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    I wrote an article for my patients regarding stretching here: http://painsciencecenter.com/2015/08/23/research-review-the-science-of-a-stretch/ and i though i should share the research part of it with you all in this group. i hope i make sense.

    The Science of a Stretch

    Part 1: Does stretching work?

    Have researchers found that stretching improves flexibility for everyone?
    (I have given three answers based on research)

    1. Yes – stretching improves flexibility and here are some publications:

    “Active and passive stretching both appeared to increase the flexibility of tight hip flexor muscles in patients with musculoskeletal impairments.” Published by Winters MV in 2004

    “These data indicate that static stretching 1 repetition for 30 seconds 3 days per week increased hamstring length in young healthy subject” Published by Davis DS in 2005

    “After 4 weeks of stretching, there was a statistically significant improvement in hamstring length (p < 0.05) using active stretches as compared with passive stretches. From weeks through 8, hamstring length for the active stretching groups decreased. After 8 weeks of stretching, the passive stretch group had the greatest improvement in hamstring length.” Published by Fasem JM in 2009

    “Stretching produced no significant change in maximal contraction but significantly decreased stiffness and hysteresis.The present results suggest that stretching decreased the viscosity of tendon structures but increased the elasticity.” Published by Kubo K in 1985

    There are hundreds of publications indicating that stretching will increase flexibility.

    2. No – stretching does not improve flexibility with more research reports.

    “These data also suggest that active self-stretching and PNF-R (proprioceptive neuromuscular facilitation) stretching 1 repetition for 30 seconds 3 days per week is not sufficient to significantly increase hamstring length” Published by Davis DS in 2005

    “A single session of 3 straight-leg raise hamstring stretches did not change pelvis, hip, or knee running kinematics” Published by Davis Hammonds AL in 2012

    “Six weeks of sustained 30-min daily stretch does not increase the extensibility of the hamstring muscle of healthy individuals.” Published by Ben M in 2010

    There are also many more articles that have found that stretching does not improve flexibility. Interesting isn’t it? It will all make sense in the end. Please keep reading.

    3. THE CONCLUSION FOR THE MOMENT: There are numerous research studies that show stretching improves flexibility and does not improve flexibility. So the final answer is based on a Cochrane Review that looked at over 1000 research studies

    “Stretching does not have clinically important effects on joint mobility in people with, or at risk of, contractures (stiffness in the body) if performed for less than seven months. The effects of stretch performed for periods longer than seven months have not been investigated.” Published by Katalinic OM in 2010.

    WHAT DOES THIS MEAN???

    This does not mean that you should not stretch!

    Stretching can be beneficial and it can also feel good.

    If it works for you and you enjoy stretching, then it is probably a good idea to keep doing it. But, it is important to understand that the mechanisms of how stretching works is not fully understood or agreed upon.
    …..
    Part 2: Does stretching improve performance?

    It is often assumed that stretching is a good way to warm up to increase performance or activity. Researchers have found the opposite to be true for static stretching. Dynamic stretching appears to help with performance. Here are some definitions for different types of stretching that have been studied.

    Static Stretching consists of holding a stretched position for a prolonged period of time, often 20-60 seconds. Here is a video on a static hamstring stretch on YouTube: https://www.youtube.com/watch?v=z73l6oZUniQ ).

    Dynamic Stretching consists of repetitive active movement into end range or close to end range without holding. Here is a YouTube video on it: https://www.youtube.com/watch?v=z7qKc5_4Tes. Notice that the instructor in the video mentioned the possibility of nerve tension while stretching the hamstrings. This concept will be discussed later. Here is another video on Dynamic Warm-ups: http://greatist.com/fitness/full-body-dynamic-warm-up

    PNF-Contract Relax Stretching consists of activation of muscles for a brief period and then stretching for a brief period. It is thought that greater relaxation will occur after brief muscle contractions to enhance the body’s ability to become more flexible. Here is a video example: https://www.youtube.com/watch?v=bg9pSuAXIYY

    Ballistic Stretching involves repetitive bouncing using momentum during a stretch. It is a higher level of dynamic stretching and is not recommended by the American Academy of Orthopaedic Surgeons. Read their recommendation here in their website. Here is a video example of it: https://www.youtube.com/watch?v=eXjK49c69Qg. There may be situations in sports and in our daily lives when ballistic stretching may be appropriate but the risk of injury may outweigh the benefits for the general population. So I will not go into detail regarding this type of stretch.

    Here is what researchers have to say about stretching and performance:

    “Substantial evidence is now available to state that static stretching can impair strength and power performance…” Published by Young WB & Behm DG in 2002

    “After static stretching, there were significant overall 9.5% and 5.4% decrements in the torque or force of the quadriceps for maximal voluntary force. Force remained significantly decreased for 120 min (10.4%)” Published by Power K in 2004 (this study indicates that negative effects of static stretching may last for 2 hours!)

    “Vertical jump height decreased after static and PNF stretching (4.0% and 5.1%, p < 0.05) and there was a smaller decrease after ballistic stretching (2.7%, p > 0.05). However, jumping performance had fully recovered 15 minutes after all stretching conditions. In conclusion, vertical jump performance is diminished for 15 minutes if performed after static or PNF stretching, whereas ballistic stretching has little effect on jumping performance. Consequently, PNF or static stretching should not be performed immediately prior to an explosive athletic movement.” Published by Bradley PS in 2007

    ""therefore, in healthy patients, a (Static)muscle stretch, such as used in this study, is probably of little therapeutic value.” Published by Bohannon RW in 1985

    “It was concluded that static stretching as part of a warm-up may decrease short sprint performance, whereas active dynamic stretching seems to increase 20-m sprint performance.” Published by Fletcher IM in 2004

    “There was no short-term effect of stretching in the warm-up on the tennis serve performance of adult players, so adding stretching to the traditional 5-minute warm-up in tennis does not affect serve performance.” Published by Knudson DV in 2004

    “…the results of this study indicate a relative performance enhancement with the dynamic warm up group (not the static stretching group), the utility of warm up routines that use static stretching as a stand-alone activity should be reassessed.” Published by McMillian DJ in 2006

    “The results indicated that submaximum running and practice jumps had a positive effect whereas static stretching had a negative influence on explosive force and jumping performance. It was suggested that an alternative for static stretching should be considered in warm-ups prior to power activities” Published by Young WB in 2003

    “The results of this study suggest that performing a static stretch protocol following a dynamic warm up will inhibit sprint performance in collegiate athletes.” Published by Winchester JB in 2008

    “The findings suggest that the elevation in perceived exertion following knee flexor muscle stretching may be greater in women than men, despite no significant alterations in mechanical measures of muscle fatigue.” Published by Heuser M in 2010

    “The results of this inquiry strongly suggest that a total-body passive static stretching routine should be avoided before practice or competition in favor of a gradual active – dynamic movements” Published by Gergley JC in 2010

    “An acute bout of stretching does not improve force or jump height, and the results for running speed are contradictory. Regular stretching improves force, jump height, and speed, although there is no evidence that it improves running economy.” Published by Shrier I. in 2004

    The articles quoted above stated that static stretching limits performance and dynamic movements are better. Unfortunately, they didn’t go into detail as to why static stretching may be related to decreased performance, which leads to the next section.
    …..
    Part 3: How does performance decrease following static stretching?
    Here are research reports that discussed possible reasons why performance decreases after static stretching:

    “Stretching prior to stretch-shortening cycle activities like the vertical jump results in small decreases in performance in some subjects, but the non-significant biomechanical changes suggest that neuromuscular inhibition may be the mechanism rather than changes in muscle stiffness” Published by Knudson D in 2001 (In other words, decreased performance may be related to changes within the brain and the activation of protective mechanisms through the nervous system.)

    “…multiple mechanisms may be involved in stretch-induced strength inhibition.” Published by Winchester JB in 2009

    “A single 30-second stretch, if held at the limit of toleration, is sufficient to cause an inhibition in a person’s 1-rep-max. Additional bouts of stretching will further decrease the 1-rep max, suggesting that multiple mechanisms may be involved in stretch-induced strength inhibition.” Published by Winchester JB in 2009

    These studies state that inhibition or protective mechanisms as reasons for decreased performance. What is that?

