Effect of a Combined Stretching and Strength Training Program on Gait Function in Children with Cerebral Palsy, GMFCS Level I & II: A Randomized Controlled Trial.

Background and objectives: Ambulant children with cerebral palsy (CP) often develop impaired gait, and reduced active knee extension is often a part of the problem. This study aimed to evaluate the effect of a combined intervention program including stretching and progressive resistance exercise (PRE) targeting active knee extension on gait function, in children with spastic CP. Materials and methods: Thirty-seven children (21 boys, 16 girls, mean age 10.2 (±2.3) years), classified by Gross Motor Function Classification System I-III, were randomized to an intervention (n = 17) and a comparison group (n = 20). The intervention group received a 16-week combined exercise program (3 sessions per week) including stretching of hamstrings and PRE targeting the lower extremities, followed by a 16-week maintenance program (1 session per week). The comparison group received care as usual. Gait function was evaluated by three-dimensional gait analysis (3DGA); knee, hip and pelvic kinematics in the sagittal plane, step length and speed, Gait Deviation Index (GDI), and Six-Minute Walk test (6MWT) at 0, 16, and 32 weeks. Results: There were no statistically significant differences between the intervention group and the comparison group for any of the gait parameters measured at 16 and 32 weeks. There was a significant increase in gait distance measured by 6MWT within both groups; however, no differences between the groups were found. Conclusion: A 16-week combined stretching and PRE program followed by a 16-week maintenance program did not improve gait function in ambulant children with CP.

Randomized Trial of Modified Stretching Exercise Program for Menstrual Low Back Pain.

This study aimed to examine the effectiveness of a modified stretching exercise program on young women with menstrual low back pain. Overall, 127 young women were randomly assigned to the experimental ( n = 63) and control ( n = 64) groups. The experimental group followed the modified stretching exercise program, whereas the control group performed their usual activities. At 1, 4, 8, and 12 months, the experimental group had significantly lower scores on the visual analog scale for pain (95% confidence interval [CI] = [0.73, 1.96]; p < .05) and the Oswestry Low Back Pain Disability Questionnaire than the control group (95% CI = [0.68, 2.03]; p < .001). At 12 months, the experimental group showed significantly higher exercise self-efficacy than the control group (95% CI = [-6.87, 0.62]; p = .003). These findings can be used to enhance self-care capabilities by using the modified stretching exercise program for young women with menstrual low back pain.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs.

OBJECTIVE: To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. METHODS: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+ or D-) was based on statistical significance ( p < 0.5) and clinical importance (⩾15% improvement). RESULTS: The 26 high-quality studies identified demonstrated that various strengthening exercise programs with/without other types of therapeutic exercises are generally effective for improving knee osteoarthritis management within a six-month period. Strengthening exercise programs demonstrated a significant improvement for pain relief (four Grade A, ten Grade B, two Grade C+), physical function (four Grade A, eight Grade B) and quality of life (three Grade B). Strengthening in combination with other types of exercises (coordination, balance, functional) showed a significant improvement in pain relief (three Grade A, 11 Grade B, eight Grade C+), physical function (two Grade A, four Grade B, three Grade C+) and quality of life (one Grade A, one Grade C+). CONCLUSION: There are a variety of choices for strengthening exercise programs with positive recommendations for healthcare professionals and knee osteoarthritis patients. There is a need to develop combined behavioral and muscle-strengthening strategies to improve long-term maintenance of regular strengthening exercise programs.

Exploratory factor analysis for differentiating sensory and mechanical variables related to muscle-tendon unit elongation.

BACKGROUND: Stretching exercises are able to promote adaptations in the muscle-tendon unit (MTU), which can be tested through physiological and biomechanical variables. Identifying the key variables in MTU adaptations is crucial to improvements in training. OBJECTIVE: To perform an exploratory factor analysis (EFA) involving the variables often used to evaluate the response of the MTU to stretching exercises. METHOD: Maximum joint range of motion (ROMMAX), ROM at first sensation of stretching (FSTROM), peak torque (torqueMAX), passive stiffness, normalized stiffness, passive energy, and normalized energy were investigated in 36 participants during passive knee extension on an isokinetic dynamometer. Stiffness and energy values were normalized by the muscle cross-sectional area and their passive mode assured by monitoring the EMG activity. RESULTS: EFA revealed two major factors that explained 89.68% of the total variance: 53.13% was explained by the variables torqueMAX, passive stiffness, normalized stiffness, passive energy, and normalized energy, whereas the remaining 36.55% was explained by the variables ROMMAX and FSTROM. CONCLUSION: This result supports the literature wherein two main hypotheses (mechanical and sensory theories) have been suggested to describe the adaptations of the MTU to stretching exercises. Contrary to some studies, in the present investigation torqueMAX was significantly correlated with the variables of the mechanical theory rather than those of the sensory theory. Therefore, a new approach was proposed to explain the behavior of the torqueMAX during stretching exercises.

