Scopus, and SPORTDiscus) were systematically searched up to June 2024. Randomised and non-randomised controlled trials investigating the effects of a single session (acute) or multiple sessions (chronic) of static stretching on one or more flexibility outcomes (compared to non-stretching passive controls) among adults (aged ≥ 18 years) were included. A multi-level meta-analysis examined the effect of acute and chronic static stretching on flexibility outcomes, while multivariate meta-regression was used to determine the volume at which increases in flexibility were maximised. RESULTS Data from 189 studies representing 6654 adults (61% male; mean [standard deviation] age = 26.8 ± 11.4 years) were included. We found a moderate positive effect of acute static stretching on flexibility (summary Hedges' g = 0.63, 95% confidence interval 0.52-0.75, p < 0.001) and a large positive effect of chronic static stretching on flexibility (summary Hedges' g = 0.96, 95% confidence interval 0.84-1.09, p < 0.001). Neither effect was moderated by stretching intensity, age, sex or training status, or weekly session frequency and intervention length (chronic static stretching only) [p > 0.05]. However, larger improvements were found for adults with poor baseline flexibility compared with adults with average baseline flexibility (p = 0.01). Furthermore, larger improvements in flexibility were found in the hamstrings compared with the spine following acute static stretching (p = 0.04). Improvements in flexibility were maximised by a cumulative stretching volume of 4 min per session (acute) and 10 min per week (chronic). CONCLUSIONS Static stretching improves flexibility in adults, with no additional benefit observed beyond 4 min per session or 10 min per week. Although intensity, frequency, age, sex and training status do not influence improvements in flexibility, lower flexibility levels are associated with greater improvement following both acute and chronic static stretching. These guidelines for static stretching can be used by coaches and therapists to improve flexibility. CLINICAL TRIAL REGISTRATION PROSPERO CRD42023420168.
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Affiliation(s)
- Lewis A Ingram
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Grant R Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Noah M A d'Unienville
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Bethany Gower
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Sam Gleadhill
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Terry Boyle
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Hunter Bennett
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
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Warneke K, Behm DG, Alizadeh S, Hillebrecht M, Konrad A, Wirth K. Discussing Conflicting Explanatory Approaches in Flexibility Training Under Consideration of Physiology: A Narrative Review. Sports Med 2024; 54:1785-1799. [PMID: 38819597 PMCID: PMC11258068 DOI: 10.1007/s40279-024-02043-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
The mechanisms underlying range of motion enhancements via flexibility training discussed in the literature show high heterogeneity in research methodology and study findings. In addition, scientific conclusions are mostly based on functional observations while studies considering the underlying physiology are less common. However, understanding the underlying mechanisms that contribute to an improved range of motion through stretching is crucial for conducting comparable studies with sound designs, optimising training routines and accurately interpreting resulting outcomes. While there seems to be no evidence to attribute acute range of motion increases as well as changes in muscle and tendon stiffness and pain perception specifically to stretching or foam rolling, the role of general warm-up effects is discussed in this paper. Additionally, the role of mechanical tension applied to greater muscle lengths for range of motion improvement will be discussed. Thus, it is suggested that physical training stressors can be seen as external stimuli that control gene expression via the targeted stimulation of transcription factors, leading to structural adaptations due to enhanced protein synthesis. Hence, the possible role of serial sarcomerogenesis in altering pain perception, reducing muscle stiffness and passive torque, or changes in the optimal joint angle for force development is considered as well as alternative interventions with a potential impact on anabolic pathways. As there are limited possibilities to directly measure serial sarcomere number, longitudinal muscle hypertrophy remains without direct evidence. The available literature does not demonstrate the necessity of only using specific flexibility training routines such as stretching to enhance acute or chronic range of motion.
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Affiliation(s)
- Konstantin Warneke
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.
- Department of Movement Sciences, Institute of Sport Science, University of Klagenfurt, Universitatsstraße 65, 9020, Klagenfurt Am Wörthersee, Austria.
