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The European College of Sports Sciences Position statement: The role of stretching exercises in sports

June 2006
European Journal of Sport Science 6(2):87-91

DOI:10.1080/17461390600617865

Authors:

Stig Peter Magnusson

Bispebjerg Hospital, Copenhagen University

Per Renström

Karolinska Institutet

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The European College of Sports Sciences Position

statement: The role of stretching exercises in sports

Peter Magnusson; Per Renström

Online Publication Date: 01 June 2006

To cite this Article: Magnusson, Peter and Renström, Per (2006) 'The European

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ORIGINAL ARTICLE

The European College of Sports Sciences Position statement: The role

of stretching exercises in sports

PETER MAGNUSSON & PER RENSTRO

Introduction

The current document addresses i) the biomecha-

nics of stretching, ii) the effect of stretching on injury

risk, and iii) the effect of stretching on performance,

while it does not address the effect of stretching in

various patient populations or as parts of a rehabi-

litation regime.

Stretching is the act of performing a particular

exercise to improve joint range of motion, while

flexibility is traditionally considered the joint range

of motion that can be measured at any given time.

Flexibility is believed to be an important element of

fitness (Corbin & Noble, 1980) and, accordingly,

stretching of human skeletal muscle to improve

flexibility is a widespread practice among competi-

tive and recreational athletes. However, despite the

widespread use and popularity of stretching exercises

in sports with the goal to reduce the passive

resistance of the muscle-tendon unit, reduce injury

risk and improve performance, there is limited or

even a lack of documentation with respect to the

mechanism and effect of this practice. While much

of the knowledge in the area has been based on

human studies using goniometric measurement

technique and animal models using techniques to

evaluate the material properties, there is a growing

body of literature based on human models that

addresses the mechanical properties of the muscu-

loskeletal system.

A fundamental issue to address is how and to what

extent stretching exercises affects the mechanical

properties of the muscle-tendon unit, i.e. does the

muscle-tendon unit become more compliant (less

stiff) as a result of stretching. If the target muscle is

held stationary at some new length during so-called

static stretching, the resistance to elongation mea-

sured as joint moment will decrease with time

(Magnusson, 1998). This is called stress relaxation

and demonstrates that the muscle-tendon unit is

affected during the stretch intervention. Some stu-

dies have demonstrated this stress relaxation phe-

nomena in a human model (Magnusson et al.,

1996d; Magnusson, Simonsen, Aagaard, & Kjaer,

1996a; Magnusson, Simonsen, Aagaard, Sorensen,

& Kjaer, 1996b; McHugh, Magnusson, Gleim, &

Nicholas, 1992; McNair, Dombroski, Hewson, &

Stanley, 2001). With five repeated 90-second static

stretches it can be seen that the resistance (and

stiffness) to stretch is reduced during the subsequent

stretch, indicating that there is an, at least short-term

effect of stretching (seconds-minutes) (Magnusson

et al., 1996a). However, when the stretch is repeated

1 hour later this effect has vanished (Magnusson

et al., 1996a), and when three 45-second stretches

are performed immediately after one another, no

immediate affect can be seen at all (Magnusson,

Aagaard, & Nielson, 2000a). Together these findings

suggest that stretching may affect the passive mecha-

nical properties of the muscle-tendon unit during the

actual stretch maneuver and for some brief time

thereafter, but that this adaptation is very short lived.

Nevertheless, perhaps stretching affects the me-

chanical properties of the force transmitting struc-

tures if it is performed habitually over a longer time

period. This important question has been addressed

by several investigators. The studies show that up

to 4 weeks of stretching for a total of as much as

9,000 seconds in healthy subjects and 36,000

seconds in immobilized human muscle does not

affect the resistance to stretch (Bjorklund, Hamberg,

& Crenshaw, 2001; Halbertsma & Goeken, 1994;

Harvey et al., 2003; Magnusson, Simonsen, Aa-

gaard, Sorensen, & Kjaer, 1996c). In other words,

with one exception (Guissard & Duchateau, 2004),

the available human data overwhelmingly appears

to refute the notion that stretching exercise influ-

ences the resistance to stretch in the long term

Correspondence: P. Magnusson, E-mail: p.magnusson@mfi.ku.dk; P. Renstro

m, E-mail: Per.Renstrom@kirurgi.ki.se

European Journal of Sport Science, June 2006; 6(2): 87 91

ISSN 1746-1391 print/ISSN 1536-7290 online # 2006 European College of Sport Science

DOI: 10.1080/17461390600617865

Downloaded By: [Deutsche Sporthochschule Koeln] At: 16:39 7 November 2007

(Magnusson et al., 1996a; Magnusson et al., 2000a;

Bjorklund et al., 2001; Halbertsma & Goeken, 1994;

Harvey et al., 2003; Magnusson et al., 1996c;

Magnusson, Aagaard, Larsson, & Kjaer, 2000b;

Halbertsma, Mulder, Goeken, & Eisma, 1999;

Laessoe & Voigt, 2004; Magnusson, Aagard, Simon-

sen, & Bojsen-Moller, 1998). Notwithstanding these

relatively new findings, it is apparent to everyone

that gains in joint range of motion can readily be

achieved by performing stretching exercises. How-

ever, these gains in joint range of motion are

achieved in the absence of any altered mechanical

properties, and therefore it appears that the mechan-

ism for the improved joint range of motion is a

tolerance to the imposed stretch (Bjorklund et al.,

2001; Halbertsma & Goeken, 1994; Magnusson

et al., 1996c; Halbertsma et al., 1999; Laessoe &

Voigt, 2004; Magnusson et al., 1998). The exact

mechanism of the neural aspect of stretching the

muscle-tendon unit remains to be unraveled.

