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The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized Controlled Trial

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Taken into account the complex structure of the diaphragm and its important role in the postural chain, we were prompted to check the effects of a diaphragm technique on hamstring flexibility. The aim of this study was to evaluate the effects of the doming of the diaphragm technique on hamstrings flexibility and spine mobility. Randomized placebo controlled trial. University laboratory. Sixty young adults with short hamstring syndrome were included in this randomized clinical trial using a between-group design. The sample was randomly allocated to a placebo group (n = 30) or to an intervention group (n = 30). Duration, position, and the therapist were the same for both treatments. Hamstring flexibility was assessed using the forward flexion distance and the popliteal angle tests. The spinal motion was evaluated using the Modified Schober's test and the cervical range of movement. Two-way ANOVA afforded pre-to-post intervention statistically significant differences (p<0.001) in the intervention group compared to the placebo group for hamstrings flexibility measured by the forward flexion distance (mean change 4.59±5.66 intervention group vs 0.71±2.41 placebo group) and the popliteal angle tests (mean change intervention group 6.81± 8.52 vs. placebo group 0.57± 4.41). Significant differences (p<0.05) were also found in the modified Schober test (mean change intervention group -1.34±3.95 vs. placebo group 1.02±3.05) and the cervical range of movement. Significant between-groups differences (p<0.05) were also found in all the variables measured. The doming of the diaphragm technique provides a sustained improvement on hamstrings flexibility and spine mobility. Key words: clinical trial, kinesiology, physical-therapy, posture.
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The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
Note: This article will be published in a forthcoming issue of
the Journal of Sport Rehabilitation. The article appears here in
its accepted, peer-reviewed form, as it was provided by the
submitting author. It has not been copyedited, proofed, or
formatted by the publisher.
Section: Original Research Report
Article Title: The Immediate Effects of Doming of the Diaphragm Technique in Subjects With
Short Hamstring Syndrome: A Randomized Controlled Trial
Authors: Marie Carmen Valenza, Irene Cabrera-Martos, Irene Torres-Sánchez,; Aurelio Garcés,
Sara Mateos-Toset, and Gerald Valenza-Demet
Affiliations: Department of Physiotherapy, Faculty of Health Sciences. University of Granada,
Granada, Spain.
Running Head: Diaphragm technique and hamstring muscles
Journal: Journal of Sport Rehabilitation
Acceptance Date: June 7, 2015
©2015 Human Kinetics, Inc.
DOI: http://dx.doi.org/10.1123/jsr.2014-0190
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
Title: The effects of doming of the diaphragm technique in subjects with short hamstring
syndrome: a randomized controlled trial
Brief running head: Diaphragm technique and hamstring muscles.
Authors:
Authors: Marie Carmen Valenza*, Irene Cabrera-Martos, Irene Torres-Sánchez; Aurelio Garcés;
Sara Mateos-Toset; Gerald Valenza-Demet
Affiliations:
Department of Physiotherapy, Faculty of Health Sciences. University of Granada, Granada,
Spain.
* Corresponding author at:
Marie Carmen Valenza
Department of Physiotherapy. Faculty of Health Sciences. University of Granada.
Av de Madrid SN CP18071 Granada Spain.
Tel/Fax: +34 958242360
Email: cvalenza@ugr.es
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
ABSTRACT
Context: Taken into account the complex structure of the diaphragm and its important role in the
postural chain, we were prompted to check the effects of a diaphragm technique on hamstring
flexibility. Objective: The aim of this study was to evaluate the effects of the doming of the
diaphragm technique on hamstrings flexibility and spine mobility. Design: Randomized placebo
controlled trial. Setting: University laboratory. Patients: Sixty young adults with short
hamstring syndrome were included in this randomized clinical trial using a between-group
design. Intervention: The sample was randomly allocated to a placebo group (n = 30) or to an
intervention group (n = 30). Duration, position, and the therapist were the same for both
treatments. Main outcome measures: Hamstring flexibility was assessed using the forward
flexion distance and the popliteal angle tests. The spinal motion was evaluated using the
Modified Schober’s test and the cervical range of movement. Results: Two-way ANOVA
afforded pre-to-post intervention statistically significant differences (p<0.001) in the intervention
group compared to the placebo group for hamstrings flexibility measured by the forward flexion
distance (mean change 4.59±5.66 intervention group vs 0.71±2.41 placebo group) and the
popliteal angle tests (mean change intervention group 6.81± 8.52 vs. placebo group 0.57± 4.41).
Significant differences (p<0.05) were also found in the modified Schober test (mean change
intervention group -1.34±3.95 vs. placebo group 1.02±3.05) and the cervical range of movement.
Significant between-groups differences (p<0.05) were also found in all the variables measured.
Conclusions: The doming of the diaphragm technique provides a sustained improvement on
hamstrings flexibility and spine mobility. Key words: clinical trial, kinesiology, physical-
therapy, posture.
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
INTRODUCTION
The length of the hamstrings is important in human posture and in the efficiency of daily
human movements, such as walking and running(1), but limited hamstrings flexibility is very
common in the general population(2). Many studies have been conducted in order to clarify the
risk factors and impact of previous injuries for short hamstring syndrome(3,4). Poor hamstring
flexibility has been previously reported to impact on normal biomechanical patterns affecting
balance, functionality and sport performance and leading to impaired mobility, postural
deviations, pain and increased risk of injury(5). According to the effects of hamstring flexibility
on the spine, clinical observations suggested short hamstring muscles to be associated with
specific disorders of the lumbar spine(6,7), but this has not been widely explored in the literature(8-
10). However, it has been reported that the limited flexibility of hamstring muscles provokes
reduced pelvis mobility, disturbing the distribution of pressures in the spine, altering the lumbar
curve, causing compensatory movement patterns of the lumbar spine, and subsequently
increasing stress on the spinal soft tissues(11).
Manual techniques like stretching(12), massage(13) and myofascial release(14) have been
used to increase the lower limbs range of motion when applied to hamstring muscles with
controversial results.
It has been suggested that the shortening of a muscle creates compensation in adjacent
and also in distant muscles(15). Other authors examined the hamstring elasticity taken into
account the restrictions of the postural muscles, including the diaphragm(16). From an anatomical
viewpoint, the diaphragm is a muscle with a central trefoil-shaped tendon that blends superiorly
with the fibrous pericardium. The origins of the diaphragm are placed in the crura from bodies of
lumbar vertebrae, the arcuate ligaments, the costal margins and the xiphoid(17).
