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Comparative Effect of Ultrasound and Deep Oscillation on the Extensibility of Hamstring Muscles
Abstract
Context: Many athletes and non-athletes have tight hamstring muscles that predispose them to injury when they engage in vigorous physical activity. Thermal and mechanical modalities have been used to enhance the effectiveness of muscle stretching, but evidence supporting their benefits is mixed. Deep oscillation is a relatively new modality being used to promote healing of soft tissue injuries; however, the effect of this modality on muscle extensibility is unknown. Objective: To compare the immediate effect of a single 15-minute treatment of ultrasound (US) and deep oscillation (DO) on the extensibility of hamstring muscles.
... In randomized controlled trials, DO was reported to be effective in reducing oedema and hematoma [16,17], reducing inflammation [15] and pain [16][17][18], or increasing healing of sports traumata [16]. In one study DO showed a relaxing effect on the harmstrings muscles, which was expressed in an extension of the range of movement directly after the application [19]. Deep oscillation could be effective for promoting recovery. ...
... Deep oscillation could be effective for promoting recovery. Studies have showed that the interaction between mechanical and electrostatic stimuli in DO improves lymph flow [20], increases blood flow and perfusion [12], modulates inflammation processes [15] and positively impacts mechanical properties of muscles [19]. ...
... In a human skin model IL8 concentration and dilated vessles were reduced, demonstrating the antinflammatory effect of DO, which can be considered positive with regard to regeneration [15]. In one study, DO also showed a positive effect on the extensibility of hamstring muscles, indicating an effect viscoelastic properties of muscles and fasciae, a result which also might be relevant for regeneration and injury prevention [19]. ...
Background/objective:
In soccer the recovery time between matches is often not long enough for complete restoration. Insufficient recovery can result in reduced performance and a higher risk of injuries. The purpose of this study was to evaluate the potential of Deep Oscillation (DO) as a recovery method.
Methods:
In a randomized crossover study including 8 male soccer players (22 ± 3.3 years) the following parameters were evaluated directly before and 48 h after a fatiguing soccer-specific exercise: Maximum isokinetic strength of the leg and hip extensors and flexors (Con-Trex® Leg Press, Physiomed, Germany), rating of perceived exertion (RPE) during isokinetic testing (Borg scale 6-20), creatine kinase (CK) serum levels and Delayed Onset Muscle Soreness (DOMS; visual analogue scale 1-10). By random allocation, half of the group performed a DO self-treatment twice daily (4 applications of 15min each), whilst the other half received no intervention. 4 weeks later a cross-over was conducted. Two-way repeated measures analysis of variance was used to compare treatment versus control.
Results:
A significant treatment effect was observed for maximum leg flexion strength (p = 0.03; DO: 125 ± 206 N vs. CG: -115 ± 194; p = 0.03) and for RPE (DO: -0.13 ± 0.64; vs. CG: +1.13 ± 1.36; p = 0.03). There was a trend to better recovery for maximum leg extension strength (DO: -31 ± 165 N vs. CG: -138 ± 212; p = 0.028), CK values (DO: 72 ± 331 U/ml vs. CG: 535 ± 797 U/ml; p = 0.15) and DOMS (DO: 3.4 ± 1.5 vs. CG: 4.1 ± 2.6; p = 0.49).
Conclusion:
In the present study we found significant effects of DO on maximum leg flexion strength and perceived rate of exertion. Other variables showed a consistent trend in favour of DO compared with the control without significance. DO seems to be a promising method to accelerate the time-course of peripheral recovery of muscle which should be addressed in larger studies in future.
Trial registration:
ClinicalTrials.gov; NCT03411278, 18.01.2018 (during the study).
... [12][13][14][15]16 Previous research has also found that the use of DOT can increase muscular flexibility. 13,[17][18][19][20] Theoretically, DOT is thought to deliver various levels of frequency through an electrical circuit that is created by the modality and completed through the addition of two leads held by the patient and the clinician. The circuit created is referred to as the Johnsen-Rahbeck effect, where a magnetic force is created and a barrier is placed between two electrodes. ...
... These findings are similar to previous research regarding DOT intervention to decrease pain and improve mobility and flexibility. 13,15,17,18 While the outcomes are similar, it is important to note that the interventions methods differed in several of the previous studies that did not report clearing the lymphatic channel prior to intervention at the treatment site. Previous research has identified that a lack of ankle dorsiflexion ROM is a risk factor and contributor to lower-leg pain conditions such as MTSS. ...
Purpose: Lower extremity (LE) pain accounts for 13-20% of injuries in the active population. LE pain has been contributed to inflexibility and fascial restrictions. Deep oscillation therapy (DOT) has been proposed to improve range of motion and reduce pain following musculoskeletal injuries. Therefore, our objective was to determine the effectiveness of DOT on ankle dorsiflexion range of motion (ROM) and pain in individuals with and without lower-leg pain. Methods: We used a single blind, pre-post experimental study in a research laboratory. Thirty-two active participants completed this study. Sixteen individuals reporting lower-leg pain and sixteen non-painful individuals completed the study. Participants received a single session of DOT performed by one researcher to their affected limb or matched limb. The intervention parameters included a 1:1 mode and 70-80% dosage. The intervention began by stimulating the lymphatic channels at the cisterna chyli, the inguinal lymph node, and the popliteal lymph node at a frequency of 150 Hz all for a minute each. Next, the researcher treated the triceps surae complex for 11 minutes at three different frequencies. Finally, the participant was treated distal to the popliteal lymph node at 25 Hz for 5 minutes. The main outcome measures included pain using the VAS and ankle dorsiflexion ROM with the weight-bearing lunge test (WBLT). Statistical analyses included descriptive statistics and F-test comparisons between and within groups. Results: The average WBLT measures for all participants increased 0.6 cm, which not to the minimal detectable change for passive ankle dorsiflexion ROM. Significant differences from pre-post measures were identified for pain on the VAS. Conclusion: While increases in ROM were identified, the difference was not clinically important. DOT was successful in decreasing lower-leg pain
... • Leads to reduction of increased muscle tone and relaxation, mobilizes fascial tissue, and increases reduced range of motion in joints [2,8,9,[26][27][28]; ...
