Acute effects of dynamic versus foam rolling warm-up strategies on physical performance in elite tennis players.

To date, there is a lack of information about the optimal conditions of the warm-up to lead to a better performance in elite tennis players. The aim of this study was to compare the effects of two different warm-up protocols (dynamic vs. self-myofascial release with foam rolling) on neuromuscular variables associated with physical determinants of tennis performance. Using a crossover randomised experimental design, eleven professional men tennis players (20.6 ± 3.5 years) performed either a dynamic warm-up (DWU) or a self-myofascial release with foam rolling (SMFR) protocol. DWU consisted of 8 min of dynamic exercises at increasing intensity and SMFR consisted of 8 min of rolling on each lower extremity unilaterally. Just before (baseline) and after completing warm-up protocols, players performed a countermovement jump (CMJ), the 5-0-5 agility test, a 10-m sprint test and the Straight Leg Raise and Thomas tests to assess range of motion. Compared to baseline, the DWU was more effective to reduce the time in the 5-0-5 test than SMFR (-2.23 vs. 0.44%, respectively, p = 0.042, ηp2 = 0.19). However, both warm-up protocols similarly affected CMJ (2.32 vs. 0.61%, p = 0.373, ηp2 = 0.04) and 10-m sprint time changes (-1.26 vs. 1.03%, p = 0.124, ηp2 = 0.11). Changes in range of motion tests were also similar with both protocols (p = 0.448-1.000, ηp2 = 0.00-0.02). Overall, both DWU and SMFR were effective to prepare well-trained tennis players for highly demanding neuromuscular actions. However, DWU offered a better preparation for performing change of direction and sprint actions, and hence, in high-performance tennis players, the warm-up should include dynamic exercises.

Acute effects of different warm-up protocols on highly skilled golfers' drive performance.

Previous research has highlighted the positive effect that different warm-up protocols have on golf performance (e.g. Sorbie et al., 2016; Tilley & Macfarlane, 2012) with the design of warm-ups and programmes targeting and improving golf performance through the activation and development of specific muscle groups. This study aimed to examine the acute effects of two warm-up protocols on golf drive performance in comparison to a control condition. Using a randomised counterbalanced design over three testing sessions, twenty-three highly skilled golfers completed the control, dynamic and resistance-band warm-up conditions. Following each condition, a GC2 launch monitor was used to record ball velocity and other launch parameters of ten shots hit with the participants' own driver. A repeated-measures ANOVA found significant increases in ball velocity (ηp2 = .217) between the control and both the dynamic and resistance-band warm-up conditions but no difference between these latter two, and a reduction in launch angle between control and dynamic conditions. The use of either a dynamic stretching or resistance-band warm-up can have acute benefits on ball velocity but golfers should liaise with a PGA Professional golf coach to effectively integrate this into their golf driving performance.

Topical Analgesic Improved or Maintained Ballistic Hip Flexion Range of Motion with Treated and Untreated Legs.

Increased stretch tolerance can contribute to improved range of motion (ROM). Since menthol-based topical analgesics (TopAnalg) suppress pain, they may increase stretch thresholds improving ROM. Other modalities such as transcutaneous electrical nerve stimulation and rolling have demonstrated decreased pain sensitivity in the contralateral limb. The purpose of this study was to investigate the effects of a TopAnalg on active and passive ROM of the treated and contralateral (untreated) leg. With a double blind, repeated measures design, 14 university students had a TopAnalg or a placebo gel applied to their hamstrings, rested for 20-min and then either performed static or dynamic stretching. Prior to gel application and after stretching, participants were tested for passive static, active and ballistic hip flexion ROM. Near significant greater ballistic hip flexion ROM for both legs (treated: p = 0.08; 3.6%; contralateral: p = 0.1; 1.6%) were observed with the TopAnalg. With dynamic stretching, ballistic hip flexion ROM of both limbs at post-test (p=0.01-0.007; 3.3-4.2%) and post-10 minutes (p = 0.06-0.01; 2.7-4.1%) decreased with the placebo, whereas there were no significant reductions with the TopAnalg. There was a near significant higher active hip flexion ROM (stretched leg: p = 0.05; 4.6%), and significantly higher ballistic hip flexion ROM (p = 0.04-0.05; 3.4-3.5%) with static versus dynamic stretching for both legs. In conclusion, TopAnalg can increase hip flexion ROM of the treated and contralateral limbs. Secondly, static stretching contributed to greater ballistic ROM in both the stretched and non-stretched contralateral limbs. Hence, TopAnalg may be used to enhance flexibility training with rehabilitation or highly trained athletes.

