Efficacy of static stretching and proprioceptive neuromuscular facilitation stretch on hamstrings length after a single session.

A number of studies have investigated the efficacy of several repetitions of proprioceptive neuromuscular facilitation stretching (PNF) and static stretching (SS). However, there is limited research comparing the effects of a single bout of these stretching maneuvers. The aim of this study was to compare the effectiveness of a single bout of a therapist-applied 30-second SS vs. a single bout of therapist-applied 6-second hamstring (agonist) contract PNF. Forty-five healthy subjects between the ages of 21 and 35 were randomly allocated to 1 of the 2 stretching groups or a control group, in which no stretching was received. The flexibility of the hamstring was determined by a range of passive knee extension, measured using a universal goniometer, with the subject in the supine position and the hip at 90° flexion, before and after intervention. A significant increase in knee extension was found for both intervention groups after a single stretch (SS group = 7.53°, p < 0.01 and PNF group = 11.80°, p < 0.01). Both interventions resulted in a significantly greater increase in knee extension when compared to the control group (p < 0.01). The PNF group demonstrated significantly greater gains in knee extension compared to the SS group (mean difference 4.27°, p < 0.01). It can be concluded that a therapist applied SS or PNF results in a significant increase in hamstring flexibility. A hamstring (agonist) contract PNF is more effective than an SS in a single stretching session. These findings are important to physiotherapists or trainers working in clinical and sporting environments. Where in the past therapists may have spent time conducting multiple repetitions of a PNF and an SS, a single bout of either technique may be considered just as effective. A key component of the study methodology was the exclusion of a warm-up period before stretching. Therefore, the findings of efficacy of a single PNF are of particular relevance in sporting environments and busy clinical settings where time may be limited.

The effect of closed-kinetic chain exercises and open-kinetic chain exercise on the muscle activity of vastus medialis oblique and vastus lateralis.

Patellofemoral pain syndrome (PFPS) is one of the most prevalent musculoskeletal conditions of the lower limb. The muscle imbalance between the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles is one of the main factors leading to the development of PFPS. The disparity in research and the necessity to add to the existing literature base led to the development of this study. The aim of this study was to investigate the effect of 2 closed kinetic chain exercises and 1 open kinetic chain exercise on VMO and VL muscle activity. Twenty-two healthy asymptomatic individuals participated in this study. The surface electromyography (EMG) of VMO and VL was measured and used to calculate the VMO:VL ratio during 3 different quadriceps-strengthening exercises (a double leg squat with isometric hip adduction exercise, an open kinetic chain knee extension exercise, and a lunge exercise). The double leg squat with isometric hip adduction exercise was shown to produce a significantly greater VMO:VL ratio (1.14:1) than the other 2 exercises (p = 0.015 and p = 0.005). The open kinetic chain knee extension exercises produced significantly greater activation of VL than the lunge exercise (p = 0.001 and p = 0.036). The lunge exercise produced the VMO:VL ratio (1.18:1) closest to the idealized ratio of 1:1. Potential clinical recommendations can be made proposing the lunge exercise as a key tool in early rehabilitation when restoring preferential VMO:VL ratio is essential. The double leg squat with isometric hip adduction exercise would be useful in maintaining correct patella tracking and selectively strengthening VMO.

Gait Retraining for the Reduction of Injury Occurrence in Novice Distance Runners: 1-Year Follow-up of a Randomized Controlled Trial.

