Various theories have been proposed to explain increases in muscle extensibility observed after intermittent stretching. Most of these theories advocate a mechanical increase in length of the stretched muscle. More recently, a sensory theory has been proposed suggesting instead that increases in muscle extensibility are due to a modification of sensation only. Studies that evaluated the biomechanical effect of stretching showed that muscle length does increase during stretch application due to the viscoelastic properties of muscle. However, this length increase is transient, its magnitude and duration being dependent upon the duration and type of stretching applied. Most of these studies suggest that increases in muscle extensibility observed after a single stretching session and after short-term (3- to 8-week) stretching programs are due to modified sensation. The biomechanical effects of long-term (>8 weeks) and chronic stretching programs have not yet been evaluated. The purposes of this article are to review each of these proposed theories and to discuss the implications for research and clinical practice.

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Increasing Muscle Extensibility: A Matter of Increasing Length or Modifying Sensation?

Background: Many lower limb disorders are related to calf muscle tightness and reduced dorsiflexion of the ankle. To treat such disorders, stretches of the calf muscles are commonly prescribed to increase available dorsiflexion of the ankle joint.

Hypothesis: To determine the effect of static calf muscle stretching on ankle joint dorsiflexion range of motion.

Study design: A systematic review with meta-analyses.

Methods: A systematic review of randomised trials examining static calf muscle stretches compared with no stretching. Trials were identified by searching Cinahl, Embase, Medline, SportDiscus, and Central and by recursive checking of bibliographies. Data were extracted from trial publications, and meta-analyses performed that calculated a weighted mean difference (WMD) for the continuous outcome of ankle dorsiflexion. Sensitivity analyses excluded poorer quality trials. Statistical heterogeneity was assessed using the quantity I 2.

Results: Five trials met inclusion criteria and reported sufficient data on ankle dorsiflexion to be included in the meta-analyses. The meta-analyses showed that calf muscle stretching increases ankle dorsiflexion after stretching for ⩽15 minutes (WMD 2.07°; 95% confidence interval 0.86 to 3.27), >15–30 minutes (WMD 3.03°; 95% confidence interval 0.31 to 5.75), and >30 minutes (WMD 2.49°; 95% confidence interval 0.16 to 4.82). There was a very low to moderate statistical heterogeneity between trials. The meta-analysis results for ⩽15 minutes and >15–30 minutes of stretching were considered robust when compared with sensitivity analyses that excluded lower quality trials.

Conclusions: Calf muscle stretching provides a small and statistically significant increase in ankle dorsiflexion. However, it is unclear whether the change is clinically important.

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

Context: Many athletes report that foam rollers help release tension in their muscles, thus resulting in greater range of motion (ROM) when used before stretching. To date, no investigators have examined foam rollers and static stretching. Objective: To determine if foam rolling before static stretching produces a significant change in passive hip-flexion ROM. Design: Controlled laboratory study. Setting: Research laboratory. Participants: 40 subjects with less than 90° of passive hip-flexion ROM and no lower-extremity injury in the 6 mo before data collection. Interventions: During each of 6 sessions, subjects' passive hip-flexion ROM was measured before and immediately after static stretching, foam rolling and static stretching, foam rolling, or nothing (control). To minimize accessory movement of the hip and contralateral leg, subjects lay supine with a strap placed across their hip and another strap located over the uninvolved leg just superior to the patella. A bubble inclinometer was then aligned on...

Effect of foam rolling and static stretching on passive hip-flexion range of motion.

Study Design Randomized clinical trial. Objective To compare the effectiveness of anterior versus posterior glide mobilization techniques for improving shoulder external rotation range of motion (ROM) in patients with adhesive capsulitis. Background Physical therapists use joint mobilization techniques to treat motion impairments in patients with adhesive capsulitis. However, opinions of the value of anterior versus posterior mobilization procedures to improve external rotation ROM differ. Methods and Measures Twenty consecutive subjects with a primary diagnosis of shoulder adhesive capsulitis and exhibiting a specific external rotation ROM deficit were randomly assigned to 1 of 2 treatment groups. All subjects received 6 therapy sessions consisting of application of therapeutic ultrasound, joint mobilization, and upper-body ergometer exercise. Treatment differed between groups in the direction of the mobilization technique performed. Shoulder external rotation ROM measured initially and after each treatm...

The Effect of Anterior Versus Posterior Glide Joint Mobilization on External Rotation Range of Motion in Patients With Shoulder Adhesive Capsulitis

Postoperative rehabilitation programs following articular cartilage repair procedures will vary greatly among patients and need to be individualized based on the nature of the lesion, the unique characteristics of the patient, and the type and detail of each surgical procedure. These programs are based on knowledge of the basic science, anatomy, and biomechanics of articular cartilage as well as the biological course of healing following surgery. The goal is to restore full function in each patient as quickly as possible by facilitating a healing response without overloading the healing articular cartilage. The purpose of this paper is to overview the principles of rehabilitation following articular cartilage repair procedures. Furthermore, specific rehabilitation guidelines for debridement, abrasion chondroplasty, microfracture, osteochondral autograft transplantation, and autologous chondrocyte implantation will be presented based upon our current understanding of the biological healing response postoperatively.

https://www.jospt.org/doi/pdf/10.2519/jospt.2006.2228

Current concepts in the rehabilitation following articular cartilage repair procedures in the knee.

Background and Purpose. Warm-up prior to static stretching enhances muscle extensibility. The relative effectiveness of different modes of warm-up, however, is unknown. The purpose of this study was to evaluate the effectiveness of superficial heat, deep heat, and active exercise warm-up prior to stretching compared with stretching alone on the extensibility of the plantar-flexor muscles. Subjects. Ninety-seven subjects (59 women, 38 men) with limited dorsiflexion range of motion (ROM) were randomly assigned to 1 of 5 groups. Female subjects had a mean age of 27.6 years (SD=7.68, range=17–50), and male subjects had a mean age of 26.8 years (SD=6.87, range=18–48). Methods. The first group (group 1) was a control group and did not perform the stretching protocol. The 4 experimental groups (groups 2–5) performed a stretching protocol 3 days per week for 6 weeks. Group 2 performed the static stretching protocol only; group 3 performed active heel raises before stretching; group 4 received 15 minutes of superficial, moist heat to the plantar-flexor muscles before stretching; and group 5 received continuous ultrasound for 7 minutes before stretching. Dorsiflexion ROM measurements were taken initially and after 2, 4, and 6 weeks. Results. All experimental groups increased active and passive range of motion (AROM and PROM). The mean AROM/PROM differences at 6 weeks were 1.11/1.39 degrees for group 1, 4.10/6.11 degrees for group 2, 4.16/4.21 degrees for group 3, 4.38/4.90 degrees for group 4, and 6.20/7.35 degrees for group 5. The group receiving ultrasound before performing the stretching protocol (group 5) displayed the greatest increase in both AROM (6.20°) and PROM (7.35°). Discussion and Conclusion. Among the modalities tested, the use of ultrasound for 7 minutes prior to stretching may be the most effective for increasing ankle dorsiflexion ROM.

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Claudia A Knight

Papers

Effect of Superficial Heat, Deep Heat, and Active Exercise Warm-up on the Extensibility of the Plantar Flexors