Comparison of Supervised versus Self-Administered Stretching on Bench Press Maximal Strength and Force Development

PURPOSE

While there is reported superior effectiveness with supervised training, it usually requires specialized exercise facilities and instructors. It is reported in the literature that high-volume stretching improves pectoralis muscles strength under supervised conditions while practical relevance is discussed. Therefore, the study objective was to compare the effects of volume equated, supervised- and self-administered home-based stretching on strength performance.

METHODS

Sixty-three recreational participants were equally assigned to either a supervised static stretching, home-based stretching, or control group. The effects of 15 min pectoralis stretching, 4 days per week for 8 weeks, were assessed on dynamic and isometric bench press strength and force development.

RESULTS

While there was a large magnitude maximal strength increase (p < 0.001-0.023, ƞ2 = 0.118-0.351), force development remained unaffected. Dynamic maximal strength in both groups demonstrated large magnitude increases compared to the control group (p < 0.001-0.001, d = 1.227-0.905). No differences between the intervention group for maximal strength (p = 0.518-0.821, d = 0.101-0.322) could be detected.

CONCLUSIONS

The results could potentially be attributed to stretch-induced tension (mechanical overload) with subsequent anabolic adaptations, and alternative explanatory approaches are discussed. Nevertheless, home-based stretching seems a practical alternative to supervised training with potential meaningful applications in different settings.

Microbiological Quality and Safety of Brazilian Mozzarella Cheese During Production Stages

This study assessed the microbiological quality and safety of mozzarella during various production stages in northern Tocantins, Brazil, by identifying critical biological points in the industrial environment within a tropical climatic region. Batches of mozzarella were evaluated, from raw milk to primary packaging, with a shelf life of 120 d at 4°C. Indicator microorganisms were quantified, and through microbiological and biomolecular approaches, Salmonella spp. and Listeria monocytogenes were identified. In addition, the toxigenic potential of coagulase-positive staphylococci (CPS) was characterized. Results indicated that the raw milk used for mozzarella production had low microbiological quality; pasteurization of raw milk effectively eliminated all identified pathogens and reduced microbiological counts (p > 0.05). An increase in bacterial counts (>2 log colony-forming unit [CFU]/g) and recontamination with Salmonella spp. and CPS, which potentially produce staphylococcal enterotoxin B, were observed during milk coagulation and curd draining. Stretching of the fermented curd reduced the enterobacteria, total coliforms, and Escherichia coli median values by 2.56, 2.64, and 2.3 log CFU/mL, respectively. Similarly, brining the pieces by immersion reduced the quantity of enterobacteria and total coliforms by 2.3 and 1.6 log CFU/mL, respectively. Of interest, in the freshly finished product, Salmonella spp. was present but L. monocytogenes was absent; however, after the shelf-life period, L. monocytogenes was present but Salmonella spp. was absent. Considering the environmental conditions that can promote the multiplication and preservation of pathogens and spoilage of dairy products in tropical climates, it is necessary to review operational hygiene procedures, particularly in milk coagulation vats and fermentation tables. This will ensure the production of high-quality mozzarella cheese with a reduced consumption risk.

Combined Effects of Glenohumeral Mobilization, Stretching, and Thoracic Manipulation on Shoulder Internal Rotation Range of Motion

Background/purpose

Interventions including posterior glenohumeral mobilizations (PGM), sleeper stretches, and thoracic manipulation are commonly used to address posterior shoulder tightness. The purpose of this study was to assess the effects of adding thoracic manipulation to PGM and sleeper stretches on passive range of motion (PROM), joint mobility, and infraspinatus electromyographic (EMG) activity in shoulders with decreased internal rotation (IR) PROM.

Design

Randomized Sequential Intervention Laboratory Study.

Methods

Forty individuals with clinically significant IR loss attended two study sessions. Participants were randomized to receive five 30 seconds bouts of either grade III PGM or sleeper stretching. Following a seven-day washout period, all participants attended a second session and received a prescriptive supine HVLA manipulation targeting the T3-4 segment, followed by the previously randomized intervention. Outcome measures included internal rotation PROM, horizontal adduction PROM, posterior glenohumeral joint translation assessed via ultrasound imaging, and EMG activity of the infraspinatus during a PGM. All outcome measures were assessed pre- and immediately post-intervention and compared statistically.

Results

There were significant within-group, but not between-group, differences for IR and horizontal adduction PROM following a single session of PGM or sleeper stretch. When combined with thoracic manipulation, significantly smaller within session changes of IR PROM were observed for both PGM (mean difference 4.4, p=0.017) and sleeper stretches (mean difference 6.4, p=0.0005). There were no significant between group differences for horizontal adduction PROM, humeral head translation, or EMG activity across all time points.

Discussion

Both GH posterior mobilizations and sleeper stretches improved IR and horizontal adduction PROM in a single session. The addition of thoracic manipulation prior to local shoulder interventions resulted in smaller gains of both IR and horizontal adduction ROM.

Level of evidence

Level 2.

Effects of Different Physical Therapy Interventions in Improving Flexibility in University Students with Hamstring Tightness - A Systematic Review and Network Meta-analysis

The aim of the present study was to identify the different interventions for hamstring flexibility among university students with hamstring tightness and to determine the better treatment method.

Design

Systematic review and network meta-analysis. An electronic search of the databases: Medline, Pubmed, Cochrane, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) was conducted. A total of 11 articles were included in the review. Of these articles, 02 were case-control studies, 02 were interventional pre-post studies and 07 were RCTs. The 07 RCTs were included for network meta-analysis. The findings of the initial network meta-analysis (NMA) which compared control i.e., no intervention with other interventions revealed that all the physical therapy interventions: stretching, electrotherapy combined with stretching, massage, dry needling and neurodynamic exercises combined with stretching and neurodynamics alone were superior to control. Since most studies included stretching as an intervention, a second NMA was conducted to compare the different physical therapy interventions with stretching. The results suggested that US-guided neuromodulation (WMD: -5.80, CI: -12.11, 0.51) had large effects on hamstring flexibility compared to stretching and stretching combined with electrotherapy i.e., cryotherapy and ultrasound (WMD: 0.25, CI: -1.14 to 1.64), MET (WMD: 3.10, CI: -3.28 to 9.48) and massage (WMD: 8.05, CI: -11.90 to 27.18) were inferior to stretching. To further investigate the effects of these interventions three meta-analysis were performed. The results revealed that stretching was more effective (SMD 2.27, 95% 0.72 to 3.81, p < 0.01) compared to control (no intervention). Neurodynamic exercises combined with stretching and neurodynamics alone were found to be superior to stretching alone ((SMD -0.69, 95% -1.35 to -0.03, p < 0.01) and stretching combined with electrotherapy was not significantly better than stretching alone ((SMD -0.07, 95% -1.00 to 0.87, p=0.88). Neurodynamic exercises combined with stretching and neurodynamics alone showed to be superior to the other physical therapy interventions in improving hamstring flexibility for hamstring tightness among university students, however, the reliability of the evidence is low.

Chronic Effects of Inter-Set Static Stretching on Morphofunctional Outcomes in Recreationally Resistance-Trained Male and Female

Purpose: The purpose of this study was to compare the effects of resistance training (RT) with inter-set static stretching (IS) versus traditional RT (TRT) on morphofunctional outcomes in recreationally resistance-trained male and female. Methods: Twenty-two recreationally-trained subjects were allocated to IS group (n = 12) or TRT (n = 10) and completed eight weeks of RT. The only difference between the groups was that IS group included static stretching between sets, while the TRT rested between the sets. Ultrasound images, dynamic and isometric strength tests for the elbow flexors and elbow extensors were evaluated pre- and post-intervention period. Results: Total training volume (TTV) was greater in TRT than IS (p = .031). TRT and IS caused similar increases in maximal dynamic and isometric strength. Fascicle length of the brachialis increased following TRT (p = .033); muscle thickness and the pennation angle of the distal portion of the triceps brachii increased following IS (p = .035 and p = .007, respectively). There were no significant changes in thickness and architecture for biceps brachii in either group. There were no significant differences between groups for any muscle strength and morphology outcome. Conclusion: IS negatively affects TTV but does not affect muscle strength and architecture of recreationally resistance-trained male and female.

Flexible Strain Sensors Based on Bionic Parallel Vein-like Structures for Human Motion Monitoring

In recent years, strain sensors have penetrated various fields. The capability of sensors to convert physical signals into electrical signals is of great importance in healthcare. However, it is still challenging to obtain sensors with high sensitivity, large operating range and low cost. In this paper, a stretchable strain sensor made of a double-layer conductive network, including a biomimetic multilayer graphene-Ecoflex (MLG-Ecoflex) substrate and a multilayer graphene-carbon nanotube (MLG-CNT) composite up-layer was developed. The combined action of the two layers led to an excellent performance with an operating range of up to 580% as well as a high sensitivity (gauge factor (GFmax) of 1517.94). In addition, a pressure sensor was further designed using the bionic vein-like structure with a multi-layer stacking of MLG-Ecoflex/MLG-CNT/MLG-Ecoflex to obtain a relatively high deformation along the direction of thickness. The device presented a high sensing performance (up to a sensitivity of 0.344 kPa-1) capable of monitoring small movements of the human body such as vocalizations and gestures. The good performance of the sensors together with a simple fabrication procedure (flip-molding) make it of potential use for some applications, for example human health monitoring and other areas of human interaction.

