Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review
Publication: Applied Physiology, Nutrition, and Metabolism
8 December 2015
Abstract
Recently, there has been a shift from static stretching (SS) or proprioceptive neuromuscular facilitation (PNF) stretching within a warm-up to a greater emphasis on dynamic stretching (DS). The objective of this review was to compare the effects of SS, DS, and PNF on performance, range of motion (ROM), and injury prevention. The data indicated that SS- (–3.7%), DS- (+1.3%), and PNF- (–4.4%) induced performance changes were small to moderate with testing performed immediately after stretching, possibly because of reduced muscle activation after SS and PNF. A dose–response relationship illustrated greater performance deficits with ≥60 s (–4.6%) than with <60 s (–1.1%) SS per muscle group. Conversely, SS demonstrated a moderate (2.2%) performance benefit at longer muscle lengths. Testing was performed on average 3–5 min after stretching, and most studies did not include poststretching dynamic activities; when these activities were included, no clear performance effect was observed. DS produced small-to-moderate performance improvements when completed within minutes of physical activity. SS and PNF stretching had no clear effect on all-cause or overuse injuries; no data are available for DS. All forms of training induced ROM improvements, typically lasting <30 min. Changes may result from acute reductions in muscle and tendon stiffness or from neural adaptations causing an improved stretch tolerance. Considering the small-to-moderate changes immediately after stretching and the study limitations, stretching within a warm-up that includes additional poststretching dynamic activity is recommended for reducing muscle injuries and increasing joint ROM with inconsequential effects on subsequent athletic performance.
Résumé
Depuis peu, on utilise plutôt l’étirement dynamique (« DS ») que l’étirement statique (« SS ») ou la facilitation neuromusculaire proprioceptive (« PNF ») au sein d’une séance d’échauffement. Cette analyse documentaire se propose de comparer les effets de SS, DS et PNF sur la performance, l’amplitude de mouvement (« ROM ») et la prévention de blessures. D’après les données, on observe des modifications de performance faibles à modérées quand l’évaluation est réalisée immédiatement après la séance d’étirement : SS (–3,7 %), DS (+1,3 %) et PNF (–4,4 %), et ce, possiblement à cause de la diminution de l’activation musculaire consécutive à SS et PNF. La relation dose-réponse révèle une plus grande baisse de performance quand la séance de SS par groupe musculaire ≥60 s (–4,6 %) vs. <60 s (–1,1 %). Par contre, SS suscite un gain modéré de performance (2,2 %) quand le muscle est plus allongé. L’évaluation est réalisée en moyenne 3-5 minutes post-étirement. La plupart des études n’incluent pas des activités dynamiques post-étirement; avec l’inclusion de ces activités, on n’observe pas de modification nette de la performance. DS suscite des gains de performance faibles à modérés quand la séance est effectuée dans les minutes suivant l’activité. SS et PNF n’ont pas d’effet clair sur les blessures dues au surmenage ou toutes causes confondues; il n’y a pas de données au sujet de DS. Tous les types d’entraînement, notamment ceux <30 min présentent des gains de ROM. Les modifications dépendent peut-être de la diminution ponctuelle de la rigidité tendineuse et musculaire ou d’adaptations nerveuses causant une plus grande tolérance à l’étirement. Compte tenu des modifications faibles à modérées immédiatement après la séance d’étirement et des limites des études, l’inclusion des étirements au sein d’une séance d’échauffement comportant l’ajout d’activités dynamiques post-étirement est recommandée pour diminuer les blessures musculaires et accroître ROM articulaire sans conséquence sur la performance physique subséquente. [Traduit par la Rédaction]
Introduction
The conventional’ preactivity routine consists of a submaximal exercise component (e.g., running, cycling), a bout of muscle stretching in which muscles are held in an elongated position for 12–60 s (Ebben et al. 2004; Simenz et al. 2005), and a segment of skill rehearsal (specific warm-up) in which the individuals perform dynamic movements similar to those of the sport or event (Young 2007). Static stretching (SS) is considered an effective method for increasing joint range of motion (ROM) (Paradisis et al. 2014; Power et al. 2004) and is often thought to improve performance (Young and Behm 2003; Young 2007) and reduce the incidence of activity-related injuries (Ekstrand et al. 1983; Hadala and Barrios 2009). It is therefore commonly performed in preactivity routines (Ebben et al. 2005; Simenz et al. 2005). However, recent evidence suggests that sustained SS could impair subsequent performance (Shrier 2004; Behm and Chaouachi 2011; Kay and Blazevich 2012), and the perceptions regarding the benefits of SS in a preactivity routine have changed dramatically. Indeed, the current evidence indicates significant positive effects of dynamic forms of stretching (DS). There is also debate as to the benefits of preactivity stretching with respect to changes in ROM and injury risk.
Prior reviews have examined SS (Kay and Blazevich 2012), or SS and DS (Behm and Chaouachi 2011), but no reviews have comprehensively investigated the effects of preactivity SS, DS, and proprioceptive neuromuscular facilitation (PNF) on subsequent performance, ROM, and injury incidence. Furthermore, many additional studies have been published since these reviews. In this review, we provide an overview of the literature citing the effects of preactivity stretching on physical performance, injury risk, and ROM, as well as the physiological mechanisms, with the objective of investigating, analyzing, and interpreting the acute physical responses to a variety of stretching techniques to provide clarity regarding the impact on performance, ROM, and injury.
Materials and methods
Search strategy
This review included studies that examined the acute effects of SS, DS, and PNF stretching on physical performance, ROM, and injury incidence. A literature search was performed independently by the 4 authors using MEDLINE, SPORT Discus, ScienceDirect, Web of Science, and Google Scholar databases using a number of key terms: static, dynamic, ballistic stretching, PNF, flexibility, warm-up, prior exercise, performance, injury, and acute effects. These key words were used individually and/or were combined. All references from the selected articles were also cross-checked by the authors to identify relevant studies that may have been missed in the search.
Inclusion criteria
Studies examining the acute effects of muscle stretching on ROM and functional performance were included in the review if they fulfilled the following selection criteria: (i) the study contained research questions relating to the effect of SS, DS, and/or PNF stretching on performance, ROM, and injury and used (ii) healthy and active human subjects (senior adult studies excluded); (iii) the outcome was a physiological or performance measure; and (iv) the study was an English language study written between 1989 (first paper to report poststretch force impairments) and 2014 and published as an article in a peer-reviewed journal or conference proceeding (abstracts and unpublished studies were excluded). The exclusion of non-English articles is a limitation of this review. Furthermore, studies were delineated with respect to their internal validity. Selection criteria included studies involving (i) a control group, (ii) randomized control, and (iii) instruments with high reliability and validity. Studies reporting the effects of preactivity muscle stretching on joint ROM and injury incidence were also examined, without the above criteria being adhered to (some omissions were made, and these are described in the text).
Mean changes in performance were noted for each study, and the weighted means (i.e., means adjusted relative to study sample size) and 95% confidence intervals (CIs) were determined. Based on the prevalence of different magnitudes of change reported in the literature and an estimated smallest worthwhile change of 0.5%, we refer to changes of <0.5% as trivial, 0.5%–<2% as small, 2%–<5% as moderate, 5%–10% as large, and >10% as very large (Hopkins 2004). Effect sizes (ES) describing the magnitude of the differences between groups or experimental conditions (Cohen 1988) were calculated for each study for which absolute mean data and SD statistics were provided; weighted ES and 95% CIs were then determined. Cohen (1988) described ES <0.2 as representing a trivial, 0.2–0.39 as a small, 0.4–0.69 as a moderate, and ≥0.7 as a large magnitude of change.
Acute effects of muscle stretching
Static stretching
SS involves lengthening a muscle until either a stretch sensation (Cronin et al. 2008) or the point of discomfort is reached (Behm et al. 2004) and then holding the muscle in a lengthened position for a prescribed period of time (Ebben et al. 2004). SS is commonly used in clinical and athletic environments with the specific aims of increasing joint ROM and reducing injury risk (McHugh and Cosgrave 2010). However, a growing body of research has reported negative effects of SS on maximal muscular performance. Although early reviews accessed relatively few studies and reported equivocal findings (Rubini et al. 2007; Shrier 2004; Young 2007), more recent reviews encompassing a broader body of work have highlighted a clear dose–response effect in which longer stretch durations (e.g., ≥60 s) likely elicit performance impairments (Behm and Chaouachi 2011; Kay and Blazevich 2012), which may have important implications for athletic and clinical performance.
The largest systematic review to date (Kay and Blazevich 2012) examined 106 SS studies; our searches found a further 19 studies since 2011 that met our criteria, resulting in 125 studies incorporating 270 maximal performance measures (Table 1, Supplementary Table S11 and Supplementary Fig. S1a1) examining the acute effects of SS on performance (e.g., vertical jump height, sprint running time, chest and bench press 1-repetition maximum (1-RM), and maximal voluntary contractions (MVC)). The data revealed 119 significant performance reductions, 145 nonsignificant findings, and 6 significant improvements after SS. Unfortunately, 42 studies failed to adequately report either mean changes (16 nonsignificant and 2 significant; 7% of total findings) or pre- and poststretch means ± SD data (36 significant and 38 nonsignificant; 27% of total findings), which prevented the inclusion of ES for these measures. The weighted estimates of the remaining 178 measures revealed a moderate 3.7% mean performance reduction (Table 1). Thus, although there are some occasions in which large or very large reductions are reported (e.g., Trajano et al. 2014), SS generally induces moderate mean (<5%) performance impairments when testing is performed within minutes of stretching. Given the substantial between-study differences in poststretch changes (range, +5% to –20.5%), closer examination of the possible variables that influence the likelihood and magnitude of performance change after SS is required.
Table 1.
Note: “With 0s” refers to calculations in which means and effect sizes were given values of zero (0) when data for nonsignificant changes were not published, and “no 0s” refers to calculations that excluded studies that did not report data for nonsignificant changes. CC, counterbalanced control; CI, confidence interval; CV, cardiovascular; N, number of participants; NR, not reported; POD, point of discomfort; RC, randomized control; Sens, stretch sensation.
