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PubMed2003

Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma.

The decreased mouth opening (microstomia) represents a frequent finding in patients with systemic scleroderma (SSD), but little information is available about the efficacy of nonsurgical management of this condition. The aim of this study is to assess the effects of a nonsurgical exercise program on the decreased mouth opening in a group of 10 SSD patients with severe microstomia (maximal mouth opening < or =30 mm). The subjects were instructed to perform an exercise program including both mouth-stretching and oral augmentation exercises. The effects of such exercises were assessed after an 18-week period by measuring the maximal mouth opening of each subject. All patients completed the study and no adverse effects occurred, with the exception of transient muscular fatigue. The exercise program improved the mouth opening of all subjects (mean increase: 10.7+/-2.06 mm, P<0.005), without significant differences between dentate and edentulous ones (P>0.1). At the end of the 18-week period, all patients commented that eating, speaking and oral hygiene measures were easier. The edentulous subjects also experienced less difficulty inserting their own dentures. These findings suggest that regular application of the proposed exercise program may be useful in the management of microstomia in SSD patients.

Adult↗

PubMed1983

Subluxation of the shoulder in athletes.

Shoulder subluxation is an extremely common problem confronting the sports medicine physician and may present in a variety of ways, with the patient complaining of pain of a sense of instability. In throwing spots, tendinitis secondary to impingement is common, but it may also be secondary to instability as a result of traction or compression of the rotator cuff. In addition, subluxation may develop initially, then progress to dislocation, or the converse may occur. However, some patients may have subluxation over an extended period of time. The physician must consider the entity and take a careful history, followed by an examination that notes subtle losses of motion and strength and the presence of apprehension. The x-ray films may be helpful when the standard views are supplemented by the West Point and Stryker notch views. Examination under anesthesia and arthroscopy have played an increasingly significant role in the recognition and evaluation of these patients. At times, arthroscopy is helpful in the treatment of shoulder subluxation in patients who have partial labral detachment. This is mainly in throwers or tennis players in whom open surgery is likely to result in significant loss of athletic ability. Stretching and strengthening exercises are frequently helpful in managing subluxations and tendinitis associated with the microtrauma of repetitive use in contrast to traumatic subluxation. Operative procedures are indicated after the failure of conservative treatment. It is important to explore the joint to find loose bodies and to note any labral damage or detachment. Great care must be taken to avoid excessively tightening the capsule, which will limit athletic activity and may increase the instability in the opposite direction. Postoperatively, a well-directed exercise program to restore the patient's flexibility and strength is indicated prior to the resumption of any sporting activity.

Arthrography↗

PubMed1990

Walking efficiency before and after long-term muscle stretch in patients with spastic paraparesis.

Eight patients with stationary, spastic paraparesis were treated with long-term stretch of the hip adductor muscles to improve walking ability. Gait pattern, walking speed and perceived exertion of walking were assessed. Walking efficiency was assessed before and after treatment by measuring oxygen consumption and blood lactate level. After treatment walking pattern was improved. Perceived exertion decreased but walking speed was unchanged. Oxygen cost directly after treatment was lower in six patients, unchanged in one and higher in one. In the patient with unchanged oxygen cost the blood lactate level decreased, probably due to decreased recruitment of fast, type II muscle fibres. Blood lactate was unchanged in the other patients. When assessing walking ability, measurement of energy cost was found to be a valuable supplement to clinical judgement, but in spastic patients both oxygen cost and blood lactate must be considered.

Aged↗

PubMed2004

Effect of acute static stretching on force, balance, reaction time, and movement time.

PURPOSE: The purpose of the study was to investigate the effect of an acute bout of lower limb static stretching on balance, proprioception, reaction, and movement time. METHODS: Sixteen subjects were tested before and after both a static stretching of the quadriceps, hamstrings, and plantar flexors or a similar duration control condition. The stretching protocol involved a 5-min cycle warm-up followed by three stretches to the point of discomfort of 45 s each with 15-s rest periods for each muscle group. Measurements included maximal voluntary isometric contraction (MVC) force of the leg extensors, static balance using a computerized wobble board, reaction and movement time of the dominant lower limb, and the ability to match 30% and 50% MVC forces with and without visual feedback. RESULTS: There were no significant differences in the decrease in MVC between the stretch and control conditions or in the ability to match submaximal forces. However, there was a significant (P < 0.009) decrease in balance scores with the stretch (decreasing 9.2%) compared with the control (increasing 17.3%) condition. Similarly, decreases in reaction (5.8%) and movement (5.7%) time with the control condition differed significantly (P < 0.01) from the stretch-induced increases of 4.0% and 1.9%, respectively. CONCLUSION: In conclusion, it appears that an acute bout of stretching impaired the warm-up effect achieved under control conditions with balance and reaction/movement time.