    The term inhibit is defined by Webster as follows: (click here for the Webster webpage)
    1. to keep (someone) from doing what he or she wants to do
    2. to prevent or slow down the activity or occurrence of (something)

    Muscles can become inhibited due to surgery, pain, overwork, fatigue, and stress just to name a few. Stretching may be another factor involved with muscle inhibition due to protective responses.
    …..
    Part 4: What are researchers publishing regarding the relationship of stretching and the prevention of injures?

    “Despite a few outlying studies, consistently favorable estimates were obtained for all injury prevention measures except for stretching” Published by Lauersen JB in 2014 (this was published based on a systematic review of research of over 3000 research articles! They only considered high quality research for this review.)

    “In stop-and-go sports like soccer, Australian Rules football, rugby or football, hamstring muscle injuries are the most common injuries. Studies with low qualitative and quantitative characteristics have been published over the last decades. It is therefore not possible to find documentation concerning the effects of static stretching on prevention of hamstring injuries.” Published by Rogan S in 2013. This is a systematic review of all research they found regarding football (American football, rugby, and international football / soccer)

    “A typical muscle stretching protocol performed during pre-exercise warm-ups does not produce clinically meaningful reductions in risk of exercise-related injury in army recruits. Fitness may be an important, modifiable risk factor.” Published by Pope RP in 2003. Based on the findings of this study involving 1538 army recruits, overall fitness may prevent injury rather than flexibility.

    “The cohort (4610 participates) was followed for a mean of 4.9 years for self-reported low back pain…Those who reported stretching, as a specific flexibility activity were at a higher risk of developing low back pain compared with those who performed no flexibility exercises” Published by Sandler RD in 2014

    “No evidence was found for a positive effect of stretching exercises (for tendon injuries).” Published by Peters JA in 2015

    WOW! Stretching may increase flexibility but it has not been proven to prevent injury! Don’t get me wrong here. There are many studies that show that limited flexibility may be associated with injury. But just because stretching may increase flexibility, it doesn’t mean that it will translate into decreased risk of injury because flexibility is a complicated topic.
    …..
    Part 5: What are the mechanisms of increased flexibility?

    In 2010 Weppler et. al. published a research paper that reviewed stretching. It is one of my favorite articles on this topic. They discussed various components of stretching and provided research to support their claims. This next section is mostly based from their article.

    Here are the various hypothesis involved with stretching:

    1. Viscoelasticity or a biomechanical term called creep.
    MerrianWebster defines creep as “to change shape permanently from prolonged stress or exposure to high temperatures”.

    Elasticity of our body can change. If you were to pull the skin of a younger person, it returns back to its original state quickly. But for an older person, the skin returns back to its original state much slower. The skin can become permanently stretched due to various reasons and can have varying degrees of elasticity. It is thought that muscles can change its elasticity when stretched.

    What about the “viscus” portion of viscoelasticity?

    Our body consists of approximately 60% water, which means that stretching muscle also involves viscosity, the thickness of fluids within and surrounding muscle. If fluid is too thick there is increased friction and decreased movement. If viscosity is too low, there will also be increased friction of muscle, tendon and etc during movement. The optimal degree of viscosity will enhance movement.

    Many studies have concluded that stretching can effect creep / viscoelasticity to promote increased flexibility. Published by Kubo 1985, Webright WG in 1997, Zito M in 1997, Taylor DC in 1999, Winters MV 2004.

    Many studies have also shown that the viscoelastic properties of stretching are nonexistent or short term from 20 seconds up to 1 hour. Published by Magnusson SP in 1996, Magnusson SP in 2000, McNair PJ in 2001, Duong B in 2001, Ryan ED in 2008, Tian M 2011)

    Here we go again, studies show change and some do not. This is the common theme of every hypothesis or theory involving stretching. So there may not be a universally valid theory or reason why movement or stretching enhances flexibility.

    Why is that?

    Structures have elastic and plastic properties. When an object is initially stretched, it goes through an elastic phase of stretch. When the tension is removed, the elastic properties allow the object to return to its original state. When an object is stretched past its elastic properties, then plastic deformation occurs.
    Wikipedia has an article on the stress strain curve that explains elastic and plastic deformation here.

    If you were to pull a rubber band or spring with a certain degree of tension, it will increase its length. When the tension is removed, it returns back to its original state. Our skin, tendons, ligaments, bones, and etc also have the same type of elastic property. When we stretch, there is a short term increase in flexibility but after a while, the body part returns back to its original state. This can be why some research studies find no changes following changes, some state that there is change, and some report that increased flexibility can be short term.

    2. Plastic or permanent deformation of muscle tissue.
    Weppler describes plastic / permanent deformation as follows: “The classical model of plastic deformation would require a stretch intensity sufficient to pull connective tissue within the muscle past the elastic limit and into the plastic region of the torque/angle curve so that once the stretching force is removed, the muscle would not return to its original length but would remain permanently in a lengthened state.”

    The same thing occurs with elastic bands on clothing, which can stretch and return to its functional tightness to keep our pants up. But once it is over-stretched past its functioning tension, the elasticity is permanently changed.

    Researchers have suggested that plastic deformation can be a reason for increased flexibility. (Published by Sapega AA in 1981, Hortobágyi T in 1985, Wessling KC in 1987, Zito M in 1997, Chan SP in 2001, Feland JB in 2001, Draper DO in 2004)

    Researchers have also stated that plastic deformation is not the reason why muscles increase flexibility. (Published by Wepler CH 2010, Cipriani DJ in 2012)

    Let’s say that plastic deformation did occur to improve flexibility, there might be a problem with overly stretching muscle because it may trigger more protective mechanisms, decrease the ability to produce force, and possibly lead to injury. (Published by Avela J in 1985, Fowles JR in 2000)

    3. Increased sarcomeres in series or increased sarcomere length.

    A sarcomere consists of contractile tissue found in muscle filaments which form myofibrils that make muscle fibers. Sarcomeres run the length of muscle tissue and are arranged in series. You can learn what a sarcomere is by checking out this site.

    It has been suggested that stretching programs of 3 to 8 weeks can increase the length of sarcomeres and that it can be associated with increased flexibility in animal studies. Published by Williams PE in 1978, Wessling KC in 1987, Webright WG in 1997, Gajdosik RL in 2001, Chan SP in 2001, Gajdosik RL in 2005

    This may be the most valid mechanical theory involved with stretching, but this investigation has not been performed on humans.

    Muscle fibers can change from fast twitch to slow twitch based of activity so it may be possible for stretching to change muscle physiology. Weppler states that technology may eventually allow us to assess this without injuring muscle tissue of humans tested.

    4. Neuromuscular relaxation.

    It is proposed that stretching may decrease involuntary muscle contraction associated with stretch reflexes to improve flexibility. A stretch reflex is the natural muscle contraction that occurs during a stretch. It is often performed during during physician, physical therapy, or chiropractic evaluations. A reflex hammer can test the stretch reflex of various tendons in the body.

    There are studies that suggest that changes in stretch reflexes promote increased flexibility.. (Published by Tanigawa MC in 1972, Hortobágyi T in 1985, Smith CA in 1994, Spernoga SG in 2001, Chan 2001, de Weijer VC in 2003)
    But many studies refute this claim. (Moore Ma in 1980, Liebesman J in 1994, Magnusson SP in 1998, Sharman MJ in 2006)

    5. Sensory theory

    Numerous studies have found positive change to no change in mechanical properties related to stretching and flexibility. These mechanical components of stretching are hypothesized to occur, they just haven’t been consistently proven to be a concrete theory explaining why flexibility can increase.