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
- Human Performance Lab, Department of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Martin Hillebrecht
- University Sports Center, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Andreas Konrad
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
- University Sports Center, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Klaus Wirth
- University of Applied Sciences Wiener Neustadt, Vienna, Austria
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Pietrzak K, Bania A, Nowocień K, Kraszewski B, Wiernicka M. The influence of gender and sport on popliteal angle and dorsiflexion in junior high school students. BMC Musculoskelet Disord 2024; 25:393. [PMID: 38764029 PMCID: PMC11102625 DOI: 10.1186/s12891-024-07429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/09/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND The aim of the study was to assess factors affecting the popliteal angle and foot dorsiflexion, in particular gender. The subjects were 142 students from the 2nd and 3rd year of Poznań junior high schools. METHODS The participants included 57 girls and 87 boys. Three raters examined each subject: a specialist in orthopaedics, a resident doctor and a physical therapy student. Foot dorsal flexion was tested in a supine position with lower limbs extended. Next, dorsal flexion was evaluated with the knee and hip in 90 degrees of flexion. Finally, a passive knee extension (PKE) test was carried out. The significance of the PKE test is that the lower the angle the more flexible the hamstrings. This is because the PKE measurement is the distance to the right angle, that is a full knee extension with the hip flexed. RESULTS The non-parametric test (Mann-Whitney) and the Student's t-test showed differences between the female and male gender in the measurements of the popliteal angle (p < .05000). The correlation was negative, which means that the hamstrings are more flexible in girls. No differences were found between gender and passive foot dorsiflexion and dorsiflexion with a flexed hip and knee. No differences were found between the group with the extended PE curriculum and the group with the standard number of PE classes in the range of motion of foot dorsiflexion and the value of the popliteal angle. CONCLUSIONS Girls between 13 and 15 years old have a significantly larger hamstring flexibility, which is confirmed by the tests of the popliteal angle. No differences were found in dorsiflexion between girls and boys who have not been trained using a training model.
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Affiliation(s)
- Krzysztof Pietrzak
- Pediatric and Adult Orthopedics Poland, Dolna Wilda 88G/104, 61-501, Poznań, Poland.
| | - Artur Bania
- PhysioCenter, Osiedle Zwycięstwa 124, Poznań, Poland
- Department of Kinesiotherapy and Developmental Physiotherapy, Poznan University of Physical Education, Poznań, Poland
| | - Krzysztof Nowocień
- The Orthopedic Department, Poznań Multidisciplinary Municipal Hospital, Poznań, Poland
| | - Bartosz Kraszewski
- Public Health Faculty, Poznań University of Medical Sciences, Poznań, Poland
| | - Marzena Wiernicka
- Department of Kinesiotherapy and Developmental Physiotherapy, Poznan University of Physical Education, Poznań, Poland
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Namsawang J, Srijunto W, Werasirirat P, Snieckus A, Bradauskiene K, Kamandulis S, Muanjai P. The effects of 6-week home-based static stretching, dynamic stretching, or eccentric exercise interventions on muscle-tendon properties and functional performance in older women. J Exerc Sci Fit 2024; 22:117-126. [PMID: 38283890 PMCID: PMC10820338 DOI: 10.1016/j.jesf.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Background Joint inflexibility is acknowledged as a significant contributor to functional limitations in the older adult, with lengthening-type exercises identified as a potential remedial approach. Nevertheless, the responses to eccentric exercise in female older adults have not been extensively studied especially in home-based environment. Here, we aimed to assess the effectiveness of home-based static stretching (ST), dynamic closed-chain stretching (DCS), or eccentric exercise (ECC) interventions on flexibility, musculotendinous architecture, and functional ability in healthy older women. Methods We randomly assigned 51 healthy older women (age 65.9 ± 3.4 years) to one of three interventional exercise groups: DCS (N = 17), ECC (N = 17), or ST (N = 17). The training was performed 3 times a week for 6 weeks. The participants' musculotendinous stiffness, fascicle length, eccentric strength, and functional capacities were measured before the intervention, after 6 weeks of exercise, and at a 1-month follow-up. Results The results showed that all three interventions improved hamstring flexibility and passive ankle dorsiflexion (p < 0.001), with increased biceps femoris and medial gastrocnemius fascicle length (p < 0.01). However, there was no significant change in musculotendinous stiffness. The ECC intervention produced a greater improvement in knee flexor and calf eccentric peak torque (p < 0.05), and gait speed (p = 0.024) than the other two interventions. The changes in flexibility and knee flexor strength remained for up to 4 weeks after detraining. Conclusion In conclusion, the present study suggests that home-based ECC may be more beneficial in enhancing physical capacities in older women compared with either DCS or SS interventions.