A low-frequency and low-intensity pulsed electrostatic field is applied as a treatment method in Rehabilitation Medicine. The technique is known as Deep Oscillation® therapy. At present, it has been established that the therapeutic effects of the electrostatic field on the tissues depend on the field frequency (5-250 Hz). The advantage of the method is the operation with a low amperage of 5-7 μA and a bipolar form of the wave. Deep Oscillation® was originally created to improve tissue lymphatic drainage. Subsequently, it was found that it reduces acute and chronic pain, improves blood and lymph circulation in the region of application, and reduces edema and fibrosis. In addition to this, tissue elasticity, joint mobility, and the condition of muscle and nerve tissue are improved. The aim of this research project is to investigate the therapeutic impact of a low-frequency and low-intensity pulsed electrostatic field in patients with symptomatic knee osteoarthritis.
... The study carried out by, [11] M.R.Hinmann(2013)et al. which was RCT on 15 athletes and non-athletes to estimate the effect of Ultrasound vs. Deep oscillation treatment on hamstring muscles. The length of the muscle was measured by passive SLR (Single Leg Raise) using an inclinometer. ...
BACKGROUND: As a result of restricted joint range of motion due to spasticity in patients with spastic cerebralpalsy, the patient’s ability to regain normal functioning may be hindered.PURPOSE: To evaluate the effectiveness of Myofascial Release Therapy (MFR) versus Deep Oscillation Therapy(DOT) in helping children with spastic cerebral palsy to relax and extend their hamstring range of motion.METHODOLOGY: A total of 32 individuals with spastic cerebral palsy, aged 2 to 10, were recruited for thiscomparative experimental study through a method of random sampling. Sixteen subjects were assigned to eachgroup. Group 1(N=16) received two sessions of MFR with conventional exercise per day, whereas Group 2(N=16)received a single session of DOT with conventional exercise per day. Throughout the course of four weeks, bothgroups got therapy five days per week. A universal goniometer was used to compare the knee extension passiverange of motion (PROM), active range of motion (AROM), and Popliteal angle (POP angle) measurements betweenthe pre- and post-treatment periods. Statistical analyses were conducted using ANOVA 2×2 and Post hoctables.RESULT: Both groups’ post-mean values for each of the dependent variables (AROM, PROM, and POP angle)statistically improved (p< 0.05). Both groups’ mean differences in the PROM and POP angles were statisticallysignificant, and Group 1’s spastic hamstring muscle was more improved than Group 2’s, but both groups’ AROMshowed almost equal improvement.CONCLUSION: In children with spastic cerebral palsy, both MFR and DOT, when combined with conventionaltherapy, reduce spasticity and increase length (AROM & PROM) in the hamstring muscle. However, our studyclearly shows that MFR is more successful than DOT.
... Повлиява се мускулния спазъм и се постига релаксация на мускулите. Deep Oscillation проявява лимфодренажен ефект [13,16], редуцира се едема на периставните тъкани [17,18,20]. Намаляването на отока и подобряването на функционалното състояние на интерстициалното простронство [13,20] способства за по-бързото елиминиране на метаболитните продукти и интерстициална течност. ...
Osteoarthritis (OA) is the most common rheumatic disease. It is a long-term chronic disease, which is characterized by destructive changes in the cartilage of joints. Clinically, OA is manifested with pain, stiffness and a reduced range of movement of the joints. There is established increase of symptomatic knee OA worldwide is observed. OA is the most common cause of disability in the elderly people which affects the knee. This leads to reduced daily functional activity and reduced quality of life. Pain is often the first and major symptom of knee joint OA (KJ) and is often associated with functional deficiency of the affected joint.
Pathogenesis of OA pain is multifactorial. It may be due to the engagement of the intra- and / or the structures around the joint. Pain reduction is an important factor in improving quality of life and in avoiding a number of side effects such as decreased muscle activity, muscular atrophy, reduction in overall muscle activity, osteopenia, sleep disturbance and psychosocial stress.
Purpose: To evaluate the therapeutic effects of a complex rehabilitation involving Deep Oscillation (DO) and Kinesitherapy on pain in patients with symptomatic knee osteoarthritis.
Materials and methods: The study included 57 patients (42 women and 15 men, average age 65.6 ± 11.3 years) with clinical expression of symptomatic knee OA and radiographic data of II and III-grade of Kellgren and Lawrence system for classification of knee osteoarthritis. Patients underwent a ten-day complex rehabilitation including Deep Oscillation treatment using a hand applicator. The knee joint, the surrounding tissues and the m. Quadriceps femoris area were treated. The therapeutic course for all patients included 10 kinesitherapy procedures (KT) including different types of exercises, carried out immediately after electrotherapy.
Results: The results were scored by assessing the pain at rest, walking, descent stairs and ascending stairs in four time periods: before and after treatment, at I-st and III-rd month, through VAS (a Visual-Analogue Scale for pain). We recognize statistically significant pain reduction after treatment, I and III month at rest (p<0.001), walking (p<0.001), descent (p<0.001) and ascending (p<0.001). The post-treatment effect was observed at 3-months after complex rehabilitation.
Conclusion: The results of the conducted observational study show prolonged (at least III months) pain reduction effect in patients with gonarthritis, who underwent complex rehabilitation with Deep Oscillation and Kinesitherapy. Complex rehabilitation, including Deep Oscillation and kinesitherapy, could be an effective pain relief option in patients with symptomatic osteoarthritis of the knee joint. In our opinion, more objective results can be achieved through by conducting randomized trials evaluating the therapeutic effects of complex rehabilitation involving Deep Oscillation therapy in larger number of patients.
Keywords: Gonarthritis, Deep Oscillation therapy, Pain, VAS, Kinesitherapy
ABSTRACT:
The advancement of technology has led to the development of surgical instruments that aim to assist and improve surgical skills and patient satisfaction after operation. One of the most significant advancements in this field has been the introduction of navigation systems for knee arthroplasty. Computer-assisted orthopedic surgery and navigation applications work towards fusing images with anatomical landmarks in real-time. In addition to being an educational tool for less experienced surgeons, this technology also assists experienced surgeons in planning bone cuts, tunneling, and ligament balancing.
Purpose: This study explores the potential benefits of physical therapy methods for patients who have undergone Navigated total knee replacement.
Material/Methods: The study comprised ten patients of both sexes aged between 18 and 80 years with an assisted total knee arthroplasty who fulfilled the specified inclusion criteria. The patients underwent navigated total knee arthroplasty, which resulted in postoperative contracture and oedema. Patients are followed up at three-time points and assessed using a knee injury and osteoarthritis outcome score questionnaire, circumference measurements, range of motion and a pain rating scale (visual analogue scale).