Plyometric type neuromuscular exercise is a treatment to postural control deficits of volleyball players: a case study / Exercícios neuromusculares do tipo pliométrico como tratamento de déficits no controle postural de jogadores de voleibol: um estudo de caso / Ejercicios neuromusculares de tipo pliométrico como tratamiento de déficits de control postural de jugadores de voleibol: a propósito de un caso

Objective. The effects of exercise protocols on postural control changes have been supported, but the influence of a common and specific type neuromuscular exercise such as plyometric on postural control is not clear. Therefore, the aim of this study was to examine the effects of plyometric type neuromuscular exercise on balance or postural control performance of young male volleyball players. Method. Ten professional young male volleyball players participated in this study and performed plyomeric exercises including 4 × 10 squat jump, broad jump, tuck jump with knee to chest, and depth jump from 45-cm box high 60 and 90 s rest between sets and exercises, respectively. Before and immediately after completing the plyometric exercise, postural control was assessed by the Star Excursion Balance Test (SEBT) at 8 directions (anterior, A; anteromedial, AM; anterolateral, AL; medial, M; lateral, L; posterior, P; posteromedial, PM; and posterolateral, PL). Results. The results indicated that plyometric exercise induced deficits in reach directions and greater changes occurred in the M, P and AL directions. Conclusions. It can be recommend that strength and conditioning professionals in the field of volleyball do not perform other type of landing exercise in plyometric training sessions because of postural control impaired and consequently the probability of lower extremity injuries will increase (AU)

Objetivo. O efeito de protocolos de exercícios sobre as mudanças no controle postural ébem conhecido, mas a influência de um tipo de treinamento neuromuscular comum e específico como o pliométrico no controle postural não está claro. O objetivo deste estudo foi examinar os efeitos dos exercícios neuromusculares do tipo pliométrico no equilíbrio e controle postural de jovens jogadores de voleibol masculino. Métodos. Dez jovens, jogadores profissionais de voleibol, participaram desse estudo e realizaram exercícios pliométricos que incluíram: 4 × 10 saltos partindo da posição de agachamento, saltos longitudinais, saltos com joelho encostando no peito e salto com rebote sob uma caixa de 40 cm de altura, com descanso entre 60-90 segundos entre as séries e exercícios, respectivamente. Antes e imediatamente após completarem o exercício de pliometria, o controle postural foi medido com as 8 direções do Star Excursion Test (SEBT) (anterior: A; antero-medial; AM; antero-lateral: AL; medial: M; lateral: L; posterior: P; póstero-medial: PM e postero-lateral: PL). Resultados. Os resultados indicam que os exercícios pliométricos induziram déficits no alcance das direções do SEBT e as maiores mudanças ocorrem nas direções M, P e AL. Conclusão. Pode ser recomendado que os profissionais que trabalham com força e condicionamento físico voltado ao voleibol não realizem outro tipo de exercício com carga nas sessões de pliometria, por causa da debilidade no controle postural que o treinamento pliométrico ocasiona e consequentemente na probabilidade de aumentar o risco de lesões nos membros inferiores (AU)

Objetivo. El efecto de protocolos de ejercicios, en cambios del control postural, son bien conocidos, pero la influencia de un sencillo y específico tipo de ejercicio neuromuscular, como los ejercicios pliométricos, en el control postural, no está clara. Por tanto, el objetivo de este estudio fue examinar los efectos de los ejercicios neuromusculares, de tipo pliométrico, en el equilibrio o en el control postural, de varones jóvenes jugadores de voleibol. Método. Diez varones jóvenes jugadores profesionales de voleibol participaron en este estudio y realizaron ejercicios pliométricos incluyendo 4 × 10 saltos con sentadilla, saltos de longitud, saltos con rodillas al pecho y saltos con rebote desde un cajón de 45 cm de altura, con 60 y 90 s de reposo entre series y ejercicios, respectivamente. Antes e inmediatamente después de completar los ejercicios pliométricos se midió el control postural mediante el Star Excursion Balance Test (SEBT) en 8 direcciones (anterior: A; anteromedial: AM; anterolateral: AL; medial: M; lateral: L; posterior: P; posteromedial: PM y posterolateral: PL). Resultados. Los resultados indican que los ejercicios pliométricos indujeron déficits en las direcciones analizadas y que los mayores cambios se produjeron en las direcciones M, P y AL. Conclusión. Se puede recomendar, a los profesionales del voleibol, en el campo del entrenamiento de la fuerza, que no realicen otros tipos de ejercicios de suelo en las sesiones de entrenamiento pliométrico, porque la disminución del control postural podría incrementar secundariamente la probabilidad de lesión del miembro inferior (AU)

Exploratory factor analysis for differentiating sensory and mechanical variables related to muscle-tendon unit elongation

ABSTRACT Background Stretching exercises are able to promote adaptations in the muscle-tendon unit (MTU), which can be tested through physiological and biomechanical variables. Identifying the key variables in MTU adaptations is crucial to improvements in training. Objective To perform an exploratory factor analysis (EFA) involving the variables often used to evaluate the response of the MTU to stretching exercises. Method Maximum joint range of motion (ROMMAX), ROM at first sensation of stretching (FSTROM), peak torque (torqueMAX), passive stiffness, normalized stiffness, passive energy, and normalized energy were investigated in 36 participants during passive knee extension on an isokinetic dynamometer. Stiffness and energy values were normalized by the muscle cross-sectional area and their passive mode assured by monitoring the EMG activity. Results EFA revealed two major factors that explained 89.68% of the total variance: 53.13% was explained by the variables torqueMAX, passive stiffness, normalized stiffness, passive energy, and normalized energy, whereas the remaining 36.55% was explained by the variables ROMMAX and FSTROM. Conclusion This result supports the literature wherein two main hypotheses (mechanical and sensory theories) have been suggested to describe the adaptations of the MTU to stretching exercises. Contrary to some studies, in the present investigation torqueMAX was significantly correlated with the variables of the mechanical theory rather than those of the sensory theory. Therefore, a new approach was proposed to explain the behavior of the torqueMAX during stretching exercises.