Comparative Analysis of Various Rotator Cuff Stretching Techniques: Efficacy and Recommendations for Gym Enthusiasts

Shoulder pain is a common complaint among gym-going individuals, particularly those engaged in upper limb workouts. The rotator cuff, comprising four muscles, plays a crucial role in stabilizing the shoulder joint during movements and supporting its mobility. Imbalances or weaknesses in these muscles can lead to shoulder injuries, affecting performance and overall well-being. The main aim of this review is to explore the benefit of one of the approaches in preventing shoulder pain and improving performance among gym-going individuals. Specific rotator cuff stretching exercises target the entire shoulder complex to enhance the mobility, control, and stabilization of the joint. The dynamic warm-up routine will actively engage the relevant muscles in various planes of motion, promoting the increased range of motion and reduced inflammation. Ultimately, the results from this review can serve as important knowledge for gym-going individuals, trainers, and fitness enthusiasts, guiding them in incorporating evidence-based warm-up strategies to optimize their workouts. Empowering individuals to take proactive measures in caring for their shoulder health can lead to improved overall performance and a better training experience in the gym.

Stretching is not essential for managing MS spasticity: A randomized controlled trial

BACKGROUND

Clinical practice, expert opinion, and evidence-based guidelines recommend daily stretching as first-line treatment for multiple sclerosis (MS) spasticity, but this has not been evaluated by fully powered clinical trials.

OBJECTIVE

To determine whether MS Spasticity: Take Control (STC), a guideline-based program of spasticity education and stretching exercises has different effects on the impact of spasticity than a control program of different spasticity education and range of motion (ROM) exercises.

METHODS

Ambulatory people with self-reported MS spasticity were randomly assigned to STC or ROM, delivered in same duration, facilitator-led, group classes, face-to-face (F2F) initially and later virtually, due to coronavirus disease 2019 (COVID-19). Multiple Sclerosis Spasticity Scale (MSSS) scores were compared between groups at 1 (primary outcome) and 6 months after interventions.

RESULTS

A total of 231 people enrolled. There was no significant difference in MSSS scores between STC and ROM at 1 month (mean difference = 0.28, 95% (confidence interval (CI)) = [-9.45 to 10.01], p = 0.955). There were significant group mean improvements in MSSS scores and most other outcomes at 1 and 6 months.

CONCLUSION

Education with stretching exercises, the first-line recommended treatment for MS spasticity, and education with ROM exercises may both improve MS spasticity to a similar degree. This study debunks the belief that stretching is essential to managing MS spasticity.

Effect of PNF stretching performed in the AKE position on hip, knee, and ankle flexibility

BACKGROUND

To measure hamstring flexibility, the active knee extension (AKE) test is preferred over the straight leg raise (SLR) test as it can be used to measure hamstring flexibility more selectively. However, hamstring stretching is primarily conducted in the SLR position (maximal hip flexion in the supine position) as it allows for maximal hip flexion in the supine position.

OBJECTIVE

This study evaluates the effects of proprioceptive neuromuscular facilitation (PNF) stretching in the AKE position (maximal knee extension with 90∘ flexion of the hip in the supine position) on hip, knee, and ankle flexibility.

METHODS

SLR, AKE, and active dorsiflexion (ADF) tests were used to determine the range of motion (ROM) before (pre-ROM) and after (post-ROM) stretching. PNF stretching consisted of maximal isometric knee flexion at the end range with external resistance to prevent knee flexion. One set of PNF stretches (five trials of six seconds each) was conducted.

RESULTS

The post-ROMs of hip, knee, and ankle measured via the SLR, AKE, and ADF tests, respectively, were significantly higher than the pre-ROMs.

CONCLUSIONS

The improvement in knee flexibility was greater than the improvement in hip and ankle flexibility. The AKE position is recommended in clinical settings during PNF stretching for individuals with hamstring tightness. Furthermore, PNF stretching in the AKE position increases the ADF ROM.

Outcomes After Proximal Medial Gastrocnemius Recession and Stretching vs Stretching as Treatment of Chronic Plantar Fasciitis at 6-Year Follow-up

BACKGROUND

Evidence from prospective short-term studies suggest that proximal medial gastrocnemius recession is a safe and efficient procedure to treat chronic plantar fasciitis resistant to nonoperative treatment. The aim of this study was to evaluate the long-term clinical outcomes of proximal medial gastrocnemius recession and stretching compared to a stretching exercise protocol for patients with chronic plantar fasciitis and an isolated gastrocnemius contracture (IGC).

METHODS

Forty patients with plantar fasciitis lasting more than 1 year were prospectively randomized to a home stretching exercise program only, or to proximal medial gastrocnemius recession in addition to the stretching program. Clinical and functional data in this study were obtained at baseline and 6-year follow-up. The main outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Secondary outcomes were the visual analog scale (VAS) for pain, the Manchester Oxford Foot Questionnaire (MOxFQ), ankle dorsiflexion, and Achilles complex performance.

RESULTS

Thirty-three of 40 patients completed the 6-year follow-up. Seven patients had crossed over from nonoperative treatment to operative treatment. At 6 years, the operative group demonstrated significantly better outcomes with AOFAS (88.9 vs 78.6, P = .012), for pain measured by VAS (2.5 vs 5.5, P < .001) and with the MOxFQ total score (24.4 vs 45.9, P = .05) (per protocol analysis excluding crossovers). No between-group differences were observed for ankle dorsiflexion or Achilles complex performance at 6 years.

CONCLUSION

This study demonstrates that the improved function and reduced level of pain by proximal medial gastrocnemius recession and stretching is better compared to stretching alone after 6 years of follow-up for patients with chronic plantar fasciitis and a concomitant isolated gastrocnemius contracture.

LEVEL OF EVIDENCE

Level I, randomized controlled trial.

Effect of stretching on inflammation in a subcutaneous carrageenan mouse model analyzed at single-cell resolution

Understanding the factors that influence the biological response to inflammation is crucial, due to its involvement in physiological and pathological processes, including tissue repair/healing, cancer, infections, and autoimmune diseases. We have previously demonstrated that in vivo stretching can reduce inflammation and increase local pro-resolving lipid mediators in rats, suggesting a direct mechanical effect on inflammation resolution. Here we aimed to explore further the effects of stretching at the cellular/molecular level in a mouse subcutaneous carrageenan-inflammation model. Stretching for 10 min twice a day reduced inflammation, increased the production of pro-resolving mediator pathway intermediate 17-HDHA at 48 h postcarrageenan injection, and decreased both pro-resolving and pro-inflammatory mediators (e.g., PGE2 and PGD2 ) at 96 h. Single-cell RNA sequencing analysis of inflammatory lesions at 96 h showed that stretching increased the expression of both pro-inflammatory (Nos2) and pro-resolution (Arg1) genes in M1 and M2 macrophages at 96 h. An intercellular communication analysis predicted specific ligand-receptor interactions orchestrated by neutrophils and M2a macrophages, suggesting a continuous neutrophil presence recruiting immune cells such as activated macrophages to contain the antigen while promoting resolution and preserving tissue homeostasis.

Stretch tolerance and elastic passive reaction of the quadriceps femoris seem to depend more on the fascia profundis taut surfaces than on the underlying stretched muscle

The rectus femoris and its covering, the fascia lata (i.e., fascia profundis), are two anatomical structures involved in anterior thigh stretching. This study aimed to identify the role of strain changes in the fascia lata in limiting stretch tolerance. The reaction force intensity of 11 men and 5 women was assessed during passive stretching of the anterior thigh at 130, 110, 90, and 70° of knee flexion. Recent data suggest that the fascia lata strain field is modified with knee flexion. Therefore, the relationship between knee flexion angle and stretch tolerance was assessed. We found that the reaction force of the anterior thigh increased almost linearly with the degree of knee extension between 130° and 70°. The fascia lata stretched surface proprioceptive information seems responsible for stretch tolerance. Fascia profundis strain field must be considered during stretching experiments.

Effectiveness of Deep Cervical Fascial Manipulation® and Sequential Yoga Poses on Pain and Function in Individuals with Mechanical Neck Pain: A Randomised Controlled Trial

BACKGROUND

This study aimed to investigate the effect of fascial manipulation (FM) of the deep cervical fascia (DCF) and sequential yoga poses (SYP) on pain and function in individuals with mechanical neck pain (MNP).

METHOD

Following the predefined criteria, ninety-nine individuals with MNP were recruited, randomised, and assigned to either the intervention group (IG) (n = 51) or the control group (CG) (n = 48). Individuals in the IG received FM (4 sessions in 4 weeks) and the home-based SYP (4 weeks). The CG participants received their usual care (cervical mobilisation and thoracic manipulation (4 sessions in 4 weeks) along with unsupervised therapeutic exercises (4 weeks). The participants underwent baseline and weekly follow-up measurements of pain using a numerical pain rating scale (NPRS) and elbow extension range of motion (EEROM) during the upper limb neurodynamic test 1 (ULNT1). The baseline and the fourth session follow-up measurements of the patient-specific functional scale (PSFS) and fear-avoidance behavior Questionnaire (FABQ) were also taken.