Dose–response relationship
Several original (Kay and Blazevich 2008; Knudson and Noffal 2005; Robbins and Scheuermann 2008; Siatras et al. 2008) and review (Behm and Chaouachi 2011; Kay and Blazevich 2012) articles report a clear dose–response relationship, with ≥60 s of SS being more likely to result in a significant performance impairment, but shorter durations having little effect (Behm and Chaouachi 2011; Kay and Blazevich 2012). Thus, studies were separated into those in which total stretch duration per muscle group was <60 s and those in which it was ≥60 s. Thirty-nine studies incorporating 60 maximal performance measures used <60 s of SS, with 45 nonsignificant changes reported. Statistically significant reductions (range, –1.2% to –8.5%) were found in 10 measures, including sprint running velocity (Fletcher and Jones 2004), jump height (Hough et al. 2009), and knee extensor MVC (Siatras et al. 2008). Interestingly, significant improvements (range, +1.6% to +4.1%) were also found in 5 measures, including sprint running time (Little and Williams 2006), jump height (Murphy et al. 2010b), and peak cycling power (O’Connor et al. 2006). However, because most findings were nonsignificant, it is unsurprising that the weighted estimates revealed a small 1.1% mean reduction in performance. Ninety-eight studies incorporating 210 maximal performance measures using longer stretch durations (≥60 s) revealed 109 significant reductions, 100 nonsignificant findings, and only 1 significant improvement. Given the greater prevalence of significant reductions, it was not surprising that the weighted mean change was larger (–4.6%) (Supplementary Table S41). Thus, despite the clear dose–response relationship, the likely effect on performance was moderate (<5%) even after longer stretch durations, although in many contexts these impairments will be practically relevant (e.g., in elite competitions such as sprinting, long and high jumps, throws (discus, javelin, shot), and others).
Effect of SS in different performance tasks
To determine whether SS produced similar performance changes in different performance activities, the findings of the studies were separated into power–speed- or strength-based tasks. Fifty-two studies reported 82 power–speed-based measures (i.e., jumping, sprint running, throwing), with 56 nonsignificant changes, 21 significant reductions, and 5 significant improvements; collectively, there was a small 1.3% reduction in performance. Seventy-six studies reported 188 strength-based measures (i.e., 1-RM, MVC), with 79 nonsignificant changes, 108 significant reductions, and only 1 significant improvement. There was a moderate reduction in performance (–4.8%), which indicates a more substantial effect of SS on strength-based activities. The stretch durations imposed between activity types were considerably longer for strength-based activities (5.1 ± 4.6 min) than for power–speed-based activities (1.5 ± 1.6 min), which may explain the greater mean performance reductions after SS.
Dose–response effect in power–speed tasks
Twenty-six studies incorporating 38 power–speed-based measures used <60 s of SS, with 29 nonsignificant changes, 4 significant reductions, and 5 significant improvements in performance; collectively, there was a trivial change in performance (–0.15%) (Supplementary Table S41). It is interesting to note that although most of the findings were not statistically significant after short-duration stretching, a greater number of significant improvements than reductions were found in jumping (Murphy et al. 2010b), sprint running (Little and Williams 2006), and cycling (O’Connor et al. 2006) performances. Thus, there is no clear effect of short-duration SS on power–speed-based activities, although changes may be observed on a study-by-study (and hence, subject-by-subject) basis. Nonetheless, when 28 power–speed-based studies (44 measures) using ≥60 s of stretching were examined, 27 nonsignificant changes and 17 significant reductions were found, with no study reporting a significant performance improvement. Compared with shorter-duration stretching, the mean reductions were marginally greater (–2.6%) (Supplementary Table S41). Despite a greater likelihood and magnitude of effect of longer-duration SS, changes are most likely to be small to moderate.
Dose–response effect in strength tasks
Fourteen studies incorporating 22 maximal strength–based measures imposed <60 s of SS, with 16 nonsignificant changes, 6 significant reductions, and no significant improvements in performance being reported; collectively, there was a moderate reduction in performance (–2.8%) (Supplementary Table S41). However, when strength-based studies using ≥60 s were examined, 72 studies incorporating 166 measures with 73 nonsignificant changes and 92 significant reductions were found; only 1 significant improvement in performance was observed. Compared with shorter-duration stretches, the mean 5.1% reduction was greater. Mean changes are clearly greater for strength- than for power–speed-based tasks regardless of duration (although this may be the result of strength-based studies using substantially longer stretch durations), and the dose–response effect remains clear.
Dose–response effect for contraction types
Similar moderate-to-large reductions were reported in studies measuring concentric (–4.4%) and eccentric (–4.2%) strength, with slightly greater mean reductions in isometric strength (–6.3%). Studies were further separated based on stretch durations (<60 s vs. ≥60 s), with a negative dose-dependent effect of stretch on concentric (<60 s, –1.5%; ≥60 s, –4.8%) and isometric (<60 s, –4.5%; ≥60 s, –6.8%) strength calculated for shorter and longer stretch durations. respectively. Only 9 studies examined the influence of SS on eccentric strength, incorporating 23 measurements and all imposing ≥60 s of stretch. Thus, dose-dependent effects cannot be examined suitably in this context. Nonetheless, 3 studies (Brandenburg 2006; Sekir et al. 2010; Costa et al. 2013) reported significant reductions in a total of 8 eccentric strength measures, whereas 6 studies (Ayala et al. 2014; Cramer et al. 2006, 2007; Gohir et al. 2012; McHugh and Nesse 2008; Winke et al. 2010) reported no change in 15 eccentric measures (≥60 s, –4.2%); these small-to-moderate changes are similar to those observed when isometric and concentric testing were completed (Supplementary Table S41). Considering that most muscle strain injuries occur during the eccentric phase in most activities (Orchard et al. 1997), the limited number of studies describing the effect of SS on maximal eccentric strength is problematic, especially given that no studies have examined the effects of shorter stretch durations. The limited data available on the impact of longer-duration SS on eccentric strength suggest that a small negative effect may be likely; nonetheless, the influence of shorter durations of SS on eccentric strength remains to be studied properly.
Effect of muscle length on SS-induced performance changes
Five studies examined whether the muscle length adopted during testing influenced the subsequent strength loss (Nelson et al. 2001; Herda et al. 2008; McHugh and Nesse 2008; McHugh et al. 2013; Balle et al. 2015). Four studies examined the knee flexors (Herda et al. 2008; McHugh and Nesse 2008; McHugh et al. 2013; Balle et al. 2015) and the other examined the knee extensors (Nelson et al. 2001). All 5 studies demonstrated marked strength loss at short muscle lengths (–10.2%), which contrasted with moderate strength gains at the longest muscle lengths tested (+2.2%). Notwithstanding this, potential reductions in maximal force may be notable in activities performed at shorter muscle lengths, yet performance may be enhanced in activities performed at longer muscle lengths; this may be of practical importance given that muscle strain injuries are more likely to occur with the muscle at a longer, rather than a shorter, length.
Effect of SS in different muscle groups
Lower-limb strength was examined in 67 of the 75 studies in which strength tests were completed. Overall, similar responses were observed in the knee extensors (–3.7%), knee flexors (–6.3%), and plantar flexors (–5.6%). When these studies were further separated based on the stretch duration (<60 s vs. ≥60 s per muscle group), evidence for a dose-dependent effect of stretch was observed in the knee extensors (<60 s, –2.6%; ≥60 s, –3.8%), knee flexors (<60 s, –4.8%; ≥60 s, –6.4%), and plantar flexors (<60 s, –3.5%; ≥60 s, –5.9%). Taken together, these data are indicative of a dose-dependent effect of stretch, with similar moderate-to-large mean changes calculated for all muscle groups after shorter and longer stretch durations, respectively. However, considering the large 95% CIs in several of the findings (Supplementary Table S41), some caution should be used when interpreting the mean changes reported, because substantial variability exists among studies.
Dynamic stretching
DS involves the performance of a controlled movement through the ROM of the active joint(s) (Fletcher 2010). For a number of reasons, DS is sometimes considered preferable to SS in the preparation for physical activity. First, there may be a close similarity between the stretching and exercise movement patterns (Behm and Sale 1993). Second, DS activities can elevate core temperature (Fletcher and Jones 2004), which can increase nerve conduction velocity, muscle compliance, and enzymatic cycling, accelerating energy production (Bishop 2003). Third, DS and dynamic activities tend to increase rather than decrease central drive, as may occur with prolonged SS (Guissard and Duchateau 2006; Trajano et al. 2013).
An examination of the data (48 studies incorporating 80 measures) (Table 2, Supplementary Table S21 and Supplementary Fig. S1b1) revealed that the weighted mean performance enhancement associated with DS was 1.3%. Unsurprisingly, given the modest changes, almost one-half of the measurements (37 of 80) demonstrated trivial magnitude changes, with only 6 studies reporting subsequent small-to-large relative performance impairments (Nelson and Kokkonen 2001; Bacurau et al. 2009; Curry et al. 2009; Barroso et al. 2012; Franco et al. 2012; Costa et al. 2014). Thus, although there are occasions in which moderate or large improvements in performance are reported, overall, no robust evidence exists for substantial performance enhancements after DS.
Table 2.
Note: “With 0s” refers to calculations in which means and effect sizes were given values of zero (0) when data for nonsignificant changes were not published, and “no 0s” refers to calculations that excluded studies that did not report data for nonsignificant changes. “Rest period–stretch” refers to the recovery time between repetitions. All percentage changes and effect sizes compare the dynamic stretch intervention with a control measure where possible. CC, counterbalanced control; N, number of participants; NA, not available.
Dose–response relationship for DS
Most studies did not report specific stretch durations but rather, gave descriptions of the number of exercises, sets, and repetitions. The weighted mean DS workload was 49.2 repetitions (95% CI 25.1–73.2). When reported, 11 studies had set durations of 30 s, 8 studies used 15-s set durations, and 4 studies used set durations of 20, 25, and 40 s, respectively (Table 2 and Supplementary Table S21). Behm and Chaouachi (2011) reported a DS dose–response effect in which greater overall peak force and power improvements were observed when >90 s (7.3% ± 5.3%) vs. <90 s (0.5% ± 2.3%) of DS was imposed immediately before testing. However, trivial ES or statistically nonsignificant performance changes were also elicited by both longer DS durations of 10 min (Needham et al. 2009) and 15 min (Zourdos et al. 2012) and by 180 repetitions (Herda et al. 2008), as well as by shorter durations, such as 45 s (Beedle et al. 2008), 60 s (Samuel et al. 2008), and 150 s (Amiri-Khorasani et al. 2010), or 2 repetitions of 4 exercises (Dalrymple et al. 2010). Hence, based on the variability among studies, it is difficult to demonstrate a dose–response relationship with DS.
