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PubMed2003

Differences in hamstring muscle stretching of elite field hockey players and normal subjects.

OBJECTIVES: To investigate differences in stretching behaviour of hamstring muscles in elite field hockey players and normal subjects. METHODS: 16 normal healthy subjects (group A) and 16 elite field hockey players (group B). Stretching of the hamstrings was performed with a knee extension device. Two successive single stretches (1 and 2) until the maximum stretch tolerance was achieved were applied to each subject twice. Simultaneously range of movement (ROM), passive resistance to stretch (PRS) at 36 degrees ROM, and electromyographic (EMG) activity of the biceps femoris and semitendinosus muscles were recorded. RESULTS: ROM (p=0.02 for stretch 1; p=0.04 for stretch 2) and PRS (p=0.04 and p=0.03) were significantly higher in group B, as compared to group A. The EMG activity of the biceps femoris (p=0.02 for stretch 1; p=0.3 for stretch 2) and semitendinosus (p=0.03 and p=0.11) were significantly higher in group B only for stretch 1. From stretch 1 to 2, a significant increase in ROM was observed in both group A (p=0.002) and group B (p=0.0003), as well as a significant decrease of PRS (p=0.0002; p=0.002). EMG activity only showed a significant decrease in group B (biceps p=0.03;semitendinosus p=0.01), but not in group A (p=0.6; p=0.06). The EMG activity sets in when the subjects begin to perceptive pain in the stretched muscles. CONCLUSIONS: Significant differences exist. in the stretching behaviour of elite field hockey players and non-athletes. ROM, PRS and EMG activity are higher in athletes. Implications for treatment should be considered, but recommendations cannot be made on the basis of this study yet.

Adult↗

PubMed1993

The effects of static and ballistic stretching on delayed onset muscle soreness and creatine kinase.

The purpose of this study was to determine if static and ballistic stretching would induce significant amounts of delayed onset muscle soreness (DOMS) and increases in creatine kinase (CK). Twenty males were randomly assigned to a static (STATIC) or ballistic stretching (BALLISTIC) group. All performed three sets of 17 stretches during a 90-min period, the only group difference being that STATIC remained stationary during each 60-s stretch while BALLISTIC performed bouncing movements. Subjective ratings of DOMS (scale: 1-10) and serum CK levels were assessed before and every 24 hours post stretching, for 5 days. A repeated measures ANOVA revealed a significant main effect due to time (p < 0.05), with peak soreness occurring at 24 hours after (M = 2.8 +/- 1.6). Surprisingly, a group effect (p < .05) demonstrated that DOMS was significantly greater for STATIC than for BALLISTIC. At 24 hours there was a 62% (p < .05) increase in CK for combined groups. These findings indicate that similar bouts of static and ballistic stretching induce significant increases in DOMS and CK in subjects unaccustomed to such exercise. Furthermore, static stretching induced significantly more DOMS than did ballistic.

Adult↗

PubMed2003

Impact of prior exercise on hamstring flexibility: a comparison of proprioceptive neuromuscular facilitation and static stretching.

Position stands from the American College of Sports Medicine and the Surgeon General site a need for strategies capable of enhancing the effectiveness of stretching on flexibility and joint range of motion. One strategy for enhancing flexibility that has received anecdotal support but lacks substantial experimental evidence is the impact of prior exercise. This study compared 5 minutes of static stretching and proprioceptive neuromuscular facilitation (PNF) on hamstring flexibility performed with and without exercise. Forty undergraduate student-athletes participated in a repeated measure, counterbalanced experimental design. Within-group comparisons indicated that PNF resulted in a significant (p < 0.05) increase in flexibility after 60 minutes of exercise when compared with baseline (9.6%) and without exercise (7.8%). No differences were observed with static stretching across time. In addition, no differences were observed between the groups at any time point. Results demonstrated that PNF performed after exercise enhanced acute hamstring flexibility, and implementing a PNF stretching routine following exercise may augment current stretching practices among athletes.

Adolescent↗

PubMed2002

Self-reported hamstring injuries in student-dancers.