Effects of stretching on injury risk

The practice of performing stretching before exercise

prior to participation in sports with the aim to

reduce injury has received some attention in the

literature in recent review articles (Herbert &

Gabriel, 2002; Thacker, Gilchrist, Stroup, & Kim-

sey, 2004; Shrier, 2005). In a thorough review by

Shrier (2005) it was shown that out of 293 articles

on the topic a mere 14 included a control group,

which therefore warranted further analysis. Five

articles suggested that stretching was beneficial while

three articles suggested that it was detrimental and

six suggested no effect at all. However, the articles

that suggested a beneficial effect suffered from the

fact that they included multiple interventions, which

makes it difficult or impossible to attribute the

reduced injury risk to stretching alone. One of the

most commonly cited references is that of Ekstrand,

Gillquist, and Liljedahl (1983) in which the authors

demonstrated that an intervention program that

included 1) correction of training, 2) provision of

optimum equipment; 3) prophylactic ankle taping;

4) controlled rehabilitation; 5) exclusion of players

with grave knee instability; 6) information about the

importance of disciplined play and the increased risk

of injury at training camps; and 7) correction and

supervision by doctor(s) and physiotherapist(s) re-

duced the injury risk substantially. Naturally the

multiple intervention strategy makes it unattainable

to attribute any single one to the observed effect.

Other studies are of questionable value because of

problems related to the randomization procedure

and the use of historical controls (Shrier, 2005).

Three cross-sectional studies (Howell, 1984; Jacobs

& Berson, 1986; Kerner & D’Amico, 1983) suggest

that stretching may actually increase the risk of

sustaining an injury, although these studies should

be viewed with caution since they did not control for

many other factors that may contribute to the injury

risk. Six studies (Blair & Kohl, 1987; Brunet, Cook,

Brinker, & Dickinson, 1990; Macera et al., 1989;

Pope, Herbert, Kirwan, & Graham, 2000; van

Mechelen, Hlobil, Kemper, Voorn, & de Jongh,

1993; Walter, Hart, McIntosh, & Sutton, 1989)

have demonstrated no effect of stretching on injury

risk. One of the most extensive undertaking was that

of Pope et al. (2000) who randomized 1,538 military

recruits to warm-up with or without added stretch-

ing. The results did not support that the stretching

intervention had any effect on injury risk. In another

study Van Mechelen et al. (1993) randomized 421

runners to a stretching and non-stretching group

without demonstrating any effect of the intervention.

It should be noted that these types of studies are very

difficult to perform: the sample size required is

substantial, which makes it costly, and the various

factors, including for example previous injury, that

need to be controlled for, are numerous and

challenging. Notwithstanding these challenges, there

is currently no firm evidence that stretching before

exercise can reduce the injury risk.

The effects of stretching on performance

It seems to be a well accepted notion that stretching

can improve performance in addition to reducing

injury risk. Obviously performance of a given sport

may be very task specific and highly complex, and

such specificity and complexity often precludes it

from being measured in the laboratory setting.

However, some aspect of performance, such as

maximal isometric and dynamic strength, and jump

height are more readily measured and analyzed and

have thus been examined following a stretching

regime. [For a recent review see Shrier (2004)].

There are numerous studies that examine the

acute effects of stretching on performance defined

as maximal voluntary muscle contraction (1 RM,

isometric and isokinetic contraction) or jump per-

formance, and the data show that stretching reduces

these kinds of performance tasks (Avela, Kyrolainen,

& Komi, 1900; Behm, Button, & Butt, 2001; Behm,

Bambury, Cahill, & Power, 2004; Church, Wiggins,

Moode, & Crist, 2001; Cornwell, Nelson, & Sid-

away, 2002; Cramer et al., 2005; Evetovich, Nau-

man, Conley, & Todd, 2003; Fowles, Sale, &

MacDougall, 2000; Knudson & Noffal, 2005; Kok-

konen, Nelson, & Cornwell, 1998; Laur, Anderson,

Geddes, Crandall, & Pincivero, 2003; Mcneal &

Sands, 2003; Nelson, Guillory, Cornwell, & Kokko-

nen, 2001a; Nelson, Allen, Cornwell, & Kokkonen,

2001b; Nelson, Kokkonen, & Arnall, 2005a; Power,

88 P. Magnusson & P. Renstro

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Behm, Cahill, Carroll, & Young, 2004; Young &

Elliott, 2001; Young & Behm, 2003). It is notable

that there is no single study suggesting that muscle

performance is augmented as a function of stretch-

ing. Therefore the evidence overwhelmingly sup-

ports the notion that an acute bout of stretching will

diminish maximal muscle efforts, including jump

performance, immediately after an acute bout of

stretching. Both neural and mechanical properties

have been implicated, but the mechanism for the

stretching associated reduction in performance re-

mains unknown. The effect of stretching on running

speed has also been investigated, and these pub-

lished studies report a lack of effect (deVries, 1962;

Pyke, 1968) or a negative effect (Nelson, Driscoll,

Landin, Young, & Schexnayder, 2005b) on running

speed.