RESULTS

A repeated-measures ANOVA was performed. There were statistically significant differences between the IG and CG on the NPRS third and fourth sessions, with mean differences (MD) of -1.009 (p < 0.05) and -1.701 (p < 0.001), respectively. Regarding EEROM, there was a 20.120° difference (p < 0.001) in the fourth session between the groups. The MD in FABQ was -5.036 (p < 0.001), but there were no significant differences in PSFS between the groups during the follow-up.

CONCLUSION

FM and SYP can aid in reducing pain and fear-avoidance behaviour and improve the function and extensibility of the upper quarter region.

Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

Torsion of the Achilles tendon (AT) enhances tensile strength, but a high degree of torsion might also be a risk factor for Achilles tendinopathy, due to greater internal compression exerted during tensile loading. However, evidence supporting the grounds for this assumption is lacking. Hence, we aimed to investigate the impact of AT torsion type on intratendinous pressure. Eighteen human fresh frozen cadaveric legs were mounted in a testing rig and a miniature pressure catheter was placed through ultrasound-guided insertion in the midportion region of the AT. Intratendinous pressure was measured during a simulated straight-knee calf stretch and eccentric heel drop. The AT was then carefully dissected and classified into Type I (least), Type II (moderate), and Type III (extreme) torsion. Of the ATs examined, nine were found to have Type I torsion (50%), nine Type II (50%), and none Type III. It was found that the intratendinous pressure of the AT increased exponentially with ankle dorsiflexion during both exercises (p < 0.001) and that this increase was greater in ATs with Type II torsion than Type I torsion (p < 0.05). This study provides the first biomechanical data to support the hypothesis that in athletes with a high degree of torsion in the AT, the midportion area will experience more internal compression during exercise, for example, calf stretching and eccentric heel drops. Whether this phenomenon is also associated with an elevated risk for Achilles tendinopathy needs further prospective investigation.

Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis

CONTEXT

Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking.

OBJECTIVE

A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA.

DATA SOURCES

Seven databases, English-language.

STUDY SELECTION

Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs).

RESULTS

We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate.

CONCLUSION

There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty.

Educational intervention promotes injury prevention adherence in club collegiate men's lacrosse athletes

CONTEXT

Club sports are intercollegiate athletics that are student-led and not university-funded, many of which are without professional credentialing. Collegiate club athletes have an increased rate of injury compared to their NCAA counterparts. Education and implementation of stretching and strength training have demonstrated decreased rates of noncontact injuries.

OBJECTIVES

Educational intervention was given to club collegiate athletes to determine its effect on injury rates, perceived pain, and compliance toward injury-prevention practices.

METHODS

Intramural collegiate athletes were educated on injury prevention that focused on targeted stretching. Surveys designed to assess the impact of the education were distributed to three men's club lacrosse teams in Utah at the beginning and end of the season. The questions measured pain and time missed due to noncontact injury.

RESULTS

Two-tailed unpaired t tests demonstrated p values <0.05 for: overall decreased levels of pain (p<0.0001); increased range of motion (ROM, p<0.0001); increased frequency of stretching the muscle groups psoas (p<0.0001), calves (p=0.0081), and piriformis (p<0.0001); decreased pain levels for the hamstring (p=0.0274); and increased frequency of stretching after practice (p<0.0001).

CONCLUSIONS

The increased frequency of stretching suggests increased compliance toward injury prevention practices. Decreased self-reported levels of overall pain, and decreased pain in the hamstring, show that the subjects surveyed in the sample reported less pain and increased time stretching at the end of the season compared with the beginning of the season. Educational intervention offers an affordable measure to provide club collegiate athletes with resources to reduce injury rates through athlete compliance to targeted stretches.

Advancements in Restless Leg Syndrome Management: A Review of Physiotherapeutic Modalities and Their Efficacy

The goal of this review is to compile information on the use of physiotherapeutic treatments for the treatment of restless leg syndrome (RLS) and to classify the effectiveness of conservative methods in relieving the discomfort due to RLS. English literature found on PubMed, Google Scholar, and Scopus was used in the present review. According to the titles and matters of the abstracts, each literature item connected to RLS was retrieved, analyzed, and reviewed. The 24 papers that were considered admissible were those that included manual approaches, exercises, and alternative RLS management, which were then analyzed for data by the authors. A consistent trend in the data demonstrated benefits in lessening RLS symptom severity across the 24 papers that met the selection criteria. Patients were chosen based on clinical diagnostic standards, and the effectiveness of stretching, exercise therapy, yoga, vibration therapy, reflexology and massage, muscular relaxation techniques, and electrical stimulation was determined. Our findings indicated that each type of therapy significantly affected the manifestations of the illness. Stretching, fitness training, and reflexology were very beneficial, with no side effects and shorter intervention periods.

Changes in echo intensity of the gastrocnemius muscle with passive ankle dorsiflexion: can echo intensity be used to assess muscle elongation?

Introduction: While shear modulus has been used as an index of muscle elongation, high costs prevent its general adoption. A more general indicator that can quantify muscle elongation non-invasively is needed to develop effective methods for stretching each muscle. The purpose of this study was to determine whether the echo intensity of the muscle changes with muscle elongation compared with the shear modulus. Methods: Sixteen healthy males (24.1 ± 2.8 years) participated in the study. Shear modulus and echo intensity of the medial gastrocnemius were assessed at 20° and 10° of ankle plantar-flexion, and 0°, 10°, and 20° of ankle dorsiflexion (presented as -20°, -10°, and 0°, +10°, +20°, respectively). Shear modulus was measured using ultrasound shear wave elastography. The echo intensity was quantified using the average grayscale value of a given region of interest (RoI) in longitudinal and transverse B-mode images. Grayscale analysis was performed using two RoIs: one which included as much of the muscle as possible (maximum RoI), and a rectangular one whose size and depth was identical for all images (rectangular RoI). Pearson's correlation coefficients between either the shear modulus or echo intensity and the ankle angle and between the echo intensity and shear modulus were calculated separately for each participant. Results: Average Pearson's correlation coefficient between shear modulus and ankle angle of the participants was 0.904. The average Pearson's correlation coefficients between the echo intensity and ankle angle were estimated to be 0.797 and 0.222 for the maximum RoI and 0.698 and 0.323 for the rectangular RoI in the longitudinal and transverse images, respectively. The average Pearson's correlation coefficients between the echo intensity and shear modulus were 0.684 and 0.514 for the maximum RoI, and 0.611 and 0.409 for rectangular RoI in the longitudinal and transverse images, respectively. Discussion: The results indicate that the echo intensity in the longitudinal image of the gastrocnemius, especially when assessed using the maximum RoI, increased with muscle elongation by passive ankle dorsiflexion. Therefore, assessment of the echo intensity using the maximum RoI in the longitudinal image might be useful for quantifying the muscle elongation.

The effect of myofascial release of the physiological chains on the pain and health status in patients with fibromyalgia, compared to passive muscle stretching and a control group: a randomized controlled clinical trial

OBJECTIVE

To explore the potential effectiveness of myofascial release compared to passive muscle stretching and to a control group in modulating pain intensity and health status in adults diagnosed with fibromyalgia (FM).

MATERIALS AND METHODS

A preliminary randomized controlled clinical trial was conducted, consisting of eight weekly sessions. The participants were divided into three groups: myofascial release group (RG = 13), a muscle stretching group (SG = 13), and a control group (CG = 12), which received advice from a rheumatologist. The outcomes measured were the visual analogue pain scale (VAS), the fibromyalgia impact questionnaire (FIQ) (representing health status), and the number of painful areas. Univariate analyzes of covariance (ANCOVA) were performed at baseline, after 4 weeks (during treatment), after 8 weeks (post-treatment), and after 12 weeks (follow-up). The International Physical Activity Questionnaire (IPAQ), the Beck Depression Inventory (BDI) and the Pain Catastrophizing Scale (PCS) were included as covariates. Clinical trial registration number: NCT: 03408496.

RESULTS

After eight weeks, the RG showed lower VAS scores compared to the CG (mean difference 95% CI: -5.10 to -1.26) and the SG (mean difference 95% CI: -4.9 to -0.23) with no difference between the SG and the CG. The total FIQ score for the RG was lower than the CG after 4 weeks (95% CI: -49.92 to -5.61), and 8 weeks (mean difference 95% CI: -52.72 to -15.73), although there was no difference between the RG and SG, as well as between the SG and CG, at both time points. The number of painful body areas was similar in all groups at the four time points.

CONCLUSION

Preliminary results suggest that the RG possibly showed greater improvements in pain intensity and health status compared to the CG, and possibly greater improvements in pain intensity compared to the SG.

The Impact of Stretching Intensities on Neural and Autonomic Responses: Implications for Relaxation

Stretching is an effective exercise for increasing body flexibility and pain relief. This study investigates the relationship between stretching intensity and relaxation effects, focusing on brainwaves and autonomic nervous system (ANS) activity. We used a crossover design with low- and high-intensity conditions to elucidate the impact of varying stretching intensities on neural activity associated with relaxation in 19 healthy young adults. Participants completed mood questionnaires. Electroencephalography (EEG) and plethysmography measurements were also obtained before, during, and after stretching sessions. The hamstring muscle was targeted for stretching, with intensity conditions based on the Point of Discomfort. Data analysis included wavelet analysis for EEG, plethysmography data, and repeated-measures ANOVA to differentiate mood, ANS activity, and brain activity related to stretching intensity. Results demonstrated no significant differences between ANS and brain activity based on stretching intensity. However, sympathetic nervous activity showed higher activity during the rest phases than in the stretch phases. Regarding brain activity, alpha and beta waves showed higher activity during the rest phases than in the stretch phases. A negative correlation between alpha waves and sympathetic nervous activities was observed in high-intensity conditions. However, a positive correlation between beta waves and parasympathetic nervous activities was found in low-intensity conditions. Our findings suggest that stretching can induce interactions between the ANS and brain activity.

