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PubMed2006

Warming up improves speech production in patients with adult onset myotonic dystrophy.

UNLABELLED: This investigation was conducted to study whether warming up decreases myotonia (muscle stiffness) during speech production or causes adverse effects due to fatigue or exhaustion caused by intensive speech activity in patients with adult onset myotonic dystrophy. Thirty patients with adult onset myotonic dystrophy (MD) and ten healthy controls were examined, using a protocol that requires subjects, to speak continuously for at least 10 min. In MD patients, warming up led to an increase in speech rate and a decrease in speech variability without causing signs of fatigue or exhaustion as a result of prolonged and intensive use of the speech musculature. No significant changes were found in the controls. After warming up, MD patients achieved a habitual speech rate in reading and reciting similar to that of healthy controls. LEARNING OUTCOMES: As a result of this activity the reader will learn that 1. In contrast to most neuromuscular disorders, speech production in patients with adult onset myotonic dystrophy improves by activity. 2. Myotonia in speech musculature in patients with adult onset myotonic dystrophy can be reduced by instructing them to warm up their muscles by repetitive movements. 3. Warming up is a valuable intervention because it improves the velocity and fluency of speech production without aggravating the signs of flaccid dysarthria.

Adolescent↗
PubMed2006

Triceps surae stretch and voluntary contraction alters maximal M-wave magnitude.

UNLABELLED: Reliability of the motor response (M-wave) is fundamental in many reflex studies; however it has recently been shown to change during some investigations. The aim of this investigation was to determine if triceps surae stretch and voluntary contraction, or recording and analysis techniques, affect the maximal M-wave magnitude. The maximal M-wave was investigated in human gastrocnemius and soleus during different foot positions and during triceps surae contraction. Both bipolar and monopolar-recoding methods, and area and peak-to-peak (PTP) amplitude analysis methods were used. RESULTS: Maximal M-wave magnitude changed significantly between test muscle conditions, and is largest during dorsiflexion, probably due to changes in muscle bulk and recording electrode relationship. The maximal M-wave was up to 88% smaller when recorded by bipolar electrodes compared to monopolar electrodes, which is discussed in relation to signal cancellation. Area analysis provided more significant differences in M-wave magnitude between test muscle conditions than did PTP amplitude analysis, and the maximal M-wave shape changed significantly between test muscle conditions. This study suggests that maximal M-wave magnitude can vary depending on muscle condition, it highlights the importance of using correct recording and analysis techniques, and questions the reliability of using M-wave magnitude to monitor the relationship between the nerves and stimulating electrodes.

Adolescent↗
PubMed2006

Bouts of passive stretching after immobilization of the rat soleus muscle increase collagen macromolecular organization and muscle fiber area.

This study evaluated the effect of short bouts of stretching on the soleus muscle after immobilization, by measuring the birefringence of the intramuscular connective tissue (ICT) and the muscle fiber area. Thirty rats were divided into five groups: the left soleus was immobilized in the shortened position; after immobilization the animals remained free; after immobilization, the soleus was stretched daily (10 stretches of 60 sec followed by 30 sec rest); after immobilization, the soleus was stretched 3 times a week; control. Immobilization caused a loss of birefringence of the ICT and of muscle fiber area and only daily stretching increased both compared with the control (p< 0.01). In conclusion, short daily bouts of stretching after immobilization induced molecular reorganization of the collagen bundles and muscle fiber hypertrophy in the rat soleus.

Animals↗
PubMed2002

Management of myofascial trigger point pain.

Successful management of myofascial trigger point (MTrP) pain depends on the practitioner finding all of the MTrPs from which the pain is emanating, and then deactivating them by one of several currently used methods. These include deeply applied procedures, such as an injection of a local anaesthetic into MTrPs and deep dry needling (DDN), and superficially applied ones, including an injection of saline into the skin and superficial dry needling (SDN) at MTrP sites. Reasons are given for believing that DDN should be employed in cases where there is severe muscle spasm due to an underlying radiculopathy. For all other patients SDN is the treatment of choice. Following MTrP deactivation, correction of any postural disorder likely to cause MTrP reactivation is essential, as is the need to teach the patient how to carry out appropriate muscle stretching exercises. It is also important that the practitioner excludes certain biochemical disorders.