A separate issue is if stretching on a routine basis

can affect performance. There are several studies

that suggest that stretching on a routine basis other

than immediately prior to exercise can improve

performance, such as maximal voluntary contraction

and jump height (Dintiman, 1964; Handel, Horst-

mann, Dickhuth, & Gulch, 1997; Hortobagyi,

Faludi, Tihanyi, & Merkely, 1985; Hunter & Mar-

shall, 2002; Wilson, Elliott, & Wood, 1992; Worrell,

Smith, & Winegardner, 1994). How the magnitude

of this augmentation compares with that of other

forms of training is largely unexplored. The mechan-

ism for the apparent paradox between the immediate

(negative) and long term (positive) effects of stretch-

ing regimes remains unknown.

Another type of measurable ‘performance’ is

running economy, i.e. the energy requirement for

an individual at a given constant speed of locomo-

tion. Although musculoskeletal flexibility is a com-

bination of neural and the mechanical properties of

the muscle-tendon unit (Magnusson et al., 1997), it

is of interest to note that muscoskeletal ‘tightness’ is

associated with greater economy of movement, and

not vice versa (Gleim, Stachenfeld, & Nicholas,

1990), which is a common notion. In line with the

lack of a long term mechanical effect of stretching,

habitual stretching over weeks does not appear to

affect running economy (Godges, MacRae, & En-

gelke, 1993; Nelson, Kokkonen, Eldredge, Corn-

well, & Glickman-Weiss, 2001c), although one study

has shown a small improvement immediately after

stretching (Godges, MacRae, Longdon, Tinberg, &

MacRae, 1989).

Conclusions

. During passive static stretching stress relaxation

occurs, i.e. the mechanical properties of the

muscle-tendon unit are affected during the

actual stretch maneuver, however, this mechan-

ical effect appears to rapidly (minutes) disap-

pear.

. Stretching produces gains in maximal joint

range of motion: the mechanism for the aug-

mented joint range of motion is an increased

tolerance to applied stretch, rather than a

change in the mechanical properties of the

muscle-tendon unit.

. The currently available evidence does not sup-

port the notion that stretching prior to exercise

can effectively reduce injury risk.

. There is no evidence that muscle strength or

jump performance will improve with an acute

bout stretching. In fact, there is firm evidence

that muscle strength and jump performance is

diminished immediately after stretching.

. Habitual stretching may improve maximal mus-

cle strength and jump height.

. Habitual stretching is unlikely to improve run-

ning economy.

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Is There a “Window of Opportunity” for Flexibility Development in Youth? A Systematic Review with Meta-analysis

Article

Full-text available

Jul 2022

Is There a “Window of Opportunity” for Flexibility Development in Youth? A Systematic Review with Meta-analysis

Article

Full-text available

Dec 2022

Background Flexibility is an important component of physical fitness for competitive and recreational athletes. It is generally suggested that flexibility training should start from childhood (6–11 years of age) to optimize joint range of motion (ROM) increases; however, evidence is limited and inconsistent. Objective To examine whether there is a difference in the effect of stretching training on flexibility during childhood (6–11 years of age) and adolescence (12–18 years of age). Design Systematic review and meta-analysis. Methods We searched PubMed Central, Web of Science, Scopus, Embase, and SPORTDiscus, to conduct this systematic review. Randomized controlled trials and non-randomized controlled trials were eligible. No language and date of publication restrictions were applied. Risk of bias was assessed using Cochrane RoB2 and ROBINS-I tools. Meta-analyses were conducted via an inverse variance random-effects model. GRADE analysis was used to assess the methodological quality of the studies. Results From the 2713 records retrieved 28 studies were included in the meta-analysis ( n = 1936 participants). Risk of bias was low in 56.9% of all criteria. Confidence in cumulative evidence was moderate. We found that stretching was effective in increasing ROM in both children (SMD = 1.09; 95% CI = 0.77–1.41; Z = 6.65; p < 0.001; I ² = 79%) and adolescents (SMD = 0.90; 95% CI = 0.70–1.10; Z = 8.88; p < 0.001; I ² = 81%), with no differences between children and adolescents in ROM improvements ( p = 0.32; I ² = 0%). However, when stretching volume load was considered, children exhibited greater increases in ROM with higher than lower stretching volumes (SMD = 1.21; 95% CI = 0.82–1.60; Z = 6.09; p < 0.001; I ² = 82% and SMD = 0.62; 95% CI = 0.29–0.95; Z = 3.65; p < 0.001; I ² = 0%, respectively; subgroup difference: p = 0.02; I ² = 80.5%), while adolescents responded equally to higher and lower stretching volume loads (SMD = 0.90; 95% CI = 0.47–1.33; Z = 4.08; p < 0.001; I ² = 83%, and SMD = 0.90; 95% CI = 0.69–1.12; Z = 8.18; p < 0.001; I ² = 79%, respectively; subgroup difference: p = 0.98; I ² = 0%). Conclusions Systematic stretching training increases ROM during both childhood and adolescence. However, larger ROM gains may be induced in childhood than in adolescence when higher stretching volume loads are applied, while adolescents respond equally to high and low stretching volume loads. Registration: INPLASY, registration number: INPLASY202190032; https://inplasy.com/inplasy-2021-9-0032/