Effect of DS on strength vs. power measures
Force measurements have been performed using isometric or slower, dynamic movements (e.g., leg extensions, squats); thus, the test movement velocity does not always correspond with the DS movement velocity. The data analysis revealed small weighted changes for both strength-based performances (18 measures) and power-based tests (51 measures) (Table 2). When evaluated further, moderate mean improvements of 2.1% were observed for jump performances (34 measures), whereas repetitive actions such as running or sprinting or agility (17 measures) showed a small 1.4% improvement. The lack of movement velocity similarity between the leg press and DS activities may have been a factor, with a trivial (4 measures) mean impairment of –0.23%. This may indicate that part of the positive effect of DS comes from allowing practice at tasks similar to those in the tests.
Effect of DS by contraction type
Only 11 studies tested specifically during concentric (16 measures) or eccentric (3 measures) contractions (Table 2 and Supplementary Table S41). There was a trivial average 0.4% increase in concentric force or torque (Supplementary Table S41). The 3 eccentric measures meeting our criteria had extensive variability (Supplementary Table S41), and thus, the relatively small percentage decrease (–1.2%) is not truly reflective. Hence, the limited data indicate generally inconsequential contraction type–dependent effects of DS on force production.
Effect of DS movement frequency
The stretch frequency and ROM (and possibly perceived intensity) of stretches may also influence the effect of DS. Some studies do not report stretch intensity (Manoel et al. 2008; Dalrymple et al. 2010), but some report movement frequency (i.e., the number of dynamic movements per unit time) (Bacurau et al. 2009; Fletcher 2010). Higher frequencies of DS and ballistic stretching (stretching using momentum in an attempt to exceed the normal ROM, which can include bouncing) may augment spindle reflex afferent excitation of the motor neurons and may theoretically affect subsequent performance (Matthews 1981). Fletcher (2010) reported that dynamic leg swings at 100·min−1 resulted in significantly greater (6.7%–9.1%) countermovement jump and drop jump heights than did DS activities at 50·min−1. However, even the lower-frequency DS (50·min−1) elicited 3.6% significantly greater jump performances than did a no-stretch condition. Studies combining both slow and faster rates of dynamic movements in the same preactivity routine have reported significant improvements in vertical jump height (4.9%) (Hough et al. 2009), hamstrings and quadriceps eccentric and concentric torque (∼7%–15%) (Sekir et al. 2010), and leg extension power (10.1%) (Yamaguchi et al. 2007). However, Franco and colleagues (2012) combined slow and fast movements (3 exercises, with 5 slow plus 5 fast movements) and reported a decrease in Wingate peak power and time to peak power (mean and % changes were not provided). Cycling is not a DS-shortening cycle movement, so this negative result is consistent with the previously discussed potential for a movement pattern–specific effect of DS.
Inconsistent results are reported with the use of ballistic or bobbing (bounce through the movement at the end of ROM) movements. Both Bacurau and colleagues (2009) and Nelson and Kokkonen (2001) used 20 min of ballistic stretch activities and reported a 2.2% decrease in leg press 1-RM and a ∼5%–7% decrease in knee flexion and extension 1-RMs, respectively (likely fatigue related). Other studies imposing shorter durations of ballistic stretching or bobbing actions at end ROM have reported no significant effects (Bradley et al. 2007; Samuel et al. 2008). Cumulatively, the data show a tendency toward an increase in performance with faster and/or more intense ballistic stretches, but substantial variability exists among studies and with regard to performances in different tests within studies, so a firm conclusion cannot be drawn.
Effect of magnitude of DS movement on performance
The ROMs adopted during DS vary considerably among studies, with authors describing “ROM” as a DS through the active ROM, maximal or end of ROM, exaggerated movements, bobbing, bouncing, ballistic bouncing movements (indeterminate ROM extent), mild stretch, and others. Most studies report that movements were performed through a full or nearly full active ROM. Stretches performed through the active or maximal ROM resulted in trivial and nonsignificant performance changes (Beedle et al. 2008; Herda et al. 2008; Curry et al. 2009; Amiri-Khorasani et al. 2010; Chaouachi et al. 2010; Paradisis et al. 2014), performance enhancements (Fletcher and Anness 2007; Yamaguchi et al. 2007; Chaouachi et al. 2010), or performance impairments (Curry et al. 2009). Two studies reporting performance impairments required subjects to perform small ballistic bouncing or bobbing movements near the end ROM (Nelson and Kokkonen 2001; Bacurau et al. 2009). Studies using “exaggerated movements”, which may or may not reach the end of the active ROM, report both performance impairments (Costa et al. 2014) and no significant effect (Dalrymple et al. 2010). Thus, there is no identifiable trend as to the effects associated with DS through a full (maximal) or nearly full (submaximal) ROM.
PNF stretching
PNF stretching incorporates SS and isometric contractions in a cyclical pattern to enhance joint ROM, with 2 common techniques being contract relax (CR) and contract relax agonist contract (CRAC) (Sharman et al. 2006). The CR method includes an SS phase followed immediately by an intense, isometric contraction of the stretched muscle, with a further additional stretch of the target muscle completed immediately after contraction cessation. On the other hand, the CRAC method requires an additional contraction of the agonist muscle (i.e., opposing the muscle group being stretched) during the stretch, prior to the additional stretching of the target muscle (Sharman et al. 2006). Despite its efficacy in increasing ROM, PNF stretching is rarely used in athletic preactivity routines, possibly because (i) there is normally a requirement for partner assistance, (ii) it may be uncomfortable or painful, and (iii) muscle contractions performed at highly stretched muscle lengths can result in greater cytoskeletal muscle damage (Butterfield and Herzog 2006) and speculatively an increased risk of muscle strain injury (Beaulieu 1981), although no data clearly support this. Notwithstanding these potential limitations, PNF stretching remains an effective practice and its impact on muscular performance is worthy of examination.
Relatively few studies report the effects of PNF stretching, and no comprehensive or meta-analytical review exists that evaluates the effects of PNF stretching. This is surprising because PNF is a highly effective stretching method for ROM gain and includes an SS phase within the protocol and thus may be predicted to influence physical performance. Our search revealed 14 studies reporting the effects of PNF stretching on performance, with 11 using the CR method and 3 using CRAC. Because of the limited number of studies using CRAC, and the differences in methodology across stretching modes, we have reported only on CR stretching. Eleven studies incorporated 23 performance measures (Table 3, Supplementary Table S31, and Supplementary Fig. S1c1) examining the acute effects of CR PNF stretching on maximal muscular strength and power performance. Seventeen nonsignificant findings and 6 significant performance reductions were reported; no studies reported a performance improvement immediately after PNF stretching. Although the majority of studies reported no significant change in performance, our weighted estimate showed a 4.4% mean reduction in performance (Table 3). Thus, although notable performance impairments have been reported, PNF stretching generally induces small-to-moderate changes in performance that may be meaningful only in some clinical or athletic environments.
Table 3.
Note: CC, counterbalanced control; CV, cardiovascular; N, number of participants; NR, not reported; POD, point of discomfort; RC, randomized control; Sens, stretch sensation.
Dose–response relationship
The limited number of studies imposing PNF stretching, coupled with the relatively small range of stretch durations (5–50 s), made an examination of the dose–response relationship impossible. The CR routine was normally repeated 2–5 times, providing an average SS phase of 2.5 ± 2.9 min. Based on our report of the effects of SS using durations >60 s, it may be concluded that the deficit induced by SS (–4.6%) is similar to that induced by PNF stretching (–4.4%). However, 9 of the 11 studies incorporating PNF stretching also compared the results with an SS condition, which enabled a direct comparison of the 2 stretch modes and eliminated stretch duration as a confounding factor. These studies showed that SS had a smaller negative impact (–2.3%) than did PNF stretching (–6.4%), indicating a more substantive effect after PNF. Regardless, the data are indicative of a small-to-large effect of PNF stretching on maximal muscular performance.
Effect of PNF on power–speed tasks
Three studies reported 4 vertical jump performances, including squat and countermovement jump heights. One study reported a moderate-to-large and statistically significant reduction (–5.1%) in jump height (Bradley et al. 2007); however, this effect was no longer observed at 15 min after stretch; no significant difference was reported in the remaining 2 studies (Christensen and Nordstrom 2008; Young and Elliott 2001). One study (Bradley et al. 2007) examining 2 jump measures did not report either the mean changes or pre- and poststretch results, which prevented the calculation of ES for these measures. Nonetheless, analysis of the available data revealed a small mean reduction (–1.6%); thus, any impact on jump performance is likely to be trivial to small (Supplementary Table S41).
Effect of PNF on strength tasks
Eight PNF studies examined 19 strength-based measures; 16 nonsignificant findings and only 3 significant losses were reported. One study (Reis et al. 2013) did not report percentage changes, which would have enabled weighted estimate calculation, whereas another study (Balle et al. 2015) did not report pre- and poststretching results, which would have enabled ES calculation. Nonetheless, the weighted estimate for the available findings revealed a large mean performance reduction (–5.5%); however, large 95% CIs (Supplementary Table S41) indicate a highly variable impact on muscular strength that may be practically meaningful yet small in comparison to interindividual variability in strength scores.
Effect of PNF on different contraction types
Five studies reported 11 findings pertaining to concentric strength with a moderate mean reduction (–2.1%) observed. Four studies reported 8 findings pertaining to isometric strength with a larger but variable effect (–8.3%) (Supplementary Table S41). However, 1 study (Reis et al. 2013) did not report percentage change data for its nonsignificant finding, whereas another study (Balle et al. 2015) did not report pre- and poststretching results, which would have enabled ES calculation. Thus, caution should be used when interpreting our estimate given the proportionally large number of studies omitted from the analysis. Interestingly, no studies were found that examined the influence of PNF stretching on eccentric strength. Considering that eccentric strength (Orchard et al. 1997) is a factor purported to influence muscle strain injury risk, and that most muscle strain injuries occur during the eccentric phase of activities, the influence of PNF stretching on eccentric strength requires further investigation.