Adult↗

PubMed1997

Hamstring release for fixed knee flexion contracture in hemophilia.

Sixteen hamstring tenotomies and posterior capsulotomies were assessed retrospectively in 10 patients with hemophilia. The average age of the patients was 17 years (range, 16-24 years). The main indication for surgery was a fixed knee flexion contracture of 30 degrees to 45 degrees, associated with repeated hemarthroses, and failure of conservative treatment after 6 months. A posterior transverse capsulotomy and a Z shaped hamstring tenotomy were performed. The postoperative treatment consisted of repeated stretching exercises for a 6-month period. An average decrease of 25 degrees in the amount of fixed knee flexion contracture was obtained (range, 10 degrees-40 degrees). Followup for an average of 9.5 years showed 11 good, four fair, and one poor result regarding their joint scores. It is concluded that hamstring release is an effective surgical procedure for fixed knee flexion contracture in hemophilia. It seems to reduce the incidence of hemarthrosis relating to such a deformity.

Adolescent↗

PubMed1998

The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome.

Primary shoulder impingement syndrome is a common shoulder problem which, if treated ineffectively, can lead to more serious pathology and expensive treatment. This study examined whether subjects receiving joint mobilization and comprehensive treatment (hot packs, active range of motion, physiologic stretching, muscle strengthening, soft tissue mobilization, and patient education) would have improved pain, mobility, and function compared with similar patients receiving comprehensive treatment alone. Subjects were eight men and six women (mean age = 52.9 years) with primary shoulder impingement syndrome (superolateral shoulder pain, decreased active humeral elevation, limited overhead function). Following random assignment to experimental (N = 7) and control groups (N = 7), three blinded evaluators tested 24-hour pain (visual analog scale), pain with subacromial compression test (visual analog scale), active range of motion (goniometry), and function (reaching forward, behind the head, and across the body in an overhead position) before and after nine treatments. One-tailed analyses of covariance (baseline values as covariates) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differences in range of motion and function (Mann-Whitney U) compared with controls. The experimental group improved on all variables, while the control group improved only on mobility and function (one-tailed, paired t tests; Wilcoxon matched pairs). Age, side of dominance, duration of symptoms, treatment attendance, exercise quality, and adherence had no effect on the outcomes. Results may be affected by inadequate sample size, minimal capsular tightness, insensitive functional scale, nonspecific motion measurements, position at which mobilization treatment was given, or a strong effect of comprehensive treatment. Mobilization decreased 24-hour pain and pain with subacromial compression test in patients with primary shoulder impingement syndrome, but larger replication studies are needed to assess more clearly mobilization's influence on motion and function.

Female↗

PubMed2004

[Mechanical stretching inhibits adipocyte differentiation of 3T3-L1 cells: the molecular mechanism and pharmacological regulation].

Obesity frequently promotes a variety of cardiovascular diseases including atherosclerosis, hypertension, and type 2 diabetes. In a view of both the preventive and therapeutic aspects of the abovementioned diseases, most intensive clinical interventions have been primarily directed at decreasing excessive amounts of fat tissue by a change in the balance between intake and expenditure of energy; such changes are typically effected via daily exercise and diet control. Mechanical stimuli such as stretching and rubbing of fat tissues using gymnastic exercises or massage are believed to decrease obesity; however, there is no report concerning the direct effect of the mechanical stimulation on adipocytes. Here, we demonstrated that cyclic stretch inhibited adipocyte differentiation of mouse 3T3-L1 cells, which was attributable to a reduced expression of adipogenic transcription factor peroxisome proliferator-activated receptor (PPAR)gamma(2) via the activation of an extracellular signal-regulated protein kinase (ERK) pathway. The inhibitory effect of the cyclic stretching on the differentiation of 3T3-L1 cells could be restored by troglitazone, a synthetic ligand for PPARgamma. Our results provide a molecular basis for the physiological significance of the local application of mechanical stimuli to fat tissues, which is totally independent of a mechanism for systemic energy consumption.

3T3-L1 Cells↗

PubMed2000

Tibialis posterior myofascial tightness as a source of heel pain: diagnosis and treatment.