The Effects of Postural Education or Corrective Exercise on the Craniovertebral Angle in Young Adults with Forward Head Posture: A Randomized Controlled Trial

The purpose of this study was to compare the effects of three different intervention strategies, postural education (PE) and two corrective exercise programs (CEPs), on the craniovertebral angle (CVA) in young adults with forward head posture (FHP). A prospective four-arm parallel randomized controlled trial with repeated measures was performed. Seventy-nine healthy young adults (55 women, 24 men; mean age: 20.08 ± 2.19 years) with FHP were randomized into four groups: PE group, self-myofascial release + stretching group (SMRS), self-myofascial release + stretching + strengthening group (SMRSS), and a control group (CG). Participant CVA (°) was assessed before and after a 4-week intervention. Seventy-two participants completed the trial. Mean difference comparisons of within-group change in mean CVA revealed an increase in the PE (MD = 3.1, p < .01), SMRS (MD = 3.8, p < .01), and SMRSS (MD = 4.4, p < .01) groups. Mean difference comparison of between-group change in mean CVA supported greater CVA change in the SMRS and SMRSS groups compared to the CG (F(3, 68) = 5.26, p < .01, η2 = .188). All three interventions appear to be effective techniques for improving FHP in young adults, however CEPs may provide superior outcomes than PE alone. A 4-week CEP consisting of self-myofascial release + stretching may yield similar CVA enhancements as a CEP consisting of self-myofascial release + stretching + strengthening. Study findings can assist fitness professionals in designing evidence-based FHP intervention programs for young adults.

Physiotherapeutic Interventions for Individuals Suffering From Plantar Fasciitis: A Systematic Review

The foot and the lower leg comprise the ankle joint complex. The foot is crucial for the maintenance of posture. Frequently, overuse or repeated microtrauma to the fascia causes plantar fasciitis. This review aims to suggest the efficacy of various plantar fasciitis (PF) interventions based on modifications in clinical results. This review included studies from 2019 to March 2023 identified through a systematic literature search. The measures used to predict improvement in pain, discomfort, and foot function symptoms included the Visual Analog scale, Numerical Pain Rating Scale, Pressure Point Threshold by algometer, Weight-Bearing Lunge Test by inch tape, and range of motion. The review included 20 studies that fulfilled the inclusion criteria. Therapeutic interventions included insoles, foot orthosis, foam roller stretching, manual stretching, muscle strengthening, intrinsic muscle activities, extracorporeal shock wave lithotripsy, dry needling, laser, ultrasound, and others, which resulted in pain reduction, improved foot function, and ease of everyday routine. All therapeutic strategies used impacts resulting from minimal to maximal recovery. Various advanced approaches are more effective than conventional physical therapy. In conclusion, conservative therapeutic strategies with manual techniques, orthoses, and alternative intervention strategies can be combined to effectively relieve pain and improve function and overall results. Further high-quality studies are essential to learn more about the ideal dose, treatment approaches, and long-term impacts of these therapies.

Stretching and Releasing of Iliotibial Band Complex in Patients with Iliotibial Band Syndrome: A Narrative Review

Iliotibial band syndrome (ITBS) is one of the most common overuse syndromes causing knee pain; it is especially prevalent in runners and also common in cyclists, rowers, and field athletes, with occasional cases occurring in non-athletes too. ITBS symptoms can negatively affect not only knee function, but also mental and physical aspects of health-related quality of life. Although various conservative treatment options have been investigated and discussed, there is still no consensus on a standard of care for ITBS. Moreover, the literature on the etiology and risk factors of ITBS, which could help in selecting appropriate treatment methods, is conflicting and inconclusive. The role of individual treatment modalities such as stretching and releasing techniques has not been extensively studied and remains unclear. In this article, we will critically review the available evidence for the benefits of ITB stretching and "release" methods in the treatment of ITBS. In addition to the direct evidence (clinical studies examining the effects of ITB stretching and other methods that purportedly stretch or "release" the ITB), we present several additional lines of reasoning that discuss the rationale for ITB stretching/releasing in terms of the etiology of ITBS, the mechanical properties and behavior of the ITB, and the risk factors for ITBS development. We conclude that the current literature provides some evidence for the inclusion of stretching or other "release" methods in the early rehabilitation of ITBS. Long-term interventions typically include ITB stretching; however, it remains unclear to what extent stretching within a multimodal treatment actually contributes to resolving the symptoms. At the same time, there is no direct evidence to suggest that stretching and "release" methods have any negative effects.

Association between flexibility activity and blood-pressure change among older adults in Japan: A 5-year longitudinal study

This longitudinal study examined the relationship between flexibility-activity and blood-pressure (BP) change among older adults in Japan. Our study included 452 older adults who took part in our survey in both 2012/2013 and 2017/2018. The seated systolic blood pressure (SBP) and diastolic BP (DBP) were measured both at baseline and at the 5 years follow-up. The frequencies of the different physical activities at baseline were assessed using a questionnaire. A generalized linear mixed model was used to estimate the non-standardized coefficient (B) of BP change associated with flexibility activity, after adjustments for sex, age, body mass index, smoking status, alcohol consumption, antihypertensive medication use, history of heart disease, walking time, and muscle-strengthening activity as a fixed-effect, and area of residence as a random-effect. Higher flexibility-activity frequency was significantly associated with reduced SBP (B = -0.77 [95% confidence intervals = -1.36, -0.18], p for linear trend = 0.01, p for quadratic trend = 0.85) and DBP (-0.33 [-0.71, 0.05], p for linear trend = 0.09, p for quadratic trend = 0.04). Engaging in flexibility activity for 5 days per week was significantly associated with a reduction in DBP (B = -4.16, 95% CI [-7.53, -0.79], p = 0.02) compared with that in the reference group (0 days per week). Interaction tests were not significant between basic variables (sex, age, BMI, and antihypertensive medication) and flexibility. In conclusion, higher flexibility activity frequency was associated with a reduction in BP in older adults. Future longitudinal and interventional studies should examine the effects of flexibility activity on cardiovascular disease prevention.

Effects of Whole-Body Stretching Exercise during Lunch Break for Reducing Musculoskeletal Pain and Physical Exertion among Healthcare Professionals

Background and Objectives: To investigate the effect of whole-body stretching (WBS) exercise during lunch break for reducing musculoskeletal pain and physical exertion among healthcare professionals. Methods: Full-time healthcare professionals working in hospitals with more than one year of experience were invited to participate. Sixty healthcare professionals (age 37.15  ±  3.9 Years, height 1.61  ±  0.04 m, body mass 67.8  ±  6.3 kg, and BMI 26.5 ± 2.1 kg/m²) participated in this single-blinded, two-arm randomized controlled trial (RCT). Participants were divided into WBS (n = 30) and control (n = 30) groups. The WBS group performed a range of stretching exercises targeting the entire body during a lunch break period for 3 times a week for 6 weeks. The control group received an education program. Musculoskeletal pain and physical exertion were assessed using the Nordic musculoskeletal questionnaire and Borg rating of perceived exertion scale, respectively. Results: The 12-month prevalence of musculoskeletal discomfort among all healthcare professionals was highest in the low back region (46.7%), followed by the neck (43.3%), and then the knee (28.3%). About 22% of participants said that their neck discomfort impacted their job, while about 18% reported that their low back pain impacted their job. Results indicate that the WBS and education program had a beneficial impact on pain and physical exertion (p < 0.001). When comparing the two groups, the WBS group experienced a significantly greater decrease in pain intensity (mean difference 3.6 vs. 2.5) and physical exertion (mean difference 5.6 vs. 4.0) compared to an education program only. Conclusions: This study suggests that doing WBS exercises during lunchtime can help lessen musculoskeletal pain and fatigue, making it easier to get through the workday.

Effects of elongation longitudinaux avec decoaption osteo-articulaire and post-facilitation stretching technique on pain and functional disability in mobile users with text neck syndrome during COVID-19 pandemic: A randomized controlled trial

BACKGROUND

Adolescent smartphone users have developed a variety of musculoskeletal conditions due to their use of smartphones. ELDOA (Elongation longitudinaux avec decoaption osteo-articulaire) is based on maximizing facial and spinal stretching by assuming specific posture for 1 minute and post facilitation stretching is also a type of muscle energy technique that is used for chronically shortened or tight muscles. This aimed to compare the effects of post-facilitation stretching technique and ELDOA on neck pain and functional disability in mobile users experiencing Text neck syndrome during COVID-19.

