Do the fasciae of the soleus have a role in plantar fasciitis?

Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.

Stretch-Induced Healing of Injured Muscles Is Associated With Myogenesis and Decreased Fibrosis.

BACKGROUND: Alghouth therapeutic stretching exercise has been applied to accelerate the healing of injured skeletal muscles, mechanisms behind the mechanical stretch-induced muscle recovery remain unclear. PURPOSE: To examine stretch-associated antifibrotic and myogenic responses in injured muscles and to evaluate the feasibility of the ultrasonic Nakagami parametric index (NPI) in assessing muscle morphology during recovery. STUDY DESIGN: Controlled laboratory study. METHODS: Skeletal muscle fibrosis was induced in the right hind legs of 48 rats by making a posterior transverse incision in the gastrocnemius muscle; the left hind legs remained intact as a comparative normal reference. After surgery, the 48 rats were randomly divided into the stretch (S) and control (C) groups. The S group received stretching interventions on the injured hind leg from week 3 to week 7 after surgery, while the C group did not receive stretching throughout the study period. The muscle fibrosis percentage and the ultrasonic NPI were examined sequentially after surgery. Relative expressions of myogenesis-related proteins, including myoblast determination protein 1 (MyoD), myogenin, and embryonic myosin heavy chain (MHCemb), were also evaluated during the follow-up. RESULTS: Mean fibrosis percentages in the injured hind leg were approximately 25% at week 3 in both groups, but they were significantly decreased by approximately 20% from week 4 to the end of the follow-up in the S group only (all, P < .05). Upon injury, the NPI values of injured hind legs in both groups dramatically dropped. Within the S group, stretching increased the NPI values of injured hind legs, which approached those of control hind legs at weeks 6 and 7. The highest MyoD, myogenin, and MHCemb levels were observed at week 6 in both groups. The NPI values corresponded to the MyoD expression in the S group during the follow-up. CONCLUSION: Stretching induced a decrease in muscle fibrosis and an increase in myogenesis in injured muscles. The NPI values correspond to the myogenesis process. CLINICAL RELEVANCE: The NPI may be capable of continuously monitoring the injured skeletal muscle morphology during the healing process in clinical settings.

Performance of Passive Muscle Stiffness in Diagnosis and Assessment of Disease Progression in Duchenne Muscular Dystrophy.

The aim of this study was to evaluate the performance of passive muscle stiffness in diagnosing and assessing disease progression in Duchenne muscular dystrophy (DMD). Boys with DMD and age-matched controls were recruited. Shear wave elastography (SWE) videos were collected by performing dynamic stretching of the gastrocnemius medius (GM). At ankle angles from plantar flexion (PF) 30° to dorsiflexion (DF) 20°, the shear modulus of the GM was measured for each 10° of ankle movement. Shear modulus at each ankle angle was compared between the DMD and control group. Correlation between passive muscle stiffness and motor function grading was also analyzed. A total of 26 patients with DMD and 20 healthy boys were enrolled. At multiple stretch levels, passive muscle stiffness of the GM was significantly higher in patients with DMD than in those in the control group (all p values <0.05). The shear modulus of GM at an ankle angle of DF 10° had the largest area under the receiver operating characteristic curve in differentiating DMD patients from normal subjects (AUC = 0.902, 95% confidence interval: 0.814-0.990). Motor function grading was a significant determinant of passive muscle stiffness at an ankle angle of DF 10° (B = 21.409, t = 3.372, p = 0.003). Passive muscle stiffness may potentially serve as a useful non-invasive tool to monitor disease progression in DMD patients.

Tongue stretching: technique and clinical proposal.

OBJECTIVES: The tongue is an organ with multiple functions, from sucking to phonation, from swallowing to postural control and equilibrium. An incorrect position or mechanics of the tongue can causes sucking problems in the newborn or atypical swallowing in the adult, with repercussions on the position of the head and neck, up to influencing upright posture and other problems. Tongue dysfunctions are quite frequent (10-15%) in the population. For the manual therapist, this frequency indicates one to two subjects every 30 patients. Exercises have been proposed to improve the tone and strength of the swallowing muscles but the results are not so clear in the literature. The aim of this study is to describe and provide a tongue muscle normalization technique that helps the manual therapist in the treatment of problems related to it. METHODS: The literature has been investigated through pubmed, Google scholar of the last 10 years, the keywords used and combined with the Boolean operators AND and OR, are: "tongue, tongue habits, tongue diseases, taste disorder, neck pain, posture, postural balance, atypical swallowing, muscle stretching exercise, tissue expansion, soft tissue therapy, osteopathic manipulative treatment". RESULTS AND CONCLUSIONS: The technique is possible to be executed even in a sitting position, in the case the patient is unable to assume a supine position, the subject should provides immediate feedback that allows the therapist to understand if the technique has been correctly executed. The simplicity of execution and application of the technique makes it a possible and immediate therapeutic tool in the clinical setting.

A comparison of the effects of different stretching methods on flexibility, muscle activity, and pain threshold in ballet dancers; a preliminary randomized controlled trial.