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
The doming of diaphragm (DD) technique is used to restore the normal movement of the
diaphragm and to improve its function(18). Kinetic chain approaches are based on movement
patterns, the body works as a dynamic unit rather than as isolated segments(19). Therefore, the
biomechanical relationship between the diaphragm and other structures support that a diaphragm
technique can have a repercussion in others distant structures(15) such as the hamstring muscles.
To our knowledge, no previous studies have evaluated the effects of a diaphragm technique on
hamstring length and spine mobility. Taken into account the complex structure of the diaphragm
and its important biomechanical role in the postural chain(15), our hypothesis is that a
normalization technique of the diaphragm can have an effect on the posterior muscle chain. The
outcomes were flexibility of the hamstring muscles assessed using the forward flexion distance
and the popliteal angle tests and spinal mobility evaluated using the Modified Schobers test and
the cervical range of movement. It was expected an improvement on hamstrings flexibility and
an increase in the spinal range of motion. Thus, the aim of this study was to test the effects of the
DD technique on patients with short hamstring
syndrome.
METHODS
Design
Randomized placebo controlled trial, with a single blinded design. It was completed in a
laboratory in the Health Sciences Faculty.
Participants
Email and word of mouth were used to recruit a non-probabilistic convenience sample of
68 subjects from the staff and student body of the Health Sciences Faculty, as well as their
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
friends and relatives (Figure 1). Subjects were given all information about exclusion criteria at
the time of recruitment and they were reminded of the relevant criteria 24 to 36 hours before
their arranged time of participation.
Subject inclusion was limited to individuals between 18 and 40 years old. The inclusion
criteria were as follows: willingness of the subjects to participate in the study (written informed
consent signature), popliteal angle test (PAT) value of 15° or more and forward flexion distance
(FFD) test of more than 5 cm.
Participants were excluded if they exhibited history of neck trauma, history of fracture in
any part of the body, history of neck or low back pain, herniated disk or lumbar protrusion,
symptoms in the lower extremity, some muscle tendon injury of the hamstring muscles, or
regular use of analgesic or anti-inflammatory drugs. Those who were pregnant, reported
experiencing major psychological stress, or had consumed caffeinated food and/or beverage
products within the previous 24 hours were excluded from the study. Subjects were also
excluded if they had received manual therapy within the previous month.
Approval for the study was obtained from the University Ethics Committee and each
participant signed a written informed consent.
Procedures
Outcome measures
The study assessor who collected the outcome measures was blinded to study hypotheses
and group allocation. After all the baseline measures were taken, subjects were led to another
room where they received the diaphragmatic technique or the placebo intervention. Subjects
were then taken back to the first room for the post-intervention measures. Main outcome
measures were collected immediately after the session.
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
Anthropometric measures
All subjects completed the same battery of tests before and after the intervention. For
descriptive purposes, anthropometric measurements were taken at baseline. Weight was
measured in kilograms (kg) to the nearest 0.1 kg on a calibrated digital medical scale (Seca 843,
Switzerland) with participants dressed in standard T-shirts and shorts. Height was measured in
centimeters (cm) to the nearest 0.5 cm via a standard wall-mounted stadiometer.
Hamstring flexibility was assessed using the FFD test and the PAT. In the FDD test, the
subject, standing on an anthropometric box, performed a maximum and progressive anterior
flexion of the trunk, maintaining the knees straight and lengthening the arms with the palms
parallel and the fingers extended(20).The therapist used a metric tape to determine the distance
from the distal part of the fingers to the box on a millimeter ruler placed on the vertical side of
the box(21). This test has been reported to have good validity and reliability(10). The PAT started
out from the supine position, with the hip and knee flexed at 90°. From this position and with the
axis of the goniometer placed on the lateral condyle of the femur, the subject was asked to
perform extension of the knee, without modifying the flexion of the hip and avoiding pelvic
movements. The angle remaining for full extension of the knee reflected the degree of hamstring
shortening(22,23).
The spinal motion was evaluated using the Modified Schober’s test and the cervical range
of movement. According to the description of the modified Schober's test(24), an anchor is
established at the L5 level of the lumbar spine, from which marks at 10 cm above and 5 cm
below are placed, with the patient standing upright. The distance between the superior and
inferior mark is measured and recorded(25). The cervical range of movement was assessed using a
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
full-circle goniometer(26,27). Three measurements were made alternatively for each direction
(flexion, extension, and lateral flexions) and the mean value was considered for the analysis.
Interventions
Subjects were randomly allocated into one of two groups (intervention and control) by
choosing a sealed envelope, after which they received the diaphragm technique or the placebo
intervention. The doming of the diaphragm is a technique designed to relax the resting state of
the diaphragm, enhancing its contraction and relaxation functions. It is designed to create a
greater pressure gradient between the thorax and the abdomen, augmenting the expiration
phase(18). It was performed by a therapist with more than seven years of experience.The patient
position is seated and relaxed. The therapist stands behind the subject and puts his hands around
the thoracic cage, introducing the fingers beneath the costal margins (Figure 2). The thorax is
then carefully rotated to the left and to the right to determine which direction offers the greatest
degree of freedom and ease of motion. The thorax is eased in the direction in which it rotates
more freely. This position is held for 5 minutes, and the hands are used to support and to follow
the tissues as a slow releasing. Disconnected ultrasound was applied distal the xyphoid process
for 5 minutes as placebo treatment (Figure 3). The duration of the intervention, the position of
the patient and the therapist and the therapist who performed the intervention were the same for
both groups.
Statistical Analyses
The sample size was set at a minimum of 28 patients in each group based on an expected
improvement of 7.5±6.2º in the intervention group (mean±standard deviation) in the popliteal
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
angle test(28), an α value set at 0.05 (type I error), and β at 0.20 (type II errors). Thus, a priori, we
intended to include 60 patients in expectation of a number of dropouts.
The statistical distribution of the data was analyzed with the Kolmogorov-Smirnov test.
The distribution of the quantitative variables was normal. Qualitative variables are presented as
percentage (%) (sex) and quantitative variables (antropometric measures, hamstrings flexibility
and spinal movement) as mean±standard deviation. The demographic data and initial assessment
results were compared with T-tests and the χ2 test using SPSS (Statistical Package for the Social
Sciences) software, version 20.0 (SPSS Inc., Chicago, IL, USA). The data were analyzed with
the 2-way analysis of variance ANOVA using unrepeated measure factor to analyze within group
values and repeated measure factor to compare pre- to post-intervention between groups
measures. The alpha level was set at 0.05.