Dancing involves powerful movements as well as flexibility exercises, both of which may be related to specific injuries to the musculo-tendinosus tissue, e.g., the hamstring muscle complex. In this study, the occurrence of acute and overuse injuries to the rear thigh in dancers was investigated retrospectively by means of a questionnaire. All but one (n = 98) of the student-dancers (age 17-25 years) at the Ballet Academy in Stockholm participated. The results demonstrated that, during the past 10 years, every third dancer (34%) reported that they had acute injuries and every sixth dancer (17%) had overuse injuries to the rear thigh. Most (91%) of the acute injuries were subjectively located to an area close to tuber ischiadicum. The majority (88%) stated that the acute injury occurred during slow activities in flexibility training, e.g., splits, and only a few (12%) in powerful movements. Continuing problems were reported by 70% of the acutely injured dancers. Many of the dancers neglected their acute injury (14 did not even stop the ongoing dance activity) and they also greatly underestimated the recovery time. Only 4 dancers (12%) received acute medical assistance. Thus the results, based on the recollection of the subjects, indicated that stretching could induce severe strain injuries to the proximal hamstrings in dancers. Extrapolating these results to the practice, it can be recommended that stretching exercises be executed with caution in connection with dancing sessions and training, and that, information about the seriousness and acute treatment of such injuries be added to the student-dancers' curriculum.

Acute Disease↗

PubMed2005

The influence of small fibre muscle mechanoreceptors on the cardiac vagus in humans.

We have previously shown that activation of muscle receptors by passive stretch (PS) increases heart rate (HR) with little change in blood pressure (BP). We proposed that PS selectively inhibits cardiac vagal activity. We attempted to test this by performing PS during experimental alterations in vagal tone. Large decreases in vagal tone were induced using either glycopyrrolate or mild rhythmic exercise. Milder alterations in vagal tone were achieved by altering carotid baroreceptor input: neck pressure (NP) or neck suction (NS). PS of the triceps surae was tested in 14 healthy human volunteers. BP, ECG and respiration were recorded. PS alone caused a significant decrease (P < 0.05) in R-R interval (962 +/- 76 ms at baseline compared to 846 +/- 151 ms with PS), and showed a reduction in HR variability, which was not significant. The decrease in R-R interval with PS was significantly less (P < 0.05, n = 3) following administration of glycopyrrolate (-8.1 +/- 4.5 ms) compared to PS alone (-54 +/- 11 ms), and also with PS during handgrip (+10 +/- 10 ms) compared with PS alone (-74 +/- 15 ms) (P < 0.05, n = 5). Milder reductions in vagal activity (NP) resulted in a small but insignificant further decrease in R-R interval in response to PS (-107 +/- 17 ms compared to PS alone -96 +/- 13 ms, n = 5). Mild increases in vagal activity (NS) during PS resulted in smaller decreases in R-R interval (-39 +/- 5.5 ms) compared to PS alone (-86 +/- 17 ms) (P < 0.05, n = 8). BP was not significantly changed by stretch in any tests. The results indicate that amongst muscle receptors there is a specific group activated by stretch that selectively inhibit cardiac vagal tone to produce tachycardia.

Adult↗

PubMed1992

Stretching in the rehabilitation of low-back pain patients.

The major objective of this investigation was to study the effectiveness of the physical conditioning program used at the University of Miami Comprehensive Pain and Rehabilitation Center in restoring certain elements of the functional abilities of individuals suffering from chronic low-back pain and to evaluate the effectiveness of using a systematically applied, aggressive stretching maneuver as an add-on therapy in the treatment of chronic low-back pain patients. The effect(s) of the proposed stretching maneuver was evaluated. Twenty-eight chronic low-back pain patients were randomly assigned to one of two groups. The control group underwent a multimodal rehabilitation program, and the experimental group underwent the same rehabilitation program in addition to the systematic stretching maneuver under investigation. The results obtained showed that patients undergoing the multimodal rehabilitation program with and without the proposed systematic stretching maneuver showed a significant improvement in their functional abilities as seen from the significant increase in the static strength of the back extensors, with corresponding significant increase in back muscle myoelectric signals. Also, a significant decrease in their pain level was reported after 2 weeks of continuous treatment. The use of the systematic stretching maneuver enhanced the functional gains of chronic low-back pain patients compared to the control group.

