Article

The Immediate Effects of Passive Hamstring Stretching Exercises on the Cervical Spine Range of Motion and Balance

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  • shinsung university
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Abstract

[Purpose] The purpose of the present study was to examine the immediate effects of passive hamstring stretching exercises on cervical spine range of motion and balance. [Subjects] The present study was conducted with 60 healthy university students without any musculoskeletal dysfunction as subjects. They were divided into an experimental group consisting of 30 subjects and a control group consisting of 30 subjects. [Methods] Cervical spine range of motion was measured using a cervical range of motion goniometer, and the stability test was conducted to assess balance. The experimental group were administered hamstring stretching with ankle dorsiflexion for 30 seconds three times, whereas the control group received the same treatment without ankle dorsiflexion. [Results] Cervical spine range of motion and balance immediately increased in the experimental group while there was no change in the control group. [Conclusion] The results show that hamstring muscle stretching exercises the fascia of the skeletal muscles of the human body and that the fascia are connected to each other by interactions of force. The human skeletal muscles interacted with each other to increase the flexion and extension range of motion of the cervical spine. In addition, the transfer of these forces to the stabilizer muscles of the pelvis and spine were the most important factor in the improvement of the subjects' balance.

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... This particular habit of sitting for long hours has given them obesity and stiff posture leading to decreased flexibility (6,7). Poor flexibility and stiff lower limb muscles leads to low back pain and injuries to the lower limbs (8,9,10,11,12). So, having good hamstring flexibility is necessary for the prevention as well as management of various musculoskeletal disorders (13,14). ...
... Evidence points to the movement of forces across pathways of intramuscular connective tissue and inter muscular connective tissue (33,34,35,36). Previous researches conducted for the same objective to examine the functional significance of SBL, have reported similar results (8,12,39,40,41). Plantar fascia which is a small link in the entire SBL, plays crucial role in regulating the tension of the entire system as there is integrity of all the structures of SBL (37). ...
... MFR has been compared to other soft tissue manipulative techniques like deep tissue massage, static and dynamic stretching, proprioceptive neuromuscular facilitation technique, and contract-relax technique in various studies (8,12,41,46,48). Data and results of all studies found MFR more beneficial than other techniques. ...
Article
Background and Aim: Myofascial Release (MFR) is a soft tissue mobilization technique that has been widely researched and supported to increase muscular flexibility and joint range of motion along superficial back line (SBL) structures. The purpose of the present study is to examine and compare the acute effects of MFR and post-isometric relaxation (PIR) applied on plantar fascia, on flexibility of superficial back line (hamstring muscle). Design: This was a pilot single blind randomized control trial (RCT). Participants: Thirty young healthy students (24 boys and 6 girls; mean age 21.46±0.97) Methods: Inclusion and exclusion criteria were followed, and baseline measurements for the Toe-Touch test (TTT) and active straight leg raise test (SLRT) were obtained. Subjects were then randomly assigned to the MFR group and the PIR group. The MFR group received the technique on plantar surface of the feet by applying a gentle and sustained pressure into the myofascial connective tissue. The PIR group received the technique on plantar flexors by placing them in stretched position, performing isometric contraction followed by relaxation and lengthening. Both interventions will be performed for 10 minutes. Afterwards, the Toe Touch Test and straight leg raise test were re-assessed. Results: Before and after intervention SLRT (both right and left) and TTT difference (within group differences) is statistically significant (p<0.05) in both MFR and PIR group. Between-group comparison also shows significant difference in both groups with p<0.05. The MFR group showed a significant difference in the SLR test and Toe Touch test compared to the PIR group (p<0.05). Conclusion: The results of the current study showed that MFR on the planter fascia was immediately effective for improving flexibility of the SBL for the hamstring muscle.
... The integrated concept of the kinetic chain suggests that muscle pathways are connected to each other and form a large network of myofascial chains, which may transfer force between its components [2,[11][12][13]. The myofascial force transmission was suggested based on cadaveric research [7,14] and in vivo studies [15,16]. Hyoung et al. [16] have reported that the restriction in ankle range of motion was probably affected by forward head posture. ...
... Hyoung et al. [16] have reported that the restriction in ankle range of motion was probably affected by forward head posture. In different research by Hyoung et al. [15], it was shown that passive hamstring stretching influenced cervical spine range of motion. Some studies reported the relationship between body posture and temporomandibular dysfunctions and have suggested that alterations in head position and body posture may be influenced by inaccurate proprioceptive information from the masticatory system muscles [17][18][19]. ...
Article
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Abstract The foot arches are responsible for proper foot loading, optimal force distribution, and transmission throughout the soft tissues. Since the foot arch is an elastic structure, able to adapt to forces transmitted by the foot, it was reported that low arch is related to excessive foot pronation, while high arched foot is more rigid and inflexible. Therefore, it is also probable, that foot arch alterations may change the force transmission via myofascial chains. The objective of this study was to evaluate the effect of symmetrical and asymmetrical excessive feet arching on muscle fatigue in the distal body parts such as the lower limbs, trunk, and head. Seventy-seven women (25.15 ± 5.97 years old, 62 ± 10 kg, 167 ± 4 cm) were assigned to three groups according to the foot arch index (Group 1—both feet with normal arch, Group 2—one foot with normal arch and the other high-arched, Group 3—both feet with high-arch). The bioelectrical activity of the right and left hamstrings muscles, erector spine, masseter, and temporalis muscle was recorded by sEMG during the isometric contraction lasting for 60 s. The stable intensity of the muscle isometric contraction was kept for all the time during the measurement. Mean frequency difference (%), slope (Hz), and intercept (Hz) values were calculated for muscle fatigue evaluation. No differences were observed in fatigue variables for all evaluated muscles between the right and left side in women with symmetrical foot arches, but in the group with asymmetric foot arches, the higher muscle fatigue on the normal-arched side compared to the high-arched side was noted. Significantly greater values of the semitendinosus—semimembranosus muscle frequency difference was observed on the normal-arched side compared to the high-arched side (p = 0.04; ES = 0.52; −29.5 ± 9.1% vs. −24.9 ± 8.4%). In the group with asymmetric foot arches, a significantly higher value of lumbar erector spinae muscle frequency slope (p = 0.01; ES = 1.32; −0.20 ± 0.04 Hz vs. −0.14 ± 0.05 Hz) and frequency difference (p = 0.04; ES = 0.92; −7.8 ± 3.1% vs. −4.8 ± 3.4%) were observed on the high-arched foot side compared to the side with normal foot arching. The thoracic erector spine muscle frequency slope was significantly larger in women with asymmetrical arches than in those with both feet high-arched (right side: p = 0.01; ES = 1.25; −0.20 ± 0.08 Hz vs. −0.10 ± 0.08 Hz); (left side: p = 0.005; ES = 1,17; −0.19 ± 0.04 Hz vs. −0.13 ± 0.06 Hz) and compared to those with normal feet arches (right side: p = 0.02; ES = 0.58; −0.20 ± 0.08 Hz vs. −0.15 ± 0.09 Hz); (left side: p = 0.005; ES = 0.87; −0.19 ± 0.04 Hz vs. −0.14 ± 0.07 Hz). In the group with asymmetric foot arches, the frequency difference was significantly higher compared to those with both feet high-arched (right side: p = 0.01; ES = 0.87; −15.4 ± 6.8% vs. 10.4 ± 4.3%); (left side: p = 0.01; ES = 0.96; 16.1 ± 6.5% vs. 11.1 ± 3.4%). In the group with asymmetric foot arches, a significantly higher value of the masseter muscle frequency difference was observed on the high-arched side compared to the normal-arched side (p = 0.01; ES = 0.95; 6.91 ± 4.1% vs. 3.62 ± 2.8%). A little increase in the longitudinal arch of the foot, even though such is often not considered as pathological, may cause visible changes in muscle function, demonstrated as elevated signs of muscles fatigue. This study suggests that the consequences of foot high-arching may be present in distal body parts. Any alterations of the foot arch should be considered as a potential foot defect, and due to preventing muscle overloading, some corrective exercises or/and corrective insoles for shoes should be used. It can potentially reduce both foot overload and distant structures overload, which may diminish musculoskeletal system pain and dysfunctions.