Can chronic stretching change the muscle-tendon mechanical properties? A review.

It is recognized that stretching is an effective method to chronically increase the joint range of motion. However, the effects of stretching training on the muscle-tendon structural properties remain unclear. This systematic review with meta-analysis aimed to determine whether chronic stretching alter the muscle-tendon structural properties. Published papers regarding longitudinal stretching (static, dynamic and/or PNF) intervention (either randomized or not) in humans of any age and health status, with more than 2 weeks in duration and at least 2 sessions per week, were searched in PubMed, PEDro, ScienceDirect and ResearchGate databases. Structural or mechanical variables from joint (maximal tolerated passive torque or resistance to stretch) or muscle-tendon unit (muscle architecture, stiffness, extensibility, shear modulus, volume, thickness, cross-sectional area, and slack length) were extracted from those papers. A total of 26 studies were selected, with a duration ranging from 3 to 8 weeks, and an average total time under stretching of 1165 seconds per week. Small effects were seen for maximal tolerated passive torque, but trivial effects were seen for joint resistance to stretch, muscle architecture, muscle stiffness, and tendon stiffness. A large heterogeneity was seen for most of the variables. Stretching interventions with 3- to 8-week duration do not seem to change either the muscle or the tendon properties, although it increases the extensibility and tolerance to a greater tensile force. Adaptations to chronic stretching protocols shorter than 8 weeks seem to mostly occur at a sensory level.

The effects of different durations of static stretching within a comprehensive warm-up on voluntary and evoked contractile properties.

Evidence for performance decrements following prolonged static stretching (SS) has led to a paradigm shift in stretching routines within a warm-up. Rather than SS, dynamic stretching (DS) and dynamic activity (DA) have replaced SS within warm-up routines. The objective of the present study was to compare the effect of differing lower limb SS durations (30 [SS30s], 60 [SS60s] or 120 s [SS120s] of SS per muscle group or no-stretch control) within a comprehensive warm-up protocol consisting of aerobic activity, DS and DA. Sixteen male participants completed the four stretching conditions in a randomized order, after a 5-min low-intensity (cycle) warm-up and before a DS/DA component on separate days. Tests included passive hip and knee ranges of motion (ROM), maximum voluntary knee extensor/flexor force, force produced at 100 ms (F100), vertical jump height and evoked knee extensor contractile properties. For hip flexion (hamstrings) ROM, SS120s provided the largest increase (5.6-11.7%) followed by SS60s (4.3-11.4%), control (4.4-10.6%) and SS30s (3.6-11.1%). For knee flexion (quadriceps) ROM, SS30s provided the largest increase (9.3-18.2%) followed by SS120s (6.5-16.3%), SS60s (7.2-15.2%) and control (6.3-15.2%). There were decreases in quadriceps F100 following SS in SS120s (29.6%) only. There were increases in vertical jump performance in the control (6.2%), SS60s (4.6%) and SS30s (3.3%). While 120 s SS per muscle increased ROM, even within a comprehensive warm-up routine, it also elicited notable performance decrements. However, moderate durations of SS were observed to improve ROM whilst either having negligible or beneficial (but not detrimental) effects on specific aspects of athletic performance.