STUDY DESIGN: We report 2 cases in which a novel tibialis posterior muscle stretch is used to treat heel pain and lower extremity impairment. OBJECTIVES: To explore dysfunction of the tibialis posterior as a source of heel pain. BACKGROUND: Heel pain is a common symptom of orthopaedic dysfunction of the lower extremity. Tibialis posterior tendon dysfunction is well documented in the medical and surgical literature, but its identification in its early or precursive stages has received little attention. METHODS AND MEASURES: An examination and treatment outline, incorporating a novel assessment and stretching technique, is presented. RESULTS: We identified a stage of dysfunction of the tibialis posterior ("Pre-Stage 1") without clinically identifiable tendon pathology. We refer to this as tibialis posterior myofascial tightness (TPMT). CONCLUSION: Tibialis posterior myofascial tightness is a clinical entity that may be differentially diagnosed in cases of heel pain and specifically treated.

Adolescent↗

PubMed2003

Interval sprint training enhances endothelial function and eNOS content in some arteries that perfuse white gastrocnemius muscle.

The purpose of this study was to test the hypothesis that interval sprint training (IST) selectively increases endothelium-dependent dilation (EDD) and endothelial nitric oxide synthase and/or superoxide dismutase-1 protein content in arteries and/or arterioles that perfuse the white portion of rat gastrocnemius muscle (WG). Male Sprague-Dawley rats completed 10 wk of IST (n = 62) or remained sedentary (Sed) (n = 63). IST rats performed six 2.5-min exercise bouts, with 4.5 min of rest between bouts (60 m/min, 15% incline), 5 days/wk. EDD was assessed from acetylcholine (ACh)-induced increases in muscle blood flow measured in situ and by ACh-induced dilation of arteries and arterioles [first to third order (1A-3A)] that perfuse red gastrocnemius muscle (RG) and WG. Artery protein content was determined with immunoblot analysis. ACh-induced increases in blood flow were enhanced in WG of IST rats. eNOS content was increased in conduit arteries, gastrocnemius feed artery, and fourth-order arterioles from WG and fifth-order arterioles of RG but not in 2As from RG. EDD was examined in 2As and 3As from a subset of IST and Sed rats. Arterioles were canulated with micropipettes, and intraluminal pressure was set at 60 cmH2O. Results indicate that passive diameter (measured in 0 calcium PSS) of WG 2As was similar in IST and Sed, whereas diameter of WG 3As was greater in IST (96 +/- 8 microm) than Sed (73 +/- 4 microm). WG 2As and 3As of IST rats exhibited greater spontaneous tone, but sensitivity to stretch, phenylephrine, and sodium nitroprusside was similar to Sed arterioles. ACh-induced dilation was enhanced by IST in WG 2As but not in RG 2As or WG 3As. We conclude that IST induces vascular adaptations nonuniformly among arteries that perfuse WG muscle.

Animals↗

PubMed2006

Effects of stretch shortening cycle exercise fatigue on stress fracture injury risk during landing.

The purpose of this study was to examine changes in landing performance during fatigue that could result in increased stress fracture injury risk. Five participants performed nonfatigued and fatigued drop landings (0.60 m), while ground reaction force (GRF), electromyographic (EMG) activity, and kinematics were recorded. Fatigue was defined as a 5-20% reduction in vertical jumping performance. Single-subject analyses revealed that all participants were affected (p < or = .05) by fatigue. Post hoc comparisons revealed a group effect (p < or = .05) for selected variables. Participants landed with (a) less joint flexion at contact and used a greater range of motion, (b) greater GRF peaks and loading rates, and (c) less EMG activity. These changes were consistent with greater risk of stress fracture.

Adult↗

PubMed1994

Manual therapy with steroid injections--a new approach to treatment of low back pain. A controlled multicenter trial with an evaluation by orthopedic surgeons.

Fifty-three acute or subacute patients with low back pain were given standardized but optimized activating conventional treatment by primary health care teams. Forty-eight patients received an experimental treatment that included specific manual treatment, such as manipulation and specific mobilization, muscle stretching, auto-traction, and cortisone injections. After 4 months, the experimental group had a less restricted range of movement in extension, less restricted side-bending to the right and to the left, less local pain caused by extension and side-bending to the right, less pain radiating to the right leg caused by side-bending to the left, and a less positive straight leg raising test (both sides) than the conventionally treated group. Manual treatment was superior to the conventional activating treatment in normalizing pathologic findings on physical examination of the lower back. These results agree with the positive influence on pain, drug consumption, sick-leave, disability rating, and quality of life reported in other reports from the same study.