Results: A significant improvement has been observed in reducing girth measurements and pain rating scale, as measured by (VAS), increase in ROM and a decrease in contracture.
Conclusions: Combining the surgical technological revolution with the potential of restorative physical therapy methods is essential for achieving sustainable and fast results.
Keywords: navigation systems for knee arthroplasty, total knee replacement, kinesitherapy, deep oscillation therapy
Context:
Hamstring inflexibility is typically treated using therapeutic massage, stretching, and soft tissue mobilization. An alternative intervention is deep oscillation therapy (DOT). Currently, there is a lack of evidence to support DOT's effectiveness to improve flexibility.
Objective:
To explore the effectiveness of DOT to improve hamstring flexibility.
Design:
Randomized single-cohort.
Setting:
Research laboratory.
Participants:
Twenty-nine healthy (males=14, females=15; height=172.9±9.7 cm; mass=76.4±14.5 kg; age=22.9±2.3 years), physically-active individuals (self-reported activity of a minimum 200 minutes per week).
Interventions:
All participants received a single session of DOT with randomization of the participant's leg for the intervention. The DOT intervention parameters included a 1:1 mode and 70-80% dosage at various frequencies for 28 minutes. Hamstring flexibility was assessed using passive straight leg raise (PSLR) for hip flexion using a digital inclinometer. Patient-reported outcomes were evaluated using the Copenhagen Hip and Groin Outcome Score (HAGOS) and the Global Rating of Change (GRoC).
Main outcome measure:
The independent variable was time (pre and post). The dependent variables included PSLR (mean degrees), the GRoC (points), and the participant's perceptions of the intervention (points). Statistical analyses included a dependent t-test and a Pearson correlation.
Results:
Participants reported no issues with sport, daily living or quality of life prior to beginning the intervention study on the HAGOS. PSLR significantly improved post-DOT (95% CI: 4.48-7.85°, p < 0.001) with a mean difference of 6.17±4.42° (pre-DOT = 75.43±21.82° and post-DOT = 81.60±23.17°). Participants noted feeling between "somewhat" to "moderately better" (3.17±1.56) post-DOT on the GRoC. A significant moderate positive correlation was identified (r=0.439, p=0.017) amongst all participants between the GRoC and the mean change score of hamstring flexibility. Participants believed that the intervention improved their hamstring flexibility (5.41±1.02 points) and was relaxing (6.21±0.86).
Conclusions:
DOT is an effective intervention to increase hamstring flexibility using patient- and clinician-reported outcome measures.
Background: Family caregivers play an important role in the support of terminal ill at home. However, there are few models of clinic supervision that help nurses to make decisions according the clinical situation of the terminally ill and needs of family caregiver.
Aim: The aim of this PhD was develop a Model of Clinical Supervision to be used by nurses, in order to help on take clinic decision according with the self-care needs of patient and needs of family caregiver at home.
Methods: Data collection was performed between December 2012 and June 2013, using interviews (11), observations (44) and field notes (Ethnography). All the data were transcribed verbatim and subjected to codification using content analysis and international classification for nursing practice. After this, researcher built the Model which was subject to assessment of experts in primary and palliative care (Delphi technique).
Results: 10 terminal ill were recruited, 8 were women, mean age of 84 years. 8 of participants had dementia as principal medical diagnosis, followed by oncologic disease (1) and degenerative bone disease (1). All participants needed 24 hours of care. Family caregivers (10), with mean age of 58,9 years, 9 female and 8 were unemployed. Data were categorised into problems of the terminal ill that conducted to dependence in self-care, degree of dependence, which risks of complication resulting therefrom, which the care provided and training needs expressed by family carers, what needs caregiver ignores according the clinical condition of terminal ill. Formal and informal support was assessed to.
Conclusion: Models of clinical supervision that use real and encoded data allow the detection of real needs, while obtaining immediate indicators of the health of terminal ill, diagnostic of the meet and unmet needs of family caregivers and the support used. The study presents as limitation the small number of participants, which does not detract from the importance of the results.
Stretching is often used to improve joint range of motion (ROM), but also whole body vibration training seems to help in increasing the range of motion. The purpose of this study was to determine the effect of whole body vibration, PNF training or a combination of both on range of motion of the hamstrings and the maintenance of range of motion after stopping the flexibility training program in male students. The result showed that all groups had a significant increase in hamstring range of motion and combination group showed greater increase. After three weeks of cessation training all groups showed significant decrease in hamstring range of motion but in WBV group decrease was less than other groups. This study showed that WBV in combination with PNF stretching is a more effective regiment to increase range of motion of the hamstrings than PNF or WBV training alone. Also only WBV training can be used for increasing range of motion in the hamstrings.
Does the localised application of vibration over the hamstrings improve hamstring extensibility?
Randomised controlled trial with concealed allocation, intention-to-treat analysis, and assessor blinding.
30 non-athletic females (aged 18-22 yrs) with limited hamstring extensibility bilaterally.
The experimental group received 3 sessions of localised application of vibration per week for 8 weeks. At each session, 3 sets of vibration were applied over the left and right hamstring muscles. The control group continued their usual daily activities. Both groups were asked to perform no specific exercises during the 8-week intervention period.
Hamstring muscle extensibility was measured bilaterally at baseline and at the end of the 8-week intervention period by measuring passive knee extension in supine with 90 deg of hip flexion.
At baseline, the mean lack of knee extension was 27 deg (SD 9) in the experimental group and 24 deg (SD 8) in the control group. At 8 weeks, this had changed to 13 deg (SD 5) in the experimental group and 23 deg (SD 9) in the control group. This was a significant treatment effect: mean between-group difference of 13 deg (95% CI 11 to 16).
An 8-week regimen of localised application of vibration over the hamstring muscles significantly reduces knee extension lack in women with reduced range on the passive knee extension test.
IRCT201011031254N6.
Serious stretching in many sports involves discomfort and is often an early ceiling on improvements.
To continue investigation of the use of vibration to enhance acute range of motion while assessing the influence of vibration and stretching on pressure-to-pain threshold perception.
