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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↗
PubMed1999

Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences.

OBJECTIVE: To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities. DESIGN: Randomised controlled trial of progressive exercise programme compared with usual primary care management. Patients' preferences for type of management were elicited independently of randomisation. PARTICIPANTS: 187 patients aged 18-60 years with mechanical low back pain of 4 weeks to 6 months' duration. INTERVENTIONS: Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups, stretching exercises, relaxation session, and brief education on back care. A cognitive-behavioural approach was used. MAIN OUTCOME MEASURES: Assessments of debilitating effects of back pain before and after intervention and at 6 months and 1 year later. Measures included Roland disability questionnaire, Aberdeen back pain scale, pain diaries, and use of healthcare services. RESULTS: At 6 weeks after randomisation, the intervention group improved marginally more than the control group on the disability questionnaire and reported less distressing pain. At 6 months and 1 year, the intervention group showed significantly greater improvement in the disability questionnaire score (mean difference in changes 1.35, 95% confidence interval 0.13 to 2.57). At 1 year, the intervention group also showed significantly greater improvement in the Aberdeen back pain scale (4.44, 1.01 to 7.87) and reported only 378 days off work compared with 607 in the control group. The intervention group used fewer healthcare resources. Outcome was not influenced by patients' preferences. CONCLUSIONS: The exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference, and was cost effective.

Adolescent↗
PubMed2003

Akt signaling in skeletal muscle: regulation by exercise and passive stretch.

Akt/protein kinase B is a serine/threonine kinase that has emerged as a critical signaling component for mediating numerous cellular responses. Contractile activity has recently been demonstrated to stimulate Akt signaling in skeletal muscle. Whether physiological exercise in vivo activates Akt is controversial, and the initiating factors that result in the stimulation of Akt during contractile activity are unknown. In the current study, we demonstrate that treadmill running exercise of rats using two different protocols (intermediate high or high-intensity exhaustive exercise) significantly increases Akt activity and phosphorylation in skeletal muscle composed of various fiber types. To determine if Akt activation during contractile activity is triggered by mechanical forces applied to the skeletal muscle, isolated skeletal muscles were incubated and passively stretched. Passive stretch for 10 min significantly increased Akt activity (2-fold) in the fast-twitch extensor digitorum longus (EDL) muscle. However, stretch had no effect on Akt in the slow-twitch soleus muscle, although there was a robust phosphorylation of the stress-activated protein kinase p38. Similar to contraction, stretch-induced Akt activation in the EDL was fully inhibited in the presence of the phosphatidylinositol 3-kinase inhibitor wortmannin, whereas glycogen synthase kinase-3 (GSK3) phosphorylation was only partially inhibited. Stretch did not cause dephosphorylation of glycogen synthase on GSK3-targeted sites in the absence or presence of wortmannin. We conclude that physiological exercise in vivo activates Akt in multiple skeletal muscle fiber types and that mechanical tension may be a part of the mechanism by which contraction activates Akt in fast-twitch muscles.

Androstadienes↗
PubMed2006

Quadriceps contusions: clinical results of immediate immobilization in 120 degrees of knee flexion.

OBJECTIVE: Quadriceps contusions often result in significant time loss and the possibility of myositis ossificans. The objective of this descriptive case series was to document the results of an initial treatment regimen instituted within 10 minutes from the time of the injury. DESIGN: This study was a prospective case series of 47 midshipmen who sustained quadriceps contusions between August 1987 and December 2005 and who were treated identically and followed by serial examinations until the return to unrestricted full athletic activities. SETTING: United States Naval Academy (USNA), Annapolis, Maryland. PARTICIPANTS: USNA midshipmen who sustained quadriceps contusions while participating in sports activities. Inclusion criteria were (1) stated inability at the time of the injury to continue participation and (2) the inability to perform a pain-free, isometric quadriceps contraction and maintain the knee in full extension with a straight leg lift. INTERVENTIONS: On diagnosis the knee was passively flexed painlessly to 120 degrees and held continuously in that position for 24 hours. Use of the brace was discontinued at 24 hours and the midshipman was instructed to perform active, pain-free quadriceps stretching several times a day and to perform pain-free isometric quadriceps strengthening exercises as soon as possible. Goals included pain-free knee flexion and quadriceps size and firmness equal to the uninjured side. MAIN OUTCOME MEASUREMENTS: Average time from the day of the injury to return to unrestricted full athletic activities with no disability. RESULTS: The average time to return to unrestricted full athletic activities with no disability was 3.5 days (range of 2 to 5 days). Radiographic examination of the first 23 midshipmen at 3 and 6 months following the injury revealed 1 case of myositis ossificans. CONCLUSIONS: Placing and holding the knee in 120 degrees of flexion immediately following a quadriceps contusion appears to shorten the time to return to unrestricted full athletic activities compared with reports in other studies.

