Effects of two different stretching techniques on proprioception and hamstring flexibility: a pilot study
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: This study aimed to compare the immediate and long-term effect of proprioceptive neuromuscular facilitation (PNF) contract–relax–antagonist–contract (CRAC) exercises versus static stretching on proprioception and flexibility in males with hamstring shortness. Patients & methods: Knee extension angle test was used to measure flexibility and isokinetic dynamometer to evaluate proprioception. Assessments were evaluated at baseline, after first exercise and eighth week. The hamstring stretching was applied 3 days a week for 8 weeks. Results: Flexibility and position sense were similar in the immediate and long term (p > 0.05). However, the motion sense increased significantly in long term within the PNF CRAC group (p = 0.02). Conclusion: Both stretching exercises are effective for improving flexibility. Moreover, PNF CRAC improved motion sense more than static stretching in the long term.
Clinical trial registration number: NCT04026646.
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References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Tuthill JC, Azim E. Proprioception. Curr. Biol. 28(5), R194–R203 (2018).
2.
Marini F, Ferrantino M, Zenzeri J. Proprioceptive identification of joint position versus kinaesthetic movement reproduction. Human Mov. Sci. 62, 1–13 (2018).
3.
Röijezon U, Clark NC, Treleaven J. Proprioception in musculoskeletal rehabilitation. Part 1: basic science and principles of assessment and clinical interventions. Manual Ther. 20(3), 368–377 (2015).
4.
Macefield VG. Physiological characteristics of low-threshold mechanoreceptors in joints, muscle and skin in human subjects. Clin. Exp. Pharmacol. Physiol. 32(1–2), 135–144 (2005).
5.
Bigongiari A, Francica JV, Franciulli PM, Mochizuki L, Hamill J, Ervilha UF. Aerobic training in aquatic environment improves the position sense of stroke patients: a randomized clinical trial. Motriz: Revista de Educação Física 24(1), 1–7 (2018).
6.
Cho S-H, Bae C-H, Gak H-B. Effects of closed kinetic chain exercises on proprioception and functional scores of the knee after anterior cruciate ligament reconstruction. J. Phys. Ther. Sci. 25(10), 1239–1241 (2013).
7.
Kalirathinam D, Hashim HA, Ismail MSB. A 12-weeks multimodal exercise training on ankle joint position sense in lateral ankle ligament injury of athletes. Res. J. Pharm. Technol. 11(9), 4074–4083 (2018).
8.
Walsh GS. Effect of static and dynamic muscle stretching as part of warm up procedures on knee joint proprioception and strength. Human Mov. Sci. 55, 189–195 (2017).
9.
Takasaki H, Okubo Y, Okuyama S. The effect of proprioceptive neuromuscular facilitation on joint position sense: a systematic review. J. Sport Rehab. 29(4), 488–497 (2019).
10.
Ryan EE, Rossi MD, Lopez R. The effects of the contract-relax-antagonist-contract form of proprioceptive neuromuscular facilitation stretching on postural stability. J. Strength Cond. Res. 24(7), 1888–1894 (2010).
•• Investigates the effects of proprioceptive neuromuscular facilitation (PNF) exercises.
11.
Streepey JW, Mock MJ, Riskowski JL, VanWye WR, Vitvitskiy BM, Mikesky AE. Effects of quadriceps and hamstrings proprioceptive neuromuscular facilitation stretching on knee movement sensation. J. Strength Cond. Res. 24(4), 1037–1042 (2010).
•• Investigates the effects of PNF exercises.
12.
Weerapong P, Hume PA, Kolt GS. Stretching: mechanisms and benefits for sport performance and injury prevention. Phys. Ther. Rev. 9(4), 189–206 (2004).
13.
Osternig LR, Robertson RN, Troxel RK, Hansen P. Differential responses to proprioceptive neuromuscular facilitation (PNF) stretch techniques. Med. Sci. Sports Exercise 22(1), 106–111 (1990).
14.
