The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older.

BACKGROUND AND PURPOSE: Stretching protocols for elderly people (> or = 65 years of age) have not been studied to determine the effectiveness of increasing range of motion (ROM). The purpose of this study was to determine which of 3 durations of stretches would produce and maintain the greatest gains in knee extension ROM with the femur held at 90 degrees of hip flexion in a group of elderly individuals. SUBJECTS: Sixty-two subjects (mean age = 84.7 years, SD = 5.6, range = 65-97) with tight hamstring muscles (defined as the inability to extend the knee to less than 20 degrees of knee flexion) participated. Subjects were recruited from a retirement housing complex and were independent in activities of daily living. METHODS: Subjects were randomly assigned to 1 of 4 groups and completed a physical activity questionnaire. The subjects in group 1 (n = 13, mean age = 85.1 years, SD = 6.4, range = 70-97), a control group, performed no stretching. The randomly selected right or left limb of subjects in group 2 (n = 17, mean age = 85.5 years, SD = 4.5, range = 80-93), group 3 (n = 15, mean age = 85.2 years, SD = 6.5, range = 65-92), and group 4 (n = 17, mean age = 83.2 years, SD = 4.6, range = 68-90) was stretched 5 times per week for 6 weeks for 15, 30, and 60 seconds, respectively. Range of motion was measured once a week for 10 weeks to determine the treatment and residual effects. Data were analyzed using a growth curve model. RESULTS: A 60-second stretch produced a greater rate of gains in ROM (60-second stretch = 2.4 degrees per week, 30-second stretch = 1.3 degrees per week, 15-second stretch = 0.6 degrees per week), which persisted longer than the gains in any other group (group 4 still had 5.4 degrees more ROM 4 weeks after treatment than at pretest as compared with 0.7 degrees and 0.8 degrees for groups 2 and 3, respectively). DISCUSSION AND CONCLUSION: Longer hold times during stretching of the hamstring muscles resulted in a greater rate of gains in ROM and a more sustained increase in ROM in elderly subjects. These results may differ from those of studies performed with younger populations because of age-related physiologic changes.

Effects of tape and exercise on dynamic ankle inversion.

OBJECTIVE: To compare the effects of tape, with and without prewrap, on dynamic ankle inversion before and after exercise. DESIGN AND SETTING: Doubly multivariate analyses of variance were used to compare the taping and exercise conditions. Subjects were randomly assigned to a fixed treatment order as determined by a balanced latin square. The independent variables were tape application (no tape, tape with prewrap, tape to skin) and exercise (before and after). The dependent variables were average inversion velocity, total inversion, maximum inversion velocity, and time to maximum inversion. SUBJECTS: Thirty college-age male and female students (17 males, 13 females; mean age = 24.9 +/- 4.3 years, range, 19 to 39 years) were tested. Subjects were excluded from the study if they exhibited a painful gait or painful range of motion or had a past history of ankle surgery or an ankle sprain within the past 4 weeks. MEASUREMENTS: We collected data using electronic goniometers while subjects balanced on the right leg on an inversion platform tilted about the medial-lateral axis to produce 15 degrees of plantar flexion. Sudden ankle inversion was induced by pulling the inversion platform support, allowing the platform support base to rotate 37 degrees . Ten satisfactory trials were recorded on the inversion platform before and after a prescribed exercise bout. We calculated total inversion, time to maximum inversion, average inversion velocity, and maximum inversion velocity after sudden inversion. RESULTS: We found no significant differences between taping to the skin and taping over prewrap for any of the variables measured. There were significant differences between both taping conditions and no-tape postexercise for average inversion velocity, maximum inversion, maximum inversion velocity, and time to maximum inversion. The total inversion mean for no-tape postexercise was 38.8 degrees +/- 6.3 degrees , whereas the means for tape and skin and for tape and prewrap were 28.3 degrees +/- 4.6 degrees and 29.1 degrees +/- 4.7 degrees , respectively. After exercise, inversion increased by 1.0 degrees +/- 2.8 degrees for the no-tape condition, whereas the tape-to-skin and tape-over-prewrap inversion increased by 2.1 degrees +/- 3.2 degrees and 1.7 degrees +/- 2.2 degrees , respectively. CONCLUSIONS: There was no difference in the amount of inversion restriction when taping with prewrap was compared with taping to the skin. Tape and tape with prewrap significantly reduced the average inversion velocity, maximum inversion, maximum inversion velocity, and the time to maximum inversion. Both taping conditions offered residual restriction after exercise.