Back Pain↗

PubMed2003

Quantifying the magnitude of torque physiotherapists apply when stretching the hamstring muscles of people with spinal cord injury.

OBJECTIVE: To quantify the magnitude of stretch that physiotherapists apply to the hamstring muscles of people with spinal cord injury (SCI). DESIGN: Repeated-measures design. SETTING: SCI unit in Australia. PARTICIPANTS: Fifteen individuals with motor complete paraplegia or tetraplegia. INTERVENTION: Twelve physiotherapists manually administered a stretch to the hamstring muscles of each subject. The stretch was applied by flexing the hip with the knee extended. MAIN OUTCOME MEASURE: Applied hip flexor torque. RESULTS: Therapists applied median hip flexor torques of between 30 and 68Nm, although some torques were as large as 121Nm. The stretch applied by different therapists to any 1 subject varied as much as 40-fold. CONCLUSION: There is a large range of stretch torques provided by physiotherapists to patients with SCI. Some therapists provide stretch torques well in excess of those tolerated by individuals with intact sensation.

Activities of Daily Living↗

PubMed1999

Exercise-induced muscle damage and potential mechanisms for the repeated bout effect.

Unfamiliar, predominantly eccentric exercise, frequently results in muscle damage. A repeated bout of similar eccentric exercise results in less damage and is referred to as the 'repeated bout effect'. Despite numerous studies that have clearly demonstrated the repeated bout effect, there is little consensus as to the actual mechanism. In general, the adaptation has been attributed to neural, connective tissue or cellular adaptations. Other possible mechanisms include, adaptation in excitation-contraction coupling or adaptation in the inflammatory response. The 'neural theory' predicts that the initial damage is a result of high stress on a relatively small number of active fast-twitch fibres. For the repeated bout, an increase in motor unit activation and/or a shift to slow-twitch fibre activation distributes the contractile stress over a larger number of active fibres. Although eccentric training results in marked increases in motor unit activation, specific adaptations to a single bout of eccentric exercise have not been examined. The 'connective tissue theory' predicts that muscle damage occurs when the noncontractile connective tissue elements are disrupted and myofibrillar integrity is lost. Indirect evidence suggests that remodelling of the intermediate filaments and/or increased intramuscular connective tissue are responsible for the repeated bout effect. The 'cellular theory' predicts that muscle damage is the result of irreversible sarcomere strain during eccentric contractions. Sarcomere lengths are thought to be highly non-uniform during eccentric contractions, with some sarcomeres stretched beyond myofilament overlap. Loss of contractile integrity results in sarcomere strain and is seen as the initial stage of damage. Some data suggest that an increase in the number of sarcomeres connected in series, following an initial bout, reduces sarcomere strain during a repeated bout and limits the subsequent damage. It is unlikely that one theory can explain all of the various observations of the repeated bout effect found in the literature. That the phenomenon occurs in electrically stimulated contractions in an animal model precludes an exclusive neural adaptation. Connective tissue and cellular adaptations are unlikely explanations when the repeated bout effect is demonstrated prior to full recovery, and when the fact that the initial bout does not have to cause appreciable damage in order to provide a protective effect is considered. It is possible that the repeated bout effect occurs through the interaction of various neural, connective tissue and cellular factors that are dependent on the particulars of the eccentric exercise bout and the specific muscle groups involved.

Adaptation, Physiological↗

PubMed1998

Central interaction between carotid baroreceptors and skeletal muscle receptors inhibits sympathoexcitation.