THE EFFECTS OF THE CONTEMPORARY DANCE ON THE PHYSICAL ABILITIES AND BODY BALANCE ON THE 6-9 YEAR-OLD GIRLS: PILOT STUDY

Article

Full-text available

Jul 2023

Introduction. Contemporary dance, with influences from ballet and gymnastics, is an appealing and effective way of practising physical drills in an entertaining way. Objective. The aim of the study was to verify the effect of a 4 week contemporary dance training programme and of some measuring tools as well as the analysis of the entertainment contemporary dance on the motor skills and body balance of the 6-9 year old children. Materials and Methods. The subjects were 16 girls of 6-9 years of age (M=7, STDEV=1,06) who attended contemporary dance training sessions twice a week for a period of 4 weeks. The level of the motor skills was evaluated through standing broad jump (SBJ), back saver sit & reach with alternatively reached legs (S&R_RL – right leg reached, S&R_LL – left leg reached), Matorin test (MatT), crunches (C). The balance was measured standing on both legs (SBL) and on one leg (SOL) on Wii Balance Board fromNintendo (WBB), connected to SeeSway, Ross Clark software . The resulting data were analysed with the SPSS programme. Results. There have been identified statistically significant differences between the initial and final measurements when testing the motor skills and improvements in the balance parameters between the two evaluations, but these differences have not been statistically significant for any of the parameters measured. Conclusions. The study shows that a 4-week workout programme of entertainment contemporary dance may contribute to the development of motor skills. Also, the measuring tools are adequate and easy to use.

Prolonged static stretching increases the magnitude and decreases the complexity of knee extensor muscle force fluctuations

Article

Full-text available

Jul 2023
PLOS ONE

Static stretching decreases maximal muscle force generation in a dose-response manner, but its effects on the generation of task-relevant and precise levels of submaximal force, i.e. force control, is unclear. We investigated the effect of acute static stretching on knee exten-sor force control, quantified according to both the magnitude and complexity of force fluctuations. Twelve healthy participants performed a series of isometric knee extensor maximal voluntary contractions (MVCs) and targeted intermittent submaximal contractions at 25, 50 and 75% MVC (3 x 6 seconds contraction separated by 4 seconds rest, with 60 seconds rest between each intensity) prior to, and immediately after, one of four continuous static stretch conditions: 1) no stretch; 2) 30-second stretch; 3) 60-second stretch; 4) 120-second stretch. The magnitude of force fluctuations was quantified using the standard deviation (SD) and coefficient of variation (CV), while the complexity of fluctuations was quantified using approximate entropy (ApEn) and detrended fluctuation analysis (DFA) α. These measures were calculated using the steadiest 5 seconds of the targeted submaximal contractions at each intensity (i.e., that with the lowest SD). Significant decreases in MVC were evident following the 30, 60 and 120-second stretch conditions (all P < 0.001), with a significant correlation observed between stretch duration and the magnitude of decrease in MVC (r =-0.58, P < 0.001). The 120-second stretch resulted in significant increases in SD at 50% MVC (P = 0.007) and CV at 50% (P = 0.009) and 75% MVC (P = 0.005), and a significant decrease in ApEn at 75% MVC (P < 0.001). These results indicate that the negative effects of prolonged static stretching extend beyond maximal force generation tasks to those involving generation of precise levels of force during moderate-to high-intensity submaximal contractions.