Immediate and residual changes in dorsiflexion range of motion using an ultrasound heat and stretch routine.

OBJECTIVE: With respect to increasing ankle dorsiflexion range of motion, our objective was to examine the influence, if any, of preheating the triceps surae with ultrasound before stretching. DESIGN AND SETTING: Subjects were assigned to either group A (ultrasound and stretch) or group B (stretch alone). Group A received 3-MHz ultrasound (1.5 W/cm(2), 4 times effective radiating area) for 7 minutes to the musculotendinous junction of the triceps surae before stretching. Group B rested for 7 minutes before stretching. Both groups then performed identical calf stretches for 4 minutes. Treatment for both groups was conducted at the Brigham Young University Sports Injury Research Laboratory twice daily for 5 days with at least 3 hours between procedures. We analyzed the data with a 2 x 3 x 10 factorial analysis of variance with repeated measures. A Tukey post hoc test was used to identify significant differences in range of motion. SUBJECTS: Forty college students (male = 18, female = 22, age = 20.4 +/- 2.5 years) volunteered for the study. MEASUREMENTS: Maximal ankle dorsiflexion range of motion was measured using an inclinometer before and after each treatment. RESULTS: Immediate effects were that ultrasound and stretch increased mean dorsiflexion range of motion in all sessions significantly more than stretch alone in three treatment sessions. Residual effects were that dorsiflexion range of motion increased 3 degrees in both groups after nine treatment sessions; however, neither group significantly outperformed the other. CONCLUSION: As studied, an ultrasound and stretch routine may increase immediate range of motion more than stretch alone, possibly enhancing performance in practice and competition. This increased range of motion, however, is not maintained over the long term and is not more than the range of motion gained from stretching alone. A similar study using subjects with decreased range of motion after immobilization or injury should be conducted to see if the ultrasound and stretch regimen would produce lasting range-of-motion increases.

An electromyographic investigation of 4 elastic-tubing closed kinetic chain exercises after anterior cruciate ligament reconstruction.

OBJECTIVE: To determine the electromyographic (EMG) activity of the vastus medialis oblique (VMO), vastus lateralis (VL), semitendinosus and semimembranosus (ST), and biceps femoris (BF) muscles during 4 elastic-tubing closed kinetic chain exercises in postoperative patients with anterior cruciate ligament (ACL)-reconstructed knees. DESIGN AND SETTING: A 4 x 4 repeated-measures analysis of variance design guided this study. Independent variables were type of exercise and muscle; the dependent variable was EMG activity. SUBJECTS: Fifteen patients, 5 to 24 weeks after ACL reconstruction. MEASUREMENTS: Subjects performed 4 exercises (front pull, back pull, crossover, reverse crossover) with elastic tubing attached to the foot of the uninjured leg. Time-and amplitude- normalized EMG activity was recorded from the VMO, VL, ST, and BF muscles of the injured leg. The hamstrings: quadriceps ratio was calculated. RESULTS: The normalized VMO, VL, and BF EMG activity ranged from 25% to 50% of maximum voluntary isometric contraction for the 4 exercises. The ST ranged from 12% on the back pull to 58% on the front pull. The hamstrings: quadriceps ratios were 137% (front pull), 115% (crossover), 70% (back pull), and 60% (reverse crossover). CONCLUSIONS: We suggest that clinicians use these exercises during early ACL rehabilitation since they incorporate early weightbearing with hamstring and quadriceps coactivation.

Pulsed ultrasound fails to diminish delayed-onset muscle soreness symptoms.