... Moreover, the normal length of the hamstring can affect hip strategy through its proximal attachment to the ischial tuberosity. Several authors have investigated the possible effects of stretching on balance ability, but they have reported inconclusive results: some indicating positive effects [14], some adverse effects [15,16], and the others without meaningful effects [17]. ...
... The results of the single leg stance balance test showed that static stretch could improve dynamic balance performance in mediolateral direction by decreasing mean and standard deviation of COP-mediolateral, while no significant change was observed in the mean and standard deviation of COP-anteroposterior, indicating no change in balance ability in the anteroposterior direction. Our findings were consistent with the previous reports by Hyong and Kang [15] and Reddy and Alahmari [16]. However, Behm et al. [17] observed some conflicting results as they reported adverse effects of stretching exercise on subjects' balance. ...
Article
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Introduction: Flexibility is an essential component of muscle function, and insufficient muscle flexibility may lead to muscle injuries. Decreased hamstring flexibility is one of the frequently reported risk factors for a hamstring strain and diminished athletic performance. Stretching is a commonly used intervention for increasing muscle length. There is a lack of evidence concerning the possible effects of hamstring stretching in balance and gait biomechanics. So, this study was designed to investigate the potential effects of static hamstring stretching on the range of motion (ROM), dynamic balance, and biomechanical variables of gait in athletes with hamstring tightness. Materials and Methods: This study is a single-group, pretest-posttest clinical trial performed on semi-professional female athletes. Twelve female athletes aged 20 to 35 years with bilateral hamstring tightness received a single session of unilateral static hamstring stretching on their randomly selected side. All subjects were assessed for straight leg raise, popliteal angle (using standard goniometry), perceived hamstring tightness (using a visual analog scale). They completed single-leg standing and 15-m walking and running tasks before and immediately after the intervention. The biomechanical parameters, including gait-line length, swing duration, and stance duration in walking tasks, maximum total force and mean total force in running task, and center of pressure (COP) displacement and standard deviation during balance task were measured using OpenGo sensor insole system. The pre-post values were compared using the paired sample t-test, and the level of significance was 0.05. Results: The values for straight leg raise and popliteal angle significantly increased (P
... Hamstrings are considered to have greater tendency to shorten as it is a multi-joint muscle and is constantly under varying amounts of tensile forces (Davis et al., 2005;Medeiros et al., 2016). Poor hamstring flexibility has been associated with lower extremity injuries and low backache (Grieve et al., 2015;Esola et al., 1996;Mason et al., 2016;Hartig and Henderson, 1999;Witvrouw et al., 2003;Hyong and Kang, 2013). Restoring hamstring flexibility is vital in the management of various musculoskeletal disorders (Michaeli et al., 2017;Medeiros et al., 2016). ...
... Evidence points towards the transmission of forces through intramuscular connective tissue pathways and intermuscular connective tissue pathways (Krause et al., 2016;Huijing and Jaspers, 2005;Yucesoy, 2010;Turrina et al., 2013). Previous studies performed with the similar purpose to investigate the functional significance of SBL have yielded identical results (Grieve et al., 2015;Hyong and Kang, 2013;Hyong and Kim, 2012;Wilke et al., 2016;Wilke et al., 2017;Sung-Hak et al., 2015). ...
Article
Background The existence of continuity between fascia and muscles that may be anatomically distant from each other is emphasized in the tensegrity principle. Despite evidence from in vitro studies, there is a dearth of literature concerning the in vivo behavior of these connections. Aim To compare the effect of Static Stretching (SS) of hamstrings with remote Myofascial Release (MFR) (bilateral plantar fascia and suboccipital region) and a combination of SS and remote MFR on hamstring flexibility. The secondary aim of this study was to investigate the difference between therapist administered and self-administered interventions. Design Three arm assessor-blinded Randomized Clinical Trial (RCT). Participants Fifty-eight asymptomatic participants (16 Males; Mean age 22.69 ± 2.65 years). Method Participants with tight hamstrings defined by a passive Knee Extension Angle (KEA) > 20° were included in the study and were assigned to one of the three groups. Group A (n = 19) was SS, group B (n = 20) was remote MFR, group C (n = 19) was a combination group who received both SS and remote MFR. Seven sessions of therapist administered intervention were delivered over a period of 10 days, which was followed by a 2-week self-administered home program. KEA and Sit and Reach Test (SRT) were used as outcomes and measurements were performed at baseline, end of the seventh session and after atwo-week follow-up. Results The results demonstrated that hamstring flexibility improved in all three groups after therapist administered interventions (p < 0.05), whereas, group C demonstrated additional benefits. None of the groups showed a statistically significant (p > 0.05) change in the KEA with self-intervention. Conclusion The findings of this study indicated that all three interventions were effective in improving hamstring flexibility in young asymptomatic individuals when performed by the therapist.
... A previous systematic review [20] demonstrated that the connective tissue, as proposed by Myers [13], links the individual muscles of the body to myofascial chains. Both in vitro experiments with cadavers [2,14] and in vivo trials [5,11] yield indications for strain transmission along these meridians thereby providing an argument to incorporate them into training and exercise therapy. ...
... Such research helps to estimate the practical relevance of observational and biomechanical in vitro studies. Preliminary available evidence points towards a significant role of myofascial strain transmission in influencing movement behavior [5,9,11]. ...
Article
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Purpose: Recent research indicates that the skeletal muscles of the human body do not function as independent actuators. Instead, they seem to be linked by connective tissue forming myofascial chains. While the existence of such meridians has been demonstrated for the ventral and the dorsal side of the body, no data are available for morphological fusion of lateral muscles. This study aimed to provide evidence for the inferior part of the lateral myofascial chain. Methods: Fourteen legs (7 embalmed cadavers, four ♂, 86 ± 7 years) were dissected to reveal a potential myofascial continuity between the fibularis longus muscle, more detailed, its fascia, and the iliotibial tract (ITT). Three investigators judged the general existence as well as the degree and characteristics of the continuity. If an anatomical continuity was evident, strain was applied to both structures in order to evaluate the tissues' ability for tensile transmission. Results: An indirect connection between the iliotibial tract and the fascia of the fibularis longus muscle was found: in all examined legs, the ITT fused strongly with the crural fascia. The latter was hardly separable from the fibularis longus fascia. Application of strain to the ITT caused local movement in the crural fascia and the underlying fascia of the fibularis muscle. Conclusions: The iliotibial tract fuses firmly with the crural fascia and the degree of continuity suggests that moderate amounts of strain might be transmitted. However, biomechanical studies precisely quantifying this tensile transmission are warranted in order to estimate the relevance of the linkage for the locomotor system.
... Passive stretching creates tension on the 302 Myofascial Release Therapy versus Muscle Energy Technique on Hamstring Flexibility in Physically Inactive Students -A Randomized Controlled Trial muscle-tendon, which activates the Golgi tendon organ and produces autogenic inhibition of the muscles being stretched [26]. Literature has found that passive hamstring stretching improves the range [27]. The study experienced a few limitations, including dropouts during the Study process. ...