Adolescent↗
PubMed2006

Pectoral stretching program for women undergoing radiotherapy for breast cancer.

Surgery and radiotherapy commonly cause adverse musculoskeletal problems, particularly loss of strength and range of motion, in the upper quadrant of breast cancer patients. Few well-designed studies have investigated whether these impairments can be prevented. Stretching is an effective technique for increasing range of motion, hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer. Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery. Participants were randomised to either a control or stretch group. Participants in both groups were reviewed by the physical therapist on a weekly basis for approximately 6 weeks, and were given general information about skin care and lymphedema. The control group received no advice about exercise. The stretch group received instruction on low-load, prolonged pectoral stretches, which were to be performed daily and were checked at weekly visits. Shoulder range of motion, strength, arm circumference, and quality of life measurements were taken prior to, and at completion of radiotherapy, and at 7 months after radiotherapy. There was no difference in any outcome between groups. Breast symptoms increased for both groups during radiotherapy, without loss of strength or range of movement. The incidence of lymphedema during the study was low for both groups and did not differ between groups. The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture.

Breast Neoplasms↗
PubMed2006

Effect of age on metabolic fatigue and on indirect symptoms of skeletal muscle damage after stretch-shortening exercise.

AIM: The purpose of this study was to establish the main differences between men (M) and adolescents (A) (males) in metabolic fatigue and damage induced by exercise performed at maximal intensity. METHODS: Healthy A (age 13.4 0.6 years, n = 12) and healthy adult M (age 25.4 1.7 years, n = 12) participated in this study. To induce muscle damage and metabolic fatigue stretch-shortening exercise (SSE) (5 bouts of 20 jumps with counter-movement to 90 degrees angle in the knee with 10 s between bouts) has been chosen. The following data were measured: the force of the quadriceps muscle, aroused by electrical stimulation at different frequencies, maximal voluntary contraction force, height of jump (JH), muscle soreness, lactate (La) concentration and creatine kinase (CK) activity in the blood. All the parameters mentioned were measured before exercise and 2-5 min, 20 min, 24 h and 48 h after the SSE, except for La concentration changes in the blood measured before exercise, 2 min and 20 min after the SSE. RESULTS: The main findings in this study are the following: 1) during SSE JH decreased significantly (P < 0.05) more in M than in A, whereas La concentration in the blood after SSE increased more in M than in A; 2) indirect symptoms of muscle damage were more evident in M than in A; 3) there was secondary decrease in electrically induced muscle force at 10-20 Hz from 3 min until 20 min after SSE but only in the muscles of M; 4) low frequency fatigue after SSE was more evident in M than A. CONCLUSIONS: The results of the present study indicate that the muscles of adolescents are more resistant to both metabolic fatigue and exercise-induced damage than those of men.

Adolescent↗
PubMed1987

Cellular infiltrates in human skeletal muscle: exercise induced damage as a model for inflammatory muscle disease?

The type and distribution of mononuclear cell infiltrates in muscle biopsies taken from 9 subjects at differing times after exercise in which the muscle is stretched (eccentric exercise) has been characterised. The appearances are compared to those seen in muscle from patients with inflammatory muscle disease. After exercise infiltrating cells were seen in perivascular, perimysial and endomysial regions, the extent being greater in the later biopsies (9-14 days). The predominant cell type was the macrophage (46-100% of all infiltrating cells), the remainder were T lymphocytes with a predominance of the CD4 positive helper/inducer subset. Approximately one third of the T cells expressed DA2 (class 2) antigen indicating that they were activated. Very few B lymphocytes and no Leu7 positive cells were seen. There was evidence of class 1 expression on some of the damaged muscle fibres. The appearance of the experimentally damaged muscle in normal subjects was very similar to untreated polymyositis suggesting that a proportion of the infiltrating cells seen in this disease may be present as part of a natural response to damage rather than being its cause.