Alternative to traditional stretching methods for flexibility enhancement in well-trained combat athletes: local vibration versus whole-body vibration.

This study aimed to compare the effect of local vibration (LV) and whole body vibration (WBV) on lower body flexibility and to assess whether vibration treatments were more effective than traditionally used static and dynamic stretching methods. Twenty-four well-trained male combat athletes (age: 22.7 ± 3.3 years) performed four exercise protocols - LV (30 Hz, 4 mm), WBV (30 Hz, 4 mm), static stretching (SS), and dynamic stretching (DS) - in four sessions of equal duration 48 hours apart in a randomized, balanced order. During a 15-minute recovery after each protocol, subjects performed the stand and reach test (S&R) at the 15th second and the 2(nd), 4(th), 6(th), 8(th), 10(th) and 15(th) minute. There was a similar change pattern in S&R scores across the 15-minute recovery after each protocol (p = 0.572), remaining significantly elevated throughout the recovery. A significant main protocol effect was found for absolute change in S&R scores relative to baseline (p = 0.015). These changes were statistically greater in LV than WBV and DS. Changes in SS were not significantly different from LV, but were consistently lower than LV with almost moderate effect sizes. After LV, a greater percentage of subjects increased flexibility above the minimum detectable change compared to other protocols. Subjects with high flexibility (n = 12) benefited more from LV compared with other methods (effect size ≥ 0.862). In conclusion, LV was an effective alternative exercise modality to acutely increase lower extremity flexibility for well-trained athletes compared with WBV and traditional stretching exercises.

The effects of plantar flexor static stretching and dynamic stretching using an aero-step on foot pressure during gait in healthy adults: a preliminary study.

[Purpose] The aim of this study was to examine whether plantar flexor static stretching and dynamic stretching using an Aero-Step results in changes in foot pressure during gait in healthy adults. [Subjects] Eighteen normal adults were randomly allocated to either a dynamic stretching using an Aero-Step group (DSUAS) group (n = 8) or a static stretching (SS) group (n = 10). [Methods] The DSUAS and SS participants took part in an exercise program for 15 minutes. Outcome measures were foot plantar pressure, which was measured during the subject's gait stance phase; the asymmetric ratio of foot pressure for both feet; and the visual analogue scale (VAS) measured during the interventions. [Results] There were significant differences in the asymmetric ratio of foot pressure for both feet and VAS between the two groups after intervention. However, there were no significant differences in foot plantar pressure during the gait stance phase within both groups. [Conclusion] DSUSAS is an effective stretching method, as pain during it is lower than that with SS, which can minimize the asymmetric ratio of foot pressure for both feet during gait due to asymmetric postural alignment.

Stretching exercises for growing children: evaluation of obesity, flexibility, pain and injury of musculoskeletal organs before and one year later.

Objective: Rapid bone development in growing children causes excessive tension in the lower extremities' muscles and tendons, leading to reduced flexibility and increased musculoskeletal disorder risk. Further, lack of exercise causes obesity. Therefore, we created a stretching exercise protocol to prevent musculoskeletal disorders in elementary school (middle and upper grades) children during their growth period, when rapid bone development begins. Patients and Methods: We examined the effects on pain, injury, and flexibility. Fifty-three (boys: 34, girls: 19) students in grades 3-5 (ages 9-11) performed the stretching exercises at school thrice a week for one year, and we compared the results before and a year after the intervention. Results: A three-minute stretching exercise routine achieved an intensity of 4.6-4.9 metabolic equivalents (METs; equivalent to brisk walking). Obesity (P=1.000), flexibility problems (inability to bend forward [P=0.754] or squat problems [P=1.000]), bone/joint pain (P=1.000), and injury (P=1.000) did not significantly increase. Conclusion: Stretching exercises during the growth period may help prevent childhood musculoskeletal disorders, obesity, and flexibility loss.

Acute Effect of Four Stretching Protocols on Change of Direction in U-17 Male Soccer Players.