Acupuncture Analgesia↗
PubMed2006

Residual force enhancement after lengthening is present during submaximal plantar flexion and dorsiflexion actions in humans.

Stretch of an activated muscle causes a transient increase in force during the stretch and a sustained, residual force enhancement (RFE) after the stretch. The purpose of this study was to determine whether RFE is present in human muscles under physiologically relevant conditions (i.e., when stretches were applied within the working range of large postural leg muscles and under submaximal voluntary activation). Submaximal voluntary plantar flexion (PF(v)) and dorsiflexion (DF(v)) activation was maintained by providing direct visual feedback of the EMG from soleus or tibialis anterior, respectively. RFE was also examined during electrical stimulation of the plantar flexion muscles (PF(s)). Constant-velocity stretches (15 degrees /s) were applied through a range of motion of 15 degrees using a custom-built ankle torque motor. The muscles remained active throughout the stretch and for at least 10 s after the stretch. In all three activation conditions, the stable joint torque measured 9-10 s after the stretch was greater than the isometric joint torque at the final joint angle. When expressed as a percentage of the isometric torque, RFE values were 7, 13, and 12% for PF(v), PF(s), DF(v), respectively. These findings indicate that RFE is a characteristic of human skeletal muscle and can be observed during submaximal (25%) voluntary activation when stretches are applied on the ascending limb of the force-length curve. Although the underlying mechanisms are unclear, it appears that sarcomere popping and passive force enhancement are insufficient to explain the presence of RFE in these experiments.

Adult↗
PubMed2006

Lengthening the hamstring muscles without stretching using "awareness through movement".

BACKGROUND AND PURPOSE: Passive stretching is widely used to increase muscle flexibility, but it has been shown that this process does not produce long-term changes in the viscoelastic properties of muscle as originally thought. The authors tested a method of lengthening hamstring muscles called "Awareness Through Movement" (ATM) that does not use passive stretching. SUBJECTS: Thirty-three subjects who were randomly assigned to ATM and control groups met the screening criteria and completed the intervention phase of the study. METHODS: The ATM group went through a process of learning complex active movements designed to increase length in the hamstring muscles. Hamstring muscle length was measured before and after intervention using the Active Knee Extension Test. RESULTS: The ATM group gained significantly more hamstring muscle length (+7.04 degrees ) compared with the control group (+1.15 degrees ). DISCUSSION AND CONCLUSION: The results suggest that muscle length can be increased through a process of active movement that does not involve stretching. Further research is needed to investigate this finding.

Adult↗
PubMed1999

Early events in stretch-induced muscle damage.

Unaccustomed exercise involving stretch of active muscle at long length causes an immediate loss of tension-generating capacity, a shift of optimum length, and changes in excitation-contraction coupling. Eventually, fiber damage may be observed, resulting in pain and tenderness. The subject of this review is the early stage in this process, particularly the cause of the immediate drop in tension. There is strong evidence pointing to sarcomere length instabilities and nonuniformities as important contributors to these changes. The evidence includes the influence of initial length, electron microscopy of rapidly fixed active fibers, the shift in optimum length in single fibers, and the effects of training on sacomere numbers. Experiments using Ca(2+)-sensitive dyes clearly show changes in excitiation-contraction coupling, but cross-species comparisons indicate that these are not always able to explain the consequences seen. We conclude that sarcomere length instabilities provide the most comprehensive explanation of the early consequences of eccentric exercise.

Animals↗
PubMed2002

Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review.