Adult↗
PubMed2004

MRI evaluation of topical heat and static stretching as therapeutic modalities for the treatment of eccentric exercise-induced muscle damage.

The aim of this study was to monitor the effects of topical heat and/or static stretch treatments on the recovery of muscle damage by eccentric exercise. For this purpose, 32 untrained male subjects performed intense eccentric knee extension exercise, followed by 2 weeks of treatment (heat, stretch, heat plus stretch) or no treatment (control, n=8/group). Isometric strength testing, pain ratings, and multi-echo magnetic resonance imaging of the thigh were performed before and at 2, 3, 4, 8, and 15 days following the exercise. Increased T2 relaxation time, muscle swelling, pain ratings, and strength loss confirmed significant muscle damage during the post-exercise period. Pain ratings and muscle volume recovered to baseline by 15 days, although muscle strength remained lower [77 (4) vs. 95 (3) kg pre-exercise, mean (SE)] and T2 values higher [32.2 (0.8) vs. 28.6 (0.2) ms pre-exercise]. Our results indicate that heat and/or static stretching does not consistently reduce soreness, swelling or muscle damage. The practical implication of our findings is that clinicians should be aware that prescribing heat and/or static stretching following intense eccentric or unaccustomed exercise will not enhance the recovery of damaged muscles.

Adult↗
PubMed2006

Use of neurodevelopmental treatment techniques in a client with kyphosis: a case report.

This case report describes use of an intervention developed for patients with neurological diagnoses (neurodevelopmental treatment [NDT]) with a patient with musculoskeletal and pulmonary diagnoses. The patient was a 78-year-old woman referred to physical therapy for gait training, therapeutic exercises, and neuromuscular reeducation. Standing at her most upright, the patient initially had a 30 degrees kyphosis with extreme capital extension to bring her head to vertical. Shoulders were internally rotated, and the medial borders of the scapulae rested near the lateral border of the ribs and the scapular spines were at the level of C7. To address the postural impairments, I used NDT spinal and scapular mobilization techniques and strengthening in weight-bearing postures with modified bridging as preparation for gait training. At the end of the episode of care, the patient's upright posture had improved to 10 degrees kyphosis with head in neutral extension in both standing and walking.

Aged↗
PubMed2006

Effects of static stretching volume and intensity on plantar flexor explosive force production and range of motion.

AIM: The aim of the study was to determine the effects of volume and intensity of static stretching in a warm-up on explosive force production and range of motion (ROM) of the plantar flexors. METHODS: Twenty subjects performed 5 warm-ups on different days. The warm-ups contained a 5 min treadmill run and various protocols of 30 s static stretches (SS) of the plantar flexors. Stretching involved dorsi flexion just before the pain threshold, which was considered 100% intensity. The treatments that immediately followed the run were: (i) no other treatment (control); (ii) 1 min SS; (iii) 2 min SS; (iv) 4 min SS; (v) 2 min SS at 90% intensity. Ankle ROM was assessed before and after each warm-up and a concentric calf raise and drop jump (DJ) test was conducted after each warm-up. RESULTS: There were no significant differences (P > 0.05) in peak force or rate of force production in the explosive calf raise between any of the warm-ups. However the run plus 2 min stretch and the run plus 4 min stretch protocols produced significantly lower (P < 0.05) DJ performance (jump height/ground contact time) than the run. The run plus 4 min stretch warm-up also produced a significantly lower DJ score than the run plus 1 min stretch warm-up. There were no significant differences between any of the warm-ups in ankle ROM. CONCLUSIONS: The addition of 2-4 min of SS at 100% intensity to a run caused an impairment to fast stretch shortening cycle muscle performance. The greater impairment from the 4 min stretching condition supported a volume-effect. Two minutes of stretching at 90% intensity had no significant influence on muscle function. The addition of up to 4 min of SS to a run had no appreciable effect on ankle ROM, possibly because of the prior influence of the run.

Adolescent↗
PubMed2000

In vivo dynamics of human medial gastrocnemius muscle-tendon complex during stretch-shortening cycle exercise.