Perfil autonómico cardíaco y respuesta cardiopulmonar después de una prueba de esfuerzo máximo con estiramiento antes del ejercicio / Cardiac autonomic profile and cardiopulmonary response after maximal treadmill exercise testing with pre-exercise stretching

Objectives. This study investigated the cardiac autonomic profile and cardiopulmonary responses at rest and after maximal treadmill exercise testing with or without pre-exercise stretching. Methods. Eight men (age = 24.6 ±mm 5.5 years; height = 179 ±mm 4.1 cm; mass = 78.1 ±mm 3.4 kg; body mass index = 24 ±mm 2.5 kg/m–²; body fat = 18.9 #mm 4.3%) completed a maximal treadmill exercise test under two randomly ordered conditions: pre-exercise stretching (PES) and no stretching (CONTROL). Electrocardiogram (ECG) and respired gas analysis were continuously recorded at rest, during, and for 5 min following exercise testing. The stretching exercises for the PES condition consisted of six passive stretches comprising upper and lower body muscle groups performed three times each for 30 sec with 10 sec passive rest between repetitions. Results. The results indicated that the rMSSD was significantly (p < 0.01) faster for the CONTROL versus the PES condition during the 5 min following exercise testing. Additionally, significantly lower low-frequency power (PES = 3.20 ±mm 1.14 ms2; CONTROL= 24.65 ±mm 7.57 ms2; p < 0.001) and total power (PES = 23.57 ±mm 7.41 ms2; CONTROL = 195.90 ±mm 46.37 ms2; p < 0.001) responses were visually detected for the PES versus CONTROL condition following exercise testing. Anaerobic threshold was decrease in PES when compared to CONTROL conditions. Conclusion. These data indicate that PES promotes dysfunction in the tonic cardiac autonomic regulation as evidenced by delayed parasympathetic reactivation, during the initial 5 minutes of recovery following maximal exercise testing(AU)

Objetivos. Este trabajo investiga el perfil autonómico cardiaco y las respuestas cardiopulmonares en reposo y después de las pruebas de esfuerzo máximo con o sin estiramiento antes del ejercicio. Métodos. Ocho varones (edad = 24,6 ±mm 5,5 años; talla = 179 ±mm 4,1 cm; peso = 78,1 ±mm 3,4 kg; índice de masa corporal = 24 ±mm 2,5 kg/m²; grasa corporal = 18,9 ±mm 4,3%) completaron una prueba de esfuerzo máximo en cinta bajo dos condiciones: estiramiento antes del esfuerzo (EAE) y ningún estiramiento (CONTROL). ECG y análisis de gas inspirado se registraron continuamente en reposo, durante y 5 minutos después de la prueba de esfuerzo. Los ejercicios de estiramiento constaban de seis estiramientos pasivos que comprenden los grupos de músculos superiores e inferiores del cuerpo. Resultados. rMSSD fue significativamente (p < 0,01) más rápida para la condición CONTROL frente a la condición EAE durante los 5 minutos después de las pruebas de esfuerzo. Respuestas de energía de baja frecuencia (EAE = 3,20 ±mm 1,14 ms2; CONTROL = 24,65 ±mm 7,57 ms2; p < 0,001) y de energía total (EAE = 23,57 ±mm 7,41 ms2; CONTROL = 195,90 ±mm 46,37 ms2; p < 0,001) fueron significativamente más bajas en la condición EAE después de las pruebas de esfuerzo. El umbral anaeróbico se disminuyó en la condición EAE frente a la condición CONTROL. Conclusión. El presente estudio sugieren que el EAE promueve la disfunción en la regulación tónica autonómica cardiaca durante los primeros 5 minutos de recuperación después de las pruebas de esfuerzo máximo(AU)

An examination of preactivity and postactivity stretching practices of crosscountry and track and field distance coaches.

This study sought to determine the effectiveness of coach certification courses in promoting proper preactivity and postactivity stretching practices in National Collegiate Athletic Association (NCAA) Division I, II, and III crosscountry programs. Distribution of questionnaires to 770 NCAA Division I, Division II, and Division III programs in the U.S.A. resulted in 111 coaches (88 [78.2%] men and 25 [21.8%] women) participating. Chi-square analyses revealed that noncertified coaches reported significantly greater (χ² = 21.582, p = 0.0174) usage of static stretching alone as their preactivity modality (18.9%, n = 9) vs. their certified counterparts (1.8%, n = 1). In addition, certified coaches reported a higher usage of dynamic flexibility only during the preactivity period (47.4%, n = 27) vs. their noncertified peers (32.4%, n = 16). Coaches were also asked if they allowed for static stretching between interval work and events in track and field, and a significantly higher percentage (χ² = 11.948, p = 0.0177) of noncertified coaches (45.5%, n = 23) reported allowing the athletes to perform static stretches between intervals at practice than certified peers (37.9%, n = 22). These significant differences help demonstrate that coaching certification courses are an effective tool for communicating current information about stretching practices. However, the results also revealed that there are still many certified coaches who are not implementing best practices in preactivity routines.

Tempo e o percentual de alongamento estático influenciam a resposta mecânica do tendão? / How does static stretching influence the tendons mechanical response?