Prolonged static stretching increases the magnitude and decreases the complexity of knee extensor muscle force fluctuations

Article

Full-text available

Jun 2023
PLOS ONE

Static stretching decreases maximal muscle force generation in a dose-response manner, but its effects on the generation of task-relevant and precise levels of submaximal force, i.e. force control, is unclear. We investigated the effect of acute static stretching on knee extensor force control, quantified according to both the magnitude and complexity of force fluctuations. Twelve healthy participants performed a series of isometric knee extensor maximal voluntary contractions (MVCs) and targeted intermittent submaximal contractions at 25, 50 and 75% MVC (3 x 6 seconds contraction separated by 4 seconds rest, with 60 seconds rest between each intensity) prior to, and immediately after, one of four continuous static stretch conditions: 1) no stretch; 2) 30-second stretch; 3) 60-second stretch; 4) 120-second stretch. The magnitude of force fluctuations was quantified using the standard deviation (SD) and coefficient of variation (CV), while the complexity of fluctuations was quantified using approximate entropy (ApEn) and detrended fluctuation analysis (DFA) α. These measures were calculated using the steadiest 5 seconds of the targeted submaximal contractions at each intensity (i.e., that with the lowest SD). Significant decreases in MVC were evident following the 30, 60 and 120-second stretch conditions (all P < 0.001), with a significant correlation observed between stretch duration and the magnitude of decrease in MVC (r = -0.58, P < 0.001). The 120-second stretch resulted in significant increases in SD at 50% MVC (P = 0.007) and CV at 50% (P = 0.009) and 75% MVC (P = 0.005), and a significant decrease in ApEn at 75% MVC (P < 0.001). These results indicate that the negative effects of prolonged static stretching extend beyond maximal force generation tasks to those involving generation of precise levels of force during moderate- to high-intensity submaximal contractions.

Effects of agility, coordination, and flexibility on dribbling skills in senior high school female field hockey players

Article

Full-text available

Jan 2023

Physical condition is an important factor affecting dribbling skills in field hockeys. In this regard, agility, hand-eye coordination, and waist flexibility have not been investigated simultaneously in field hockey players. Therefore, the purpose of this study was to evaluate the effects of agility, hand-eye coordination, and waist flexibility on dribbling skills in senior high school female field hockey players. Thirty female senior high school students in Indonesia were recruited as the research sample. The participants were female students involved in coaching field hockey extracurricular activities at school, average age 17.90 ± 0.80 yrs, height 159.17 ± 1.82 cm, body weight 53.60 ± 3.51 kg, and BMI 21.16 ± 2.89. Data were collected using the agility t-test, throw catch test tennis ball, sit and reach test, and Schmithals-French hockey test. They were then analyzed using correlation and regression. The results showed that agility, hand-eye coordination, and waist flexibility had a significant effect on dribbling skills (p < 0.05). Partially, the effects of agility, hand-eye coordination is 37.40%, and waist flexibility were 76.30 %, 37.40 %, 46.20%, and 84.00%, respectively. Of these three components, agility is the most influential component of dribbling skills, without neglecting hand-eye coordination or waist flexibility. In conclusion, the level of agility, hand-eye coordination, and waist flexibility have a significant impact on dribbling skills in senior high school female field hockey players. Coaches should prepare and develop appropriate training programs for these three components to improve hockey dribbling skills. Future studies are needed to incorporate the physical component and other factors related to field hockey dribbling skills, as well as diversity, and a wider sample size.

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

Article

Full-text available

Mar 2023

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.

London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport

Article

Jan 2023
BRIT J SPORT MED

Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.

Resistance Training Induces Improvements in Range of Motion: A Systematic Review and Meta-Analysis

Article

Full-text available

Jan 2023
SPORTS MED

Background Although it is known that resistance training can be as effective as stretch training to increase joint range of motion, to date no comprehensive meta-analysis has investigated the effects of resistance training on range of motion with all its potential affecting variables. Objective The objective of this systematic review with meta-analysis was to evaluate the effect of chronic resistance training on range of motion compared either to a control condition or stretch training or to a combination of resistance training and stretch training to stretch training, while assessing moderating variables. Design For the main analysis, a random-effect meta-analysis was used and for the subgroup analysis a mixed-effect model was implemented. Whilst subgroup analyses included sex and participants’ activity levels, meta-regression included age, frequency, and duration of resistance training. Data Sources Following the systematic search in four databases (PubMed, Scopus, SPORTDiscus, and Web of Science) and reference lists, 55 studies were found to be eligible. Eligibility Criteria Controlled or randomized controlled trials that separately compared the training effects of resistance training exercises with either a control group, stretching group, or combined stretch and resistance training group on range of motion in healthy participants. Results Resistance training increased range of motion (effect size [ES] = 0.73; p < 0.001) with the exception of no significant range of motion improvement with resistance training using only body mass. There were no significant differences between resistance training versus stretch training (ES = 0.08; p = 0.79) or between resistance training and stretch training versus stretch training alone (ES = − 0.001; p = 0.99). Although “trained or active people” increased range of motion (ES = 0.43; p < 0.001) “untrained and sedentary” individuals had significantly (p = 0.005) higher magnitude range of motion changes (ES = 1.042; p < 0.001). There were no detected differences between sex and contraction type. Meta-regression showed no effect of age, training duration, or frequency. Conclusions As resistance training with external loads can improve range of motion, stretching prior to or after resistance training may not be necessary to enhance flexibility.