OBJECTIVE: We investigated the effects of pulsed ultrasound on swelling, muscle soreness perception, relaxed-elbow extension angle, and muscular strength. DESIGN AND SETTING: Eight sets of concentric and eccentric actions induced delayed-onset muscle soreness of the elbow flexors. Group 1 received 20% pulsed ultrasound treatments (1-MHz, 7 minutes, 1.5 W/ cm(2) temporal peak intensity) twice a day immediately after postexercise assessments and at 3, 24, 27, 48, 51, 72, and 75 hours postexercise. Group 2 received sham treatments immediately after postexercise assessments and at 3,27, 51, and 75 hours postexercise and true treatments of pulsed ultrasound at 24, 48, and 72 hours postexercise. Group 3 received sham treatments of no ultrasonic output immediately after postexercise assessments and at 3, 24, 27, 48, 51, 72, and 75 hours postexercise. SUBJECTS: Thirty-six college-age females. MEASUREMENTS: We recorded upper-arm circumference, perceived soreness, relaxed-elbow extension angle, and elbow-flexion strength before (pretest), immediately postexercise, and at 24, 48, 72, and 96 hours postexercise. RESULTS: We noted differences over time but no treatment effect between groups or interactions between time and group for upper-arm circumference, perceived soreness, relaxed-elbow extension angle, or elbow-flexion strength. CONCLUSIONS: Pulsed ultrasound as used in this study did not significantly diminish the effects of delayed-onset muscle soreness on soreness perception, swelling, relaxed-elbow extension angle, and strength.

The effects of high-volt pulsed current electrical stimulation on delayed-onset muscle soreness.

OBJECTIVE: We investigated three 30-minute high-volt pulsed current electrical stimulation (HVPC) treatments of 125 pps to reduce pain, restore range of motion (ROM), and recover strength loss associated with delayed-onset muscle soreness (DOMS). DESIGN AND SETTING: Randomized, masked comparison of three 30-minute treatment and sham HVPC regimens over a 48-hour period. SUBJECTS: Twenty-eight college students. MEASUREMENTS: Subjects performed concentric and eccentric knee extensions with the right leg to induce muscle soreness. Assessments were made before and after the exercise bout and each treatment at 24, 48, and 72 hours postexercise. RESULTS: Three separate 2 x 3 x 2 ANOVAs were used to determine significant differences (p < .05) between days, treatments, and pre-post treatment effects and significant interaction among these variables. Scheffe post hoc tests showed no significant reduction in pain perception or improvement in loss of function at 24, 48, and 72 hours postexercise. Mean pain perception assessments (0 = no pain, 10 = severe pain) for the HVPC group were 2.9, 4.5, and 3.5 and for the sham group 3.8, 4.8, and 3.5). Mean ROM losses for the HVPC group were 9.0 degrees , 22.3 degrees , and 26.2 degrees , and for the sham group were 9.5 degrees , 23.1 degrees , and 23.0 degrees . Mean strength losses (1RM) for the HVPC group were 25.9, 25.7, and 20.8 lbs and for the sham group were 22.3, 22.3, and 13.8 lbs. CONCLUSIONS: HVPC as we studied it was ineffective in providing lasting pain reduction and at reducing ROM and strength losses associated with DOMS.

The effects of spatting and ankle taping on inversion before and after exercise.

OBJECTIVE: To compare the effects of spatting, taping and spatting, taping, and not taping on the amount and rate of inversion of the ankle before and after exercise. DESIGN AND SETTING: We filmed subjects at 60 Hz while they stood on a platform that suddenly inverted the right ankle. Five trials were measured before and after a 30-minute period of drills. SUBJECTS: We tested 15 male rugby players with no history of lower-leg injury within the previous 6 months limiting activity for more than 2 days. MEASUREMENTS: The amount and rate of inversion in the four conditions were digitized and analyzed. RESULTS: The combination of spatting and taping was the most effective in reducing inversion rate and range of motion before and after exercise. CONCLUSIONS: All three taping treatments were effective in reducing the amount and rate of inversion. Exercise loosened the tape, but there may be a functional restriction of the amount and rate of inversion after exercise.

The Stretching Window Part Two: Rate of Thermal Decay in Deep Muscle Following 1-MHz Ultrasound.

