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PubMed2002

Does stretching induce lasting increases in joint ROM? A systematic review.

BACKGROUND AND PURPOSE: Stretching (that is, interventions that apply tension to soft tissues) induces increases in the extensibility of soft tissues, and is therefore widely administered to increase joint mobility and reverse contractures. However, it is not clear whether the effects of stretching are lasting. A systematic review was conducted to determine if stretching (either self-administered, administered manually by therapists or by some external device such as a splint) produces lasting increases in the mobility of joints not directly affected by surgery, trauma or disease processes. METHOD: In order to determine the lasting effects of stretching, only studies that measured joint range of motion (ROM) at least one day after the cessation of stretching were included. MEDLINE (from 1966 to June 2000), EMBASE (from 1988 to June 2000), the Cochrane Controlled Trials Register and PEDro databases were searched, and citation tracking was used to identify randomized studies that met the inclusion criteria. Each study was rated by two independent assessors on the PEDro scale, which rated trials according to criteria such as concealed allocation, blinding and intention-to-treat analysis. RESULTS: Thirteen studies satisfied the inclusion criteria. All examined the effect of stretching (median number of stretch sessions = eight) on joint ROM in healthy subjects without functionally significant contractures. Four studies were of 'moderate' quality and the remaining nine were of 'poor' quality. The 'moderate' quality studies suggest that regular stretching increases joint ROM (mean increase in ROM = 8 degrees; 95% CI 6 degrees to 9 degrees) for more than one day after cessation of stretching and possibly that the effects of stretching are greater in muscle groups with limited extensibility. CONCLUSIONS: The results of four 'moderate' quality studies show a convincing effect of stretching in people without functionally significant contracture. These findings require verification with high-quality studies. Lasting effects of intensive stretching programmes (for example, stretching applied for more than six weeks or for more than 20 minutes a day) or of stretching on people with functionally significant contracture have not yet been investigated with randomized studies.

Exercise Therapy↗
PubMed1994

Dynamic exercise stimulates group III muscle afferents.

1. In decerebrate cats, we investigated the responses of group III muscle afferents to dynamic exercise. The cats performed low intensity dynamic exercise on a treadmill. Group III afferent activity from the dynamically exercising triceps surae muscles was recorded from L7-S1 dorsal root filaments. 2. Single-unit recordings were obtained from 15 group III afferent fibers whose receptive fields were in the triceps surae muscles and from one group III afferent whose receptive field was in the flexor digitorum longus muscle. Conduction velocities for the 16 group III afferents ranged from 3.0 to 27.9 m/s (15.6 +/- 1.9 m/s, mean +/- SE). 3. Ten of 16 group III muscle afferents were stimulated by dynamic exercise. Of the 10, 7 were strongly responsive and 3 were mildly responsive to dynamic exercise. Each of the 10 afferents displayed at least some activity that was synchronized to the contraction phase of the step cycle. The mean developed tensions for strongly responsive afferents, mildly responsive afferents, and afferents that did not respond were 0.8 +/- 0.3, 1.3 +/- 0.5, and 0.7 +/- 0.3 Kg, respectively (P > 0.05). Thus differences in the responsiveness of the afferents to exercise were not attributable to differences in developed tensions. 4. The group III afferents that were strongly responsive to dynamic exercise were also mechanically sensitive. Each strongly responsive afferent (n = 7) was stimulated by nonnoxious pressure applied to its receptive field. Most strongly responsive afferents (n = 5) were stimulated by stretch of the triceps surae muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

Afferent Pathways↗
PubMed1997

+GZ-induced neck injuries in Royal Australian Air Force fighter pilots.

+GZ-induced neck injuries are a relatively common occurrence in pilots of high performance fighter aircraft. We surveyed 52 fighter pilots from the Royal Australian Air Force Base at Williamtown via an anonymous questionnaire in order to determine the prevalence and operational significance of these injuries. The pilots flew either the F/A-18 Hornet or the MB326H Macchi. Of the respondents, 44 reported having had a neck injury under +GZ. A higher rate was reported in pilots of the F/A-18. Most of these injuries were simple muscle sprains. There were 20 pilots who reported their neck injury as having interfered with mission completion. Only 12 pilots reported doing any regular neck strengthening exercises, while 33 pilots reported doing preflight neck stretches immediately prior to high +GZ exposure. There were 14 pilots who sought medical attention for their injury, with 9 being taken off flight status for an average of 2 weeks. Air combat maneuvering sorties and the "check six" head position were identified as causal factors by most pilots. This study demonstrates the operational significance of these injuries, and highlights the need for more research into this important aerospace medicine issue.

