Effects of chronic static stretching interventions on jumping and sprinting performance-a systematic review with multilevel meta-analysis

When improving athletic performance in sports with high-speed strength demands such as soccer, basketball, or track and field, the most common training method might be resistance training and plyometrics. Since a link between strength capacity and speed strength exists and recently published literature suggested chronic stretching routines may enhance maximum strength and hypertrophy, this review was performed to explore potential benefits on athletic performance. Based on current literature, a beneficial effect of static stretching on jumping and sprinting performance was hypothesized. A systematic literature search was conducted using PubMed, Web of Science and Google scholar. In general, 14 studies revealed 29 effect sizes (ES) (20 for jumping, nine for sprinting). Subgroup analyses for jump performance were conducted for short- long- and no stretch shortening cycle trials. Qualitative evaluation was supplemented by performing a multilevel meta-analysis via R (Package: metafor). Significant positive results were documented in six out of 20 jump tests and in six out of nine sprint tests, while two studies reported negative adaptations. Quantitative data analyses indicated a positive but trivial magnitude of change on jumping performance (ES:0.16, p = 0.04), while all subgroup analyses did not support a positive effect (p = 0.09-0.44). No significant influence of static stretching on sprint performance was obtained (p = 0.08). Stretching does not seem to induce a sufficient stimulus to meaningfully enhance jumping and sprinting performance, which could possibly attributed to small weekly training volumes or lack of intensity.

Effects of Dynamic Stretching Combined with Manual Therapy on Pain, ROM, Function, and Quality of Life of Adhesive Capsulitis

This study was conducted to evaluate the effects of dynamic stretching combined with manual therapy on pain, range of motion, function, and quality of life in patients with adhesive capsulitis. The participants were randomly divided into two groups: the dynamic stretching combined with manual therapy (DSMT) group (n = 17) and the static stretching combined with manual therapy (SSMT) group (n = 17). Both groups received manual therapy for 10 min and two sessions per week for 4 weeks. The DSMT group also performed additional dynamic stretching for 20 min per session, two sessions per week for 4 weeks. The SSMT group practiced additional static stretching for 20 min per session, two sessions per week for 4 weeks. The pain, ROM, function, and quality of life were measured and evaluated before and after treatment. There were significant improvements in the outcomes of pain, flexion and abduction of shoulder ROM, Shoulder Pain and Disability Index (SPADI), and the physical component score and mental component score of the Short Form-36 (SF-36) in both groups. Additionally, the external and internal rotation of the shoulder ROM and the SF-36 general health factor increased significantly more in the A group (DSMT group) compared to the B group (SSMT). In conclusion, dynamic stretching plus manual therapy offers the same results as static stretching plus manual therapy, but with additional improvement in internal and external rotation.

Effects of a Home-Based Stretching Program on Bench Press Maximum Strength and Shoulder Flexibility

Recent research showed significant stretch-mediated maximum strength increases when performing stretching between 5 to 120 minutes per day with the calf muscle. However, since the practical applicability of these long stretching durations was questioned and studies exploring the transferability to the upper body are scarce, the aim of this study was to investigate the possibility of using a home-based stretching program to induce significant increases in maximum strength and flexibility. Therefore, 31 recreationally active participants (intervention group: 18, control group: 13) stretched the pectoralis major for 15min/day for eight weeks, incorporating three different stretching exercises. The maximum strength was tested isometrically and dynamically in the bench press (one-repetition maximum: 1RM) as well as shoulder range of motion (ROM) performing bilateral shoulder rotation with a scaled bar. Using a two-way analysis of variance (ANOVA) with repeated measures, the results showed high magnitude Time effects (ƞ² = 0.388-0.582, p < 0.001) and Group*Time interaction (ƞ² = 0.281-0.53, p < 0.001-0.002), with increases of 7.4 ± 5.6% in 1RM and of 9.8 ± 5.0% in ROM test in the intervention group. In the isometric testing, there was a high-magnitude Time effect (ƞ² = 0.271, p = 0.003), however, the Group*Time interaction failed to reach significance (p = 0.75). The results are in line with previous results that showed stretch-mediated maximum strength increases in the lower extremity. Future research should address the underlying physiological mechanisms such as muscle hypertrophy, contraction conditions as well as pointing out the relevance of intensity, training frequency and stretching duration.

Alternative Flexibility Training

Over the last approximately 20 years, research has reported on performance impairments following prolonged durations of static stretching. This has led to a paradigm shift towards dynamic stretching. There has also been a greater emphasis using foam rollers, vibration devices, and other techniques. Recent commentaries and meta-analyses suggest that stretching need not be listed as a fitness component as other activities such as resistance training can provide similar range of motion benefits. The commentary aims to review and compare the effects of static stretching and alternative exercises for improving range of motion.

Effects of Different Recovery Modalities on Delayed Onset Muscle Soreness, Recovery Perceptions, and Performance Following a Bout of High-Intensity Functional Training

The purpose of this study was to investigate the effects of the foam rolling technique and static stretching on perceptual and neuromuscular parameters following a bout of high-intensity functional training (HIFT), which consisted of 100 pull-ups, 100 push-ups, 100 sit-ups, and 100 air squats (Angie benchmark) in recreationally trained men (n = 39). Following baseline measurements (Feeling Scale, Visual Analogue Scale, Total Quality Recovery, Sit-and-Reach, Countermovement Jump, and Change-of-Direction t-test), the volunteers performed a single bout of HIFT. At the end of the session, participants were randomly assigned to one of three distinct groups: control (CONT), foam rolling (FR), or static stretching (SS). At the 24 h time-point, a second experimental session was conducted to obtain the post-test values. The level of significance was set at p < 0.05. Regarding power performance, none of the three groups reached pretest levels at 24 h point of the intervention. However, the CONT group still showed a greater magnitude of effect at the 24 h time-point (ES = 0.51, p ≥ 0.05). Flexibility presented the same recovery pattern as power performance (post × 24 h CONT = ES = 0.28, FR = ES = 0.21, SS = ES = 0.19). At 24 h, all groups presented an impaired performance in the COD t-test (CONT = ES = 0.24, FR = ES = 0.65, SS = ES = 0.56 p ≥ 0.05). The FR protocol resulted in superior recovery perceptions (pre × 24 h TQR = ES = 0.32 p ≥ 0.05). The results of the present study indicate that the use of FR and SS exercises may not be indicated when aiming to restore neuromuscular performance following a single bout of HIFT. The use of the FR technique during the cooldown phase of a HIFT session may be helpful in improving an individual's perception of recovery.

Acute effect of diagonal stretching using the posterior oblique sling system on contralateral ankle dorsiflexion

BACKGROUND

A significant increase in the dorsiflexion range of motion (DFROM) after calf muscle stretching has been widely studied. However, it has been shown that the upper body is connected to the ankle joint by passive connective tissues.

OBJECTIVE

The purpose of this study was to examine the effect of upper-back stretching on the mobility of the contralateral ankle.

METHODS

In the supine position, DFROM in the contralateral leg was measured. In the sitting position with and without trunk rotation, DFROM was measured in both legs. In the sitting position with trunk rotation, dorsiflexion was measured only in the contralateral leg. Static diagonal stretching combining trunk rotation with slight trunk flexion was performed in the sitting position with a neutral pelvis.

RESULTS

After stretching, DFROM in contralateral and ipsilateral legs were measured in the sitting position with a neutral pelvis. In the contralateral leg, significant differences in ΔDFROM were observed between the sitting position with trunk rotation and the supine position and between the sitting position with trunk rotation and the sitting position after stretching.

CONCLUSION

In clinical settings, diagonal stretching of the unilateral posterior trunk causes a significant increase in the DFROM of the contralateral lower limb.

Effects of Plantar Flexor Stretching on Static and Dynamic Balance in Healthy Adults

Stretching can affect balance ability by generating biomechanical and physiological changes in the postural muscles. Stretching of the lower extremity muscles can greatly affect posture maintenance strategies and balance ability. However, the relationship between stretching and balance ability has not been clarified. Therefore, this study aimed to investigate the effect of plantar flexor stretching on balance ability. Forty-four healthy young adults were randomly assigned to four groups (static stretching, dynamic stretching, ballistic stretching, and control). Ankle joint range of motion, static balance ability, and dynamic balance ability were evaluated before, immediately after, and 20 min after stretching. Stretching did not affect balance ability in the open-eye condition. After stretching, the sway area was significantly reduced in the closed-eye condition (p < 0.05). After stretching, the reach distance of dynamic balance ability increased significantly (p < 0.05). The results show that plantar flexor stretching can positively affect balance ability. Therefore, plantar flexor stretching should be considered a rehabilitation method to improve balance.

Effects of daily static stretch training over 6 weeks on maximal strength, muscle thickness, contraction properties, and flexibility

Purpose

Static stretch training (SST) with long stretching durations seems to be sufficient to increase flexibility, maximum strength (MSt) and muscle thickness (MTh). However, changes in contraction properties and effects on muscle damage remain unclear. Consequently, the objective of the study was to investigate the effects of a 6-week self-performed SST on MSt, MTh, contractile properties, flexibility, and acute response of creatine kinase (CK) 3 days after SST.

