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The effect of heat applied with stretch to increase range of motion: A systematic review
Abstract and Figures
Application of heat to muscle is commonly advocated to enhance the efficacy of stretching. However, the effect of this combined therapy using different methods of heating, applied to different muscles, and after one or multiple treatments, is not known. To perform a systematic review to address the question: Does stretching augmented by heat application result in greater gains in range of motion (ROM) compared to stretch alone? The following databases were searched for original articles that evaluated our question: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, SPORTDiscus and PEDro databases. After title and abstract screening followed by full-text screening, the quality of included articles was assessed and their data was abstracted. Screening, data abstraction and quality assessment was performed and consensus was achieved by two reviewers. Range of motion (ROM) data were synthesized by meta-analyses for overall effect and subgroup analysis according to muscle group, method of heat application, single or multiple treatments, and reported tightness of muscle. Twelve studies were included and reported the effects of stretch with or without heat on ROM of 352 participants. Heat applications included ultrasound, shortwave diathermy and hot packs. Meta-analyses and subgroup analyses demonstrated greater increases in ROM after heat and stretch (H + S) than heat alone. Subgroup analysis of muscle groups and the method of heat application showed some trends, but no significant differences. Multiple treatments (more so than single treatments) showed consistent treatment effects of H + S versus stretch alone amongst subgroups. Muscles described as tight did not show a greater treatment effect in response to H + S compared to muscles not reported as tight. Heating provides an added benefit on stretch related gains of ROM in healthy people.
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... The primary goal of a hamstring rehabilitation program is for the athlete to return to playing sport at their prior level of performance, with minimal risk of injury recurrence [29]. In this regard, the best-available evidence suggests clinical and performance benefits following warm-up procedures or the reduction of muscle cooling [30,31]. However, the benefit derived from each component (static vs. dynamic) is still up for debate. ...
... Ostrowski et al. (2017) [32] reported the need to increase the intramuscular temperature by 3-4 • Celsius (Cs), while Sawyer et al. [33] did not increase the temperature by more than 0.4 • Cs after 20-25 min of application. Despite this, previous studies show improvement after the local application of heat modalities on the calf [8,31,34]. The statistically significant changes observed after 10 min in the SW group (Table 2) could be due to the acute effect on viscoelastic properties after local application of hot packs to the muscle. ...
... The statistically significant changes observed after 10 min in the SW group (Table 2) could be due to the acute effect on viscoelastic properties after local application of hot packs to the muscle. [31]. Funk et al. [35] showed similar increases in RoM in recreational sport players with hamstring shortness after the use of a moist heat pack during 20 min (1.24 • after the test and 2.62 • after 8 min). ...
Background:
Few previous studies have analyzed the effects of certain specific static and dynamic warm-up components on recreational sports players with a previous hamstring injury. Therefore, the aim of this study was to analyze changes in some modifiable and external risk factors after (immediately and in a follow-up assessment after 10 min) a static or dynamic warm-up program on recreational sports players with a previous hamstring injury.
Methods:
A total of 62 participants were randomized into 2 groups: static warm-up (SW) (n = 31) or dynamic warm-up (DW) (n = 31). Range of movement (RoM), perceived pain, the pressure-pain threshold, and joint position sense were assessed at baseline, immediately after the intervention and 10 min afterwards. The intervention for the SW (hot pack procedures in both hamstring muscles) lasted 20 min. The DW intervention consisted of a running exercise performed on a treadmill for 10 min.
Results:
Both groups showed statistically significant changes (p ≤ 0.05) in the primary outcomes (perceived pain and the pressure-pain threshold) at the three measurement times (this was also true for RoM for the SW group, with statistically significant differences only between times from the baseline to the 10-min follow-up; p ≤ 0.05, d = 0.23). The intra-group secondary outcome showed no statistically significant changes (p > 0.05) in both groups (except for the period from the baseline-immediately after in the DW group; p ≤ 0.05, d = 0.53). The comparison between groups showed no statistically significant differences for any of the variables analyzed. (p ≥ 0.05).
Conclusion:
The present findings suggest that both specific warm-up modalities seem to positively influence perceived pain on stretching and the pressure threshold; however, the significant reduction in the joint repositioning error and the larger effect sizes observed in the DW group suggest that this method has a greater beneficial impact in recreational sports players with clinical histories of hamstring injuries.
