An Analysis of the Effectiveness of Strengthening or Stretching Exercises in Patients Performing Prolonged Sedentary Work with Non-Specific Lower Back Pain.

BACKGROUND: Non-specific LBP refers to back pain which arises from the spine, intervertebral discs and surrounding soft tissues in the absence of pathologic lesions. Most cases of non-specific LBP are not the result of a single injury from a high load, but the result of repetitive, cumulative micro-injuries. The aim of the study was to assess the effectiveness of strengthening, stretching and mixed exercises in patients with non-specific LBP and their impact on pain intensity. MATERIAL AND METHODS: We analysed 90 patients with non-specific LBP who performed prolonged sedentary work. Patients were qualified following history-taking, a physical examination and radiological evaluation if no pathology had been revealed on examination or on the available diagnostic imaging scans. The participants were randomly divided into 3 groups of 30 individuals each. The patients in each group performed one type of exercise (strengthening, stretching, mixed) for a period of 3 months. Both before starting and on completion of the exercise period, the patients were assessed with an original questionnaire as well as the Rolland-Morris, Oswestry and SF-12 scoring systems. RESULTS: Strengthening exercises were the most effective in reducing pain; on completion of the exercise period, pain assessed with the NRS scale was 2 points in the strengthening exercise group, 3 points, in the mixed group, and 4 points in the stretching group. The SF-12 questionnaire showed an improvement in the patients' health (increase in "excellent" and "very good" scores from 7% to 60%). According to the Oswestry disability questionnaire, strengthening exercises were the most effective (mean disability score of 4). CONCLUSIONS: 1. The use of strengthening exercises in patients with non-specific LBP most effectively improves function and reduces back pain. 2. The use of stretching and mixed exercises in patients with non-specific LBP improves function and reduces back pain, but to a lesser extent than strengthening exercises.

The Effects of Static Stretching 2-Hours Prior to a Traditional Warm-Up on Performance.

Whereas prolonged static stretching (SS: >60-seconds per muscle) can increase range of motion (ROM) for up to 2-hours, it can also decrease maximal voluntary isometric contraction (MVIC) forces, countermovement (CMJ) and drop jump (DJ) heights, and muscle activation immediately after the stretching exercise. When an appropriate SS duration (<60-seconds per muscle) is incorporated into a dynamic warm-up, performance decrements are often trivial. However, there is a lack of studies that observed the effects of extensive SS (180-seconds) 2-hours prior to a dynamic warm-up. The objective was to investigate ROM and performance effects of prolonged SS, 2-hours prior to a traditional warm-up. This study investigated 9 female and 8 male healthy recreationally active, young adult participants on the effects of prolonged SS (180-seconds per muscle) of the quadriceps and hamstrings, 2-hours before a traditional warm-up compared to an active control condition on hip flexion ROM, knee extension and flexion MVIC forces, CMJ, DJ, and quadriceps and hamstrings electromyography (EMG). There were no significant changes in knee flexion/extension MVIC forces, EMG, CMJ, or DJ height. However, there was significant, small magnitude (p = 0.002) greater post-warm-up left hip flexion ROM (115.4° ± 17.2) than pre-SS (108.9° ± 17.13, Effect size [ES]: 0.28) and control post-warm-up (p = 0.05, ES: 0.31, 109.5° ± 20.55). Similarly, right hip flexion ROM (117.2° ± 16.5) also demonstrated significant small magnitude (p = 0.003) greater than the pre-SS (112.4° ± 18.4, ES: 0.22) and control post-warm-up (p = 0.046, ES: 0.33, 110.8° ± 20.5). Additionally, significant, large magnitude greater hip flexion ROM was observed with the women vs. men (ES: 1.29 - 1.34). Significant hip flexion ROM increases were not accompanied by significant changes in knee flexion/extension MVIC forces, EMG, or jump heights, suggesting that extensive SS can positively impact ROM without performance deficits when followed by a traditional warm-up, 2-hours after SS.