Methods

Forty-four participants were divided into a control (CG, n = 22) and an intervention group (IG, n = 22), who performed a daily SST for 5 min for the lower limb muscle group. While isometric MSt was measured in leg press, MTh was examined via sonography and flexibility by functional tests. Muscle stiffness and contraction time were measured by tensiomyography on the rectus femoris. Additionally, capillary blood samples were taken in the pretest and in the first 3 days after starting SST to measure CK.

Results

A significant increase was found for MSt (p < 0.001, η ² = 0.195) and flexibility in all functional tests (p < 0.001, η ² > 0.310). Scheffé post hoc test did not show significant differences between the rectus femoris muscle inter- and intragroup comparisons for MTh nor for muscle stiffness and contraction time (p > 0.05, η ² < 0.100). Moreover, CK was not significantly different between IG and CG with p > 0.05, η ² = 0.032.

Discussion

In conclusion, the increase in MSt cannot be exclusively explained by muscular hypertrophy or the increased CK-related repair mechanism after acute stretching. Rather, neuronal adaptations have to be considered. Furthermore, daily 5-min SST over 6 weeks does not seem sufficient to change muscle stiffness or contraction time. Increases in flexibility tests could be attributed to a stretch-induced change in the muscle-tendon complex.

Comparative effects of different manual techniques on electromyography activity, kinematics, and muscle force in limited ankle dorsiflexion syndrome

BACKGROUND

Although the instrument-assisted manual (IM) technique has been widely utilised to improve soft tissue and joint mobility, its therapeutic benefits and underlying neuromechanical mechanisms remain unknown compared to those of conventional static stretching (SS) and hold-relax (HR) manual techniques.

OBJECTIVE

This study aimed to compare the effects of the SS, HR, and IM techniques on muscle activity, kinematics, and strength during deep squatting in limited ankle dorsiflexion (DF) syndrome.

METHODS

This was a cross-sectional randomised controlled study including 39 adults divided into three groups: SS group: 13, HR group: 13, IM group: 13. Outcome measures were the tibialis anterior (TA): gastrocnemius (GCM) balance ratio and ankle, knee, hip and thoracolumbar junction angles. TA muscle strength was analysed to evaluate the limited ankle DF. Analysis of variance was performed, with P< 0.05.

RESULTS

The TA:GCM balance ratio, ranges of motion of ankle DF and knee flexion, and TA muscle strength in the IM group improved significantly compared to that in either the SS group or HR group (P< 0.05).

CONCLUSIONS

Our novel results demonstrated that IM was most effective in normalising TA:GCM balance, ankle DF range of motion, and TA muscle strength during deep squatting in adults with limited ankle DF.

Effects of autogenic and reciprocal inhibition muscle energy techniques on isometric muscle strength in neck pain: A randomized controlled trial

BACKGROUND

Neck is one of the most common sites of musculoskeletal symptoms, and muscle shortening and weakness is observed to be a common cause of neck pain and disability.

OBJECTIVE

To compare the immediate and short term effects of static stretching (SS), autogenic inhibition (AI) and reciprocal inhibition (RI) muscle energy techniques (MET) on isometric muscle strength in the management of mechanical neck pain.

METHODS

A randomized controlled trial was conducted on 78 participants with neck pain randomly allocated to SS, AI-MET and RI-MET groups. All the participants received Trans Cutaneous Electrical Nerve Stimulation (TENS), hot pack and unilateral postero-anterior glide, followed by 3-5 repetitions of either SS, AI-MET or RI-MET for five consecutive sessions. Numeric pain rating scale (NPRS) and Modified Sphygmomanometer Dynamometry (MSD) were used as outcome measurement tools. One way ANOVA and repeated measures ANOVA were used for inter-group and intra-group comparison.

RESULT

In terms of MSD scores, a significant difference (p< 0.05) was observed between the groups. Both AI-MET and RI-MET were found to be comparatively more effective than SS, however AI-MET was found to be the most effective.

CONCLUSION

AI-MET is more effective than SS and RI-MET in terms of improving isometric muscle strength in patients with mechanical neck pain.

Effect of Acute Static Stretching on the Activation Patterns Using High-Density Surface Electromyography of the Gastrocnemius Muscle during Ramp-Up Task

This study aimed to evaluate motor unit recruitment during submaximal voluntary ramp contraction in the medial head of the gastrocnemius muscle (MG) by high-density spatial electromyography (SEMG) before and after static stretching (SS) in healthy young adults. SS for gastrocnemius was performed in 15 healthy participants for 2 min. Normalized peak torque by bodyweight of the plantar flexor, muscle activity at peak torque, and muscle activation patterns during ramp-up task were evaluated before and after SS. Motor unit recruitment during the submaximal voluntary contraction of the MG was measured using SEMG when performing submaximal ramp contractions during isometric ankle plantar flexion from 30 to 80% of the maximum voluntary contraction (MVC). To evaluate the changes in the potential distribution of SEMG, the root mean square (RMS), modified entropy, and coefficient of variation (CV) were calculated from the dense surface EMG data when 10% of the MVC force was applied. Muscle activation patterns during the 30 to 80% of MVC submaximal voluntary contraction tasks were significantly changed from 50 to 70% of MVC after SS when compared to before. The variations in motor unit recruitment after SS indicate diverse motor unit recruitments and inhomogeneous muscle activities, which may adversely affect the performance of sports activities.

The Effects of Static Stretching On Dynamic Postural Control During Maximum Forward Leaning Task

The purpose of this study was to determine how the application of static stretching to ankle plantar flexors affects postural control during maximum forward leaning. Twenty-six volunteer males (age 21.4 ± 1.2 years) were randomly assigned to stretching and control conditions. Participants conducted 5-min stretching on a stretch board for the stretching condition and were kept standing for 6-min for the control condition. Before and after intervention, the range of motion (ROM) at ankle dorsiflexion and the center of pressure (COP) excursion during maximal forward leaning were determined. Mean anteroposterior COP position, COP velocity and COP areas were calculated to compare the change in postural control. After stretching, ROM was significantly increased. During maximal forward leaning after stretching, both COP position and velocity showed significant increases compared to before stretching. Moreover, COP position and velocity in the stretching condition were significantly higher than in the control condition after stretching. No significant differences were found in COP area before and after stretching. Five-minute stretching increased not only ROM but also the anterior limit of stability while maintaining posture and led to faster COP shift than before stretching. These results indicate that static stretching would improve dynamic postural control as well.

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

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

Plantar flexor muscle stretching depresses the soleus late response but not tendon tap reflexes

The purpose of this study was to investigate changes in muscle spindle sensitivity with early and late soleus reflex responses via tendon taps and transcranial magnetic stimulation, respectively, after an acute bout of prolonged static plantar flexor muscle stretching. Seventeen healthy males were tested before and after 5 min (5 × 60-s stretches) of passive static stretching of the plantar flexor muscles. Maximal voluntary isometric torque and M wave-normalized triceps surae muscle surface electromyographic activity were recorded. Both soleus tendon reflexes, evoked by percussion of the Achilles tendon during rest and transcranial magnetic stimulation-evoked soleus late responses during submaximal isometric dorsiflexion were also quantified. Significant decreases in maximal voluntary isometric plantar flexion torque (-19.2 ± 13.6%, p = .002) and soleus electromyographic activity (-20.1 ± 11.4%, p < .001) were observed immediately after stretching, and these changes were highly correlated (r = 0.76, p < .001). No changes were observed in tendon reflex amplitude or latency or peak muscle twitch torque (p > .05). Significant reductions in soleus late response amplitudes (-46.9 ± 36.0%, p = .002) were detected, although these changes were not correlated with changes in maximal electromyographic activity, torque or tendon reflex amplitudes. No changes in soleus late response latency were detected. In conclusion, impaired neural drive was implicated in the stretch-induced force loss; however, no evidence was found that this loss was related to changes in muscle spindle sensitivity. We hypothesize that the decrease in soleus late response indicates a stretch-induced reduction in a polysynaptic postural reflex rather than spindle reflex sensitivity.

Comparison of the Effects of Static-Stretching and Tubing Exercises on Acute Shoulder Range of Motion in Collegiate Baseball Players

BACKGROUND

The overhead throwing motion repetitively stresses the dominant arm in baseball players, frequently altering normal range of motion (ROM) in multiple directions. Baseball players regularly perform a combination of static stretches (SS) and dynamic tubing (DT) resistance exercises in pre-throwing warm-up routines intended to improve shoulder ROM and reduce injuries.

PURPOSE

The purpose of this study was to compare acute changes in dominant shoulder ROM improvements between SS and DT warm-up exercise protocols. The DT exercises were hypothesized to elicit greater improvements in shoulder ROM.

STUDY DESIGN

Two-way crossover study.

METHODS

Twenty-five healthy collegiate baseball players (mean age = 19.8 ±1.0 years) presenting with glenohumeral internal rotation deficit (GIRD) >20° and total rotational range of motion (TRROM) losses >5° completed the SS and DT interventions on different days. Dominant arm internal rotation (IR), external rotation (ER) and TRROM were measured before, immediately after, 30-minutes after, and 60-minutes after each treatment session. A two-way repeated measures analysis of variance (ANOVA) compared the effect of SS and DT over time on IR, ER and TRROM.