... Therefore, the maintenance of the flexibility of hamstrings in athletes is a major issue in physiotherapy. Various methods are used to improve the muscle flexibility of athletes, including stretching and thermotherapy [4]. Static stretching (SS), due to its low risk of inducing injury, is one GMJ.2023;12:e2981 ...
Background: Transfer energy capacitive and resistive (TECAR) therapy (TT) is a newly developed deep heating therapy that can generate heat within tissues through high-frequency wave stimulation. Compared to conventional physiotherapy methods, the application of TT especially in sports rehabilitation is becoming more popular. This study aimed to investigate the comparative effect of TT and therapeutic ultrasound (US) on hamstring muscle shortness. Additionally, the effects of TT with static stretching (SS) were compared with US combined with SS.Materials and Methods: Totally, 39 male athletes with hamstring shortness were randomly assigned into three groups: A, B, and C. Group A received 15 minutes of TT plus SS, while Group B received 15 minutes of US with SS, and Group C only performed SS. Hamstring flexibility was measured by active knee extension (AKE), passive knee extension (PKE), and the sit and Reach (SR) tests before the intervention, and following the first, and third treatment sessions.Results: The range of motion of the AKE and PKE, and displacement range in the SR test improved significantly after the first and third sessions in all three groups (P<0.0001). The improvement of the three flexibility indices in the TT group was greater than in the other two groups.Conclusion: The present study showed that TT could increase the flexibility of hamstring muscles more than US therapy. However, TT in combination with SS had a similar effect to SS alone.
... At least one expert recommends the regular practice of flexibility activities like yoga and stretching. To increase the range of motion of a joint, vibration, transcutaneous electrical nerve stimulation, and heated packs are frequently used as exogenous stimulation to skeletal muscles or tendons around the joint (45). The essential mechanism of vibration in enhancing muscle flexibility is presynaptic inhibition of group Ia afferent fibers or a "busy line" phenomenon that is formed when vibration stimulation and stretching influence the same Ia pathways. ...
Nr 2023;13 (3):504-515 504 SUMMARY Background. Flexibility and muscular performance assist in maintaining posture, encourage effective movement, prevent improper body alignment, maintain proper muscle length and balance, and also lower the chance of injury. The neuromuscular training technique known as whole-body vibration (WBV) has recently gained favor in health and fitness facilities. WBV has long been utilized as a non-invasive, physical therapy aid in rehabilitation, to improve muscle performance (strength, power, and endurance), encourage bone formation, and decrease the risk of injury. Objective. The possibility of WBV exercise as a helpful and secure strategy for enhancing muscular performance and flexibility was therefore examined in the current review. Methods. The current narrative review used a search strategy and conducted a literature search in January 2023, retrieving data from the following databases: Web of Science, PubMed, Scopus, and Google Scholar. Results. Recommendations on how to increase muscle performance and flexibility, lower the chance of injury, and generally improve the overall quality of life are provided by the majority of the selected literature. Conclusions. The usage of this paradigm in practice increases muscle performance and flexibility in both healthy adult athletic and non-athletic subjects is proposed. KEY WORDS Muscle performance; flexibility; whole body vibration training; risk of injury; healthy adult subject.
... In a systemic review by Nakano et al. 27 they aimed to answer the question of whether the application of heat enhances the effect of stretching on range of motion (ROM) compared to stretching alone. The investigators indicated that different heat applications can improve the effect of stretching exercises on ROM immediately, and they suggested that future studies should determine the most efficient application method. ...
... Amongst these, HP application is the most prevalent method of thermal therapy as it is the simplest and least expensive to administer. Previous research has demonstrated that heat application can augment a range of motion (ROM) (Bleakley and Costello, 2013;Kain et al., 2011), and heat applied with stretching provides larger gains in ROM compared to stretching alone (Fujita et al., 2018;Knight et al., 2001;Nakano et al., 2012). ...