Hindle K, Whitcomb T, Briggs W, Hong J. Proprioceptive neuromuscular facilitation (PNF): its mechanisms and effects on range of motion and muscular function. J. Hum. Kinet. 31(2012), 105–113 (2012).
15.
Ghaffarinejad F, Taghizadeh S, Mohammadi F. Effect of static stretching of muscles surrounding the knee on knee joint position sense. Brit. J. Sports Med. 41(10), 684–687 (2007).
•• Examines the effects of static stretching (SS) exercises on proprioceptive sense.
16.
Larsen R, Lund H, Christensen R, Røgind H, Danneskiold-Samsøe B, Bliddal H. Effect of static stretching of quadriceps and hamstring muscles on knee joint position sense. Brit. J. Sports Med. 39(1), 43–46 (2005).
•• Examines the effects of SS exercises on proprioceptive sense.
17.
Ogura Y, Miyahara Y, Naito H, Katamoto S, Aoki J. Duration of static stretching influences muscle force production in hamstring muscles. J. Strength Cond. Res. 21(3), 788 (2007).
18.
Robin K, Raj YL. Impact of PNF stretching on muscular flexibility in football. Int. J. Yogic Hum. Mov. Sports Sci. 4(1), 686–688 (2019).
19.
Singh AK, Nagaraj S, Palikhe RM, Neupane B. Neurodynamic sliding versus PNF stretching on hamstring flexibility in collegiate students: a comparative study. Int. J. Phys. Educ. Sports Health 1(1), 29–33 (2017).
20.
Ün N, Yüktaşır B, Ergun N. Statik germe süresinin hamstring kas esnekliği üzerine etkisi. Fizyoterapi Rehabilitasyon 13(2), 72–76 (2002).
21.
Ford GS, Mazzone MA, Taylor K. The effect of 4 different durations of static hamstring stretching on passive knee-extension range of motion. J. Sport Rehab. 14(2), 95–107 (2005).
22.
Youdas JW, Haeflinger KM, Kreun MK, Holloway AM, Kramer CM, Hollman JH. The efficacy of two modified proprioceptive neuromuscular facilitation stretching techniques in subjects with reduced hamstring muscle length. Physiother. Theory Pract. 26(4), 240–250 (2010).
23.
Sivagnanam R, Paul J, Natarajan SK, Sudhakar S. Comparative effect of PNF stretching technique on hamstring flexibility. Int. J. Med. Exercise Sci. 4(1), 443–447 (2018).
24.
López-Bedoya J, Vernetta-Santana M, Robles-Fuentes A, Ariza-Vargas L. Effect of three types of flexibility training on active and passive hip range of motion. J. Sports Med. Phys. Fitness 53(3), 304–311 (2013).
25.
Davis DS, Ashby PE, McCale KL, McQuain JA, Wine JM. The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. J. Strength Cond. Res. 19(1), 27 (2005).
•• Uses the same stretching volume in PNF and SS exercises.
26.
Mallmann JS, Moesch J, Tomé F, Vieira L, Ciqueleiro RT, Bertolini GRF. Comparação entre o efeito imediato e agudo de três protocolos de alongamento dos músculos isquiotibiais e paravertebrais. Rev. Bras. Clin. Med. 9(5), 354–359 (2011).
•• Uses the same stretching volume in PNF and SS exercises.
27.
Magnusson SP, Simonsen EB, Aagaard P, Dyhre-Poulsen P, McHugh MP, Kjaer M. Mechanical and physiological responses to stretching with and without preisometric contraction in human skeletal muscle. Arch. Phys. Med. Rehabil. 77(4), 373–378 (1996).
28.
Miyahara Y, Naito H, Ogura Y, Katamoto S, Aoki J. Effects of proprioceptive neuromuscular facilitation stretching and static stretching on maximal voluntary contraction. J. Strength Cond. Res. 27(1), 195–201 (2013).
29.