RESULTS

IR improved on average 10.68 ± 0.82° (p < .001) post intervention, 11.18 ± 0.79° (p < .001) 30-min post intervention, and 9.03 ± 0.95° (p < .001) 60-min post intervention. ER improved on average 8.60 ± 0.67° (p < .001) post intervention, 8.25 ± 0.85° (p < .001) 30-min post intervention, and 6.65 ± 0.91° (p < .001) 60-min post intervention. TRROM improved on average 19.28 ± 1.09° (p < .001) post intervention, 19.43 ± 1.36° (p < .001) 30-min post intervention, and 15.68 ± 1.55° (p < .001) 60-min post intervention. There were no significant differences between the main effects of treatment and time for IR, ER, and TRROM. For IR, SS improved by an average of 1.73 ± 0.55° (p = .005) more than DT. For ER and TRROM, there were no differences between SS and DT.

CONCLUSION

Both SS and DT exercises improve glenohumeral IR, ER and TRROM up to one-hour post intervention, with no significant differences noted between interventions for treatment or time. Baseball players can benefit equally from performing SS or DT exercises to acutely improve shoulder ROM.

LEVEL OF EVIDENCE

Level 3.

Static and Dynamic Quadriceps Stretching Exercises in Patients With Patellofemoral Pain: A Randomized Controlled Trial

BACKGROUND

Limited data are available on the effect of stretching exercise in patients with patellofemoral pain (PFP) who have inflexible quadriceps, which is one of the various causes of PFP syndrome. This study compares quadriceps flexibility, strength, muscle activation time, and patient-reported outcomes after static and dynamic quadriceps stretching exercises in patients with PFP who had inflexible quadriceps.

HYPOTHESIS

Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes would improve with dynamic quadriceps stretching as compared with static quadriceps stretching exercises.

STUDY DESIGN

Randomized controlled trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

Of the 44 patients included in the study, 20 performed static stretching and 24 performed dynamic stretching. Quadriceps flexibility was assessed by measuring the knee flexion angle during knee flexion in the prone position (the Ely test). Muscle strength and muscle activation time were measured using an isokinetic device. The patient-reported outcomes were evaluated using the visual analogue scale for pain and anterior knee pain scale.

RESULTS

No significant differences in quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in the involved knees were found between the 2 groups (P values > 0.05).

CONCLUSION

Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in patients with PFP who had inflexible quadriceps showed no significant differences between the static and dynamic quadriceps stretching exercise groups.

CLINICAL RELEVANCE

Both static and dynamic stretching exercises may be effective for improving pain and function in patients with PFP who have inflexible quadriceps.

The Comparison of Different Stretching Intensities on the Range of Motion and Muscle Stiffness of the Quadriceps Muscles

Muscle strain is one of the most frequent sports injuries, having the rectus femoris (RF) muscle as the reported preferred site of quadriceps muscle strain. The decrease muscle stiffness could be an effective RF muscle strain prevention. In recent studies, a high-intensity static stretching intervention decreased passive stiffness, though no study has investigated on the effect of the different static stretching intervention intensities on quadriceps muscle stiffness. The purpose of this study was to investigate the three different quadriceps muscle stiffness intensities (120 vs. 100 vs. 80%). Eighteen healthy, sedentary male volunteers participated in the study and randomly performed three intensities. The static stretching intervention was performed in knee flexion with 30° hip extension. Three 60-second stretching intervention with a 30-second interval were performed at each stretching intensity. We measured knee flexion range of motion and shear elastic modulus of the RF muscle used by ultrasonic shear-wave elastography before and after the static stretching intervention. Our results showed that the knee flexion range of motion was increased after 100% (p < 0.01) and 120% intensities (p < 0.01) static stretching intervention, not in 80% intensity (p = 0.853). In addition, our results showed that the shear elastic modulus of the RF muscle was decreased only after 100% intensity static stretching intervention (p < 0.01), not after 80% (p = 0.365), and 120% intensities (p = 0.743). To prevent the quadriceps muscle strain, especially the RF muscle, 100%, not 120% (high) and 80% (low), intensity stretching could be beneficial in sports setting application.

Effects of Static Stretching With High-Intensity and Short-Duration or Low-Intensity and Long-Duration on Range of Motion and Muscle Stiffness

This study investigated the effects of static stretching (SS) delivered with the same load but using two protocols – high-intensity and short-duration and low-intensity and long-duration – on range of motion (ROM) and muscle stiffness. A total of 18 healthy students participated in the study. They randomly performed high-intensity and short-duration (120% and 100 s) or low-intensity and long-duration (50% and 240 s) SS. Outcomes were assessed on ROM, passive torque at dorsiflexion ROM, and shear elastic modulus of the medial gastrocnemius before and after static stretching. The results showed that ROM increased significantly at post-stretching compared to that at pre-stretching in both high-intensity and short-duration [+6.1° ± 4.6° (Δ25.7 ± 19.9%)] and low-intensity and long-duration [+3.6° ± 2.3° (Δ16.0 ± 11.8%)]. Also, the ROM was significantly higher at post-stretching in high-intensity and short-duration conditions than that in low-intensity and long-duration. The passive torque at dorsiflexion ROM was significantly increased in both high-intensity and short-duration [+5.8 ± 12.8 Nm (Δ22.9 ± 40.5%)] and low-intensity and long-duration [+2.1 ± 3.4 Nm (Δ6.9 ± 10.8%)] conditions, but no significant differences were observed between both conditions. The shear elastic modulus was significantly decreased in both high-intensity and short-duration [−8.8 ± 6.1 kPa (Δ − 38.8 ± 14.5%)] and low-intensity and long-duration [−8.0 ± 12.8 kPa (Δ − 22.2 ± 33.8%)] conditions. Moreover, the relative change in shear elastic modulus in the high-intensity and short-duration SS was significantly greater than that in low-intensity and long-duration SS. Our results suggest that a higher intensity of the static stretching should be conducted to increase ROM and decrease muscle stiffness, even for a short time.

The Relationship between Stretching Intensity and Changes in Passive Properties of Gastrocnemius Muscle-Tendon Unit after Static Stretching

This study aimed to investigate the relationship between relative or absolute intensity and changes in range of motion and passive stiffness after static stretching. A total of 65 healthy young adults voluntarily participated in this study and performed static stretching of the plantar flexor-muscle for 120 s. Dorsiflexion range of motion and passive torque during passive dorsiflexion before and after stretching were assessed. We measured the passive torque at a given angle when the minimum angle was recorded before and after stretching. The angle during stretching was defined as the absolute intensity. Dorsiflexion range of motion before stretching was defined as 100%, and the ratio (%) of the angle during stretching was defined as the relative intensity. A significant correlation was found between absolute intensity and change in passive torque at a given angle (r = -0.342), but relative intensity and range of motion (r = 0.444) and passive torque at dorsiflexion range of motion (r = 0.259). A higher absolute intensity of stretching might be effective in changing the passive properties of the muscle-tendon unit. In contrast, a higher relative intensity might be effective in changing the range of motion, which could be contributed by stretch tolerance.

Dry Needling for Hamstring Flexibility: A Single-Blind Randomized Controlled Trial

CONTEXT

Hamstring muscle tightness is one of the most common problems in athletic and healthy people. Dry needling (DN) was found to be an effective approach for improving muscle flexibility, but there is no study to compare this approach with static stretching (SS) as a common technique for the increase of muscle length.

OBJECTIVE

To compare the immediate effects of DN and SS on hamstring flexibility in healthy subjects with hamstring tightness.

STUDY DESIGN

A single-blind randomized controlled trial.

SETTING

A musculoskeletal physiotherapy clinic at Tehran University of Medical Sciences.

SUBJECTS

Forty healthy subjects (female: 32, age range: 18-40 y) with hamstring tightness were randomly assigned into 2 groups of DN and SS.

INTERVENTION

The DN group received a single session of DN on 3 points of the hamstring muscles, each for 1 minute. The SS group received a single session of SS of the hamstrings, consisting of 3 sets of 30-second SS with a 10-second rest between sets in the active knee extension test (AKET) position.

MAIN OUTCOME MEASURES

The AKET, muscle compliance, passive peak torque, and stretch tolerance were measured at the baseline, immediately, and 15 minutes after the interventions.

RESULTS

Improvements in all outcomes was better for the DN group than for the SS group. DN increased muscle compliance significantly 15 minutes after the intervention, but it did not improve in the SS group.

CONCLUSION

DN is effective in improving hamstring flexibility compared with SS. One session of DN can be an effective treatment for hamstring tightness and increase hamstring flexibility. The improvements suggest that DN is a novel treatment for hamstring flexibility.