OBJETIVO: Analisar in vitro, a resposta mecânica de tendões calcâneo bovino, submetidos ao alongamento estático e avaliar a influência do alongamento no evento lesivo.MÉTODOS: Seis grupos de espécimes de tendões calcâneos bovinos (n=10) foram submetidos a alongamento estático: três intervalos (15, 30, 45 segundos) e percentuais de alongamento inicial (2,5 e 3,5%). O grupo controle (n=10) não realizou alongamento prévio. Ao termino do ensaio de alongamento, os espécimes foram submetidos ao ensaio de ruptura.RESULTADOS: Os valores de relaxamento de força apresentaram estabilização a partir do trigésimo segundo (p<0.0001) nos dois níveis de deformação estudados. Foi observado maior relaxamento de força (p<0.0026) e menor tensão de ruptura (p = 0.0123) para o grupo submetido a maior taxa de alongamento percentual (3,5%). Não houve diferença nos parâmetros de ruptura entre os grupos alongamento e controle. As variáveis tempo e percentual de alongamento não apresentaram interação.CONCLUSÃO: Considerando-se o relaxamento de estresse, o intervalo de 30 segundos parece ser o mais efetivo no alongamento de tendões, fato a ser considerado no estabelecimento de novos protocolos clínicos de alongamento. Trabalho experimental.

OBJECTIVE: Analyze in vitro the mechanical response of bovine calcaneus tendons subjected to static stretching in three different intervals (15, 30, 45 s).METHODS: Six groups of bovine calcaneus tendons (n=10) were formed according to the static stretching protocol: three different intervals (15, 30, 45 s) and initial stretching percentage (2.5% and 3.5%). The control group (n=10) did not perform prior stretching. At the end of the stretching tests, the specimens were subjected to stress rupture tests.RESULTS: The values for force relaxation presented stability after the 30th second (p<0.0001) at both levels of deformation. Greater force relaxation (p<0.0026) and the least tensile strength (p=0.0123) was observed in the group that was subjected to the highest stretch percentage (3.5%). No difference was observed between the rupture parameters of the stretch and control groups. The variables, stretch duration and percentage did not demonstrate interaction.CONCLUSION: In relation to force relaxation, the 30 second interval seems to be the most effective when stretching tendons. This fact should be considered when establishing new clinical stretching protocols. Laboratory investigation.

Efecto agudo del estiramiento activo sobre la fuerza y potencia de la flexión y extensión de rodilla / Acute effect of active stretching on knee flexion and extension strength and power output

Objetivo. Analizar el efecto agudo de un protocolo de estiramientos estáticos activos de corta duración sobre la potencia y máxima fuerza isocinética concéntrica y excéntrica de la flexión y extensión de rodilla en deportistas recreativos. Método. Un total de 27 hombres y 25 mujeres completaron tres sesiones de evaluación, una inicial de familiarización y dos experimentales (control y estiramientos en orden aleatorio), con un intervalo de 72-96 horas entre sesiones consecutivas. El protocolo de estiramientos estáticos activos consistió en cinco ejercicios unilaterales diseñados para estirar los principales grupos musculares de la extremidad inferior. Cada ejercicio de estiramiento fue realizado dos veces, manteniendo la posición de estiramiento durante 30 s (2 x 30 s), con un periodo de descanso entre serie, pierna contralateral y/o ejercicio de 20 s. En la sesión de control no se realizó el programa de estiramientos. Inmediatamente después de ambos tratamientos (control y estiramientos), se valoraron los índices isocinéticos pico de fuerza máximo (PFM) y potencia media (PM) durante los movimientos de flexión y extensión de rodilla concéntrica y excéntrica. Resultados. El análisis ANOVA llevado a cabo reveló la no existencia de un efecto de interacción significativo entre las sesiones de evaluación (control y estiramiento) para las variables PFM y PM (concéntrica y excéntrica) de la flexión y extensión de rodilla. Conclusiones. Un protocolo de estiramientos estáticos activos de corta duración (2 x 30 s por grupo muscular) del miembro inferior no causó una alteración negativa en la potencia y máxima fuerza isocinética concéntrica y excéntrica de la flexión y extensión de rodilla(AU)

Aim. To analyze the acute effect of a short duration active-static stretching protocol on maximal isokinetic strength and power output during concentric and eccentric flexion and extension knee movements in recreational athletes. Method. A total of 27 males and 25 females completed three measurement sessions, an initial session of familiarization and two experimental session (control and active stretching in randomized order) with 72-96 hours interval among consecutive sessions. The active stretching protocol consisted in 5 different unilateral exercises designed to stretch the major lower limb muscle groups. Each stretching exercise was performed twice, holding the position during 30s (2 x 30s), with a rest-interval among series, contra-lateral leg and /or exercises of 20s. In the control session no stretching exercises were performed. Immediately after performed both treatments (control and stretching), the isokinetic indexes of peak torque (PT) and average power (AP) were tested during concentric and eccentric flexion and extension knee movements. Results. The ANOVA analysis carried out revealed no significant interaction effect between testing sessions (control and stretching) for knee flexion and knee extension peak torque and mean power in both concentric and eccentric muscle contractions. Conclusions. Short (2 x 30s per muscle group) pre-exercise active-static lower-limb stretching routine did not elicit stretching-induce reductions in knee flexor and knee extensor isokinetic concentric and eccentric strength(AU)

Comparación entre biodanza en medio acuático y stretching en la mejora de la calidad de vida y dolor en los pacientes con fibromialgia / Comparison between aquatic-biodanza and stretching for improving quality of life and pain in pations with fibromyalgia