What Is Plantar Fasciitis?

This JAMA Patient Page describes the condition of plantar fasciitis and its diagnosis and treatment.

Effect of Dry Needling Plus Static Stretching on Plantar Flexors Spasticity in Chronic Stroke Patients.

Importance: Stroke is a leading cause of disability worldwide and is often accompanied by complications such as spasticity. Static stretching (SS) is a common physiotherapy intervention for reducing spasticity, whereas dry needling (DN) is a novel approach. However, the combined effects of DN and SS on spasticity have not been thoroughly investigated. Given the pivotal effect of spasticity on daily activities, mitigating spasticity can significantly contribute to restoring patient independence. Objective: This study will explore the impact of DN plus SS on spasticity, alpha motor neuron excitability, overall function, and quality of life in patients with chronic stroke. Design, Setting, and Population: A double-blind, randomized, sham-controlled trial will be conducted in patients with post-stroke spasticity in the plantar flexor muscles. Twentyeight participants will be randomly assigned to either an intervention or control group. The intervention group will receive DN (60s × 3 days/week; 1 week) plus SS (20 min × 5 days/ week; 1 week). The control group will undergo sham DN (60s × 3 days/week; 1 week) and SS (20 min × 5 days/week; 1 week). Exposures: DN plus SS or sham DN plus SS. Main Outcomes and Measures: Both groups will be assessed at baseline, immediately post-treatment, and after 1 week of follow-up. Outcome measures will include the Modified Modified Ashworth Scale, H-reflex latency, Hmax/Mmax ratio, active and passive ankle dorsiflexion range of motion, timed up and go test, and the EuroQol questionnaire. Results: Results from this randomized, sham-controlled study will provide evidence for the effectiveness of DN in combination with SS for spasticity. Conclusions and Relevance: The additional impact of DN in conjunction with SS, a widely used method for reducing muscle tone, remains unclear and warrants investigation. This study, with a high level of evidence, aims to address this knowledge gap.

Acute effects of voluntary isometric contractions at maximal shortening vs. ballistic stretching on flexibility, strength and jump.

Background: Isometric training is used in sport, conventional physical activity and rehabilitation. Understandably, there is a great deal of research related to its effect on performance. It is known that the length of the muscle at the moment of contraction is a determinant of strength levels. In the literature we find research on isometric training in short muscle lengths, although it has not been studied in maximally shortened positions or the acute effects that occur after its application. Ballistic stretching (BS) is also popular in sport. Their execution involves actively reaching maximally shortened muscle positions. So far, isometric training has not been compared with protocols involving ballistic stretching. Considering the above, the aim of the present study was to investigate the effects of BS and voluntary isometric contraction at maximal shortening (VICAMS) on range of motion, strength and vertical jump. Methods: The study involved 60 healthy, physically active individuals (40 and 52 years old) who were randomly assigned to three groups: BS, VICAMS and a control group (CG). To assess acute effects, before and after the intervention, active range of motion (AROM), maximal voluntary isometric force (MVIF) and countermovement jump height (CMJ) were determined. Results: Time main effects and time*group interactions were found for all variables (p < 0.001). Between-group differences were shown for the VICAMS group after the intervention, with statistically significant higher AROM values compared to the other groups. MVIF values were also higher in the VICAMS group. Intra-group differences were observed for the VICAMS and Ballistic groups, as values on all variables increased from baseline. For the CMJ, intra-group differences showed that both the VICAMS and BS groups improved values compared to baseline values. Conclusions: The application of VICAMS induced acute improvements over BS in AROM, MVIF and CMJ. These results are important for coaches seeking immediate performance improvement and offer an optimal solution to the warm-up protocol.

Effect of improving asymmetry through self-myofascial release in adolescent soccer player with hypomobility syndrome hip: A randomized controlled trial.