BACKGROUND: The ability to rapidly change direction while sprinting is a desirable athletic skill in soccer. Enhancing change of direction (COD) performance depends almost exclusively on specific training, with stretching traditionally considered one such intervention. However, the comparative impact of diverse stretching methods on COD in soccer players remains an area of interest. Therefore, this study aimed to compare the effects of different stretching methods on COD ability in soccer players. METHODS: Twelve male soccer players playing in the national championship football division II (age: 16.3 ± 0.3 years, height: 1.81 ± 0.10 m, body mass: 67.7 ± 7.2 kg) were tested for COD performance (i.e., Illinois agility test) after (1) control condition (20 min general warm-up without stretching), (2) static stretching, (3) dynamic stretching, (4) combined static-dynamic stretching, and (5) combined dynamic-static stretching. The duration of stretching intervention was approximately 6 min for static and dynamic stretching and 12 min for both the combined stretching conditions. The experimental sessions were separated by 72 h. RESULTS: COD improved after dynamic stretching when compared to any other condition (p: 0.03-0.002; ηp2: 0.56-0.73), except for the control condition (p = 0.146; ηp2 = 0.18). In contrast, static stretching induced a detrimental effect on COD when compared only to the dynamic stretching condition (p < 0.01; ES = 1.35). CONCLUSION: Dynamic stretching exercises used by male soccer players in the warm-up improved COD. Other forms of stretching exercises, particularly static stretching, negatively impacted the COD performance. Therefore, coaches can consider integrating dynamic stretching protocols tailored to the athletes' specific needs. Moreover, extending the investigation to encompass a wider range of athletes, including different age groups and genders, would enhance the applicability and generalization of the findings.

Effects of Plantar Flexor Stretching on Static and Dynamic Balance in Healthy Adults.

Stretching can affect balance ability by generating biomechanical and physiological changes in the postural muscles. Stretching of the lower extremity muscles can greatly affect posture maintenance strategies and balance ability. However, the relationship between stretching and balance ability has not been clarified. Therefore, this study aimed to investigate the effect of plantar flexor stretching on balance ability. Forty-four healthy young adults were randomly assigned to four groups (static stretching, dynamic stretching, ballistic stretching, and control). Ankle joint range of motion, static balance ability, and dynamic balance ability were evaluated before, immediately after, and 20 min after stretching. Stretching did not affect balance ability in the open-eye condition. After stretching, the sway area was significantly reduced in the closed-eye condition (p < 0.05). After stretching, the reach distance of dynamic balance ability increased significantly (p < 0.05). The results show that plantar flexor stretching can positively affect balance ability. Therefore, plantar flexor stretching should be considered a rehabilitation method to improve balance.

Effects of Dynamic Stretching Combined with Manual Therapy on Pain, ROM, Function, and Quality of Life of Adhesive Capsulitis.

This study was conducted to evaluate the effects of dynamic stretching combined with manual therapy on pain, range of motion, function, and quality of life in patients with adhesive capsulitis. The participants were randomly divided into two groups: the dynamic stretching combined with manual therapy (DSMT) group (n = 17) and the static stretching combined with manual therapy (SSMT) group (n = 17). Both groups received manual therapy for 10 min and two sessions per week for 4 weeks. The DSMT group also performed additional dynamic stretching for 20 min per session, two sessions per week for 4 weeks. The SSMT group practiced additional static stretching for 20 min per session, two sessions per week for 4 weeks. The pain, ROM, function, and quality of life were measured and evaluated before and after treatment. There were significant improvements in the outcomes of pain, flexion and abduction of shoulder ROM, Shoulder Pain and Disability Index (SPADI), and the physical component score and mental component score of the Short Form-36 (SF-36) in both groups. Additionally, the external and internal rotation of the shoulder ROM and the SF-36 general health factor increased significantly more in the A group (DSMT group) compared to the B group (SSMT). In conclusion, dynamic stretching plus manual therapy offers the same results as static stretching plus manual therapy, but with additional improvement in internal and external rotation.