... Therefore, we conducted additional searches from the perspective of exercise and found that existing studies have reached a cautious conclusion: yoga can increase the cervical spine mobility of patients with chronic cervical spondylosis, but the specific strength of evidence requires subsequent research and exploration [18]. There is also evidence that stretching exercises can directly affect the range of motion of the cervical spine and that passive hamstring stretching exercises can directly affect the range of motion and balance of the cervical spine [46]. This evidence indicates that exercise may improve the cervical spine mobility of patients with cervical spondylosis. ...
Article
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Background Long-term and high-intensity work can lead to considerable discomfort in people’s cervical spines. Objectives This study sought to explore the effect of mind-body exercise intervention on the cervical spine mobility of people with neck discomfort through meta-analysis. Methods This study’s researchers were searched a total of five research databases for data retrieval: China National Knowledge Infrastructure (from 1979), Web of Science (from 1950), PubMed (from 1965), Cochrane (from 1991), and EBSCO (from 1949) (Date of retrieval: March 10, 2021). Two authors independently searched literature records, scanned titles, abstracts, and full texts, collected data, and assessed materials for risk of bias. Stata14.0 software was used for the data analysis (Registration number: INPLASY202140126). Results Four articles were finally included with a total of 208 participants, and their age range was 18–65 years old. (1) Mind-body exercise intervention had a significant improving effect on Cervical extension, effect size of [SMD = 0.51 (95% CI 0.13 to 0.88), p <0.01; I2 = 45.2%], there was moderate heterogeneity; Mind-body exercise intervention had a significant improving effect on Cervical flexion, effect size of [SMD = 0.61 (95% CI 0.32 to 0.90), p <0.01; I2 = 5.7%], no heterogeneity; (2) Mind-body exercise intervention was no effect on the other four cervical range of motions; (3) The difference in participant’s neck discomfort was the source of heterogeneity, and all results had the potential risk of publication bias. Conclusion This study showed that mind-body exercise had a positive effect on the extension and flexion of people with neck discomfort. However, further research and more reliable evidence were needed to prove that mind–body exercise could be used for the treatment of neck discomfort.
... It has been proposed that mobilization of myofascial chains and interconnected connective tissue remote from the targeted body area encourage an enhanced ROM after stretching (28,66) and myofascial release therapy (25). For example, the self-myofascial release (SMR) technique with a tennis ball, acting as a type of myofascial release when pressed on the plantar fascia, caused an imminent increase in hip and lumbar spine flexibility (25,47). ...
... [19] There is also evidence that stretching exercises can directly affect the range of motion of the cervical spine and that passive hamstring stretching exercises can directly affect the range of motion and balance of the cervical spine. [36] This evidence indicates that exercise may improve the cervical spine mobility of patients with cervical spondylosis. Although there is potential evidence that exercise can have a positive effect on the cervical spine mobility of people with cervical spine discomfort, direct evidence of the benefits of exercise intervention may be more important. ...
Article
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Background: With the development of the economy and society, the pace of in-person work has gradually accelerated, resulting in longer and more intense work hours. Long-term and high-intensity work can lead to considerable discomfort in people's cervical spines. Objectives: This study aims to explore the effect of mind-body exercise intervention on the cervical spine mobility of people with neck discomfort through meta-analysis. Methods: This study's researchers will search a total of 5 research databases for data retrieval: China National Knowledge Infrastructure (from 1979), Web of Science (from 1950), PubMed (from 1965), Cochrane (from 1991), and EBSCO (from 1949) (Date of retrieval: March 10, 2021). Two authors will independently search literature records, scan titles, abstracts, and full texts, collect data, and assess materials for risk of bias. Stata14.0 software will be used for the data analysis. Results: The current study is a systematic review and meta-analysis program with no results. Data analysis will be completed after the program has been completed. Discussion: There is potential evidence that exercise can have a positive effect on the cervical spine mobility of people with cervical spine discomfort. In addition, direct evidence of the benefits of mind-body exercise intervention may be more important. Inplasy registration number: INPLASY202140126.
... That is because the force of stretching is transmitted to other joint by the fascias that connect human skeletal muscles with each other. So it stabilizes the pelvic and spinal muscles, and therefore improves balance [34]. ...
Article
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Background Hamstring shortening may have negative impacts on function and biomechanics of knee and hip joints and lumbo-pelvic rhythm. Many interventions are believed to correct hamstring to its normal length. There are several reports of impairment in postural control of patients with low back pain. The purpose of this study was to compare the effect of stretching exercise and strengthening exercise in lengthened position of the hamstring muscle on improving the dynamic balance of the person in patients with chronic low back pain with short hamstring muscles. Methods Forty-five patients with hamstring shortening who referred to physiotherapy clinic of Kermanshah university of Medical Sciences, Kermanshah, Iran were randomly allocated to the three groups; static stretching (n = 15), strengthening exercise in lengthened hamstring position (n = 15) and control (n = 15). All groups received conventional physiotherapy for low back pain and the two intervention groups received stretching exercise and strengthening exercise in lengthened position programs as well. All groups performed three treatment sessions for a week, a total of 12 sessions. For balance assessment, Y-Balance test was performed for each participant in three reach directions. To determine the important and significant variables, all variables entered a model (Generalized Estimation Equations method). Results The results indicate that based on GEE model, by controlling other variables, participants of static stretching exercise showed more improvement in balance than control group (β = 9.58, p-value = 0.014). Also, balance status showed significant improvement in the end of study compared to baseline of the study (β = 7.71, P-value< 0.001). In addition, the balance in three reach directions improved significantly and the greatest balance improvement was in the anterior reach direction (β ranged over = 6.16 to 11.59) and the height of patients affected their balance (β = 0.28, P-value = 0.034). Conclusions Group (type of intervention), phase of intervention, reach direction of test (anterior, posteromedial and posterolateral) and height of participants were associated with balance performance. Static stretching exercise was more effective than muscle strengthening exercise in lengthened position for improving dynamic balance in low back pain patients with hamstring tightness. Trial registration Iranian Registry of Clinical Trials (IRCT201507258035n2). Registered 16th September 2015.
... Regarding the kyphotic angle, the results of the current study revealed a significant difference between both groups regarding the effect of cervical radiculopathy on the kyphotic angle. The findings of this study showed that the kyphotic angle has been increased in people with cervical radiculopathy, this in accordance with Berthonnaud et al., [9] , Hyong and Kang [10] and Özerkaya et al., [11] who reported that the thoracic and cervical segments are correlated, where forward head posture is associated with increased thoracic kyphosis. ...
... Furthermore, an enhanced range of motion in the ankle after calf muscle foam rolling was reported by Halperin et al. [43]. Hyong and Kang [44] examined the immediate effects of passive hamstring stretching exercises on muscle flexibility and range of motion. The participants of their experimental group underwent hamstring stretching for 30 s, three times with ankle dorsiflexion, whereas the control group received the same therapy protocol without ankle dorsiflexion. ...