    This means we should be careful when explaining how stretching can improve flexibility because we really don’t know why. But let’s not throw away these ideas since research and learning will always be on-going. Just know that they are there. Also innovative or different concepts will arise that may help improve our understanding of stretching and flexibility and here is an example a concept from 2010:

    Weppler and colleagues reviewed many research articles covering stretching and concluded that the most consistent set of changes associated with flexibility in many studies involve the following:

    improved range of motion without changes in mechanical properties
    increased torque or pressure of the stretch tolerated during a stretching program
    changes in sensation involving pain onset, maximum stretch, or maximum pain tolerance with improved range of motion

    Here is a quote from their study: “A growing body of research refutes mechanical theories (traditional theories involved with stretching muscles), suggesting instead that in subjects who are asymptomatic, increases in muscle extensibility observed immediately after a single stretching session and after short term (3- to 8-week) stretching regimens are predominantly due to modification in subjects’ sensation.” Published by Weppler CH in 2010.

    They have found that the “modification of sensation” was the most consistent factor related to increased flexibility.

    What does this mean? … How can we use this article to our benefit?

    Weppler’s comment that increased flexibility is “predominantly due to modification in subjects’ sensation” may mean that we should focus on how the body feels while we stretch. Focus on the sensation of the stretch and allow the brain and the nervous system to process the stretch or movement exercise in a nonthreatening way. This might be an important factor with improving flexibility to decrease inhibition and protective mechanisms.

    Regardless of whether we agree or disagree with their findings, we should take advantage of sensation as a component of our flexibility exercises.

    6. Adaptive Potential


    Adaptive Potential involves the body’s ability to interact with its environment in an efficient manner. It is defined as “the ability of the system to tolerate a repetitive movement, a forceful blow or a prolonged position” (Published by Dorko BL 1988)

    I really like this term because it makes sense to me.

    Dorko explains the difference between flexibility vs. adaptive potential and I have added my personal notes below: (essentially, flexibility is a the ability to move and adaptive potential is the ability to control that movement)

    Flexibility (F)
    Adaptive Potential (AP)
    (personal notes)

    F: Demonstrated by measurable joint range.
    AP: Demonstrated by a painless response to repetitive movement, a forceful blow or a prolonged position.
    notes: If flexibility is gained, it may not be of use unless we are able to tolerate repetition, pressure and be able to maintain the gained range of movement.

    F: Implies easy, painless active or passive excursion of tissue in many planes.
    AP: Implies the ability to account for, tolerate and disperse long or short-term force.
    notes: It is great to be able to move in many ways in a pain free manner, but we should also be able to tolerate force or tension for short and long durations.

    F: Primarily dependent on connective tissue length and secondarily on CNS activity.
    AP: Primarily dependent on CNS “plasticity” and secondarily on connective tissue length.
    notes: Muscle flexibility is more related to the mechanical properties that may occur such as changes in viscoelasticity, plasticity, changes in the cellular level (sarcomeres- actin, myosin), and neuroreflexes. Movement limited by adaptive potential is more related to various mechanisms involved in the nervous system such as sensation, fear, avoidance of movement, increased protective responses, impaired neuromuscular control and inhibition of movement due to pain, injury, or potential injury.

    F: Can be seen and measured with relative ease
    AP: Difficult to measure; typically inferred by history.

    F: Tends to change slowly in either direction
    P: May rapidly alter in response to a series of processes
    notes: Significant change in muscle flexibility takes time. There is potential for rapid changes in mobility if limited movement is related to decreased adaptive potential. (Changes in sensation may change quickly) There are also components of adaptive potential that will take time to change. (For example, fear of movement after injury may improve quickly or linger for a prolonged period of time. )

    What this might mean is that flexibility gained from stretching is not functional unless our body can control it and adapt to the new range of motion. Otherwise there may be an increased risk of injury because there is more movement that the body is not able to safely control.


    Part 6: So now what? Let’s Apply the Research

    How do we utilize concepts such as sensation and adaptive potential to improve flexibility, decrease pain, and possibly prevent injury? (Please keep in mind that there are situations when an injury simple cannot be prevented.)

    1. Stretch as you normally have done even if it is contract-relax, static or dynamic especially if it feels good, because you may be modifying your sensation of the stretch in a positive way. Try to not be too aggressive to minimize the potential of triggering protective mechanisms.

    2. Pay attention to your body to promote improved sensation and adaptive potential via motor control exercises. (this can include body awareness, movement awareness, mindfulness with movement, and eccentric control just to name a few)

    Be mindful of the exercise you are performing. Pay attention to your body while you are moving. Feel your body move into good quality movement. Feel where your body is more limber and more limited while doing active range of motion exercises or active stretching.
    Perhaps, it might be wise to put away the headphones and music once in a while so that you (specifically, your central nervous system) can listen and feel your body while exercising rather than the beat of your favorite song.

    One type of exercise that focuses on body awareness involves movement based on Moshe Feldenkrais. Click here to learn more about him.

    Here are some articles and videos about Feldenkrais to get a better understanding:

    “Muscle length can be increased through a process of active movement (awareness through movement) that does not involve stretching.” Published by Stephens J in 2006

    “Feldenkrais (awareness with movement) method is an effective intervention for chronic neck/scapular pain in patients with visual impairment.” Published by Lundqvist LO in 2014

    “This study has demonstrated that the three outcome measurement tools selected in this study all showed statistically significant improvements in daily function, pain and health-related quality of life after a series of Feldenkrais sessions. The length of time clients had been experiencing their symptoms prior to commencing Feldenkrais sessions (a median time of 12 months) suggests that the changes were not simply due to spontaneous recovery.” Published by Connors KA in 2010

    Youtube videos below to see his work in action.
    https://www.youtube.com/watch?v=TYFyKm-bbOs
    https://www.youtube.com/watch?v=y6NnVWeJ-nY
    https://www.youtube.com/watch?v=0cfYsRm4xTw
    http://www.feldenkraisseattle.net/articles/ (currently under construction)

    Movements based on eccentric control:

    Eccentric movement is a form of motor control. Slowly controlling your body during resistive movements, active movement, and dynamic stretching may promote more mindfulness allowing you to pay attention to the sensation of movement. Also focusing on eccentric exercise many help you control your body in various positions allowing the body to adapt to various types of stress on the body

    Here are some quotes on eccentric control:

    “The results support the hypothesis that eccentric training is an effective method of increasing lower limb flexibility” Published by O’Sullivan K in 2012

    “An eccentric hamstring exercise program was associated with lower rates of new and recurrent hamstring injuries in Danish male soccer players.” Published by Nichols AW in 2013

    “An eccentric strengthening exercise program for the hamstring muscles that can be performed during training can help prevent hamstring injuries in soccer players.” Published by Schache A. in 2012

    Here are other studies that report that neuro-muscular motor control or body awareness is important for movement:

    “Understanding the neuromuscular influences on muscle flexibility will assist in the development of new rehabilitative and injury preventative techniques. The present pilot study implicates neural contributions to muscle flexibility.” Published by Krabak BJ in 2001

    “These results indicate that changes in passive range of motion or core endurance do not automatically transfer to changes in functional movement patterns. This implies that training and rehabilitation programs may benefit from an additional focus on ‘grooving’ new motor patterns if new found movement range is to be used.” Published by Moreside JM in 2013. This study indicates that even if flexibility was gained, we need to learn motor control to improve function.”

    “Additional biomechanical and neuromuscular differences were also identified as potential risk factors (for injury).” Published by Landry SC in 2014

    3. Use various “neuromobilization” techniques.

    In 2008, a systematic review of neurodynamic / neuromobilization was published and they did not find that it was significant. Since then research on neuromobilization has increased and here are some findings:

    “…passive extensibility of neural tissues can limit hamstring flexibility” Published by McHugh MP in 2012

    “Findings suggest that a neurodynamic sliding technique can increase hamstring flexibility in healthy, male soccer players” Published by Castellote-Caballero Y in 2013

    “…neurodynamic sliding technique will increase hamstring flexibility to a greater degree than static hamstring stretching in healthy subjects..” Published by Castellote-Caballero Y in 2014

    “The findings demonstrate that different types of nerve gliding exercises have largely different mechanical effects on the peripheral nervous system. The findings of this study and a discussion of possible beneficial effects of nerve gliding exercises on neuropathological processes may assist the clinician in selecting more appropriate nerve gliding exercises in the conservative and post-operative management of common neuropathies.” Published by Coppieters MW in 2008

    There is a medical journal article explaining neuromobilization here.