BACKGROUND: The purpose of this study is to compare the effects of stretching methods on flexibility, muscle activation, and pressure pain threshold in ballet dancers, and to suggest an effective stretching method. METHODS: Thirty-three ballet dancers were randomized to the static stretching group (n = 11), muscle energy technique stretching group (n = 11), and vibration-assisted stretching group (n = 11). The angle of hip joint extension in arabesque, activation of the rectus femoris in devéloppé, and pressure pain threshold on the rectus femoris in the sitting position were measured to compare the effects of the different stretching methods. Paired t-test was used to compare the pre and post-intervention findings within each group and one-way analysis of variance to compare the difference in the amount of changes among the groups. RESULTS: The hip joint extension angles increased in all stretching methods (p < 0.05); however, vibration-assisted stretching and muscle energy technique stretching were more effective than static stretching (p < 0.05). The activation of the rectus femoris decreased in all groups (p < 0.05); however the muscle energy technique stretching group and vibration-assisted stretching group showed a significant decrease in muscle activation compared with the static stretching group (p < 0.05). The pressure pain threshold significantly improved only in the static stretching group (p < 0.05); and vibration-assisted stretching group (p < 0.05). CONCLUSIONS: Compared with static stretching and muscle energy technique stretching, vibration-assisted stretching is a beneficial method for improving flexibility, muscle activation, and pressure pain threshold in ballet dancers.

Effects of chronic stretching on soleus muscle of Wistar female rats / Efectos del estiramiento crónico en el músculo sóleo de ratas hembras Wistar

The purpose of this study was to evaluate the chronic effects of stretching exercise on soleus muscle histomorphology and histomorphometry of young and aged rats. Thirty-eight female rats were divided into young control group (YCG, n=10;274±50 g); young stretching group (YSG, n=8;274±12 g); aged control group (ACG, n=10;335±39 g); and aged stretching group (ASG, n=10;321±32g). A mechanical apparatus was used to stretch muscle in 4 repetitions, 60 s each, 30 s interval between repetitions in each session, 3 times a week for 3 weeks. Twenty-four hours after the last stretching session, soleus muscle was removed for micromorphology and immunostaining analysis. Data analyses were performed with one-way ANOVA, post-hoc Tukey, or Kruskal-Wallis tests for parametric and nonparametric, respectively (p≤0.05). Muscle fiber cross-sectional area (MFCSA) of ACG was lower (18 %) compared to the YCG. Stretching increased MFCSA comparing YSG to YCG (5,681.15± 1,943.61 µm2 vs 5,119.84±1,857.73 µm2, p=0.00), but decreased comparing ASG to ACG (3,919.54± 1,694.65 µm2 vs 4,172.82±1,446.08 µm2, p=0.00). More serial sarcomere numbers were found in the YSG than YCG (12,062.91±1,564.68 vs 10,070.39±1,072.38, p=0.03). Collagen I and collagen III were higher in YSG than ASG (7.44±7.18 % vs 0.07±0.09 %, p=0.04) and (14.37 %± 9.54 % vs 5.51 %±5.52 %, p=0.00), respectively. TNF-a was greater in ASG than YSG (43.42 %±40.19 % vs 1.72 ± 2.02 %, p=0.00). Epimysium was larger in the YSG compared to YCG (201.83±132.07 % vs 181.09±147.04 %, p=0.00). After 3-week stretching the soleus muscles from aged rats were smaller than their younger counter-parts. Interestingly, while stretching appeared to positively affect young soleus muscle, the opposite was detected in the muscle of the aged rats.

El propósito de este estudio fue evaluar los efectos crónicos del ejercicio de estiramiento sobre la histomorfología e histomorfometría del músculo sóleo de ratas jóvenes y envejecidas. Se dividieron 38 ratas hembras en un grupo control joven (YCG, n = 10; 274 ± 50 g); grupo de estiramiento joven (YSG, n = 8; 274 ± 12 g); grupo control de edad (ACG, n = 10; 335 ± 39 g); y grupo estiramiento envejecido (ASG, n = 10; 321 ± 32 g). Se usó un aparato mecánico para estirar el músculo en 4 repeticiones, 60 s cada una, intervalo de 30 s entre repeticiones en cada sesión, 3 veces por semana, durante 3 semanas. Veinticuatro horas después de la última sesión de estiramiento, se extrajo el músculo sóleo para análisis de micromorfología e inmunotinción. Los análisis de datos se realizaron con pruebas ANOVA de una vía, Tukey post-hoc o Kruskal-Wallis para pruebas paramétricas y no paramétricas, respectivamente (p≤0,05). El área de la sección transversal de fibra muscular (MFCSA) de GCE fue menor (18 %) en comparación con el GCJ. El estiramiento aumentó ASTFM comparando GEJ con GCJ (5.681,15 ± 1.943,61 µm2 vs 5.119,84 ± 1.857,73 µm2, p = 0,00), pero disminuyó comparando GEE con GCE (3.919,54 ± 1.694,65 µm2 vs 4.172,82 ± 1.446,08 µm2, p = 0,00). Se encontraron más sarcómeros en serie en el GEJ que en el GCJ (12.062,91 ± 1.564,68 vs 10.070,39 ± 1,072.38, p = 0,03). El colágeno I y el colágeno III fueron más numerosos en GEJ que en GEE (7,44 ± 7.18 % vs 0,07 ± 0,09 %, p = 0,04) y (14,37 % ± 9,54 % vs 5,51 % ± 5,52 %, p = 0,00), respectivamente. TNF-α fue mayor en GEE que GEJ (43,42 % ± 40,19 % vs 1,72 ± 2,02 %, p = 0,00). El epimisio fue mayor en el GEJ en comparación con el GCJ (201,83 ± 132,07 % vs 181,09 ± 147,04 %, p = 0,00). Después de 3 semanas de estiramiento, los músculos sóleo de las ratas envejecidas eran más pequeños que sus contrapartes más jóvenes. Curiosamente, si bien el estiramiento pareció afectar positivamente el músculo sóleo joven, se detectó lo contrario en el músculo de las ratas envejecidas.