To determine the potential of an inhibitory interaction between the carotid sinus baroreflex (CSB) and the exercise pressor reflex (EPR), both pathways were activated to produce sympathoexcitation. It was hypothesized that, under conditions when the baroreflex increased sympathetic outflow, the interaction between CSB and EPR would be inhibitory. Bilateral carotid occlusion (BCO), electrically induced muscle contraction (EMC), and passive muscle stretch (PMS) were used to evoke sympathoexcitation. BCO decreased sinus pressure 50 +/- 5 mmHg, and the levels of muscle tension generated by EMC and PMS were 7 +/- 2 and 8 +/- 1 kg, respectively. This resulted in significant increases in mean arterial pressure (MAP) of 55 +/- 9, 50 +/- 7, and 50 +/- 6 mmHg (P = not significant, BCO vs. EMC vs. PMS) and in heart rate (HR) of 7 +/- 2, 19 +/- 4, and 17 +/- 2 beats/min (P < 0. 05, BCO vs. EMC and PMS). When BCO was combined with EMC or PMS, the reflex increase in MAP was augmented (80 +/- 8 and 79 +/- 10 mmHg; BCO+EMC and BCO+PMS, respectively; P < 0.05). However, summation of the individual MAP responses was greater than the response evoked during coactivation (106 +/- 11 and 103 +/- 12 mmHg, respectively, P < 0.05). Because summing the individual blood pressure responses exceeded the response during coactivation, the net effect was that the CSB and EPR interacted in an occlusive manner. In contrast, summation of the individual chronotropic responses was the same as the response evoked during coactivation. Moreover, there was no difference in summation of the individual MAP or HR responses when muscle afferents were activated by either EMC or PMS. In conclusion, the interaction between the CSB and the EPR in control of MAP was occlusive when both reflexes were stimulated to evoke sympathoexcitation. However, summation of the reflex changes in HR was simply additive.

Animals↗

PubMed2004

Effects of muscle damage on stretch-shortening cycle function and muscle stiffness control.

This experiment examined the effect of eccentric contraction-induced muscle damage on the stretch-shortening cycle and vertical leg spring stiffness during jumping activities. Ten moderately active male and female adult volunteers participated in this study (aged 23 +/- 2.3 years). Temporary muscle damage to the knee extensors was administered by a bout of eccentric contractions on an isokinetic dynamometer. Measurements were obtained of maximum voluntary force and of take-off velocities for single-leg countermovement jumps (CMJs), squat jumps (SJs), and drop jumps (DJs), performed on a specially constructed sledge and force plate apparatus. These measurements were obtained before and after the damage intervention, and the undamaged leg was used as a control. The results indicated that eccentric muscle damage significantly affected stretch-shortening cycle performance by causing relatively greater reductions in SJ performance than CMJ or DJ. The muscle damage intervention also significantly increased leg-spring stiffness, which indicates that the changes in leg stiffness may be an important adaptation resulting from eccentric exercise.

Adolescent↗

PubMed1977

Physical management of muscular low back pain in the athlete.

The Canadian medical staff at the 1976 Olympic Games found that muscular low back pain was a common problem among the athletes. The problem had usually developed during training as a result of neglect of certain anatomic areas, particularly the abdominal region. A five-point treatment and prevention program was used with good results. It included (a) relief of spasm and pain, (b) stretching, (c) exercise, (d) alteration of the training program and (e) education to prevent future problems or worsening of the present problem.

Back Pain↗

PubMed1990

[Athletic injuries in children].

Sports participation can have both beneficial and negative effects. Specific effects are injuries. The change of incidence is dependent on a number of personal and environmental factors. Epidemiological research in the Netherlands in school aged children has shown that sports injuries occur primarily in club sport, even more during competition. The injuries are localised in the lower limbs: especially the knee and the ankle. The injuries are distortions and contusions and fewer fractures and muscle tears. The number of overuse injuries seems to be rising because children are doing increasingly more intensive sport at younger ages. A preventive sports medical examination has been discussed as well as the preventive effect of warming-up and cooling down, stretching exercises, rehabilitation, taping, rules of play and sports facilities. Finally, attention has been given to the general care of sports injuries in the way of active and functional guidance in the healing process.

Adolescent↗

PubMed2005

The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury.