Ten young male gymnasts were assessed for split range of motion. One side split was randomly assigned as the experimental condition, and the other side split was assigned as the control. Both side splits were performed on a vibration device; the experimental condition had the device turned on and the control condition was performed with the device turned off. In addition, the athletes were assessed for pressure-to-pain transition using an algometer on the biceps femoris (stretched muscle) and vastus lateralis (nonstretched muscle) bilaterally.
Pre-post difference scores between the vibrated split (most improved) and the nonvibrated split were statistically different (P=.001, 95% confidence interval of the difference 2.3 to 5.8 cm). Following the stretching protocol, the force values for the pressure-to-pain threshold comparing the vibrated and nonvibrated biceps femoris muscle were not statistically different. The nonstretched vastus lateralis muscle also showed no statistical difference in pressure-to-pain threshold between the vibration and nonvibration conditions.
This study showed that vibration improved split range of motion over stretching alone, but did not show a difference in pressure-to-pain perception in either the stretched or nonstretched muscles.
OBJECTIVE: To compare the effects of low-load, short-duration stretching with or without high-intensity, pulsed short-wave diathermy on hamstring flexibility. DESIGN AND SETTING: We used a single-blind, repeated-measures design (pretest and posttest for all treatments) that included a placebo. The 3 independent variables were treatment mode, pretest and posttest measurements, and day. Treatment mode had 3 levels: diathermy and stretching, stretching alone, and control. The dependent variable was range of motion. Subjects were randomly assigned to the diathermy and stretching, stretching-only, or control group. Subjects were treated and tested each day (at approximately the same time) for 5 days, with a follow-up test administered 72 hours later. Hamstring flexibility was tested using a sit-and-reach box before and after each treatment. Diathermy and stretching subjects received a 15-minute diathermy treatment on the right hamstring at a setting of 7000 pulses per second, with an average pulse width of 95 μsec. Stretching-only subjects received a 15-minute sham diathermy treatment. Both diathermy and stretching and stretching-only subjects then performed three 30-second stretches (short duration) before being retested. Control subjects lay prone for 15 minutes before being retested. SUBJECTS: Thirty-seven healthy college students (11 men, 26 women, age = 20.46 +/- 1.74 years) volunteered. MEASUREMENTS: Hamstring flexibility was measured using a sit-and-reach box before and after each treatment. RESULTS: The average increases in hamstring flexibility over the 5 treatment days for the diathermy and stretching, stretching-only, and control groups were 6.06 cm (19.6%), 5.27 cm (19.7%), and 3.38 cm (10.4%), respectively. Three days later (after no treatment), the values for the diathermy and stretching, stretching-only, and control groups were 8.27 cm (26.7%), 6.83 cm (25.3%), and 4.15 cm (14.2%), respectively. No significant differences in hamstring flexibility were noted among the groups. CONCLUSIONS: Diathermy and short-duration stretching were no more effective than short-duration stretching alone at increasing hamstring flexibility. The effects of diathermy with longer stretching times need to be researched.
The purpose of this study was to investigate the effect of dynamic soft tissue mobilisation (STM) on hamstring flexibility in healthy male subjects.
Forty five males volunteered to participate in a randomised, controlled single blind design study. Volunteers were randomised to either control, classic STM, or dynamic STM intervention. The control group was positioned prone for 5 min. The classic STM group received standard STM techniques performed in a neutral prone position for 5 min. The dynamic STM group received all elements of classic STM followed by distal to proximal longitudinal strokes performed during passive, active, and eccentric loading of the hamstring. Only specific areas of tissue tightness were treated during the dynamic phase. Hamstring flexibility was quantified as hip flexion angle (HFA) which was the difference between the total range of straight leg raise and the range of pelvic rotation. Pre- and post-testing was conducted for the subjects in each group. A one-way ANCOVA followed by pairwise post-hoc comparisons was used to determine whether change in HFA differed between groups. The alpha level was set at 0.05.
Increase in hamstring flexibility was significantly greater in the dynamic STM group than either the control or classic STM groups with mean (standard deviation) increase in degrees in the HFA measures of 4.7 (4.8), -0.04 (4.8), and 1.3 (3.8), respectively.
Dynamic soft tissue mobilisation (STM) significantly increased hamstring flexibility in healthy male subjects.
Therapeutic ultrasound is an effective deep heating modality commonly applied alone or after cooling or heating of the treatment area. The purpose of this study was to examine the tissue temperature rise in the human triceps surae muscle group after ultrasound with prior heating via a silicate gel hot pack.
This study was designed as a 2 x 2 x 3 factorial with repeated measures on two factors (depth and time). Independent variables were temperature of pack (hot and room temperature), depth of measurement (1 cm and 3 cm), and time (beginning, after pack application, and after ultrasound). The dependent variable was tissue temperature. Subjects were assigned to one of two treatment groups: ultrasound preceded by a 15-minute hot pack treatment or ultrasound preceded by a 15-minute application with a silicate gel pack at room temperature. Measurements were taken while subjects were treated in a university training room.
Twenty-one uninjured male and female college student volunteers were randomly assigned to one of the two pack groups.
The hot packs were stored in 75 degrees C water. A 1-MHz ultrasound treatment was administered for 10 minutes at an intensity of 1.5 W/cm(2). Tissue temperature was measured every 30 seconds using 23-gauge hypodermic microprobes interfaced with a telethermometer and inserted 1 and 3 cm below the surface of anesthetized triceps surae muscle.
At both tissue depths, there was a 0.8 degrees C greater increase in tissue temperature with hot packs and ultrasound. At 1 cm, ultrasound increased temperature 3.5 degrees C after a 0.5 degrees C rise during the room temperature-pack application, but only 0.6 degrees C after a 3.8 degrees C increase during hot-pack application. At 3 cm, ultrasound increased temperature 3.85 degrees C following a slight (-0.26 degrees C) decrease during the room temperature-pack application and 3.68 degrees C after a 0.74 degrees C increase during hot-pack application.
Vigorous increases in deep muscle temperature (>/=4 degrees C) can be reached with 2 to 3 minutes less total sonation time when preheated with a hot pack. Thus, ultrasound and hot packs have an additive effect on intramuscular temperature, but the characteristics of the additive effect are different, primarily because there appears to be a tissue temperature plateau.
To investigate the efficacy of stretching with ice for increasing hamstring flexibility.
Supine hamstring flexibility was measured before and after subjects accomplished a 20-minute hamstring stretching routine. Two groups of eight subjects accomplished the routine using one of two modalities. A control group (n = 8) accomplished the routine without a modality. The measurements were compared.