Stretching-induced force loss mechanisms
Understanding the mechanisms underpinning the stretch-induced force loss allows us to make sense of between-study differences in results and to develop strategies to overcome any force and/or performance reductions. Minimal evidence has been presented as to how DS affects the neuromuscular system, although one may speculate that its effects are similar to those of other dynamic warm-up methods (e.g., Bishop 2003); thus, this section focuses on the effects of SS and PNF stretching.
Changes in tendon stiffness and the force–length relationship
Acute muscle stretching has been hypothesized as reducing tendon stiffness, forcing the muscle to work at shorter and weaker (according to its force–length relationship) lengths (Cramer et al. 2007; Fowles et al. 2000; Nelson et al. 2001; Weir et al. 2005). Indeed, several studies have demonstrated greater stretch-induced strength loss at short vs. long muscle lengths (e.g., Nelson et al. 2001; Herda et al. 2008), although this effect may also be explained by muscle length–specific reductions in central (neural) drive (see Reduced central (efferent) drive). Evidence against this hypothesis includes data showing that gastrocnemius works at the same length after acute muscle stretching despite a reduction in peak force production (Kay and Blazevich 2009); thus, muscle length did not cause the force decline. In addition, potential reductions in muscle length would not affect, or may even increase, force production in muscles working at optimum length or on the descending limb of their force–length relation. Given our current understanding, changes in muscle length are unlikely to be an important mechanism influencing the force reduction after SS.
Stretch-induced contractile “fatigue” or damage
Mechanical stretch imposed on the muscle–tendon unit could cause damage within the muscle itself, thus reducing contractile force capacity (i.e., length at optimum force) (Brooks et al. 1995). Decreases in electrically stimulated force after acute plantar flexor stretches (Trajano et al. 2013, 2014) may be considered evidence for the hypothesis; however, these reductions were disproportionally smaller than, and not correlated with, the loss of voluntary force and were not correlated with the recovery of force after stretch (Trajano et al. 2014). As yet, practically meaningful muscle damage has not been reported after SS in humans.
Muscle stretching may also reduce blood flow and tissue oxygen availability, causing an accumulation of metabolic end products and/or reactive oxygen and nitrogen species (Palomero et al. 2012). In animal studies, passive stretching has increased nitric oxide (Tidball et al. 1998) and reactive oxygen species (Palomero et al. 2012) production. No direct measurements have been made in humans; however, Trajano and colleagues (2014) observed that intermittent stretching (15 s rest between 5 stretches of 1 min each) caused notable perfusion and reperfusion of plantar flexor muscles and a greater magnitude of and longer-lasting force loss than did the same volume of continuous stretching, even though the absolute level of deoxygenation was greater during continuous stretches. Thus, ischemia–reperfusion cycles induced by intermittent stretching appear to be particularly problematic. The mechanism by which these cycles impair force production is not known specifically, but it appears not to be caused by a decrease in intracellular free calcium concentration (Trajano et al. 2014).
Diminished electromechanical coupling
Theoretically, impaired sarcolemmal action potential transmission may impair calcium release during muscle activation. Eguchi and colleagues (2014) observed decreases in electromyography (EMG) signal frequency during 30-s low-intensity (submaximal) deltoid contractions after 30-s SS or DS; however, it is not clear whether this indicates a change in sarcolemmal transmission or a shift in the motor unit recruitment pattern towards lower-threshold (e.g., type I) motor units. Furthermore, Trajano and colleagues (2014) reported no change in M-wave amplitude after 5 plantar flexor stretches of 1 min each. No other studies have made such measurements, and no studies have used other methods such as assessment of action potential velocity or EMG frequency characteristics during maximal, or maximally fatiguing, contractions.
Changes in tendon stiffness also speculatively influence electromechanical delay (Cresswell et al. 1995; Waugh et al. 2013, 2014) and thus reduce the rate of force production. However, despite correlations being observed between tendon stiffness (or changes with exercise training) and electromechanical delay (or its change with training) (Waugh et al. 2013, 2014), this effect has not been shown explicitly. Reductions in tendon stiffness are also thought to affect the rate of force development (Bojsen-Møller et al. 2005; Waugh et al. 2013). However, small changes in tendon stiffness (e.g., a 30% increase after strength training in children) do not appear to influence the rate of force development (Waugh et al. 2014) so it is unlikely that the changes in tendon stiffness elicited by acute muscle stretching meaningfully influence it.
In addition, muscle stretching theoretically could reduce the force transfer efficiency from the contractile component to the skeleton (e.g., endo-, epi-, and perimysial transmission) (Huijing 1999) alongside the stretch-induced reductions in muscle stiffness (Kay and Blazevich 2009; Morse et al. 2008). However, this possibility has not been assessed directly in humans.
Reduced central (efferent) drive
Associations between reductions in EMG amplitude and maximal voluntary force production have been observed (Fowles et al. 2000; Kay and Blazevich 2009). However, others report no changes in EMG amplitude (e.g., Herda et al. 2008; Ryan et al. 2008), so a consensus cannot be reached regarding changes in central drive as assessed using EMG. Nonetheless, reductions in the EMG/M ratio (reducing peripheral influences on EMG amplitude), voluntary activation levels (measured using the interpolated twitch technique), and V-wave amplitude (a variant of the H reflex providing evidence of voluntary drive to the motoneurons) have been observed after stretch (Trajano et al. 2013, 2014). Furthermore, these variables increased in the early period (<15 min) after stretch, and their changes were correlated with the changes in maximal force production (e.g., Trajano et al. 2013, 2014). Indeed, the simultaneous recoveries of voluntary force and central drive (EMG) have been observed in other studies. Thus, changes in central drive appear to underpin changes in muscular force production after stretching.
Central drive can be modulated by sensory (afferent) inputs (Matthews 1981), which may modulate supraspinal outflow from the motor cortex. Alternatively, reductions in muscle spindle–dependent feedback to the motoneuron pool (i.e., at the spinal cord), reductions in intrafusal (muscle spindle) discharge leading to a reduction in voluntary drive onto the motoneurons via the γ-loop, altered excitability of spinal interneurons (facilitatory and inhibitory), or a change in excitability of the postsynaptic membrane may contribute. Recent evidence suggests that muscle stretching can reduce persistent inward current formation at the motoneurons (Trajano et al. 2014), which probably occurs via a reduced muscle spindle facilitation of the motoneuron. Thus, changes at the spinal level appear to be closely linked with the reduction in muscle force. Given that inward currents are amplified by central nervous system stimulants (e.g., caffeine), emotional arousal, and the simultaneous contraction of other muscles, such findings hint at potential interventions that may reduce the loss of force after muscle stretching. Persistent inward current formation was also greater at longer than at shorter muscle lengths, which may partly explain the greater loss of muscle force at shorter muscle lengths (Herda et al. 2008; McHugh et al. 2013).
Acute effects of SS, DS, and PNF on joint ROM
Although SS, DS, and PNF can significantly increase passive ROM (Sharman et al. 2006), whether PNF, SS, or DS provide greater acute ROM benefits is disputed. A number of studies report greater ROM improvements after PNF compared with SS within a single session (Etnyre and Lee 1988; Ferber et al. 2002; O’Hora et al. 2011). On the other hand, SS has also been shown to provide ROM increases similar to those of PNF within a single session (Condon and Hutton 1987; Maddigan et al. 2012). There is also conflict in the DS literature, with some studies reporting that an acute bout of DS provides either similar (Beedle and Mann 2007; Perrier et al. 2011) or greater (Duncan and Woodfield 2006; Amiri-Khorasani et al. 2011) increases in flexibility than does SS, whereas many other studies have reported that DS was not as effective as SS within a single preactivity routine (Samuel et al. 2008; Bacurau et al. 2009; Sekir et al. 2010; Barroso et al. 2012; Paradisis et al. 2014). Few studies have compared PNF with DS; however, Wallin and colleagues (1985) showed greater ROM increases after PNF (11%–24%) than after ballistic stretching (3%–7%) over 14 training sessions. Small-to-large relative ROM increases have been reported to persist for 5 (Whatman et al. 2006), 10 (Behm et al. 2011), 30 (Fowles et al. 2000), 90 (Knudson 1999), and 120 min (Power et al. 2004) after SS. Unfortunately, ROM changes after DS and PNF have been monitored only for a maximum of 10 min after stretch. Although it is not possible to confidently rank stretching methods on their effectiveness in increasing flexibility, all 3 forms of stretching have been shown to increase ROM.
ROM mechanisms after acute muscle stretching
SS, DS, and PNF stretching have distinct loading characteristics that likely influence the specific mechanisms responsible for acute increases in ROM. However, our understanding of the underlying mechanisms remains limited. Acute increases after SS have been attributed largely to concomitant increases in the capacity to tolerate loading prior to stretch termination (i.e., stretch tolerance) (Magnusson et al. 1996a) and/or to changes in mechanical properties (i.e., reduced muscle stiffness) (Morse et al. 2008). However, although both mechanisms are reported commonly, substantial differences in study methodology (duration, intensity, muscle group, subject demographics) limit our ability to fully determine the importance of these mechanisms to increases in ROM after SS.
Historically, autogenic inhibition has been theorized to explain PNF’s superior efficacy to enhance ROM (Hindle et al. 2012), because the intense isometric contraction phase was thought to increase Ib muscle afferent activity. This activity may hyperpolarize the dendritic ends of spinal α-motoneurons of the stretched muscle, minimizing or removing the influence of stretch-induced type Ia–mediated reflexive activity (McNair et al. 2001), enabling further increases in ROM. However, there is no direct evidence of a causal relationship between reflexive activity and ROM, and several studies report increased resting EMG activity immediately after the contraction phase of a PNF stretch (Magnusson et al. 1996a; Mitchell et al. 2009). Consequently, debate exists as to the involvement of autogenic inhibition (Hindle et al. 2012; Sharman et al. 2006). However, because PNF stretching includes an SS phase, SS and PNF likely share common mechanisms underpinning acute increases in ROM. In fact, increased stretch tolerance (Mitchell et al. 2007) and reduced stiffness (Magnusson et al. 1996b) have both been reported after PNF stretching. However, distinct tissue property changes are reported after PNF, with reductions in tendon stiffness also reported (Kay et al. 2015), although changes in stiffness were not correlated with changes in ROM. Thus, it is likely that similar underlying mechanisms are associated with changes in ROM after PNF and SS modalities.