    4. Use a method called graded motor imagery

    Here is the official site graded motor imagery website.

    Most of the studies on graded motor imagery involve movement regarding chronic pain and the ability to function. I found one study specifically on flexibility:

    “Psychological and physiological effects of motor imagery could explain the increase in range of motion, suggesting that imagery enhances joint flexibility during both active and passive stretching” Published by Guillot A in 2010.


    In short, what this means is that visualizing the body move may promote flexibility. Visualizing an activity can stimulate parts of the brain that are active as if you are actually doing it and this may enhance neuromuscular control and promote decreased protective mechanisms.

    5. Promote various and novel movement patterns to stimulate the brain in a positive way.

    Here are articles that discuss variability or novel movements:

    “Only those subjects for whom pain induced a reduction in variability of the postural strategy failed to return to a normal strategy when pain stopped.” Published by Moseley GL in 2006. This study reported that a decrease in movement variability is a result of pain.

    “From our perspective, the goal of neurologic physical therapy should be to foster the development of optimal amount of movement variability by incorporating a rich repertoire of movement strategies. The development of such a repertoire can be enhanced by incorporating a multitude of experiences within the therapeutic milieu. Promoting complex variation in human movement allows either motor development or the recovery of function after injury not to be hard coded, but determined instead by the active engagement of the individual within their environment.” Published by Stergiou N in 2006

    “…vibration training, alone or combined with stretching, is a viable alternative to a standard stretching routine when attempting to increase shoulder flexibility. Adding vibration training to a flexibility regimen may improve the likelihood of regularly performing flexibility sessions because of increased variety.” Published by Ferguson SL in 2013

    Here are some videos on novel movements and movement variability by a Cory Blickenstaff, physical therapy at Forward Motion PT:
    https://www.youtube.com/watch?v=IXj64-Sv16E
    https://www.youtube.com/watch?v=hm0MY9jt9rk

    6. Go out and try something new!

    Try Yoga, Pilates, gyrotonics, line dancing, and etc. Each method of movement has similar principles. Overall, there might not be a right or wrong way to move or exercise, but there might be an ideal one for you.

    Further Reading:

    During my quest to understand stretching, I have read many articles that contradict each other. Feel free to read the articles that I have referenced.

    Also many health care providers have answered these same questions that I have presented and have interesting as well as different viewpoints regarding stretching and movement. check them out.
    http://saveyourself.ca/articles/stretching.php
    http://www.theptdc.com/2014/06/shoul...ients-stretch/
    http://breakingmuscle.com/mobility-r...-think-it-does
    http://www.somastruct.com/problems-s...of-stretching/

    References:

    Avela J, Finni T, Liikavainio T, Niemelä E, Komi PV. Neural and mechanical responses of the triceps surae muscle group after 1 h of repeated fast passive stretches. J Appl Physiol (1985). 2004 Jun;96(6):2325-32. Epub 2004 Feb 13. PubMed PMID: 14966020.

    Ben M, Harvey LA. Regular stretch does not increase muscle extensibility: a randomized controlled trial. Scand J Med Sci Sports. 2010 Feb;20(1):136-44. doi: 10.1111/j.1600-0838.2009.00926.x. Epub 2009 May 22. PubMed PMID: 19497032.

    Bohannon RW, Gibson DF. Effect of quadriceps femoris muscle stretch on knee extension torque. Phys Ther. 1985 Mar;65(3):312-3. PubMed PMID: 3975280.

    Bradley PS, Olsen PD, Portas MD. The effect of static, ballistic, and proprioceptive neuromuscular facilitation stretching on vertical jump performance. J Strength Cond Res. 2007 Feb;21(1):223-6. PubMed PMID: 17313299.

    Davis DS, Ashby PE, McCale KL, McQuain JA, Wine JM. The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. J Strength Cond Res. 2005 Feb;19(1):27-32. PubMed PMID: 15705041.

    Castellote-Caballero Y, Valenza MC, Martín-Martín L, Cabrera-Martos I, Puentedura EJ, Fernández-de-Las-Peñas C. Effects of a neurodynamic sliding technique on hamstring flexibility in healthy male soccer players. A pilot study. Phys Ther Sport. 2013 Aug;14(3):156-62. doi: 10.1016/j.ptsp.2012.07.004. Epub 2012 Nov 8. PubMed PMID: 23142014.

    Castellote-Caballero Y, Valenza MC, Puentedura EJ, Fernández-de-las-Peñas C, and Alburquerque-Sendín5Immediate F. Effects of Neurodynamic Sliding versus Muscle Stretching on Hamstring Flexibility in Subjects with Short Hamstring Syndrome. J Sports Med. Volume 2014, Article ID 127471, 8 pages. http://dx.doi.org/10.1155/2014/127471

    Chan SP, Hong Y, Robinson PD. Flexibility and passive resistance of the hamstrings of young adults using two different static stretching protocols. Scand J Med Sci Sports. 2001 Apr;11(2):81-6. PubMed PMID: 11252465.

    Cipriani DJ, Terry ME, Haines MA, Tabibnia AP, Lyssanova O. Effect of stretch frequency and sex on the rate of gain and rate of loss in muscle flexibility during a hamstring-stretching program: a randomized single-blind longitudinal study. J Strength Cond Res. 2012 Aug;26(8):2119-29. doi: 10.1519/JSC.0b013e31823b862a. PubMed PMID: 22027850.

    Connors KA, Pile C, Nichols ME. Does the Feldenkrais Method make a difference? An investigation into the use of outcome measurement tools for evaluating changes in clients. J Bodyw Mov Ther. 2011 Oct;15(4):446-52. doi: 10.1016/j.jbmt.2010.09.001. Epub 2010 Oct 23. PubMed PMID: 21943618.

    Coppieters MW, Butler DS. Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008 Jun;13(3):213-21. Epub 2007 Mar 30. PubMed PMID: 17398140.

    Davis Hammonds AL, Laudner KG, McCaw S, McLoda TA. Acute lower extremity running kinematics after a hamstring stretch. J Athl Train. 2012 Jan-Feb;47(1):5-14. PubMed PMID: 22488225; PubMed Central PMCID: PMC3418114. Free full text

    de Weijer VC, Gorniak GC, Shamus E. The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours. J Orthop Sports Phys Ther. 2003 Dec;33(12):727-33. PubMed PMID: 14743986.

    Dorko BL. Adaptive Potential: A New Concept in Pain of Mechanical Origin. The Physical Therapy Forum. 1988 July 18: Vol. VII No. 29. Accessible at barrettdorko.com here

    Draper DO, Castro JL, Feland B, Schulthies S, Eggett D. Shortwave diathermy and prolonged stretching increase hamstring flexibility more than prolonged stretching alone. J Orthop Sports Phys Ther. 2004 Jan;34(1):13-20. PubMed PMID: 14964587.

    Duong B, Low M, Moseley AM, Lee RY, Herbert RD. Time course of stress relaxation and recovery in human ankles. Clin Biomech (Bristol, Avon). 2001 Aug;16(7):601-7. PubMed PMID: 11470302.

    Fasen JM, O’Connor AM, Schwartz SL, Watson JO, Plastaras CT, Garvan CW, Bulcao C, Johnson SC, Akuthota V. A randomized controlled trial of hamstring stretching: comparison of four techniques. J Strength Cond Res. 2009 Mar;23(2):660-7. doi: 10.1519/JSC.0b013e318198fbd1. PubMed PMID: 19204565.

    Feland JB, Myrer JW, Schulthies SS, Fellingham GW, Measom GW. The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Phys Ther. 2001 May;81(5):1110-7. PubMed PMID: 11319936.

    Fletcher IM, Jones B. The effect of different warm-up stretch protocols on 20 meter sprint performance in trained rugby union players. J Strength Cond Res. 2004 Nov;18(4):885-8. PubMed PMID: 15574098.

    Ferguson SL, Kim E, Seo DI, Bemben MG. Comparing the effects of 3 weeks of upper-body vibration training, vibration and stretching, and stretching alone on shoulder flexibility in college-aged men. J Strength Cond Res. 2013 Dec;27(12):3329-34. doi: 10.1519/JSC.0b013e31828f27af. PubMed PMID: 23478479.