Alternative Flexibility Training.

Over the last approximately 20 years, research has reported on performance impairments following prolonged durations of static stretching. This has led to a paradigm shift towards dynamic stretching. There has also been a greater emphasis using foam rollers, vibration devices, and other techniques. Recent commentaries and meta-analyses suggest that stretching need not be listed as a fitness component as other activities such as resistance training can provide similar range of motion benefits. The commentary aims to review and compare the effects of static stretching and alternative exercises for improving range of motion.

Hamstrings fascicle length and physical performance changes after a single bout of dynamic stretching or neurodynamic gliding in healthy young and older adults.

INTRODUCTION: The physiological and structural alterations have been less reported in response to dynamic stretching (DS) or neurodynamic nerve gliding (NG). Accordingly, this study investigated the changes in fascicle lengths (FL), popliteal artery velocity, and physical fitness in response to a single bout of DS or NG. METHODS: The study included 15 healthy young adults (20.9 ± 0.7 yrs) and 15 older adults (66.6 ± 4.2 yrs) who randomly performed three different interventions (DS, NG, and rest control) for 10 min and 3 days apart. The biceps femoris and semitendinosus FL, popliteal artery velocity, sit and reach (S&R), straight leg raise (SLR), and fast walking speed were measured before and immediately after the intervention. RESULTS: After NG intervention, S&R was largely greater by 2 cm (1.2, 2.8 cm) and 3.4 cm (2.1, 4.7 cm) with largely increased SLR angles of 4.9° (3.7°, 6.1°) and 4.6° (3.0°, 6.2°) with all p < 0.001 for the older adults and young groups, respectively. A similar magnitude improvement in the S&R and SLR testing was also seen for both groups after DS (p < 0.05). Moreover, no changes were seen in FL, popliteal artery velocity, fast gait speed, and age effect following all three intervention occasions. CONCLUSION: Stretching with DS or NG immediately increased flexibility, which appeared to be largely due to changes in stretch tolerance rather than an increase in fascicle length. Furthermore, age dependency in response to stretching exercise was not seen in the present study.

Recovery Effects of Foam Rolling on Psychophysiological Responses in Thai National Male Ice Hockey Players.

We examined the short-term effects of foam rolling (FR), dynamic stretching (DS), and passive rest (PR) following simulated ice hockey exercise (IHE) on heart rate (HR), blood lactate (BL), leg choice reaction time (CRTleg), rating of perceived exertion (RPE), and global rating of change (GRC) in elite ice hockey players. The study followed a randomized cross-over design. Fifteen national male ice hockey players were assigned to the FR, DS, or PR interventions for 10 mins following 35- min of simulated IHE. HR and BL were obtained at 0-, 5- and 10-min post-intervention. CRTleg and RPE were assessed pre-and post-intervention. GRC was evaluated post-intervention. The PR decreased HR faster than the DS at 5-min of post-treatment. Whereas the FR and DS reduced BL levels faster than the PR at 5- and 10-min post-treatment. There was no difference in CRTleg among the FR, DS, and PR. The FR had lower RPE scores compared to the DS and PR post-treatment. As perceptual aspects, the FR was the most preferred treatment by ice hockey athletes. The FR and DS exerted more beneficial effects on BL but not on HR by the passive rest. The FR showed the most effective treatment on the psychological demands by improving RPE and perceptual responses over the DS and PR. Thus, the FR could be used as a choice for post-game recovery treatment on improving physiological and perceptual responses following an intense match-play in ice hockey players.

Acute effects of three different stretching protocols on the wingate test performance.