Twenty-four male collegiate baseball players.
Heat or ice applied to the hamstring.
We found differences in the responses among subject groups. Supine hamstring flexibility after stretching with ice was greater than both stretching with heat and stretching alone. Scores after stretching with heat and stretching alone were not different.
The results of our investigation suggest that the application of ice may provide enhanced short-term improvements in hamstring flexibility over heat or stretching alone. Further research is necessary to investigate the possible mechanisms for these improvements and to determine whether similar results can be obtained with other muscle groups.
The reliability and measurement error of several impairment measures used during the clinical examination of patients with patellofemoral pain syndrome (PFPS) has not been established. The purpose was to determine the inter-tester reliability and measurement error of measures of impairments associated with PFPS in patients with PFPS.
A single group repeated measures design was used. Two pairs of physical therapists participated in data collection. Examiners were blinded to each others' measurements.
Thirty patients (age 29 +/- 8; 17 female) with PFPS participated in this study. Inter-tester reliability coefficients were substantial for measures of hamstrings, quadriceps, plantarflexors, and ITB/TFL complex length, hip abductors strength, and foot pronation (ICCs from .85 to .97); moderate for measures of Q-angle, tibial torsion, hip external rotation strength, lateral retinacular tightness, and quality of movement during a step down task (ICCs from .67 to .79); and poor for femoral anteversion (ICC of .45). Standard error of measurement (SEM) for measures of muscle length ranged from 1.6 degrees to 4.3 degrees. SEM for Q-angle, tibial torsion, and femoral anteversion were 2.4 degrees, 2.9 degrees, and 4.5 degrees respectively. SEM for foot pronation was 1 mm. SEM for measures of muscle strength was 1.8 Kg for abduction and 2.4 Kg for external rotation.
Several of the impairments associated with PFPS had sufficient reliability and low measurement error. Further investigation is needed to test if these impairment measurements are related to physical function and whether or not they are useful for decision-making.
Authored by two leading researchers in the athletic training field, the Second Edition of Therapeutic Modalities: The Art and Science provides the knowledge needed to evaluate and select the most appropriate modalities to treat injuries. The authors use an informal, student-friendly writing style to hold students' interest and help them grasp difficult concepts. The unique approach of the text teaches aspiring clinicians both the how and the why of therapeutic modality use, training them to be decision-making professionals rather than simply technicians. The Second Edition is revised and expanded to include the latest research in therapeutic modalities. New material has been added on evidence-based practice, and other areas, such as pain treatment, are significantly expanded. It retains the successful format of providing the necessary background information on the modalities, followed by the authors' "5-Step Application Procedure." New photos, illustrations, and case studies have also been added.
Poor muscle flexibility has often been associated with injury. Therapeutic heating modalities are frequently used to increase the extensibility of the muscle. The purpose of this study was to compare immediate changes in hamstring flexibility following the application of superficial (moist heat pack) and deep (1 MHz ultrasound) heating modalities. Twenty-four college aged subjects met the inclusion criteria and volunteered for this study. Subjects reported to the Athletic Training Lab and received either the ultrasound or moist heat pack treatment. Hamstring flexibility was measured pre and post treatment using an active knee extension test with an inclinometer. An average of three measurements was used in the analysis. Subjects who received the ultrasound treatment showed greater immediate gains in hamstring flexibility. Therefore ultrasound would be the recommended treatment for increasing extensibility of the hamstring muscles.
The most common lower quarter neurodynamic test is the straight leg raise (SLR) test. Quantification of limb motion during SLR testing should utilize reliable and valid measurement tools that are highly sensitive to change. The purpose of this study was to determine the psychometric properties of a hand-held inclinometer commonly utilized during SLR testing.
Cross-sectional measurement, intra-rater reliability and validity study.
Research laboratory.
Twenty individuals without pain in their low back or extremities and no history of nerve injury participated in the study.
Two repetitions of the SLR were performed in each limb in two ankle positions (plantar flexion and dorsiflexion). A digital inclinometer and digital goniometer were utilized as the comparisons for range of motion measurements.
Intra-rater reliability for the hand-held inclinometer during SLR testing was excellent (ICCs, 0.95 to 0.98). The standard error of measurement was between 0.54° and 1.22° and the minimal detectable change was between 1.50° and 3.41°. Construct validity revealed hand-held inclinometer measurements were highly correlated with both the digital inclinometer and digital goniometer measures. The mean difference scores between hand-held inclinometer and digital inclinometer (∼1.5°) and digital goniometer (∼10°) suggest that the hand-held inclinometer better matches the construct measured by the digital inclinometer (limb elevation angle) compared to the digital goniometer (hip flexion angle).
The hand-held inclinometer is a valid method for measuring limb elevation angle during the SLR neurodynamic test in a research setting. The hand-held inclinometer has high reliability and low minimal detectable change when used in healthy individuals.
Summary The straight leg raise (SLR) test is widely used by physiotherapists, orthopaedic surgeons and physicians in assessment, reassessment, diagnosis and research. This review investigated the reliability of the SLR test. It revealed that test-retest reliability has not been well established. Methodological flaws confound the interpretation of the reported reliability in many of the studies. In addition, most studies reported reliability using correlation coefficients, which did not indicate the size of error typically associated with the test. To calculate error in degrees and to compare results across studies, wherever possible the standard error of measurement (SEM) and 95% confidence intervals for the difference between repeated measurements were calculated from reported data. The most credible results estimated that to be 95% confident that a real change in SLR has occurred, test-retest measurements need to change by more than 6°. Inter-session measurements need to change by more than 16°, and inter-tester measurements need to change by more than 14°. However, factors such as testing asymptomatic subjects, inadequate description of methodology, and non-blinded measurement procedures limit application of some of these results. A number of procedures to decrease error in SLR measurements are proposed, including standardisation of the SLR test protocol.
The aim was to introduce and evaluate the reliability and validity of an active hamstring flexibility test as a complement to common clinical examination when determining safe return to sport after hamstring injury.
Eleven healthy subjects (28 years) were tested on repeated occasions, and 11 athletes (21 years) with MRI-verified acute hamstring strain were tested when common clinical examination revealed no signs of remaining injury, i.e. there was no differences between the legs in palpation pain, manual strength tests, and passive straight leg raise. Flexibility, i.e. highest range of motion of three consecutive trials, was calculated from electrogoniometer data during active ballistic hip flexions and conventional passive slow hip-flexions in a supine position. A VAS-scale (0-100) was used to estimate experience of insecurity during active tests.