Morphometric and molecular muscle remodeling after passive stretching in elderly female rats

OBJECTIVES: To determine the effects of three sessions of a passive stretching exercise protocol on the muscles of elderly female rats. METHODS: The effects of the stretching exercises on the soleus muscle were analyzed using immunohistochemistry [tissue inhibitors of matrix metalloproteinases (TIMP), the tumor necrosis factor-alpha (TNF-α), and the gene expression levels using real-time PCR of the transforming growth factor-beta 1 (TGF-β1), collagen type 1 (COL1), and collagen type 3 (COL3)]. Fifteen 26-month-old female Wistar rats were randomly divided into two groups, namely, Stretching (SG, n=8) and Control (CG, n=7). The passive mechanical stretching protocol consisted of a set of 4 1-minute repetitions, with 30 seconds between each repetition (total treatment of 4 minutes), three times a week for 1 week. RESULTS: Immunohistochemical analysis revealed an increase of 71.4% in the TNF-α (p=0.04) gene expression levels for the SG and a 58% decrease in the TGF-β1 gene expression levels (p=0.005) in the SG compared to that in the CG. No significant differences were observed between the groups for the immunostaining of TIMP-1 or the gene expression levels of COL1 and COL3. CONCLUSION: Three sessions of static stretching reduced the gene expression level of TGF-β1, which, owing to its anti-fibrotic role, might contribute to the remodeling of the intramuscular connective tissue of the aging muscle. In addition, immunostaining revealed that TNF-α levels increased in the aging muscle tissue in response to stretching, indicating its effect on stimulating extracellular matrix degradation. These outcomes have important clinical implications in reinforcing the use of stretching exercises in the elderly, considering that the aging muscle presents an infiltration of connective tissue.

The effects of stretching on muscle morphometry of ovariectomized rats / Efeitos do alongamento na morfometria do músculo em ratas ovarectomizadas / Los efectos del ejercicio de estiramiento en la morfometria muscular de las ratas ovariectomizadas

Abstract Introduction: Ageing is responsible for structural alterations, declining of all physiological variables, including range of motion and skeletal muscle function, known as sarcopenia. Objective: The aim of the study was to evaluate the effects of stretching on muscle morphometry in ovariectomized rats. Method: 21 female Wistar rats (12 weeks, 218 ± 22 g) were divided into 4 groups: control (CONTROL, n = 3) intact; ovariectomized and hysterectomized (OH, n = 6); Stretching (STRET, n = 6); ovariectomized and hysterectomized and stretching (OHS, n = 6). The rats were subjected to ovariectomy and hysterectomy. The stretching protocol of the soleus muscle lasted 10 repetitions of 1 minute with 45s interval between each repetition performed 3 times a week for 3 weeks. After 3 weeks, the rats were weighed and the muscles of both hind limbs were removed weighed and analyzed at muscle length; serial sarcomere number; sarcomere length; muscle fiber cross-sectional area (MFCSA) and percentage of connective tissue. Results: The final body weight increased in all groups. The serial sarcomere number of STRET was greater than the OH. The muscle fibers' cross-sectional area of OHS was higher than CONTROL. Conclusion: It can be concluded that ovariectomy and hysterectomy prevented sarcomerogenesis even when stretching was applied. However, the stretching protocol enhanced muscle trophismof ovariectomized and hysterectomized rats. It might be suggested that longitudinal growth (serial sarcomeres) and radial (ASTFM) are differently regulated by stretching in intact and/or estrogen depleted (ovariectomy and hysterectomy) skeletal muscle.

Resumo Introdução: O envelhecimento é responsável por alterações estruturais, com declínio de todas as variáveis fisiológicas, incluindo amplitude de movimento e função muscular esquelética. Objetivo: O objetivo do estudo foi avaliar os efeitos do alongamento na morfometria muscular de ratas ovariectomizadas. Método: Assim, 21 ratas Wistar (12 semanas, 218 ± 22 g) foram divididas em 4 grupos: Controle (CONTROL, n = 3) intacto; Ovariectomizadas e histerectomizadas (OH, n = 6); Alongamento (ALONG, n = 6); Ovariectomizadas e histerectomizadas e Alongamento (OHA, n = 6). As ratas foram submetidas a ovariectomia e histerectomia. O alongamento do músculo sóleo foi composto de 10 repetições de 1 minuto com intervalo de 45s entre cada repetição, realizado 3 vezes por semana, durante 3 semanas. Após 3 semanas, as ratas foram pesadas e os músculos sóleos de ambas as patas foram retirados, pesados e analisados: comprimento do músculo; número de sarcômeros em série; comprimento do sarcômero; área da seção transversal das fibras musculares (ASTFM) e porcentagem de tecido conjuntivo. Resultados: O peso corporal final aumentou em todos os grupos. O número de sarcômeros em série do ALONG foi maior que o OH. A área de secção transversa das fibras musculares do OHA foi superior ao CONTROL. Conclusão: Conclui-se que a ovariectomia e histerectomia impediram a sarcomerogênese mesmo quando realizado alongamento. Porém, o protocolo de alongamento incrementou o trofismo muscular em ratas ovarietomizadas e histerectomizadas. Sugere-se que o crescimento longitudinal (número sarcômeros em série) e radial (ASTFM) respondem diferentemente ao alongamento em músculo esquelético intacto e/ou com depleção estrogênio (ovarietomia e histerectomia).