RESULTS
Sixty-eight participants were recruited for the study, and 8 of them were excluded
because they did not meet the inclusion criteria. The flow diagram(29) of participants through the
trial is shown in Figure 1.
Baseline characteristics (Table 1) of both groups were similar, although the intervention
group had comparatively fewer men 10 (34.9%), vs. 13 (40.7%) . Body mass index (BMI)
values were extremely similar (mean 23.26 ± 3.3 vs. mean 23.02 ± 3.36).
Baseline characteristics of both groups in the outcome measures are presented in Table 2,
showing no significant differences between groups in all the variables.
Intervention (Table 3) showed significant changes between measures in the technique
group. By contrast, the placebo group did not show pre -to post differences (p>0.05) in any
measure. Significant pre to post intervention differences (p<0.001) were found in the
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
intervention group compared to the placebo group for hamstrings flexibility measured by the
forward flexion distance (mean change 4.59±5.66 intervention group vs 0.71±2.41 placebo
group) and the popliteal angle tests (mean change intervention group 6.81± 8.52 vs. placebo
group 0.57± 4.41). Significant differences (p<0.05) were also found in the modified Schober test
(mean change intervention group -1.34±3.95 vs. placebo group 1.02±3.05) and all cervical
movements (mean change intervention group vs. control group: flexion -7.09 vs. 0.33, extension
-4.57 vs. 0.863, right lateral flexion -4.28 vs. -0.27 and left lateral flexion -4.29 vs. -0.53)
Between groups differences (p<0.05) were also found in hamstrings flexibility and spine
mobility (table 3).
DISCUSSION
The main purpose of the current study was to analyze the effects of an indirect doming of
the diaphragm technique on hamstrings flexibility and spinal mobility in participants with limited
flexibility of hamstring muscles. The results of this study showed a significant improvement on
hamstrings flexibility (p<0.001) and in the cervical and lumbar range of motion (p<0.05) after
the technique whilst no significant changes occurred in placebo group.
The sample of subjects included in both placebo and intervention groups did not present
significant differences at baseline. This decreases the chances of having confounding variables
that could have affected the value of our results.
The hamstrings are primarily hip extensors and secondarily knee flexors; they have a
mechanical advantage at the hip. However, they also play an important role in the stance and
swing phases during gait as they stabilize the knee at initial contact and decelerating the shank in
terminal swing(30). The interventions on hamstring muscles are important because disturbed
length of the muscles can affect muscular efficiency and it has reported to be a frequent
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
condition due to the sedentary life style. It has been previously reported that hamstring muscles
tend to become short and tight because of sedentary activities (31).
Our theoretical approach is that the application of the DD technique would result in an
activation of core stabilizing muscles and a normalization of the aberrant motor control strategies
displayed by the subjects with short hamstring syndrome(32), with consequent improvements in
hamstrings flexibility and spinal movement. Previous studies have investigated the effects of
different techniques on hamstrings flexibility. Some authors explore the effects of long distances
techniques on hamstrings elasticity.
Aparicio et al.(10) identify the effects of the suboccipital muscle inhibition technique
performed during 2 minutes in patients with short hamstring muscle, modifying the elasticity and
also the pressure algometry of the semimembranous muscle. They reported an increase in the
FDD test and in the PAT after the suboccipital muscle inhibition technique. In our study, the
subjects showed higher values of change after performing the DD technique; the experimental
group obtained an increase in FDD test and in the PAT. Pollard and Ward(8) compared two
techniques, a suboccipital muscle contraction-relaxation technique and a contraction-relaxation
technique on the hamstring muscles. They used the straight leg raise test as an outcome measure,
showing a significant improvement in the experimental group after the technique. Taylor et al.(9)
used a cervical spine contract-relax technique with a contraction of 3 to 5 seconds and a
stretching repeated 3 times, showing no evidence supporting the effectiveness of this technique
to increase hamstring extensibility.
Numerous studies focus on techniques on the hamstrings such as stretching (2, 12) or deep
stripping massage (5) that increase the muscle flexibility. They established a program to increase
the flexibility, but in our study significant differences were found as immediate effects pre-to
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
post-doming of the diaphragm technique. In the study of George et al.(31), it is reported to
increase hamstring flexibility in only one session with active release technique in asymptomatic
male participants. Aparicio et al.(10) also obtained immediate improvements on hamstring
flexibility after a suboccipital technique.
To our knowledge, no studies have used a diaphragm technique in order to obtain an
effect on hamstring flexibility and/or spine mobility.
Some limitations and strengths of this study should be noted. One weakness is the
absence of knowledge about how long the benefits of the technique last. Another limitation is
the use of an ultrasound procedure as placebo to be compared to a hands-on technique. Noll et
al.34 recommended that investigators use deferred or no treatment control group in addition to a
sham control. A randomized clinical trial in manual medicine should ideally include three arms:
an active treatment group, a sham group and a no-treatment group. However, such a study design
is more costly and requires a large number of participants to achieve adequate statistical power.
Additionally, previous studies have compared a manual therapy technique to this procedure
(35,36). Other limitations are that this study only shows immediate effects of the technique and the
lack of follow-up.
Despite this, the trial has the strength of being based on a randomized controlled design.
This is also the first study that shows a significant improvement on hamstring flexibility and
spine mobility after a short diaphragm technique. Moreover, the population of the study is quite
representative of patients suffering from short hamstrings syndrome, thus makes this research a
realistic base for future studies in this field. It is evidenced that obtaining and maintaining the
range of motion is very important and a key factor in injury prevention. According to that, the
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
technique proposed of doming the diaphragm is useful, safe and well-tolerated with an
immediate significant effect.
CONCLUSIONS
Patients with short hamstring syndrome who underwent doming of the diaphragm
technique significantly improved pre- to post technique hamstring flexibility and the spinal range
of motion, with no significant changes in the placebo group. Doming of the diaphragm technique
can be used as an effective therapeutic tool with an immediate response in short hamstrings. The
results of this study provide new and additional data to assist the therapeutic approaches.
Conflict of interest:
The authors state that there are no conflicts of interest with this work.
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
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The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
Figure 1. Flow diagram of the progress through the phases of a parallel randomised trial of two
groups.
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
Figure 2. Doming of the diaphragm technique.
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
Figure 3. Placebo intervention.
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
Table 1. Descriptive data of the sample included in the study (n=60).