Minute oscillation stretching: A novel modality for reducing musculo-tendinous stiffness and maintaining muscle strength

A novel stretching modality was developed to provide repetitive small length changes to the plantar flexors undergoing passive stretch defined as "minute oscillation stretching" (MOS). This study investigated the effects of MOS on neuromuscular activity during force production, the rate of torque development (RTD), and the elastic properties of the plantar flexors and Achilles tendon. Ten healthy males participated in this study. The neuromuscular activity of the triceps surae and tibialis anterior muscles during maximal voluntary plantar flexion torque [MVT], RTD of plantar flexion, Achilles tendon stiffness, and muscle stiffness were measured before and after two types of interventions for a total of 5 minutes: static stretching (SS) and MOS at 15 Hz and without intervention (control). Achilles tendon stiffness was calculated from the tendon elongation measuring by ultrasonography. Muscle stiffness was determined for the medial gastrocnemius [MG] using shear wave elastography. The MVT, mean electromyographic amplitudes [mEMG] of MG and lateral gastrocnemius [LG], and RTD were significantly decreased following SS (MVT: -7.2 ± 7.9%; mEMG of MG: -8.7 ± 10.2%; mEMG of LG: -12.4 ± 10.5%; RTD: -6.6 ± 6.8%), but not after MOS. Achilles tendon stiffness significantly decreased after SS (-13.4 ± 12.3%) and MOS (-9.7 ± 11.5%), with no significant differences between them. Muscle stiffness significantly decreased in SS and MOS, with relative changes being significantly greater for MOS (-7.9 ± 8.3%) than SS (-2.3 ± 2.9%) interventions. All variables remained unchanged in the controls. In conclusion, MOS changed muscle-tendon compliance without loss of muscle function.

Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial

BACKGROUND

Patellofemoral pain (PFP) syndrome is closely associated with muscle tightness. However, studies regarding the effects of stretching exercises on PFP patients with inflexible hamstrings are scarce. The aim of the study was to compare the effects between static and dynamic hamstring stretching in patients with PFP who have inflexible hamstrings.

HYPOTHESIS

Compared with static hamstring stretching, dynamic hamstring stretching will improve the parameters of hamstring flexibility, knee muscle strength, muscle activation time, and clinical outcomes in this patient population.

STUDY DESIGN

Prospective randomized controlled trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

A total of 46 patients (25, static stretching; 21, dynamic stretching) participated. Hamstring flexibility was assessed according to the popliteal angle during active knee extension. Muscle strength and muscle activation time were measured using an isokinetic device. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain and the anterior knee pain scale (AKPS).

RESULTS

There were no differences in hamstring flexibility and knee muscle strength of the affected knees between the groups (P > 0.05). Significantly improved muscle activation time and clinical outcomes of the affected knees were observed in the dynamic stretching group compared with the static stretching group (all Ps < 0.01 for hamstring, quadriceps, VAS, and AKPS).

CONCLUSION

In patients with PFP who have inflexible hamstrings, dynamic hamstring stretching with strengthening exercises was superior for improving muscle activation time and clinical outcomes compared with static hamstring stretching with strengthening exercises.

CLINICAL RELEVANCE

Clinicians and therapists could implement dynamic hamstring stretching to improve function and reduce pain in patients with PFP who have inflexible hamstrings.

The Recovery of Muscle Spindle Sensitivity Following Stretching Is Promoted by Isometric but Not by Dynamic Muscle Contractions

It is often suggested that stretching-related changes in performance can be partially attributed to stretching-induced neural alterations. Recent evidence though shows that neither spinal nor cortico-spinal excitability are susceptible of a long-lasting effect and only the amplitude of stretch or tap reflex (TR) is reduced up to several minutes. Since afferents from muscle spindles contribute to voluntary muscle contractions, muscle stretching could be detrimental to muscle performance. However, the inhibition of muscle spindle sensitivity should be reversed as soon as the stretched muscle contracts again, due to α-γ co-activation. The present work evaluated which type of muscle contraction (static or dynamic) promotes the best recovery from the inhibition in spindle sensitivity following static stretching. Fifteen students were tested for TR at baseline and after 30 s maximal individual static stretching of the ankle plantar flexors followed by one of three randomized interventions (isometric plantar flexor MVC, three counter movement jumps, and no contraction/control). Ten TRs before and 20 after the procedures were induced with intervals of 30 s up to 10 min after static stretching. The size of the evoked TRs (peak to peak amplitude of the EMG signal) following stretching without a subsequent contraction (control) was on average reduced by 20% throughout the 10 min following the intervention and did not show a recovery trend. Significant decrease in relation to baseline were observed at 9 of the 20 time points measured. After MVC of plantar flexors, TR recovered immediately showing no differences with baseline at none of the investigated time points. Following three counter movement jumps it was observed a significant 34.4% group average inhibition (p < 0.0001) at the first time point. This effect persisted for most of the participants for the next measurement (60 s after intervention) with an average reduction of 23.4% (p = 0.008). At the third measurement, 90 s after the procedure, the reflexes were on average still 21.4% smaller than baseline, although significant level was not reached (p = 0.053). From 120 s following the intervention, the reflex was fully recovered. This study suggests that not every type of muscle contraction promotes a prompt recovery of a stretch-induced inhibition of muscle spindle sensitivity.

Does soft tissue mobilization assist static stretching to improve hamstring flexibility? A randomized controlled trial

Objectives Objective of the study is to investigate whether Soft tissue mobilization (STM) can assist with static stretching to improve hamstring flexibly. Methods The design of the study was repeated measure design. The study was conducted at the physical therapy laboratory of Jamia Hamdard University, New Delhi. Participants included 78 healthy males with hamstring tightness, randomly assigned to either the control group (static stretching) or the experimental group (STM and static stretching). The experimental group received five sets of four different STM techniques, followed by two sets of 30-s static stretches 3 days per week over the course of 12 weeks. The control group received 5 min of sham ultrasound with an inactive probe prior to static stretching. Active knee extension test (AKE) was the outcome measure. Results Both groups showed significant improvement in AKE compared with the baseline measurements. With ingroup analysis showed a significant difference in AKE across all measured time periods (weeks 4, 8, and 12) with pre-test in both groups (p<0.05). No significant difference in AKE improvement was found between groups (p>0.05). Conclusion The results of this study show that STM prior to static stretching does not significantly improve hamstring flexibility among healthy individuals. Although this study cannot be generalized, the results may be useful for evidence-based practice in the management of hamstring tightness.

Lack of cortical or Ia-afferent spinal pathway involvement in muscle force loss after passive static stretching

This study investigated whether modulation of corticospinal-motoneuronal excitability and/or synaptic transmission of the Ia afferent spinal reflex contributes to decreases in voluntary activation and muscular force after an acute bout of prolonged static muscle stretching. Fifteen men performed five 60-s constant-torque stretches (15-s rest intervals; total duration 5 min) of the plantar flexors on an isokinetic dynamometer and a nonstretching control condition in random order on 2 separate days. Maximum isometric plantar flexor torque and triceps surae muscle electromyographic activity (normalized to M wave; EMG/M) were simultaneously recorded immediately before and after each condition. Motor-evoked potentials (using transcranial magnetic stimulation) and H-reflexes were recorded from soleus during EMG-controlled submaximal contractions (23.4 ± 6.9% EMG maximum). No changes were detected in the control condition. After stretching, however, peak torque (mean ± SD; -14.3 ± 7.0%) and soleus EMG/M (-17.8 ± 6.2%) decreased, and these changes were highly correlated (r = 0.83). No changes were observed after stretching in soleus MEP or H-reflex amplitudes measured during submaximal contractions, and interindividual variability of changes was not correlated with changes in EMG activity or maximum torque. During EMG-controlled submaximal contractions, torque production was significantly decreased after stretching (-22.7 ± 15.0%), indicating a compromised muscular output. These data provide support that changes in the excitability of the corticospinal-motoneuronal and Ia afferent spinal reflex pathways do not contribute to poststretch neural impairment.NEW & NOTEWORTHY This study is the first to specifically examine potential sites underlying the decreases in neural activation of muscle and force production after a bout of muscle stretching. However, no changes were found in either the H-reflex or motor-evoked potential amplitude during submaximal contractions.

Comparison of the effects of static stretching on range of motion and jump height between quadriceps, hamstrings and triceps surae in collegiate basketball players

Objectives

The purpose of the present study was to compare the effects of static stretching (SS) on the range of motion and vertical jump height between the quadriceps, hamstrings and triceps surae in collegiate basketball players.

Methods

Fourteen male collegiate basketball players (20.2±0.7 years, 179.0±5.0 cm, 71.9±8.3 kg) underwent 5 min of SS for the quadriceps, hamstrings and triceps surae, in random order. Before and after each stretch, the range of motion (ROM) and vertical jump height were measured.

Results

ROM of the quadriceps, hamstrings and triceps surae were increased without any difference of relative change in the range. The vertical jump height showed no change after SS of the quadriceps and hamstrings, while it decreased after SS of the triceps surae (p<0.05).

Conclusion

These results suggested that SS for the triceps surae may have a large impact on jump performance.

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.