The purpose of this study was to examine the acute effects of different stretching exercises on the performance of the traditional Wingate test (WT). Fifteen male participants performed five WT; one for familiarization (FT), and the remaining four after no stretching (NS), static stretching (SS), dynamic stretching (DS), and proprioceptive neuromuscular facilitation (PNF). Stretches were targeted for the hamstrings, quadriceps, and calf muscles. Peak power (PP), mean power (MP), and the time to reach PP (TP) were calculated. The MP was significantly lower when comparing the DS (7.7 ± 0.9 W/kg) to the PNF (7.3 ± 0.9 W/kg) condition (p < 0.05). For PP, significant differences were observed between more comparisons, with PNF stretching providing the lowest result. A consistent increase of TP was observed after all stretching exercises when compared to NS. The results suggest the type of stretching, or no stretching, should be considered by those who seek higher performance and practice sports that use maximal anaerobic power.

Influence of dynamic stretching on ankle joint stiffness, vertical stiffness and running economy during treadmill running.

The purpose of the present study was to investigate whether and how dynamic stretching of the plantarflexors may influence running economy. A crossover design with a minimum of 48 h between experimental (dynamic stretching) and control conditions was used. Twelve recreational runners performed a step-wise incremental protocol to the limit of tolerance on a motorised instrumented treadmill. The initial speed was 2.3 m/s, followed by increments of 0.2 m/s every 3 min. Dynamic joint stiffness, vertical stiffness and running kinematics during the initial stage of the protocol were calculated. Running economy was evaluated using online gas-analysis. For each participant, the minimum number of stages completed before peak O2 uptake (V̇O2peak) common to the two testing conditions was used to calculate the gradient of a linear regression line between V̇O2 (y-axis) and speed (x-axis). The number of stages, which ranged between 4 and 8, was used to construct individual subject regression equations. Non-clinical forms of magnitude-based decision method were used to assess outcomes. The dynamic stretching protocol resulted in a possible decrease in dynamic ankle joint stiffness (-10.7%; 90% confidence limits ±16.1%), a possible decrease in vertical stiffness (-2.3%, ±4.3%), a possibly beneficial effect on running economy (-4.0%, ±8.3%), and very likely decrease in gastrocnemius medialis muscle activation (-27.1%, ±39.2%). The results indicate that dynamic stretching improves running economy, possibly via decreases in dynamic joint and vertical stiffness and muscle activation. Together, these results imply that dynamic stretching should be recommended as part of the warm-up for running training in recreational athletes examined in this study.

Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial.

BACKGROUND: Patellofemoral pain (PFP) syndrome is closely associated with muscle tightness. However, studies regarding the effects of stretching exercises on PFP patients with inflexible hamstrings are scarce. The aim of the study was to compare the effects between static and dynamic hamstring stretching in patients with PFP who have inflexible hamstrings. HYPOTHESIS: Compared with static hamstring stretching, dynamic hamstring stretching will improve the parameters of hamstring flexibility, knee muscle strength, muscle activation time, and clinical outcomes in this patient population. STUDY DESIGN: Prospective randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 46 patients (25, static stretching; 21, dynamic stretching) participated. Hamstring flexibility was assessed according to the popliteal angle during active knee extension. Muscle strength and muscle activation time were measured using an isokinetic device. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain and the anterior knee pain scale (AKPS). RESULTS: There were no differences in hamstring flexibility and knee muscle strength of the affected knees between the groups (P > 0.05). Significantly improved muscle activation time and clinical outcomes of the affected knees were observed in the dynamic stretching group compared with the static stretching group (all Ps < 0.01 for hamstring, quadriceps, VAS, and AKPS). CONCLUSION: In patients with PFP who have inflexible hamstrings, dynamic hamstring stretching with strengthening exercises was superior for improving muscle activation time and clinical outcomes compared with static hamstring stretching with strengthening exercises. CLINICAL RELEVANCE: Clinicians and therapists could implement dynamic hamstring stretching to improve function and reduce pain in patients with PFP who have inflexible hamstrings.

Ligament-Inspired Tough and Anisotropic Fibrous Gel Belt with Programed Shape Deformations via Dynamic Stretching.