Resumen Introducción: El envejecimiento es responsable de cambios estructurales del organismo, con disminución de todas las variables fisiológicas, incluyendo la amplitud de movimiento y función muscular esquelética, conocida como sarcopenia. Objetivo: El objetivo del estudio fue evaluar los efectos de los ejercicios de estiramiento en la morfometria muscular de ratas ovarectomizadas. Método: Fueron seleccionadas 21 ratas Wistar (12 semanas, 218 ± 22g) que fueron divididas en 4 grupos: control (CONTROL, n = 3) intacto; ovarectomizadas y histerectomizadas (OH, n = 6); estiramiento (ALONG, n = 6); ovarectomizadas y histerectomizadas y estiramiento (OHA, n = 6). Las ratas han sido sometidas a ovariectomía y histerectomía. El protocolo de estiramiento del músculo sóleo fue realizado en 10 repeticiones de 1 minuto con intervalos de 45 segundos entre cada repetición, realizada 3 veces por semana, durante 3 semanas. Después de 3 semanas, las ratas fueron pesadas y los músculos de ambas patas fueron retirados para analizar el peso muscular; la longitud del músculo; número de sarcómera en serie; longitud de sarcómera; área de la sección transversal de las fibras musculares (ASTFM) y porcentaje del tejido conjuntivo. Resultado: El peso corporal final aumentó en todos los grupos. El número de sarcómera en serie de ALONG fue mayor que el OH. El área de la sección transversal de las fibras musculares del OHA fue superior al de CONTROL. Conclusión: En conclusión, ovariectomía y histerectomía impiedieron la sarcomerogénesis mismo cuando se realizó el estiramiento. Sin embago, el estiramiento aumentó el trofismo muscular de las ratas ovarectomizadas y histerectomizadas. Sugiere que el crescimiento longitudinal (número sarcômeros) y radial (área de sección transversal) responden diferentemente al estiramiento en músculo esqueletico intacto y/o con depleción estrógeno (ovariectomía y histerectomía).

Acute Effects of Intermittent Versus Continuous Bilateral Ankle Plantar Flexor Static Stretching on Postural Sway and Plantar Pressures: A Randomized Clinical Trial.

BACKGROUND: Postural balance and fall efficacy (self-perceived confidence in performing daily physical activities) have been found to be risk factors associated with falls in older adults. Stretching is one intervention that has been investigated to improve balance and therefore reduce fall risk. Various forms of stretching have been evaluated with different outcomes, but there is a lack of knowledge about the effect of stretching (continuous and intermittent) on plantar pressures and balance. Therefore, the aim of the present study was to analyze the effects of stretching (continuous and intermittent) of the bilateral ankle plantar flexors on plantar pressures and static balance. METHODS: A randomized clinical trial was carried out. Forty-eight healthy subjects (42 females and 6 males) were recruited in an outpatient clinic. Subjects were randomly assigned to an intermittent stretching group (five sets of 1 min; 15 s of rest) or a continuous stretching group (2 min of continuous stretching) of the plantar flexors. Plantar pressures and balance using stabilometry were measured before and after stretching. RESULTS: There were significant differences between intermittent and continuous stretching in rearfoot maximum pressure, forefoot surface area, and center of pressure surface area with eyes open. CONCLUSIONS: Bilateral intermittent stretching of the ankle plantar flexors was found to be more effective than continuous stretching for the reduction of rearfoot maximum pressure and improved balance.

The development of a mechanical device to stretch skeletal muscle of young and old rats

OBJECTIVE: How much force is needed to stretch skeletal muscle is still unknown. The aim of this study was to develop a device that mechanically stretches rat muscle to compare the force (N) required to stretch the soleus muscle of young and aged rats and the tibio-tarsal angle joint at neutral and stretched positions. METHODS: Twelve female Wistar rats were divided into two groups: a young group (YG, n=6, 311±11 g) of rats 3 months old and an aged group (AG, n=6, 351±43 g) of rats 15 months old. The left soleus muscle was mechanically held in full dorsal flexion and submitted to mechanical passive stretching: 1 bout of 10 repetitions, each repetition lasted 60 seconds with an interval of 45 seconds between repetitions, performed once a day, twice a week, for 1 week. The force required during stretching was measured by a load cell, and the tibio-tarsal angle joint was measured by photometry. RESULTS: The load cell calibration showed excellent reliability, as confirmed by the intraclass correlation coefficient value of 0.93. A decrease in delta force was found in the comparison between YG and AG (0.11±0.03 N vs 0.08±0.02 N, p<0.05, repeated measures ANOVA). There was no difference between the YG and the AG in the tibio-tarsal angle at resting position (87.1±3.8° vs 87.1±3.5°, p=0.35, Kruskal Wallis) and at the end of the stretching protocol (43.9±4.4° vs 42.6±3.4°, p=0.57, Kruskal Wallis). CONCLUSION: The device presented in this study is able to monitor the force necessary to stretch hindlimb rat muscles. Aged rats required less force than young rats to stretch the soleus muscle, and there was no difference regarding the tibio-tarsal angle between the two groups.