Article
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The flexibility and proper functioning of all myofascial chains are crucial for athletes, especially for long-distance runners. Due to the continuity of the myofascial structures, restrictions in one part of the body may cause excessive tension in others. The aim of our study was to evaluate the influence of short foot muscle exercises on muscle flexibility and the quality of movement patterns in amateur runners. Eighty long-distance runners, aged 20-45, were randomly divided into two groups: Group 1 (n = 48) and Group 2 (n = 32). Participants in Group 1 performed foot exercises daily for six weeks. Subjects in Group 2 were without any intervention. At baseline and after six weeks, the quality of movement patterns with the Functional Movement Screen and muscle flexibility was evaluated. In Group 1, significantly higher Functional Movement Screen values in individual tasks and in the total score were noted after six weeks. The total score increased from 17 to 18 points (Median (Me) ± half of interquartile range (IQR/2) (Standard Error of Measurement-SEM) 17 ± 1.5 (0.23) at baseline and 18 ± 1.5 (0.24) after six weeks) (p < 0.01), whereas in Group 2, its level remained at 16 points (Me ± IQR/2 (SEM) 16 ± 1.5 (0.31) at baseline and 16 ± 1.25 (0.31) after six weeks). In Group 1, the significant improvement in muscle flexibility was noted (e.g., results for external rotation muscles: (Mean ± SD (SEM) 60.3 ± 0.4 (1.50) at baseline and 62.4 ± 10.3 (1.49) after six weeks) (p = 0.005). In Group 2, significant improvement was observed only for one task in the Active straight leg raise test (p = 0.005 and 0.02). During the measurement of external rotation muscles, a significant decrease in flexibility was observed (Mean ± SD (SEM) 60.1 ± 9.0 (1.60) at baseline and 58.0 ± 8.5 (1.51) after six weeks) (p = 0.001). Plantar short foot muscle exercises may improve muscle flexibility in the upper parts of the body within myofascial chains and influence the quality of fundamental movement patterns. Such exercises may be beneficial for all physically active people and can be performed as part of overall fitness programmes. Moreover, including such exercises in daily training routines of long-distance runners, as well as by athletes in other sport disciplines is also recommended.
... The concept of myofascial meridians or myofascial chains has been explored in numerous studies (Hyong and Kang, 2013;Weisman et al., 2014;Grieve, 2015). Wilke et al. (2016a) were the first to conduct a methodologically high quality systematic review of anatomy dissection studies adhering to PRISMA guidelines, exploring the existence of meridians. ...
Article
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Introduction Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists may use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of ‘fascial connectivity’ evolved two decades ago from a simple anatomical hypothesis called ‘myofascial meridians’. Since then it has been widely researched, as conceptually it makes more sense for functional movements than ‘single-muscle’ theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field. Methods A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine’s scoring). Results Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment. Conclusion Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.
... [2] The most prevalent finding of the present study was Hyong and Kang (2013) in a randomised control trial showed that passive hamstring stretching exercises along the superficial back line do have positive influence on cervical spine range of motion and balance. [15] Kuruma H et al (2013) studied effects of myofascial release and stretching technique on range of motion and reaction time, concluded that Myofascial release (MFR), has been identified in increasing quadriceps and hamstrings range of motion [16] that the roller-massager increased the sit and reach test for hamstrings' flexibility 4.3% without any significant voluntary performance detriment. In addition, hamstrings' flexibility increased with just 10s of rolling. ...
... According to Myers, the superficial back line is one of myofascial meridians transmitting the tension generated by the head or gastrocnemius to other muscles [31] . The current study confirmed that human muscles relate to each other by fascia enabling interaction with each other, as changes in the head posture affected ankle ROM. ...
... The initial literature search yielded a total of 29,964 citations, from which 196 were included for further reading. After review of full texts, 188 studies were excluded leaving 8 eligible randomized controlled studies [13][14][15][16][17][18][19][20] to be included in the review. The PEDro criteria and final scores assigned to each study are presented in Table 1. ...
Article
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Context Anatomical and in vivo studies suggest that muscles function synergistically as part of a myofascial chain. A related theory is that certain myofascial techniques have a remote and clinically important effect on range of motion (ROM). Objective To determine if remote myofascial techniques can effectively increase range of motion at a distant body segment. Evidence Acquisition In November 2018, we searched three electronic databases (CENTRAL, MEDLINE, PEDro) and hand searched journals and conference proceedings. Inclusion criteria were: Randomized controlled trials (RCT) comparing remote myofascial techniques with: passive intervention (rest/sham), or a local treatment intervention. The primary outcome of interest was ROM. Quality assessment was performed using the PEDro Scale. Three authors independently evaluated study quality and extracted data. RevMan software was used to pool data using a fixed-effect model. Evidence Synthesis Eight RCTs, comprising n=354 participants were included (mean age range 22-36y; 50% female). Study quality was low with PEDro scores ranging from 2 to 7 (median scores 4.5/10). None of the studies incorporated adequate allocation concealment and just two used blinded assessment of outcomes. In all studies, treatments and outcomes were developed around the same myofascial chain (superficial back line). Five studies included comparisons between remote interventions to sham or inactive controls; pooled results for ROM showed trends in favor of remote interventions (SMD 0.23 [95% CIs -0.09 to 0.55], 4 studies) at immediate follow ups. Effects sizes were small, corresponding to mean differences of 9% or 5 degrees in cervical spine ROM, and 1-3 cm in sit and reach distance. Four studies compared remote interventions to local treatments, but there were few differences between groups. Conclusions Remote exercise interventions may increase ROM at distant body segments. However, effect sizes are small and the current evidence base is limited by selection and measurement bias.
... The myofascial meridians have been referenced in several studies (Hyong & Kang, 2013;Weisman et al., 2014;Grieve et al., 2015). Despite the references, the theory of the myofascial meridians is based on anecdotal evidence rather than evidence based research. ...
Thesis
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Introduction: Myofascial release (MFR) is a form of manual therapy that involves the application of a low load, long duration stretch to the myofascial complex, intended to restore optimal length, decrease pain, and improve function. MFR is being used to treat patients with a wide variety of conditions, but there is a scarcity of evidence to support its efficacy. Studies are emerging in this field with varying results and conclusions. Analysis of the recent research trials and reviews will be a better way to appraise the quality and reliability of such works. Objective: This work attempts to analyse and summarise the evidence from three randomised controlled trials (RCTs) and one systematic review of the effectiveness of MFR on various neuromuscular conditions and pain. Methodology: Effectiveness of MFR on tension type headache, lateral epicondylitis and chronic low back pain were the RCTs identified for the analysis. The systematic review selected analysed the published RCTs on MFR till 2014. The methodological qualities of the studies were assessed using the PEDro, Centre for Evidence-Based Medicine's (CEBM) Level of Evidence Scale, Risk of Bias (RoB) Analysis Tool and AMSTAR 2. Results: The RCTs analysed in this study were of moderate to high methodological quality (PEDro scale), with higher level of evidence (CEBM scale) and less bias (RoB). The effectiveness of MFR on tension type headache (TTH) was the first among the studies with a moderate methodological quality (6/10 in PEDro), with a 2b level of evidence on the CEBM scale. The study proved that direct technique or indirect technique MFR was more effective than the control intervention for TTH. The second RCT studied MFR for lateral epicondylitis (LE). The study was of a moderately high quality on the PEDro scale (7/10) with a 1b- level in CEBM. The MFR was found more effective than a control intervention for LE in computer professionals. The RCT on chronic low back pain (CLBP) also scored 7/10 in the PEDro scale and 1b in the CEBM scale. This study confirmed that MFR is a useful adjunct to specific back exercises and more helpful than a control intervention for CLBP. All three RCTs stated the usage of self-report measures and underpowered sample size as the major limitations along with a performance bias reported in the TTH trial. The systematic review demonstrated moderate methodological quality as per the AMSTAR 2 tool which analysed 19 RCTs for a result. The literature regarding the effectiveness of MFR was mixed in both quality and results. Omission of a risk of bias analysis was the major limitation of this review. The authors quoted that “MFR may be useful as either a unique therapy or as an adjunct therapy to other established therapies for a variety of conditions”. Conclusion: Critical appraisal is an important element of evidence-based medicine to carefully and systematically examine research to judge its trustworthiness, its value and relevance in a particular context. This review concludes that the three RCTs and the systematic review analysed were completed with moderate to good quality as per various quality measures, but with reported methodological flaws and interpretation biases. These studies with the critical appraisal can act as ‘pavements’ on which high quality future MFR trials and evidence can be built on. KEY WORDS: myofascial release, myofascial release therapy
... An RCT investigated the effects of hamstring passive stretching on the range of motion of the neck in healthy adults. The range of motion of the cervical, which is the ascending part of SBL, increased after hamstring stretching [27]. According to Spina [28], a patient with chronic hamstring pain was relieved of pain and dysfunction by applying an active release technique to the SBL, the lumbar spine, and calf. ...