The application of thermal agents via hot packs is a commonly utilized method. However, the time-course changes in the range of motion (ROM), stretch sensation, shear elastic modulus, and muscle temperature during hot pack application are not well understood. This study aimed to investigate the time-course changes in these variables during a 20-minute hot pack application. Eighteen healthy young men (21.1 ± 0.2 years) participated in this study. We measured the dorsiflexion (DF) ROM, passive torque at DF ROM (an indicator of stretch tolerance), and shear elastic modulus (an indicator of muscle stiffness) of the medial gas-trocnemius before and every 5 minutes during a 20-minute hot pack application. The results showed that hot pack application for ≥5 minutes significantly (p < 0.01) increased DF ROM (5 minutes: d = 0.48, 10 minutes: d = 0.59, 15 minutes: d = 0.73, 20 minutes: d = 0.88), passive torque at DF ROM (5 minutes: d = 0.71, 10 minutes: d = 0.71, 15 minutes: d = 0.82, 20 minutes: d = 0.91), and muscle temperature (5 minutes: d = 1.03, 10 minutes: d = 1.71, 15 minutes: d = 1.74, 20 minutes: d = 1.66). Additionally , the results showed that hot pack application for ≥5 minutes significantly (p < 0.05) decreased shear elastic modulus (5 minutes: d = 0.29, 10 minutes: d = 0.31, 15 minutes: d = 0.30, 20 minutes: d = 0.31). These results suggest that hot pack application for a minimum 5 minutes can increase ROM and subsequently decrease muscle stiffness.
... If, for one side, the deep warm reach soft tissues, like muscles, connective tissue and skin in homogeneously and continuously, for another side the superficial warm and cooling reach objectively the skin and the adipose tissue, limiting the deep thermotherapy. 28,29 Besides, it is very hard to keep a constant temperature superficially, once these therapies are applied with hot or cold water bags, or even ice packs. 29 The kind of stretch most found was the static, 9,12,13,14,23 presenting important results. ...
Background: The stretching with thermotherapies associated have been related in the literature as a way to increase the range of motion, but still are not consensus about this efficacy and cost-effectiveness. The muscle stretching is a useful technique in rehabilitation and in physical activities programs, either to gain or maintain the flexibility, as a recovery of musculoskeletal and joint injuries. Aim: To determine the effects of thermotherapies associated to flexibility training in ROM of knee extension in healthy adults. Method: Cochrane Library, LILACS, PEDro, PUBMED/ MedLine, Scopus and Web of Science accessed in October 2016. Randomized clinical trials that have executed a training of hamstrings stretching, associated or not with one or more thermotherapies in healthy young adults with knee extension ROM outcomes published in Portuguese and English. The Cochrane Collaboration’s Risk of Bias Tool was used to evaluate risk of bias, and the methodological quality assessment was rated following the PEDro Scale. Results: Eight articles were included, totalizing 260 participants. The papers showed low methodological quality, and uncertain risk of bias. All studies reported difference between the control and experiment groups, in all treatment ways. However, the thermotherapy action associated with stretching is still unclear, because the results suggest that even without the thermotherapy there are ROM increases. Limitations: Low methodological quality of selected papers make the conclusions untrustworthy. Conclusion: The stretching is effective in knee extension ROM improvement in healthy adults, with or without thermotherapy. New studies with higher methodological rigor and standardized protocols are needed.
Key-words: Muscle Stretching Exercises; Hyperthermia, Induced; Cryotherapy; Systematic review; Thermotherapy.
... Clinical experience shows that the increased contact design of the ETDNO helps to minimize edema and to control scar volume [22]. Patients reported that the neoprene tends to increase digit warmth and may provide the added benefit of the combination of heat and stretch [23]. Ninety per cent of the subjects described the orthosis as easy to wear and indicated that it did not interfere with their ADL. ...
Flexion contracture of the proximal interphalangeal joint (PIPJ) is one of the most frequent complications in finger trauma. Orthoses are the most widely used method to optimize total end-range time (TERT). No previous studies showed that an elastic tension orthosis could be applied for longer than 12 hours. We aimed to demonstrate that the elastic-tension digital neoprene orthosis (ETDNO) can achieve higher TERT and therefore better range of motion than other elastic-tension orthoses (ETO) described in the literature. A prospective study of treatment of PIPJ flexion contracture included 10 PIP joints in 8 patients who met the selection criteria. They were instructed to use the ETDNO for around 23 hours per day as far as possible, during a period of 3 weeks. Patients reported a mean TERT of 20.6 hours a day. PIPJ contracture improved by a mean Torque Range of Motion (TROM) of 23.5 ° at 500 gr and 22.9º at 800 g of passive extension force during the 3-week treatment. Based on the results of this study, the ETDNO appears to offer a highly effective approach for improving PIPJ flexion contracture, increasing range of motion in extension. ETDNO’s efficacy probably lies in the significantly improved comfort and low-profile design, enabling excellent compliance and thus optimizing TERT.
Level of evidence
Level III.