Intervention group
(n=30)
Control group
(n=30)
P-value
Sex
(% males)
34.9
40.7
0.404
Age (years)
(Mean±SD
22.33±4.90
23.40±5.80
0.856
Height (cm)
(Mean±SD)
167±0.83
169±0.99
0.226
Weight (Kg)
(Mean±SD)
65.22±12.59
66.50±12.10
0.676
BMI (kg/cm2)
(Mean±SD)
23.26±3.30
23.02±3.36
0.764
SD: standard deviation; BMI: body mass index; n: number of participants.
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized
Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
Table 2. Pre-intervention values in the different tests performed.
Intervention group
(n=30)
Control group
(n=30)
p-value
Hamstring muscles flexibility
Forward Flexion Distance Test
(cm)
21.97±7.75
23.17±7.99
0.610
Popliteal angle test (degrees)
32.98±11.58
34.28±12.36
0.432
Spine Mobility
Schober Test (cm)
2.11±1.30
2.19±1.32
0.351
Modified Schober test (cm)
5.83±3.93
5.64±6.57
0.401
Cervical range of movement (degrees)
Flexion
63.79±8.43
64.53±8.39
0.171
Extension
61.61±11.43
61.143±11.68
0.407
Right lateral flexion
47.16±8.79
47.85±9.61
0.471
Left lateral flexion
48.23±8.86
48.72±8.57
0.165
The Immediate Effects of Doming of the Diaphragm Technique in Subjects With Short Hamstring Syndrome: A Randomized Controlled Trial” by Valenza MC et al.
Journal of Sport Rehabilitation
© 2015 Human Kinetics, Inc.
Table 3. Pre- to post-intervention values in the participants of the study (n=60).
Intervention
group
(n=30)
Within group
p-value
Control
group
(n=30)
Within group
p-value
Between groups
mean difference±SD
(95% CI)
Between
groups p-
value
Hamstring flexibility
Forward Flexion
Distance Test (cm)
17.38±9.78
p<0.001**
22.45±7.60
0.190
-5.07±2.63 (-7.41, -
2.19)
p<0.001**
Popliteal angle test
(degrees)
26.16±14.56
p<0.001**
33.71±11.41
0.559
-7.41±4.57 (-8.45, -
3.81)
p<0.001**
Spine Mobiliy
Modified Schober
test (cm)
6.49±1.95
0.049*
4.63±1.21
0.142
-1.34±3.95 (0.05,
2.68)
p<0.001**
Cervical range of movement (degrees)
Flexion
70.88±10.29
p<0.001**
64.20±8.45
0.201
-7.10±8.57 (-9.99, -
4.20)
p<0.001**
Extension
66.18±10.79
0.005*
60.28±12.59
0.147
-4.57±9.17 (-7.67, -
1.46)
p<0.001**
Right lateral
flexion
51.44±9.36
0.015*
48.12±8.23
0.329
-4.28±10.09 (-7.69, -
0.87)
0.032*
Left lateral flexion
52.52±7.84
0.004*
49.25±9.33
0.356
-4.28±8.34 (-7.10, -
1.46 )
0.029*
*p<0.05; **p<0.001; CI: confidence interval; SD: standard deviation; n: number of participants.
... Desde un punto de vista terapéutico, la terapia manual del diafragma puede ser usada como una herramienta clínica efectiva con una respuesta inmediata (160), mejorando la viscoelasticidad muscular y consecuentemente reduciendo la rigidez muscular e incrementando la movilidad torácica (162)(163)(164)(165). Ha obtenido beneficios en ganancia de movilidad espinal (151,160,166) y de la cadena muscular posterior (160,166). Se ha demostrado su beneficio a nivel respiratorio mejorando la función pulmonar de pacientes con EPOC (167), aumentando la movilidad diafragmática en esta misma patología (161), incrementando significativamente la capacidad vital forzada (FVC), el volumen espirado máximo en el primer segundo de la espiración forzada (FEV1) y la capacidad funcional (FC) (168), y consiguiendo una mejora en la presión espiratoria máxima (169). ...
... Desde un punto de vista terapéutico, la terapia manual del diafragma puede ser usada como una herramienta clínica efectiva con una respuesta inmediata (160), mejorando la viscoelasticidad muscular y consecuentemente reduciendo la rigidez muscular e incrementando la movilidad torácica (162)(163)(164)(165). Ha obtenido beneficios en ganancia de movilidad espinal (151,160,166) y de la cadena muscular posterior (160,166). Se ha demostrado su beneficio a nivel respiratorio mejorando la función pulmonar de pacientes con EPOC (167), aumentando la movilidad diafragmática en esta misma patología (161), incrementando significativamente la capacidad vital forzada (FVC), el volumen espirado máximo en el primer segundo de la espiración forzada (FEV1) y la capacidad funcional (FC) (168), y consiguiendo una mejora en la presión espiratoria máxima (169). ...
... Los efectos musculoesqueléticos de la terapia manual del diafragma en la literatura científica fueron investigados realizando previamente un protocolo de revisión sistemática que fue aprobado por la base de datos PROSPERO (173), excluyendo aquellos estudios que valoraron únicamente parámetros respiratorios. Después de analizar las diez investigaciones seleccionadas, se encontró que la terapia manual sobre el diafragma obtuvo beneficios en la movilidad de este músculo valorada mediante ecografía (159,161,172), movilidad de la parrilla torácica (151,(158)(159)(160)169) y abdominal (151,158,169) durante el ciclo respiratorio, aumento de la flexibilidad de la cadena posterior (151,158,160,166), y mejoras en parámetros relacionados con la columna lumbar (158,171) y cervical (160,166,170). Ninguno de los estudios encontrados utilizó este tipo de técnica para valorar resultados en la región del hombro. ...