Chronic effect of different types of stretching on ankle dorsiflexion range of motion: Systematic review and meta-analysis.

The calf muscles are one of the muscle groups that have the most need for adequate flexibility since they are deeply related to normal lower limb function. When the goal is to increase flexibility, the most commonly used technique is stretching. However, it remains unknown which stretching technique and parameters are the most effective to increase flexibility. Hence, the aim of the current review was to investigate the influence of chronic stretching on ankle dorsiflexion range of motion (DFROM) of healthy individuals. The search strategy included MEDLINE, PEDro, Cochrane CENTRAL, LILACS, and manual search from inception to February 2017. Randomized and controlled clinical trials that have analyzed the influence of chronic stretching on DFROM were included. On the other hand, studies with special populations (children, and people with any dysfunction/disease), and articles with no control group were excluded. Twenty studies were included out of 493 identified. The meta-analysis was performed according to the stretching technique used in the study. The results show that static stretching (5.17°; 95% CI: 4.39-5.95; I2: 0%) and proprioceptive neuromuscular facilitation (4.32°; 95% CI: 1.59-7.04; I2: 46%) are effective in increasing DFROM. Ballistic stretching did not show positive results to increase DFROM (3.77°; 95% CI: -0.03 to 7.56; I2: 46%). In conclusion, chronic stretching is an effective way of improving ankle mobility in healthy individuals, especially when it contains a static component.

Efeitos do exercício de alongamento em pessoas com síndrome de Down / Effects of stretching exercise in people with Down syndrome

Introdução: Estratégias de esquema corporal são comumente utilizadas para minimizar disfunções musculoesqueléticas decorrentes da Síndrome de Down (SD). Dessa forma, posturas adotadas nessas estratégias promovem o alongamento muscular, entretanto não são claros os efeitos do exercício de alongamento neste público. Objetivo: Verificar as evidências a respeito dos efeitos dos exercícios de alongamento muscular em pessoas com SD. Material e métodos: Foi realizada revisão sistemática com 3 avaliadores independentes, nas bases de dados: Bireme, Pubmed, Pedro e Cinahl. Com os descritores: "alongamento", "exercício de alongamento", "Síndrome de Down", "flexibilidade" e "amplitude de movimento" combinados, e em inglês e português. Os critérios de inclusão foram a presença dos descritores no título e a relação com o tema, artigos publicados até julho de 2017. Foram excluídos títulos repetidos, títulos cujo resumo não se relacionava com a SD e artigos que não tratavam sobre flexibilidade ou alongamento na SD. Resultados: Foram encontrados 372 artigos, sendo selecionados 9 artigos de acordo com o título para leitura dos resumos. Após leitura dos resumos, apenas 5 artigos foram selecionados para análise na íntegra. Conclusão: Não há evidências suficientes na literatura que indiquem os efeitos do exercício de alongamento muscular em pessoas com SD. (AU)

Introduction: Body scoring strategies are commonly used to minimize musculoskeletal dysfunctions resulting from Down Syndrome (DS). Thus, postures adopted in these strategies promote muscle stretching; however, the effects of the stretching exercise in this public are not clear. Objective: To verify the evidence regarding the effects of muscle stretching exercises in people with DS. Methods: A systematic review was carried out with 3 independent evaluators, in the databases: Bireme, Pubmed, Pedro and Cinahl. With the descriptors: "stretching", "stretching exercise", "down syndrome", "flexibility", "range of motion" combined, in English and Portuguese. The inclusion criteria were the presence of the descriptors in the title and the relation with the theme, articles published until July 2017. We excluded repeated titles, titles whose summary was not related to DS, and articles that did not relate flexibility or stretching in DS. Results: A total of 372 articles were found, and 9 articles were selected according to the title for the reading of the abstracts. After reading the abstracts, only 5 articles were selected for analysis in their entirety. Conclusion: There is insufficient evidence in the literature to indicate the effects of muscle stretching exercise in people with DS. (AU)

Changes in Postural Sway After a Single Global Postural Reeducation Session in University Students: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to assess the effectiveness of a single session of global postural reeducation (GPR) in postural sway in young adult university students who use data visualization screens. METHODS: A randomized controlled trial with 2 parallel groups was performed. Sixty-four subjects were randomized in the experimental group (12 men and 20 women) who underwent the GPR session, and a control group (13 men and 19 women) that did not receive any intervention was included. Center of pressure (COP) was assessed using a stabilometric platform, with eyes open and eyes closed before, immediately after, 48 hours after, and 7 days after intervention in both groups. RESULTS: In the interaction of time and gender, statistically significant differences were found for the area covered by COP (P = .020) and for the standard deviation (SD) in the mediolateral axis (P = .035). Considering the complete interaction time, gender, and group, statistically significant differences were found (P = .015) for the anteroposterior rate covered by COP and the SD in the anteroposterior axis (P = .033). In eyes closed condition, the intersubject analysis showed statistically significant differences for the interaction between group and gender for the variable mediolateral SD (P = .043). Considering the interaction of time with group, statistically significant differences were found for full length covered by COP (P = .017). CONCLUSIONS: Changes in postural sway were observed after a single GPR session, mainly at 48 hours, with different behaviors between men and women.