No significant test-retest differences were observed. Intra-class correlation coefficients ranged 0.94-0.99 and coefficients of variation 1.52-4.53%. Active flexibility was greater (23%) than passive flexibility. In the athletes, the injured leg showed smaller (8%) active, but not passive, flexibility than the uninjured leg. Average insecurity estimation was 52 (range 28-98) for the injured and 0 for the uninjured leg, respectively.
The new test showed high reliability and construct validity; furthermore, it seems to be sensitive enough to detect differences both in active flexibility and in insecurity after acute hamstring strains at a point in time when the commonly used clinical examination fails to reveal injury signs. Thus, the test could be a complement to the common clinical examination before the final decision to return to sport is made.
Various theories have been proposed to explain increases in muscle extensibility observed after intermittent stretching. Most of these theories advocate a mechanical increase in length of the stretched muscle. More recently, a sensory theory has been proposed suggesting instead that increases in muscle extensibility are due to a modification of sensation only. Studies that evaluated the biomechanical effect of stretching showed that muscle length does increase during stretch application due to the viscoelastic properties of muscle. However, this length increase is transient, its magnitude and duration being dependent upon the duration and type of stretching applied. Most of these studies suggest that increases in muscle extensibility observed after a single stretching session and after short-term (3- to 8-week) stretching programs are due to modified sensation. The biomechanical effects of long-term (>8 weeks) and chronic stretching programs have not yet been evaluated. The purposes of this article are to review each of these proposed theories and to discuss the implications for research and clinical practice.
In Germany approximately 2 million sports injuries occur per year. Most common are distorsions and ligamentous injury going along with posttraumatic lymphoedema. With the therapy method deep oscillation very good results in other indications and in lymphdrainage were reached. The purpose of this experimental study was the evaluation of the effects of the therapy method deep oscillation in immediate therapy and after-care of different sports injuries in addition to usual care (complex physical and medical therapy).
Two soccer teams were supported by a sports medicine section of a rehabilitation hospital. In n = 14 people (mean age 23.9 years) 49 sports injuries of different kind were treated.
Subjective rating of the symptoms by VAS improved significant (p = 0.001) from 8.7 (baseline) to 2.1 points (post-treatment). Objective rating by the attending physician according to different clinically relevant parameters lead to "very good" or "good" results in 90 % of the patients.
In conclusion it can be stated that therapy method deep oscillation is an easy to use and comparably cost effective adjuvant therapy option. We already had good experience with it in other indications concerning reabsorption of oedema, reducing pain, anti-inflammatory effect, promotion of motoricity, promotion of wound healing, anti-fibrotic effect and improvement in trophicity and quality of the tissue. All these mentioned effects can be confirmed in the treatment of patients with acute sports injury and trauma. The soft mode of action is the reason that in contrast to other electric and mechanical therapies it is no contraindication in immediate therapy. In general we noted no side effects; patients were highly compliant and rated this therapy as very good.
To investigate symptoms and functional impairment in women with secondary lymphoedema of the breast following surgical treatment and to assess the therapeutic benefit of treatment with low-intensity and extremely low-frequency electrostatic fields (Deep Oscillation), supplementing manual lymphatic drainage.
Twenty-one patients were randomized either to the treatment group (n=11): 12 sessions of manual lymphatic drainage supplemented by Deep Oscillation, or to the control group (n=10): manual lymphatic drainage alone. Assessment included subjective pain and swelling evaluation, range of motion of the shoulder and the cervical spine, and analysis of breast volume using a 3D measuring system.
Patients had high pain and swelling scores at baseline. Shoulder mobility was impaired in all patients; restriction of cervical spine mobility was common at baseline and declined further in the control group. Deep Oscillation resulted in significant pain reduction in the treatment group. The subjective reported reduction of swelling in both groups was confirmed objectively by 3D measurement only in the treatment group.
Additional Deep Oscillation supplementary to manual lymphatic drainage can significantly enhance pain alleviation and swelling reduction in patients with secondary breast lymphoedema compared with manual lymphatic drainage alone.
This study was designed to measure the effect on range of motion of a single massage treatment to the hamstring muscle group. Thirty-four normal female subjects between 18 and 35 years of age were given a 9- 12 minute massage treatment to the posterior aspect of one randomly assigned lower extremity. Passive range of motion of both lower extremities was measured by taking the perpendicular distance from the lateral malleolus to the table surface in a straight leg raise and by conventional goniometry for hip flexion and knee extension. Measurements were taken pre-, and post-, and 7-days postmassage treatment. Immediate postmassage increases in range of motion were noted in the test group (massaged) legs with significance at the 0.05 level. The possible uSe of this treatment in athletics and pathological conditions are discussed. J Orthop Sports Phys Ther 1984;6(3):168-172.
Hamstring muscle injury is a complex problem for athletes, physicians, physical therapists, and athletic trainers. This injury tends to recur and to limit participation in athletic competition. The etiology of hamstring muscle injury continues to be confusing and incomplete for clinicians and researchers. The purposes of this paper are: 1) to review briefly hamstring muscle group anatomy and function, 2) to review the clinical and animal research literature concerning the role of strength, flexibility, warm-up, and fatigue in hamstring muscle injury, 3) to present an evaluation and rehabilitation scheme for hamstring muscle injury, 4) to describe a theoretical multiple factor hamstring injury model, and 5) to offer recommendations concerning prevention of hamstring muscle injury. During preseason screening and rehabilitation following hamstring muscle injury, clinicians should consider the influence of hamstring strength, flexibility, warm-up, and fatigue on muscle performance. Additional research concerning these factors is recommended. J Orthop Sports Phys Ther 1992;16(1):12-18.