OBJECTIVE: To determine the influence of contractures and different stretching velocities on the reliability of the Modified Ashworth Scale (MAS) in patients with severe brain injury and impaired consciousness. DESIGN: Cross-section observational study. SETTING: A rehabilitation centre for adult persons with neurological disorders. SUBJECTS: Fifty patients with impaired consciousness due to severe cerebral damage of various aetiologies. MEASUREMENT PROTOCOL: Three experienced and trained medical professionals rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, knee and ankle spasticity were assessed by the use of the MAS with different stretching velocities. The presence of contractures was assessed by a goniometer. MAIN OUTCOME MEASURES: Retest and inter-rater reliability (k(w) = weighted kappa) of the MAS. RESULTS: The retest reliability of the MAS was good (shoulder joints (k(w) 0.74), elbow joints (k(w) 0.74), wrist joints (k(w) 0.72), knee joints (k(w) 0.72), ankle joints (k(w) 0.77)) and the inter-rater reliability was moderate (shoulder joints (k(w) 0.49), elbow joints (k(w) 0.52), wrist joints (k(w) 0.51), knee joints (k(w) 0.54) ankle joints (k(w) 0.49)). The presence of contractures significantly influenced the reliability of MAS in shoulder and wrist joints. No influence of stretching velocity on the reliability of the MAS was found. CONCLUSION: In patients with impaired consciousness due to severe brain injury the MAS has good retest, but only limited inter-rater, reliability. The presence of contractures may influence reliability of the MAS, but stretching velocity does not.

Brain Injuries↗

PubMed1999

Repeated passive stretching: acute effect on the passive muscle moment and extensibility of short hamstrings.

OBJECTIVE: To examine the response of short hamstring muscles to repeated passive stretching. DESIGN: A repeated measures design. SETTING: A university laboratory for human movement analysis in a department of rehabilitation. SUBJECTS: Students (7 men, 10 women) from the Department of Human Movement Sciences. MAIN OUTCOME MEASURES: The lift force, range of motion, pelvic-femoral angle, first sensation of pain, and electromyogram of the hamstrings were measured. RESULTS: Comparison of the data of the test group (n = 17) after five successive passive stretch tests by means of an instrumental straight-leg raising test showed no significant change of the variables passive muscle stiffness and extensibility (p>.05). CONCLUSION: The acute effect of repeated passive stretching of short hamstring muscles is negligible. With an instrumental straight-leg raising test, the relevant muscle variables can be examined noninvasively.

Adult↗

PubMed2006

Effect on spasticity after performance of dynamic-repeated-passive ankle joint motion exercise in chronic stroke patients.

Spasticity associated with abnormal muscle tone is a common motor disorder following stroke, and the spastic ankle may affect ambulatory function. The purpose of this study was to investigate the short-term effect of dynamic-repeated-passive ankle movements with weight loading on ambulatory function and spastic hypertonia of chronic stroke patients. In this study, 12 chronic stroke patients with ankle spasticity and inefficient ambulatory ability were enrolled. Stretching of the plantar-flexors of the ankle in the standing position for 15 minutes was performed passively by a constant-speed and electrically powered device. The following evaluations were done before and immediately after the dynamic-repeated-passive ankle movements. Spastic hypertonia was assessed by the Modified Ashworth Scale (MAS; range, 0-4), Achilles tendon reflexes test (DTR; range, 0-4), and ankle clonus (range, 0-5). Improvement in ambulatory ability was determined by the timed up-and-go test (TUG), the 10-minute walking test, and cadence (steps/minute). In addition, subjective experience of the influence of ankle spasticity on ambulation was scored by visual analog scale (VAS). Subjective satisfaction with the therapeutic effect of spasticity reduction was evaluated by a five-point questionnaire (1 = very poor, 2 = poor, 3 = acceptable, 4 = good, 5 = very good). By comparison of the results before and after intervention, these 12 chronic stroke patients presented significant reduction in MAS and VAS for ankle spasticity, the time for TUG and 10-minute walking speed (p < 0.01). The cadence also increased significantly (p < 0.05). In addition, subjective satisfaction with the short-term therapeutic effect was mainly good (ranging from acceptable to very good). In conclusion, 15 minutes of dynamic-repeated-passive ankle joint motion exercise with weight loading in the standing position by this simple constant-speed machine is effective in reducing ankle spasticity and improving ambulatory ability.