KUERSETİN VE RESVERATROL TÜKETİMİNİN ELİT ADÖLESAN ATLETİZM MESAFE KOŞUCULARININ LAKTİK ASİT DÜZEYLERİ İLE KOŞU PERFORMANSI ÜZERİNE ETKİLERİNİN İNCELENMESİ

Thesis

Full-text available

Jun 2020

Büşra Akkaya

ÖZET Kuersetin ve Resveratrol Tüketiminin Elit Adölesan Atletizm Mesafe Koşucularının Laktik Asit Düzeyleri ile Koşu Performansı Üzerine Etkilerinin İncelenmesi Bu çalışmanın amacı kuersetin ve resveratrol tüketiminin elit adölesan atletizm mesafe koşucularının laktik asit düzeyleri ile koşu performansı üzerine etkilerinin incelenmesidir. Araştırmaya Isparta ilinde bulunan elit düzeyde atletizm ile ilgilenen 4 kadın ve 4 erkek adölesan sporcu katılmıştır. Çalışmaya katılan elit adölesan atletlerin yaş ortalamaları 16,13±2,03 yıl, sporcuların vücut ağırlığı ortalamaları 52,02±6,91 kg, boy ortalamaları ise 168,3±10,61 cm olarak tespit edilmiştir. Adölesan sporcuların performanslarına kuersetin ve resveratrolün etkisini ölçmek için çalışma birer hafta ara ile 3 hafta sürmüştür. Her haftanın belirlenen 2 günü kampa alınarak ilk hafta plasebo, ikinci hafta 500 mg kuersetin ve üçüncü hafta 100 mg resveratrol takviyeleri verilmiştir. Kampın ilk günü takviyesiz 1500 m koşmaları istenmiştir. Koşu öncesi ve sonrası laktik asit ölçümü alınmış ve koşu süreleri kaydedilmiştir. İkinci günü ise takviyeler verilerek aynı ölçümler tekrarlanmıştır. Araştırmada; lactate scout, kronometre ve bioelektrik direnç ölçüm cihazı kullanılmıştır. Elde edilen verilerin analizi için Paired – T Testi ve Korelasyon Testlerinden faydalanılmıştır, anlamlılık düzeyi 0,05 olarak kabul edilmiştir. Elde edilen bulgulara bakıldığında; Kuersetin takviyesinin akut etkisinin kadın sporcularda biriken laktik asit seviyelerinde anlamlı düzeyde olduğu, erkeklerde ise koşu süresinde fark oluşturmasına rağmen istatistiksel olarak anlamlı olmadığı, resveratrol takviyesinde ise akut etkinin olmadığı dolayısıyla anlamlı bir sonuç çıkmadığı tespit edilmiştir. Sonuç olarak; kuersetin ve resveratrol müdahalelerinde yalnızca kuersetin takviyesinin kadın elit adölesan atletlerde istatistiksel olarak anlamlı fark yarattığı görülmüştür. Fakat istatistiksel olarak anlamlı çıkmasa da Atletizm spor dalı için çok önemli olan koşu süresi farklılıkları ile karşılaşılmıştır. Dolayısıyla bu çalışmanın özellikle kadın ve nispeten erkek sporcular için kuersetin takviyesinin laktik asit seviyelerini azalttığı, yorgunluğun gecikmesini sağlayarak daha iyi bir performans gösterebileceğini anlatan bir çalışma olduğu söylenebilmektedir. Anahtar Kelimler: Kuersetin, Resveratrol, Laktik Asit, Yorgunluk, Sportif Performans, Adölesan, Kadın Sporcular, Besin Takviyesi, Atletizm ABSTRACT Investigation of the Effects of Quercetin and Resveratrol Consumption on Lactic Acid Levels and Running Performance of Elite Adolescent Athletics Distance Runners The aim of this study is to investigate the effects of quercetin and resveratrol consumption on the lactic acid levels and running performance of elite adolescent athletics distance runners. 4 women and 4 male adolescent athletes interested in elite athletics in Isparta province participated in the study. The average age of elite adolescent athletes participating in the study was 16.13 ± 2.03 years, the average weight of athletes was 52.02 ± 6.91 kg, and the average height was 168.3 ± 10.61 cm. The study took 3 weeks, one week apart, to measure the effect of quercetin and resveratrol on the performance of adolescent athletes. The two days of each week were taken to the camp and the first week was given placebo, the second week was 500 mg quercetin and the third week was 100 mg resveratrol supplements. On the first day of the camp, they were asked to run 1500 m without reinforcement. Before and after the run, lactic acid measurement was taken and the running times were recorded. On the second day, the same measurements were repeated with supplements. In the study; lactate scout, stopwatch and bioelectric resistance measurement device were used. Paired - T Test and Correlation Tests were used for the analysis of the data obtained, the significance level was accepted as 0.05. Considering the findings obtained; It has been determined that the acute effect of quercetin supplement is significant in lactic acid levels accumulated in female athletes, although it is not statistically significant in males despite the difference in running time, and there is no significant result in resveratrol supplement due to the absence of acute effect. As a result; In quercetin and resveratrol interventions, only quercetin supplementation was found to make a statistically significant difference in female elite adolescent athletes. However, although not statistically significant, differences in running time, which are very important for Athletics sports branch, were encountered. Therefore, it can be said that this study is a study explaining that quercetin supplementation decreases lactic acid levels, especially for female and relatively male athletes, and provides a better performance by providing delay of fatigue. Key Words: Quercetin, Resveratrol, Lactic Acid, Fatigue, Sporty Performance, Adolescent, Women Athletes, Nutritional Supplement, Athletic