Thermal ultrasound can be effective in increasing extensibility of collagen, thus aiding joint mobilization and stretching. In 1995, we reported on the rate of temperature decay following 3-MHz ultrasound in subcutaneous tissues. We repeated that study at 1-MHz frequency to see if the stretching window is different for deep muscle. Twenty subjects had two 23-gauge thermistors inserted 2.5 cm and 5 cm deep into their triceps surae muscle. We administered 1-MHz continuous ultrasound at 1.5 W/cm(2) until the tissue temperature increased 4 degrees C (vigorous heating). Immediately following the treatment, we recorded the rate at which the temperature dropped at 30second intervals. We ran a stepwise nonlinear regression analysis to predict temperature decay as a function of time following ultrasound treatment. There was a significant nonlinear relationship between time and temperature decay. At 2.5 cm, the average time for the temperature to drop each degree was: 1 degrees C = 2:34; 2 degrees C = 6:35; 3 degrees C = 12:10: and 4 degrees C = 21:14. At 5 cm, the average time for the temperature to drop each degree was: 1 degrees C = 2:31, 2 degrees C = 6:50: 3 degrees C = 14:32; and 4 degrees C = 27:49. Based upon prior research, thermal decay of 1-MHz ultrasound was slower than 3 MHz, and the deeper tissue cooled at a slower rate than superficial tissue following 1-MHz ultrasound. The data illustrated that the stretching window was open longer for deep-seated structures than for superficial ones.

Relative and absolute reliability of the KT-2000 arthrometer for uninjured knees. Testing at 67, 89, 134, and 178 N and manual maximum forces.

We assessed the reliability of the KT-2000 knee arthrometer at 67, 89, 134, and 178 N and at manual maximum forces on 30 college students who were free from present or previous knee injuries. Two examiners tested all subjects on two occasions. Anterior laxity (P < 0.0001) and side-to-side difference (P < 0.05) significantly increased as force increased. There was a significant difference (P < 0.0001) between testers for anterior laxity but not for side-to-side difference. We used intraclass correlation coefficients to estimate relative reliability. Anterior laxity intraclass correlation coefficients (2,1) between testers ranged from 0.81 to 0.86 and within tester correlations ranged from 0.92 to 0.95. Intraclass correlation coefficients for between testers for side-to-side differences ranged from 0.38 to 0.58 and within tester correlations ranged from 0.53 to 0.64. Subject-to-subject variability needs to be taken into account when interpreting intraclass correlation coefficient values. Our absolute reliability estimates (95% confidence intervals) were small, indicating little variability. Our data demonstrate the KT-2000 arthrometer to be reliable. Researchers should present both relative and absolute reliability estimates, although we believe absolute estimates are of greater clinical value. Side-to-side differences are better discriminators than individual absolute values. We recommend that a < 3 mm side-to-side difference be used to indicate stable knees.

Examiner proficiency in performing the anterior drawer and Lachman tests.

The anterior drawer and Lachman tests are frequently used for determining anterior cruciate ligament (ACL) instability. The Lachman test is considered to be the most accurate, yet it is difficult to perform on a large person, especially by an examiner with small hands. One procedure, the alternate Lachman test, has been used with some success by examiners who have difficulty performing the Lachman test. The purpose of this study was to compare these three manual tests with respect to predicting ACL stability. These findings were compared with those of the KT-1000 knee arthrometer. Seventy-four subjects (mean age = 22 years) volunteered for the study. Girth measurements were recorded for each subject at 8 cm above and below the midpoint of the patella. An examiner with small hands (21-cm span) performed each of the three tests on both knees of the subjects and then recorded which knee he believed was the most lax of the two with respect to each test. Another examiner then tested each subject's knees with the KT-1000. A log-linear model with terms for manual test type, category, and thigh girth was used for statistical analysis. The alternate Lachman test significantly outperformed the other two tests. Subjects with > 2.5 mm bilateral laxity difference were correctly evaluated 100% of the time using the alternate Lachman test. In subjects with large thigh girth (> 43 cm), 1) the alternate Lachman test was correct 78% of the time; 2) the anterior drawer test was correct 59% of the time; and 3) the Lachman test produced only 28% correct examinations. Based upon these results, the alternate Lachman test should be included in the regimen of manual ACL tests, especially for athletes with large thigh circumference or when performed by examiners with small hands.