Topical Analgesic Improved or Maintained Ballistic Hip Flexion Range of Motion with Treated and Untreated Legs

Increased stretch tolerance can contribute to improved range of motion (ROM). Since menthol-based topical analgesics (TopAnalg) suppress pain, they may increase stretch thresholds improving ROM. Other modalities such as transcutaneous electrical nerve stimulation and rolling have demonstrated decreased pain sensitivity in the contralateral limb. The purpose of this study was to investigate the effects of a TopAnalg on active and passive ROM of the treated and contralateral (untreated) leg. With a double blind, repeated measures design, 14 university students had a TopAnalg or a placebo gel applied to their hamstrings, rested for 20-min and then either performed static or dynamic stretching. Prior to gel application and after stretching, participants were tested for passive static, active and ballistic hip flexion ROM. Near significant greater ballistic hip flexion ROM for both legs (treated: p = 0.08; 3.6%; contralateral: p = 0.1; 1.6%) were observed with the TopAnalg. With dynamic stretching, ballistic hip flexion ROM of both limbs at post-test (p=0.01-0.007; 3.3-4.2%) and post-10 minutes (p = 0.06-0.01; 2.7-4.1%) decreased with the placebo, whereas there were no significant reductions with the TopAnalg. There was a near significant higher active hip flexion ROM (stretched leg: p = 0.05; 4.6%), and significantly higher ballistic hip flexion ROM (p = 0.04-0.05; 3.4-3.5%) with static versus dynamic stretching for both legs. In conclusion, TopAnalg can increase hip flexion ROM of the treated and contralateral limbs. Secondly, static stretching contributed to greater ballistic ROM in both the stretched and non-stretched contralateral limbs. Hence, TopAnalg may be used to enhance flexibility training with rehabilitation or highly trained athletes.

The Effect of Static and Dynamic Stretching Exercises on Sprint Ability of Recreational Male Volleyball Players

The aim of the present trial was to investigate the effect of two stretching programs, a dynamic and a static one, on the sprint ability of recreational volleyball players. The sample consisted of 27 male recreational volleyball players (age 21.6 ± 2.1 years, mean ± standard deviation, body mass 80.3 ± 8.9 kg, height 1.82 ± 0.06 m, body mass index 24.3 ± 2.5 kg.m⁻², volleyball experience 7.7 ± 2.9 years). Participants were randomly divided into three groups: (a) the first performing dynamic stretching exercises three times per week, (b) the second following a static stretching protocol on the same frequency, and (c) the third being the control group, abstaining from any stretching protocol. The duration of the stretching exercise intervention period was 6 weeks, with all groups performing baseline and final field sprinting tests at 4.5 and 9 m. The post-test sprint times were faster in both the 4.5 (p = 0.027, η² = 0.188) and 9 m tests (p < 0.001, η² = 0.605) compared to the pre-test values. A large time × group interaction was shown in both the 4.5 (p = 0.007, η² = 0.341) and 9 m tests (p = 0.004, η² = 0.363) with the static and dynamic stretching groups being faster in the post-test than in the pre-test, whereas no change was found in the control group. The percentage change in the 4.5 m sprint time correlated with volleyball experience (r = −0.38, p = 0.050), i.e., the longer the volleyball experience, the larger the improvement in the 4.5 m sprint. Thus, it is concluded that both stretching techniques have a positive effect on the velocity of recreational male volleyball players, when performed at a frequency of three times per week for 6 weeks under the same conditions as defined in the study protocol.

Static stretching time required to reduce iliacus muscle stiffness

Static stretching (SS) is an effective intervention to reduce muscle stiffness and is also performed for the iliopsoas muscle. The iliopsoas muscle consists of the iliacus and psoas major muscles, among which the former has a greater physiological cross-sectional area and hip flexion moment arm. Static stretching time required to reduce muscle stiffness can differ among muscles, and the required time for the iliacus muscle remains unclear. The purpose of this study was to investigate the time required to reduce iliacus muscle stiffness. Twenty-six healthy men participated in this study. A 1-min hip extension SS was performed five times. Shear elastic modulus, an index of muscle stiffness, of the iliacus muscle was measured using ultrasonic shear wave elastography before SS and immediately after each SS. One-way repeated analysis of variance showed a statistical effect of time on the shear elastic modulus. A paired t-test with Holm adjustment revealed that the shear elastic moduli after 1-5 SS were statistically lower than that before SS. In addition, the shear elastic modulus after 5 SS was statistically lower than that after 1 SS. The results suggested that the stiffness of the iliacus muscle decreased with 1-min SS and further decreased with 5-min SS.

Does the combination of resistance training and stretching increase cardiac overload?

OBJECTIVES

To compare the effects of combinations of resistance training (RT) and static stretching (SS) on heart rate (HR), systolic pressure (SBP), diastolic pressure (DBP), rate pressure product (RPP), oxygen saturation (SpO2), rating of perceived effort (RPE), and heart rate variability (HRV) in men.

METHODS

Twelve normotensive healthy men participated in four protocols: a) SS+RT, b) RT+SS, c) RT, and d) SS. Variables were measured before, immediately after, and 15, 30, and 45 min after the sessions.

RESULTS

The combination of SS and RT increased (p<0.001) HR when compared to the effects of the noncombined protocols (from 2.38 to 11.02%), and this result indicated metabolic compensation. Regarding DBP, there were differences (p<0.001) between the RT and SS groups (53.93±8.59 vs. 67.00±7.01 mmHg). SS has been shown to be able to reduce (p<0.001) SpO2 (4.67%) due to the occlusion caused by a reduction in the caliber of the blood vessels during SS compared to during rest. The increase in RPP (6.88% between RT and SS+RT) along with the HR results indicated higher metabolic stress than that reflected by the RPE (combined protocols increased RPE from 21.63 to 43.25%). The HRV analysis confirmed these results, showing increases (p<0.01) in the LF index between the combined and noncombined protocols. Compared to the effect of RT, the combination of SS and RT promoted a vagal suppression root mean square of the successive differences (RMSSD) index (from 9.51 to 21.52%) between the RT and SS+RT groups (p<0.01) and between the RT and RT+SS groups (p<0.001).

CONCLUSION

Static stretching increases cardiac overload and RPE, reducing oxygen supply, especially when performed in combination with RT.

Chronic Stretching During 2 Weeks of Immobilization Decreases Loss of Girth, Peak Torque, and Dorsiflexion Range of Motion

CONTEXT

Chronic plantarflexor (PF) stretching during ankle immobilization helps preserve calf girth, plantarflexion peak torque, and ankle dorsiflexion (DF) motion. Immobilization can lead to decreases in muscle peak torque, muscle size, and joint range of motion (ROM). Recurrent static stretching during a period of immobilization may reduce the extent of these losses.

OBJECTIVE

To investigate the effects of chronic static stretching on PF peak torque, calf girth, and DF ROM after 2 weeks of ankle immobilization.

DESIGN

Randomized controlled clinical trial.

SETTING

Athletic training facility.

PARTICIPANTS

A total of 36 healthy college-aged (19.81 [2.48]) females.

INTERVENTIONS

Subjects were randomly assigned to one of 3 groups: control group, immobilized group (IM), and immobilized plus stretching (IM+S) group. Each group participated in a familiarization period, a pretest, and, 2 weeks later, a posttest. The IM group and IM+S group wore the Aircast Foam Pneumatic Walker for 2 weeks on the left leg. During this time, the IM+S group participated in a stretching program, which consisted of two 10-minute stretching procedures each day for the 14 days.

MAIN OUTCOME MEASURES

One-way analysis of variance was used to determine differences in the change of ankle girth, PF peak torque, and DF ROM between groups with an α level of <.05.

RESULTS

A significant difference was noted between groups in girth (F2,31 = 5.64, P = .01), DF ROM (F2,31 = 26.13, P < .001), and PF peak torque (F2,31 = 7.74, P = .002). Post hoc testing also showed a significance difference between change in calf girth of the control group compared with the IM group (P = .01) and a significant difference in change of peak torque in the IM+S group and the IM group (P = .001). Also, a significant difference was shown in DF ROM between the control group and IM+S group (P = .01), the control group and the IM group (P < .001), and the IM+S group and the IM group (P < .001).

CONCLUSION

Chronic static stretching during 2 weeks of immobilization may decrease the loss of calf girth, ankle PF peak torque, and ankle DF ROM.

Five minutes static stretching influences neural responses at spinal level in the background of unchanged corticospinal excitability

OBJECTIVES

Corticospinal tract excitability and spinal reflex pathways are transiently affected by short applications of static stretching. However, it remains unclear whether the duration and magnitude of these neurophysiological responses can be increased with a longer duration of the applied stretch. The purpose of this study was to investigate alterations in cortical and spinal excitability following five minutes static stretching.

METHODS

Seventeen participants (22.8±2.3 years old) were tested for the tendon tap reflex (T-reflex), Hoffman reflex (H-reflex) and motor-evoked potentials (MEPs) after transcranial magnetic stimulation (TMS) of the ankle flexor muscles in two separate occasions: before and after 5 minute static stretching or 5 minute control period, in a randomized order.

RESULTS

No changes were observed following the control condition. H/M ratio increased by 16.2% after stretching (P=.036). Furthermore, immediately after stretching it was observed a strong inhibition of the T-reflex (57.6% inhibition, P=.003) that persisted up to five minutes after stretching (16.2% inhibition, P=.013) but returned to baseline following 10 minutes. MEPs were not affected by stretching.

CONCLUSIONS

This study suggests that the neuromuscular responses that follow five minute of static stretching do not influence the excitability of the corticospinal tract and follow a different time course within spinal reflex pathways.