DS involves repeated cyclical loading and unloading of the musculature, often for several minutes (Fletcher 2010). Despite the ability of DS to increase ROM, there have been limited attempts to identify the influential mechanisms, and no clear mechanism(s) have been identified. However, repetitive lengthening of the musculature can increase muscle fibre temperature, decrease viscosity, and increase extensibility in animal models (Mutungi and Ranatunga 1998), with 1 study reporting reductions in passive muscle stiffness with increased ROM after DS in humans (Herda et al. 2013). Thus, limited data exist describing the mechanisms for ROM enhancement after DS, and it is not known whether changes in stretch tolerance are as influential as in SS and PNF forms of stretching.
Influence of preactivity stretching on injury risk
Effect of preactivity stretching on subsequent injury risk
Stretching is generally incorporated into the preactivity routine in numerous sports. For the purposes of this review, studies reporting the effects of stretching that were performed only after exercise, or as part of a holistic training program not specifically before exercise, were not included. All 12 studies used some type of SS or PNF stretching, with none using DS (Supplementary Tables S5a and S5b1).
Eight studies showed some effectiveness of stretching, whereas 4 showed no effect. Of practical importance, there was no evidence that stretching negatively influences injury risk. Several of the studies had design limitations that made it difficult to confidently attribute an apparent injury reduction effect specifically to the preactivity muscle stretching.
The 12 studies were assessed with respect to 5 potentially confounding factors summarized below.
Study design (randomized trials vs. other study designs)
Although a lower proportion of randomized (4 of 7) than nonrandomized (4 of 5) trials showed a benefit of stretching with respect to injury reduction (mostly muscle injuries), it is notable that the majority of randomized trials showed some efficacy.
Stretch duration (short vs. long stretch durations)
Five studies imposed stretching interventions lasting ≤5 min. Of these, 2 showed a benefit of stretching, 1 of which was a survey-driven retrospective correlation analysis, indicating that hamstring injury rates were lower in teams reporting the use of stretching (Dadebo et al. 2004). Six studies imposed total stretch durations >5 min, with 5 showing some benefit of stretching with respect to injury risk. One study did not report stretch duration. Thus, longer (total)-duration stretching interventions may have a greater potential to decrease injury risk.
Three studies imposed stretches on single muscle groups (2 on hamstrings, 1 on plantar flexors). The other 9 studies imposed stretches on multiple muscle groups. For example, Pope and colleagues (2000) imposed single 20-s stretches on bilateral gastrocnemius, soleus, hamstrings, quadriceps, hip adductors, and hip flexors. Thus, the total stretch time for single muscle group studies is not directly comparable with that of multiple muscle group studies. However, some stretches targeting a single muscle group (e.g., straight leg raise hamstring stretch) may also stretch ipsilateral (e.g., calf) and contralateral (e.g., hip flexors) muscle groups.
Type of sport–activity (endurance activities with a predominance of overuse injuries vs. sprinting sports with a high prevalence of muscle injuries)
Five studies examined injury rates in endurance sports or military training in which there was a predominance of overuse injuries. Only 2 of the studies showed a benefit of stretching, with reduced muscle injuries being the common finding. Six studies involved sprint running–type sports, with fewer muscle injuries reported in 5 of the 6 studies with stretching (1 addressed ankle sprains only). The 1 longitudinal study (Hadala and Barrios 2009), completed on yachting crews, was not included in this comparison because it did not fit either activity classification (it showed a benefit of stretching on muscle injuries). Overall, the current research indicates that preactivity stretching may be beneficial for injury prevention in sports with a sprint running component but not in endurance-based running activities (including military training) with a predominance of overuse injuries.
Stretching with vs. without warm-up
Based on the current body of research, it is not possible to comment on the role of stretching with respect to injury prevention when performed with vs. without warm-up. However, because muscle stretching and warm-up may have similar effects on muscle viscoelastic properties (Taylor et al. 1997), it is possible that both may influence injury risk, and this would not be noticeable without a nonstretching, non-warm-up control group.
All-cause injury rate vs. specific injury rates
Eight studies examined all types of injuries or all lower-extremity injuries. The other 4 studies examined specific injuries, (2 studied hamstring strains, 1 studied all lower-extremity muscle strains, 1 studied ankle sprains). Of the 8 studies examining the effect of stretching on total injury rates, only 2 reported a benefit of stretching (Ekstrand et al. 1983; Hadala and Barrios 2009).
One study reported a benefit of stretching for ankle sprains (McKay et al. 2001); however, this was a retrospective survey study, and 4 randomized controlled trials have shown no benefits of stretching on the rates of ankle sprains (Amako et al. 2003; Pope et al. 1998, 2000; van Mechelen et al. 1993).
Six studies specified the effects of stretching on the prevalence of acute muscle injuries. From these studies, it was possible to compute the relative risk of sustaining an acute muscle injury associated with stretching vs. not stretching (Supplementary Table S61). Taken together, these studies indicate a 54% risk reduction in acute muscle injuries associated with stretching.
One study also indicated that stretching was associated with a reduction in “bothersome soreness” (Jamtvedt et al. 2010). However, most research has demonstrated that stretching prior to exercise is ineffective in reducing soreness or other symptoms of muscle damage (Black and Stevens 2001; Gulick et al. 1996; High et al. 1989; Johansson et al. 1999; Khamwong et al. 2011; Lund et al. 1998; McHugh and Nesse 2008), with 1 recent exception showing some benefit of stretching (Chen et al. 2014).
Limitations
A number of limitations were encountered when reviewing this literature. They included issues related to internal validity (i.e., bias caused by expectancy effects) and external validity (i.e., ecological validity of stretch durations and warm-up components, description detail of stretches, reporting bias against nonsignificant results). A detailed discussion is provided as a digital supplement (Supplementary Appendix S71).
Conclusions
SS- (–3.7%), DS- (+1.3%), and PNF- (–4.4%) induced performance changes were typically small to moderate in (relative) magnitude when testing was performed soon after the stretching. An initial assumption based on the overall results may be to not recommend SS or PNF stretching within pre-event warm-up activities when test performance is required immediately after stretching. However, the average poststretching measurement time was 3–5 min, which does not coincide with typical stretching-to-performance durations of >10 min in many circumstances (e.g., sports competitions). In studies that conducted tests >10 min after stretching, performance changes were typically statistically trivial unless extreme stretch protocols were used (Fowles et al. 2000; Power et al. 2004).
SS impairments were more substantial with ≥60 s (–4.6%) vs. <60 s (–1.1%) of stretching for each muscle group. Dose–response relationships could not be established firmly for PNF or DS. There is some evidence that >2 min and faster frequencies of DS provide a greater performance increase. Thus, longer-duration SS and PNF may be done well before (e.g., >10 min) task performance is required to allow effects to resolve, but DS may be performed closer to the performance. There were no significant response differences when stretching was based on muscle contraction type or muscle group stretched. Because muscle strain injuries are more likely to occur with the muscle at a longer length, the very large performance reductions (–10.2%) at short muscle lengths, but moderate performance increases (2.2%) at longer muscle lengths, could influence the decision to use SS. Although no significant differences were observed between testing types for DS and PNF, there were greater SS-induced deficits in strength (–4.8%) vs. power–speed (–1.3%) tests. There was some evidence of a movement pattern–specific effect of DS, because jump performance (2.1%) improved to a greater extent than tests involving slower, uniarticular concentric (0.4%) or eccentric (–1.2%) contractions.
The few studies that included poststretching dynamic activity (i.e., Murphy et al. 2010a; Samson et al. 2012) did not show substantial evidence for an effect on performance. There is no evidence as to whether there are any psychological or group–team cohesion influences on muscle stretching. All forms of muscle stretching have been shown to provide a significant acute ROM benefit. Despite some evidence for a greater ROM benefit with PNF, a confident conclusion cannot be reached based on the available evidence.
SS and PNF show no overall effect on all-cause injury or overuse injuries, but there may be a benefit in reducing acute muscle injuries with running, sprinting, or other repetitive contractions. Limited data indicate a potentially greater effect of SS and PNF on injury risk for longer stretch durations (>5 min of total stretch time of task-related multiple muscle groups). There is conflicting evidence as to whether stretching in any form before exercise can reduce exercise-induced muscle soreness. Hence, stretching in some form appears to be of greater benefit than cost (in terms of performance, ROM, and injury) but the type of stretching chosen, and the make-up of the stretch routine, will depend on the context within which it is used.
The Canadian Society for Exercise Physiology position stand recommendations based on this stretch literature review are available as a digital supplement (Supplementary Appendix S81).
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Footnote
1
Supplementary data are available with the article through the journal Web site at Supplementary Material.
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Applied Physiology, Nutrition, and Metabolism
Volume 41 • Number 1 • January 2016
Pages: 1 - 11
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Received: 11 May 2015
Accepted: 14 October 2015
Version of record online: 8 December 2015
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© 2015.
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David G. Behm, Anthony J. Blazevich, Anthony D. Kay, and Malachy McHugh. 2016. Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Applied Physiology, Nutrition, and Metabolism.