Adult↗

PubMed2006

Muscle power output properties using the stretch-shortening cycle of the upper limb and their relationships with a one-repetition maximum bench press.

The purpose of this study was to examine the output properties of muscle power by the dominant upper limb using SSC, and the relationships between the power output by SSC and a one-repetition maximum bench press (1 RM BP) used as a strength indicator of the upper body. Sixteen male athletes (21.4+/-0.9 yr) participated in this study. They pulled a load of 40% of maximum voluntary contraction (MVC) at a stretch by elbow flexion of the dominant upper limb in the following three preliminary conditions: static relaxed muscle state (SR condition), isometric muscle contraction state (ISO condition), and using SSC (SSC condition). The velocity with a wire load via a pulley during elbow flexion was measured accurately using a power instrument with a rotary encoder, and the muscle power curve was drawn from the product of the velocity and load. Significant differences were found among all evaluation parameters of muscle power exerted from the above three conditions and the parameters regarding early power output during concentric contraction were larger in the SSC condition than the SR and ISO conditions. The parameters on initial muscle contraction velocity when only using SSC significantly correlated with 1 RM BP (r=0.60-0.62). The use of SSC before powerful elbow flexion may contribute largely to early explosive power output during concentric contraction. Bench press capacity relates to a development of the above early power output when using SSC.

Adult↗

PubMed1992

A muscle fatigue index based on the relationship between preceding background activity and myotatic reflex response (MRR).

A new index of muscular fatigue was developed using the myotatic reflex response (MRR). The MRR of masseter muscles is evoked by periodical mechanical chin tapping during clenching. The MRR waveform is composed of somewhat synchronized action potentials of muscle fibers. We estimate the change of the MRR waveform due to fatigue using the instantaneous frequency pattern (IFP) with the Hilbert transform. As a result, the features of IFP were different from the monotonic changes that have been observed by the conventional fatigue indices. That is, a plateau IFP was observed ahead of considerable fatigue, whereas the IFP showed a monopeak pattern during other phase of an exercise. Also, the relationship between the preceding background mean power frequency and the instantaneous frequency around the first part of the MRR waveform was nonlinear during the whole process of fatigue. These features may allow us to estimate the degree of fatigue at each time instant. Although the details have not yet been solved, by using the computer simulations one of them seemed to be the alteration of the dominant frequency components. The dominant frequency components may be related to the active muscle fiber types.

Action Potentials↗

PubMed2006

Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level.

OBJECTIVES: To investigate possible links between aetiology of acute, first time hamstring strains in sprinters and dancers and recovery of flexibility, strength, and function as well as time to return to pre-injury level. [figure: see text]. METHODS: Eighteen elite sprinters and 15 professional dancers with a clinically diagnosed hamstring strain were included. They were clinically examined and tested two, 10, 21, and 42 days after the acute injury. Range of motion in hip flexion and isometric strength in knee flexion were measured. Self estimated and actual time to return to pre-injury level were recorded. Hamstring reinjuries were recorded during a two year follow up period. RESULTS: All the sprinters sustained their injuries during high speed sprinting, whereas all the dancers were injured while performing slow stretching type exercises. The initial loss of flexibility and strength was greater in sprinters than in dancers (p<0.05). At 42 days after injury, both groups could perform more than 90% of the test values of the uninjured leg. However, the actual times to return to pre-injury level of performance were significantly longer (median 16 weeks (range 6-50) for the sprinters and 50 weeks (range 30-76) for the dancers). Three reinjuries were noted, all in sprinters. CONCLUSION: There appears to be a link between the aetiologies of the two types of acute hamstring strain in sprinters and dancers and the time to return to pre-injury level. Initially, sprinters have more severe functional deficits but recover more quickly.

Adolescent↗

PubMed2006

Active leg stiffness and energy stored in the muscles during maximal counter movement jump in the aged.

The purpose of this study was to examine the effects of age on active leg stiffness adjustment, electromyogram (EMG) activities and energy stored during eccentric and concentric phases in performing a maximal functional task involving stretch-shorten cycle. Ten young (24.3+/-2 years) and 10 old (68.6+/-5 years) healthy male subjects were filmed during maximal performance of counter movement jump (CMJ) and squat jump (SJ) on force plate. Integrated EMG (IEMG), ground reaction force (GRF), active leg stiffness, energy stored/returned and active work done by the muscles were compared between two groups on eccentric (ECC) and concentric (CON) phases of CMJ. The GRF, leg stiffness and energy stored in ECC and GRF, IEMG, energy returned and active work in CON were less in the elderly (p<0.05). These results demonstrate that the neuromuscular function of adjusting active stiffness, storing elastic energy and optimizing the performance may decrease with age during CMJ.