    Fowles JR, Sale DG, MacDougall JD. Reduced strength after passive stretch of the human plantarflexors. J Appl Physiol (1985). 2000 Sep;89(3):1179-88. PubMed PMID: 10956367.

    Gajdosik RL. Passive extensibility of skeletal muscle: review of the literature with clinical implications. Clin Biomech (Bristol, Avon). 2001 Feb;16(2):87-101. Review. PubMed PMID: 11222927.

    Gajdosik RL, Vander Linden DW, McNair PJ, Williams AK, Riggin TJ. Effects of an eight-week

    stretching program on the passive-elastic properties and function of the calf muscles of older women. Clin Biomech (Bristol, Avon). 2005 Nov;20(9):973-83. PubMed PMID: 16054737.

    Gergley JC. Latent effect of passive static stretching on driver clubhead speed, distance, accuracy, and consistent ball contact in young male competitive golfers. J Strength Cond Res. 2010 Dec;24(12):3326-33. doi: 10.1519/JSC.0b013e3181e725e4. PubMed PMID: 21068685.

    Goldspink G, Tabary C, Tabary JC, Tardieu C, Tardieu G. Effect of denervation on the adaptation of sarcomere number and muscle extensibility to the functional length of the muscle. J Physiol. 1974 Feb;236(3):733-42. PubMed PMID: 4822582; PubMed Central PMCID: PMC1350860. Free full text

    Guillot A, Tolleron C, Collet C. Does motor imagery enhance stretching and flexibility? J Sports Sci. 2010 Feb;28(3):291-8. doi: 10.1080/02640410903473828. PubMed PMID: 20077278.

    Heuser M, Pincivero D. The effects of stretching on knee flexor fatigue and perceived exertion. J Sports Sci. 2010 Jan;28(2):219-26. doi: 10.1080/02640410903460718. PubMed PMID: 20391093.

    Hortobágyi T, Faludi J, Tihanyi J, Merkely B. Effects of intense “stretching”-flexibility training on the mechanical profile of the knee extensors and on the range of motion of the hip joint. Int J Sports Med. 1985 Dec;6(6):317-21. PubMed PMID: 4077358

    Katalinic OM, Harvey LA, Herbert RD, Moseley AM, Lannin NA, Schurr K. Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD007455. doi: 10.1002/14651858.CD007455.pub2. Review. PubMed PMID: 20824861.

    Knudson D, Bennett K, Corn R, Leick D, Smith C. Acute effects of stretching are not evident in the kinematics of the vertical jump. J Strength Cond Res. 2001 Feb;15(1):98-101. PubMed PMID:

    Knudson DV, Noffal GJ, Bahamonde RE, Bauer JA, Blackwell JR. Stretching has no effect on tennis serve performance. J Strength Cond Res. 2004 Aug;18(3):654-6. PubMed PMID: 15320640

    Krabak BJ, Laskowski ER, Smith J, Stuart MJ, Wong GY. Neurophysiologic influences on hamstring flexibility: a pilot study. Clin J Sport Med. 2001 Oct;11(4):241-6. PubMed PMID: 11753061

    Kubo K, Kanehisa H, Kawakami Y, Fukunaga T. Influence of static stretching on viscoelastic
    properties of human tendon structures in vivo. J Appl Physiol (1985). 2001 Feb;90(2):520-7. PubMed PMID: 11160050.

    Landry SC, McKean KA, Hubley-Kozey CL, Stanish WD, Deluzio KJ. Neuromuscular and lower limb biomechanical differences exist between male and female elite adolescent soccer players during an unanticipated run and crosscut maneuver. Am J Sports Med. 2007 Nov;35(11):1901-11. Epub 2007 Aug 29. PubMed PMID: 17761606.

    Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014 Jun;48(11):871-7. doi: 10.1136/bjsports-2013-092538. Epub 2013 Oct 7. PubMed PMID: 24100287.

    Lenssen TA, van Steyn MJ, Crijns YH, Waltjé EM, Roox GM, Geesink RJ, van den Brandt PA, De Bie RA. Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty. BMC Musculoskelet Disord. 2008 Apr 29;9:60. doi: 10.1186/1471-2474-9-60. PubMed PMID: 18442423; PubMed Central PMCID: PMC2386789. Free full text

    Liebesman J, Cafarelli E . Physiology of range of motion in human joints: a critical review. Crit Rev Phys Rehabil Med. 1994;6:131–160.

    Lundqvist LO, Zetterlund C, Richter HO. Effects of Feldenkrais method on chronic neck/scapular pain in people with visual impairment: a randomized controlled trial with one-year follow-up. Arch Phys Med Rehabil. 2014 Sep;95(9):1656-61. doi: 10.1016/j.apmr.2014.05.013. Epub 2014 Jun 4. PubMed PMID: 24907640.

    McHugh MP, Johnson CD, Morrison RH. The role of neural tension in hamstring flexibility. Scand J Med Sci Sports. 2012 Apr;22(2):164-9. doi: 10.1111/j.1600-0838.2010.01180.x. Epub 2010 Aug 24. PubMed PMID: 20738821

    McMillian DJ, Moore JH, Hatler BS, Taylor DC. Dynamic vs. static-stretching warm up: the effect on power and agility performance. J Strength Cond Res. 2006 Aug;20(3):492-9. PubMed PMID: 16937960.

    McNair PJ, Dombroski EW, Hewson DJ, Stanley SN. Stretching at the ankle joint: viscoelastic responses to holds and continuous passive motion. Med Sci Sports Exerc. 2001 Mar;33(3):354-8. PubMed PMID: 11252058.

    Magnusson SP, Simonsen EB, Aagaard P, Kjaer M. Biomechanical responses to repeated stretches in human hamstring muscle in vivo. Am J Sports Med. 1996 Sep-Oct;24(5):622-8. PubMed PMID: 8883682.

    Magnusson SP, Aagaard P, Nielson JJ. Passive energy return after repeated stretches of the hamstring muscle-tendon unit. Med Sci Sports Exerc. 2000 Jun;32(6):1160-4. PubMed PMID: 10862546.

    Magnusson SP, Simonsen EB, Aagaard P, Kjaer M. Biomechanical responses to repeated stretches in human hamstring muscle in vivo. Am J Sports Med. 1996 Sep-Oct;24(5):622-8. PubMed PMID: 8883682.

    Meyer GA, McCulloch AD, Lieber RL. A nonlinear model of passive muscle viscosity. J Biomech Eng. 2011 Sep;133(9):091007. doi: 10.1115/1.4004993. PubMed PMID: 22010742; PubMed Central PMCID: PMC3705798.Free full text

    Moore MA, Hutton RS. Electromyographic investigation of muscle stretching techniques. Med Sci Sports Exerc. 1980;12(5):322-9. PubMed PMID: 7453508.
    Moreside JM, McGill SM. Improvements in hip flexibility do not transfer to mobility in functional movement patterns. J Strength Cond Res. 2013 Oct;27(10):2635-43. doi: 10.1519/JSC.0b013e318295d521. PubMed PMID: 23591949.

    Moseley GL, Hodges PW. Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: a risk factor for chronic trouble? Behav Neurosci. 2006 Apr;120(2):474-6. PubMed PMID: 16719709.

    Nichols AW. Does eccentric training of hamstring muscles reduce acute injuries in soccer? Clin J Sport Med. 2013 Jan;23(1):85-6. doi: 10.1097/JSM.0b013e31827e9f40. PubMed PMID: 23269328.

    Nijs J, Lluch Girbés E, Lundberg M, Malfliet A, Sterling M. Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories. Man Ther. 2014 Jul 18. pii: S1356-689X(14)00130-1. doi: 10.1016/j.math.2014.07.004. [Epub ahead of print] PubMed PMID: 25090974.

    O’Sullivan K, McAuliffe S, Deburca N. The effects of eccentric training on lower limb flexibility: a systematic review. Br J Sports Med. 2012 Sep;46(12):838-45. doi: 10.1136/bjsports-2011-090835. Epub 2012 Apr 20. Review. PubMed PMID: 22522590.