BACKGROUND: Hypomobility syndrome (HMS), or limited hip range of motion (ROM), is often reported in adolescents who train heavily. This study was aimed to investigate the impact of traditional static stretching (STR) and self-myofascial release (MFR) in adolescents with HMS hip. METHODS: This study was a randomized controlled trial. Adolescent athletes with HMS hip were grouped as 23 STR and 23 MFR. Foam rolling was employed as the training method for MFR. Both interventions were performed twice a day for 20 minutes in 6 weeks. The training was filmed and distributed via the mobile video. Self-assessed Copenhagen Hip & Groin Outcome Score, ROM, strength, and hop tests were measured before and after the interventions. The healthy side without limitations was designated as non-HMS (nHMS) and taken as reference value. RESULTS: The study participants had limitations in flexion (FLX), abduction (ABD), internal rotation (IR), and external rotation (ER). The ROM of STR group was recovered to nHMS level. The FLX and ABD of MFR group was also recovered, however the IR and ER had lower angles compared to nHMS. MFR FLX, ABD, ER strength, and single hop test were restored like that of nHMS, however STR group was substantially lower than nHMS despite the improvements. Both groups depicted lower pre-intervention Copenhagen Hip & Groin Outcome Score subscale activities daily living, sport, and physical activity compared to nHMS. Activities daily living and physical activity were improved to healthy levels after the intervention, however sport was lower than that of nHMS. CONCLUSION: Both STR and MFR had impact on hip mobility and hip self-assessment score. Furthermore, MFR had strength improvements in FLX, ABD, and ER. However, the improvements in MFR group regarding triples, crossover hops, and self-assessed sports were limited. Therefore, STR and MFR are effective in improving not only ROM but also muscle function asymmetry in HMS hip.

The Impact of Different Muscle Relaxation Techniques on the Upper Trapezius and Its Relationship with the Middle Trapezius.

ABSTRACT: The relaxation of trapezius muscles is widely believed to alleviate fatigue or injury of the trapezius muscles and reduce the risk of shoulder and neck pain. This study aims to examine the effects of different muscle relaxation techniques on the physical properties of the trapezius muscle and to explore how changes in the physical properties of the upper trapezius muscle affect those of the middle trapezius muscle. Twenty-four healthy males (mean age: 23.08 ± 0.97 years; height: 172.42 ± 4.61 cm; weight: 66.38 ± 6.68 kg; and body mass index: 22.30 ± 1.81 kg/m2), randomly divided into four groups: stretching relaxation group (ST, n = 6), mechanical vibration massage (MV, n = 6), pulse massage (PU, n = 6), and control (CO, n = 6). Measurements using the Myoton digital muscle assessment system were conducted daily over 2 weeks. The experimental groups demonstrated a notable decrease in tension and stiffness, accompanied by heightened elasticity in the upper trapezius muscles. Conversely, the control group exhibited contrasting trends. Although no significant variances were detected among the relaxation techniques, all proved efficacious compared to the control group (P < 0.05). Moreover, relaxation of the upper trapezius muscles significantly influenced the middle trapezius muscles (P < 0.05). Various relaxation methods positively influenced trapezius muscle attributes over 2 weeks, with inter-regional effects noted.

Gaelic Games Players' and Practitioners' Perceptions of Recovery Strategies.