Soleus H-Reflex Inhibition Decreases During 30 s Static Stretching of Plantar Flexors, Showing Two Recovery Steps

During the period when the ankle joint is kept in a dorsiflexed position, the soleus (SOL) H-reflex is inhibited. The nature of this inhibition is not fully understood. One hypothesis is that the decrease in spinal excitability could be attributed to post-activation depression of muscle spindle afferents due to their higher firing rate during the stretch-and-hold procedure. As the static stretching position is maintained though, a partial restoration of the neurotransmitter is expected and should mirror a decrease in H-reflex inhibition. In the present study, we explored the time course of spinal excitability during a period of stretching. SOL H-reflex was elicited during a passive dorsiflexion movement, at 3, 6, 9, 12, 18, 21, and 25 s during maximal ankle dorsiflexion, during plantar flexion (PF) and after stretching, in 12 healthy young individuals. Measurements during passive dorsiflexion, PF and after stretching were all performed with the ankle at 100° angle; measurements during static stretching were performed at individual maximal dorsiflexion. H-reflex was strongly inhibited during the dorsiflexion movement and at maximal dorsiflexion (p < 0.0001) but recovered during PF and after stretching. During stretching H-reflex showed a recovery pattern (r = 0.836, P = 0.019) with two distinct recovery steps at 6 and 21 s into stretching. It is hypothesized that the H-reflex inhibition observed until 18 s into stretching is the result of post-activation depression of Ia afferent caused by the passive dorsiflexion movement needed to move the ankle into testing position. From 21 s into stretching, the lower inhibition could be caused by a weaker post-activation depression, inhibition from secondary afferents or post-synaptic inhibitions.

Transient Increase in Cortical Excitability Following Static Stretching of Plantar Flexor Muscles

Spinal excitability in humans is inhibited by both passively holding a static position with the muscle lengthened (static stretching) and by a single non-active lengthening movement. However, whilst immediately after a passive lengthening movement the inhibition persists for several seconds, there seem to be an immediate recovery following static stretching. This result is counter intuitive and could be attributed to methodological procedures. Indeed, differently to what has been done until now, in order to study whether static stretching has a transient effect on the neuromuscular pathway, the procedure should be repeated many times and measurements collected at different time points after stretching. In the present study we repeated 60 times 30 s static stretching of ankle plantar flexors and measured tap reflex (T-reflex), Hoffman reflex (H-reflex), and motor evoked potentials (MEPs) from the Soleus muscle at several time points, starting from immediately after until 30 s following the procedure. T-reflex was strongly inhibited (range 31–91%, p = 0.005) and the inhibition persisted for 30 s showing a slow recovery (r = 0.541, p = 0.037). H-reflex was not affected by the procedure. Stretching increased the size of the MEPs (p < 0.0001), differences at times 0 and 2 s after stretching (p = 0.015 and p = 0.047, respectively). These results confirm that static stretching reduces muscle spindle sensitivity. Moreover it is suggested that post-activation depression of Ia afferents, which is commonly considered the cause of H-reflex depression during both dorsiflexion and static stretching, vanished immediately following stretching or is counteracted by an increased corticospinal excitability.

Can chronic stretching change the muscle-tendon mechanical properties? A review

It is recognized that stretching is an effective method to chronically increase the joint range of motion. However, the effects of stretching training on the muscle-tendon structural properties remain unclear. This systematic review with meta-analysis aimed to determine whether chronic stretching alter the muscle-tendon structural properties. Published papers regarding longitudinal stretching (static, dynamic and/or PNF) intervention (either randomized or not) in humans of any age and health status, with more than 2 weeks in duration and at least 2 sessions per week, were searched in PubMed, PEDro, ScienceDirect and ResearchGate databases. Structural or mechanical variables from joint (maximal tolerated passive torque or resistance to stretch) or muscle-tendon unit (muscle architecture, stiffness, extensibility, shear modulus, volume, thickness, cross-sectional area, and slack length) were extracted from those papers. A total of 26 studies were selected, with a duration ranging from 3 to 8 weeks, and an average total time under stretching of 1165 seconds per week. Small effects were seen for maximal tolerated passive torque, but trivial effects were seen for joint resistance to stretch, muscle architecture, muscle stiffness, and tendon stiffness. A large heterogeneity was seen for most of the variables. Stretching interventions with 3- to 8-week duration do not seem to change either the muscle or the tendon properties, although it increases the extensibility and tolerance to a greater tensile force. Adaptations to chronic stretching protocols shorter than 8 weeks seem to mostly occur at a sensory level.

Prophylactic stretching does not reduce cramp susceptibility

INTRODUCTION

Some clinicians advocate stretching to prevent muscle cramps. It is unknown whether static or proprioceptive neuromuscular facilitation (PNF) stretching increases cramp threshold frequency (TF_c ), a quantitative measure of cramp susceptibility.

METHODS

Fifteen individuals completed this randomized, counterbalanced, cross-over study. We measured passive hallux range of motion (ROM) and then performed 3 minutes of either static stretching, PNF stretching (hold-relax-with agonist contraction), or no stretching. ROM was reassessed and TF_c was measured.

RESULTS

PNF stretching increased hallux extension (pre-PNF 81 ± 11°, post-PNF 90 ± 10°; P < 0.05) but not hallux flexion (pre-PNF 40 ± 7°, post-PNF 40 ± 7°; P > 0.05). Static stretching increased hallux extension (pre-static 80 ± 11°, post-static 88 ± 9°; P < 0.05) but not hallux flexion (pre-static 38 ± 9°, post-static 39 ± 8°; P > 0.05). No ROM changes occurred with no stretching (P > 0.05). TF_c was unaffected by stretching (no stretching 18 ± 7 Hz, PNF 16 ± 4 Hz, static 16 ± 5 Hz; P = 0.37).

DISCUSSION

Static and PNF stretching increased hallux extension, but neither increased TF_c . Acute stretching may not prevent muscle cramping. Muscle Nerve 57: 473-477, 2018.

STATIC STRETCHING DOES NOT REDUCE VARIABILITY, JUMP AND SPEED PERFORMANCE

BACKGROUND

Stretching is often part of the warm-up routine prior to athletic participation; however, controversial evidence exists on the effects of stretching on countermovement jump (CMJ) and sprint performance. Additionally, analysis of variability between repeated tasks is useful for monitoring players, to analyze factors that could affect the performance, and to guide clinical decisions for training strategies.

PURPOSE

The purpose of this study was to examine whether static stretching (SS) prior to CMJ and 20-meter (20-m) sprint would affect performance, and to investigate whether SS affects an athlete's ability to perform these tasks consistently.

METHODS

Twenty-two trained healthy athletes (23.2 ± 5.0 years) attended, randomly, two testing sessions, separated by 48 hours. At session one, all participants underwent 10 minutes of dynamic running warm-up followed by the experimental tasks (three CMJ and three 20-m sprint), whereas five minutes of stretching was added after the warm-up routine at session two. All participants performed the same experimental tasks in both sessions. The stretching protocol consisted of five stretching exercises for each lower limb.

RESULTS

The paired-samples t-test revealed no significant differences between the stretching protocol condition and no stretching condition for the 20-m sprint (t(21)=.920; p=.368) and CMJ (t(21)=.709; p=.486). There were no significant differences in trial-by-trial variability on 20-m sprint (t(21)=1.934; p=.067) and CMJ scores (t(21)=.793; p=.437) as result of SS.

CONCLUSION

The SS protocol did not modify jumping and running ability in trained healthy athletes. The SS prior to training or competition may not cause detrimental effects to athletic performance.

LEVEL OF EVIDENCE

Level III, Nonrandomized controlled trial.

Acute effects of antagonist static stretching in the inter-set rest period on repetition performance and muscle activation

The purpose of this study was to investigate the effects of antagonist passive static stretching (AS) during the inter-set rest period on repetition performance and muscle activation. Ten trained men (22.4 ± 0.9 years) participated in this study. Two protocols were adopted: Passive recovery (PR)--three sets to repetition failure were performed for the seated row (SR) with two-minute rest interval between sets without pre-exercise stretching; AS--forty seconds of stretching was applied to pectoralis major prior to each set of SR. Significant increases in the number of repetitions were noted under AS compared with PR (p < 0.05). Significant increases on latissimus dorsi (p = 0.002) and biceps brachii (p = 0.001) muscle activity were noted inter-sets under the AS compared with the PR condition. Therefore, the AS adopted during the inter-set rest period may enhance repetition performance and activation of agonist muscles in an acute manner.