Thesis
Effects of diaphragm muscle treatment in shoulder pain and mobility in subjects with rotator cuff injuries. Introduction: The rotator cuff inflammatory or degenerative pathology is the main cause of shoulder pain. The shoulder and diaphragm muscle have a clear relation through innervation and the connection through myofascial tissue. In the case of nervous system, according to several studies the phrenic nerve has communicating branches to the brachial plexus with connections to shoulder key nerves including the suprascapular, lateral pectoral, musculocutaneous, and axillary nerves, besides, the vagal innervation that receives the diaphragm and their connections with the sympathetic system could make this muscle treatment a remarkable way of pain modulation in patients with rotator cuff pathology. To these should be added a possible common embryological origin in some type of vertebrates. Considering the connection through myofascial system, the improving of chest wall mobility via diaphragm manual therapy could achieve a better function of shoulder girdle muscles with insertion or origin at ribs and those that are influenced by the fascia such as the pectoralis major muscle, latissimus dorsi and subscapularis. Objectives: • Main objective: To compare the immediate effect of diaphragm physical therapy in the symptoms of patients with rotator cuff pathology regarding a manual treatment over shoulder muscles. • Specific objectives: 1. To evaluate the immediate effectiveness of each of the three groups in shoulder pain using a numerical pain rating scale (NPRS) and compare between them. 27 2. To evaluate the immediate effectiveness of each of the three groups in shoulder range of motion (ROM) using an inclinometer and compare between them. 3. To evaluate the immediate effectiveness of each of the three groups in pressure pain threshold (PPT) using an algometer and compare between them. Material and method: A prospective, randomized, controlled, single-blind (assessor) trial with a previous pilot study in which a final sample size of 45 subjects was determined to people diagnosed with rotator cuff injuries and with clinical diagnosis of myofascial pain syndrome at shoulder. The sample were divided into 3 groups of treatment (15 subjects per group): 1. A direct treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (control / rotator cuff group). 2. Diaphragm manual therapy techniques (diaphragm group). 3. Active diaphragm mobilization by hipopressive gymnastic (hipopressive group). The pain and range of shoulder motion were assessed before and after treatment in all the participants by inclinometry, NPRS of pain in shoulder movements and algometry. The data obtained were analyzed by an independent (blinded) statistician, who compared the effects of each one of the treatments using the Student’s t-test for paired samples or the Wilcoxon signed rank test, and calculated the post -intervention percentage of change in every variable. An analysis of variance (ANOVA) followed by the post-hoc test or a non-parametric Kruskal-Wallis test for non-parametric multiple-groups comparisons were performed to compare pre- to post-intervention outcomes between groups. Effect-size estimates of each intervention and between groups were calculated to allow interpretation of results in a more functional and meaningful way. Results: Both the control group and diaphragm group showed a statistically (p< 0.005) and clinically significant improvement, as well as a significant effect size (moderate to strong), on the NPRS in shoulder flexion and abduction movements. Regarding NPRS in shoulder external rotation, only the control group obtained a significant effect size. There was a significant increase in shoulder abduction and external rotation ROM (p< Efectos del tratamiento del músculo diafragma en el dolor y la movilidad del hombro en sujetos con patología del manguito rotador. 28 0.001) with a significant effect size in the control group. The PPT at the xiphoid process of the sternum showed a statistically (p< 0.001) and clinically significant improvement in the diaphragm group. The hipopressive gymnastic treatment was found to be no clinically effective in the shoulder pain and mobility, and showed a less efficacy than the other two groups. Conclusion: Both the shoulder non-direct treatment by a protocol of diaphragm manual therapy techniques and the rotator cuff MTP intervention showed been clinically effective in reducing pain (NPRS) immediately in shoulder flexion and abduction movements. The ROM assessment improvements obtained post- intervention by the diaphragm group have not been enough to consider them as clinically significant. The control group has obtained a significant effect size in shoulder abduction and external rotation ROM improvement. Both the control group and the diaphragm group treatments have been more effective in improving shoulder pain and mobility than the hipopressive group. The control group intervention has been the most effective in improving shoulder external rotation pain and mobility. The diaphragm group intervention was more effective in improving PPT at the xiphoid process than the other groups. Neither the effect size nor clinical significance proves the short-term benefit of the hipopressive gymnastic treatment in shoulder pain and mobility. Future studies are necessary to show the effectiveness of the diaphragm manual therapy applied in several sessions to determine its long-term effects in shoulder pain and mobility.
... 30,31 The stretching techniques focus on increasing the length of a musculotendinous unit, in essence increasing the distance between the origin and insertions of the diaphragmatic muscle to reduce the tension generated by the shortening of their fibers and promote greater effectiveness of muscle contraction, 32 and are some of the most frequently studied in the scientific literature. 19,33 On the other hand, through myofascial release techniques, the connective tissue could be indirectly stretched after a static load because of its innate viscoelastic properties, causing a modification of the nociceptive sensation and possible reflex changes. 34 Diaphragmatic myofascial release techniques have obtained benefits in both muscle and joint mobility in different studies. ...
... The complete bibliographic search strategy is presented in fig 2. Clinical characteristics of the studies Most of the studies were conducted in participants without a specific pathology, 3 of them in healthy adults, 19,29,48 1 of them with sedentary women, 20 and 1 in a condition that cannot be classified as pathologic, which is short hamstring syndrome. 33 The study by Mart ı-Salvador et al 27 used participants with chronic nonspecific low back pain, while 3 studies used a sample with respiratory disease. 35,36,49 The samples included in each study and their summary characteristics are presented in table 3. ...
... Based on the critical evaluation with the PEDro scale, the methodological quality of 3 articles 27,35,48 was considered very high with a very low risk of bias. Five studies 19,20,29,33,49 were assessed as high quality with a low risk of bias. One study 36 was considered of moderate quality with a high risk of bias. ...
Article
Objectives To analyze the effects at the musculoskeletal level of manual treatment of the diaphragm muscle in adults. Data Sources Systematic review using four databases: PubMed, Science Direct, Web of Science and Scopus. Study selection and data extraction Two independent reviewers applied the selection criteria and assessed the quality of the studies using the Physiotherapy Evidence Database (PEDro) scale for experimental studies. A third reviewer intervened in cases where a consensus had not been reached. A total of 9 studies were included in the review. Results Manual therapy directed to the diaphragm has been shown to be effective in terms of the immediate increase in diaphragmatic mobility and thoracoabdominal expansion. The immediate improvement in the posterior muscle chain flexibility test is another of the most frequently found findings in the evaluated studies. Limited studies show improvements at the lumbar and cervical level in the range of motion and in pain. Conclusion Manual diaphragm therapy has shown an immediate significant effect on parameters related to costal, spinal and posterior muscle chain mobility. Further studies are needed, not only to demonstrate the effectiveness of manual diaphragm therapy in the long term and in symptomatic populations, but also to investigate the specific neurophysiological mechanisms involved in this type of therapy.
... Some evidence supports 11 a relationship between trunk muscle activity and posterior chain muscle movement. Different studies [12][13][14] have used stretching techniques including diaphragm stretching for spinal pain relief, improving the posture 12 , stability 13 , and the length of the posterior muscle chain 14 . However, few studies have explored the effect of stretching techniques on diaphragm and spine kinematics. ...