METHODS

This single-blinded randomized control trial with a parallel group design was conducted at the Department of Physiotherapy Safi Hospital (Faisalabad, Pakistan) from September 2021 to April 2022. Forty smartphone users between the ages of 18 and 35 who had a Neck Disability Index score of >10 due to neck pain without unilateral arm symptoms participated in the study. Of the 40 participants, twenty were randomly assigned to the ELDOA group and twenty were assigned to the post facilitation stretching group, and each group received 3 weekly sessions of treatment for 6 weeks. The Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), and Smartphone Addiction Scale (SAS) were used to measure pain intensity, functional disability, and smartphone addiction at baseline and after 18 sessions of treatment. SPSS version 22 was used to enter and analyze the data. To find comparisons between groups an independent sample t test was used, and a paired sample t test was used to find the difference within each group.

RESULTS

Post-treatment values showed statistically significant difference between groups. ELDOA group showed greater improvement in pain (P < .03) with 95% CI [-1.33, -0.068] and functional disability (P < .05) with 95% CI [-4.44, 0.143] at 6th week. There was no statistically significant difference (P = .35) with 95% CI [-28.6, 10.4] between the two groups regarding smartphone addiction. The NPRS, NDI, SAS scores were significantly different within each group with P < .05.

CONCLUSION

The study concluded that ELDOA method and post-facilitation stretching both were effective in treating neck pain and functional disability. However, ELDOA method was superior to post-facilitation stretching effects on neck pain and functional disability among patients with text neck syndrome.

The Effects of Static Stretching Intensity on Range of Motion and Strength: A Systematic Review

The aim of this study was to systematically review the evidence on the outcomes of using different intensities of static stretching on range of motion (ROM) and strength. PubMed, Web of Science and Cochrane controlled trials databases were searched between October 2021 and February 2022 for studies that examined the effects of different static stretching intensities on range of motion and strength. Out of 6285 identified records, 18 studies were included in the review. Sixteen studies examined outcomes on ROM and four on strength (two studies included outcomes on both ROM and strength). All studies demonstrated that static stretching increased ROM; however, eight studies demonstrated that higher static stretching intensities led to larger increases in ROM. Two of the four studies demonstrated that strength decreased more following higher intensity stretching versus lower intensity stretching. It appears that higher intensity static stretching above the point of discomfort and pain may lead to greater increases in ROM, but further research is needed to confirm this. It is unclear if high-intensity static stretching leads to a larger acute decrease in strength than lower intensity static stretching.

Influence of Stretching on Liquid Transport in Knitted Fabrics

The transport of liquid sweat in clothing worn close to human skin is very important from the point of view of the thermo-physiological comfort of clothing users. It ensures the drainage of sweat secreted by the human body and condensed on the human skin. In the presented work, knitted fabrics made of cotton and cotton blends with other fibers (elastane, viscose, polyester) were measured in the range of liquid moisture transport using the Moisture Management Tester MMT M290. The fabrics were measured in unstretched form and stretched to 15%. Stretching of the fabrics was performed using the MMT Stretch Fabric Fixture. Obtained results confirmed that stretching significantly changed the values of parameters characterizing the liquid moisture transport in the fabrics. Before stretching, the best liquid sweat transport performance was stated for the KF5 knitted fabric made of 54% cotton and 46% polyester. For this, the greatest value (10 mm) of maximum wetted radius for the bottom surface was obtained. The Overall Moisture Management Capacity (OMMC) of the KF5 fabric was 0.76. This was the highest value among all values obtained for the unstretched fabrics. The lowest value of the OMMC parameter (0.18) was stated for the KF3 knitted fabric. After stretching, the KF4 fabric variant was assessed as the best one. Its OMMC improved from 0.71 before stretching to 0.80 after stretching. The value of the OMMC for the KF5 fabric remained after stretching at the same level (0.77) than before stretching. The most significant improvement was observed for the KF2 fabric. Before stretching, the value of the OMMC parameter for the KF2 fabric was 0.27. After stretching, the OMMC value increased to 0.72. It was also stated that the changes in the liquid moisture transport performance of the investigated knitted fabrics were different for the particular fabrics being investigated. Generally, in all cases, the ability of the investigated knitted fabrics to transfer liquid sweat was improved after stretching.

Comparative Effectiveness of Gua Sha, Cryostretch, and Positional Release Technique on Tenderness and Function in Subjects with Plantar Fasciitis: a Randomized Clinical Trial

Background

Plantar fasciitis (PF) can be treated effectively with manual techniques like cryostretch (CS) and the positional release technique (PRT). Although Gua Sha (GS) has been suggested in the literature for PF, its efficacy has not been studied in the research.

Objective

To determine and compare the effectiveness of GS, CS, and PRT in subjects with PF in terms of pain intensity, pain pressure threshold, and foot function.

Methods/Design

Thirty-six patients with PF (n=36) were randomly allocated to three study groups (12 in each group)-group GS, group CS, and group PRT, respectively.

Settings

A randomized clinical trial was conducted at physiotherapy OPD in a tertiary health center.

Participants

Subjects of all genders with plantar fasciitis of the age group 20-60 years. Thirty-six subjects with plantar fasciitis out of whom 12 were males and 24 females. There were no dropouts in this study.

Intervention

The interventions included the Gua Sha technique (1 session), the cryostretch technique with a frozen tennis ball (3 sessions), and the positional release technique (7 sessions), along with common exercises for all three groups.

Outcome Measures

Pain intensity, foot functions, and pain pressure threshold were assessed using the Numerical Pain Rating Scale, Foot Function Index, and pressure algometer, respectively, on day 1 (pre-intervention) and day 7 (post-intervention).

Results

Between-group analyses showed that group GS was more effective than CS and PRT for pain (p=.0001), group CS was more effective than GS and PRT for foot function (p=.0001) whereas group PRT was more effective than GS and CS for pain pressure threshold (p=.0001).

Conclusion

Although all three groups showed improvement, Gua Sha was superior in terms of reducing pain, cryostretch for improving foot functions, and PRT for reducing tenderness. The interventions used in this study are cost-effective and have proved to be simple and safe techniques.

Breaking the Gingival Barrier in Periodontitis

The break of the epithelial barrier of gingiva has been a subject of minor interest, albeit playing a key role in periodontal pathology, transitory bacteraemia, and subsequent systemic low-grade inflammation (LGI). The significance of mechanically induced bacterial translocation in gingiva (e.g., via mastication and teeth brushing) has been disregarded despite the accumulated knowledge of mechanical force effects on tight junctions (TJs) and subsequent pathology in other epithelial tissues. Transitory bacteraemia is observed as a rule in gingival inflammation, but is rarely observed in clinically healthy gingiva. This implies that TJs of inflamed gingiva deteriorate, e.g., via a surplus of lipopolysaccharide (LPS), bacterial proteases, toxins, Oncostatin M (OSM), and neutrophil proteases. The inflammation-deteriorated gingival TJs rupture when exposed to physiological mechanical forces. This rupture is characterised by bacteraemia during and briefly after mastication and teeth brushing, i.e., it appears to be a dynamic process of short duration, endowed with quick repair mechanisms. In this review, we consider the bacterial, immune, and mechanical factors responsible for the increased permeability and break of the epithelial barrier of inflamed gingiva and the subsequent translocation of both viable bacteria and bacterial LPS during physiological mechanical forces, such as mastication and teeth brushing.

Acute Effects of Combination Therapy by Triceps Surae Stretching and Electrical Stimulation to the Tibialis Anterior on Medial Forefoot Plantar Pressure During Gait in Patients With Diabetes Mellitus

High plantar flexor moment and limited ankle mobility are known to cause high plantar pressure under the forefoot. Stretching is an effective physical therapy for the limited ankle range of motion (ROM), and electrical stimulation is used to regulate the activity of antagonistic muscle via the action of reciprocal inhibition. Additionally, stretching paired with electrical stimulation has been reported to improve the limited ROM significantly. This study aims to investigate the influences of stretching on triceps surae (STR), electrical stimulation to tibialis anterior (ES), and the combination (ES+STR) on the ROM, kinematic parameters, and plantar pressure distribution during gait in patients with diabetes mellitus. Planter pressure and other parameters were measured before and after the intervention of ES, STR, ES+STR, or the rest sitting on the bed (CON) for 10 min. Pressure time integral under the medial forefoot decreased in the ES+STR compared to CON (P< .05). Interestingly, ES+STR increased passive and dynamic ROM on ankle dorsiflexion during gait and increased the lateral center of pressure excursion (P < .05). Furthermore, these changes were followed by decreased contact duration under the medial forefoot (P < .05). The combined therapy improves ankle mobility during gait and reduces the contact duration and the plantar pressure under the medial forefoot in patients with diabetes mellitus.

Shin Splint: A Review

Medial tibial stress syndrome (MTSS), usually referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of athletes. A variety of factors can lead to shin splints, including overtraining, poor footwear, muscular imbalances at the ankle, overtight or weak triceps surae muscles, imbalances at the thoracolumbar complex, and a body mass index (BMI) above 30. Injuries present with diffuse palpable pain that is often described as a dull ache following exercise. The pain is often alleviated by resting. Often, athletes complain of tenderness along the posteromedial edge of the tibia and pain along the middle to distal third of the posteromedial border of the tibia following an exercise session. The pain caused by a shin splint should be categorized according to its location and cause, such as lower medial tibial pain caused by periostitis or upper lateral tibial pain caused by raised compartment pressure. In order to prevent MTSS or shin splints, it is important to avoid excessive stress. The main objectives of shin splint treatment are to relieve pain and to enable the patient to return to normal activities without pain. To prevent shin splints, repetitive stress should be avoided. In this paper, we review what is known about the pathophysiology of shin splint syndrome, present evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and make recommendations for prevention. The purpose of this study is to assess the effectiveness of interventions to prevent shin splints.