O'Hora J, Cartwright A, Wade CD, Hough AD, Shum GL. Efficacy of static stretching and proprioceptive neuromuscular facilitation stretch on hamstrings length after a single session. J. Strength Cond. Res. 25(6), 1586–1591 (2011).
30.
Wicke J, Gainey K, Figueroa M. A comparison of self-administered proprioceptive neuromuscular facilitation to static stretching on range of motion and flexibility. J. Strength Cond. Res. 28(1), 168–172 (2014).
31.
Yıldırım M, Ozyurek S, Tosun O, Uzer S, Gelecek N. Comparison of effects of static, proprioceptive neuromuscular facilitation and Mulligan stretching on hip flexion range of motion: a randomized controlled trial. Biol. Sport 33(1), 89 (2016).
32.
Yıldırım MŞ, Tuna F, Kabayel DD, Süt N. The cut-off values for the diagnosis of hamstring shortness and related factors. Balkan Med. J. 35(5), 388 (2018).
33.
Haji Hasani A, Bakhtiari AH, Amoozadeh Khalili M. Comparative study of static stretch and hold relax on increasing the motion range of knee extension and flexibility of shortened hamstring muscles of male students in semnan. Middle East J. Rehab. Health 1, 2 (2014).
34.
Bolívar YA, Munuera PV, Padillo JP. Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot Ankle Int. 34(1), 42–48 (2013).
35.
White LC, Dolphin P, Dixon J. Hamstring length in patellofemoral pain syndrome. Physiotherapy 95(1), 24–28 (2009).
36.
Mistry GS, Vyas NJ, Sheth MS. Comparison of hamstrings flexibility in subjects with chronic low back pain versus normal individuals. J. Clin. Exp. Res. 2(1), 85 (2014).
37.
Kaur M, Paul R, Kumar S, Arora R, Arora L. A randomized controlled trial to compare the effectiveness of static stretching versus PNF stretching of hamstring muscles following superficial heat in athletes. Int. J. Sci. Res. Pub. 4(7), 1–4 (2014).
38.
Lim K-I, Nam H-C, Jung K-S. Effects on hamstring muscle extensibility, muscle activity, and balance of different stretching techniques. J. Phys. Ther. Sci. 26(2), 209–213 (2014).
39.
Ramanand CJ. A study to compare the effect of scapular taping along with stretching and stretching alone in patients with postural neck pain – randomised control trial. Indian J. Physiother. Occ. Ther. 9(3), 1–6 (2015).
40.
Ahmed H, Iqbal A, Anwer S, Alghadir A. Effect of modified hold-relax stretching and static stretching on hamstring muscle flexibility. J. Phys. Ther. Sci. 27(2), 535–538 (2015).
41.
Ramachandran S, Paul J, Senthilkumar N, Sudhakar S, Tamilselvi. Comparative effect of pnf stretching techniques on hamstring flexibility. Int. J. Med. Exercise Sci. 4(1), 443–447 (2018).
42.
Nagarwal A, Zutshi K, Ram C, Zafar R, Hamdard J. Improvement of hamstring flexibility: a comparison between two PNF stretching techniques. Int. J. Sports Sci. Engineer. 4(1), 25–33 (2010).
43.
Youdas JW, Krause DA, Hollman JH, Harmsen WS, Laskowski E. The influence of gender and age on hamstring muscle length in healthy adults. J. Orthopaed. Sports Phys. Ther. 35(4), 246–252 (2005).
44.
Drust B, Waterhouse J, Atkinson G, Edwards B, Reilly T. Circadian rhythms in sports performance: an update. Chronobiol. Int. 22(1), 21–44 (2005).
45.
Davis DS, Quinn RO, Whiteman CT, Williams JD, Young CR. Concurrent validity of four clinical tests used to measure hamstring flexibility. J. Strength Cond. Res. 22(2), 583–588 (2008).
46.
Stillman BC. An investigation of the clinical assessment of joint position sense [PhD thesis]. The University of Melbourne, Victoria, Australia (2000).