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Objective: The purpose of this study was to investigate the immediate effect of applying self-myofascial release (SMR) to the plantar fascia using a foam roller on hamstring and lumbar spine superficial back line (SBL). Design: Randomized controlled trial. Methods: Thirty-one healthy adults agreed to the method and purpose of the study. Selection and exclusion criteria were screened, and baseline measurements for the Toe Touch test and passive straight leg raise (PSLR) test were obtained. The participants were then randomly assigned to the SMR group or the sham group. After group assignment, the SMR group rolled the surface of the foot from the heel to the metatarsal head using a foam roller for 5 minutes. The sham group received passive mobilization of the ankle joint in the supine position. Afterwards, the Toe Touch test and the passive straight leg-raise test were re-assessed. Results: In the SMR group, the Toe Touch test results showed significant improvement (p<0.05). Left and right PSLR test results showed a significant increase (p<0.05). In the sham group, there was no significant difference between pre and post-test results. The SMR group showed a significant difference in the PSLR test and Toe Touch test compared to the sham group (p<0.05). Conclusions: The results of this study showed that SMR on the plantar fascia was immediately effective for improving the flexibility of the SBL of the lumbar spine and hamstring.
... There is further evidence that passive myofascial connections exist between the gluteus maximus and its distal attachment to the iliotibial band [26,39,47] and into the fibularis longus muscle of the lower leg [48]. There is also evidence that utilizing myofascial chains and interconnected connective tissues, that are remote from the targeted tissues during the intervention demonstrate altered effects in both strength and range of motion [49][50][51][52]. Although preliminary, the entirety of this evidence supports our hypothesis that integrated muscular myofascial connections, can make important contributions to the stability of the human skeleton [31,36,38,39,49,[53][54][55]. ...
Article
Human movement is a complex orchestration of events involving many different body systems. Understanding how these systems interact during musculoskeletal movements can directly inform a variety of research fields including: injury etiology, injury prevention and therapeutic exercise prescription. Traditionally scientists have examined human movement through a reductionist lens whereby movements are broken down and observed in isolation. The process of reductionism fails to capture the interconnected complexities and the dynamic interactions found within complex systems such as human movement. An emerging idea is that human movement may be better understood using a holistic philosophy. In this regard, the properties of a given system cannot be determined or explained by its components alone, rather, it is the complexity of the system as a whole, that determines how the individual component parts behave. This paper hypothesizes that human movement can be better understood through holism; and provides available observational evidence in musculoskeletal science, which help to frame human movement as a globally interconnected complex system. Central to this, is biotensegrity, a concept where the bones of the skeletal system are postulated to be held together by the resting muscle tone of numerous viscoelastic muscular chains in a tension dependent manner. The design of a biotensegrity system suggests that when human movement occurs, the entire musculoskeletal system constantly adjusts during this movement causing global patterns to occur. This idea further supported by recent anatomical evidence suggesting that the muscles of the human body can no longer by viewed as independent anatomical structures that simply connect one bone to another bone. Rather, the body consists of numerous muscles connected in series, and end to end, which span the entire musculoskeletal system, creating long polyarticular viscoelastic myofascial muscle chains. Although theoretical, the concept of the human body being connected by these muscular chains, within a biotensegrity design, could be a potential underpinning theory for analyzing human movement in a more holistic manner. Indeed, preliminary research has now used the concept of myofascial pathways to enhance musculoskeletal examination, and provides a vivid example of how range of motion at a peripheral joint, is dependent upon the positioning of the entire body, offering supportive evidence that the body's kinetic chain is globally interconnected. Theoretical models that introduce a complex systems approach should be welcomed by the movement science field in an attempt to help explain clinical questions that have been resistant to a linear model.
... Webb and Rajendran [36] reported in systemic review by each indicate that MFR reduces hamstring pain and increases joint ROM. Hyong and Kang also found that passive hamstring stretching was effective in improving cervical ROM and balance ability [37]. ...
... An RCT, by Hyong and Kang in 2013 showed the positive effects of passive hamstring stretching exercises along the SBL on cervical spine range of motion and balance. [27] Kuruma H et al 2013 studied effects of myofascial release and stretching technique on range of motion and reaction time, concluded that Myofascial release (MFR), has been identified in increasing quadriceps and hamstrings ROM. [28] The dose-response of the acute effects of SMFR on flexibility is also still unclear. ...
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Background: Flexibility is the ability to move a single or series of joints smoothly and easily through an unrestricted, pain-free range of motion. Decreased hamstring flexibility is considered to be a predisposing factor for lower back pain and injury. The purpose of the study was to see the immediate effect of a single session of self-myofascial release on plantar aspect of foot, on hamstring and lumbar spine flexibility. Methodology: A Quasi experimental study was conducted on 30 subjects who were randomly allocated into 2 groups. Group A-self-myofascial release was given. Group B was a control group (no therapy).Baseline and post flexibility was assessed by sit-and-reach test (SRT) and Active Knee Extension (AKE) test. Results: Within group analysis in group A showed significant difference in both AKE (right and left) scores and sit and reach scores (p 0.05). Conclusion: A single session of SMR on bilateral plantar aspect of foot is effective in increasing hamstrings length, but there was no change seen in lumbar spine flexibility in young asymptomatic individuals.
... Despite some methodological flaws, recent studies have yielded encouraging evidence that previous in vitro findings can be transferred to in vivo conditions. For example, ankle ROM seems to be affected by forward head posture (Hyong & Kim, 2012), passive hamstring stretching tended to increase cervical spine ROM (Hyong & Kang, 2013), self-myofascial release on the plantar fascia increased sit-and-reach performance (Grieve et al. 2015), and ankle ROM seems to be affected not only by knee, but also hip position (Mitchell et al. 2008). These findings endorse incorporating entire myofascial chains in the strength and conditioning process and during flexibility training. ...