PURPOSE: This study both investigated and compared Gaelic games players' and practitioners' perceptions of the importance of postexercise recovery strategies. METHODS: Gaelic players (n = 1178 [n = 574 female], age 24.6 [6.6] y) and practitioners (n = 148 [n = 29 female], age 35.9 [8.7] y) completed a questionnaire assessing their perceptions of various postexercise recovery strategies (importance ranked out of 5 [1 "not important at all" to 5 "extremely important"]). Players were further categorized by playing standard into developmental (club/collegiate; n = 869) and national (intercounty; n = 309) levels and by sport: Gaelic football (n = 813), camogie/hurling (n = 342), and Gaelic handball (n = 23). Practitioners were categorized as sport coaches (n = 67), strength and conditioning staff (n = 34), nutrition staff (n = 15), and athletic rehabilitation staff (n = 32). RESULTS: Gaelic players prevalently perceived sleep (76.4%), rehydration (72.5%), postexercise meal (48.4%), stretching (47.6%), active cool-down (25.1%), foam rolling (23.1%), and massage by therapist (22.6%) as "extremely important." Practitioners prevalently perceived sleep (90.1%), rehydration (83.6%), postexercise meal (76.6%), daytime naps (36.2%), stretching (25.4%), discussion with teammates (24.6%), and getting into nature (19.4%) as "extremely important." CONCLUSIONS: While strategies with well-documented efficacy such as sleep, nutrition, and rehydration were rated as most important, a distinct and possibly problematic disconnect exists between the perceived importance of many strategies and their empirically demonstrated effectiveness. For instance, active cool-downs and stretching were perceived as highly important despite prevailing evidence suggesting that their effects are often small in magnitude. Collectively, work promoting optimal recovery practices and aligning player-practitioner perspectives would be beneficial to maximize time and resource allocation and enhance player buy-in.

The effectiveness of stretching exercises in patients with fibromyalgia: A systematic review.

Fibromyalgia is one of the most prevalent chronic pain disorders. Fibromyalgia is characterised by generalised pain. In addition, patients with fibromyalgia often have co-morbidity. Since no cure is available, the treatment is based on symptom management, with physical exercise being the recommended first-line treatment. Different exercise modalities have been examined, including the practice of stretching exercises. The aim of the systematic review is to summarise the efficacy of stretching exercises on fibromyalgia symptoms and to study the content and the quality of the current evidence. The review followed the recommendations of the PRISMA statement. The search for articles was performed in April 2023. We searched on MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, AMED, PEDro, ClinicalTrials.gov and the Cochrane Collaboration Trials Register. The search was updated in March 2024. The protocol was registered in PROSPERO. Risk of Bias was assessed using the Cochrane Risk of Bias tool, and quality assessment was performed using the GRADE approach. In total, 2586 studies were found in the database searches, of which nine were included in the analysis. The primary outcome was pain. Secondary outcomes were self-reported quality of life, fatigue and physical and mental functioning. The available evidence shows that stretching exercises may improve pain, health-related quality of life and physical and mental functioning, but the level of evidence is low. The main limitation is due to issues with the heterogeneity of the interventions and small sample sizes. Trial registration: PROSPERO registration number CRD42023399614. Key Points • Stretching exercises show promise in the treatment of fibromyalgia. They may improve pain, health-related quality of life, physical functioning and mental health, but the level of evidence is low. • This study goes beyond previous research by presenting a more comprehensive and detailed analysis of the content and methodological quality of the current evidence. • Further research with clearly outlined protocols must be carried out to advance our understanding of the benefits of stretching exercises on fibromyalgia symptoms.

Combining clinically common drugs with hindlimb stretching in spinal cord injured rodents.

STUDY DESIGN: Preclinical pilot study. OBJECTIVES: To explore peripheral and central nociceptive mechanisms that contribute to muscle stretch-induced locomotor deficits following spinal cord injury. SETTING: Kentucky Spinal Cord Injury Research Center, Louisville, KY, USA. METHODS: Ten female Sprague-Dawley rats received moderate, 25 g/cm T10 contusion injuries and recovered for 4 weeks. Rats were divided into three groups: Morphine/Ibuprofen-treated, Acetaminophen/Baclofen-treated, and saline control. Each group received daily hindlimb muscle stretching during weeks 4, 5, 9, and 10 post-injury and drugs were administered with stretching during weeks 4 and 9 only. Locomotor function was assessed throughout the experiment using the BBB Open Field Locomotor Scale. Hindlimb responses including spasticity, writhing, and clonic-like vibrations during muscle stretching were classified and scored. RESULTS: Consistent with our previous studies, hindlimb muscle stretching caused significant deficits in locomotor recovery following spinal cord injury. Baclofen and Ibuprofen partially mitigated the stretching effect, but none of the drugs significantly prevented the drop in locomotor function during stretching. Interestingly, treatment with Baclofen or Ibuprofen significantly reduced hindlimb responses such as spasticity and writhing during stretching, while Morphine exacerbated clonic-like vibrations in response to stretching maneuvers. CONCLUSIONS: These findings suggest that stretching may inhibit locomotor recovery through combined mechanisms of peripheral inflammation and sensitization of nociceptive afferents. When combined with central sprouting and loss of descending controls after SCI, this results in exaggerated nociceptive input during stretching. The inability of the applied clinical drugs to mitigate the detrimental effects of stretching highlights the complexity of the stretching phenomenon and emphasizes the need for further investigation.