... Some evidence supports 11 a relationship between trunk muscle activity and posterior chain muscle movement. Different studies [12][13][14] have used stretching techniques including diaphragm stretching for spinal pain relief, improving the posture 12 , stability 13 , and the length of the posterior muscle chain 14 . However, few studies have explored the effect of stretching techniques on diaphragm and spine kinematics. ...
... The short length of the therapeutic session (5-7 minutes) could be one of the limitations of this study. However, previous studies 2, 14 have investigated the immediate effects of manual techniques with beneficial results. ...
Article
Full-text available
Background: Few studies have explored the effects of stretching techniques on diaphragm and spine kinematics. Objective: To determine whether the application of diaphragm stretching resulted in changes in posterior chain muscle kinematics and ribcage and abdominal excursion in healthy subjects. Method: Eighty healthy adults were included in this randomized clinical trial. Participants were randomized into two groups: the experimental group, which received a diaphragmatic stretching technique, or the placebo group, which received a sham-ultrasound procedure. The duration of the technique, the position of participants, and the therapist who applied the technique were the same for both treatments. Participant assessment (cervical range of movement, lumbar flexibility, flexibility of the posterior chain, and rib cage and abdominal excursion) was performed at baseline and immediately after the intervention by a blinded assessor. Results: The mean between-group difference [95% CI] for the ribcage excursion after technique at xiphoid level was 2.48 [0.97 to 3.99], which shows significant differences in this outcome. The remaining between-group analysis showed significant differences in cervical extension, right and left flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level (p<0.05) in favor of the experimental group. Conclusion: Diaphragm stretching generates a significant improvement in cervical extension, right and left cervical flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level compared to a placebo technique in healthy adults.
... This is the first study to evaluate the effects of a stretching technique on the diaphragm in asthmatic patients. Previous studies [15,32] have explored the effects of the same technique in healthy people. González-Alvarez et al. [15] evaluated the effects of diaphragm stretching on pulmonary function and respiratory pressures in healthy adults. ...
... In another study [32] carried out in 2015, the effects of diaphragm stretching were evaluated in patients with short hamstring syndrome. The aim of the study was to assess the effects of the technique on hamstring flexibility and spine mobility in patients with short hamstring syndrome. ...
Article
Background: Stretching of respiratory muscles is included in what is known as manual therapy techniques. A diaphragm stretching technique has shown beneficial effects on respiratory function and thoracic and spinal mobility in healthy subjects. However, its effects on asthmatic patients have not been evaluated. Objective: To evaluate the effects of manual therapy on the diaphragm in allergic and non-allergic asthmatic patients regarding respiratory pressures and chest mobility. Design: Single-blinded randomized pilot study. Setting: Faculty of Health Sciences of Granada, Spain. Methods: Thirty-two participants were randomized into two groups: an intervention group in which a diaphragm stretching technique was performed and a placebo group. Respiratory pressures, thoracic and lumbar mobility, and flexibility were evaluated before the technique was performed, immediately afterwards, and at 5 and 20 min. Participants: Allergic and non-allergic asthmatic patients. Results: Our results support the immediate effectiveness of the technique in maximal inspiratory pressure at 5 min of diaphragm stretching (p = 0.031). Significant results were also shown in mobility and flexibility, with a significant improvement in the subaxillary and abdominal perimeter as well as in the finger-floor test and the Schober test (p < 0.05). Conclusions: The results may show that a diaphragm stretching technique in asthmatic patients leads to an improvement in the following parameters: maximum inspiratory pressures 5 min after the technique; and flexibility and mobility of the rib cage at 5 min, which remains at 20 min. Further work is required to test the reproducibility of these results in a definitive trial.
... All of results corroborate the majority of studies published about the topic, most likely because these studies applied similar techniques. Valenza et al. (2015) recruited 60 young adults with short-hamstring syndrome and applied a diaphragm stretching technique similar to the diaphragm lift but with different positioning and duration. A placebo technique was performed in the control group with a disconnected ultrasound in the xiphoid process for 5 min. ...
... Intragroup EG (n ¼ 50) performed in patients with ankylosing spondylitis (Gonz alez- Alvarez et al., 2016;Valenza et al., 2015). ...
Article
Background Although diaphragmatic myofascial release techniques are widely used in clinical practice, few studies have evaluated the simultaneous acute effects of these techniques on the respiratory and musculoskeletal systems. Objective To evaluate the immediate effects of diaphragmatic myofascial release in sedentary women on the posterior chain muscle flexibility; lumbar spine range of motion; respiratory muscle strength; and chest wall mobility. Design A randomized placebo-controlled trial with concealed allocation, intention-to-treat analysis, and blinding of assessors and participants. Participants Seventy-five sedentary women aged between 18 and 35 years. Intervention The sample was randomly allocated into one of two groups; the experimental group received two diaphragmatic myofascial release techniques in a single session, and the control group received two placebo techniques following the same regimen. Outcomes measures The primary outcome was chest wall mobility, which was analyzed using cirtometry. The secondary outcomes were flexibility, lumbar spine range of motion, and respiratory muscle strength. Outcomes were measured before and immediately after treatment. Results The manual diaphragm release techniques significantly improved chest wall mobility immediately after intervention, with a between-group difference of 0.61 cm (95% CI, 0.12–1.1) for the axillary region, 0.49 cm (95% CI, 0.03–0.94) for the xiphoid region, and 1.44 (95% CI, 0.88–2.00) for the basal region. The techniques also significantly improved the posterior chain muscle flexibility, with a between-group difference of 5.80 cm (95% CI, 1.69–9.90). All movements except flexion of the lumbar spine significantly increased. The effects on respiratory muscle strength were non-significant. Conclusion The diaphragmatic myofascial release techniques improve chest wall mobility, posterior chain muscle flexibility, and some movements of the lumbar spine in sedentary women. These techniques could be considered in the management of people with reduced chest wall and lumbar mobility. Trial registration NCT03065283.
... Several studies in the literature have used the anterior approach to understand or palpate the movement of the diaphragm [61,[66][67][68]. Considering that in this region the muscle only moves a few millimeters, we can say posterior palpation will be more indicative, probably, of the overall movement of the diaphragm. ...