Nature provides perpetual inspiration for exploring anisotropic materials to implement complex functions and motions like biological organisms. In particular, fibrous hydrogel-based anisotropic aggregates have attracted tremendous interest as fantastic materials for development into artificial ligaments or muscles. Such aggregates combine the structural anisotropy and macroscopic flexibility of fiber materials, with the intelligence, softness, and wetness of hydrogel materials. However, controlled fabrication of such hydrogels with aligned microstructures, even in a macroscopic level, remains a challenge. Here, a facile and general strategy was proposed to develop ligament-inspired multistructural (mono/bilayer) gel belts via dynamic stretching of multistrand pregels, accompanied by the simultaneous assembly of hydrogel fibers. The resultant gel belts evolved into anisotropic and aligned micro- and macrostructures, exhibiting high elastic moduli (0.01-23.5 MPa) and unique anisotropic swelling behaviors. Through further physical and chemical structure design, bioinspired multiple fibrous gel-based actuators were developed to achieve anisotropic, relatively fast (within 60 s), and delicate macroscopic shape deformations. This work provides a great platform for the design and construction of next-generation soft materials for biomimetic tissues.

Static and Dynamic Quadriceps Stretching Exercises in Patients With Patellofemoral Pain: A Randomized Controlled Trial.

BACKGROUND: Limited data are available on the effect of stretching exercise in patients with patellofemoral pain (PFP) who have inflexible quadriceps, which is one of the various causes of PFP syndrome. This study compares quadriceps flexibility, strength, muscle activation time, and patient-reported outcomes after static and dynamic quadriceps stretching exercises in patients with PFP who had inflexible quadriceps. HYPOTHESIS: Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes would improve with dynamic quadriceps stretching as compared with static quadriceps stretching exercises. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: Of the 44 patients included in the study, 20 performed static stretching and 24 performed dynamic stretching. Quadriceps flexibility was assessed by measuring the knee flexion angle during knee flexion in the prone position (the Ely test). Muscle strength and muscle activation time were measured using an isokinetic device. The patient-reported outcomes were evaluated using the visual analogue scale for pain and anterior knee pain scale. RESULTS: No significant differences in quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in the involved knees were found between the 2 groups (P values > 0.05). CONCLUSION: Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in patients with PFP who had inflexible quadriceps showed no significant differences between the static and dynamic quadriceps stretching exercise groups. CLINICAL RELEVANCE: Both static and dynamic stretching exercises may be effective for improving pain and function in patients with PFP who have inflexible quadriceps.

The Addition of Active Stretching to Balance Strategy Exercise is the Most Effective as a Home-Based Exercise Program in Improving the Balance of the Elderly.

Background: The decreased balance in the elderly increases the risk of falling. An effective type of exercise is needed to improve balance for the elderly. Aims: The purpose of this study was to determine the difference in the effectiveness of adding active stretching with dynamic stretching to balance strategy exercise as a home-based exercise program in improving the balance for the elderly. Participants and Methods: This research was a randomized control trial. The participants were 36 elderly selected based on the inclusion and exclusion criteria, divided into three groups. Group 1 was given dynamic stretching exercises to balance strategy exercises, Group 2 was assigned active stretching exercises to balance strategy exercise, and Group 3 was given balance strategy exercise only as a control group. Each group was given different exercises three times a week for 6 weeks. The balance ability of the elderly is measured using a Berg balance scale (BBS). Results: The mean difference scores of BBS before and after exercise with paired sample t-test increased in both groups with P < 0.05. It means that all groups had a significant impact, where the highest different score is in Group 2. The one-way ANOVA test showed a significant difference in the average posttest BBS value between the groups. Furthermore, the data were analyzed by the LSD post hoc test, where the results showed that all groups have significant differences against other groups (P < 0.05), with the best group being Group 2. Conclusion: According to the results, the addition of active stretching exercise to the balance strategy exercise as a home-based exercise program is the most effective in improving balance for the elderly.