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The present review aims to provide a systematic overview on tensile transmission along myofascial chains based on anatomical dissection studies and in vivo experiments. Evidence for the existence of myofascial chains is growing, and the capability of force transmission via myofascial chains has been hypothesized. However, there is still a lack of evidence concerning the functional significance and capability for force transfer. A systematic literature research was conducted using MEDLINE (Pubmed), ScienceDirect and Google Scholar. Studied myofascial chains encompassed the superficial backline (SBL), the back functional line (BFL) and the front functional line (FFL). Peer-reviewed human dissection studies as well as in vivo experiments reporting intermuscular tension transfer between the constituents of a myofascial chain were included. To assess methodic quality, two independent investigators rated studies by means of validated assessment tools (QUACS and PEDro Scale). The literature research identified 1022 articles. Nine studies (moderate to excellent methodological quality) were included. Concerning the SBL and the BFL, there is moderate evidence for force transfer at all three transitions (based on six studies), and one of two transitions (three studies). One study yields moderate evidence for a slight, but not significant force transfer at one transition in the FFL. The findings of the present study indicate that tension can be transferred between some of the examined adjacent structures. Force transfer might have an impact in overuse conditions as well as on sports performance. However, different methods of force application and measurement hinder the comparability of results. Considering anatomical variations in the degree of continuity and histological differences of the linking structures is crucial for interpretation. Future studies should focus on the in vivo function of myofascial continuity during isolated active or passive tissue tensioning.
... Even if the biceps femoris also displayed a structural continuity to the gluteus maximus, this connection would not be considered part of the meridian because of its curved, nonlinear course. Although used and referred to in several studies, [17][18][19][20][21][22] the myofascial meridians are based on anecdotal evidence from practice and have never been verified. Confirming body-wide direct morphologic continuity between muscle and fascial tissue would therefore yield both an empirical background for such trials and an argument for practitioners to take treatment of complete meridians into consideration. ...
Article
To provide evidence for the existence of six myofascial meridians proposed by Myers (1997) based on anatomical dissection studies. Relevant articles published between 1900 and December 2014 were searched in MEDLINE (Pubmed), ScienceDirect and Google Scholar. Peer-reviewed human anatomical dissection studies reporting morphological continuity between the muscular constituents of the examined meridians were included. If no study demonstrating a structural connection between two muscles was found, papers on general anatomy of the corresponding body region were targeted. A continuity between two muscles was only documented if two independent investigators agreed that it was reported clearly. Also, two independent investigators rated methodological quality of included studies by means of a validated assessment tool (QUACS). The literature search identified 6589 articles. Of these, 62 papers met the inclusion criteria. The studies reviewed suggest strong evidence for the existence of three myofascial meridians: the superficial back line (all three transitions verified, based on 14 studies), the back functional line (all three transitions verified, 8 studies) and the front functional line (both transitions verified, 6 studies). Moderate to strong evidence is available for parts of the spiral line (five of nine verified transitions, 21 studies) and the lateral line (two of five verified transitions, 10 studies). No evidence exists for the superficial front line (no verified transition, 7 studies). The present systematic review suggests that most skeletal muscles of the human body are directly linked by connective tissue. Examining the functional relevance of these myofascial chains is the most urgent task of future research. Strain transmission along meridians would both open a new frontier for the understanding of referred pain and provide a rationale for the development of more holistic treatment approaches. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
... Only a few studies have used a quantified stretching force (kg). 16,30 Clinically, hamstring length is not measured directly, but indirectly by measuring hip range of motion (ROM) during a passive straight leg raise (SLR) or active knee extension (AKE) ROM with the ipsilateral hip positioned at 90°of flexion. 3,4 Gajdosik and Lusin 3 advocate the AKE test because it is more selective for measuring hamstring length than the passive SLR. ...
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Experimental pretest-posttest control design. The purpose of the study was twofold: (1) to determine the lasting effect of static stretch on hamstring length for up to 24 hours and (2) to compare the efficacy of static stretch with and without warm-up exercise on hamstring length. Research is limited on the lasting effects of static stretching and is controversial on the combined effects of warm-up activities and static stretching on muscle lengthening. Fifty-six volunteer subjects (ages 18-42 years) with limited bilateral hamstring length were assigned to 1 of 4 groups: (1) warm-up and static stretch, (2) static stretch only, (3) warm-up only, and (4) control. The warm-up was 10 minutes of stair climbing at 70% of maximum heart rate. Static stretch consisted of a single session of three 30-second passive stretches of the hamstring. Hamstring length was measured preintervention and at several intervals postintervention (immediately and then at 15 minutes, 60 minutes, 4 hours, and 24 hours) using the active knee extension (AKE) test. Data were analyzed using a mixed-model analysis of variance. The warm-up-and-static-stretch group and the static-stretch-only group showed a significant increase in hamstring length between preintervention and all postintervention measurements. At 24 hours poststretch, the warm-up-and-static-stretch group had a mean increase of 10.3 degrees (95% confidence interval, 7.7-12.9) and the static-stretch-only group had a mean increase of 7.7 degrees (95% confidence interval, 4.7-10.7) in AKE range of motion (ROM). Both of these groups did show significant decrease (2.9 degrees and 4.0 degrees, respectively) in hamstring muscle length (AKE ROM) at 15 minutes poststretch when compared to immediate poststretch values. The static-stretch-only and the warm-up-and-static-stretch groups did not differ significantly from each other. Control and warm-up-only groups showed no significant increase in hamstring length between preintervention and any of the postintervention measurements. A significant increase in hamstring length can be maintained for up to 24 hours when using static stretching. Muscle length gains are greatest immediately after stretching and decline within 15 minutes. The addition of a warm-up exercise prior to stretching does not appear to significantly increase the effectiveness of static hamstring stretching.
Article
In recent years, various studies have demonstrated that the fascia can transmit the mechanical tensions generated by muscle activity over a distance. However, it is not yet clear whether this transmission follows precise anatomical lines. The present study aims to understand if the exercises at a distance can influence the range of motion of the neck, and if the effects are different by performing the exercises in various directions. The study was attended by 30 healthy volunteers aged between 19 and 32 years. Anterior flexion of the neck was checked before the protocols and retested to compare the difference after stretching the hamstrings and adductors. All evaluations were performed by the same operator using an electronic goniometer. Cervical ROM increased during both procedures, but after the hamstrings stretch it increased significantly more than after the adductors stretch (6.22° versus 1.44°). This study highlighted how fascia can transmit forces at a distance, but only according to precise myofascial sequences. Consequently, it is important to know the fascial organization in order to properly train the fascial system.
Article
Objective To compare the mobility of neck and back flexor and extensor muscle chains in women with migraine, chronic migraine and headache-free. Methods This is a cross-sectional study. The muscle chain test was performed based on the theoretical assumptions of the Busquet method, in women with migraine (MG, n=24), chronic migraine (CMG, n=36) and headache-free (CG, n= 27). The evaluation of neck and back mobility was performed by an examiner expert in the Busquet method with the aid of cervical range of motion (CROM®) device (neck muscles) and the Tiltmeter® application (back muscles). Results Compared to woman headache-free, women with migraine (MD= -12º [CI95%= -19º, -5º] and chronic migraine (MD= -15º [CI95%= -21º, -8º] present reduced mobility in the neck extensor muscle chain. Also, in the back extensor muscle chain, migraine vs headache-free (MD= -9º [CI95%= -15º, -2º]) and chronic migraine vs headache-free (MD= -10º [CI95%= -16º, -4º]) and in the back flexor muscle chain, migraine vs headache-free (MD= -6º [CI95%= -10º, -0.1º]) and chronic migraine vs headache-free (MD= -7 [CI95%= -11º, -2º]), with an effect sizes varying between 1.19 e 2.38. No difference was found between groups for neck flexor muscle chain. Conclusion: Women with migraine and chronic migraine have hypomobility of the neck and back extensor muscle chains, and of the back flexor chain.