Adult↗
PubMed2006

Does stretching increase ankle dorsiflexion range of motion? A systematic review.

BACKGROUND: Many lower limb disorders are related to calf muscle tightness and reduced dorsiflexion of the ankle. To treat such disorders, stretches of the calf muscles are commonly prescribed to increase available dorsiflexion of the ankle joint. HYPOTHESIS: To determine the effect of static calf muscle stretching on ankle joint dorsiflexion range of motion. STUDY DESIGN: A systematic review with meta-analyses. METHODS: A systematic review of randomised trials examining static calf muscle stretches compared with no stretching. Trials were identified by searching Cinahl, Embase, Medline, SportDiscus, and Central and by recursive checking of bibliographies. Data were extracted from trial publications, and meta-analyses performed that calculated a weighted mean difference (WMD) for the continuous outcome of ankle dorsiflexion. Sensitivity analyses excluded poorer quality trials. Statistical heterogeneity was assessed using the quantity I2. RESULTS: Five trials met inclusion criteria and reported sufficient data on ankle dorsiflexion to be included in the meta-analyses. The meta-analyses showed that calf muscle stretching increases ankle dorsiflexion after stretching for < or = 15 minutes (WMD 2.07 degrees; 95% confidence interval 0.86 to 3.27), > 15-30 minutes (WMD 3.03 degrees; 95% confidence interval 0.31 to 5.75), and > 30 minutes (WMD 2.49 degrees; 95% confidence interval 0.16 to 4.82). There was a very low to moderate statistical heterogeneity between trials. The meta-analysis results for < or = 15 minutes and > 15-30 minutes of stretching were considered robust when compared with sensitivity analyses that excluded lower quality trials. CONCLUSIONS: Calf muscle stretching provides a small and statistically significant increase in ankle dorsiflexion. However, it is unclear whether the change is clinically important.

Ankle Joint↗
PubMed2001

Effects of concentric and eccentric contractions on phosphorylation of MAPK(erk1/2) and MAPK(p38) in isolated rat skeletal muscle.

1. Exercise and contractions of isolated skeletal muscle induce phosphorylation of mitogen-activated protein kinases (MAPKs) by undefined mechanisms. The aim of the present study was to determine exercise-related triggering factors for the increased phosphorylation of MAPKs in isolated rat extensor digitorum longus (EDL) muscle. 2. Concentric or eccentric contractions, or mild or severe passive stretches were used to discriminate between effects of metabolic/ionic and mechanical alterations on phosphorylation of two MAPKs: extracellular signal-regulated kinase 1 and 2 (MAPK(erk1/2)) and stress-activated protein kinase p38 (MAPK(p38)). 3. Concentric contractions induced a 5-fold increase in MAPK(erk1/2) phosphorylation. Application of the antioxidants N-acetylcysteine (20 mM) or dithiothreitol (5 mM) suppressed concentric contraction-induced increase in MAPK(erk1/2) phosphorylation. Mild passive stretches of the muscle increased MAPK(erk1/2) phosphorylation by 1.8-fold, whereas the combination of acidosis and passive stretches resulted in a 2.8-fold increase. Neither concentric contractions, nor mild stretches nor acidosis significantly affected phosphorylation of MAPK(p38). 4. High force applied upon muscle by means of either eccentric contractions or severe passive stretches resulted in 5.7- and 9.5-fold increases of phosphorylated MAPK(erk1/2), respectively, whereas phosphorylation of MAPK(p38) increased by 7.6- and 1.9-fold (not significant), respectively. 5. We conclude that in isolated rat skeletal muscle an increase in phosphorylation of both MAPK(erk1/2) and MAPK(p38) is induced by mechanical alterations, whereas contraction-related metabolic/ionic changes (reactive oxygen species and acidosis) cause increased phosphorylation of MAPK(erk1/2) only. Thus, contraction-induced phosphorylation can be explained by the combined action of increased production of reactive oxygen species, acidification and mechanical perturbations for MAPK(erk1/2) and by high mechanical stress for MAPK(p38).

Acids↗
PubMed1991

Exertional muscle injury: evaluation of concentric versus eccentric actions with serial MR imaging.