The purpose of this study was to investigate the dynamics of human muscle-tendon complex (MTC) during stretch-shortening cycle exercises through in vivo observation. A total of seven male subjects performed dorsi flexion followed by plantar flexion at two different frequencies, 0.3 Hz (slow) and 1.0 Hz (fast), in a toe-standing position. The fascicle length (LF) of the medial gastrocnemius muscle during the movements was determined using a real-time ultrasonography in vivo. The LF at the switching phase from dorsi to plantar flexion was significantly shorter in the fast exercise (54.4 +/- 5.5 mm) than in the slow one (58.2 +/- 5.4 mm), suggesting that the elongation of tendon structures at that time was significantly greater in the former than in the latter. Furthermore, at the initial stage of plantar flexion during the fast movement, the LF hardly changed with a rapid shortening of tendon structures at that time. The observed relation between MTC length and force showed that the behaviour of tendon structures contributed to 20.2 and 42.5% of the total amount of work completed during plantar flexion phase in the slow and fast movements, respectively. Thus, the present results suggest that tendon structures make the dynamics of MTC more efficient during stretch-shortening cycle exercises by changing their lengths.

Adult↗
PubMed2006

Progressive resistance training and stretching following surgery for breast cancer: study protocol for a randomised controlled trial.

BACKGROUND: Currently 1 in 11 women over the age of 60 in Australia are diagnosed with breast cancer. Following treatment, most breast cancer patients are left with shoulder and arm impairments which can impact significantly on quality of life and interfere substantially with activities of daily living. The primary aim of the proposed study is to determine whether upper limb impairments can be prevented by undertaking an exercise program of prolonged stretching and resistance training, commencing soon after surgery. METHODS/DESIGN: We will recruit 180 women who have had surgery for early stage breast cancer to a multicenter single-blind randomized controlled trial. At 4 weeks post surgery, women will be randomly assigned to either an exercise group or a usual care (control) group. Women allocated to the exercise group will perform exercises daily, and will be supervised once a week for 8 weeks. At the end of the 8 weeks, women will be given a home-based training program to continue indefinitely. Women in the usual care group will receive the same care as is now typically provided, i.e. a visit by the physiotherapist and occupational therapist while an inpatient, and receipt of pamphlets. All subjects will be assessed at baseline, 8 weeks, and 6 months later. The primary measure is arm symptoms, derived from a breast cancer specific questionnaire (BR23). In addition, range of motion, strength, swelling, pain and quality of life will be assessed. DISCUSSION: This study will determine whether exercise commencing soon after surgery can prevent secondary problems associated with treatment of breast cancer, and will thus provide the basis for successful rehabilitation and reduction in ongoing problems and health care use. Additionally, it will identify whether strengthening exercises reduce the incidence of arm swelling. TRIAL REGISTRATION: The protocol for this study is registered with the Australian Clinical Trials Registry (ACTRN012606000050550).

Arm↗
PubMed2006

A randomized comparative trial of the efficacy and safety of exercise during pregnancy: design and methods.

Use of an exercise intervention for high-risk and vulnerable populations, such as pregnant women at risk for gestational hypertension or preeclampsia, requires special consideration. A comparative trial testing the effects of two types of physical exercises - stretching (a comparator) and walking (a testing intervention) - for sedentary pregnant women at risk for preeclampsia - is presented in this paper. The study was designed to reduce post-randomization bias and dropout rates from both groups, and closely to monitor safety of subjects. The strengths of the study design and methods include use of a run-in phase; use of a stretching exercise as a comparator; multiple ways to measure daily physical activities and the exercise intervention; and tailored support to remove barriers to exercise for subjects. The intervention consists of 40 min of walking at moderate intensity (i.e., 55-69% of maximum heart rate and rating of perceived exhaustion 12-13) five times a week from 18 weeks gestation until birth. The comparator exercise consists of 40 min of stretching exercise without increasing heart rate to more than 10% of resting heart rate, five times a week from 18 weeks gestation until birth. The primary outcome is the incidence of preeclampsia. Secondary outcomes include the physiologic effects of the intervention and birth outcomes.

Adult↗
PubMed1986

Muscle pain after exercise is linked with an inorganic phosphate increase as shown by 31P NMR.