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Currently, greater background is required about the effectiveness of myofascial release (MFR) on muscle flexibility. Objective Our goal was to determine the immediate effect of a direct MFR technique on hip and cervical flexibility in inactive females with hamstring shortening. Method The sample group included 68 female university students, randomly divided into a control group (n = 34) and an experimental group (n = 34). A placebo technique was used with the control group, and direct MFR on the posterior thigh region was used with the experimental group. Results The mixed factorial ANOVA did not show significant intergroup differences (p>0.05). In the experimental group, Bonferroni post hoc test showed significant intragroup differences between pre-test and post-test 1, as well as between pre-test and post-test 2 for the three ischiotibial muscle flexibility tests (p<0.001). Cervical flexion range of motion showed significant differences between pre-test and post-test 1 (p<0.001). Conclusions We conclude that the protocol based on a single direct MFR intervention was no more effective than the placebo in improving flexibility both locally at the hamstring level and remotely at the level of the cervical extensor muscles. Future research should consider different MFR techniques on the immediate increase in muscle flexibility and the long-term effect of MFR, as well as consider different intervention groups.
Article
Self myofascial release (SMR) via a tennis ball to the plantar aspect of the foot is widely used and advocated to increase flexibility and range of movement further along the posterior muscles of a proposed "anatomy train". To date there is no evidence to support the effect of bilateral SMR on the plantar aspect of the feet to increase hamstring and lumbar spine flexibility. The primary aim was to investigate the immediate effect of a single application of SMR on the plantar aspect of the foot, on hamstring and lumbar spine flexibility. The secondary aim was to evaluate the method and propose improvements in future research. A pilot single blind randomised control trial. Twenty four healthy volunteers (8 men, 16 women; mean age 28 years ± 11.13). Participants underwent screening to exclude hypermobility and were randomly allocated to an intervention (SMR) or control group (no therapy). Baseline and post intervention flexibility was assessed by a sit-and-reach test (SRT). A one way between groups analysis of covariance (ANCOVA) was conducted to compare between group outcome SRT measurements. Baseline pre-intervention and control SRT measurements were used as the covariate in the analysis. There was a significant increase (p = 0.03) in the intervention SRT outcome measurements compared to the control group, with a large effect size. An immediate clinical benefit of SMR on the flexibility of the hamstrings and lumbar spine was indicated and suggestions for methodological improvements may inform future research. Copyright © 2015. Published by Elsevier Ltd.
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To examine electromyography (EMG) activity, passive torque, and stretch perception during static stretch and contract-relax stretch. Two separate randomized crossover protocols: (1) a constant angle protocol on the right side, and (2) a variable angle protocol on the left side. 10 male volunteers. Stretch-induced mechanical response in the hamstring muscles during passive knee extension was measured as knee flexion torque (Nm) while hamstring surface EMG was measured. Final position was determined by extending the knee to an angle that provoked a sensation similar to a stretch maneuver. Constant angle stretch: The knee was extended to 10 degree below final position, held 10sec, then extended to the final position and held for 80 sec. Variable angle stretch: The knee was extended from the starting position to 10 degrees below the final position, held 10sec, then extended to the onset of pain. Subjects produced a 6-sec isometric contraction with the hamstring muscles 10 degrees below the final position in the contract-relax stretch, but not in the static stretch. Passive torque, joint range of motion, velocity, and hamstring EMG were continuously recorded. Constant angle contract-relax and static stretch did not differ in passive torque or EMG response. In the final position, passive torque declined 18% to 21% in both contract-relax and static stretch (p<.001), while EMG activity was unchanged. In the variable angle protocol, maximal joint angle and corresponding passive torque were significantly greater in contract-relax compared with static stretch(p<.01), while EMG did not differ. At a constant angle the viscoelastic and EMG response was unaffected by the isometric contraction. The variable angle protocol demonstrated that PNF stretching altered stretch perception.
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This study explored the relationships between the motor and cognitive abilities, and the functional performance of patients with stroke. Motor and cognitive abilities were measured by the Fugl-Meyer Assessment (FMA) and the Neurobehavioural Cognitive Status Examination (NCSE), and functional performance was measured by the Functional Independence Measure (FIM). All assessments were conducted at admission, after 2 and 4 weeks, and at discharge. A total of 37 patients with first stroke at mean age 62.3 years (SD=5.4) participated in the study. Results indicated that the lower extremity and balance scores on the FMA were highly correlated with the FIM (motor subscale) on all occasions (r = 0.65--0.92), whereas upper extremity and hand scores on the FMA were moderately correlated (r = 0.53--0.73). Cognitive abilities such as judgement, comprehension and repetition had moderate positive relationships with functional performance (r = 0.35--0.62). Consistent with previous studies, motor functional performance at discharge was best predicted by balance and judgement abilities at admission, or lower extremity abilities and balance at 2-weeks, or lower extremity and repetition abilities at 4-weeks. At admission, lower extremity and cognitive abilities were found to be the best predictors of patients' length of stay. The results from this study substantiated the fact that motor impairment, including balance and lower limb ability, strongly accounts for functional recovery in the rehabilitation of patients with stroke staying in hospital. This study provided good data for rehabilitation professionals on monitoring neurological recovery, especially balance and lower extremity abilities, to enhance the functional recovery of patients after stroke. More intensive intervention in these aspects should be provided to patients to promote more efficient functional regain and shortening of the length of stay.
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Experimental pretest-posttest control design. The purpose of the study was twofold: (1) to determine the lasting effect of static stretch on hamstring length for up to 24 hours and (2) to compare the efficacy of static stretch with and without warm-up exercise on hamstring length. Research is limited on the lasting effects of static stretching and is controversial on the combined effects of warm-up activities and static stretching on muscle lengthening. Fifty-six volunteer subjects (ages 18-42 years) with limited bilateral hamstring length were assigned to 1 of 4 groups: (1) warm-up and static stretch, (2) static stretch only, (3) warm-up only, and (4) control. The warm-up was 10 minutes of stair climbing at 70% of maximum heart rate. Static stretch consisted of a single session of three 30-second passive stretches of the hamstring. Hamstring length was measured preintervention and at several intervals postintervention (immediately and then at 15 minutes, 60 minutes, 4 hours, and 24 hours) using the active knee extension (AKE) test. Data were analyzed using a mixed-model analysis of variance. The warm-up-and-static-stretch group and the static-stretch-only group showed a significant increase in hamstring length between preintervention and all postintervention measurements. At 24 hours poststretch, the warm-up-and-static-stretch group had a mean increase of 10.3 degrees (95% confidence interval, 7.7-12.9) and the static-stretch-only group had a mean increase of 7.7 degrees (95% confidence interval, 4.7-10.7) in AKE range of motion (ROM). Both of these groups did show significant decrease (2.9 degrees and 4.0 degrees, respectively) in hamstring muscle length (AKE ROM) at 15 minutes poststretch when compared to immediate poststretch values. The static-stretch-only and the warm-up-and-static-stretch groups did not differ significantly from each other. Control and warm-up-only groups showed no significant increase in hamstring length between preintervention and any of the postintervention measurements. A significant increase in hamstring length can be maintained for up to 24 hours when using static stretching. Muscle length gains are greatest immediately after stretching and decline within 15 minutes. The addition of a warm-up exercise prior to stretching does not appear to significantly increase the effectiveness of static hamstring stretching.