OBJECTIVE: To determine the effects of stretching before and after exercising on muscle soreness after exercise, risk of injury, and athletic performance. METHOD: Systematic review. DATA SOURCES: Randomised or quasi-randomised studies identified by searching Medline, Embase, CINAHL, SPORTDiscus, and PEDro, and by recursive checking of bibliographies. MAIN OUTCOME MEASURES: Muscle soreness, incidence of injury, athletic performance. RESULTS: Five studies, all of moderate quality, reported sufficient data on the effects of stretching on muscle soreness to be included in the analysis. Outcomes seemed homogeneous. Stretching produced small and statistically non-significant reductions in muscle soreness. The pooled estimate of reduction in muscle soreness 24 hours after exercising was only 0.9 mm on a 100 mm scale (95% confidence interval -2.6 mm to 4.4 mm). Data from two studies on army recruits in military training show that muscle stretching before exercising does not produce useful reductions in injury risk (pooled hazard ratio 0.95, 0.78 to 1.16). CONCLUSIONS: Stretching before or after exercising does not confer protection from muscle soreness. Stretching before exercising does not seem to confer a practically useful reduction in the risk of injury, but the generality of this finding needs testing. Insufficient research has been done with which to determine the effects of stretching on sporting performance.

Athletic Injuries↗
PubMed2004

Popping sarcomere hypothesis explains stretch-induced muscle damage.

1. Exercise that involves stretching a muscle while active cause microscopic areas of damage, delayed onset muscle soreness and adaptation to withstand subsequent similar exercise. 2. Longer muscle lengths are associated with greater damage and recent animal experiments show that it is the length relative to optimum that determines the damage. 3. In humans, walking down stairs, taking two at a time, increases the length of the muscle during the lengthening and increases the delayed onset muscle soreness. 4. The observed pattern of damage is consistent with explanations based on sarcomere length instabilities. 5. The pattern of adaptation is consistent with the number of sarcomeres in series in a muscle being modulated by exercise, especially the range of muscle lengths over which eccentric exercise regularly occurs.

Exercise↗
PubMed2006

Effects of stretching on passive muscle tension and response to eccentric exercise.

BACKGROUND: Stretching is used in an attempt to improve performance and reduce the risk of muscle injury, with little evidence to support its effectiveness. HYPOTHESIS: Four weeks of static or ballistic stretching can attenuate the increased soreness and decreased flexibility seen after eccentric exercise. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty-nine male subjects were randomly assigned to a static stretching, ballistic stretching, or control group. On each of 4 consecutive days, they completed 4 maximal range of motion stretches using a Cybex isokinetic dynamometer to passively stretch the hamstrings at 0.087 rad.s(-1) (5 deg.s(-1)). Stiffness from 0.87 to 1.48 rad (50 degrees -85 degrees ), peak range of motion, work absorption, peak resistive torque, and soreness were measured. Participants then completed 4 weeks of either static or ballistic stretching for a total stretching duration of 3600 seconds. After training, the 4 days of testing were repeated with an eccentric exercise task added after day 1. RESULTS: Stretching groups had an increase in range of motion and stretch tolerance after 4 weeks of stretching, with no change in muscle stiffness, work absorption, or delayed onset muscle soreness. After eccentric exercise, they also had greater range of motion and stretch tolerance than did controls. CONCLUSION: Both static stretching and ballistic stretching increase range of motion, most likely as a result of enhanced stretch tolerance rather than changes in muscle elasticity. Four weeks of stretching maintain range of motion and stretch tolerance in the days after eccentric exercise.

Adolescent↗
PubMed1995

Comparison of blood pressure and heart rate responses to isometric exercise and passive muscle stretch in humans.