31P nuclear magnetic resonance (NMR) spectra were obtained from the forearm muscles of 5 subjects before and after performing a muscle stretching (eccentric) exercise routine. Spectra collected before and immediately after exercise showed normal resting phosphorylated metabolite levels and unchanged intracellular pH (pHi). Measurements made on the day following exercise, when muscular pain was apparent, revealed an elevated inorganic phosphate level. No significant changes in other metabolites or pHi were detected. This study gives the first indication of biochemical change following a form of exercise that is associated with considerable muscle pain and damage. The findings may help in understanding pathological processes resulting in pain and damage in muscle.

Humans↗
PubMed2026

Could creatine supplementation combined with physical rehabilitation accelerate return to play in athletes with patellar tendinopathy?

BACKGROUND: Several dietary supplements have been proposed to positively influence the rehabilitation process following injury. However, to date, no studies have specifically examined the effects of scientifically supported ergogenic aids on recovery outcomes when combined with physical performance interventions. Therefore, the aim of this study was to analyze the ergogenic effects of creatine supplementation on neuromuscular performance, tendon thickness, pain, and body composition in athletes diagnosed with patellar tendinopathy (PT). METHODS: Using a triple-blind experimental design, 20 federated athletes (age: 33.7&#x2009;&#xb1;&#x2009;9.84 years) with PT were randomly assigned to either a creatine supplementation group (CR; n&#x2009;=&#x2009;9) or a placebo group (PLA; n&#x2009;=&#x2009;11). All participants followed a physical rehabilitation intervention that included daily eccentric training combined with stretching exercises, along with one session every 10 days of extracorporeal shock wave therapy (ESWT) and manual therapy targeting the tendon and surrounding muscle tissue. At the end of each eccentric training session, the participants ingested 3 capsules of creatine monohydrate - Creapure&#xae; (CR) or sucrose (PLA). At the beginning (PRE), after 4 weeks (MID), and after 8 weeks (POST), the pain level (Victorian Institute for Sports Assessment-Patella, VISA-P), tendon thickness (echography), body composition (bioelectrical impedance system), and neuromuscular performance using a countermovement jump test (CMJ) and a strength test (5-RM) of knee extension in the injured leg. RESULTS: A significant main effect of time was observed for VISA-P scores (p&#x2009;<&#x2009;0.001; &#x3b7;2 p&#x2009;=&#x2009;0.626), indicating a reduction in pain over time in both the creatine (CR) and placebo (PLA) groups. At POST, both groups showed significant improvements compared to PRE (CR: 78.0 points [69.2-86.8] vs. 60.6 points [53.4-67.7]; p&#x2009;=&#x2009;0.002; PLA: 75.2 points [66.3-84.0] vs. 60.0 points [52.5-67.5]; p&#x2009;=&#x2009;0.003). However, only the CR group showed a statistically significant improvement in the MID compared to PRE (MID: 70.2 points [60.0-80.5]; p&#x2009;=&#x2009;0.027). A significant main effect of time was observed for both tendon thickness (p&#x2009;<&#x2009;0.001; &#x3b7;2 p&#x2009;=&#x2009;0.629) and the 5-RM leg extension test (p&#x2009;<&#x2009;0.001; &#x3b7;2 p&#x2009;=&#x2009;0.739), with both groups showing progressive improvements over time. Nevertheless, as trend toward a statistically significant time&#xb7;supplementation interaction was observed (p&#x2009;=&#x2009;0.099; &#x3b7;2p&#x2009;=&#x2009;0.126), with an increase in performance only in CMJ in MID vs PRE (36.8&#x2009; cm (33.8-39.7) vs 34.3&#x2009; cm (30.8-37.7); p&#x2009;=&#x2009;0.019) and POST vs MID (POST: 37.6&#x2009; cm (33.5-41.8); p&#x2009;=&#x2009;0.015). CONCLUSIONS: A physical rehabilitation program involving eccentric training, stretching, and ESWT is effective in reducing tendon thickness and increasing muscle strength. However. It seems that the addition of CR induces an earlier reduction of pain and a positive effect on CMJ performance. Therefore, CR could be considered as an ergogenic recovery aid in athletes with PT.

Humans↗