Background:
Arthrolysis is usually performed when stiffness has a disabling effect on quality of life and in cases where physiotherapy has not been effective. This report describes one patient with a chronic stiff wrist who underwent open arthrolysis. The purpose of this case report is to describe the rehabilitation following arthrolysis, in order to illustrate the effects of intensive physiotherapy for this patient.
Case description:
A 54-year-old woman with chronic wrist stiffness secondary to a radio-ulnar fracture was described. The patient presented severe pain and unsatisfactory wrist range of motion and muscle strength almost 2 years after the traumatic event.
Intervention:
Post-arthrolysis rehabilitation was based on edema control, manual therapy, transcutaneous electrical nerve stimulation (TENS), static splinting and strengthening exercises. In addition, graded motor imagery and proprioceptive rehabilitation were included to address impaired motor control. Outcome measures of passive range of motion (PROM), active range of motion (AROM), grip and pinch strength, numeric rating scale (NRS), disability of the arm, shoulder and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) were recorded.
Conclusions:
The outcomes of this case report suggest that arthrolysis combined with immediate and intensive physiotherapy were a suitable option for the treatment of post-traumatic wrist stiffness in this patient. The passive motion measured intraoperatively was maintained, while pain, functional active motion and strength were improved allowing for social reintegration.
Reverse shoulder arthroplasty has seen increased acceptance among shoulder surgeons since it was first introduced. Originally viewed with skepticism, it now accounts for over one-third of shoulder arthroplasty volume in the United States. Treatment indications have similarly grown. Initially reserved for elderly patients suffering cuff tear arthropathy, it is now an accepted treatment modality for pathology ranging from massive irreparable cuff tears, asymmetric glenohumeral osteoarthritis, proximal humerus fractures, and revision arthroplasty. Additionally, the patient cohort is becoming younger and more active. These patients present unique challenges due to increased life expectancy and functional demand, combined with more complex diagnoses and multiple prior surgical episodes. Outcomes for younger patients are promising, with significant improvements in patient-reported and objective metrics. However, they do not uniformly attain the same level of perceived improvement compared to elderly patients, possibly related to increased functional desire, higher rate of prior operations, and higher complication rate.KeywordsReverse shoulder arthroplastyShoulder arthroplastyShoulder replacementYoung patientGlenohumeral arthritisMassive cuff tearPseudoparalysisCuff tear arthropathyProximal humerus fractureRevision arthroplasty
Only a few studies were conducted to investigate the effect of ultrasound in conjunction with stretch duration on the hamstring muscle flexibility. This study aimed to determine passive knee extension in subjects with tight hamstrings and to evaluate the effectiveness of stretch duration and therapeutic ultrasound on the flexibility of this muscle. Fifty boy students aging 12-14 years were randomly assigned to 1 of 5 groups: ultrasound therapy (1), ultrasound therapy and 15 sec stretch (2), ultrasound therapy and 30 sec stretch (3), 15 sec stretch (4) and 30 sec stretch (5). The passive knee extension (degrees) was measured at 0 and 3 weeks. Data were analyzed using one-way ANOVA and t-paired tests. Passive knee extension increased from 160.2° ±7.9° to 163.5° ±7.5° in group one (p=0.001), from 161.1° ±6.9° to 166.5° ±5.9° in group two (p<0.0001), from 163.5° ±6.7° to 171.2° ±5.9° in group three (p<0.0001), from 161° ±11.8° to 164.4° ±11.3° in group four (p = 0.005) and from 166.1° ±5.6° to 171.1° ±4.8° in group five (p = 0.001). There was not significant difference between five groups before (p = 0.48) and after intervention (p = 0.059). Our results showed that hamstring muscle group flexibility was increased in all groups. The gains achieved in range of motion of knee extension with the ultrasound therapy and 30 sec stretch were greater than to those made by ultrasound and 15 sec stretch methods. No advantage was apparent in using any of these protocols with respect to others to increase hamstring muscle group flexibility.
Clinical Sports Medicine has been fully updated from the popular 2nd edition (2000). It is even more practical, now superbly illustrated, easy-to-read and packed with substantially updated and new material. There are samples of several chapters online including the whole "Pain in the Achilles region" chapter. This book describes a completely symptom-oriented approach to treating clinical problems.