41(1): 1-11. https://doi.org/10.1139/apnm-2015-0235
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141. The Effects of a Compensatory Training Program Adding an Isoinertial Device in the Shoulder Function on Young Tennis Players
142. Does Stretching Training Influence Muscular Strength? A Systematic Review With Meta-Analysis and Meta-Regression
143. THE ACUTE EFFECT OF STATIC VERSUS PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION STRETCHING COMBINED WITH KINESIOLOGY TAPING® OF HAMSTRING MUSCLES ON FUNCTIONAL TESTS IN ADOLESCENT TAEKWONDO ATHLETES
144. Effect of a 4-week static stretching program for plantar flexor muscles on physical performance and muscle properties
145. Effects of Eccentric Resistance Training on Lower-Limb Passive Joint Range of Motion: A Systematic Review and Meta-analysis
146. Are Acute Effects of Foam-Rolling Attributed to Dynamic Warm Up Effects? A Comparative Study
147. Effect of a home-based exercise training program on anthropometric characteristics and exercise performance during Covid-19 quarantine in young high-level kayak athletes
148. Resistance Training Induces Improvements in Range of Motion: A Systematic Review and Meta-Analysis
149. Chronic Effects of Static Stretching Exercises on Muscle Strength and Power in Healthy Individuals Across the Lifespan: A Systematic Review with Multi-level Meta-analysis
150. Why Flexibility Deserves to Be Further Considered as a Standard Component of Physical Fitness: A Narrative Review of Existing Insights from Static Stretching Study Interventions
151. The effects of a land-based home exercise program on surfing performance in recreational surfers
152. Warm-up stretching exercises and physical performance of youth soccer players
153. The Combined Effect of Static Stretching and Foam Rolling With or Without Vibration on the Range of Motion, Muscle Performance, and Tissue Hardness of the Knee Extensor
154. The effect of two different stretching exercises on the muscle tendon unit and range of motion
155. Differential effects of dynamic and ballistic stretching on contralateral lower limb flexibility
156. The Acute Effects of Pectoralis Major Foam Ball Rolling on Shoulder Extension Range of Motion, Isometric Contraction Torque, and Muscle Stiffness
157. Reduced isometric knee extensor force following anodal transcranial direct current stimulation of the ipsilateral motor cortex
158. IMMEDIATE EFFECTS OF POST-ISOMETRIC RELAXATION AND STATIC STRETCHING ON QUADRICEPS MUSCLE DURING VERTICAL JUMP IN VOLLEY BALL AND BASKETBALL PLAYERS
159. Prevention Strategies of Lower Limb Muscle Injuries
160. Rehabilitation Principles for Interventional Orthopedics and Orthobiologics
161. Motorische Basisfähigkeiten
162. Strukturelle Grundlagen der Neurodynamik
163. Schmerz und Training
164. Literaturverzeichnis
165. Objective Evaluation of Coordinative Abilities and Training Effectiveness in Sports Scenarios: An Automated Measurement Protocol
166. Etiology and Prevention of Common Injuries in Golf
167. Acute influence of myofascial self-mobilization using foam roller on muscle strength and flexibility
168. Effects of Different Iliopsoas Stretching Methods on the Spine and Pelvis: Randomized Crossover Study
169. Depression and Anxiety Symptoms and Their Associated Factors Among Chinese Residents After the Lifting of the Dynamic Zero-COVID Policy: A Cross-Sectional Study
170. Support Your Recovery Needs (SYRN) – a systemic approach to improve sport performance
171. The Clinical Benefits of a Dynamic vs. Static Component as Part of a Comprehensive Warm-Up for Recreational Sports Players with Clinical Histories of Hamstring Injuries: A Randomized Clinical Trial
172. Symposium12-2
173. Neuromuscular Warm-Up is Associated with Fewer Overuse Injuries in Ballet Dancers Compared to Traditional Ballet-Specific Warm-Up
174. Does static stretching change uniformly the quadriceps elasticity in physically actives subjects?
175. Positional transversal release is effective as stretching on range of movement, performance and balance: a cross-over study
176. Effects of Different Long-Term Exercise Modalities on Tissue Stiffness
177. Stretching Practices of International Powerlifting Federation Unequipped Powerlifters
178. Comparison Between Foam Rolling With and Without Vibration on Passive and Active Plantar Flexor Muscle Properties
179. Acute and Chronic Effects of Supervised Flexibility Training in Older Adults: A Comparison of Two Different Conditioning Programs
180. The Influence of a Single Instrument-Assisted Manual Therapy (IAMT) for the Lower Back on the Structural and Functional Properties of the Dorsal Myofascial Chain in Female Soccer Players: A Randomised, Placebo-Controlled Trial
181. Effects of Speed and Amplitude of Dynamic Stretching on the Flexibility and Strength of the Hamstrings
182. Acute Effects of Different Intensity and Duration of Static Stretching on the Muscle-Tendon Unit Stiffness of the Hamstrings
183. Influence of dynamic stretching on ankle joint stiffness, vertical stiffness and running economy during treadmill running
184. Foam Rolling Training Effects on Range of Motion: A Systematic Review and Meta-Analysis
185. Effects of stretching intensity on range of motion and muscle stiffness: A narrative review
186. Quadriceps or triceps surae proprioceptive neuromuscular facilitation stretching with post-stretching dynamic activities does not induce acute changes in running economy
187. Effects of cathodal transcranial direct current stimulation on hip range of motion of healthy sedentary women: A crossover study
188. Usefulness of Surface Electromyography Complexity Analyses to Assess the Effects of Warm-Up and Stretching during Maximal and Sub-Maximal Hamstring Contractions: A Cross-Over, Randomized, Single-Blind Trial
189. The Effects of Foam Rolling Training on Performance Parameters: A Systematic Review and Meta-Analysis including Controlled and Randomized Controlled Trials
190. Effects of a dynamic stretching warm-up on functional movement patterns in female hip-hop dancers
191. Changes in stiffness of the specific regions of knee extensor mechanism after static stretching
192. Eccentric exercise improves joint flexibility in adults: A systematic review update and meta-analysis
193. Acute Effects of Different Warm-up Protocols on Sports Performance in Elite Male Collegiate Handball Players
194. Acute Effects of Static and Ballistic Stretching on Muscle-Tendon Unit Stiffness, Work Absorption, Strength, Power, and Vertical Jump Performance
195. DESIGN AND DEVELOPMENT OF A STROKE REHABILITATION GLOVE FOR MEASURING AND MONITORING HAND MOTIONS
196. A comparison of a single bout of stretching or foam rolling on range of motion in healthy adults
197. Which stretching instruction should be given to assess joint maximal range of motion?
198. The Effect of Static Stretching Exercises at Different Times on Heart Rate Variability Before Anaerobic Capacity Test
199. Acute Effect of Small-Sided Game-Based Warm-Up on Change of Direction Speed Performance
200. The Time-Course Changes in Knee Flexion Range of Motion, Muscle Strength, and Rate of Force Development After Static Stretching
201. Impact of Flexibility on Vertical Jump, Balance and Speed in Amateur Football Players
202. Comparison of A Single Vibration Foam Rolling and Static Stretching Exercise on the Muscle Function and Mechanical Properties of the Hamstring Muscles
203. The Immediate Effect of Adding Lumbar Mobilization to A Static Stretching Program on Hamstrings Range of Motion: An Exploratory Study
204. Effects of Dynamic Warm-up Programs Including Self-Myofascial Relexation on Soft Tissue Stiffness and Exercise Performance
205. Warm-Up Intensity and Time-Course Effects on Jump Height under Cold Conditions
206. What to stretch? - Isolated proprioceptive neuromuscular facilitation stretching of either quadriceps or triceps surae followed by post-stretching activities alters tissue stiffness and jump performance
207. The acute effects of different hamstring muscle stretching techniques on reducing muscle resistance to movement by ultrasound elastography
208. An Intense Warm-Up Does Not Potentiate Performance Before or After a Single Bout of Foam Rolling
209. Cross-education effect of 4-week high- or low-intensity static stretching intervention programs on passive properties of plantar flexors
210. Normalized hand-behind-back for the measurement of shoulder internal rotation
211. Effect of Static Stretching, Dynamic Stretching, and Myofascial Foam Rolling on Range of Motion During Hip Flexion: A Randomized Crossover Trial
212. Long-term effects of asymmetrical posture in boxing assessed by baropodometry
213. Range of Motion in Selected Joints in Relation to Sports Performance and Technique Effectiveness in Weightlifting
214. Acute Effects of Soleus Stretching on Ankle Flexibility, Dynamic Balance and Speed Performances in Soccer Players
215. Comparison of the Effect of Muscle Energy Techniques and Stretching Exercises on Pain and Psychosocial Dysfunction Levels in Individuals With Low Back Pain
216. Chronic and Residual Effects of a Two-Week Foam Rolling Intervention on Ankle Flexibility and Dynamic Balance
217. Different volumes and intensities of static stretching affect the range of motion and muscle force output in well-trained subjects
218. The effects of using a combination of static stretching and aerobic exercise on muscle tendon unit stiffness and strength in ankle plantar‐flexor muscles
219. Exercise Selection and Adaptations During Pregnancy
220. Sportmotorische Fähigkeiten und sportliche Leistungen – Trainingswissenschaft
221. Rehabilitation Principles for Interventional Orthopedics and Orthobiologics
222. Verletzungsprävention
223. Beweglichkeit
224. Does the Self‐Myofascial Release Affect the Activity of Selected Lower Limb Muscles of Soccer Players?
225. Power Output Differences in the Context of Dynamic Stretching in Young Male Athletes
226. Influence of stress relaxation and load during static stretching on the range of motion and muscle–tendon passive stiffness
227. Association between static stretching load and changes in the flexibility of the hamstrings
228. The acute effects of high-intensity jack-knife stretching on the flexibility of the hamstrings
229. The Effectiveness of Neuromuscular Warmups for Lower Extremity Injury Prevention in Basketball: A Systematic Review
230. Acute Effects of Static Self-Stretching Exercises and Foam Roller Self-Massaging on the Trunk Range of Motions and Strength of the Trunk Extensors
231. Myofascial Treatment Techniques on the Plantar Surface Influence Functional Performance in the Dorsal Kinetic Chain
232. Effects of Static and Dynamic Stretching Performed Before Resistance Training on Muscle Adaptations in Untrained Men
233. Effects of Brief Dry Cupping on Muscle Soreness in the Gastrocnemius Muscle and Flexibility of the Ankle
234. The effect of static stretching of agonist and antagonist muscles on knee joint position sense
235. Passive static stretching alters the characteristics of the force-velocity curvature differently for fast and slow muscle groups—A practical application of Hill's equation
236. Manorah training alleviates median neural tension and improves physical fitness in sedentary young adults: A randomized control trial
237. Relationship between changes in passive properties and muscle strength after static stretching
238. Morphological Changes in the Motor Endplate and in the Belly Muscle Induced by Previous Static Stretching to the Climbing Protocol
239. Crossover effects of ultrasound-guided percutaneous neuromodulation on contralateral hamstring flexibility
240. A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies
241. A Comparison of the Effects of Foam Rolling and Stretching on Physical Performance. A Systematic Review and Meta-Analysis
242. Acute Effect of Vibration Roller With and Without Rolling on Various Parts of the Plantar Flexor Muscle
243. Effects of a Single Proprioceptive Neuromuscular Facilitation Stretching Exercise With and Without Post-stretching Activation on the Muscle Function and Mechanical Properties of the Plantar Flexor Muscles
244. Intraday variation in short-term maximal performance: effects of different warm-up modalities
245. A single session with a roller massager improves hamstring flexibility in healthy athletes: a randomized placebo-controlled crossover study