BACKGROUND: The increasing popularity of distance running has been accompanied by an increase in running-related injuries, such that up to 85% of novice runners incur an injury in a given year. Previous studies have used a gait retraining program to successfully lower impact loading, which has been associated with many running ailments. However, softer footfalls may not necessarily prevent running injury. PURPOSE: To examine vertical loading rates before and after a gait retraining program and assess the effectiveness of the program in reducing the occurrence of running-related injury across a 12-month observation period. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 320 novice runners from the local running club completed this study. All the participants underwent a baseline running biomechanics evaluation on an instrumented treadmill with their usual running shoes at 8 and 12 km/h. Participants were then randomly assigned to either the gait retraining group or the control group. In the gait retraining group (n = 166), participants received 2 weeks of gait retraining with real-time visual feedback. In the control group (n = 154), participants received treadmill running exercise but without visual feedback on their performance. The training time was identical between the 2 groups. Participants' running mechanics were reassessed after the training, and their 12-month posttraining injury profiles were tracked by use of an online surveillance platform. RESULTS: A significant reduction was found in the vertical loading rates at both testing speeds in the gait retraining group ( P < .001, Cohen's d > 0.99), whereas the loading rates were either similar or slightly increased in the control group after training ( P = .001 to 0.461, Cohen's d = 0.03 to -0.14). At 12-month follow-up, the occurrence of running-related musculoskeletal injury was 16% and 38% in the gait retraining and control groups, respectively. The hazard ratio between gait retraining and control groups was 0.38 (95% CI, 0.25-0.59), indicating a 62% lower injury risk in gait-retrained runners compared with controls. CONCLUSION: A 2-week gait retraining program is effective in lowering impact loading in novice runners. More important, the occurrence of injury is 62% lower after 2 weeks of running gait modification. Registration: HKUCTR-1996 (University of Hong Kong Clinical Trials Registry).

Back pain is associated with changes in loading pattern throughout forward and backward bending.

STUDY DESIGN: Experimental study to determine the kinetics of the lumbar spine (LS) and hips during forward and backward bending. OBJECTIVE: To investigate the effects of back pain, with and without a positive straight leg raise (SLR) sign, on the loading patterns in the LS and hip during forward and backward bending. SUMMARY OF BACKGROUND DATA: Forward and backward bending are important components of many functional activities and are part of routine clinical examination. However, there is a little information about the loading patterns during forward and backward bending in people with back pain with or without a positive SLR sign. METHODS: Twenty asymptomatic participants, 20 back pain participants, and 20 participants with back pain and a positive SLR sign performed 3 continuous cycles of forward and backward bending. Electromagnetic sensors were attached to body segments to measure their kinematics while 2 nonconductive force plates gathered ground reaction force data. A biomechanical model was used to determine the loading pattern in LS and hips. RESULTS: Although the loading on the LS at the end of the range decreased significantly, the loading at the early and middle ranges of forward bending actually increased significantly in people with back pain, especially in those with positive SLR sign. This suggests that resistance to movement is significantly increased in people with back pain during this movement. CONCLUSION: This study suggested that it is not sufficient to study the spine at the end of range only, but a complete description of the loading patterns throughout the range is required. Although the maximum range of motion of the spine is reduced in people with back pain, there is a significant increase in the moment acting through the range, particularly in those with a positive SLR sign.

Three-dimensional kinetics of the lumbar spine and hips in low back pain patients during sit-to-stand and stand-to-sit.

STUDY DESIGN: Experimental, biomechanical study to determine the kinetics of the lumbar spine and hips during sit-to-stand and stand-to-sit. OBJECTIVE: To investigate the effects of back pain, with and without limitation in straight leg raise, on the joint moment and power of the lumbar and hips during sit-to-stand and stand-to-sit. SUMMARY OF BACKGROUND DATA: Movements of the lumbar spine and hips, and their coordination have been reported to be affected by the presence of low back pain (LBP), especially in those with a positive straight leg raise. However, the literature has no information concerning moment and power characteristics of the lumbar spine and hips during sit-to-stand and stand-to-sit in such patients. METHODS: Twenty asymptomatic subjects, 20 LBP patients, and 20 patients with LBP and a positive straight leg raise sign were requested to perform the sit-to-stand and stand-to-sit activities. Electromagnetic sensors were attached to the body segments to measure their kinematics while 2 nonconductive force plates gathered ground reaction force data. Biomechanical models were used to determine the muscle moments and power at the lumbosacral (L5/S1) joint and hips. RESULTS: Muscle moments acting at the lumbar spine and hip in the sagittal plane were found to decrease in subjects with LBP, but there were significant increases in moments in other planes of motion. The power patterns of the spine and hips were also significantly altered, particularly in subjects with a positive straight leg raise sign. CONCLUSIONS: Back pain subjects exhibit compensatory movements and altered load sharing strategies during the sit-to-stand and stand-to-sit activities. Exercise therapy should take account of these changes so that the normal kinematic and kinetic characteristics of the spine and hips can be restored.