To achieve the thermal effects of ultrasound, the tissue temperature must be raised from 1 to > or = 4 degrees C, depending on the desired outcome of the treatment. In the past 25 years, there have been no in vivo studies that have measured rate of change in temperature during 1-MHz ultrasound treatments, and none have ever been performed with the 3-MHz frequency. Thus, we are left to pure speculation regarding how long to administer an ultrasound treatment. We performed this study to plot the rate of temperature increase during ultrasound treatments delivered at various intensities and frequencies. We inserted two 23-gauge thermistors into each subjects' medial triceps surae at the following depths: 1 MHz at depths of 2.5 and 5.0 cm (12 subjects) and 3 MHz at depths of .8 and 1.6 cm (12 subjects). Each subject received a total of four 10-minute treatments, one each at .5, 1.0, 1.5, and 2.0 W/cm2, and temperature was measured every 30 seconds. No significant difference was found in the rate of heating at the two depths (p = .987) within the same frequency and dose levels. The 3-MHz frequency heated significantly faster than the 1-MHz frequency at all doses tested (p < .001). On average, the rate of temperature increased per minute at the two depths of the 1-MHz frequency was: .04 degrees C at .5 W/cm2; .16 degrees C at 1.0 W/cm2; .33 degrees C at 1.5 W/cm2; and .38 degrees C at 2.0 W/cm2. The rate of temperature increase per minute at the two depths of the 3-MHz frequency was: .3 degrees C at .5 W/cm2; .58 degrees C at 1.0 W/cm2; .89 degrees C at 1.5 W/cm2; and 1.4 degrees C at 2.0 W/cm2. The results of this research should enable clinicians to choose the correct frequency, intensity, and treatment time when using thermal ultrasound.
Warm-up prior to static stretching enhances muscle extensibility. The relative effectiveness of different modes of warm-up, however, is unknown. The purpose of this study was to evaluate the effectiveness of superficial heat, deep heat, and active exercise warm-up prior to stretching compared with stretching alone on the extensibility of the plantar-flexor muscles.
Ninety-seven subjects (59 women, 38 men) with limited dorsiflexion range of motion (ROM) were randomly assigned to 1 of 5 groups. Female subjects had a mean age of 27.6 years (SD=7.68, range=17-50), and male subjects had a mean age of 26.8 years (SD=6.87, range=18-48).
The first group (group 1) was a control group and did not perform the stretching protocol. The 4 experimental groups (groups 2-5) performed a stretching protocol 3 days per week for 6 weeks. Group 2 performed the static stretching protocol only; group 3 performed active heel raises before stretching; group 4 received 15 minutes of superficial, moist heat to the plantar-flexor muscles before stretching; and group 5 received continuous ultrasound for 7 minutes before stretching. Dorsiflexion ROM measurements were taken initially and after 2, 4, and 6 weeks.
All experimental groups increased active and passive range of motion (AROM and PROM). The mean AROM/PROM differences at 6 weeks were 1.11/1.39 degrees for group 1, 4.10/6.11 degrees for group 2, 4.16/4.21 degrees for group 3, 4.38/4.90 degrees for group 4, and 6.20/7.35 degrees for group 5. The group receiving ultrasound before performing the stretching protocol (group 5) displayed the greatest increase in both AROM (6.20() and PROM (7.35().
Among the modalities tested, the use of ultrasound for 7 minutes prior to stretching may be the most effective for increasing ankle dorsiflexion ROM.
Inadequate flexibility is a contributing factor to muscle injury, especially with respect to the hamstring muscle group. Simple therapeutic regimens capable of increasing hamstring flexibility may reduce the injury potential of athletes with below-average hamstring flexibility or history of injury. This study compared 30 seconds of static stretching with 20 minutes of heat application on hamstring flexibility. A secondary purpose was to determine the relationship between the subjects attitude toward each treatment and the efficacy of treatment. Thirty undergraduate student athletes who were current members of a Midwestern collegiate football team participated in a 2 (treatment: heat vs. stretching) by 2 (coun-terbalanced order: heat first vs. stretching first) repeated-measures design. Results indicated that significant benefits to increase hamstring flexibility could be gained by using moist heat packs in comparison with static stretching despite a perceived attitudinal bias in favor of stretching. These findings may have implications for orthopedic fitness as well as injury prevention for an athlete with prior hamstring injury or inadequate flexibility.
The purpose of this study was to determine whether the application of a moist heat pack (MHP) could increase hamstring flexibility. Both legs for each subject were used for this study. Each leg was randomly assigned to either an MHP leg or a control leg condition. Twenty-seven male subjects (height = 178.5 +/- 8.6 cm; weight = 84.4 +/- 18.7 kg; age = 21.9 +/- 6.3 years) volunteered for this study. For the MHP leg condition, baseline hamstring flexibility was measured using an active knee extension test. A 23-ga indwelling thermistor was inserted to a depth of 2.54 cm to measure hamstring temperature. After baseline temperature was recorded, 2 MHPs were placed on either side of the thermistor until temperature was increased by 0.4 degrees C. Hamstring flexibility postintervention measurements were performed at 0, 4, 8, and 16 minutes. The same protocol was used for the control leg, without the MHP application. A 2 x 5 repeated-measures analysis of variance revealed no significant interaction between the MHP and the control leg condition. These results support previous findings that MHP application does not significantly affect muscle flexibility. After application of an MHP, it takes 20-25 minutes to increase intramuscular temperatures by 0.4 degrees C. Both of these findings should be taken into consideration when using an MHP to increase muscle flexibility.
To investigate if a single massage of the hamstring muscle group would alter the performance of the sit and reach test.
Before treatment, each of 11 male subjects performed the sit and reach test. The treatment consisted of either massage of the hamstring muscle group (both legs, total time about 15 minutes) or supine rest with no massage. Performance of the sit and reach test was repeated after treatment. Each subject returned the subsequent week to perform the tests again, receiving the alternative treatment relative to their initial visit. Mean percentage changes in sit and reach scores after treatment were calculated for the massage and no massage treatments, and analysed using Student's t tests.
Mean (SD) percentage changes in sit and reach scores after massage and no massage were small (6.0 (4.3)% and 4.6 (4.8)% respectively) and not significantly different for subjects with relatively high (15 cm and above) values before treatment. Mean percentage changes in sit and reach scores for subjects with relatively low values before treatment (below 15 cm) were large (18.2 (8.2)% and 15.5 (16.2)% respectively), but no significant differences were found between the massage and no massage groups.
A single massage of the hamstring muscle group was not associated with any significant increase in sit and reach performance immediately after treatment in physically active young men.
A randomized, counterbalanced 2x3x5 repeated-measures design.
To compare changes in hamstring flexibility after treatments of pulsed shortwave diathermy and prolonged stretch, sham diathermy and prolonged stretch, and control.