246. Changes in neural drive to calf muscles during steady submaximal contractions after repeated static stretches
247. Does the Expectancy on the Static Stretching Effect Interfere With Strength-Endurance Performance?
248. Effects of Stretching on Injury Risk Reduction and Balance
249. Acute Hemodynamic Responses to Three Types of Hamstrings Stretching in Senior Athletes
250. Effect of vibration foam rolling on the range of motion in healthy adults: a systematic review and meta-analysis
251. ACUTE EFFECT OF FOAM ROLLER APPLIED AT DIFFERENT FREQUENCY LEVELS ON FLEXIBILITY IN AMPUTEE PLAYERS
252. Are Strength Indicators and Skin Temperature Affected by the Type of Warm-Up in Paralympic Powerlifting Athletes?
253. The Effect of Static and Dynamic Stretching during Warm-Up on Running Economy and Perception of Effort in Recreational Endurance Runners
254. Exploring Shank Circumference by Stretching after Training among Volleyball Players
255. Time to Move From Mandatory Stretching? We Need to Differentiate “Can I?” From “Do I Have To?”
256. The Hamstrings: Anatomic and Physiologic Variations and Their Potential Relationships With Injury Risk
257. High-Intensity Static Stretching in Quadriceps Is Affected More by Its Intensity Than Its Duration
258. Genç Futbolcularda Statik ve Dinamik Germe Egzersizlerinin Tekrarlı Sprint Performansına Etkisi
259. Kinematics and Esthetics of Grand Battement After Static and Dynamic Hamstrings Stretching in Adolescents
260. Effect of Acute Static Stretching on the Activation Patterns Using High-Density Surface Electromyography of the Gastrocnemius Muscle during Ramp-Up Task
261. The Accumulated Effects of Foam Rolling Combined with Stretching on Range of Motion and Physical Performance: A Systematic Review and Meta-Analysis
262. Local and Non-local Effects of Foam Rolling on Passive Soft Tissue Properties and Spinal Excitability
263. Regenerative Rehabilitation in Injuries of Tendons
264. The effects of 12 weeks of static stretch training on the functional, mechanical, and architectural characteristics of the triceps surae muscle–tendon complex
265. Non-local acute stretching effects on strength performance in healthy young adults
266. Return to Basketball Play Following COVID-19 Lockdown
267. In-Bed Sensorimotor Rehabilitation in Early and Late Subacute Stroke Using a Wearable Elbow Robot: A Pilot Study
268. Effects of Tissue Flossing on the Healthy and Impaired Musculoskeletal System: A Scoping Review
269. Non-local Acute Passive Stretching Effects on Range of Motion in Healthy Adults: A Systematic Review with Meta-analysis
270. Plantar flexor muscle stretching depresses the soleus late response but not tendon tap reflexes
271. The tolerance to stretch is linked with endogenous modulation of pain
272. Foam rolling during a simulated half-time attenuates subsequent soccer-specific performance decrements
273. Static Stretching Reduces Motoneuron Excitability: The Potential Role of Neuromodulation
274. Passive torque influences the Hoffmann reflex pathway during the loading and unloading phases of plantar flexor muscles stretching
275. Effects of different stretching methods on vertical jump ability and range of motion in young female artistic gymnastics athletes
276. A Survey on Stretching Practices in Women and Men from Various Sports or Physical Activity Programs
277. Effects of 2 Intersection Strategies for Physical Recovery in Jiu-Jitsu Athletes
278. Peripheral Nerve Responses to Muscle Stretching: A Systematic Review
279. Acute effects of dynamic stretching on neuromechanical properties: an interaction between stretching, contraction, and movement
280. Acute and Prolonged Effects of Stretching on Shear Modulus of the Pectoralis Minor Muscle
281. The Acute and Prolonged Effects of Different Durations of Foam Rolling on Range of Motion, Muscle Stiffness, and Muscle Strength
282. Acute and chronic effects of static stretching at 100% versus 120% intensity on flexibility
283. Self-Selected Resistance Exercise Load: Implications for Research and Prescription
284. The Influence of Stretching the Hip Flexor Muscles on Performance Parameters. A Systematic Review with Meta-Analysis
285. The Impact of a Single Stretching Session on Running Performance and Running Economy: A Scoping Review
286. A descriptive study quantifying warm-up patterns in elite and non-elite dressage horses in a field environment
287. Prevention of Esports Injuries
288. Mechanisms underlying performance impairments following prolonged static stretching without a comprehensive warm-up
289. A Self-Efficacy Reinforcement Stretching Exercise Program for Community-Dwelling Older Women With Osteoarthritis: A Pilot Study
290. Minute oscillation stretching: A novel modality for reducing musculo‐tendinous stiffness and maintaining muscle strength
291. Effect of Stretching Protocols on Glenohumeral-Joint Muscle Activation in Elite Table Tennis Players
292. Passive Recovery Strategies after Exercise: A Narrative Literature Review of the Current Evidence
293. The effect of static stretching on key hits and subjective fatigue in eSports
294. Study on the Effect of PNF Method on the Flexibility and Strength Quality of Stretching Muscles of Shoulder Joints of Swimmers
295. Effects of different stretching exercises on hamstring flexibility and performance in long term
296. High-impact Routines to Ameliorate Trunk and Lower Limbs Flexibility in Women
297. Acute effects of aerobic activity, static stretching, and explosive exercises on muscular performance and range of motion of young soccer players
298. Effects of Static Stretching With High-Intensity and Short-Duration or Low-Intensity and Long-Duration on Range of Motion and Muscle Stiffness
299. Foam Rolling Prescription: A Clinical Commentary
300. The Relationship between Stretching Intensity and Changes in Passive Properties of Gastrocnemius Muscle-Tendon Unit after Static Stretching
301. Examination of exercise load for recovering decreased muscle strength caused by static stretching
302. Effects of low-intensity and short-duration isometric contraction after static stretching on range of motion, passive stiffness, and isometric muscle force
303. Grand battement kinematics and aesthetics in adolescent recreational dancers: Short term effects of static and dynamic hamstrings stretching
304. Effects of Acute Static Stretching Exercises on Velocity, Anaerobic Power and Balance Performance
305. Evidence for improved systemic and local vascular function after long‐term passive static stretching training of the musculoskeletal system
306. Postactivation potentiation effects of Back Squat and Barbell Hip Thrust exercise on vertical jump and sprinting performance
307. Prolonged static stretching causes acute, nonmetabolic fatigue and impairs exercise tolerance during severe-intensity cycling
308. A conceptual model and detailed framework for stress-related, strain-related, and overuse athletic injury
309. Impact of Trunk Resistance and Stretching Exercise on Fall-Related Factors in Patients with Parkinson’s Disease: A Randomized Controlled Pilot Study
310. The immediate effect of IASTM vs. Vibration vs. Light Hand Massage on knee angle repositioning accuracy and hamstrings flexibility: A pilot study
311. Chronic Effects of Static and Dynamic Stretching on Hamstrings Eccentric Strength and Functional Performance: A Randomized Controlled Trial
312. Acute effects of static stretching on Wingate testing in men
313. A Primer on Running for the Orthopaedic Surgeon
314. Agility performance variation from morning to evening: dynamic stretching warm-up impacts performance and its diurnal amplitude
315. The Effect of Proprioceptive Neuromuscular Facilitation on Joint Position Sense: A Systematic Review
316. Lack of cortical or Ia-afferent spinal pathway involvement in muscle force loss after passive static stretching
317. Latihan fleksibilitas statis bagi persendian ekstremitas inferior lansia
318. Warm-Up With Dynamic Stretching: Positive Effects on Match-Measured Change of Direction Performance in Young Elite Volleyball Players
319. Acute Effects of a Static vs. a Dynamic Stretching Warm-up on Repeated-Sprint Performance in Female Handball Players
320. Static stretch and dynamic muscle activity induce acute similar increase in corticospinal excitability
321. Acute effects of stretching and/or warm-up on neuromuscular performance of volleyball athletes: a randomized cross-over clinical trial
322. Acute Effects of Intermittent and Continuous Static Stretching on Hip Flexion Angle in Athletes with Varying Flexibility Training Background
323. The Effects of Proprioceptive Neuromuscular Facilitation and Static Stretching Performed at Various Intensities on Hamstring Flexibility
324. The acute and prolonged effects of 20-s static stretching on muscle strength and shear elastic modulus
325. Acute Effects of Foam Rolling on Range of Motion in Healthy Adults: A Systematic Review with Multilevel Meta-analysis
326. Considerations for the Postpartum Runner
327. Effects of an Evidence-based Exercise Intervention on Clinical Outcomes in Breast Cancer Survivors: A Randomized Controlled Trial
328. Skeletal Muscle Aging Atrophy: Assessment and Exercise-Based Treatment
329. Regenerationsmanagement und Ernährung
330. Muskelverletzungen
331. The effects of acute static and dynamic stretching on spring-mass leg stiffness
332. Static Stretching Intensity Does Not Influence Acute Range of Motion, Passive Torque, and Muscle Architecture
333. Passive muscle stretching reduces estimates of persistent inward current strength in soleus motor units
334. Does the stretching intensity matter when targeting a range of motion gains? a randomized trial
335. Effect of 4-week cyclic stretching program on muscle properties and physical performance in healthy adult men
336. Effects of Vibration Rolling with and without Dynamic Muscle Contraction on Ankle Range of Motion, Proprioception, Muscle Strength and Agility in Young Adults: A Crossover Study
337. Passive muscle stretching impairs rapid force production and neuromuscular function in human plantar flexors
338. A combined plyometric and resistance training program improves fitness performance in 12 to 14-years-old boys
339. Respiratory and muscular response to acute non-metabolic fatigue during ramp incremental cycling
340. Climbers! Don’t stretch your forearm muscles before climbing: Effect of static stretching on a finger strength in various grip positions
341. Stimulating injury-preventive behaviour in sports: the systematic development of two interventions
342. Acute Effects of Static Stretching on Muscle Strength and Power: An Attempt to Clarify Previous Caveats
343. Comparative Effects of Tensioning and Sliding Neural Mobilization on Static Postural Control and Lower Limb Hop Testing in Football Players
344. The loss of muscle force production after muscle stretching is not accompanied by altered corticospinal excitability
345. Acute effects of foam rolling on passive stiffness, stretch sensation and fascial sliding: A randomized controlled trial
346. Effects of Instrument-assisted Soft Tissue Mobilization on Musculoskeletal Properties
347. Two Sets of Dynamic Stretching of the Lower Body Musculature Improves Linear Repeated-Sprint Performance in Team-Sports.