The responses of mean arterial blood pressure (BPa) and heart rate (fc) to isometric contraction and passive stretch were compared in seven healthy male subjects at identical external forces. They were investigated in the sitting position with the hip and knee joint flexed to 90 degrees. Each subject performed two tests, separated by a day, in which the stimuli were applied in random order. After 5 min of rest they performed either 10-min static plantar flexion of one calf (200 N) or 10 min of passive calf muscle stretch at the same load. After 5-min rest, the second stimulus was applied for a further 10 min followed by 5-min rest. The second test was identical except for the sequence of the stimuli. The BPa was measured by a noninvasive and continuous method. Contraction of the vastus lateralis, gastrocnemius lateralis, and soleus muscles were determined by the myo-electric activity (electromyogram, EMG) by means of surface electrodes. The EMG activity of the vastus lateralis muscle remained at resting values throughout the experiments. Increases in EMG activity could only be detected for the triceps surae muscles during isometric contraction. During the initial 2 min of stimulation the BPa and fc responses to active contraction and passive stretch were comparable. Thereafter, both parameters showed significantly higher values during contraction. It was concluded that mechanical stress may have contributed to the early response of BPa during both passive stretch and voluntary contraction but that chemical stimuli were needed to maintain the peripheral cardiovascular drive.

Blood Pressure↗
PubMed2006

Neural aspects of muscle stretching.

Neural mechanisms contribute significantly to the gains that occur in the range of motion about a joint with stretching exercises. In the acute condition, lengthening of a muscle-tendon unit decreases spinal reflex excitability, which reduces passive tension and increases joint range of motion. Similarly, participation in a stretch-training program decreases tonic reflex activity and increases flexibility.

Humans↗
PubMed2006

Effects of exhaustive stretch-shortening cycle exercise on muscle blood flow during exercise.

AIM: The influence of exhaustive stretch-shortening cycle exercise (SSC) on skeletal muscle blood flow (BF) during exercise is currently unknown. METHODS: Quadriceps femoris (QF) BF was measured in eight healthy men using positron emission tomography before and 3 days after exhaustive SSC exercise. The SSC protocol consisted of maximal and submaximal drop jumps with one leg. Needle biopsies of the vastus lateralis muscles were taken immediately and 2 days after SSC for muscle endothelial nitric oxide synthase (eNOS) and interleukin-1-beta (IL-1beta) mRNA level determinations. RESULTS: All subjects reported subjective muscle soreness after SSC (P < 0.001), which was well in line with a decrease in maximal isometric contraction force (MVC) and increase in serum creatine kinase activity (CK) (P = 0.018). After SSC muscle BF was 25% higher in entire QF (P = 0.043) and in its deep and superficial muscle regions, whereas oxygen uptake remained unchanged (P = 0.893). Muscle biopsies revealed increased IL-1beta (30 min: 152 +/- 75%, P = 0.012 and 2 days: 108 +/- 203%, P = 0.036) but decreased or unchanged eNOS (30 min; -21 +/- 57%, P = 0.050 and 2 days: +101 +/- 204%, P = 0.779) mRNA levels after SSC. CONCLUSION: It was concluded that fatiguing SSC exercise induces increased muscle BF during exercise, which is likely to be associated with pro-inflammatory processes in the exercised muscle.

Adult↗
PubMed2006

Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders.

OBJECTIVE: The aim of this study was to investigate the effect of a specific therapeutic jaw exercise on the temporomandibular disorders of patients with chronic whiplash-associated disorders. MATERIAL AND METHODS: Ninety-four consecutive patients with whiplash-related conditions were referred to and accepted for a treatment period at a center for functional evaluation and rehabilitation during 2001-2002. The patients followed a program of physical therapy, occupational therapy, and pain management. At the start of their stay, they were examined by a physician specialized in rehabilitation medicine and also by a dentist who performed a functional examination of the stomatognathic system. Of the 93 patients who accepted participation in the study, 55 were diagnosed with temporomandibular disorders and chronic whiplash-associated disorders in accordance with the inclusion criteria. They were randomized into a jaw exercise group (n = 25), who performed specific therapeutic jaw exercises, and a control group (n = 30). Both groups undertook the whiplash rehabilitation program at the center. RESULTS: There were no inter- or intra-group differences in symptoms and signs of temporomandibular disorders at baseline, nor at the 3-week and 6-month follow-ups, except for an increase of maximum active mouth-opening capacity in the control group. CONCLUSIONS: In conclusion, the therapeutic jaw exercises, in addition to the regular whiplash rehabilitation program, did not reduce symptoms and signs of temporomandibular disorders in patients with chronic whiplash-associated disorders.