Heat and stretch techniques have been touted for years. To date, the effect of shortwave diathermy and hamstring stretching has not been studied. Because diathermy heats a large area and penetrates deep into the muscle, use of this device prior to or during hamstring stretching may increase flexibility.
Thirty college-age students (mean age, 21.5 years) with tight hamstrings (inability to achieve greater than 160 degrees knee extension at 90 degrees hip flexion) participated. Subjects were assigned to 1 of 3 groups: diathermy and stretch, sham diathermy and stretch, and control). Range of motion was recorded before and after each treatment for 5 days and on day 8. A straight leg-raise stretch was performed using a mechanical apparatus. Subjects in the diathermy-and-stretch group received 10 minutes of diathermy (distal hamstrings) followed by 5 minutes of simultaneous diathermy and stretch, followed by 5 minutes of stretching only. Subjects in the sham-diathermy-and-stretch group followed the same protocol, but with the diathermy unit turned off. Subjects in the control group lay on the table for 20 minutes. Data were analyzed using an ANOVA and post hoc t tests.
Mean (+/- pooled SE) increases in knee extension after 5 days were 15.8 degrees 2.2 degrees for the diathermy-and-stretch group, 5.2 degrees +/- 2.2 degrees for the sham-diathermy-and-stretch group, and -0.3 degrees +/- 2.2 degrees for the control group. Seventy-two hours after the last treatment, the diathermy-and-stretch group lost 1.9 degrees +/- 2.2 degrees, the sham-diathermy-and-stretch group lost 3.0 degrees +/- 2.2 degrees, and the control group changed -0.4 degrees +/- 2.2 degrees.
These results suggest that hamstring flexibility can be greatly improved when shortwave diathermy is used in conjunction with prolonged stretching.
Muscle strain is one of the most common injuries, resulting in a decreased range of motion (ROM) in this group of muscles. Systematic stretching over a period of time is needed to increase the ROM. The purpose of this study was to determine if whole-body vibration (WBV) training would have a positive effect on flexibility training (contract-release method) and thereby on the ROM of the hamstring musculature. In this study, 19 undergraduate students in physical education (12 women and 7 men, age 21.5 +/- 2.0 years) served as subjects and were randomly assigned to either a WBV group or a control group. Both groups stretched systematically 3 times per week for 4 weeks according to the contract-release method, which consists of a 5-second isometric contraction with each leg 3 times followed by 30 seconds of static stretching. Before each stretching exercise, the WBV group completed a WBV program consisting of standing in a squat position on the vibration platform with the knees bent 90 degrees on the Nemes Bosco system vibration platform (30 seconds at 28 Hz, 10-mm amplitude, 6 times per training session). The results show that both groups had a significant increase in hamstring flexibility. However, the WBV group showed a significantly larger increase (30%) in ROM than did the control group (14%). These results indicate that WBV training may have an extra positive effect on flexibility of the hamstrings when combined with the contract-release stretching method.
To determine the rate and magnitude of temperature change in response to ultrasound in human patellar tendon for two treatment sizes.
A thermistor was inserted into the medial aspect of each subject's right patellar tendon, and the baseline temperature was recorded. Using stratified random sampling and using a transducer head with an effective radiating area (ERA) of 4.5 cm(2), we had eight subjects each undergo either the 2-or 4-ERA ultrasound treatment first. Each subject received a 3-MHz continuous ultrasound treatment at 1 W/cm(2) for both the 2-and 4-ERA treatment sizes.
Sixteen subjects (8 males, 21.3 +/- 1.9 years, and 8 females, 21.0 +/- 2.8 years) participated.
We moved the sound head at a speed of 2 to 3 cm/sec while recording the tendon temperature every 30 seconds during, and for 20 minutes after, the 4-minute treatment. Twenty minutes after the treatment, we applied the second treatment to the other ERA treatment size.
At the end of the treatment, the mean temperature increase was significantly different (P = .006) between treatment sizes (8.3 degrees C +/- 1.7 degrees C (2 x ERA) and 5.0 degrees C +/- 1.0 degrees C (4 x ERA)). The rate of increase was also significantly different (P < .001). The heating rate per minute for the 2-ERA treatment was 2.1 degrees C +/- 0.4 degrees C and 1.3 degrees C +/- 0.3 degrees C for the 4-ERA treatment. There was a significant difference in the cooling between treatment sizes (P = .001). The rate of temperature decrease between treatment sizes was significantly different only during the first 5-minute interval post-treatment.
Three-megahertz ultrasound at an intensity of 1 W/cm(2) significantly increased patellar tendon temperature at both 2 and 4 x ERA, but our results confirm that the 2-ERA treatment size provided higher and longer heating than the 4-ERA treatment size.
The most popular method of stretching is static stretching. Vibration may provide a means of enhancing range of motion beyond that of static stretching alone.
This study sought to observe the effects of vibration on static stretching to determine whether vibration-aided static stretching could enhance range of motion acquisition more than static stretching alone in the forward split position.
Ten highly trained male volunteer gymnasts were randomly assigned to experimental (N = 5) and control (N = 5) groups. The test was a forward split with the rear knee flexed to prevent pelvic misalignment. Height of the anterior iliac spine of the pelvis was measured at the lowest split position. Athletes stretched forward and rearward legs to the point of discomfort for 10 s followed by 5 s of rest, repeated four times on each leg and split position (4 min total). The experimental group stretched with the device turned on; the control group stretched with the device turned off. A pretest was followed by an acute phase posttest, then a second posttest measurement was performed following 4 wk of treatment. Difference scores were analyzed.
The acute phase showed dramatic increases in forward split flexibility for both legs (P < 0.05), whereas the long-term test showed a statistically significant increase in range of motion on the right rear leg split only (P < 0.05). Effect sizes indicated large effects in all cases.
This study showed that vibration can be a promising means of increasing range of motion beyond that obtained with static stretching in highly trained male gymnasts.
Dynamic soft tissue mobilization increases hamstring flexibility in healthy male subjects
- D Hopper
- S Deacon
- S Das
- A Jain
- D Riddell
- T Hall
- B Vicenzino
Hopper, D., Deacon, S., Das, S., Jain, A., Riddell, D., Hall, T.,... Vicenzino, B. (2005).
Dynamic soft tissue mobilization increases hamstring flexibility in healthy male subjects.
British Journal of Sports Medicine, 39, 594-598.