Effects of an 8-week multimodal program on thoracic posture, glenohumeral range of motion and serve performance in competitive young tennis players

Introduction

Intensive tennis practice is known to generate sport-specific adaptations at the shoulder region and influence the sagittal spinal curvature. However, increased thoracic kyphosis decreases the shoulder functional capacity, which could limit tennis performance. Therefore, the aim of this study was to investigate the effects of an 8-week multimodal program on thoracic posture, glenohumeral range of motion, and serve performance in competitive young tennis players.

Methods

Eighteen male and four female players (age: 16.0 ± 2.4 years, height: 170.7 ± 11.0 cm; mass: 62.1 ± 11.5 kg; International Tennis Number: 3-4) performed their regular training during 8 weeks, which was used as a reference period, and implemented a multimodal program including stretching, strengthening, and myofascial release exercises, four times per week during 8 additional weeks, which corresponded to the intervention period. The thoracic curvature angle and mobility, the biacromial and interscapular distances, the glenohumeral range of motion and the tennis serve performance were assessed three times, i.e., before and after the regular training and after the 8-week multimodal program.

Results

The results showed that the 8-week regular training had no significant effects on thoracic curvature angle [effect size (ES) = 0.02-0.36, p = 0.06-0.46] and mobility (ES = 0.05-0.26, p = 0.13-0.42), biacromial (ES = 0.05, p = 0.18) and interscapular distances (ES = 0.03, p = 0.45), ranges of motion in glenohumeral internal (ES = 0.04, p = 0.43) and external rotation (ES = 0.43, p = 0.06), and tennis serve accuracy (ES = 0.33, p = 0.07) and velocity (ES = 0.09, p = 0.35). The 8-week multimodal program increased moderately the thoracic mobility (ES = 0.55, p = 0.01), moderately to strongly the serve accuracy and velocity (ES = 0.65, p = 0.003, for both), strongly decreased the interscapular distance (ES = 1.02, p < 0.001), and strongly increased the range of motion in glenohumeral internal (ES = 0.90, p < 0.001) and external rotation (ES = 1.49, p < 0.001).

Discussion

These findings indicated that an 8-week multimodal program, including spine and glenohumeral mobility and shoulder girdle strength exercises, performed four times per week during 8 weeks, is moderately relevant to rectify the sagittal thoracic curvature in competitive tennis players, while such a program may help regain the range of motion in glenohumeral rotation without tennis serve performance impairment.

Study of Nanoparticle-Polymer Interactions via the Mechanical Stretching of Surface-Enhanced Raman Scattering Substrates

It is shown that the aligned electrospun fibers are a convenient platform for studying the mechanical effects on nanomaterials, particularly when using surface-enhanced Raman scattering as a sensitive tool of monitoring. The ligands on the surface of the embedded Au nanoparticles fall off easily with the shear force from the stretching, in contrast to the counterparts protected by polymer/silica shells. Upon stretching, the chains of Au nanoparticles will reversibly break, as revealed by the dramatic changes in the longitudinal plasmon absorption. It is believed that such a platform will open a window for understanding mechanical effects at the nanoscale, and also a new means for synthetic control.

Decellularized Spinach Biomaterials Support Physiologically Relevant Mechanical Cyclic Strain and Prompt a Stretch-Induced Cellular Response

Recently, decellularized plant biomaterials have been explored for their use as tissue engineered substitutes. Herein, we expanded upon the investigation of the mechanical properties of these materials to explore their elasticity as many anatomical areas of the body require biomechanical dynamism. We first constructed a device to secure the scaffold and induce a strain within the physiological range of the normal human adult lung during breathing (12-20 movements/min; 10-20% elongation). Results showed that decellularized spinach leaves can support cyclic strain for 24 h and displayed heterogeneous local strain values (7.76-15.88%) as well as a Poisson's ratio (0.12) similar to that of mammalian lungs (10.67-19.67%; 0.01), as opposed to an incompressible homogeneous standard polymer (such as PDMS (10.85-12.71%; 0.4)). Imaging and mechanical testing showed that the vegetal scaffold exhibited strain hardening but maintained its structural architecture and water retention capacity, suggesting an unaltered porosity. Interestingly, we also showed that cells seeded on the scaffold can also sense the mechanical strain as demonstrated by a nuclear reorientation perpendicular to strain direction (63.3° compared to 41.2° for nonstretched cells), a nuclear location of YAP and increased expression of YAP target genes, a high cytoplasmic calcium level, and an elevated expression level of collagen genes (COL1A1, COL3A1, COL4A1, and COL6A) with an increased collagen secretion at the protein level. Taken together, these data demonstrated that decellularized plant leaf tissues have an inherent elastic property similar to that found in the mammalian system to which cells can sense and respond.

Acute and Chronic Effects of Supervised Flexibility Training in Older Adults: A Comparison of Two Different Conditioning Programs

Flexibility training is a fundamental biological process that improves the quality of life of the elderly by improving the ranges of motion of joints, postural balance and locomotion, and thus reducing the risk of falling. Two different training programs were assessed acutely and after 12 weeks by means of the sit-and-reach test. Thirty-one healthy older adults were randomly divided into three groups: the Experiment I group (Exp) performed strength and static stretching exercises; the Experiment II group performed dynamic and static stretching exercises; and participants assigned to the control group maintained a sedentary lifestyle for the entire period of the study. Flexibility acutely increased in Exp I by the first (ΔT0 = 7.63 ± 1.26%; ES = 0.36; p = 0.002) and second testing sessions (ΔT1 = 3.74 ± 0.91%; ES = 0.20; p = 0.002). Similarly, it increased in Exp II significantly by the first (ΔT0 = 14.21 ± 3.42%; ES = 0.20; p = 0.011) and second testing sessions (ΔT1 = 9.63 ± 4.29%; ES = 0.13; p = 0.005). Flexibility significantly increased over the 12 weeks of training in Exp I (ΔT0 - T1 = 9.03 ± 3.14%; ES = 0.41; p = 0.020) and Exp II (ΔT0 - T1 = 22.96 ± 9.87%; ES = 0.35; p = 0.005). The acute and chronic differences between the two groups were not significant (p > 0.05). These results suggest the effectiveness of different exercise typologies in improving the flexibility of the posterior muscular chains in older adults. Therefore, the selection of a program to optimize training interventions could be based on the physical characteristics of the participants.

Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading: Implications for Achilles tendinopathy

Mechanical overload is considered the main cause of Achilles tendinopathy. In addition to tensile loads, it is believed that the Achilles tendon may also be exposed to compressive loads. However, data on intratendinous pressures are lacking, and consequently, their role in the pathophysiology of tendinopathy is still under debate. Therefore, we aimed to evaluate the intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading. Twelve pairs of human cadaveric legs were mounted in a testing rig, and a miniature pressure catheter was placed through ultrasound-guided insertion in four different regions of the Achilles tendon: the insertion (superficial and deep layers), mid-portion, and proximal portion. Intratendinous pressure was measured during three simulated loading conditions: a bent-knee calf stretch, a straight-knee calf stretch, and an eccentric heel-drop. It was found that the intratendinous pressure increased exponentially in both the insertion and mid-portion regions of the Achilles tendon during each loading condition (p < 0.001). The highest pressures were consistently found in the deep insertion region (p < 0.001) and during the eccentric heel-drop (p < 0.001). Pressures in the mid-portion were also significantly higher than in the proximal portion (p < 0.001). These observations offer novel insights and support a role for compression in the pathophysiology of Achilles tendinopathy by demonstrating high intratendinous pressures at regions where Achilles tendinopathy typically occurs. To what extent managing intratendinous pressure might be successful in patients with Achilles tendinopathy by, for example, avoiding excessive stretching, modifying exercise therapy, and offering heel lifts requires further investigation.

Effects of Photobiomodulation and Low-Intensity Stretching on Delayed-Onset Muscle Soreness: A Randomized Control Trial

Objective: This study aimed to investigate the effects of photobiomodulation (PBM), low-intensity stretching, and their combination on delayed-onset muscle soreness (DOMS) in the untrained population. The relationships between DOMS and muscle function and functional performance were also tested. Methods: Fifty-four participants were randomized into four groups. Eccentric exercise was used to induce DOMS. Each group received either no treatment, PBM, stretching or PBM combined with stretching at 24, 48, and 72 h postexercise. Pressure pain threshold (PPT), numerical rating scale (NRS), single-leg forward jump (SLFJ), and maximum isometric voluntary contraction (MIVC) were measured at baseline, 24, 48, 72, and 96 h after eccentric exercise. Between-group differences were tested using two-way repeated measures analysis of variance and the relationships between DOMS and MIVC, and SLFJ were examined using Pearson's correlation analysis. Results: The PPT at the vastus medialis and vastus lateral in the PBM combined with stretching group was significantly lower than that in control group at 72 h (p = 0.045) and 48 h (p = 0.037) postexercise. No significant between-group difference in PPT was found for the rest occasions. There was no significant between-group difference in NRS, MVIC, and SLFJ on any occasion (p ≥ 0.052). DOMS was not correlated with MIVC and SLFJ (p ≥ 0.09). Conclusions: PBM or low-intensity stretching did not affect DOMS and functional performance in untrained individuals. The combination of PBM and low-intensity stretching increased pain sensitivity and did not relieve soreness. The DOMS was not associated with either muscle function or functional performance.