Flexibility: A Major Component of Physical Fitness

Article

Full-text available

Jun 1980

The Effects of Two Stretching Procedures on Hip Range of Motion and Gait Economy

Article

Full-text available

Feb 1989

The purpose of this study was to 1) compare two commonly practiced stretching techniques to determine which is most effective for improving hip range of motion, and 2) evaluate the effect of these techniques on gait economy. Seven asymptomatic males, 18-22 years of age, served as subjects. Goniometric measurements of hip range of motion (ROM) and gait economy, as measured by submaximal oxygen consumption of walking and running on a treadmill, were taken before and after each of the two stretching procedures, (a) static stretching, and (b) soft tissue mobilization with proprioceptive neuromuscular facilitation (STM/PNF). Static stretching procedures resulted in significant improvements in ROM for hip extension (p < 0.01) and hip flexion (p < 0.01). The STM/PNF also resulted in significant improvements in hip extension ROM (p < 0.01) and hip flexion ROM (p < 0.05). There was a significant improvement in gait economy at 40% VO2max (p < 0.05), at 60% VO2max (p < 0.05), and at 80% VO2max (p < 0.01) following the static stretching procedure. The STM/PNF procedure improved gait economy only at one workload, 60% of VO2max (p < 0.05). These results suggest that a single bout of static stretching or STM/PNF was effective for improving hip ROM but static stretching was more effective for improving gait economy in young, asymptomatic males. J Orthop Sports Phys Ther 1989;10(9):350-357.

Viscoelastic stress relaxation in human skeletal muscle

Article

Full-text available

Dec 1992

Viscoelastic stress relaxation refers to the decrease in tensile stress over time that occurs when a body under tensile stress is held at a fixed length. The purpose of this study was to demonstrate viscoelastic stress relaxation in human skeletal muscle. Resistance to stretch (tensile force), hip flexion range of motion (ROM), and reflex contractile activity (IEMG) of the hamstring muscle group were measured during a passive straight leg raise. The testing protocol involved a first stretch to the maximum tolerated ROM with the lower extremity held at that point for 45 s (test 1). All 15 subjects tested (9 men, 6 women) had a stretch induced EMG response. The onset of a sustained EMG response occurred at a specific hip flexion angle in 10 subjects. These 10 subjects (6 men, 4 women) underwent a second straight leg raise stretch (test 2) to a ROM 5 degrees below the ROM at which the onset of EMG activity occurred in test 1. The stretch was held at this hip flexion angle for 45 s. There was a significant decrease in force at final ROM during the 45 s in test 1 (11.35 +/- 1.75 N, P < 0.0001) and in test 2 (4.2 +/- 1.55 N, P < 0.05). The percent decrease from the force at the respective final ROM was not significantly different between the tests (14.4 +/- 2.2% in test 1 and 13 +/- 2.3% in test 2). In test 1 there was a significant decrease over time in IEMG of 59.71 +/- 16.01 microV.s (P < 0.01) which was not significantly correlated to the decrease in force.(ABSTRACT TRUNCATED AT 250 WORDS)

Stretch shorten cycle performance enhancement through flexibility training

Article

Full-text available

Feb 1992

Sixteen experienced male powerlifters served as subjects in a training study designed to examine the effect of flexibility training on: (i) the stiffness of the series elastic components (SEC) of the upper body musculature and (ii) rebound and purely concentric bench press performance. Nine of the subjects participated in two sessions of flexibility training twice per week for 8 wk. Prior to and after the training period the subjects' static flexibility, SEC stiffness, rebound bench press (RBP), and purely concentric bench press (PCBP) performance were recorded. The flexibility training induced a significant reduction in the maximal stiffness of the SEC. Furthermore, the experimental subjects produced significantly more work during the initial concentric portion of the RBP lift, enabling a significantly greater load to be lifted in the post-training testing occasion. The benefits to performance achieved by the experimental group consequent to flexibility training were greater during the RBP lift as compared with the PCBP lift. The control subjects exhibited no change in any variable over the training period. These results implied that the RBP performance enhancement observed consequent to flexibility training was directly caused by a reduction in SEC stiffness, increasing the utilization of elastic strain energy during the RBP lift.