The ACSM flexibility training recommendations emphasize proper stretching of muscles supporting the major joints, but there is a little evidence to support this recommendation in terms of effectiveness, and which stretching parameters (technique and single stretch duration) are more adequate. A randomized controlled clinical trial design was use to investigate whether the ACSM flexibility training recommendation parameters improve hip flexion range of motion. A total of 173 subjects, 122 men (21.3+/-2.5 years; 176.33+/-8.35 cm; 74.42+/-10.80 kg) and 51 women (20.7+/-1.6 years; 163.43+/-6.57 cm; 60.12+/-7.88 kg), classified as recreationally active young adult university students were randomly assigned to 1 of 7 groups: 1 control group (no stretching) or 1 of 6 stretching groups. All stretching groups performed 12 weeks of flexibility training with a consistent stretch daily dose (180 s) and frequency (3 days per week) parameters and different stretch technique (passive or active) and single stretch duration (15, 30, or 45 s). Hip flexion passive range of motion (PROM) was determined through the bilateral straight-leg raise test before, during (at 4 and 8 weeks), and after the program (12 weeks). All stretching groups performed hip flexion PROM after flexibility training. A significant improvement was identified in mean PROM for each stretching group, but no significant differences were found between stretch technique and single stretch duration (p>0.05). The control group's mean PROM decreased (Delta PROM: -0.08 degrees, 95% confidence interval [CI]=-2.3 to 5.3), whereas all stretching groups increased PROM (Delta PROM: 15.14 degrees, 95% CI=10.19 to 23.56) in hip flexion after 12 weeks of stretching (p<0.05). The present study suggests that the current ACSM flexibility training recommendations are effective for improving hip flexion ROM in recreationally active young adults.
Research is limited and controversial on the effectiveness of various stretching methods on muscle lengthening. Objective: Studying the effectiveness of static stretch and muscle energy technique on the flexibility of hamstring muscles.
Thirty young females (20-25 yrs old) participated voluntarily in this study. Subjects were randomly assigned to two groups: static stretch group (controls; n=15) and muscle energy technique (MET) group (experimental; n=15). The control group underwent ten sessions of static stretches of hamstring muscle, and the experimental group was assigned to ten sessions of MET at 50% voluntary isometric contraction. Hamstring flexibility was evaluated by passive knee extension test at baseline and again following interventions.
Both treatment methods were capable of significantly improving the shortness of hamstring muscles (P< 0.01); and no considerable difference was observed between the methods.
Ten sessions of hamstring stretches in normal young women using either static stretch or MET had similar effect on restoring flexibility to hamstrings.
Background and purpose:
Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions.
Method:
In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]).
Results:
The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was.56 (95% confidence interval=.47-.65) for ratings by individuals, and the ICC for consensus ratings was.68 (95% confidence interval=.57-.76).
Discussion and conclusion:
The reliability of ratings of PEDro scale items varied from "fair" to "substantial," and the reliability of the total PEDro score was "fair" to "good."
It is generally accepted that increasing the flexibility of a muscle-tendon unit promotes better performances and decreases the number of injuries. Stretching exercises are regularly included in warm-up and cooling-down exercises; however, contradictory findings have been reported in the literature. Several authors have suggested that stretching has a beneficial effect on injury prevention. In contrast, clinical evidence suggesting that stretching before exercise does not prevent injuries has also been reported. Apparently, no scientifically based prescription for stretching exercises exists and no conclusive statements can be made about the relationship of stretching and athletic injuries. Stretching recommendations are clouded by misconceptions and conflicting research reports. We believe that part of these contradictions can be explained by considering the type of sports activity in which an individual is participating. Sports involving bouncing and jumping activities with a high intensity of stretch-shortening cycles (SSCs) [e.g. soccer and football] require a muscle-tendon unit that is compliant enough to store and release the high amount of elastic energy that benefits performance in such sports. If the participants of these sports have an insufficient compliant muscle-tendon unit, the demands in energy absorption and release may rapidly exceed the capacity of the muscle-tendon unit. This may lead to an increased risk for injury of this structure. Consequently, the rationale for injury prevention in these sports is to increase the compliance of the muscle-tendon unit.
Recent studies have shown that stretching programmes can significantly influence the viscosity of the tendon and make it significantly more compliant, and when a sport demands SSCs of high intensity, stretching may be important for injury prevention. This conjecture is in agreement with the available scientific clinical evidence from these types of sports activities. In contrast, when the type of sports activity contains low-intensity, or limited SSCs (e.g. jogging, cycling and swimming) there is no need for a very compliant muscle-tendon unit since most of its power generation is a consequence of active (contractile) muscle work that needs to be directly transferred (by the tendon) to the articular system to generate motion. Therefore, stretching (and thus making the tendon more compliant) may not be advantageous. This conjecture is supported by the literature, where strong evidence exists that stretching has no beneficial effect on injury prevention in these sports. If this point of view is used when examining research findings concerning stretching and injuries, the reasons for the contrasting findings in the literature are in many instances resolved.