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Increased muscle flexibility from static stretching is supported by the literature, but limited research has assessed the duration of maintained flexibility gains in knee joint range of motion after same-day static hamstring stretching. The purpose of our study was to determine the duration of hamstring flexibility gains, as measured by an active knee-extension test, after cessation of an acute static stretching protocol. All subjects performed 6 active warm-up knee extensions, with the last repetition serving as the baseline comparison measurement. After warm-up, the experimental group performed 4 30-second static stretches separated by 15-second rests. Thirty male subjects (age = 19.8 +/- 5.1 years, ht = 179.4 +/- 18.7 cm, wt = 78.5 +/- 26.9 kg) with limited hamstring flexibility of the right lower extremity were randomly assigned to control and experimental groups. Postexercise active knee-extension measurements for both groups were recorded at 1, 3, 6, 9, 15, and 30 minutes. Tukey post hoc analysis indicated significant improvement of knee-extension range of motion in the experimental group that lasted 3 minutes after cessation of the static stretching protocol. Subsequent measurements after 3 minutes were not statistically different from baseline. A dependent t test revealed a significant increase in knee-extension range of motion when comparing the first to the sixth active warm-up repetition. Our results suggest that 4 consecutive 30-second static stretches enhanced hamstring flexibility (as determined by increased knee-extension range of motion), but this effect lasted only 3 minutes after cessation of the stretching protocol. Future research should examine the effect of other stretching techniques in maintaining same-day flexibility gains.
Article
Few studies have reported on the amount of acute changes in flexibility of the hamstrings resulting from stretching prior to activity, and no studies of this nature have focused on an elderly population. Methods: Ninety-seven subjects (mean age=65 years, range 55–79 years) participating in the World Senior Games were randomly selected for participation in this study. Subjects were randomly assigned to either a control group (no stretching), or one of two treatment groups (contract-relax proprioceptive neuromuscular facilitation stretch [CRPNF], or a static stretch). Hamstring flexibility was measured with a Penny and Giles goniometer prior to and after one repetition of stretching lasting 32 seconds. Analysis: Differences in flexibility scores from pretest to posttest for control and two treatment groups were assessed using the Wilcoxon signed-ranks test. Pair-wise comparisons in median differences between groups were assessed using rank analysis of covariance and the Mantel-Haenszel statistic. Results: Flexibility scores for participants in each of the control and treatment groups significantly increased from pretest to posttest. However, the increase was much greater for those in the two treatment groups, with median differences of 1 degree in the control group, 5 degrees in the CRPNF group, and 4 degrees in the static group. Both gender and age influenced the median difference between CRPNF and static groups. Specifically, the median difference was significantly greater in the CRPNF versus the static group for men but not women. Similarly, the median difference was significantly greater in the CRPNF versus the static group for participants younger than age 65 but not aged 65 years or older. Conclusion: One repetition (32 seconds) of stretching provides an acute increase in flexibility of the hamstrings. CRPNF and static stretches significantly improve flexibility. For men and participants less than 65 years of age, CRPNF stretch appears more beneficial than static stretch. The benefits in flexibility between CRPNF and static stretches are similar for women and participant ages 65 years and older.
Article
To compare the effects of an acute stretching intervention on knee extension range of motion, passive resistive torque and stiffness in subjects with osteoarthritis of the knee, and to compare these variables with subjects without osteoarthritis. Cross-sectional experimental study. Human performance laboratory. A total of 55 participants were recruited: 28 subjects (males and females) with osteoarthritis of the knee joint and 27 subjects of a similar age without osteoarthritis of the knee joint. Using the Kincom dynamometer, three 60-second stretches with 60seconds of rest between stretches were applied to the hamstring muscle group. Peak knee extension range of motion, peak passive torque and stiffness in the final 10% of knee extension range of motion. A significant (P<0.05) increase in knee extension range of motion, peak passive torque and stiffness was observed in both groups. For knee extension range of motion, the mean difference for the osteoarthritis group and non-osteoarthritis group was 4.9 degrees [95% confidence interval (CI) 0.9 to 8.5] and 4.4 degrees (95% CI 1.8 to 6.8), respectively. For peak passive torque, the mean difference in the osteoarthritis group and the non-osteoarthritis group was 4.4Nm (95% CI 0.8 to 6.9) and 1.0Nm (95% CI -1.4 to 3.5), respectively. For stiffness in the final 10% of knee extension range of motion, the mean difference for the osteoarthritis group and the non-osteoarthritis group was 0.19Nm/degree (95% CI 0.08 to 0.3) and 0.04Nm/degree (95% CI -0.05 to 0.1), respectively. Stiffness in the final 10% of knee extension range of motion was significantly higher in the osteoarthritis group compared with the non-osteoarthritis group after stretching. Elderly individuals with and without osteoarthritis of the knee are able to demonstrate immediate beneficial adaptations to a stretching intervention. This is important as stretching is often used in preparation for exercise programmes.
Article
The effect of the duration of static stretching as well as that of the number of repetitions in acute stretching protocols on flexibility has not been extensively examined in the elderly. The aim of the present study was to investigate the acute effects of stretching duration on the range of motion (ROM) of the lower extremities and the trunk in elderly women, when stretching is performed once or in multiple repetitions while controlling the total amount of the time spent in one stretching session. Twenty sedentary women aging 65-85 years old (mean age=75.9) participated in this study. Subjects performed three static stretching protocols lasting for 60 s each, in non-consecutive training sessions. The first stretching protocol comprised of a 60 s stretch (1x60), the second of two 30 s stretches (2x30), whereas the third was of four 15 s stretches (4x15). ROM was determined during hip flexion, extension and abduction, knee flexion, and ankle dorsiflexion, as well as during trunk flexion, using a flexometer and a goniometer. An analysis of variance (ANOVA) with repeated measures revealed no significant differences between the stretching protocols. Further statistical analysis indicated significant (p<. 001) improvements after the stretching exercises, in all flexibility protocols. The findings suggest that a single 60 s static stretch of the lower extremities and trunk’s muscles produced the same effect as two 30 s and four 15 s stretches during a flexibility training session involving sedentary elderly women.
Article
Hamstring muscle length may be associated with specific pelvic and trunk postures, but the influence of hamstring length on trunk postures is not well documented. The purposes of this study were to examine the influence of hamstring length on 1) the pelvic angle, lumbar angle, and thoracic angle in standing; and 2) the flexion ranges of motion of the pelvic angle, lumbar angle, and thoracic angle during the toe-touch test. Surface platform pointers over bony landmarks and photography were used to examine the pelvic and trunk angles and ranges of motion of 10 men with short hamstrings, 10 men with medium hamstrings, and 10 men with long hamstrings while standing and after assuming the toe-touch position. Separate one-way analyses of variance detected no significant differences among groups for the three angles in standing. Significant differences were detected among groups for the three angles in the toe-touch position and the flexion ranges of motion during the toe-touch test (p < 0.05). Short hamstrings were associated with decreased flexion range of motion of the pelvic angle and lumbar angle and increased flexion range of motion of the thoracic angle. Therapeutic interventions should be considered in light of the influences of hamstring length on the flexion range of motion of the pelvic angle, lumbar angle, and thoracic. angle.
Article
Literature supports habitual stretching for increasing an individual's flexibility; however, immediate gains in range of motion have received limited investigation. The purpose of this study was to determine the retention of active knee extension range of motion (AKE ROM) after a single bout of stretching. Subjects participated in three experimental stretching groups: contract-relax, agonist contract (CRAC); static stretch; and active control stretch. AKE ROM was measured by an analog inclinometer fixed to a modified Orthotron II for pretreatment and posttreatment measurements at 0, 3, 7, 12, 18, and 25 minutes. 32 active male and female college age students. Analysis suggested that stretching as a combined treatment effect demonstrated an increase in AKE ROM that lasted for 25 minutes; however, no specific method of stretching was found to be more beneficial. Stretching utilizing CRAC, static, or active control techniques lend support to their use for the purpose of increasing and retaining ROM prior to physical activity.