Objetivo: Comparar qué grado de mejoría pueden alcanzar los pacientes con fibromialgia en las variables dolor, impacto de la fibromialgia y depresión, mediante la biodanza acuática frente al stretching. Diseño: Ensayo clínico aleatorio en ámbito comunitario, con 2 grupos de intervención. Emplazamiento: Cinco centros de salud (Almería). Pacientes: Contactamos con 82 pacientes entre 18 y 65 años con fibromialgia según los criterios de American College of Rheumatology. Doce declinaron participar. La muestra restante fue distribuida aleatoriamente en 2 grupos de 35 pacientes (biodanza acuática y stretching). Excluimos a quienes no participaron en al menos 14 sesiones o efectuaron cambios en su tratamiento farmacológico durante el estudio, constituyéndose una muestra final de 19 mujeres en biodanza acuática y 20 en stretching. Son limitaciones del diseño la evaluación no cegada de los resultados y el reducido tamaño muestral agravado por los abandonos. Mediciones principales: Recogimos datos sociodemográficos y medimos impacto (Cuestionario de Impacto de Fibromialgia), dolor (cuestionario McGill-Melzack y Escala Visual Analógica), algometría por presión (algómetro Wagner FPI10) y depresión (Inventario de Beck), realizadas antes, y tras 12 semanas de terapia. Resultados: La edad media de la población fue 55,41 años. El período medio desde el diagnóstico fue de 13,44 años. Toda la muestra estuvo formada por mujeres, en su mayor parte amas de casa. Se obtuvieron diferencias significativas entre ambos grupos en dolor (p < 0,01), en impacto de fibromialgia (p < 0,01) y depresión (p < 0,04) tras el tratamiento. Conclusiones: El tratamiento mediante biodanza acuática produjo una disminución del dolor y un aumento en la calidad de vida de los pacientes con fibromialgia(AU)

Objective: To determine the level of improvement, as regards pain, impact on fibromyalgia and depression, achieved by patients with fibromyalgia by comparing aquatic biodanza and stretching exercises. Design: Randomised controlled trial with two intervention groups. Location: Five health centres (Almeria). Patients: A total of 82 fibromyalgia patients between 18 and 65 years old, diagnosed by American College of Rheumatology criteria, were included, with 12 patients declining to take part in the study. The 70 remaining patients were randomly assigned to two groups of 35 patients each: aquatic biodanza and stretching exercises. Those who did not attend in at least 14 sessions or changed their treatment during the studio were excluded. The final sample consisted of 19 patients in aquatic biodanza group and 20 in stretching group. The limitations of the study included, the open evaluation design and a sample size reduced by defaults. Main measures: The outcome measures were sociodemographic data, quality of life (Fibromyalgia Impact Questionnaire), pain (McGill-Melzack questionnaire; and Visual Analogue Scale), pressure algometry (Wagner FPI10 algometer) and depression (Beck Inventory). These were carried out before and after a 12-week therapy .Results: The mean age of the sample was 55.41 years. The mean period from diagnosis was 13.44 years. The sample consisted mainly of housewives. There were significant differences (P<0.05) between groups, in pain (P<0.01), fibromyalgia impact (P<0.01), and depression (P<0.04) after the treatment. Conclusions: The biodanza aquatic exercises improve pain and quality of life in fibromyalgia patients(AU)

El entrenamiento de la flexibilidad: técnicas de estiramiento / Flexibility training: tretching techniques

La realización sistematizada de rutinas de estiramiento es una práctica muy común en el ámbito clínico y físico-deportivo con el propósito principal de mantener o mejorar la amplitud de movimiento de una articulación o conjunto de articulaciones. Además, los estiramientos parecen ser un medio muy indicado para el cuidado, la prevención y el mantenimiento de las capacidades físicas de cada individuo o para su desarrollo. No todos los estiramientos se realizan de la misma manera o persiguen el mismo objetivo. En función del contexto (clínica, calentamiento, vuelta a la calma, sesiones específicas), la aplicación de unas u otras técnicas será más apropiada para conseguir los objetivos propuestos. Así, es de vital importancia que médicos, entrenadores, preparadores físicos y demás miembros del ámbito de la actividad físico-deportiva conozcan las características, ventajas e inconvenientes de cada una de las diferentes técnicas de estiramiento existentes en la literatura científica. Sin embargo, los términos empleados en la literatura científica para describir las diversas maniobras o técnicas de estiramiento son, a menudo, confusos debido principalmente a que clínicos e investigadores suelen emplear diferentes vocablos para describir el mismo fenómeno. Por lo tanto, los objetivos principales de este trabajo fueron: a) describir las técnicas de estiramiento más empleadas en la literatura científica, y b) analizar la literatura científica existente en lo relativo a qué técnicas de estiramiento son más eficaces para la mejora de la flexibilidad(AU)

The systematic performance of stretching routines is very common in clinic and sport setting with the main purpose of maintain or improve the range of movement in a joint or group of joints. In addition, stretching seems to be an indicate way for the care, prevention and maintenance of the abilities of each individual or for their development. Not all stretches are performed in the same way or seek the same objective. Depending on the context (rehabilitation, warm-up, cool down, specific sessions), the application of one of those techniques will be more appropriate to achieve the objectives. Thus, it is vital that clinicians, coaches, physical trainers and other members of the physical activity and sport setting know the characteristics, advantages and disadvantages of each stretching technique existing in the literature. However, the terms used in the scientific literature to describe the different stretching techniques are confuses due mainly that clinicians and researches used different concepts for describing the same phenom. Therefore, the main purposes of this manuscript were: a) to describe the more common stretching techniques present in the scientific literature; and b) to analyze the current scientific literature regarding to what stretching techniques are more effectives for improving flexibility(AU)