Relationship Between Types of Exercise and Quality of Life in a Korean Metabolic Syndrome Population: A Cross-Sectional Study.

BACKGROUND: Metabolic syndrome (MetS) significantly correlates with exercise. MetS also has an independent and inverse correlation to quality of life (QoL). However, few studies have examined the association between exercise and QoL in people with MetS. The aim of this study was to ascertain the relationship between exercise and QoL in a MetS population. METHODS: This was a cross-sectional study using public data from the Sixth Korean National Health and Nutrition Examination Survey in 2014 (n = 7550). MetS was defined on the basis of the revised National Cholesterol Education Program criteria. Demographic factors, three types of exercise (resistance, flexibility, walking), five subsets of EuroQoL (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), and QoL scores (EQ-VAS), were investigated. Independent associations of each exercise on five subsets of QoL were determined using odds ratios (OR) adjusted for four demographic factors (age group, sex, weight change, and area of residence) using multivariate logistic regression analysis. RESULTS: Prevalence of MetS was 26.4% and the ratio of subjects performing resistance, flexibility, or walking exercise was 17.7%, 45.8%, and 71.5% among this population, respectively. EQ-VAS of exercisers was significantly higher than that of non-exercisers in resistance, flexibility, and walking exercise. Although resistance and flexibility exercise did not correlate with any subsets of QoL, mobility and self-care were significantly associated with walking exercise (OR = 0.635, 95% CI = 0.439-0.919 and OR = 0.577, 95% CI = 0.348-0.958, respectively). CONCLUSIONS: All exercisers showed higher QoL scores than non-exercisers. Among QoL subsets, mobility and self-care were independently associated with walking exercise in the MetS population. Regular walking exercise was important to higher QoL in those with MetS. This is the first clinical report to indicate that QoL could be independently influenced by walking exercise.

Effectiveness of Global Postural Reeducation Compared to Segmental Stretching on Pain, Disability, and QOL of Subjects with Neck and Shoulder Pain

PURPOSE: This randomized controlled trial was conducted to compare the effectiveness of global postural reeducation to segmental stretching in subjects with neck and shoulder pain. METHODS: Sixteen subjects with neck and shoulder pain were randomized into two intervention groups, a global posture reeducation group (n=8) that performed muscle chain stretching, and a segmental stretching group (n=8) that performed conventional static muscle stretching. The intervention program consisted of two 40 minutes individual sessions per week for four weeks. Subjects were evaluated pre-intervention, two-week after intervention and at a four-week follow-up appointment for pain intensity, disability and health-related quality of life. Two-way repeated analysis of variance was used for between-time and between-group comparisons. The significance level was 0.05. RESULTS: Significant pain relief and decreasing discomfort of the neck and shoulder were observed after intervention in both groups, and there was an interaction between time lapse and groups (pain, F=10.31, neck disability, F=25.45, shoulder disability, F=12.82, p0.05). CONCLUSION: These findings suggest that a GPR intervention in subjects with neck and shoulder pain induces greater improvement of pain and disability and quality of life than segmental stretching.

Efeito agudo de diferentes técnicas de alongamento na flexibilidade de isquiotibiais / Acute effect of different stretching techniques of hamstring flexibility

O encurtamento dos músculos isquiotibiais leva ao desequilíbrio postural, compensações e outras disfunções. Assim, estudos que trabalhem com os efeitos das diferentes técnicas para a melhora da flexibilidade desses músculos são fundamentais para esclarecer os reais benefícios de suas utilizações. O objetivo deste trabalho foi verificar o efeito agudo da Bandagem Neuromuscular, Facilitação Neuromuscular Proprioceptiva (FNP) e Alongamento Estático na flexibilidade dos músculos isquiotibiais. A amostra foi constituída por 80 homens (23,37 ± 4,68 anos), que foram divididos aleatoriamente em 4 grupos: G1 (Bandagem Neuromuscular, n = 20), G2 (FNP, n = 20), G3 (Alongamento Estático, n = 20), e G4 (Grupo controle, n = 20). O nível de atividade física foi avaliado por meio do Questionário Internacional de Atividade Física (IPAQ). A flexibilidade dos músculos isquiotibiais foi avaliada pela mensuração do ângulo poplíteo com auxílio de uma prancha desenvolvida para a mesma. Todas as técnicas apresentaram resultados positivos na flexibilidade dos músculos isquiotibiais. Sugerimos novos estudos analisando efeitos crônicos do alongamento para a confirmação de nossos resultados. (AU)

The hamstring muscle leads to postural imbalance, compensation and other disorders. Thus, studies about the effects of different techniques to improve the flexibility of these muscles are essential to clarify the real benefits of their use. The aim of this study was to investigate the acute effect of Neuromuscular Bandage, Proprioceptive Neuromuscular Facilitation (PNF) and Static Stretching on hamstring muscle flexibility. The sample consisted of 80 men (23.37 ± 4.68 years) randomly divided into 4 groups: G1 (Neuromuscular Bandage, n = 20), G2 (PNF, n = 20), G3 (Static Stretching, n = 20) and G4 (Control Group, n = 20). The level of physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). All the techniques presented positive results in the flexibility of the hamstring muscles. We suggest new studies analyzing chronic effects of stretching to confirm our results. (AU)