348. Unilateral hamstrings static stretching can impair the affected and contralateral knee extension force but improve unilateral drop jump height
349. Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review
350. A Quick Fix for Better Walking? That’s Probably a Bit of a Stretch
351. Positive relationship between passive muscle stiffness and rapid force production
352. Nonlinear approach to study the acute effects of static and dynamic stretching on local dynamic stability in lower extremity joint kinematics and muscular activity during pedalling
353. Can transcranial direct current stimulation improve range of motion and modulate pain perception in healthy individuals?
354. Crossover Effects of Unilateral Static Stretching and Foam Rolling on Contralateral Hamstring Flexibility and Strength
355. Effects of Static Stretching and Foam Rolling on Ankle Dorsiflexion Range of Motion
356. Current Approaches on Warming up for Sports Performance: A Critical Review
357. The Effect of Static and Dynamic Stretching Exercises on Sprint Ability of Recreational Male Volleyball Players
358. Effects of Static and Dynamic Stretching on Force Sense, Dynamic Flexibility and Reaction Time of Children
359. Self-massage prior to stretching improves flexibility in young and middle-aged adults
360. Selective effect of static stretching, concentric contractions, and a one-leg balance task on ankle motion sense in young and older adults
361. Impact of 10-Minute Interval Roller Massage on Performance and Active Range of Motion
362. Kinetic Analysis of Unilateral Landings in Female Volleyball Players After a Dynamic and Combined Dynamic-Static Warm-up
363. Acute Effects of Stretching on Flexibility and Performance: A Narrative Review
364. Hold-relax and contract-relax stretching for hamstrings flexibility: A systematic review with meta-analysis: Letter to the editor
365. Ankle Sprain Has Higher Occurrence During the Latter Parts of Matches: Systematic Review With Meta-Analysis
366. Muscle stretching – the potential role of endogenous pain inhibitory modulation on stretch tolerance
367. FARKLI DİZ AÇILARI VE SÜRELERDE YAPTIRILAN STATİK GERMENİN, SIÇRAMA PERFORMANSI ÜZERİNE AKUT ETKİSİ
368. A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery
369. Effects of 30 second versus 45 second static stretching on vertical jump performance
370. Efficacy of proprioceptive neuromuscular facilitation compared to other stretching modalities in range of motion gain in young healthy adults: A systematic review
371. The Effect of Static Stretching of Peroneal and Tibialis Anterior Muscles on Reaction Time
372. Dynamic stretching is not detrimental to neuromechanical and sensorimotor performance of ankle plantarflexors
373. A structured exercise programme combined with proprioceptive neuromuscular facilitation stretching or static stretching in posttraumatic stiffness of the elbow: a randomized controlled trial
374. Caffeine, acute static stretching and maximum knee flexion strength
375. Acute Effects of Different Stretching Techniques on Lower Limb Kinematics, Kinetics and Muscle Activities during Vertical Jump
376. Dynamic stretching alone can impair slower velocity isokinetic performance of young male handball players for at least 24 hours
377. Selective effect of static stretching, concentric contractions, and a balance task on ankle force sense
378. Exercise Selection and Adaptations During Pregnancy
379. Hold-relax and contract-relax stretching for hamstrings flexibility: A systematic review with meta-analysis
380. Instrument-assisted soft tissue mobilization and proprioceptive neuromuscular facilitation techniques improve hamstring flexibility better than static stretching alone: a randomized clinical trial
381. Intermittent but Not Continuous Static Stretching Improves Subsequent Vertical Jump Performance in Flexibility-Trained Athletes
382. Effects of antagonistic muscle contraction exercises on ankle joint range of motion
383. Influence of a pre-shot dynamic stretching routine on free throw performance
384. The potential role of sciatic nerve stiffness in the limitation of maximal ankle range of motion
385. Acute Effects of Proprioceptive Neuromuscular Facilitation on Peak Torque and Muscle Imbalance
386. Stretch imposed on active muscle elicits positive adaptations in strain risk factors and exercise‐induced muscle damage
387. Short-Term Effects of Rolling Massage on Energy Cost of Running and Power of the Lower Limbs
388. Effect of Acute Static Stretching on Lower Limb Movement Performance Using STABL Virtual Reality System
389. Differential Effects of Different Warm-up Protocols on Repeated Sprints-Induced Muscle Damage
390. Static or dynamic stretching program does not change the acute responses of neuromuscular and functional performance in healthy subjects: a single-blind randomized controlled trial
391. The effects of different passive static stretching intensities on recovery from unaccustomed eccentric exercise – a randomized controlled trial
392. Stretch Could Reduce Hamstring Injury Risk During Sprinting by Right Shifting the Length-Torque Curve
393. Flexibility training in preadolescent female athletes: Acute and long-term effects of intermittent and continuous static stretching
394. The effects of different durations of static stretching within a comprehensive warm-up on voluntary and evoked contractile properties
395. The effects of cryotherapy versus cryostretching on clinical and functional outcomes in athletes with acute hamstring strain
396. Comparison of a foam rolling session with active joint motion and without joint motion: A randomized controlled trial
397. Preliminary research of a novel center-driven robot for upper extremity rehabilitation
398. No Effect of Muscle Stretching within a Full, Dynamic Warm-up on Athletic Performance
399. Effects of an acute bout of dynamic stretching on biomechanical properties of the gastrocnemius muscle determined by shear wave elastography
400. Acute effects of unilateral static stretching on handgrip strength of the stretched and non-stretched limb
401. The Immediate Effects of Self-administered Dynamic Warm-up, Proprioceptive Neuromuscular Facilitation, and Foam Rolling on Hamstring Tightness
402. Biomechanical Analysis of Vertical Jump Performance in Well-Trained Young Group before and after Passive Static Stretching of Knee Flexors Muscles
403. The Relationship Between Range of Motion and Injuries in Adolescent Dancers and Sportspersons: A Systematic Review
404. Acute effects of different durations of static stretching on the eccentric strength and power of leg flexor muscles
405. Prophylactic stretching does not reduce cramp susceptibility
406. Chronic effect of different types of stretching on ankle dorsiflexion range of motion: Systematic review and meta-analysis
407. Effects of Cupping Therapy in Amateur and Professional Athletes: Systematic Review of Randomized Controlled Trials
408. The Role of Rehabilitation After Regenerative and Orthobiologic Procedures for the Treatment of Tendinopathy: A Systematic Review
409. Acute Effects of Dynamic Stretching on Muscle Flexibility and Performance: An Analysis of the Current Literature
410. Herbal medicine for sports: a review
411. Comparison between static stretching and proprioceptive neuromuscular facilitation on hamstring flexibility: systematic review and meta-analysis
412. Principles of Rehabilitation
413. The Effect of Different Passive Static Stretching Intensities on Perceived Muscle Soreness and Muscle Function Recovery Following Unaccustomed Eccentric Exercise: A Randomised Controlled Trial
414. Effect of Deep Transverse Friction Massage on Antagonist Muscle Function
415. A Tailored Advice Tool to Prevent Injuries Among Novice Runners: Protocol for a Randomized Controlled Trial
416. Acute effects of contract-relax proprioceptive neuromuscular facilitation stretching of hip abductors and adductors on dynamic balance
417. Acute changes of hip joint range of motion using selected clinical stretching procedures: A randomized crossover study
418. Flexibility is associated with motor competence in schoolchildren
419. Effects of warm‐up on hamstring muscles stiffness: Cycling vs foam rolling
420. Acute Effects of the Different Intensity of Static Stretching on Flexibility and Isometric Muscle Force
421. A Process for Error Correction for Strength and Conditioning Coaches
422. Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 1: The mechanisms
423. Effectiveness of a 16-Week High-Intensity Cardioresistance Training Program in Adults
424. Test-retest reliability of the range of motion and stiffness based on discomfort perception
425. The effects of 4 weeks stretching training to the point of pain on flexibility and muscle tendon unit properties
426. Neurophysiological Mechanisms Underpinning Stretch-Induced Force Loss
427. Acute effect of stretching modalities on global coordination and kicking accuracy in 12–13 year-old soccer players
428. Influence of chronic stretching on muscle performance: Systematic review
429. Sports and environmental temperature: From warming-up to heating-up
430. The acute benefits and risks of passive stretching to the point of pain
431. The effects of a combined static-dynamic stretching protocol on athletic performance in elite Gaelic footballers: A randomised controlled crossover trial
432. Acute Effects of Static Stretching of Hamstring on Performance and Anterior Cruciate Ligament Injury Risk During Stop-Jump and Cutting Tasks in Female Athletes
433. Effect of the flexibility training performed immediately before resistance training on muscle hypertrophy, maximum strength and flexibility
434. Körperliches Training in Prävention und Therapie – Gestaltung und Effekte
435. Safety and Efficacy of Simultaneous Biplane Mode of 3-Dimensional Transesophageal Echocardiography-Guided Antegrade Multiple-Inflation Balloon Aortic Valvuloplasty in Patients With Severe Aortic Stenosis
436. Effects of a 12-week neck muscles training on muscle function and perceived level of muscle soreness in amateur rugby players
437. Acute Effects of Static vs. Ballistic Stretching on Strength and Muscular Fatigue Between Ballet Dancers and Resistance-Trained Women
438. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association
439. Effect of participants’ static stretching knowledge or deception on the responses to prolonged stretching
440. Flexibility Exercises and Performance
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