Efectividad de la aplicación de ultrasonido terapéutico y ejercicio de estiramiento a músculos isquiotibiales en niños con parálisis cerebral tipo diparesia espástica leve / Effectivity of the application of therapeutic ultrasound and muscle stretching exercise of the hamstring muscle in child with mild spastic diparesis cerebral palsy+5

Objetivo. Conocer si la aplicación de ultrasonido terapéutico seguido de ejercicios de estiramiento muscular es eficaz para el tratamiento de las contracturas de los músculos isquiotibiales. Diseño. Estudio cuasiexperimental, tipo antes y después, sin grupo control, donde se estudiaron 11 pacientes (22 rodillas) con parálisis cerebral infantil tipo diparesia espástica leve, con duración de 6 meses; se aplicó ultrasonido terapéutico de baja intensidad seguido de una serie de 3 estiramientos por sesión, divididas en dos bloques de 10 sesiones cada una con un periodo mínimo de descanso entre estos de 15 días. Las mediciones se realizaron al inicio y al final de cada bloque de tratamiento, consistieron en: mediciones goniométricas del ángulo poplíteo, elevación recta de la pierna, extensión, flexión y arco total de movimiento de la rodilla, tomadas por el médico especialista en rehabilitación que es ajeno al estudio. Se utilizó la prueba t de Student, del paquete estadístico SPSS 17.0, tomando un valor de p ≤0,05 como estadísticamente significativo. Resultados. Se observó una disminución en la medición del ángulo poplíteo (media basal de 47,77°; media final 23,55°; p=0,001), aumento en la elevación recta de la pierna (media basal de 49,67°; media final de 67,42°; p=0,001), aumento en el arco de movimiento de la extensión (media basal −7,05°; media final −1,95°; p=0,003) después del tratamiento. Conclusiones. El ultrasonido terapéutico seguido de ejercicios de estiramiento, es un tratamiento eficaz para las contracturas musculares de isquiotibiales (AU)

Objective. To know if the application of therapeutic ultrasound followed by muscle stretching exercises is effective in the treatment of hamstring muscle contractures. Design. An interventional, quasi-experimental, before and after design, without control group trial in which 11 patients (22 knees) with spastic diparesis infantile cerebral palsy were studied during 6 months. Low density therapeutic ultrasound was applied following by a 3 stretch series per session, divided into 2 blocks of 10 sessions each one, with at least one period of rest of 15 days between them. The clinical measurements were obtained at the onset and completion of treatment block. These consisted in: measurement of the popliteal angle, straight leg raising test, extension, flexion and total knee joint range of motion, measured by the physical medicine and rehabilitation doctor. We used the Student's T test from the SPSS statistics program version 17.0 defining a p value ≤0.05 as significant. Results. We observed a reduction in the measurement of the popliteal angle (baseline mean 47.77°; final mean 23.55°; p=0.001), an increase in the straight leg raising test (baseline mean 49.67°; final mean 67.42°; p=0.001), an increase in the extension range of motion (baseline mean −7.05°; final mean −1.95°; p=0.003), after the treatment. Conclusions. The application of therapeutic ultrasound followed by muscle stretching exercise is an effective treatment for the hamstring muscle contractures(AU)

Interpreting normalized and nonnormalized data after acute static stretching in athletes and nonathletes.

The purpose of this study was to determine the effect of acute static stretching on torque and electromyography (EMG) in female athletes (ATHs) and nonathletes (NONATHs) using both normalized (NORM) and nonnormalized (NONNORM) data. Fifteen ATHs recruited from women's National Collegiate Athletic Association Division II varsity basketball and volleyball teams were paired to 14 NONATHs. Electromyography (microV) was detected over the rectus femoris during isokinetic leg extensions at 60 and 300 degrees .s before (PRE) and after (POST) static stretching. There was a significant main effect for torque (mean +/- SD PRE = 81.9 +/- 22.7 Nxm; POST = 77.0 +/- 21.9 Nxm) and EMG amplitude (PRE = 767.6 +/- 288.6 microV; POST = 664.2 +/- 219.3 microV) for PRE compared to POST. For the NORM data, there was a significant decrease in torque for the NONATHs (mean +/- SD PRE = 73 +/- 12 Nxm; POST = 67 +/- 12 Nxm) but no significant difference for the ATHs (mean +/- SD PRE = 65 +/- 11 Nxm; POST = 66 +/- 8 Nxm). The NONNORM data indicated that both the ATHs and NONATHs displayed a stretching-induced decrease in torque that may be manifested in a decreased ability to activate the muscle. The NORM data revealed the NONATHs but not the ATHs were hindered in their ability to produce torque as a result of the stretching. Coaches and ATHs may want to carefully consider whether to include stretching in their precompetition routine. When reading the literature, the practitioner should consider the manner in which the data were calculated and analyzed (NORM or NONNORM) because it may affect the conclusions of the study.

Chronic flexibility improvement after 12 week of stretching program utilizing the ACSM recommendations: hamstring flexibility.