Effects of the stretching program in male volleyball players with posterior shoulder tightness.

BACKGROUND: Stretching programs are often used to improve muscle stiffness and thereby posterior shoulder tightness (PST); however, knowledge about their effects on the viscoelastic properties of muscles and performance is limited. OBJECTIVE: The aim of this study was to investigate the effects of a six-week stretching program on the viscoelastic properties of posterior shoulder muscles, shoulder functional performance and range of motion in volleyball players with PST. STUDY DESIGN: A Randomized Controlled Trial. LEVEL OF EVIDENCE: Level II. METHODS: The study was conducted in 34 male (aged 19-26) professional volleyball players with PST. They were randomly assigned to stretching and control groups. A stretching routine (combining sleeper stretch and cross body stretch exercises) was performed in the stretching group for six weeks. Measurements were taken during the first assessment and six weeks after the initiation of stretching for the following: shoulder external/internal rotation range of motion, spike velocity, single arm seated shot-put test, and infraspinatus- posterior deltoid muscle stiffness (by shear wave elastography). RESULTS: While the stretching group had statistically better results regarding increased shoulder internal rotation (p < 0.01), spike velocity (p = 0.02) and seated single arm shot put distance (p < 0.01), stretching did not have any effect on tissue stiffness. CONCLUSIONS: A 6-week program of sleeper stretch, and cross body stretch exercises improved shoulder internal rotation and functional performance. A clinically meaningful change in muscle mechanical properties cannot be detected after a 6-week stretching program.

Assessing the Post-Activation Performance Enhancement of Upper Limbs in Basketball Athletes: A Sensor-Based Study of Rapid Stretch Compound and Blood Flow Restriction Training.

OBJECTIVE: This study introduces a novel methodology combining rapid stretch compound training with blood flow restriction (BFR) to investigate post activation performance enhancement (PAPE) in basketball players, a field that has been predominantly explored for lower limbs. We aimed to assess the efficacy of this combined approach on upper limb muscle performance in athletes. METHODS: We employed a randomized, self-controlled crossover trial with ten male basketball players. The bench press throw (BPT) served as the primary metric, with players undergoing four interventions post-baseline: (1) STR-plyometric training; (2) BFR-blood flow restriction; (3) COMB-STR integrated with BFR; and (4) CON-control. Innovatively, we utilized an intelligent tracking sensor to precisely measure peak power (PP), peak velocity (PV), mean power (MP), and mean velocity (MV) at 4, 8, and 12 min post-intervention, providing a detailed temporal analysis of PAPE. RESULTS: The COMB intervention demonstrated superior PAPE effects at 4 min, significantly outperforming STR and BFR alone and the control group across all measured indices (p < 0.05). Notably, the COMB group maintained these improvements for PV, PP, and H up to 12 min post-intervention, suggesting a prolonged effect. CONCLUSION: (1) The COMB stimulation has been shown to successfully induce PAPE more effectively than STR and BFR modality alone. (2) It appears that the optimal effects of PAPE are achieved within 4 min of exercising under this COMB. By the 12 min mark, only the COMB group continued to show significant improvements in PV, PP, and H compared to both the baseline and the CON group, while the effects in the STR and BFR groups further diminished. This suggests that although the PAPE effect is maintained over time, its optimal performance may peak at the 4 min mark and then gradually weaken as time progresses.