Efeito agudo do alongamento por Facilitação Neuromuscular Proprioceptiva associado a TENS e crioterapia na flexibilidade dos músculos isquiossurais de mulheres saudáveis / Acute effect of Proprioceptive Neuromuscular Facilitation stretching associated with TENS and cryotherapy in the flexibility of hamstring muscles of healthy women

Introdução: O alongamento por Facilitação Neuromuscular Proprioceptiva (FNP) é o mais efetivo dentre os tipos de alongamento. O ganho de flexibilidade após o alongamento se deve também ao aumento da tolerância do indivíduo ao estiramento do músculo, portanto, recursos analgésicos associados ao alongamento por FNP podem potencializar o efeito desta técnica. Objetivo: Verificar o efeito agudo do alongamento por FNP associado a Estimulação Elétrica Nervosa Transcutânea (TENS) e a crioterapia na flexibilidade dos músculos isquiossurais de mulheres saudáveis. Material e métodos: Sessenta voluntarias foram distribuídas aleatoriamente em quatro grupos: (G1) Grupo Controle; (G2) Alongamento por FNP isolado; (G3) Alongamento FNP associado a TENS; (G4) Alongamento FNP associado à crioterapia. Resultados: Na análise intragrupo foi observado aumento da flexibilidade na comparação antes e depois da aplicação das técnicas em todos os grupos (p < 0,001), exceto no G1. Na análise intergrupo, foi observada diferença estatística apenas na comparação dos três grupos experimentais (G2, G3 e G4) com o grupo controle (G1) (p ≤ 0,002). Conclusão: O alongamento por FNP aplicado isoladamente e associado a TENS ou crioterapia são igualmente eficazes para aumentar a flexibilidade de forma aguda dos músculos isquiossurais de mulheres saudáveis. (AU)

Introduction: Stretching by Proprioceptive Neuromuscular Facilitation (PNF) is the most effective among the types of stretching. Increased flexibility after stretching is also due to increased tolerance of the subject to the stretching of the muscle, therefore, analgesic resources associated with PNF stretching may potentiate the effect of this technique. Objective: To measure the acute effect of PNF stretching associated with Transcutaneous Electrical Nerve Stimulation (TENS) and cryotherapy in the flexibility of hamstring muscles of healthy women. Methods: Sixty volunteers were randomly assigned to four groups: (G1) Control Group; (G2) PNF Stretching isolated; (G3) PNF with TENS; (G4) PNF associated with cryotherapy. Results: In the intragroup analysis, an increase in flexibility was observed in the comparison before and after the application of the techniques in all groups (p < 0.001), except G1. In the intergroup analysis, a statistical difference was observed only in the comparison of the three experimental groups (G2, G3 and G4) with the control group (G1) (p ≤ 0.002). Conclusion: PNF stretching applied isolated and associated with TENS or cryotherapy are equally effective to increase the acute flexibility of the hamstring muscles of healthy sedentary women. (AU)

Pilot study of effective methods for measuring and stretching for pectoral muscle tightness in breast cancer patients.

[Purpose] To evaluate differences in pectoral muscle tightness according to arm abduction angle and to determine the best arm abduction angle for stretching of pectoral muscle tightness in breast cancer patients. [Subjects and Methods] Horizontal abduction differences of shoulders were measured bilaterally by arm abduction to 45°, 90°, and 135° to determine the best arm abduction angle for measuring pectoral muscle tightness. Thirty-two patients were divided into three pectoral muscle stretching groups (A: 45°, B: 90°, and C: 135°). We measured the shoulder range of motion, scores of the Disabilities of the Arm, Shoulder, and Hand, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Breast Module, and pain levels (using a visual analog scale) before and after therapy. [Results] The differences in degree of horizontal abduction between shoulders were significantly larger for arm abduction to 90° and 135° than that to 45°. Groups B and C showed greater improvements in horizontal abduction limitations than group A. [Conclusion] Horizontal abduction differences between shoulders are prominent when arms are abducted to 90° and 135°. The appropriate arm abduction angle for measuring horizontal abduction and effective stretching of pectoral muscle tightness may be >90°.

A INFLUÊNCIA DA TERMOTERAPIA NO GANHO DE FLEXIBILIDADE DOS MÚSCULOS ISQUIOTIBIAIS / THE INFLUENCE OF THERMOTHERAPY IN THE FLEXIBILITY GAIN OF THE HAMSTRING MUSCLES / LA INFLUENCIA DE LA TERMOTERAPIA EN LA FLEXIBILIDAD DE LOS MÚSCULOS ISQUIOTIBIALES

RESUMO Introdução: A flexibilidade muscular é descrita como a capacidade do músculo realizar a extensão de suas fibras, influenciando a mobilidade articular. A diatermia aplicada à musculatura prepara o corpo para atividades físicas, por acelerar o metabolismo das fibras musculares e diminuir a resistência intramuscular, aumentando assim a variedade de movimento e a eficiência mecânica. A crioterapia tem diversas funções fisiológicas quando aplicada ao corpo humano, as quais, em conjunto, propiciam o relaxamento muscular. Objetivo: Avaliar o comportamento da flexibilidade dos músculos isquiotibiais frente à aplicação de alongamento passivo associado a termoterapias quente e fria. Métodos: Este estudo foi composto de 24 voluntários, de ambos os sexos, distribuídos aleatoriamente em três grupos, sendo eles: grupo alongamento passivo (G1), grupo crioterapia precedendo alongamento passivo (G2) e grupo diatermia precedendo alongamento passivo (G3). Os voluntários foram submetidos a avaliações de amplitude de movimento através da goniometria da flexão de quadril com o joelho estendido, sendo uma avaliação inicial realizada antes de iniciar o protocolo e reavaliações ao final de cada uma das quatro semanas de intervenção. Resultados: Verificou-se aumento significativo da flexão de quadril no G2 e G3 com relação ao G1. Não houve diferença estatística entre G2 e G3. Conclusão: O uso da diatermia, assim como da crioterapia, associado ao alongamento passivo é favorável para o ganho de flexibilidade muscular e, consequentemente, de amplitude de movimento em jovens saudáveis.