    Pannucci CJ & Wilkins EG. Identifying and Avoiding Bias in Research. Plast Reconstr Surg.
    Author manuscript; available in PMC 2011 August 1. Published in final edited form as: Plast Reconstr Surg. 2010 August; 126(2): 619–625. doi: 10.1097/PRS.0b013e3181de24bc

    Peters JA, Zwerver J, Diercks RL, Elferink-Gemser MT, van den Akker-Scheek I. Preventive interventions for tendinopathy: A systematic review. J Sci Med Sport. 2015 Apr 1. pii: S1440-2440(15)00080-8. doi: 10.1016/j.jsams.2015.03.008. [Epub ahead of print] Review. PubMed PMID: 25981200

    Petrofsky JS, Laymon M. Heat transfer to deep tissue: the effect of body fat and heating modality. J Med Eng Technol. 2009;33(5):337-48. doi: 10.1080/03091900802069547. PubMed PMID: 19440919.

    Pope RP, Herbert RD, Kirwan JD, Graham BJ. A randomized trial of preexercise stretching for prevention of lower-limb injury. Med Sci Sports Exerc. 2000 Feb;32(2):271-7. PubMed PMID: 10694106.

    Power K, Behm D, Cahill F, Carroll M, Young W. An acute bout of static stretching: effects on force and jumping performance. Med Sci Sports Exerc. 2004 Aug;36(8):1389-96. PubMed PMID: 15292748.

    Rogan S, Wüst D, Schwitter T, Schmidtbleicher D. Static stretching of the hamstring muscle for injury prevention in football codes: a systematic review. Asian J Sports Med. 2013 Mar;4(1):1-9. Epub 2012 Nov 20. PubMed PMID: 23785569; PubMed Central PMCID: PMC3685153. Free full text

    Ryan ED, Beck TW, Herda TJ, Hull HR, Hartman MJ, Costa PB, Defreitas JM, Stout JR, Cramer JT. The time course of musculotendinous stiffness responses following different durations of passive stretching. J Orthop Sports Phys Ther. 2008 Oct;38(10):632-9. doi: 10.2519/jospt.2008.2843. PubMed PMID: 18827325.

    Sapega AA, Quedenfeld TC, Moyer RA,Butler RA. Biophysical factors in range-of-motion exercise. Phys Sports Med. 1981;9(12):57–65.
    Sandler RD, Sui X, Church TS, Fritz SL, Beattie PF, Blair SN. Are flexibility and muscle-strengthening activities associated with a higher risk of developing low back pain? J Sci Med Sport. 2014 Jul;17(4):361-5. doi: 10.1016/j.jsams.2013.07.016. Epub 2013 Aug 8. PubMed PMID: 23988784; PubMed Central PMCID: PMC3918247.

    Schache A. Eccentric hamstring muscle training can prevent hamstring injuries in soccer players. J Physiother. 2012;58(1):58. doi: 10.1016/S1836-9553(12)70074-7. PubMed PMID: 22341384.

    Sharman MJ, Cresswell AG, Riek S. Proprioceptive neuromuscular facilitation stretching : mechanisms and clinical implications. Sports Med. 2006;36(11):929-39. Review. PubMed PMID: 17052131.

    Shrier I. Does stretching improve performance? A systematic and critical review of the literature. Clin J Sport Med. 2004 Sep;14(5):267-73. Review. PubMed PMID: 15377965.

    Smith CA. The warm-up procedure: to stretch or not to stretch. A brief review. J Orthop Sports Phys Ther. 1994 Jan;19(1):12-7. Review. PubMed PMID: 8156057.

    Spernoga SG, Uhl TL, Arnold BL, Gansneder BM. Duration of Maintained Hamstring Flexibility After a One-Time, Modified Hold-Relax Stretching Protocol. J Athl Train. 2001 Mar;36(1):44-48. PubMed PMID: 12937514; PubMed Central PMCID: PMC155401.Free full text

    Stephens J, Davidson J, Derosa J, Kriz M, Saltzman N. Lengthening the hamstring muscles without stretching using “awareness through movement”. Phys Ther. 2006 Dec;86(12):1641-50. Epub 2006 Oct 10. PubMed PMID: 17033041.

    Stergiou N, Harbourne R, Cavanaugh J. Optimal movement variability: a new theoretical perspective for neurologic physical therapy. J Neurol Phys Ther. 2006 Sep;30(3):120-9. PubMed PMID: 17029655

    Tabary JC, Tabary C, Tardieu C, Tardieu G, Goldspink G. Physiological and structural changes in the cat’s soleus muscle due to immobilization at different lengths by plaster casts. J Physiol. 1972 Jul;224(1):231-44. PubMed PMID: 5039983; PubMed Central PMCID: PMC1331536. Free full text

    Tanigawa MC. Comparison of the hold-relax procedure and passive mobilization on increasing muscle length. Phys Ther. 1972 Jul;52(7):725-35. PubMed PMID: 5034102


    Taylor DC, Dalton JD Jr, Seaber AV, Garrett WE Jr. Viscoelastic properties of muscle-tendon units. The biomechanical effects of stretching. Am J Sports Med. 1990 May-Jun;18(3):300-9. PubMed PMID: 2372082.

    Tian M, Hoang PD, Gandevia SC, Herbert RD, Bilston LE. Viscous elements have little impact on measured passive length-tension properties of human gastrocnemius muscle-tendon units in vivo. J Biomech. 2011 Apr 29;44(7):1334-9. doi: 10.1016/j.jbiomech.2011.01.005. Epub 2011 Feb 1. PubMed PMID: 21277577.

    Winters MV, Blake CG, Trost JS, Marcello-Brinker TB, Lowe LM, Garber MB, Wainner RS. Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: a randomized clinical trial. Phys Ther. 2004 Sep;84(9):800-7. PubMed PMID: 15330693.

    Webright WG, Randolph BJ, Perrin DH. Comparison of nonballistic active knee extension in neural slump position and static stretch techniques on hamstring flexibility. J Orthop Sports Phys Ther. 1997 Jul;26(1):7-13. PubMed PMID: 9201636.

    Weppler CH & Magnusson SP. Increasing Muscle Extensibility: A Matter of Increasing Length or Modifying Sensation? Phys Ther. 2010; 90:438-449. (here)

    Wessling KC, DeVane DA, Hylton CR. Effects of static stretch versus static stretch and ultrasound combined on triceps surae muscle extensibility in healthy women. Phys Ther. 1987 May;67(5):674-9. PubMed PMID: 3575424.

    Williams PE, Goldspink G. Changes in sarcomere length and physiological properties in
    immobilized muscle. J Anat. 1978 Dec;127(Pt 3):459-68. PubMed PMID: 744744; PubMed Central PMCID: PMC1235732. Free full text

    Winchester JB, Nelson AG, Landin D, Young MA, Schexnayder IC. Static stretching impairs sprint performance in collegiate track and field athletes. J Strength Cond Res. 2008 Jan;22(1):13-9. doi: 10.1519/JSC.0b013e31815ef202. PubMed PMID: 18296950.

    Winchester JB, Nelson AG, Kokkonen J. A single 30-s stretch is sufficient to inhibit maximal voluntary strength. Res Q Exerc Sport. 2009 Jun;80(2):257-61. PubMed PMID: 19650391.

    Young WB & Behm DG. Should Static Stretching Be Used During a Warm-up for Strength and Power Activities? Strength and Conditioning Journal 2002; 24:33-37.

    Young WB, Behm DG. Effects of running, static stretching and practice jumps on explosive force production and jumping performance. J Sports Med Phys Fitness. 2003 Mar;43(1):21-7. PubMed PMID: 12629458.

    Zito M, Driver D, Parker C, Bohannon R. Lasting effects of one bout of two 15-second passive stretches on ankle dorsiflexion range of motion. J Orthop Sports Phys Ther. 1997 Oct;26(4):214-21. PubMed PMID: 9310913.
    Rex Fujiwara, MPT,OCS
    Physical Therapist
    www.painsciencecenter.com

  • #2
    Sounds like this may be a "load six" issue for a lot of folks. Stretch if your "insides tells ya."