Article
Full-text available
The eupneic act in healthy subjects involves a coordinated combination of functional anatomy and neurological activation. Neurologically, a central pattern generator, the components of which are distributed between the brainstem and the spinal cord, are hypothesized to drive the process and are modeled mathematically. A functionally anatomical approach is easier to understand although just as complex. Osteopathic manipulative treatment (OMT) is part of osteopathic medicine, which has many manual techniques to approach the human body, trying to improve the patient’s homeostatic response. The principle on which OMT is based is the stimulation of self-healing processes, researching the intrinsic physiological mechanisms of the person, taking into consideration not only the physical aspect, but also the emotional one and the context in which the patient lives. This article reviews how the diaphragm muscle moves, with a brief discussion on anatomy and the respiratory neural network. The goal is to highlight the critical issues of OMT on the correct positioning of the hands on the posterolateral area of the diaphragm around the diaphragm, trying to respect the existing scientific anatomical-physiological data, and laying a solid foundation for improving the data obtainable from future research. The correctness of the position of the operator’s hands in this area allows a more effective palpatory perception and, consequently, a probably more incisive result on the respiratory function.
... The respiratory exercise regimen was designed to maintain neutral alignment of the spine by retraining the breathing pattern through relaxed diaphragm breathing. The first method used was the doming technique, which relaxes the diaphragm during rest and improves diaphragm contraction and relaxation functions [43,44]. The subject was seated at a treatment table in a comfortable and relaxed position. ...
... Manual manipulation of the diaphragm is a technique used by both manual therapist and osteopaths. It has been reported effective in patients with pulmonary disease, as well as those with short hamstring syndrome [4][5][6]. On the basis of an anatomical concept, the use of osteopathic diaphragm manipulation and thoracic pump technique in swollen ankle and postural imbalance may be reasoned [7]. It is also supported by the fact that aortic hiatus is at the T12 level and contains the aorta, thoracic duct, azygos and hemiazygos veins [8]. ...
Article
Full-text available
Introduction. Loss of stability and persistent swelling in patients with subtalar joint injury occur very often. Diaphragm plays an important role in providing proprioceptive information and its proper function remains a key factor reducing swelling in the distal part of the body. The aim of this study was to evaluate the influence of diaphragm osteopathic manipulative treatment (OMT) on postural control and swelling reduction. Methods. The study is a case report describing a 23-year-old male who injured his right subtalar joint during a football match. Before the therapy, a complex physical examination was performed: muscle strength and range of motion of lower limbs evaluation, initial testing of postural control, and the level of swelling determination with the figure-of-eight method. After extensive diagnosis, two OMT techniques were used: doming the diaphragm technique and thoracic pump with respiratory assist technique. Subsequently, the second static stability test and figure-of-eight method were applied. Results. The length of the centre of pressure (COP) path with eyes opened decreased by 15%, and with eyes closed by 45%. The surface area circled by the COP path with eyes open decreased by 22%, and with eyes closed by 68%. There was no immediate change in swelling. Conclusions. The study confirmed the efficacy of diaphragm OMT in improving postural control. Screening for diaphragm dysfunction should be part of complete osteopathic assessment in subtalar joint injury.
... 32 Other types of manual (osteopathic) techniques employ myofascial approaches, in particular by placing the hands under the chondrocostal junctions, inducing and facilitating respiratory acts. 33,34 The same techniques are also used in other fields, such as to improve the symptoms of gastroesophageal reflux, and to alleviate somatic symptoms in pregnant women. 35,36 There are several studies evaluating the effects of the manual therapy in COPD. ...
Article
Full-text available
The respiratory diaphragm is the most important muscle for breathing. It contributes to various processes such as expectoration, vomiting, swallowing, urination, and defecation. It facilitates the venous and lymphatic return and helps viscera located above and below the diaphragm to work properly. Its activity is fundamental in the maintenance of posture and body position changes. It can affect the pain perception and emotional state. Many authors reported on diaphragmatic training by using special instruments, whereas only a few studies focused on manual therapy approaches. To the knowledge of the authors, the existing scientific literature does not exhaustively examines the manual evaluation of the diaphragm in its different portions. A complete evaluation of the diaphragm is mandatory for several professional subjects, such as physiotherapists, osteopaths, and chiropractors not only to elaborate a treatment strategy but also to obtain information on the validity of the training performed on the patient. This article aims to describe a strategy of manual evaluation of the diaphragm, with particular attention to anatomical fundamentals, in order to stimulate further research on this less explored field.
Article
Shimozawa, Y, Kurihara, T, Kusagawa, Y, Hori, M, Numasawa, S, Sugiyama, T, Tanaka, T, Suga, T, Terada, RS, Isaka, T, and Terada, M. Point prevalence of the biomechanical dimension of dysfunctional breathing patterns among competitive athletes. J Strength Cond Res XX(X): 000-000, 2022-There is growing evidence of associations between altered biomechanical breathing patterns and numerous musculoskeletal and psychological conditions. The prevalence of dysfunctional and diaphragmatic breathing patterns is unknown among athletic populations. The purpose of this study was to examine the prevalence of dysfunctional and diaphragmatic breathing patterns among athletic populations with a clinical measure to assess the biomechanical dimension of breathing patterns. Using a cross-sectional design, 1,933 athletes across multiple sports and ages were screened from 2017 to 2020. Breathing patterns were assessed using the Hi-Lo test in the standing position. Scores of the Hi-Lo test were determined based on the presence or absence of abdominal excursion, anterior-posterior chest expansion, superior rib cage migration, and shoulder elevation. The Hi-Lo test scores were used to categorize observational breathing mechanics as dysfunctional and diaphragmatic breathing patterns. The prevalence of athletes with dysfunctional breathing patterns was 90.6% (1,751 of 1,933). Athletes with diaphragmatic breathing patterns accounted for 9.4% of all athletes in our sample (182 of 1,933). There were no differences in the proportion of breathing patterns between male and female athletes (p = 0.424). Breathing patterns observations were associated with sport-setting categories (p = 0.002). The highest percentages of dysfunctional breathers were in middle school student athletes (93.7%), followed by elementary school student athletes (91.2%), high school student athletes (90.6%), professional/semiprofessional athletes (87.5%), and collegiate athletes (84.8%). The current study observed that dysfunctional breathing patterns (90.6%) in the biomechanical dimension were more prevalent than diaphragmatic breathing pattern (9.4%) among competitive athletes. These results suggest that clinicians may need to consider screening breathing patterns and implementing intervention programs aimed to improve the efficiency of biomechanical dimensions of breathing patterns in athletic populations. This study may help raise awareness of impacts of dysfunctional breathing patterns on athletes' health and performance.