Combining Cyproheptadine Hydrochloride With Targeted Muscle Activation Training to Treat Upper Extremity Stroke: A Randomized, Placebo-Controlled Trial.

OBJECTIVE: To examine a treatment for upper extremity impairment in stroke survivors that combines administration of cyproheptadine hydrochloride with repetitive practice focused on control of muscle activation patterns. DESIGN: Double-blind, randomized controlled trial. SETTINGS: Laboratory within a free-standing rehabilitation hospital. PARTICIPANTS: A total of 94 stroke survivors with severe, chronic hand impairment were randomly assigned to 1 of 4 treatment groups. INTERVENTIONS: Participants received either a placebo or cyproheptadine hydrochloride in identical pill form. The daily dosage of cyproheptadine/placebo was gradually increased from 8 to 24 mg/d over 3 weeks and then maintained over the next 6 weeks while participants completed 18 therapy sessions. Therapy consisted of either (1) active practice of muscle activation patterns to play "serious" computer games or control a custom hand exoskeleton or (2) passive, cyclical finger stretching imposed by the exoskeleton. MAIN OUTCOME MEASURES: Hand control was evaluated with the primary outcome measure of time to complete the Graded Wolf Motor Function Test (GWMFT) and secondary outcome measures including finger strength and spasticity. RESULTS: Across the 88 participants who completed the study, a repeated-measures analysis of variance revealed a significant effect of GroupxEvaluation interaction on GWMFT (F=1.996, P=.026). The 3 groups receiving cyproheptadine and/or actively practicing muscle activation pattern control exhibited significant reduction in mean time to complete the GWMFT tasks; roughly one-third of these participants experienced at least a 10% reduction in completion time. Gains were maintained at the 1-month follow-up evaluation. The group receiving placebo and passive stretching did not show improvement. No significant differences among groups were observed in terms of changes in strength or spasticity. CONCLUSIONS: Despite chronic, severe impairment, stroke survivors were able to complete the therapy focused on muscle activations and achieved statistically significant improvement in hand motor control. Cyproheptadine hydrochloride is a potential complementary treatment modality for stroke survivors with hand impairment.

Proprioceptive neuromuscular facilitation stretching exercises for treatment of temporomandibular dysfunction in patients with forward head posture: A double-blinded, randomized, controlled trial.

BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated. OBJECTIVE: To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP. METHODS: A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18-40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed. RESULTS: There was no significant difference between both groups pre-treatment (p> 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p< 0.05) in favor of the PNF group. CONCLUSION: Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone.

A New Measuring Approach in Assessing Hamstring Flexibility: Reliability, Validity, and Applicability of Isolated Hamstring Flexibility Test.

OBJECTIVE: This study was planned to determine the reliability, validity, and applicability of the isolated hamstring flexibility test (IHFT). DESIGN: A cohort study (diagnosis); level of evidence, 2. SETTING: It was performed in the research and application laboratory. PARTICIPANTS: Seventy-five individuals aged 18 to 25 years, selected through simple probability random sampling, with a normal Beighton Horan and Joint Mobility Index scores, and who volunteered to participate, were included for evaluation. INTERVENTIONS: On then first and third days, participants underwent muscle strength, sit-and-reach test, active knee extension test, IHFT for validity and reliability. Stretching exercises were prescribed as a home program for 31 patients with limited knee extension, and measurements were repeated at the end of the eighth week. MAIN OUTCOME MEASURES: Sit-and-reach test, active knee extension test, IHFT. RESULTS: The test-retest reliability was high (intraclass correlation coefficient, 0.993). Our test demonstrated validity when compared in terms of flexibility gained. A significant difference was found between pre-post stretching exercise training in all 3 tests ( P < 0.05). CONCLUSION: It was observed that the IHFT is reliable and applicable in determining hamstring flexibility. Given the absence of another test specifically measuring hamstring flexibility in isolation, its indirect validity was established through analysis with other tests using the gold standard for assessing gains in hamstring flexibility.