    Comment


    • #3
      Thanks that's a great summary.

      Comment


      • #4
        “From our perspective, the goal of neurologic physical therapy should be to foster the development of optimal amount of movement variability by incorporating a rich repertoire of movement strategies. The development of such a repertoire can be enhanced by incorporating a multitude of experiences within the therapeutic milieu. Promoting complex variation in human movement allows either motor development or the recovery of function after injury not to be hard coded, but determined instead by the active engagement of the individual within their environment.” Published by Stergiou N in 2006

        “…vibration training, alone or combined with stretching, is a viable alternative to a standard stretching routine when attempting to increase shoulder flexibility. Adding vibration training to a flexibility regimen may improve the likelihood of regularly performing flexibility sessions because of increased variety.” Published by Ferguson SL in 2013

        The Effects of Vibration and Muscle Fatigue on Trunk Sensorimotor Control in Low Back Pain Patients
        http://journals.plos.org/plosone/art...l.pone.0135838

        Abstract

        Introduction

        Changes in sensorimotor function and increased trunk muscle fatigability have been identified in patients with chronic low back pain (cLBP). This study assessed the control of trunk force production in conditions with and without local erector spinae muscle vibration and evaluated the influence of muscle fatigue on trunk sensorimotor control.

        Methods

        Twenty non-specific cLBP patients and 20 healthy participants were asked to perform submaximal isometric trunk extension torque with and without local vibration stimulation, before and after a trunk extensor muscle fatigue protocol. Constant error (CE), variable error (VE) as well as absolute error (AE) in peak torque were computed and compared across conditions. Trunk extensor muscle activation during isometric contractions and during the fatigue protocol was measured using surface electromyography (sEMG).

        Results

        Force reproduction accuracy of the trunk was significantly lower in the patient group (CE = 9.81 ± 2.23 Nm; AE = 18.16 ± 3.97 Nm) than in healthy participants (CE = 4.44 ± 1.68 Nm; AE = 12.23 ± 2.44 Nm). Local erector spinae vibration induced a significant reduction in CE (4.33 ± 2.14 Nm) and AE (13.71 ± 3.45 Nm) mean scores in the patient group. Healthy participants conversely showed a significant increase in CE (8.17 ± 2.10 Nm) and AE (16.29 ± 2.82 Nm) mean scores under vibration conditions. The fatigue protocol induced erector spinae muscle fatigue as illustrated by a significant decrease in sEMG median time-frequency slopes. Following the fatigue protocol, patients with cLBP showed significant decrease in sEMG root mean square activity at L4-5 level and responded in similar manner with and without vibration stimulation in regard to CE mean scores.

        Conclusions

        Patients with cLBP have a less accurate force reproduction sense than healthy participants. Local muscle vibration led to significant trunk neuromuscular control improvements in the cLBP patients before and after a muscle fatigue protocol. Muscle vibration stimulation during motor control exercises is likely to influence motor adaptation and could be considered in the treatment of cLBP. Further work is needed to clearly identify at what levels of the sensorimotor system these gains are achievable.


        Last edited by Jo Bowyer; 28-08-2015, 01:54 PM.
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

        Comment


        • #5
          To me, the vibration intervention suggest a small version of nerve glides. Interesting that it only worked on sensitvie nerves and not healty pt's.

          Both active and passive stretching for athletes as a warm up may increase electromechanical delay too. Not exactly what you want for competition.

          Comment


          • #6
            Both active and passive stretching for athletes as a warm up may increase electromechanical delay too. Not exactly what you want for competition.
            Good point!

            I see high school runners go out on a mile warm-up. What happens during that warm-up? Blood pressure goes up, core temp up, heart rate up, muscle viscosity up, arousal up. All good for someone ready for competition.

            But then, they plop down on the grass or track and begin twenty minutes of static stretching, often to a group leader's number count. I'm guessing that in ten seconds every will have a particular muscle group adequately stretched.

            Done in a circle with runners or players all facing each other, I suppose it's a team building thing. It looks good.

            But what happens once they hit the ground after actually running or moving? All the good things of the warm-up drop down to resting levels.

            And I never could figure out--if group stretching really prepared athletes for the upcoming competitive challenges--how long the effects of the initial stretching will last. I see football teams stretch during the pre-game warm-up, but what about those athletes who might not see the field until late in the game? When a player is told to get on the field, should that player have "re-stretched" before playing? Is a pre-stretch an hour or more before he plays still make him "good to go"?

            Comment


            • #7
              Ken says:

              It looks good.
              No doubt. What isn't before our eyes is what we can't see, aren't allowed to see, what isn't brought to our attention or what scientific investigation has discovered.

              The Enlightenment might not have occurred in the minds (or teaching) of many. Perhaps our desire to get others to imagine what they don't see has gone awry. It certainly seems so.

              Now many want participation trophies eliminated, as if childhood should be a joyless slog toward the "winning" of things.

              Is this any different? Isn't it just another way that the culture controls our behavior?
              Barrett L. Dorko

              Comment


              • #8
                Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review

                http://www.nrcresearchpress.com/doi/...5#.VmiVecuLRdg

                ABSTRACT

                Recently, there has been a shift from static stretching (SS) or proprioceptive neuromuscular facilitation (PNF) stretching within a warm-up to a greater emphasis on dynamic stretching (DS). The objective of this review was to compare the effects of SS, DS, and PNF on performance, range of motion (ROM), and injury prevention. The data indicated that SS- (–3.7%), DS- (+1.3%), and PNF- (–4.4%) induced performance changes were small to moderate with testing performed immediately after stretching, possibly because of reduced muscle activation after SS and PNF. A dose–response relationship illustrated greater performance deficits with ≥60 s (–4.6%) than with <60 s (–1.1%) SS per muscle group. Conversely, SS demonstrated a moderate (2.2%) performance benefit at longer muscle lengths. Testing was performed on average 3–5 min after stretching, and most studies did not include poststretching dynamic activities; when these activities were included, no clear performance effect was observed. DS produced small-to-moderate performance improvements when completed within minutes of physical activity. SS and PNF stretching had no clear effect on all-cause or overuse injuries; no data are available for DS. All forms of training induced ROM improvements, typically lasting <30 min. Changes may result from acute reductions in muscle and tendon stiffness or from neural adaptations causing an improved stretch tolerance. Considering the small-to-moderate changes immediately after stretching and the study limitations, stretching within a warm-up that includes additional poststretching dynamic activity is recommended for reducing muscle injuries and increasing joint ROM with inconsequential effects on subsequent athletic performance.
                Keywords: static stretch, dynamic stretch, proprioceptive neuromuscular facilitation, ballistic stretch, flexibility, warm-up



                How do muscles change shape when they are passively lengthened?

                https://motorimpairment.neura.edu.au...ly-lengthened/

                Muscles are often referred to as ‘motors’ that drive human and animal movements. This analogy certainly captures the important role of muscles as active generators of force and movement. However, it sells the equally important passive properties of muscles short. Most of us will only appreciate the importance of passive muscle properties when these are affected by disease. For instance, people who have had a stroke or children with cerebral palsy frequently develop muscle contractures – a stiffening of muscles even when the muscle is not activated. Contractures frequently lead to loss of mobility, bone deformities and other undesirable effects that limit physical independence.

                Aiming to better understand the passive mechanical properties of muscles, we have used diffusion tensor imaging (DTI), a magnetic resonance imaging (MRI) technique, to obtain the most detailed measurements to date of changes in muscle structure of a human calf muscle (medial gastrocnemius) during passive lengthening (Bolsterlee et al., 2017; note that for those interested in more details on this novel imaging technique, there is a recent review paper by Damon et al., 2017). From the DTI data we measured how several thousands of muscle fibres changed length, orientation and curvature when the whole muscle was lengthened. We also measured the change in dimensions of muscle fibres, which can be thought of as several centimeter long cylindrical tubes with diameters similar to human hairs. From anatomical MRI scans the changes in three-dimensional whole-muscle shape were derived.
                g

                WHAT DID WE FIND?
                We found that the medial gastrocnemius reduced both its width and its depth when the muscle lengthened. Muscle fibres rotated by about 8° and lengthened by 35% when the whole muscle changed its length by 7%. The diffusion properties of muscle tissue measured by DTI (which gives information about the microstructure of muscle cells) suggest that the diameter of muscle fibres decreases when fibres are lengthened, presumably to maintain a constant volume.