Alternative to traditional stretching methods for flexibility enhancement in well-trained combat athletes: local vibration versus whole-body vibration

This study aimed to compare the effect of local vibration (LV) and whole body vibration (WBV) on lower body flexibility and to assess whether vibration treatments were more effective than traditionally used static and dynamic stretching methods. Twenty-four well-trained male combat athletes (age: 22.7 ± 3.3 years) performed four exercise protocols – LV (30 Hz, 4 mm), WBV (30 Hz, 4 mm), static stretching (SS), and dynamic stretching (DS) – in four sessions of equal duration 48 hours apart in a randomized, balanced order. During a 15-minute recovery after each protocol, subjects performed the stand and reach test (S&R) at the 15th second and the 2^nd, 4^th, 6^th, 8^th, 10^th and 15^th minute. There was a similar change pattern in S&R scores across the 15-minute recovery after each protocol (p = 0.572), remaining significantly elevated throughout the recovery. A significant main protocol effect was found for absolute change in S&R scores relative to baseline (p = 0.015). These changes were statistically greater in LV than WBV and DS. Changes in SS were not significantly different from LV, but were consistently lower than LV with almost moderate effect sizes. After LV, a greater percentage of subjects increased flexibility above the minimum detectable change compared to other protocols. Subjects with high flexibility (n = 12) benefited more from LV compared with other methods (effect size ≥ 0.862). In conclusion, LV was an effective alternative exercise modality to acutely increase lower extremity flexibility for well-trained athletes compared with WBV and traditional stretching exercises.

The effect of short duration static stretching and reinnervation on the recovery of denervated soleus muscle in the rat

Denervation elicits profound alterations in the morphometry of the skeletal muscle. There is evidence that the increased mechanical load placed upon the muscle via rhythmic stretching attenuates denervation induced alterations in muscle morphology. To investigate the effect of short duration static stretching (40 min/day) for denervated and reinnervated muscle, a histochemical study was performed on the soleus muscle of the rat. Twenty-one eight-week-old female Wistar rats were used. Partial denervation was carried out by locally freezing the proximal root of the sciatic nerve innervating the soleus muscle. Contralateral hindlimbs were untreated and served as control. Axonal degeneration was evident within the sciatic nerve following freezing, although variable amounts of damage were observed and thin nerve fibers were observed at 3 weeks. No clear difference of morphological change of the sciatic nerve was observed in the short duration static stretching groups (group S) or the non-stretching groups (group D). The wet weight of the denervated soleus muscles progressively declined to a minimum at 2 weeks after injury (group D, 50.8 ± 8.9%; group S, 61.3 ± 4.2%) and began to reverse in the following 3 weeks. Muscle wet weight for short duration static stretching groups similarly decreased and began to reverse in the following 3 weeks. The muscle fiber cross-sectional area also similarly changed with the muscle wet weight. The type II fiber ratios of the denervated sides were consistently higher than the control levels. In non-stretching groups, type II fibers had increased by 3 weeks after denervation (49.4%), whereas type II fiber ratios of the short duration static stretching groups decreased after 3 weeks (31.3%). These data suggests that mechanical stimuli provided by short duration static stretching can prevent the atrophy of the denervated muscle over a short period. In addition, it was indicated that short duration static stretching affected the reinnervated muscle fiber type composition. However, the reinnervation took the crucial role of recovering from the atrophy and composing the integrity of the soleus muscles.

Relief from Back Pain Through Postural Adjustment: a Controlled Clinical Trial of the Immediate Effects of Muscular Chains Therapy (MCT)

Introduction

Back pain can be one of the most common health problems, causing suffering, disabilities, and financial losses. Postural models for pain treatment state that poor posture alters the joint position and causes pain, such as back pain. Muscular Chain Therapy (MCT) is a technique that is used to treat posture pathologies, among others.

Purpose

The aim of the present study was to assess the efficiency of a single session of Muscular Chain Therapy (MCT) on complaints of undiagnosed musculoskeletal spinal pain.

Setting

Physical therapy clinic of the University of Center-West (Guarapuava, Brazil).

Participants

100 subjects, aged between 20 and 39 years, with complaints of spinal musculoskeletal pain.

Research Design

Randomized controlled trial.

Intervention

The participants were randomly assigned by a non-care provider into two groups: The MCT Group that received Muscular Chain Treatment and the Control Group that received a placebo treatment of 15 minutes turned off ultrasound therapy. All volunteers were assessed before and after treatment using an analog pain scale. A score of 0 indicated no pain and 10 was the maximum degree of pain on the scale.

Main Outcome Measure

Degree of pain measured by analog scale

Results

The chi-square goodness of fit test was used to compare gender distribution among groups displayed a p value = .25. Subject age had differences analyzed using the unpaired t test (p = .44). Pain assessment for treatment and placebo control groups was analyzed using a paired t test and unpaired t test. The paired t test was used for intragroup before/after treatment comparison (MCT p = .00001; Control Group p = .0001). The unpaired t test was used for comparing the difference of the pain level before and after treatment between groups (p = .0001). A priori statistical significance was set a p = .05.

Conclusion

It is possible to conclude that one MCT session is an effective treatment of undiagnosed spinal musculoskeletal pain.

Chronic effects of different resistance training exercise orders on flexibility in elite judo athletes

The aim of this study was to examine the effects of twelve weeks of resistance training with different exercise orders (upper limbs and lower limbs vs. lower limbs and upper limbs) on flexibility levels in elite judo athletes. Thirty-nine male athletes were randomly divided into 3 groups as follows: G1 (n = 13), G2 (n = 13), and CG (n = 13). The flexibility was assessed on 8 joint movements: shoulder flexion and shoulder extension, shoulder abduction and shoulder adduction, trunk flexion and trunk extension, and hip flexion and hip extension. Two-way repeated measures ANOVAs (time [pre-experimental vs. post-experimental] × group [G1 vs. G2 vs. CG]) were used to compare the differences between pre- and post-test situations and the differences among groups. The results from the within-group (pre vs. post) comparisons demonstrated significant increases (p < 0.05) in the range of motion of 3.93 and 5.96% for G1 and G2 training groups, respectively, in all joints. No significant changes (p > 0.05) were observed for the CG. The results from the between-group comparisons demonstrated no significant differences (p > 0.05) in the range of motion between G1post vs. G2post (1.15%). Although both exercise orders (from upper to lower limbs and from lower to upper limbs) increased flexibility, no significant variations were observed between the different exercise orders. Nevertheless, these findings demonstrate that flexibility gains could be obtained with a resistance training program, and thus, more time can be devoted to sports-specific judo training.

Influence of inter-set stretching on strength, flexibility and hormonal adaptations

Adequate levels of strength and flexibility are important for the promotion and maintenance of health and functional autonomy as well as safe and effective sports participation. The aim of the present study was to analyze the effects of 8 weeks of strength training with or without inter-set static stretching on strength, flexibility and hormonal adaptations of trained men. Sixteen trained men were randomly divided into 2 groups: the static stretching group (SSG) and passive interval group (PIG). All participants performed 24 training sessions 3 times a week. The test and retest of 8RM, strength, flexibility, cortisol and growth hormone concentration in pre and post test conditions were also evaluated. To compare the differences between and within groups in pre- and post-training tests, ANOVA with repeated measures was performed (SSG_pre x SSG_post; PIG_pre x PIG_post; SSG_post x PIG_post). An alpha level of p<0.05 was considered statistically significant for all comparisons. Both groups showed significant increases in strength (SSG_pre vs. SSG_post; PIG_pre vs. PIG_post) in the same exercises for leg extension (LE) and Low Row (LR). Specifically, in the SSG group, the parameters for LE were (p = 0.0015 and ES = 2.28 - Large), and the parameters for LR were (p = 0.002 and ES = 1.95 - Large). Moreover, in the PIG group, the parameters for LE were (p = 0.009 and ES = 1.95 - Large), and the parameters for LR were (p = 0.0001 and ES = 2.88 - Large). No differences were found between the groups (SSG_post vs. PIG_post). Both groups showed significant increases in flexibility but in different joints (SSG_pre vs. SSG_post; PIG_pre vs. PIG_post). In the SSG group, only three joints showed significant increases in flexibility: shoulder extension (p = 0.004 and ES = 1.76 - Large), torso flexion (p = 0.002 and ES = 2.36 - Large), and hip flexion (p = 0.001 and ES = 1.79 -Large). In the PIG group, only three joints showed increases in flexibility: horizontal shoulder abduction (p = 0.003 and ES = 2.07 - Large), hip flexion (p = 0.001 and ES = 2.39 – Large), and hip extension (p = 0.02 and ES = 1.79 - Large). In-between group analyses (SSG_post x PIG_post) revealed differences in two joints: shoulder extension (p = 0.001) and horizontal shoulder abduction (p = 0.001). Hormonal profiles showed no significant differences in cortisol secretion or growth hormone concentration. In conclusion, both studied strength protocols (with and without inter-set static stretching) resulted in flexibility and strength gains without an effect on the anabolic and catabolic hormonal profile.

Effect of various warm-up protocols on jump performance in college football players

The purpose of this study was to identify the effects of warm-up strategies on countermovement jump performance. Twenty-nine male college football players (age: 19.4 ± 1.1 years; body height: 179.0 ± 5.1 cm; body mass: 73.1 ± 8.0 kg; % body fat: 11.1 ± 2.7) from the Tuzla University underwent a control (no warm-up) and different warm-up conditions: 1. general warm-up; 2. general warm-up with dynamic stretching; 3. general warm-up, dynamic stretching and passive stretching; 4. passive static stretching; 5. passive static stretching and general warm-up; and, 6. passive static stretching, general warm-up and dynamic stretching. Countermovement jump performance was measured after each intervention or control. Results from one way repeated measures ANOVA revealed a significant difference on warm-up strategies at F (4.07, 113.86) = 69.56, p < 0.001, eta squared = 0.72. Bonferonni post hoc revealed that a general warm-up and a general warm-up with dynamic stretching posted the greatest gains among all interventions. On the other hand, no warm-up and passive static stretching displayed the least results in countermovement jump performance. In conclusion, countermovement jump performance preceded by a general warm-up or a general warm-up with dynamic stretching posted superior gains in countermovement jump performance.