Acute effects of static stretching exercise-induced decrease in arterial stiffness on maximal aerobic capacity.

BACKGROUND: We recently have reported that individual day-to-day arterial stiffness variations are associated with maximal aerobic capacity. However, the evidence of this phenomenon was not provided sufficiently. The present study aimed to examine whether a decrease in arterial stiffness through static stretching exercise could enhance maximal aerobic capacity. METHODS: Twelve healthy young men (age 22±2 years, mean and standard deviation) participated in this study and underwent two separate sessions in a randomized controlled crossover design: a single session of a whole-body static stretching exercise protocol that involved the trunk, upper limb, and lower limb (stretch condition), and sedentary control where they rested in the exercise room. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of systemic arterial stiffness before, immediately after and at 30 min after both conditions. Maximal oxygen uptake (V̇O2max) was assessed using a graded power test on an electronically braked cycle ergometer after these measurements. RESULTS: As we expected, there was a significant decrease in the baPWV at 30 min after the stretch trial compared to baseline values (P=0.01). The baPWV in the stretch condition was lower than that of the control condition, while V̇O2max in the stretch condition was higher than that of the control condition (P=0.03). CONCLUSIONS: Based on these findings, it can be inferred that an acute reduction in arterial stiffness may contribute to change in maximal aerobic capacity.

Acute and Chronic Effects of Static Stretching on Intramuscular Hamstring Stiffness.

Passive hamstring stiffness varies proximo-distally, resulting in inhomogeneous tissue strain during stretching that may affect localized adaptations and risk of muscle injuries. The purpose of the present study was to determine the acute and chronic effects of static stretching (SS) on intramuscular hamstring stiffness. Thirty healthy active participants had acute changes in passive biceps femoris (BF), semimembranosus (SM), and semitendinosus (ST) stiffness measured at 25% (proximal), 50% (middle), and 75% (distal) muscle length, using shear-wave elastography, immediately after SS. Participants then completed 4 weeks of either a SS intervention (n = 15) or no intervention (CON, n = 15) with stiffness measured before and after the interventions. The acute and chronic effects of SS were compared between anatomical regions and between regions on the basis of their relative stiffness pre-intervention. Acutely, SS decreased stiffness throughout the BF and SM (p ≤ 0.05) but not the ST (p = 0.326). However, a regional effect of stretching was observed for SM and ST with greater reduction in stiffness occurring in stiffer muscular regions (p = 0.001-0.013). Chronically, SS increased BF and ST (p < 0.05), but not SM (p = 0.422) stiffness compared with CON, but no regional effect of stretching was observed in any muscle (p = 0.361-0.833). SS resulted in contrasting acute and chronic effects, acutely decreasing stiffness in stiffer regions while chronically increasing stiffness. These results indicate that the acute effects of SS vary along the muscle's length on the basis of the relative stiffness of the muscle and that acute changes in stiffness from SS are unrelated to chronic adaptations.

A scoping review of the effect of chronic stretch training on sleep quality in people with sleep disorders.