47.
Ogard WK. Proprioception in sports medicine and athletic conditioning. Strength Cond. J. 33(3), 111–118 (2011).
48.
Pincivero DM, Bachmeier B, Coelho AJ. The effects of joint angle and reliability on knee proprioception. Med. Sci. Sports Exerc. 33(10), 1708–1712 (2001).
49.
Erden Z. Dizin farklı açılarında eklem pozisyon hissi farklı mıdır? Joint Dis. Rel. Surg. 20(1), 47–51 (2009).
50.
Relph N. The measurement of knee joint position sense [PhD thesis]. University of Salford, Salford, UK (2015).
• Indicates that there is no gold standard in proprioceptive sense evaluation.
51.
Kotteeswaran K, Snigdha J, Alagesan J. Effect of proprioceptive neuromuscular facilitation stretching and dynamic soft tissue mobilization on hamstring flexibility in subjects with low back ache-single blinded randomised controlled study. Int. J. Pharma Bio Sci. 5(3), 228–233 (2014).
52.
Rosenthal R, Cooper H, Hedges L. Parametric measures of effect size. Handbook Res. Synth. 621(2), 231–244 (1994).
53.
Minshull C, Eston R, Bailey A, Rees D, Gleeson N. The differential effects of PNF versus passive stretch conditioning on neuromuscular performance. Eur. J. Sport Sci. 14(3), 233–241 (2014).
54.
Chen C-H, Chen TC, Chen H-L, Lin M-J, Wu C-J, Tseng K-W. Effects of 8-week static stretch and PNF training on the angle-torque relationship. J. Med. Biol. Engineer. 29(4), 196–201 (2009).
55.
Chen C-H, Nosaka K, Chen H-L, Lin M-J, Tseng K-W, Chen TC. Effects of flexibility training on eccentric exercise-induced muscle damage. Med. Sci. Sports Exerc. 43(3), 491–500 (2011).
56.
Maddigan ME, Peach AA, Behm DG. A comparison of assisted and unassisted proprioceptive neuromuscular facilitation techniques and static stretching. J. Strength Cond. Res. 26(5), 1238–1244 (2012).
57.
Puentedura EJ, Huijbregts PA, Celeste S et al. Immediate effects of quantified hamstring stretching: hold-relax proprioceptive neuromuscular facilitation versus static stretching. Phys. Ther. Sport 12(3), 122–126 (2011).
58.
McNair PJ, Dombroski EW, Hewson DJ, Stanley SN. Stretching at the ankle joint: viscoelastic responses to holds and continuous passive motion. Med. Sci. Sports Exerc. 33(3), 354–358 (2001).
59.
Taylor DC, Brooks DE, Ryan JB. Viscoelastic characteristics of muscle: passive stretching versus muscular contractions. Med. Sci. Sports Exerc. 29, 1619–1624 (1997).
60.
Oliver KM, Florez-Paz DM, Badea TC, Mentis GZ, Menon V, de Nooij JC. Molecular development of muscle spindle and Golgi tendon organ sensory afferents revealed by single proprioceptor transcriptome analysis (2020). www.biorxiv.org/content/10.1101/2020.04.03.023986v1
61.
Alter MJ. Science of Flexibility. Human Kinetics, IL, USA (2004).
62.
Barrett KE, Barman SM, Boitano S, Brooks HL, Gökbel H. Ganong'un Tıbbi Fizyolojisi. Nobel Tıp Kitabevleri, İstanbul, Turkey (2015).
63.
Sharman MJ, Cresswell AG, Riek S. Proprioceptive neuromuscular facilitation stretching. Sports Med. 36(11), 929–939 (2006).
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PubMed: 34231374
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© 2021 Future Medicine Ltd.
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Received: 12 February 2021
Accepted: 15 June 2021
Published online: 7 July 2021
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Effects of two different stretching techniques on proprioception and hamstring flexibility: a pilot study. (2021) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2021-0040
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