ABSTRACT Introduction: Muscle flexibility is described as the ability of the muscle to extend its fibers, influencing joint mobility. Diathermy applied to the muscles prepares the body for physical activity, by accelerating the metabolism of the muscle fibers and decreasing the intramuscular resistance, thereby increasing the range of motion and the mechanical efficiency. Cryotherapy has various physiological functions when applied to the human body, which, together, provide muscle relaxation. Objective: To evaluate the flexibility of hamstring muscles by applying passive stretching associated with hot and cold thermotherapy. Methods: This study consisted of 24 volunteers of both sexes randomly divided into three groups: passive stretching group (G1), cryotherapy preceding passive stretching group (G2) and diathermy preceding passive stretching group (G3). The volunteers were evaluated for range of motion by goniometry of hip flexion with the knee extended, with an initial assessment carried out before starting the protocol and revaluations at the end of each of the four weeks of intervention. Results: There was significant increase in hip flexion in G2 and G3 compared to G1. There was no statistical difference between G2 and G3. Conclusion: The use of diathermy and cryotherapy associated with passive stretching is favorable for increasing muscular flexibility and hence the amplitude of motion in healthy young adults.

RESUMEN Introducción: La flexibilidad muscular se describe como la capacidad del músculo para lograr la extensión de sus fibras, que afecta a la movilidad articular. La diatermia aplicada a los músculos prepara el cuerpo para la actividad física, mediante la aceleración del metabolismo de las fibras musculares y disminución de la resistencia intramuscular, lo que aumenta el rango de movimiento y la eficiencia mecánica. La crioterapia tiene diversas funciones fisiológicas cuando es aplicada al cuerpo humano, que, en conjunto, proporcionan la relajación muscular. Objetivo: Evaluar la flexibilidad de los músculos isquiotibiales frente a la aplicación de alongamiento pasivo asociado a termoterapia caliente y fría. Métodos: Este estudio se compone de 24 voluntarios de ambos sexos divididos aleatoriamente en tres grupos, a saber: grupo de estiramiento pasivo (G1), grupo de crioterapia antes del estiramiento pasivo (G2) y grupo de diatermia antes del estiramiento pasivo (G3). Los voluntarios fueron sometidos a evaluaciones de amplitud de movimiento a través de la goniometría de la flexión de cadera con la rodilla extendida, siendo una evaluación inicial realizada antes de iniciar el protocolo y reevaluaciones al final de cada una de las cuatro semanas de intervención. Resultados: No hubo aumento significativo de la flexión de la cadera en G2 y G3 en comparación con G1. No hubo diferencia estadística entre G2 y G3. Conclusión: El uso de diatermia y crioterapia asociado con el estiramiento pasivo es favorable para aumentar la flexibilidad muscular y por lo tanto el rango de movimiento en adultos jóvenes sanos.

Efeitos de diferentes tempos de alongamento na flexibilidade de bailarinas / Effects of different times of stretching on flexibility of ballet dancers

Introdução: Os exercícios de alongamento têm sido frequentemente utilizados no contexto esportivo, a fim de aumentar a flexibilidade durante os treinos e atividades visando o estiramento global e reeducação postural. Objetivos: Comparar os efeitos de diferentes tempos de alongamento na flexibilidade de bailarinas. Métodos: Vinte bailarinas foram divididas em três grupos: grupo controle (GC), apenas avaliado; grupo 30 segundos (G30) e grupo três minutos (G3) analisados após duas repetições de alongamentos para isquiotibiais e adutores de coxa. Para avaliações, coletaram-se dados antropométricos e índices de flexibilidade por goniometria e caixa de sentar e alcançar de Weels. Resultados: Não houve diferença significativa entre os grupos em relação às avaliações de flexibilidade. Conclusão: Entre os tempos de alongamento não houve diferença significativa. Os dados sugerem que, em ensaios e espetáculos, o tempo menor de alongamento poderá ser utilizado como parte integrante do preparo da bailarina.

Introduction: The stretching exercises have been often used in the sporting context, in order to increase flexibility during trainings and activities, to the overall stretching and focusing the postural reeducation. Objectives: To compare the effects of different times of stretching on the ballet dancer's flexibility. Methods: Twenty ballet dancers were divided into three groups: a control group (CG), that was only evaluated; a 30-second group (30G); and a three-minute group (3G), which were assessed after two repetitions of hamstring stretches and thigh adductions. The assessments were carried out using anthropometric data and indexes of flexibility collected by goniometry and Wells' sit-and-reach box. Results: The results showed no significant difference between groups in relation to the flexibility evaluation. Conclusion: There was no significant difference between the times of stretching. The data suggest that a shorter stretching time may be used in rehearsals and performances as part of physical preparation by the ballet dancers.