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The purpose of this study was to examine intratester reliability of a test designed to measure tightness in the hamstring muscles. The test measures the angle of knee flexion with a pendulum goniometer after active knee extension with the hip stabilized at 90 degrees flexion. The angle of knee flexion represents hamstring tightness. After an instruction session for the subjects, the hamstring muscle tightness of both extremities of 15 men was measured during test and retest sessions. The reliability coefficients for test and retest measurements were .99 for the left extremity and .99 for the right extremity. High reliability resulted from strict body stabilization methods, a well-defined end point of motion, and accurate instrument placement. If conducted properly, the test should provide therapists with an objective and reliable tool for measuring hamstring muscle tightness.
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The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials.Kenneth Schulz and colleagues describe the latest version,CONSORT 2010,which updates the reporting guideline based on new methodological evidence and accumulating experience.To encourage dissemination of the CONSORT 2010 Statement,this article is freely accessible on bmj.com and will also be published in the Lancet,Obstetrics and Gynecology,PLoS Medicine,Annals of Internal Medicine,Open Medicine,Journal of Clinical Epidemiology,BMC Medicine,and Trials.
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Objective: (1) to analyse the accumulative effects of a 12-week active stretching program on hip flexion passive range of motion (HF-PROM), and (2) to compare whether participants with different PROM baseline scores (normal and limited hamstring flexibility) respond in the same way to stretching. Design: Repeated measures design. Setting: Controlled laboratory environment. Participants: 138 males were categorized according to hamstring flexibility in the unilateral passive straight-leg raise test (PSLR) and assigned to one of two groups: normal hamstring flexibility (≥80°) or limited hamstring flexibility (<80°). In each group, participants were randomly distributed into one of two treatment subgroups: (a) control or (b) active stretching. The active stretching subgroups performed 12 weeks of flexibility training, the control subgroups did not stretch. Main outcome measures: HF-PROM was determined through the PSLR test. Results: Both stretching subgroups significantly improved (p < 0.01) their HF-PROM from baseline. The control subgroups did not. Conclusions: 12 weeks of an active stretching program performed 3 days per week with a daily stretch dose of 180 s improved HF-PROM in both populations (normal and limited hamstring flexibility). The stretching program was equally effective in terms of absolute improvement values for males with normal and limited hamstring flexibility.
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La Rieducazione Posturale Globale (RPG) pone la sua attenzione sul concetto di bipolarità muscolare, che vede la differenziazione sul piano anatomico, metabolico e quindi funzionale tra fibre muscolari dinamiche e statiche. Orienta il trattamento alla rieducazione della funzione muscolare statica, individuandola quale maggior responsabile del controllo dell’atteggiamento posturale di ogni individuo e anche di numerose disfunzioni meccaniche dolorose. In contrapposizione al meccanismo patologico muscolare che produce retrazione muscolo tendinea e aumento del tono in caso di aggressione dolorosa, la RPG fa ricorso a un esercizio terapeutico che sfrutta come meccanismo d’azione l’allungamento della componente muscolare retratta e il rilasciamento riflesso. Tale esercizio si realizza facendo ricorso a posture attive che coinvolgono tutto il corpo, sfruttando le contrazioni muscolari eccentriche o isometriche a lunghezza crescente. L’obiettivo è quello di restituire un equilibrato controllo delle tensioni reciproche muscolari e di ottenere, attraverso la ripetizione attiva e consapevole dell’esercizio, una nuova registrazione a livello centrale del comportamento posturale.
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This study examined the passive compliance and length of the hamstring muscles of 15 healthy men and 15 healthy women (ages 21-37) with passive straight-leg-raising between 65° and 80°. Subjects were positioned on their left sides with the pelvis stabilized and the right thigh fixed at 90° on a horizontal platform. After three practice trials of maximal passive knee extension, subjects received three trials for data collection. Muscle activity was monitored with surface EMG and passive resistance to knee extension was measured with a dynamometer as the limb was photographed at six force-dependent positions. The passive compliance was computed as the ratio of the change in the knee angle (ΔAngle) to the change in passive torque (ΔTorque), (ΔAngle/ΔTorque). Hamstring muscle lengths were measured simultaneously. An ANovA revealed a difference (P = 0·001) between the passive compliance ratios of the men (1·4 ± 0·-03) and women (2·2 ± 0·08) but not between their initial knee angles or their maximal knee angles. Independent t-tests showed a difference (P < 0·001) between the maximal passive torque of the men (41·4 ± 5·7 Nm) and women (27·4 ± 7·7 Nm). The torques were not different when standardized to body mass. Although ANOVAS showed that the absolute hamstring muscle lengths differed between genders, they were not different when standardized as a percentage of the femur length.
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Lack of flexibility in the hamstring muscle conditions a decrease of pelvic mobility. This invariably leads to biomechanical changes in the distribution of pressures in the spine.The incidence of the shortened hamstrings syndrome is greater in men and can be associated to muscles injuries, joint alterations, sport activity and style of life.Many of the present investigations are focused on the benefits of training flexibility, acting on the mechanisms involved in such through the application of stretching programs, in order to increase the muscle tendinuos length.
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Objectives: Massage is widely used by the athletic population for a variety of purposes such as injury prevention, recovery from fatigue, relaxation, and to increase performance. This paper reviews the scientific literature on the use and effects of massage therapy in sport. Specifically, the review addresses physiological, psychological and performance effects. Method: A literature search was conducted using Medline, Psychlit and Sport Discus databases. In addition, the author's own files were considered. Results: Past studies on blood flow, blood lactate removal and delayed onset of muscle soreness are seen to have produced equivocal results, with blood lactate removal following exercise more efficiently removed through active recovery strategies rather than through massage. Studies on the psychological effects are few in number, however recent research seems to demonstrate massage having positive effects on perceptions of recovery. Few studies exist which assess massage effects on performance, and current findings appear to show little support for the use of massage for performance enhancement. Conclusions: Massage research has been affected by a lack of comparable instrumentation and different research designs that make interpretation and extrapolation of results difficult. It appears the use of massage may largely be based upon anecdotal accounts that convey positive testaments about this form of therapy. The evidence from this review suggests that more scientific research on the effects of massage needs to be undertaken to clarify the precise effects of massage for athletes, however applying scientific principles to the study of massage does pose methodological challenges for the researcher.