Adult↗
PubMedDate not supplied

Comparison of three stretches for the pectoralis minor muscle.

Pectoralis minor adaptive shortening in healthy individuals is associated with altered scapular kinematics similar to the alterations demonstrated in individuals with subacromial impingement. This associative relationship suggests that stretching of the pectoralis minor may improve scapular kinematics and assist in the management of shoulder impingement. Several stretches for the pectoralis minor are used clinically, although it is not known which stretch optimally lengthens the muscle. The purpose of this analysis was to compare the mean length change for 3 pectoralis minor stretches. Fifty subjects without shoulder pathology were examined for the change in length of the pectoralis minor during 3 separate stretches by use of an electromagnetic motion-capture system. The stretches analyzed were a unilateral self-stretch, a supine manual stretch, and a sitting manual stretch. Each stretch was significantly different from the other two (df, 2/98; F ratio, 39.09; P < .00001), with the unilateral self-stretch demonstrating the greatest length change (2.24 cm), followed by the supine manual stretch (1.69 cm) and the sitting manual stretch (0.77 cm). Knowledge of the most effective method of elongating the pectoralis minor muscle may improve clinical decision making when targeting this anterior scapulothoracic muscle as part of intervention for or prevention of shoulder impingement.

Adult↗
PubMed2006

Dynamics of indirect symptoms of skeletal muscle damage after stretch-shortening exercise.

Healthy untrained men (age 20.4+/-1.7 years, n=20) volunteered to participate in an experiment in order to establish dynamics of indirect symptoms of skeletal muscle damage (ISMD) (decrease in maximal isometric voluntary contraction torque (MVCT) and torque evoked by electrostimulation at different frequencies and at different quadriceps muscle length, height (H) of drop jump (DJ), muscle soreness and creatine kinase (CK) activity in the blood) after 100 DJs from 0.75 m height performed with maximal intensity with an interval of 20s between the jumps (stretch-shortening exercise, SSE). All ISMDs remained even 72 h after SSE (P<0.01-0.001). The muscle experienced greater decrease (P<0.01) in torque evoked by electrostimulation (at low stimulation frequencies and at short muscle length in particular) after SSE than neuromuscular performance (MVCT and H of DJ) which demonstrated secondary decrease (P<0.01) in neuromuscular performance during the first 48 h after SSE. Within 24-72 h after the SSE the subjects felt an acute muscle pain (5-7 points approximately) and the CK activity in the blood was significantly increased up to 1200 IU/L (P<0.001). A significant correlation between decrease in MVCT and H of DJ 24-48 h after SSE on the one hand and muscle soreness registered within 24-48 h after SSE on the other was observed, whereas correlation between the other indirect symptoms of skeletal muscle damage was not significant.

Acute Disease↗
PubMed1986

Effects of prestretch intensity on mechanical efficiency of positive work and on elastic behavior of skeletal muscle in stretch-shortening cycle exercise.

Mechanical efficiency of positive work (eta+) and elastic behavior of human skeletal muscles were investigated on a special sledge apparatus which allowed the use of the normal stretch-shortening cycle exercises. Twenty-five young men were investigated in a total of 92 exercise situations, in which the intensity of the prestretch (eccentric contraction) was different, but the shortening phase (concentric contraction) was kept constant in all conditions. The results demonstrated that eta+ was on the average 35.8% +/- 6.4% and correlated positively with the prestretch intensity (r = 0.413; P less than 0.001), reaching a highest individual value of 51.5%. Estimation performed on the elastic characteristics of the leg extensor muscles confirmed an earlier suggestion that the pure muscle elasticity plays an important role in potentiating performance in stretch-shortening cycle exercises. The analysis of the myoelectrical activity of the leg extensor muscles showed that the nervous system plays an essential role in regulating muscle stiffness and thus utilization of muscle elasticity in ballistic exercises.

Adult↗