Movement coordination of the lumbar spine and hip during a picking up activity in low back pain subjects.

The effect of low back pain, with or without nerve root signs, on the joint coordination and kinematics of the lumbar spine and hips during everyday activities, such as picking up an object from the floor, are largely unknown. An experimental study was designed to compare lumbar spine and hip joint kinematics and coordination in subjects with and without sub-acute low back pain, while picking up an object in a sitting position. A three-dimensional real-time electromagnetic tracking device was used to measure movements of the lumbar spine and hips. Sixty participants with subacute low back pain, with or without straight leg raise signs, and twenty healthy asymptomatic participants were recruited. The ranges of motions of lumbar spine and hips were determined. Movement coordination between the two regions was examined by cross-correlation. Results showed that mobility was significantly reduced in subjects with back pain, who compensated for limited motion through various strategies. The contribution of the lumbar spine relative to that of the hip was, however, found to be similar in all groups. The lumbar spine-hip joint coordination was substantially altered in subjects with back pain, in particular, those with a positive straight leg raise sign. We conclude that changes in the lumbar and hip kinematics were related to back pain and limitation in straight leg raise. Lumbar-hip coordination was mainly affected by the presence of positive straight leg raise sign when picking up an object in a sitting position.

Symptomatic and asymptomatic movement coordination of the lumbar spine and hip during an everyday activity.

STUDY DESIGN: This experimental study analyzed the movements of the lumbar spine and hip while putting on a sock. OBJECTIVES: To examine differences in kinematics and coordination of the lumbar and hip movements in subjects with and without subacute low back pain. SUMMARY OF BACKGROUND DATA: There is no information on the coordination of movements of lumbar spine and hips during activities of daily living such as putting on a sock. The effect of low back pain, with or without nerve root signs, is unknown. METHODS: A real-time three-dimensional electromagnetic tracking device was used to measure movements of the lumbar spine and hips in 60 subacute low back pain subjects with or without straight leg raise (SLR) signs and 20 asymptomatic subjects. Movement coordination between the two regions was examined by cross-correlation. RESULTS: Mobility was significantly reduced in back pain subjects. Symptomatic subjects compensated for limited motion through various strategies, but in all cases the contribution of the lumbar spine relative to that of the hip was significantly reduced. The lumbar spine-hip joint coordination was substantially altered in back pain subjects, in particular, when putting on a sock on the side with positive SLR sign. CONCLUSION: Changes in the lumbar and hip kinematics when putting on a sock were related to back pain and limitation in SLR. Low back pain will affect lumbar-hip coordination.

Effect of low back pain on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit.

STUDY DESIGN: Experimental study to describe lumbar spine and hip joint movements during sit-to-stand and stand-to-sit. OBJECTIVES: To examine differences in the kinematics and joint coordination of the lumbar spine and hips during sit-to-stand and stand-to-sit between healthy subjects and patients with subacute low back pain (LBP). SUMMARY OF BACKGROUND DATA: There is a paucity of information on the coordination of movements of lumbar spine and hips during sit-to-stand and stand-to-sit. The effect of LBP, with or without nerve root signs, is largely unknown. METHODS: A three-dimensional real-time electromagnetic tracking device was used to measure movements of the lumbar spine and hips during sit-to-stand and stand-to-sit. Sixty subacute LBP participants with or without straight leg raise signs and 20 healthy asymptomatic participants were recruited. The kinematic patterns of lumbar spine and hips were analyzed. Coordination between the two joints was studied by relative phase angle analysis. RESULTS: The mobility of the spine and hips was significantly limited in back pain subjects. It was observed that LBP subjects employed various strategies to compensate for the limited motions at the hips and lumbar spine. The contribution of the lumbar spine relative to that of the hip was found to be reduced for subjects with LBP. The lumbar spine-hip joint coordination was significantly altered in back pain subjects, in particular, those with positive straight leg raise sign. CONCLUSION: Back pain was related to changes in the kinematics and coordination of the lumbar spine and hips during sit-to-stand and stand-to-sit. Assessment of back pain patients should include kinematic analysis of the hips as well as the spine.