Adult↗

PubMed1999

Effect of precooling on high intensity cycling performance.

OBJECTIVE: To examine the effects of precooling skin and core temperature on a 70 second cycling power test performed in a warm and humid environment (29 degrees C, 80% relative humidity). METHODS: Thirteen male national and international level representative cyclists (mean (SD) age 24.1 (4.1) years; height 181.5 (6.2) cm; weight 75.5 (6.4) kg; maximal oxygen uptake (VO2peak) 66.1 (7.0) ml/kg/min) were tested in random order after either 30 minutes of precooling using cold water immersion or under control conditions (no precooling). Tests were separated by a minimum of two days. The protocol consisted of a 10 minute warm up at 60% of VO2peak followed by three minutes of stretching. This was immediately followed by the 70 second power test which was performed on a standard road bicycle equipped with 172.5 mm powermeter cranks and mounted on a stationary ergometer. RESULTS: Mean power output for the 70 second performance test after precooling was significantly (p<0.005) increased by 3.3 (2.7)% from 581 (57) W to 603 (60) W. Precooling also significantly (p<0.05) decreased core, mean body, and upper and lower body skin temperature; however, by the start of the performance test, lower body skin temperature was no different from control. After precooling, heart rate was also significantly lower than control throughout the warm up (p<0.05). Ratings of perceived exertion were significantly higher than the control condition at the start of the warm up after precooling, but lower than the control condition by the end of the warm up (p<0.05). No differences in blood lactate concentration were detected between conditions. CONCLUSIONS: Precooling improves short term cycling performance, possibly by initiating skin vasoconstriction which may increase blood availability to the working muscles. Future research is required to determine the physiological basis for the ergogenic effects of precooling on high intensity exercise.

Adult↗

PubMed2005

Effect of potentiation and stretching on maximal force, rate of force development, and range of motion.

The purpose of this investigation was to compare the effects of stretching vs. potentiation on subsequent maximal force and rate of force development capabilities of subjects in an isometric squat. Ten male collegiate athletes participated as subjects in this study. Subjects were tested during 3 separate sessions that involved joint range of motion (ROM) measurements of the lower body and isometric squat trials on a force plate to determine peak force (PF) and rate of force development (RFD) values. One testing session was preceded by 10 minutes of quiet sitting (C), 1 by a 30-minute lower-body stretching protocol (S), and 1 by 3 sets of a leg press exercise using 90% of the subjects' previously determined 1 repetition maximum (P). Three repetitions were performed for each set of the leg press, with a 3-minute rest period between each set. PF during the isometric squat was not significantly different following any of the 3 conditions (C: 100.0 +/- 0.0%, S: 101.2 +/- 6.5%, P: 98.6 +/- 6.2%). However, RFD was significantly lower in P (87.5 +/- 12.8%) compared with both C (100.0 +/- 0.0%) and S (102.6 +/- 18.5%). Significant improvement in ROM occurred only following P. It appears the potentiation protocol used in the current investigation may actually have had fatiguing effects instead of potentiating effects, but it did result in significant increases in ROM.

Adaptation, Physiological↗

PubMed2005

Acute effects of different warm-up protocols on fitness performance in children.

The purpose of this study was to compare the acute effects on youth fitness of 3 different warm-up protocols utilizing static stretching or dynamic exercise performance. Sixty children (mean age 11.3 +/- 0.7 years) performed 3 different warm-up routines in random order on nonconsecutive days. The warm-up protocols consisted of 5 minutes of walking and 5 minutes of static stretching (SS), 10 minutes of dynamic exercise (DY), or 10 minutes of dynamic exercise plus 3 drop jumps from 15-cm boxes (DYJ). Following each warm-up session, subjects were tested on the vertical jump, long jump, shuttle run, and v-sit flexibility. Analysis of the data revealed that vertical-jump and shuttle-run performance declined significantly following SS as compared to DY and DYJ, and long-jump performance was significantly reduced following SS as compared to DYJ (p < 0.05). There were no significant differences in flexibility following the 3 warm-up treatments. The results of this study suggest that it may be desirable for children to perform moderate- to high-intensity dynamic exercises prior to the performance of activities that require a high power output.

Child↗