                SIGNIFICANCE AND IMPLICATIONS
                These data help us understand the complex changes in structure that human muscles undergo when they passively lengthen. We can now use these methods to study, in unprecedented detail, the differences in muscle structure between healthy people and people with muscle contractures. This may give us new insights into the mechanisms of contracture, which will ultimately enable better management or treatment of this condition.

                PUBLICATION
                Bolsterlee B, D’Souza A, Gandevia SC, Herbert RD (2017). How does passive lengthening change the architecture of the human medial gastrocnemius muscle? J Appl Physiol, 122(4): 727-738.
                Update 20/04/2017
                Last edited by Jo Bowyer; 20-04-2017, 01:21 PM.
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • #9
                  Hi Barrett!


                  Now many want participation trophies eliminated, as if childhood should be a joyless slog toward the "winning" of things.

                  Is this any different? Isn't it just another way that the culture controls our behavior?
                  So true. For those who didn't see this KIA commercial, this is definitely a comment on our culture.

                  The commercial is apparently getting "rave reviews."

                  [YT]v-gwjJ_NXKU[/YT]

                  Comment


                  • #10
                    RE: Stretching and performance

                    Most studies seem to look at acute effects.

                    That's like doing a muscle biopsy after a resistance training session and saying that weights are bad for you because they cause muscle damage.

                    Most of the top athletic programs I've heard of will warm up like this:

                    - Light cardio to elevate body temperature.
                    - Stretching
                    - Dynamic drills
                    - Skill/performance

                    The stretching allows inhibition of protective mechanisms, which then improve subsequent drills/skills/performance allowing chronic positive adaptations.

                    I'm biased towards stretching for a few reasons:
                    - Anecdote. I've read about many top athletes who had long careers (much longer than the avg top flight). Aside from being highly skilled, these athletes had a few physical traits in common:
                    >> they were lighter than most, especially as the got into their 30s
                    >> they prioritised stretching or flexibility work

                    - Personal experience. After years of not stretching "because it doesn't work", I have implemented stretching regularly before my training sessions. I have noted better performance in my lifting (KB sport) as a result, as well as reduced pain (my knee and hip would often be sore towards the end of a working/training week before hand).

                    - Client/patient outcomes. Similar to my experience, repeated with clients and patients.

                    I don't do isolated stretching, rather whole body programs, with extended holds.

                    I can defend my premise for doing so based on the mechanisms mentioned above, in addition to central inhibition factors (one study reported increase in lower body flexibility after stretching upper and vice versa).

                    So whilst the cochrane recommendation is to not stretch, it seems like the most flexible athletes all do some form of stretching.

                    Why the disconnect?
                    Registered osteopath
                    Registered personal trainer
                    http://twitter.com/NickEfthimiou

                    Comment


                    • #11
                      A couple of articles from 2 respected physical preparation coaches:

                      Andrew Read: http://breakingmuscle.com/mobility-r...-professionals

                      Ian King: http://kingsportsint.blogspot.com.au...-weak-and.html

                      Obviously not research, but that has been covered in the OP.
                      Registered osteopath
                      Registered personal trainer
                      http://twitter.com/NickEfthimiou

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                      • #12
                        One further addition:

                        A personal example of such a response was a colleague conducting his Master's research thesis on hamstring stretching in professional footballers. He found no statistical benefit to the practice, so his recommendation became to stop stretching hamstrings in footballers (Personal Communication, 2005).

                        Understandably, when viewed in an isolated context, this assumption would seem to make sense; whereas from a more global perspective it doesn't reconcile with the broader literature.

                        For example, there is ample evidence that an array of factors can affect hamstring tone – from pre-existing injury or scar tissue within the muscle, to trigger points within the tissues, to lower-limb pain perception (the flexor response), to irritable bowel syndrome, constipation or other bowel disorders, to hypertonic suboccipital muscles, to lumbopelvic instability, to adverse neural tension, to muscle imbalance syndromes and more besides (Wallden, 2005).

                        So, to execute a single intervention (in this instance a passive stretching intervention) to the hamstring muscle and assume that it will have a linear response in all to whom it is applied (the muscle gets longer) is a poorly founded assumption, based on just our limited knowledge of the breadth of potential confounding variables. Of course, when this exact linear process is assessed using standard research protocols, it is likely to be found “ineffective” or statistically insignificant. This may explain why in a book containing 1200 references on flexibility, Alter (2004) found no specific stretching methodology or approach that particularly stood out as being more effective than another. It so commonly seems to be forgotten that a nervous system attaches to the muscle under scrutiny and that the influences on that nervous system are many and varied.
                        From: http://www.sciencedirect.com/science...60859215002211
                        Registered osteopath
                        Registered personal trainer
                        http://twitter.com/NickEfthimiou

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                        • #13
                          Wow. That's some editorial. Do you think it deserves it's own thread?
                          Last edited by nykinvic; 11-12-2015, 06:32 AM.
                          Christine

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                          • #14
                            Originally posted by Nick Efthimiou View Post
                            RE: Stretching and performance

                            Most studies seem to look at acute effects.

                            That's like doing a muscle biopsy after a resistance training session and saying that weights are bad for you because they cause muscle damage.

                            Most of the top athletic programs I've heard of will warm up like this:

                            - Light cardio to elevate body temperature.
                            - Stretching
                            - Dynamic drills
                            - Skill/performance

                            The stretching allows inhibition of protective mechanisms, which then improve subsequent drills/skills/performance allowing chronic positive adaptations.

                            I'm biased towards stretching for a few reasons:
                            - Anecdote. I've read about many top athletes who had long careers (much longer than the avg top flight). Aside from being highly skilled, these athletes had a few physical traits in common:
                            >> they were lighter than most, especially as the got into their 30s
                            >> they prioritised stretching or flexibility work

                            - Personal experience. After years of not stretching "because it doesn't work", I have implemented stretching regularly before my training sessions. I have noted better performance in my lifting (KB sport) as a result, as well as reduced pain (my knee and hip would often be sore towards the end of a working/training week before hand).

                            - Client/patient outcomes. Similar to my experience, repeated with clients and patients.

                            I don't do isolated stretching, rather whole body programs, with extended holds.

                            I can defend my premise for doing so based on the mechanisms mentioned above, in addition to central inhibition factors (one study reported increase in lower body flexibility after stretching upper and vice versa).

                            So whilst the cochrane recommendation is to not stretch, it seems like the most flexible athletes all do some form of stretching.

                            Why the disconnect?

                            Nick,

                            Glad you have found your preferred process for optimal performance and function.

                            My question to you regarding your stretching/flexibility/exercises....Are you or is your goal more length of the tissue?
                            OR are you seeking to reduce some other sensation, to find some relief of something? That something could be tension/tightness/stiffness/inefficient movements, etc?

                            Thanks for your response.

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                            • #15
                              Hi Nick!

                              So whilst the Cochrane recommendation is to not stretch, it seems like the most flexible athletes all do some form of stretching.

                              Why the disconnect?
                              I think it's another matter of "load six" for many athletes. Their "insides tells them" that they are better prepared for workouts or competition by stretching. Their long history of successful athletic experiences as a result makes stretching a valued routine that over time has become ritual.

                              Nothing wrong with that.

                              If whatever activities they prefer doing were causing problems, they would have stopped doing them.

                              Years ago many coaches and trainers were advocating never "bouncing" a stretch. The great hurdler Edwin Moses did it all the time.

                              Many of my high school runners have particular stretches that they do before every workout or race.

                              Reminds me of something a physiologist who attended one of my speed seminars years back said: "I know some of the drills I do don't make sense relative to the mechanics of high speed running. I just like to do them."

                              Coaches often believe "right" --or what they think is right--should always trump "like," but I don't think that is always the case, or always needs to be the case.

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