Information-Storage Expansion Enabled by a Resilient Aggregation-Induced-Emission-Active Nanocomposite Hydrogel

Advanced materials with high performance and distinctive function are one of the main driving forces for the development of human society. The selection of appropriate materials and adequately utilizing their features to apply them in a specific area rationally are of great significance but remain challenging. Herein, an aggregation-induced emission (AIE)-active nanocomposite (NC) hydrogel is developed by introducing a pH-responsive AIE luminogen (AIEgen) into a Laponite XLS/polyacrylamide-based NC hydrogel (Laponite is a trademark of the company BYK Additives Ltd.). The AIEgen can protonate to interact with the negatively charged clay through the electrostatic interaction, which results in a drastic fluorescence enhancement due to the restriction of intramolecular motion by the rigid clay to the protonated AIEgen. This behavior facilitates the input of fluorescent information with a high contrast ratio in the hydrogel by acid stimulation. Moreover, by utilizing the excellent resilience of the hydrogel, hierarchically inputting and displaying the information in the original and stretched states of the hydrogel film is realized, which achieves information-storage expansion and dual-encryption via switching between stretching and restoring the film. This work showcases fully and synergistically utilizing the superiorities of various advanced materials to achieve superior applications and should guide the future development of advanced materials in emerging areas.

Using Daily Stretching to Counteract Performance Decreases as a Result of Reduced Physical Activity-A Controlled Trial

There are many reasons for reduced physical activity leading to reduced maximal strength and sport-specific performance, such as jumping performance. These include pandemic lockdowns, serious injury, or prolonged sitting in daily work life. Consequently, such circumstances can contribute to increased morbidity and reduced physical performance. Therefore, a demand for space-saving and home-based training routines to counteract decreases in physical performance is suggested in the literature. This study aimed to investigate the possibility of using daily static stretching using a stretching board to counteract inactivity-related decreases in performance. Thirty-five (35) participants were either allocated to an intervention group (IG), performing a daily ten-minute stretch training combined with reduced physical activity or a reduced physical activity-only group (rPA). The effects on maximal voluntary contraction, range of motion using the knee-to-wall test, countermovement jump height (CMJ_height), squat jump height (SJ_height), drop jump height (DJ_height), contact time (DJ_ct) and the reactive strength index (DJ_RSI) were evaluated using a pre-test-post-test design. The rPA group reported reduced physical activity because of lockdown. Results showed significant decreases in flexibility and jump performance (d = -0.11--0.36, p = 0.004-0.046) within the six weeks intervention period with the rPA group. In contrast, the IG showed significant increases in MVC90 (d = 0.3, p < 0.001) and ROM (d = 0.44, p < 0.001) with significant improvements in SJ_height (d = 0.14, p = 0.002), while no change was measured for CMJ_height and DJ performance. Hence, 10 min of daily stretching seems to be sufficient to counteract inactivity-related performance decreases in young and healthy participants.

Effects of different stretch durations on the strength of the proximal and distal group of muscles - a randomized trial

BACKGROUND

Different researchers have studied the effects of different types of stretching on different muscle groups. Since distal muscles are fully activated and proximal muscles are sub-optimally activated; thus, we might see different responses to stretching in the proximal and distal groups of muscles depending on their muscle activation. Therefore, this study aimed to compare the acute effects of 2, 4, and 8 minutes of intermittent static stretching (SS) on the isometric maximum voluntary contraction force (MVCF) of proximal (Hamstring) and distal (Calf) groups of muscles.

METHODS

Two groups pretest-posttest experimental design was used. A total of thirty participants were randomly assigned into two groups, and twenty-eight completed the intervention. In both groups, participants participated in three experimental trials (SS2, SS4, and SS8) on 3 days. 2-minute intermittent stretching (SS2) was performed on day-I, 4-minute (SS4) on day II, and 8-minute (SS8) on day III. Isometric MVCF was measured at pre-intervention, 0-, 10-, and 20-minute post-intervention periods in both groups.

RESULTS

In the proximal group: SS2, SS4, and SS8 did not affect isometric MVCF at the 0-, 10-, and 20-minute post-intervention periods (P > .05). In distal group: SS2 did not affect isometric MVCF at 0- and 10-minute post-intervention periods (P > .05), however at 20-minute, MVCF increased by 11.06% (P < .05). SS4 and SS8 also did not alter isometric MVCF in the Calf at 0-, 10-, and 20-minute post-intervention periods (P > .05). No significant differences were observed between the proximal and distal groups (P > .05).

CONCLUSION

2-, 4-, and 8-minute intermittent SS did not affect the isometric strength in both muscle groups. In addition, proximal and distal groups of muscles responded similarly to three different duration intermittent SS.

Short-Term Effects of Three Types of Hamstring Stretching on Length, Neurodynamic Response, and Perceived Sense of Effort-A Randomised Cross-Over Trial

Background: Stretching techniques for hamstring muscles have been described both to increase muscle length and to evaluate nerve mechanosensitivity. Aim: We sought to evaluate the short-term effects of three types of hamstring stretching on hamstring length and report the type of response (neural or muscular) produced by ankle dorsiflexion and perceived sense of effort in asymptomatic subjects. Methods: A randomised cross-over clinical trial was conducted. A total of 35 subjects were recruited (15 women, 20 men; mean age 24.60 ± 6.49 years). Straight leg raises (SLR), passive knee extensions (PKE), and maximal hip flexion (MHF) were performed on dominant and non-dominant limbs. In addition, the intensity of the applied force, the type and location of the response to structural differentiation, and the perceived sensation of effort were assessed. Results: All stretching techniques increased hamstring length with no differences between limbs in the time*stretch interaction (p < 0.05). The perceived sensation of effort was similar between all types of stretching except MHF between limbs (p = 0.047). The type of response was mostly musculoskeletal for MHF and the area of more neural response was the posterior knee with SLR stretch. Conclusions: All stretching techniques increased hamstring length. The highest percentage of neural responses was observed in the SLR stretching, which produced a greater increase in overall flexibility.

Quadriceps or triceps surae proprioceptive neuromuscular facilitation stretching with post-stretching dynamic activities does not induce acute changes in running economy

Previous studies reported that both a more compliant quadriceps tendon and a stiffer Achilles tendon are associated with better running economy. While tendon stiffness can be decreased by a single bout of proprioceptive neuromuscular facilitation (PNF), post-stretching dynamic activities (PSA) can counteract the potential stretch-induced force loss. Thus, the purpose of this study was to investigate if a single, moderate duration, (4 × 15 s), bout of PNF stretching of either the quadriceps or triceps surae muscles followed each by PSA, causes either an improvement or impairment in running economy. Eighteen trained male runners/triathletes visited the laboratory five times. The first two visits were to familiarize the participants and to test for maximal oxygen consumption (VO₂max) respectively. The further three appointments were randomly assigned to either 1.) quadriceps PNF stretching + PSA or 2.) triceps surae PNF stretching + PSA or 3.) no stretching + PSA. Following the interventions, participants performed a 15-min run on the treadmill with a speed reflecting a velocity of 70% VO₂max to assess oxygen consumption (i.e., running economy) and running biomechanics. Our results showed neither a difference in oxygen consumption (p = 0.15) nor a change in any variable of the running biomechanics (p > 0.33) during the steady-state (i.e., last 5 min) of the 15-min run. Athletes can perform moderate duration PNF stretching of the quadriceps or triceps surae + PSA prior to a running event, without affecting running economy. Future studies should emphasize long-term training effects on tendon stiffness adaptations and running economy.

Mechanisms Underlying Anti-Inflammatory and Anti-Cancer Properties of Stretching-A Review

Stretching is one of the popular elements in physiotherapy and rehabilitation. When correctly guided, it can help minimize or slow down the disabling effects of chronic health conditions. Most likely, the benefits are associated with reducing inflammation; recent studies demonstrate that this effect from stretching is not just systemic but also local. In this review, we present the current body of knowledge on the anti-inflammatory properties of stretching at a molecular level. A total of 22 papers, focusing on anti-inflammatory and anti-cancer properties of stretching, have been selected and reviewed. We show the regulation of oxidative stress, the expression of pro- and anti-inflammatory genes and mediators, and remodeling of the extracellular matrix, expressed by changes in collagen and matrix metalloproteinases levels, in tissues subjected to stretching. We point out that a better understanding of the anti-inflammatory properties of stretching may result in increasing its importance in treatment and recovery from diseases such as osteoarthritis, systemic sclerosis, and cancer.

Effective stretching position for the posterior deltoid muscle evaluated by shear wave elastography

BACKGROUND

Deteriorated extensibility of the posterior deltoid muscle is one of the factors of posterior shoulder tightness, and improvement in its extensibility is needed. However, no study has investigated which shoulder positions effectively stretch the posterior deltoid muscle in vivo. The aim of this study was to verify the effective stretching position of the posterior deltoid muscle in vivo by shear wave elastography.