Eccentric muscular actions involve the forced lengthening or stretching of muscles and tend to produce exertional injuries. This study used magnetic resonance (MR) imaging to serially evaluate muscles in five healthy, untrained subjects who performed exhaustive biceps exercise by doing isolated eccentric and concentric actions with a dumbbell. Symptoms were assessed, and T2-weighted images of the arms were obtained before exercise and 1, 3, 5, 10, 25, 40, 50, 60, and 80 days after exercise. Statistically significant increases in T2 relaxation times indicative of muscle injury occurred on each day of MR imaging evaluation in muscles performing eccentric actions, peaking on day 3 in two subjects; day 5, two subjects; and day 10, one subject. The pattern and extent of the abnormalities on MR images were variable. Pain, soreness, and joint stiffness were present on days 1, 3, and 5 in muscles that performed eccentric actions. MR imaging showed subclinical abnormalities that lasted as long as 75 days after the disappearance of symptoms (two subjects). Muscles that performed concentric actions had no changes in T2 relaxation times and were asymptomatic throughout the study.

Adult↗
PubMed2001

Lengthening contractions are not required to induce protection from contraction-induced muscle injury.

We tested the hypothesis that lengthening contractions and subsequent muscle fiber degeneration and/or regeneration are required to induce exercise-associated protection from lengthening contraction-induced muscle injury. Extensor digitorum longus muscles in anesthetized mice were exposed in situ to repeated lengthening contractions, isometric contractions, or passive stretches. Three days after lengthening contractions, maximum isometric force production was decreased by 55%, and muscle cross sections contained a significant percentage (18%) of injured fibers. Neither isometric contractions nor passive stretches induced a deficit in maximum isometric force or a significant number of injured fibers at 3 days. Two weeks after an initial bout of lengthening contractions, a second identical bout produced a force deficit (19%) and a percentage of injured fibers (5%) that was smaller than those for the initial bout. Isometric contractions and passive stretches also provided protection from lengthening contraction-induced injury 2 wk later (force deficits = 35 and 36%, percentage of injured fibers = 12 and 10%, respectively), although the protection was less than that provided by lengthening contractions. These data indicate that lengthening contractions and fiber degeneration and/or regeneration are not required to induce protection from lengthening contraction-induced injury.

Animals↗
PubMed2000

Skeletal muscle Ca(2+)-independent kinase activity increases during either hypertrophy or running.

Spikes in free Ca(2+) initiate contractions in skeletal muscle cells, but whether and how they might signal to transcription factors in skeletal muscles of living animals is unknown. Since previous studies in non-muscle cells have shown that serum response factor (SRF) protein, a transcription factor, is phosphorylated rapidly by Ca(2+)/calmodulin (CaM)-dependent protein kinase after rises in intracellular Ca(2+), we measured enzymatic activity that phosphorylates SRF (designated SRF kinase activity). Homogenates from 7-day-hypertrophied anterior latissimus dorsi muscles of roosters had more Ca(2+)-independent SRF kinase activity than their respective control muscles. However, no differences were noted in Ca(2+)/CaM-dependent SRF kinase activity between control and trained muscles. To determine whether the Ca(2+)-independent and Ca(2+)/CaM-dependent forms of Ca(2+)/CaM-dependent protein kinase II (CaMKII) might contribute to some of the SRF kinase activity, autocamtide-3, a synthetic substrate that is specific for CaMKII, was employed. While the Ca(2+)-independent form of CaMKII was increased, like the Ca(2+)-independent form of SRF kinase, no alteration in CaMKII occurred at 7 days of stretch overload. These observations suggest that some of SRF phosphorylation by skeletal muscle extracts could be due to CaMKII. To determine whether this adaptation was specific to the exercise type (i.e., hypertrophy), similar measurements were made in the white vastus lateralis muscle of rats that had completed 2 wk of voluntary running. Although Ca(2+)-independent SRF kinase was increased, no alteration occurred in Ca(2+)/CaM-dependent SRF kinase activity. Thus any role of Ca(2+)-independent SRF kinase signaling has downstream modulators specific to the exercise phenotype.

Animals↗
PubMed1983

Prevention of injury to the shoulder through exercises and therapy.

An injury prevention program for the athlete combines conditioning and warm-up with appropriate stretching and strengthening exercises. Rehabilitation after injury is necessary and must include not only re-establishment of strength but also an aggressive program for restoring and maintaining muscle length.

Athletic Injuries↗
PubMed2006

Changes in exercise characteristics, maximal voluntary contraction, and explosive strength during prolonged tennis playing.