The ACSM flexibility training recommendations emphasize proper stretching of muscles supporting the major joints, but there is a little evidence to support this recommendation in terms of effectiveness, and which stretching parameters (technique and single stretch duration) are more adequate. A randomized controlled clinical trial design was use to investigate whether the ACSM flexibility training recommendation parameters improve hip flexion range of motion. A total of 173 subjects, 122 men (21.3+/-2.5 years; 176.33+/-8.35 cm; 74.42+/-10.80 kg) and 51 women (20.7+/-1.6 years; 163.43+/-6.57 cm; 60.12+/-7.88 kg), classified as recreationally active young adult university students were randomly assigned to 1 of 7 groups: 1 control group (no stretching) or 1 of 6 stretching groups. All stretching groups performed 12 weeks of flexibility training with a consistent stretch daily dose (180 s) and frequency (3 days per week) parameters and different stretch technique (passive or active) and single stretch duration (15, 30, or 45 s). Hip flexion passive range of motion (PROM) was determined through the bilateral straight-leg raise test before, during (at 4 and 8 weeks), and after the program (12 weeks). All stretching groups performed hip flexion PROM after flexibility training. A significant improvement was identified in mean PROM for each stretching group, but no significant differences were found between stretch technique and single stretch duration (p>0.05). The control group's mean PROM decreased (Delta PROM: -0.08 degrees, 95% confidence interval [CI]=-2.3 to 5.3), whereas all stretching groups increased PROM (Delta PROM: 15.14 degrees, 95% CI=10.19 to 23.56) in hip flexion after 12 weeks of stretching (p<0.05). The present study suggests that the current ACSM flexibility training recommendations are effective for improving hip flexion ROM in recreationally active young adults.

Efeitos do alongamento por inibição ativa no movimento de flexão do quadril em bailarinas / Effects of active inhibition stretching in hip flexion of ballerinas

Introdução: O alongamento é indispensável para as bailarinas, tanto para um melhor desempenho quanto como uma forma de prevenção às lesões. Objetivo: Avaliar a amplitude de movimento (ADM) de flexão do quadril direito de bailarinas clássicas submetidas a um protocolo de alongamento por método de inibição ativa. Métodos: A amostra do estudo foi formada por 20 bailarinas clássicas profissionais, sendo essa amostra dividida em dois grupos ? Grupo A, como grupo controle, e Grupo B, como grupo que recebeu o protocolo de alongamento por inibição ativa para isquiotibiais e tríceps da perna. A goniometria da flexão da articulação do quadril foi realizada antes e depois da aplicação do protocolo de alongamento, em ambos os grupos. As variáveis encontradas no estudo foram comparadas através do teste t de Student, com p ? 0,05. Resultados: Ambos os grupos tiveram aumento na ADM da flexão do quadril, sendo que o Grupo B teve um maior aumento estatisticamente significativo, concluindo assim que o alongamento por inibição ativa aplicado apresentou mais eficácia quanto ao aumento da ADM, quando comparado ao grupo controle. Conclusões: O protocolo de alongamento proposto pode ser indicado para favorecer um melhor desempenho das bailarinas clássicas profissionais em flexão do quadril, além de prevenir lesões.

Introduction: Stretching is crucial for ballerinas, both for a better performance and for preventing lesions. Objective: To evaluate the range of flexion of classic ballerinas submitted to a stretching protocol by an active inhibition method. Methods: The sample of the study was formed by 20 professional classic ballerinas, divided into two groups ? Group A, as the control group, and Group B, as the experimental group submitted to the active inhibition stretching protocol for leg hamstrings and triceps. The goniometry of the hip articulation flexion was performed before and after the application of the stretching protocol, in both groups. The variables found in the study were compared through the Student t test, with p ? 0.05. Results: Both groups presented an increase in the range of hip flexion, and Group B had a significantly higher increase, concluding that the active inhibition stretching applied was more effective in relation to the increase of movement range when compared to the control group. Conclusions: The proposed stretching protocol can be indicated to favor a better performance of the professional classic ballerinas in flexion of the hip, as well as for preventing lesions.

Stretching to reduce work-related musculoskeletal disorders: a systematic review.

OBJECTIVE: This article reviewed the literature to clarify the physiological effects and benefits of, and misconceptions about, stretches used to reduce musculoskeletal disorders. METHODS: Nine databases were reviewed to identify studies exploring the effectiveness of stretching to prevent work-related musculoskeletal disorders. Included studies were reviewed and their methodological quality was assessed using the PEDro scale. RESULTS: The physiological effects of stretches may contribute to reducing discomfort and pain. However, if other measures are not in place to remediate their causes, stretches may suppress awareness of risks, resulting in more debilitating injuries. If inadequately performed, stretches may also cause or aggravate injuries. Careful analysis and stretching program design are required before implementing stretches. Seven studies evaluating the effectiveness of stretching to prevent musculoskeletal disorders in different occupations were identified and reviewed. CONCLUSION: The studies provided mixed findings, but demonstrated some beneficial effect of stretching in preventing work-related musculoskeletal disorders. However, due to the relatively low methodological quality of the studies available in the literature, future studies are necessary for a definite response. Future studies should minimize threats to internal and external validity, have control groups, use appropriate follow-up periods, and present a more detailed description of the interventions and worker population.

[Impact of global postural reeducation for treatment of female stress urinary incontinence]. / Impacto da reeducação postural global no tratamento da incontinência urinária de esforço feminina.