METHODS

Fifteen healthy men participated in this study. The shear modulus of the posterior deltoid was measured at resting and 13 stretching positions: 60°, 90°, and 120° shoulder flexion; maximum shoulder flexion, horizontal adductions at 60°, 90°, and 120° shoulder flexion; internal rotations at 60°, 90°, and 120° shoulder flexion; and combinations of horizontal adduction with internal rotation at 60°, 90°, and 120° shoulder flexion. The shear moduli of each stretching position were compared to those of the rest. Then, among the stretching positions for which the shear modulus was significantly different from the rest, the shear moduli were compared using a three-way analysis of variance with repeated measures of the 3 factors-flexion, horizontal adduction, and internal rotation.

RESULTS

The shear moduli in all stretching positions were significantly higher than those of the rest, except for maximum shoulder flexion. The three-way analysis of variance with repeated measures revealed significant main effects in flexion and horizontal adduction. Comparing the flexion angles, the shear modulus was significantly higher at 90° than that at 60° and 120°. The shear modulus with horizontal adduction was significantly higher than that without horizontal adduction. Moreover, a significant two-way interaction was found only at flexion and horizontal adduction. The shear modulus with horizontal adduction was significantly higher at all angles than that without horizontal adduction at each flexion angle. Comparing the flexion angles with horizontal adduction, the shear modulus was significantly higher at 90° than that at 60° and 120°. No significant three-way interactions were found.

CONCLUSION

Shoulder flexion and horizontal adduction affected the extensibility of the posterior deltoid muscle, whereas the effect of shoulder internal rotation was limited. More precisely, maximal horizontal adduction at 90° shoulder flexion was the most effective stretching position for the posterior deltoid muscle.

A randomized controlled trial concerning the implementation of the postural Mézières treatment in elite athletes with low back pain

OBJECTIVE

This study aimed to evaluate the impact of adding the Mézières Method (MM) to the standard rehabilitation protocol for the elite athletes with low back pain (LBP) in reducing lumbar pain than only using the traditional rehabilitation protocol treatment. The disciplines considered in this study were soccer, rhythmic gymnastics, and basketball.

DESIGN

Randomized controlled trial.

SETTING

Training Camp.

PARTICIPANTS

One hundred thirty-nine elite athletes with low back pain of whom 69 were assigned to the experimental group.

INTERVENTION

The intervention consists of treatment with three lying postures in a 40-minutes long session twice a week. The session goal was to focus on breathing exercises, spine mobility, and stretching of the back muscles, with particular attention to the diaphragmatic, paravertebral, and latissimus dorsi muscles.

OUTCOME MEASURES

Assessments as Visual Analogue Scale (VAS), Sit and Reach flexibility test, Roland-Morris Questionnaire, and health status questionnaire (SF12) were used.

RESULTS

The evaluation of all outcomes in 4 measurement periods of the study (baseline, 4, 12, and 24 weeks) showed a significant difference between groups. Also, at the 6-month of the intervention, a significant difference in the means (SD) was observed in pain (VAS), back flexibility (Sit & Reach) and back disability (QRM) outcomes in favor of the experimental group with a medium-large effect size comparing with the control group.

CONCLUSION

The MM approach can also be applied in established conventional protocols to alleviate pain and functionality. The obtained results include improving the quality of life of the athletes and their physical and emotional states.

Clinical trial registration number ID: NCT03849053.

Effects of a physical self-care support program for patients with fibromyalgia: A randomized controlled trial

BACKGROUND

The effects of stretching exercises in fibromyalgia (FM) deserves further study.

OBJECTIVE

To evaluate the effectiveness of a Physical Self-Care Support Program (PSCSP), with emphasis on stretching exercises, in the treatment of FM.

METHODS

Forty-five women with FM were randomized to the PSCSP (n= 23) or to a control group (n= 22). The PSCSP consisted of weekly 90-minute learning sessions over 10 weeks, providing instructions on wellness, postural techniques, and active stretching exercises to be done at home. The control group was monitored through 3 medical appointments over 10 weeks and included in a waiting list. The primary outcomes were the Fibromyalgia Impact Questionnaire (FIQ), the Visual Analogue Scale (VAS) for pain, and the Sit and Reach Test (SRT) at the end of the study.

RESULTS

Nineteen and 21 patients completed the trial in PSCSP and control groups, respectively. After 10 weeks, the PSCSP group showed significantly better FIQ (difference between adjusted means, -13.64, 95% CI, -21.78 to -5.49, P= 0.002) and SRT scores (7.24 cm, 3.12 to 11.37, P= 0.001) than the control group, but no significant difference in pain VAS (-1.41, -3.04 to 0.22, P= 0.088). Analysis using multiple imputation (MI) and delta-adjusted MI for missing outcomes rendered similar results.

CONCLUSIONS

A PSCSP emphasizing stretching exercises significantly improved FIQ and SRT scores, and may be a helpful therapy for FM.

Effects of two recovery methods on the leg muscle fatigue of oceanauts in a manned submersible

BACKGROUND

The cabin of the manned submersible is a narrow and sealed space. The long-time work of oceanauts is easy to cause muscle fatigue and stiffness, which reduces efficiency. This paper explored the relative more effective way to relieve leg muscle fatigue of the oceanauts in the manned submersible.

MATERIAL AND METHODS

Twenty healthy young people with an average age of 24 years were selected as the participants, while the usual natural relaxation and the stretching method proposed by the surveys were selected as the relieve method for muscle fatigue. This study compared the effects of the 2 recovery ways using the electromyography data from the quadriceps femoris and biceps femoris, and the subjective scales.

RESULTS

With the support of data of integral electromyogram (iEMG), root-mean-square (RMS), subjective scales, authors finally found that the 2 muscles of the leg are fatigued significantly, and biceps femoris has more accumulation of fatigue. Although the 2 recovery ways have a significant relief effect on muscle fatigue, the stretching method can reduce more muscle fatigue in a short period of time, especially for biceps femoris. The stretching method is advocated for the oceanauts.

CONCLUSIONS

The findings suggested that the stretching method was optimal for relieving the muscle fatigue of the oceanauts during the operation. Med Pr. 2022;73(2).

Acute Effects of Soleus Stretching on Ankle Flexibility, Dynamic Balance and Speed Performances in Soccer Players

Most dynamic stretching protocols include the gastrocnemius muscle, but soleus stretches are often neglected, which is the key powerful muscle for the push-off (concentric) of all speed movements. The purpose of this study was to examine whether the added soleus stretch in a regular stretching protocol would have greater benefits for ankle flexibility, dynamic balance and functional performance. Fourteen healthy male soccer players received each of the stretching conditions (regular stretching only (Regular), regular stretching with soleus stretching (Soleus) and no stretching (Control)) randomly on different training days, with two-day separation. The ankle flexibility, standing heel-lift balance and speed performances were assessed following each stretching intervention. The active dynamic stretches were performed for 30 s with three repetitions on each of the three (Regular) and four (Soleus) muscles. One-way ANOVA with repeated measures (or the Friedman non-parametric test) was performed to determine any significant effect with alpha = 0.05. Our findings revealed that both the Regular and Soleus stretching groups showed an increased active range of ankle motion compared to the no-stretching control (Ps < 0.05). In the heel raise balance test, both stretching groups experienced a significant increase in maximum plantarflexion strength as well as resultant anterior−posterior and medial−lateral CoP excursions compared to the no-stretching control (Ps < 0.05). In the sprinting tasks, both the Soleus and Regular stretching groups induced faster linear and curved running times (Ps < 0.05). When comparing the two stretching groups, Soleus stretching led to better ankle flexibility, maximum plantarflexion strength and curved running time (Ps < 0.05). Thus, added stretches on the soleus muscles can provide further benefits to speed performances in soccer.

Evidence-Based Corrective Exercise Intervention for Forward Head Posture in Adolescents and Young Adults Without Musculoskeletal Pathology: A Critically Appraised Topic

Clinical Scenario: Habitual overuse of cellphones is on the rise among adolescents and young adults. Those who maintain a flexed neck posture when using a cellphone for extended periods possess an elevated risk for developing forward head posture (FHP). Chronic FHP can lead to painful medical disorders affecting the head, neck, and shoulders. Both stretching and strengthening exercises are advocated interventions to address this postural abnormality; however, due to a wide range of corrective exercise programming in the literature, the decision for which exercises to prescribe for this condition can be challenging for clinicians. Clinical Question: For adolescents and young adults without musculoskeletal pathology, what are the most frequent stretching and strengthening exercises incorporated into effective FHP intervention programs supported by current randomized control trials? Summary of Key Findings: A combined total of 5 stretches and 8 strengthening exercises were identified across 3 studies of level 1b evidence that successfully impacted FHP using a combined stretching and strengthening corrective exercise intervention. The supine chin tuck and a sternocleidomastoid stretch were utilized in all 3 studies, while scapular retraction and a pectoralis stretch were included in 2 of the 3 studies. Clinical Bottom Line: Based on the results of this appraisal, the most frequent stretches and strengthening exercises incorporated into effective FHP intervention programs supported by current randomized control trials focused on adolescents or young adults without musculoskeletal pathology include a sternocleidomastoid stretch, pectoralis stretch, the supine chin tuck, and scapular retraction. Strength of Recommendation: There is "Good" to "Excellent" evidence from 3 level 1b randomized control trials to support the inclusion of a sternocleidomastoid stretch, pectoralis stretch, the supine chin tuck, and scapular retraction exercises into a corrective exercise program to address forward head posture.