Acute Static Stretching Reduces Lower Extremity Power in Trained Children

Article

May 2003
PEDIATR EXERC SCI

Several studies utilizing adult subjects have indicated that static stretching may reduce subsequent strength and power production, possibly for as long as an hour following the stretch. This observation has not been evaluated in children, nor in athletes accustomed to performing static stretches during strength/ power type training sessions. The purpose of this investigation was to determine if an acute bout of passive, static stretching of the lower extremity would affect jumping performance in a group of young, female gymnasts. Thirteen competitive gymnasts (age 13.3 ± 2.6 yrs) performed drop jumps under two conditions: immediately following stretching and without prior stretching. The jumps were performed on separate days. The conditions were randomly ordered among the subjects. Time in the air (AIR) and ground contact time (CT) were measured during the drop jumps using a timing mat. Three different stretches of the lower extremity were conducted on each gymnast twice, each stretch being held for 30 seconds. Following the stretching condition, AIR was significantly reduced (.44 vs .46 sec, p < .001), while CT was not different (.130 for both conditions, p > .05). This study demonstrates that children's lower extremity power is reduced when the performance immediately follows passive, static stretching, even in children accustomed to static stretching during training sessions involving explosive power.

The influence of flexibility on the economy of walking and jogging

Article

Nov 1990

The relationship of 11 measures of trunk and lower limb flexibility to the economy of treadmill walking and jogging as measured by steady-state oxygen consumption (VO2) was studied. Subjects (38 women, 62 men, aged 20-62 years) were tested at six speeds between 53.6 and 187.7 m/min. By combining scores from all flexibility tests, and beginning at speeds of 107.3 m/min, the "tightest" third used significantly less O2/m/kg (9%, p less than 0.05) than the "loosest" third, with "normals" in between. Two tests, trunk rotation and lower limb turnout, gave the best separation for walking/jogging economy, with the "tightest" third differing significantly from the "loosest" (8-12%) at all speeds tested (ANOVA with Scheffe). We conclude that nonpathological musculoskeletal tightness was associated with a decreased steady-state VO2 for treadmill walking and jogging.

A survey of running injuries in 1505 competitive and recreational runners

Article

Oct 1990

A 33 item multiple choice questionnaire was circulated; completed questionnaires from 1505 runners (1130 male and 375 female) were obtained. Questions focused upon training, injuries sustained, and medical care. Biomechanical imbalances such as leg length inequality appear to be a major contributing factor to running injuries. Correction of an underlying biomechanical defect may be important in the treatment of many running injuries. Female runners were found to be more susceptible than males to stress fractures at higher mileages. The cause of this increased incidence may be attributable to lower bone mineral density levels as a result of hormonal factors. Factors such as running surface, age and stretching techniques do not appear to play a significant part in the pathogenesis of running injuries.

Predicting lower-extremity injuries among habitual runners

Article

Dec 1989
ARCH INTERN MED

This prospective study of 583 habitual runners used baseline information to examine the relationship of several suspected risk factors to the occurrence of running-related injuries of the lower extremities that were severe enough to affect running habits, cause a visit to a health professional, or require use of medication. During the 12-month follow-up period, 252 men (52%) and 48 women (49%) reported at least one such injury. The multiple logistic regression results identified that running 64.0 km (40 miles) or more per week was the most important predictor of injury for men during the follow-up period (odds ratio = 2.9). Risk also was associated with having had a previous injury in the past year (odds ratio = 2.7) and with having been a runner for less than 3 years (odds ratio = 2.2). These results suggest that the incidence of lower-extremity injuries is high for habitual runners, and that for those new to running or those who have been previously injured, reducing weekly distance is a reasonable preventive behavior.

The Ontario cohort study of running-related injuries

Article

Dec 1989
ARCH INTERN MED

A cohort of 1680 runners was enrolled through two community road race events and monitored during a 12-month follow-up period for the occurrence of musculoskeletal injuries. Forty-eight percent of the runners experienced at least one injury, and 54% of these injuries were new; the remainder were recurrences of previous injuries. The risk of injury was associated with increased running mileage but was relatively unassociated with other aspects of training, such as usual pace, usual running surface, hill running, or intense training. Injury rates were equal for all age-sex groups and were independent of years of running experience. Runners injured in the previous year had approximately a 50% higher risk for a new injury during follow-up.

Injuries to runners: A study of entrants to a 10,000 meter race

Article

Mar 1986
AM J SPORT MED

As the number of runners has increased dramatically, so has the incidence of running-related injuries. In order to determine what training factors are associated with running-related injuries, as well as what percentage of injured runners seeks professional medical attention, a random sample of entrants to a 10 kilometer race was asked to complete a questionnaire. There were 451 respondents, 355 men and 96 women, with a nonresponse rate of 12.7%. Nonrespondents did not differ from respondents with regard to age or sex. Forty-seven percent of respondents indicated that they had sustained a running-related injury in the last 2 years. Injured runners differed significantly from noninjured runners in that they were more likely to have run more miles per week, run more days per week, run a faster pace, run more races in the last year, stretched before running, and not participated regularly in other sports. Associated with injury, but not statistically significant, were those who had run marathons and had done muscle-strengthening exercises. No association was found with regard to the length of time running, running surfaces, part of the foot first contacting the ground, or running intervals, sprints, or hills. Seventy percent of those injured sought professional medical care, with 76% of these having a good or excellent recovery from their injuries. Compliance with medical advice correlated well with treatment success.

The European College of Sports Sciences Position statement: The role of stretching exercises in sports

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