Background and PurposeRange of motion (ROM) measurements have been included in several hip scores evaluating the results after hip surgery. The clinical procedures of performing these measurements vary and disagreement exists about the accuracy of visual estimatess compared to goniometer measurements. The purpose of this study was to study the reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis.Method
Hip ROM measurements (abduction, adduction, extension, flexion and internal/external rotation) were recorded by four different teams on the same day and were repeated one week later. Teams 1, 2 and 3 consisted of physiotherapists using standardized goniometric measurements. Team 4 involved an experienced orthopaedic surgeon making the assessments from visual estimates only. Twenty-five patients (6 M, 19 F; mean age 68.5 years, range 46–76 years) with osteoarthrosis of the hip, verified both clinically and radiologically, participated in the study.ResultsWith the exception of abduction (p=0.03), there were no significant differences between the measurements recorded on the first and the second occasions for the same teams. The coefficient of variance was 5.5% for flexion (lowest) and 26.1% for extension (highest). Reproducibility was best for flexion. There was also high reliability when all the arcs of motion were summed up (abuction + adduction + extension + flexion + internal/external rotation). With the exception of internal rotation, there were highly significant differences between the teams when two people performed the measurements compared to the values measured by a single individual. Concordance, expressed as the standardized agreement index, between visual estimates made by one individual (the orthopaedic surgeon) and goniometric measurements made by two experienced physiotherapists, were 0.77–0.83 which indicates good agreement.Conclusion
The reproducibility of hip ROM measurements was highest for flexion. There was also high reliability when all the six arcs of motion were summed up. Concordance between visual estimates and goniometric measurements indicates good agreement. Copyright © 2000 Whurr Publishers Ltd.
To investigate the effects of the contract-relax-antagonist-contract (CRAC) form of proprioceptive neuromuscular facilitation (PNF) stretching, with and without a warm-up, on postural stability. Thirty volunteers (15 men and 15 women, age: 25.17 +/- 5.4 years, height: 173.76 +/- 8.2 cm, and weight: 72.03 +/- 14.87 kg) were randomly assigned to 1 of 3 conditions: warm-up and stretch (WS), stretching only (SO), and a control condition (CON). Contract-relax-antagonist-contract PNF of the hamstrings, plantar flexors, and hip flexors was performed during WS and SO. A 6-minute treadmill warm-up was applied before CRAC in the WS condition. Measures of anterior/posterior and medial/lateral (M/L) postural stability were taken before and after treatment conditions. A 2 x 3 analysis of variance was used to assess for differences between conditions. Significance was set at p < 0.05. There was a time x condition interaction (F = 3.962,58; p = 0.024, Power = 0.69) for M/L stability. There was a difference between WS and CON (p = 0.037, Power = 0.57) and SO and CON (p = 0.041, Power = 0.51) posttesting. This study suggests that CRAC PNF stretching with or without warm-up improves M/L stability. Contract-relax-antagonist-contract form of stretching is a useful protocol for improving M/L stability.
This study was a randomized control trial. The purpose of this study was twofold: 1) to determine if stretching the hamstrings during whole-body-vibration (WBV) is more effective than static stretching alone; and 2) to monitor retention of flexibility changes. The main outcome measure was hamstring flexibility as measured in degrees using a passive knee extension test. Thirty-four recreationally active college-age subjects (23.4+/-1.7 yrs) completed this study (22 males, 12 females, avg. ht.=175.6+/-6.4 cm, avg. wt.=74.9+/-11.8 kg). Subjects were assigned to a control group (C), a static stretch group (SS), or a vibration + static stretch group (V). Subjects stretched 5 days/wk for 4-weeks and were followed for 3-weeks after cessation to monitor retention. Analysis showed a significant difference between treatment groups (p<0.0001), time (p<0.0001), gender (p=0.0002) and in treatment*time (p=0.0119), with 14%+/-3.86% (SEM) and 22%+/-3.86% (SEM) increases in flexibility after 4-weeks of stretching for the SS and V groups respectively. Three-week follow-up showed SS returning to baseline with V group still 6.4 degrees (11%+/-3.88% (SEM)) more flexible than at baseline. Stretching concurrently with vibration on a WBV platform appears to be a good adjunct to static stretching with the potential to enhance retention of flexibility gains.