OBJECTIVES: To examine changes in exercise characteristics, maximal voluntary contraction, and explosive strength during prolonged tennis playing. METHODS: Maximal isometric voluntary contraction (MVC), leg stiffness (hopping), and peak power in squat (SJ) and countermovement (CMJ) jumps were measured before, every 30 minutes during, and 30 minutes after a three hour tennis match in 12 well trained players. Heart rate (HR), the effective playing time (EPT), rating of perceived exertion (RPE), and muscle soreness of knee extensors were also measured. RESULTS: Decreases in MVC (-9%; p < 0.05) and leg stiffness (-9%; p = 0.17) were observed after the match and were significantly correlated (r = 0.66; p = 0.05). Peak power in SJ and CMJ tests was maintained during the match but was lower (p < 0.001) 30 minutes after. Average HR and EPT were 144 (8) beats/min and 21 (4)% respectively. A strong correlation was found between EPT and HR (r = 0.93; p < 0.05). RPE and muscle soreness increased linearly during the exercise and were significantly correlated (r = 0.99; p < 0.001). CONCLUSIONS: Progressive reductions in maximal voluntary strength and leg stiffness highly correlated with increases in perceived exertion and muscle soreness were observed throughout a three hour tennis match, whereas explosive strength was maintained and decreased only after the match. These alterations may result in less efficient on-court movement and stroke production. They are, however, lower than those reported during continuous exercise of the same duration. The intermittent pattern of tennis and the numerous stretch-shortening cycle movements partly explain these results.

Adult↗
PubMed2004

Central inhibition of the aortic baroreceptors-heart rate reflex at the onset of spontaneous muscle contraction.

Animals decerebrated at the precollicular-premammillary body level exhibit spontaneous locomotion without any artificial stimulation. Our laboratory reported that the cardiovascular and autonomic responses at the onset of spontaneous locomotor events are evoked by central command, generated from the caudal diencephalon and the brain stem (Matsukawa K, Murata J, and Wada T. Am J Physiol Heart Circ Physiol 275: H1115-H1121, 1998). In this study, we examined whether central command and/or a reflex resulting from muscle afferents modulates arterial baroreflex function using a decerebrate cat model. The baroreflex was evoked by stimulating the aortic depressor nerve (ADN) at the onset of spontaneous muscle contraction (to test the possible influence of central command) and during electrically evoked contraction or passive stretch (to test the possible influence of the muscle reflex). When the ADN was stimulated at rest, heart rate and arterial blood pressure decreased by 40 +/- 2 beats/min and 11 +/- 1 mmHg, respectively. The baroreflex bradycardia was attenuated to 55 +/- 4% at the onset of spontaneous contraction. The attenuating effect on the baroreflex bradycardia was not observed at the onset and middle of electrically evoked contraction or passive stretch. The depressor response to ADN stimulation was identical among resting and any muscle interventions. The inhibition of the baroreflex bradycardia during spontaneous contraction was seen after beta-adrenergic blockade but abolished by muscarinic blockade, suggesting that the bradycardia is mainly evoked through cardiac vagal outflow. We conclude that central command, produced within the caudal diencephalon and the brain stem, selectively inhibits the cardiac component, but not the vasomotor component, of the aortic baroreflex at the onset of spontaneous exercise.

Animals↗
PubMed2007

Static strain stimulates expression of matrix metalloproteinase-2 and VEGF in microvascular endothelium via JNK- and ERK-dependent pathways.

VEGF and MMP protein production are both required for exercise-induced capillary growth in skeletal muscle. The underlying process by which muscle activity initiates an angiogenic response is not established, but it is known that mechanical forces such as muscle stretch are involved. We hypothesized that stretch of skeletal muscle microvascular endothelial cells induces production of MMP-2 and VEGF through a common signal pathway. Endothelial cells were grown on Bioflex plates and exposed to 10% static stretch for up to 24 h. MMP-2 protein level was measured by gelatin zymography and VEGF, MMP-2, and MT1-MMP mRNA levels were quantified by real-time quantitative PCR. ERK1/2 and JNK phosphorylation and VEGF protein levels were assessed by Western blotting. Effects of mitogen-activated protein kinases (MAPKs) (ERK1/2, JNK) and reactive oxygen species (ROS) on stretch-induced expression of MMP-2 and VEGF were tested using pharmacological inhibitors. Stretching of endothelial cells for 24 h caused significant increases in MMP-2 protein and mRNA level, but no change in MT1-MMP mRNA. While MMP-2 protein production was enhanced by H(2)O(2) in unstretched cells, ROS inhibition during stretch did not diminish MMP-2 mRNA or protein production. Inhibition of JNK suppressed stretch-induced MMP-2 protein and mRNA, but inhibition of ERK had no effect. In contrast, inhibition of ERK but not JNK attenuated the stretch-induced increase in VEGF mRNA. Our results demonstrate that differential regulation of MMP-2 and VEGF by MAPK signal pathways contribute to stretch-induced activation of microvascular endothelial cells.