Adult↗

PubMed1987

Muscle damage and repair in voluntarily running mice: strain and muscle differences.

Soleus, extensor digitorum longus and tibialis anterior muscles of mice voluntarily running in wheels for periods of 5 to 120 days were studied in spaced serial and serial cross-sections. Shortly after the onset of running and during the next 2 weeks, degeneration, necrosis, phagocytosis and regeneration of muscle fibers, satellite cell proliferation and cellular infiltration were found in soleus muscles of mice from all strains investigated (CBA/J, NMRI, C57bl, NIH, SWS and Balb/c). Tibialis anterior but not extensor digitorum longus muscles were also damaged. Predominantly high-oxidative fibers were affected (both slow-oxidative and fast oxidative glycolytic in soleus, fast-oxidative glycolytic in tibialis anterior). Denervated soleus muscles that had been passively stretched during running were not damaged. Evidence was found that, during the early period of running, split fibers form by myogenesis within (regeneration) or outside (satellite cell proliferation) necrotic muscle fiber segments. Split fibers persisted in solei of long-term (2 to 3 months) exercised CBA/J but not NMRI mice. In 6 out of 20 solei of CBA/J runners exercised for 2 months or longer, fiber-type grouping was observed in the areas where extensive damage usually occurred in the early periods. The results show that different muscles are damaged and repaired to varying degrees and that marked interstrain and inter-individual differences are present. It appears that acute muscle injury occurring upon onset of voluntary running is a usual event in the adaptation of muscles to altered use.

Animals↗

PubMed2001

[Orthopaedic management for severe osteoporosis].

In severe-osteoporotic patients with vertebral fractures, back pain is usually a major complaint and can be acute or chronic. Acute back pain is usually due to a recent vertebral fracture. Chronic pain may be due to vertebral fractures per se or could result from kyphotic or scoliotic changes in the spine, with inappropriate stretching of ligaments, facet joint capsules and paraspinal muscles. Treatment of vertebral fractures must focus on relief of pain and prevention of further fractures. In many patients, significant symptomatic relief can be achieved through physical therapy, rehabilitation, and bracing. Muscle-strengthening and weight-loading exercises could be needed for prevention of further bone loss and fractures.

English Abstract↗

PubMed2005

Muscular mechanical hyperalgesia revealed by behavioural pain test and c-Fos expression in the spinal dorsal horn after eccentric contraction in rats.

Delayed onset muscle soreness (DOMS) is quite common, but the mechanism for this phenomenon is still not understood; even the existence of muscle tenderness (mechanical hyperalgesia) has not been demonstrated in experimental models. We developed an animal model of DOMS by inducing eccentric contraction (lengthening contraction, ECC) to the extensor digitorum longus muscle (EDL), and investigated the existence of mechanical hyperalgesia in the EDL by means of behavioural pain tests (Randall-Selitto test and von Frey hair test, applied to/through the skin on the EDL muscle) and c-Fos expression in the spinal dorsal horn. We found that the mechanical withdrawal threshold measured with the Randall-Selitto apparatus decreased significantly between 1 and 3 days after ECC, while that measured by von Frey hairs did not. The group that underwent stretching of the muscle only (SHAM group) showed no change in mechanical pain threshold in either test. These results demonstrated that the pain threshold of deep tissues (possibly of the muscle) decreased after ECC. c-Fos immunoreactivity in the dorsal horn (examined 2 days after ECC/SHAM exercise) was not changed by either ECC or compression (1568 mN) to the EDL muscle by itself, but it was significantly increased by applying compression to the EDL muscle 2 days after ECC. This increase was observed in the superficial dorsal horn of the L4 segment of the ipsilateral side, and was clearly suppressed by morphine treatment (10 mg kg(-1), i.p.). These results demonstrated the existence of mechanical hyperalgesia in the muscle subjected to ECC. This model could be used for future study of the neural mechanism of muscle soreness.

Animals↗