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Affiliation(s)
- Juntip Namsawang
- Department of Physical Therapy, Allied Health Sciences Faculty, Burapha University, Chonburi, Thailand
- Exercise and Nutrition Innovation and Sciences Research Unit, Burapha University, Chonburi, Thailand
| | - Wirasinee Srijunto
- Department of Physical Therapy, Allied Health Sciences Faculty, Burapha University, Chonburi, Thailand
| | - Phurichaya Werasirirat
- Department of Physical Therapy, Allied Health Sciences Faculty, Burapha University, Chonburi, Thailand
- Exercise and Nutrition Innovation and Sciences Research Unit, Burapha University, Chonburi, Thailand
| | - Audrius Snieckus
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | | | - Sigitas Kamandulis
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Pornpimol Muanjai
- Department of Physical Therapy, Allied Health Sciences Faculty, Burapha University, Chonburi, Thailand
- Exercise and Nutrition Innovation and Sciences Research Unit, Burapha University, Chonburi, Thailand
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Saito A, Mizuno T. Effects of patterned electrical sensory nerve stimulation and static stretching on joint range of motion and passive torque. Front Neurosci 2023; 17:1205602. [PMID: 37674515 PMCID: PMC10478221 DOI: 10.3389/fnins.2023.1205602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/28/2023] [Indexed: 09/08/2023] Open
Abstract
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.
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Affiliation(s)
- Akira Saito
- Center for Health and Science, Kyushu Sangyo University, Fukuoka, Japan
| | - Takamasa Mizuno
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
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Lévenéz M, Moeremans M, Booghs C, Vigouroux F, Leveque C, Hemelryck W, Balestra C. Architectural and Mechanical Changes after Five Weeks of Intermittent Static Stretch Training on the Medial Gastrocnemius Muscle of Active Adults. Sports (Basel) 2023; 11:sports11040073. [PMID: 37104147 PMCID: PMC10144030 DOI: 10.3390/sports11040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
We investigated the effects of intermittent long-term stretch training (5 weeks) on the architectural and mechanical properties of the muscle–tendon unit (MTU) in healthy humans. MTU’s viscoelastic and architectural properties in the human medial gastrocnemius (MG) muscle and the contribution of muscle and tendon structures to the MTU lengthening were analyzed. Ten healthy volunteers participated in the study (four females and six males). The passive stretch of the plantar flexor muscles was achieved from 0° (neutral ankle position) to 25° of dorsiflexion. Measurements were obtained during a single passive stretch before and after the completion of the stretching protocol. During the stretch, the architectural parameters of the MG muscle were measured via ultrasonography, and the passive torque was recorded by means of a strain-gauge transducer. Repeated-measure ANOVA was applied for all parameters. When expressed as a percentage for all dorsiflexion angles, the relative torque values decreased (p < 0.001). In the same way, architectural parameters (pennation angle and fascicle length) were compared for covariance and showed a significant difference between the slopes (ANCOVA p < 0.0001 and p < 0.001, respectively) suggesting a modification in the mechanical behavior after stretch training. Furthermore, the values for passive stiffness decreased (p < 0.05). The maximum ankle range of motion (ROM) (p < 0.01) and the maximum passive torque (p < 0.05) increased. Lastly, the contribution of the free tendon increased more than fascicle elongation to the total lengthening of the MTU (ANCOVA p < 0.001). Our results suggest that five weeks of intermittent static stretch training significantly change the behavior of the MTU. Specifically, it can increase flexibility and increase tendon contribution during MTU lengthening.
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Affiliation(s)
- Morgan Lévenéz
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1160 Brussels, Belgium
| | - Matthieu Moeremans
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1160 Brussels, Belgium
| | - Cédric Booghs
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1160 Brussels, Belgium
| | - Florent Vigouroux
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1160 Brussels, Belgium
| | - Clément Leveque
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1160 Brussels, Belgium
| | - Walter Hemelryck
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1160 Brussels, Belgium
| | - Costantino Balestra
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1160 Brussels, Belgium
- Anatomical Research and Clinical Studies, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- DAN Europe Research Division (Roseto-Brussels), 1160 Brussels, Belgium
- Physical Activity Teaching Unit, Motor Sciences Department, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Correspondence:
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