PURPOSE: The widespread and health-detrimental sleep disorders have resulted in stretching exercises being investigated as a non-drug solution for enhanced sleep quality. However, a comprehensive understanding of the impact of stretching exercises on individuals with sleep disorders is lacking. METHODS: This scoping review systematically maps the existing literature and identifies research gaps on the impact of stretching exercises on sleep quality in individuals with sleep disorders. RESULTS: Sixteen eligible studies were included, where the weighted mean changes indicate a positive trend in sleep quality improvement, ranging from trivial to very large magnitudes. However, concerning the individual study results only 5 out of 16 studies reported significant improvements. Notable enhancements include a small 1.22% overall sleep quality improvement, a large 6.51% reduction in insomnia severity, a large 8.88% increase in sleep efficiency, a moderate 4.36% decrease in sleep onset latency, a large 8.27% decrease in wake after sleep onset, and a very large 14.70% improvement in total sleep time. Trivial changes are noted in sleep duration (0.58%), sleep disturbance reduction (0.07%), and daytime dysfunction reduction (0.19%). Likely mechanisms for the improvement of sleep include autonomic nervous system modulation, muscle tension relief, cortisol regulation, enhanced blood circulation, and psychological benefits such as stress reduction and mood enhancement. CONCLUSION: There is little evidence that stretching exercises positively impact sleep quality in individuals with sleep disorders. Additionally, further research is vital for designing optimal protocols, understanding of the long-term effects, and clarification of the mechanisms.

The RELAX randomized controlled trial: Stretching versus meditation for nocturnal muscle cramps.

BACKGROUND: Muscle cramps are common among persons with cirrhosis and are associated with poor health-related quality of life (HRQOL). Treatment options are limited. We compared stretching or meditation in a randomized-controlled trial (RCT). PATIENTS: We enrolled 98 patients with a history of >4 muscle cramps in the prior month from 7/22-7/23. We randomized patients 1:1 to stretching versus meditation for 35 days. Our primary outcome was the change in cramp severity measured by the visual analogue scale for cramps (VAS-cramps, scaled 0-10). Secondary outcomes included a patient global impression of change (PGIC), change in sleep quality and global HRQOL measured using the EQ-5D and VAS-global HRQOL. RESULTS: Overall, 48% of patients had cirrhosis, 40% had diabetes, 16% the median age was 63, most were women (67%) and 81% were college educated. Both arms experienced a reduction in cramp severity-a median of 1.44 (.58-2.29) points for stretching and 1.97 (1.01-2.93) points for meditation. These changes were significant changes from baseline (p = .001 for stretching, p < .0001 for meditation) but these changes were equivalent between arms (p = .4). The PGIC was improved: 1.33 (1.02-1.65) for stretching, 1.05 (.70-1.41) for meditation, p-difference .2. Sleep was also improved for both. HRQOL did not change according to the Eq5D; according to the VAS, HRQOL rose for meditation by 6 (.1-11.8) points but not for stretching. More patients recommended stretching than meditation (79.2% vs. 55.3%, p = .02). CONCLUSION: In a randomized trial, stretching and meditation both reduced cramp severity and improved sleep quality and global impression of change. While patients preferred stretching, there was no difference in effect between arms.

Effect of muscle stretching and isometric exercises on quality of life in children undergoing regular hemodialysis.

BACKGROUND: Chronic kidney disease (CKD) is a prevalent health issue that can have detrimental effects on the quality of life (QoL) of children. Nevertheless, with adequate management and support, many children with CKD can have satisfying lives. The study aimed to investigate the effect of muscle stretching and isometric exercises on QoL of children undergoing hemodialysis. METHODS: Sixty-eight children aged 6-18 years with kidney failure undergoing hemodialysis at Assiut University Children Hospital were included. They were randomly assigned to two groups. The study group received a 40-min exercise program three times per week for 2 months, while the control group received routine hospital care. For outcome measures, two tools were used: a simple questionnaire sheet for personal and medical data and PedsQL™ scale. RESULTS: After 2 months of exercise, it was shown that most children in the study group (66.7%) had good QoL, in contrast to only 3.3% in the control group, with a highly statistically significant variation between the two examined groups pertaining to the health-related QoL scale (P value = 0.001) after exercise. CONCLUSION: The intensity of care for children on hemodialysis has a distinguished impact upon their quality of life. The implementation of muscle stretching and isometric exercises during hemodialysis represents an important aspect of such care that may be associated with significant improvement in all domains of QoL. Children undergoing hemodialysis need well-organized programs that cover all physical and psychological aspects with smart time manipulation and increased attention from their staff.