Animals↗
PubMed2002

Which factors predict outcome in the treatment program of anterior knee pain?

The goal of this prospective study was to determine the outcome-predictive role of various parameters in the nonoperative treatment of chronic anterior knee pain patients. Thirty patients followed a five-week treatment program, which consisted out of only closed kinetic chain exercises. Prior to this treatment all subjects were evaluated on muscular characteristics, subjective symptoms, weight, sex, duration of symptoms and functional performance. A multiple stepwise regression analysis revealed that the reflex response time of m. vastus medialis obliquus (VMO) (P=0.041; 0.026), and the duration of symptoms (P=0.019; 0.045) were the only two parameters which were significantly associated with the outcome (evaluated by the Kujala score) at five weeks, and at three months. The shorter the duration of symptoms, or the faster the reflex response time of VMO prior to the treatment, the better the outcome after a closed kinetic chain exercise program. The statistical significance of these parameters in this study may be seen as an indication of the importance of these variables as predictors of the outcome of a closed kinetic chain strengthening program. Using this information, it seems clinically important to begin the treatment program before the anterior knee pain becomes more chronic and treatment results become less good.

Adolescent↗
PubMedDate not supplied

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

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

Adolescent↗
PubMed1994

The warm-up procedure: to stretch or not to stretch. A brief review.

Stretching exercises are either performed alone or with other exercises as part of the athlete's warm-up. The warm-up is designed to increased muscle/tendon suppleness, stimulate blood flow to the periphery, increase body temperature, and enhance free, coordinated movement. The purpose of this paper is to review the literature regarding stretching, with the aim of defining its role during the warm-up. Implications of stretching on muscle/tendon flexibility, minimizing injury, enhancing athletic performance, and generally preparing the athlete for exercise are discussed. Physiology applied to stretching is also discussed together with different related techniques and practical aspects. A proposed model stretching regime is presented based on the literature reviewed.

Athletic Injuries↗
PubMed1999

Recovery from exercise-induced desaturation in the paraspinal muscles in idiopathic scoliosis.

STUDY DESIGN: A study using near-infrared light spectroscopy to measure recovery from exercise-induced desaturation in the paraspinal muscles of patients with idiopathic scoliosis. OBJECTIVES: To measure oxygenation of the paraspinal muscles and obtain differences between the convex and concave sides. SUMMARY OF BACKGROUND DATA: Authors of previous studies have reported that some patients experience pain on the convex side of the paraspinal muscles. The muscles on the convex side are more stretched and stressed than those on the concave side. The current authors investigated the degree of stress by measuring oxygenation and blood volume changes. METHODS: Paraspinal muscle spectral properties at L3 were investigated using near-infrared light spectroscopy. Thirty-six patients (8 men and 28 women) underwent this procedure. To assess a level of peripheral adaptations to exercise, the half-time of Oxyhemoglobin/Myoglobin recovery was measured, which indicates the recovery from energy deficit after exercise. RESULTS: The average half-time recovery on the convex side was 3.38 seconds (range, 1.5-5.5 seconds), whereas that on the concave side was 1.51 seconds (range, 0.7-4.0 seconds). The average difference between the convex side and the concave side was 1.87 seconds (range, 0.9-3.5 seconds). CONCLUSIONS: Half-time recovery on the convex side in the patients with idiopathic scoliosis was slower than that in healthy adults (P < 0.05). Half-time recovery on the concave side in such patients was faster than that on the convex side (P < 0.01). The authors consider half-time recovery an indication of back muscle stress.

Adult↗
PubMed1999

Influence of elastic properties of tendon structures on jump performance in humans.

The purpose of this study was to quantify the elastic properties of tendon structures in vivo and to investigate the influence of the tendon properties on jump performance with and without countermovement. Elongation of the tendon and aponeurosis of vastus lateralis muscle (dL) was directly measured by ultrasonography while subjects (n = 31) performed ramp isometric knee extension up to the voluntary maximum (MVC). The relationship between muscle force and dL was fitted to a linear regression above 50% MVC, the slope of which was defined as stiffness of the tendon structures. Statistical analysis revealed no significant difference between duplicated measurements of stiffness, with an interday reliability of r = 0.88 and a coefficient of variance of 6.1%. Although the stiffness was not significantly related to absolute jump height in either vertical jump, it was inversely correlated with the difference in jump height between the vertical jumps performed with and without countermovement. The results suggested that the stiffness of tendon structures has a favorable effect on stretch-shortening cycle exercise, possibly due to adequate storage and recoil of elastic energy.

Adult↗