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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Cross-education effect of 4-week high- or low-intensity static stretching intervention programs on passive properties of plantar flexors

This study aimed to compare the cross-education effect of unilateral stretching intervention programs with two different intensities (high- vs. low-intensity) on dorsiflexion range of motion (DF ROM), muscle stiffness, and muscle architecture following a 4-week stretching intervention. Twenty-eight healthy males were randomly allocated into two groups: a high-intensity static stretching (HI-SS) intervention group (n = 14; stretch intensity 6-7 out of 10) and a low-intensity static stretching (LI-SS) intervention group (n = 14; stretch intensity 0-1 out of 10). The participants were asked to stretch their dominant leg (prefer to kick a ball) for 4 weeks (3 × week for 3 × 60 s). Before and after the intervention, the non-trained leg passive properties (DF ROM, passive torque, and muscle stiffness) of the plantar flexors and the muscle architecture of the gastrocnemius medialis (muscle thickness, pennation angle, and fascicle length) were measured. Non-trained DF ROM and passive torque at DF ROM were significantly increased in the HI-SS group (p < 0.01, d = 0.64, 50.6%, and p = 0.044, d = 0.36, 18.2%, respectively), but not in the LI-SS group. Moreover, there were no significant changes in muscle stiffness and muscle architecture in both groups. For rehabilitation settings, a high-intensity SS intervention is required to increase the DF ROM of the non-trained limb. However, the increases in DF ROM seem to be related to changes in stretch tolerance and not to changes in muscle architecture or muscle stiffness.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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