OBJECTIVE: To evaluate the effect of global postural reeducation (GPR) on stress urinary incontinence (SUI) and quality of life in SUI female patients METHODS: The study design was a prospective non-randomized clinical trial. Twenty-six patients with symptoms of SUI were selected from the Urogynecology Outpatient Clinics of the State University of Campinas (Unicamp), state of São Paulo, Brazil. Age ranged from 23 to 72 years old (mean 50.8). All women were submitted to anamnesis, physical exam, postural evaluation and urodynamic testing. Patients were treated by the GPR in individual 50 minute sessions weekly for three months and twice a month for the next three months. All patients were re-evaluated at the end of treatment and six months later by means of General Impression of Improvement, Incontinence Impact, General Perception of Health, Functional Evaluation of the Pelvic Floor, Number of Leaking Episodes and Pad Use. RESULTS: At the end of treatment 4 (16%) of the patients were cured, 18 (72%) had improved significantly and 3 (12%) failed. At 6 months, 6 (24%) were cured, 16 (64%) improved and 3 (12%) failed (p<0.001). Quality of Life questionnaires presented significant improvement (p<0.05) in all domains, with emphasis on General Perception of Health, Incontinence Impact and number of leaking episodes. The Functional Evaluation of the Pelvic Floor and Pad Use also presented significant (p<0.001) improvement. CONCLUSION: These results may demonstrate that GPR is an efficient alternative for treatment of stress urinary incontinence.

Impacto da reeducação postural global no tratamento da incontinência urinária de esforço feminina / Impact of global postural reeducation for treatment of female stress urinary incontinence

OBJETIVO: Avaliar os efeitos da reeducação postural global (RPG) nos sintomas de incontinência urinária de esforço (IUE) e a qualidade de vida em um grupo de mulheres incontinentes. MÉTODOS: Ensaio clínico aberto, tipo antes e depois, prospectivo, não randomizado. Foram selecionadas 26 mulheres com queixa clínica e estudo urodinâmico compatível com IUE, do Ambulatório de Uroginecologia do Hospital das Clínicas da UNICAMP. A idade média foi de 50,76 anos (23 a 72 anos). Todas as mulheres foram avaliadas por anamnese, exames clínicos e uroginecológico, avaliação postural. Todas foram submetidas a tratamento com RPG, em sessões individuais de 50 minutos semanais por três meses e quinzenais por mais três meses. As pacientes foram submetidas a posturas de alongamento propostas pela técnica, em que se coloca em tensão as cadeias musculares responsáveis pela postura estática e estrutura do corpo. O trabalho ativo da paciente nas correções, aliado à atuação do fisioterapeuta, levam ao reequilíbrio das tensões musculares e reestruturação do corpo, o que pode favorecer as funções, especificamente as relacionadas ao assoalho pélvico. Ao término do tratamento, e após seis meses, as pacientes foram reavaliadas através do questionário de impressão geral de melhora, dos domínios relacionados à IUE do King's Health Questinnaire: impacto da incontinência, em que se avaliam os prejuízos na qualidade de vida; percepção geral da saúde, qual a classificação que a paciente dá para sua saúde no momento e a presença do sintoma de perda por esforço; avaliação funcional do assoalho pélvico (AFA) e número de trocas de protetores diários. RESULTADOS: No término do tratamento, quatro pacientes (16 por cento) estavam curadas, dezoito (72 por cento) melhoraram significativamente e três (12 por cento) falharam. Após seis meses, seis pacientes (24 por cento) estavam curadas, 16 (64 por cento) melhoraram e três (12 por cento) falharam (p <0,001). Ao avaliarmos a qualidade de vida das pacientes, observamos melhora significativa (p <0,05) em todos os domínios questionados, destacando-se percepção geral da saúde, impacto da incontinência e número de episódios de perda. A avaliação do funcional do assoalho pélvico (AFA) e do teste do absorvente (número de troca/dia) também mostrou melhora significativa (p<0,001) nos diferentes tempos de coleta. CONCLUSÃO: Os resultados mostram que a RPG pode ser uma alternativa para o tratamento da IUE.

OBJECTIVE: To evaluate the effect of global postural reeducation (GPR) on stress urinary incontinence (SUI) and quality of life in SUI female patients METHODS: The study design was a prospective non-randomized clinical trial. Twenty-six patients with symptoms of SUI were selected from the Urogynecology Outpatient Clinics of the State University of Campinas (Unicamp), state of São Paulo, Brazil. Age ranged from 23 to 72 years old (mean 50.8). All women were submitted to anamnesis, physical exam, postural evaluation and urodynamic testing. Patients were treated by the GPR in individual 50 minute sessions weekly for three months and twice a month for the next three months. All patients were re-evaluated at the end of treatment and six months later by means of General Impression of Improvement, Incontinence Impact, General Perception of Health, Functional Evaluation of the Pelvic Floor, Number of Leaking Episodes and Pad Use. RESULTS: At the end of treatment 4 (16 percent) of the patients were cured, 18 (72 percent) had improved significantly and 3 (12 percent) failed. At 6 months, 6 (24 percent) were cured, 16 (64 percent) improved and 3 (12 percent) failed (p<0.001). Quality of Life questionnaires presented significant improvement (p<0.05) in all domains, with emphasis on General Perception of Health, Incontinence Impact and number of leaking episodes. The Functional Evaluation of the Pelvic Floor and Pad Use also presented significant (p<0.001) improvement. CONCLUSION: These results may demonstrate that GPR is an efficient alternative for treatment of stress urinary incontinence.