Plantar-flexor Static Stretch Training Effect on Eccentric and Concentric Peak Torque - A comparative Study of Trained versus Untrained Subjects

The aim of this study was to examine the long-term effects of static stretching of the plantar-flexor muscles on eccentric and concentric torque and ankle dorsiflexion range of motion in healthy subjects. Seventy five healthy male volunteers, with no previous history of trauma to the calf that required surgery, absence of knee flexion contracture and no history of neurologic dysfunction or disease, systemic disease affecting the lower extremities were selected for this study. The participants were divided into three equal groups. The control group did not stretch the plantar-flexor muscles. Two Experimental groups (trained and untrained) were instructed to perform static stretching exercise of 30 second duration and 5 repetitions twice daily. The stretching sessions were carried out 5 days a week for 6 weeks. The dorsiflexion range of motion was measured in all subjects. Also measured was the eccentric and concentric torque of plantar-flexors at angular velocities of 30 and 120°/s pre and post stretching. Analysis of variance showed a significant increase in plantar-flexor eccentric and concentric torque (p < 0.05) of trained and untrained groups, and an increase in dorsiflexion range of motion (p < 0.05) at both angular velocities for the untrained group only. The static stretching program of plantar-flexors was effective in increasing the concentric and eccentric plantarflexion torque at angular velocities of 30 and 120°/s. Increases in plantar-flexors flexibility were observed in untrained subjects.

The time course of the effects of constant-angle and constant-torque stretching on the muscle-tendon unit

The purpose of the present study was to examine the time course of passive range of motion (PROM), passive torque (PASTQ), and musculo-tendinous stiffness (MTS) responses during constant-angle (CA) and constant-torque (CT) stretching of the leg flexors. Eleven healthy men [mean ± standard deviation (SD): age = 21.5 ± 2.3 years] performed 16 30-s bouts of CA and CT stretching of the leg flexors. PROM, PASTQ , and MTS were measured during stretches 1, 2, 4, 8, and 16. For PROM and PASTQ , there were no differences between CA and CT stretching treatments (P > 0.05); however, there were stretch-related differences (P < 0.001). PROM increased following one 30-s bout of stretching (collapsed across CA and CT stretching) with additional increases up to 8 min of stretching. PASTQ decreased following one 30-s bout of stretching (collapsed across CA and CT stretching) and continued to decrease up to 4 min of stretching. In contrast, only the CT stretching treatment resulted in changes to MTS (P < 0.001). MTS decreased after one 30-s bout of CT stretching, with subsequent decreases in MTS up to 6 min of stretching. These results suggested that CT stretching may be more appropriate than a stretch held at a constant muscle length for decreasing MTS.

Dynamic warm-up protocols, with and without a weighted vest, and fitness performance in high school female athletes

CONTEXT

Recent authors have not found substantial evidence to support the use of static stretching for improving performance, so interest in dynamic warm-up procedures has risen. Our findings may improve the understanding of the acute effects of different types of pre-exercise protocols on performance and may help clinicians develop effective warm-up protocols for sports practice and competition.

OBJECTIVE

To examine the acute effects of 4 warm-up protocols with and without a weighted vest on anaerobic performance in female high school athletes.

DESIGN

Randomized, counterbalanced, repeated-measures design.

SETTING

High school fitness center.

PATIENTS OR OTHER PARTICIPANTS

Eighteen healthy high school female athletes (age = 15.3 +/- 1.2 years, height = 166.3 +/- 9.1 cm, mass = 61.6 +/- 10.4 kg).

INTERVENTION(S)

After 5 minutes of jogging, subjects performed 4 randomly ordered warm-up protocols: (1) Five static stretches (2 x 30 seconds) (SS), (2) nine moderate-intensity to high-intensity dynamic exercises (DY), (3) the same 9 dynamic exercises performed with a vest weighted with 2% of body mass (DY2), and (4) the same 9 dynamic exercises performed with a vest weighted with 6% of body mass (DY6).

MAIN OUTCOME MEASURE(S)

Vertical jump, long jump, seated medicine ball toss, and 10-yard sprint.

RESULTS

Vertical jump performance was significantly greater after DY (41.3 +/- 5.4 cm) and DY2 (42.1 +/- 5.2 cm) compared with SS (37.1 +/- 5.1 cm), and long jump performance was significantly greater after DY2 (180.5 +/- 20.3 cm) compared with SS (160.4 +/- 20.8 cm) ( P </= .05). No significant differences between trials were observed for the seated medicine ball toss or 10-yard sprint.

CONCLUSIONS

A dynamic warm-up performed with a vest weighted with 2% of body mass may be the most effective warm-up protocol for enhancing jumping performance in high school female athletes.

Flexibility is not Related to Stretch-Induced Deficits in Force or Power

Previous studies have demonstrated that an acute bout of static stretching may cause significant performance impairments. However, there are no studies investigating the effect of prolonged stretch training on stretch-induced decrements. It was hypothesized that individuals exhibiting a greater range of motion (ROM) in the correlation study or those who attained a greater ROM with flexibility training would experience less stretch-induced deficits. A correlation study had 18 participants (25 ± 8.3 years, 1.68 ± 0.93 m, 73.5 ± 14.4 kg) stretch their quadriceps, hamstrings and plantar flexors three times each for 30 s with 30 s recovery. Subjects were tested pre- and post-stretch for ROM, knee extension maximum voluntary isometric contraction (MVIC) force and drop jump measures. A separate training study with 12 subjects (21.9 ± 2.1 years, 1.77 ± 0.11 m 79.8 ± 12.4 kg) involved a four-week, five-days per week, flexibility training programme that involved stretching of the quadriceps, hamstrings and plantar flexors. Pre- and post-training testing included ROM as well as knee extension and flexion MVIC, drop and countermovement jump measures conducted before and after an acute bout of stretching. An acute bout of stretching incurred significant impairments for knee extension (-6.1% to -8.2%; p < 0.05) and flexion (-6.6% to -10.7%; p < 0.05) MVIC, drop jump contact time (5.4% to 7.4%; p < 0.01) and countermovement jump height (-5.5% to -5.7%; p < 0.01). The correlation study showed no significant relationship between ROM and stretch-induced deficits. There was also no significant effect of flexibility training on the stretch-induced decrements. It is probable that because the stretches were held to the point of discomfort with all testing, the relative stress on the muscle was similar resulting in similar impairments irrespective of the ROM or tolerance to stretching of the muscle. Key PointsA correlation and training study were used to examine the effects of increased range of motion on stretch-induced changes in force and jump measuresAn acute bout of stretching incurred significant impairments for knee extension and flexion MVIC, drop jump contact time and countermovement jump height.Neither study showed any significant relationship between ROM and stretch-induced deficits.

Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Power Output

Context: Stretching is commonly used as a technique for injury prevention in the clinical setting. Our findings may improve the understanding of the neuromuscular responses to stretching and help clinicians make decisions for rehabilitation progression and return to play.Objective: To examine the short-term effects of static and proprioceptive neuromuscular facilitation stretching on peak torque (PT), mean power output (MP), active range of motion (AROM), passive range of motion (PROM), electromyographic (EMG) amplitude, and mechanomyographic (MMG) amplitude of the vastus lateralis and rectus femoris muscles during voluntary maximal concentric isokinetic leg extensions at 60 and 300 degrees .s.Design: A randomized, counterbalanced, cross-sectional, repeated-measures design.Setting: A university human research laboratory.Patients or Other Participants: Ten female (age, 23 +/- 3 years) and 9 male (age, 21 +/- 3 years) apparently healthy and recreationally active volunteers.Intervention(s): Four static or proprioceptive neuromuscular facilitation stretching exercises to stretch the leg extensor muscles of the dominant limb during 2 separate, randomly ordered laboratory visits.Main Outcome Measure(s): The PT and MP were measured at 60 and 300 degrees .s, EMG and MMG signals were recorded, and AROM and PROM were measured at the knee joint before and after the stretching exercises.Results: Static and proprioceptive neuromuscular facilitation stretching reduced PT (P = .051), MP (P = .041), and EMG amplitude (P = .013) from prestretching to poststretching at 60 and 300 degrees .s (P < .05). The AROM (P < .001) and PROM (P = .001) increased as a result of the static and proprioceptive neuromuscular facilitation stretching. The MMG amplitude increased in the rectus femoris muscle in response to the static stretching at 60 degrees .s (P = .031), but no other changes in MMG amplitude were observed (P > .05).Conclusions: Both static and proprioceptive neuromuscular facilitation stretching caused similar deficits in strength, power output, and muscle activation at both slow (60 degrees .s) and fast (300 degrees .s) velocities. The effect sizes, however, corresponding to these stretching-induced changes were small, which suggests the need for practitioners to consider a risk-to-benefit ratio when incorporating static or proprioceptive neuromuscular facilitation stretching.