Abstract
Introduction: Stretching increases the range of motion. Facilitation techniques have demonstrated their effectiveness, however, the time to be used for this purpose is not clear. Objective: To estimate the effectiveness of different application times of the proprioceptive neuromuscular facilitation technique, hold-relax, on knee mobility ranges in healthy young adults. Methodology: Randomized, double-blind controlled clinical trial in which 34 young adult, aged between 20 and 37 years, participated. Knee flexibility assessment was performed bilaterally using the popliteal angle as a reference point through videography, using Kinovea software. The subjects were then randomized and assigned to 3 stretching intervention groups with the hold-relax technique: the first 21 seconds, the second 15 seconds, and the third control group. To estimate the effectiveness of the intervention, a generalized linear model (family: normal, link: identity) was used. Results: In the intervention groups with times of 21 seconds (group 1) and 15 seconds (group 2), the average values and standard deviation in the initial baseline assessment and final assessment after the intervention show a significant gain. of the popliteal angle bilaterally in both group 1 and group 2 compared to the control group. Conclusions: The execution of the Hold-Relax proprioceptive neuromuscular facilitation protocol with different times showed that the 21 second protocol is not greater than the 15 second protocol, but they are superior to the control.
References
Dantas E, Daoud R, Trott A, Nodari R, Conceição M. Flexibility: components, proprioceptive mechanisms and methods. Biomed Hum Kinet. 2011; 3(3): 39–43. doi: http://dx.doi.org/10.2478/v10101-011-0009-2
Lima CD, Ruas CV, Behm DG, Brown LE. Acute effects of stretching on flexibility and performance: A narrative review. J Sci Sport Exerc. 2019; 1(1): 29–37. doi: https://dx.doi.org/10.1007/s42978-019-0011-x
Mohamadi P, Ghotbi N, Bashardoust S, Naghdi Dorbati S, Salehi S. Comparison of the effect of tecar therapy and static stretching on hamstring flexibility in male athletes. J Babol Univ Med Sci. 2021; 23(1): 53–59. doi: http://dx.doi.org/10.22088/jbums.23.1.53
Kumar GP. Comparison of cyclic loading and hold relax technique in increasing resting length of hamstring muscles. Hong Kong Physiother J. 2011; 29(1): 31–33. doi: http://dx.doi.org/10.1016/j.hkpj.2011.03.002
Kaneda H, Takahira N, Tsuda K, Tozaki K, Kudo S, Takahashi Y, et al. Effects of tissue flossing and dynamic stretching on hamstring muscles function. J Sport Sci Med. 2020; 19(4): 681–689.
Lempke L, Wilkinson R, Murray C, Stanek J. The effectiveness of PNF versus static stretching on increasing hip-flexion range of motion. J Sport Rehabil. 2018; 27(3): 289–294. doi: http://dx.doi.org/10.1123/jsr.2016-0098
Cayco CS, Labro AV, Gorgon EJR. Hold-relax and contract-relax stretching for hamstrings flexibility: A systematic review with meta-analysis. Phys Ther Sport. 2019; 35: 42–55. doi: http://dx.doi.org/10.1016/j.ptsp.2018.11.001
Gopi S, Mistry Neeta J, Vyas Megha S. Comparison of the effect of active release technique versus proprioceptive neuro-muscular facilitation stretching (modified hold-relax) on hamstring flexibility in patients having chronic low back pain. Natl J Integr Res Med. 2015; 6(5): 66–70.
Opplert J, Babault N. Acute effects of dynamic stretching on muscle flexibility and performance: An analysis of the current literature. Sport Med. 2017; 48(2): 299–325. doi: http://dx.doi.org/10.1007/s40279-017-0797-9
Kay AD, Blazevich AJ. Effect of acute static stretch on maximal muscle performance: A systematic review. Med Sci Sports Exerc. 2012; 44(1): 154–164. doi: http://dx.doi.org/10.1249/MSS.0b013e318225cb27
Nakamura M, Ikezoe T, Tokugawa T, Ichihashi N. Acute effects of stretching on passive properties of human gastrocnemius muscle-tendon unit: Analysis of differences between hold-relax and static stretching. J Sport Rehabil. 2015; 24(3): 286–292.doi: http://dx.doi.org/10.1123/jsr.2014-0164
Guissard N, Duchateau J. Neural aspects of muscle stretching. Exerc Sport Sci Rev. 2006; 34(4): 154–158. doi: http://dx.doi.org/10.1249/01.jes.0000240023.30373.eb
Freitas S, Mendes B, Guillaume LS, Andrade R, Nordez A, Milanovic Z. Can chronic stretching change the muscle -tendon mechanical properties? A review. Int J Lab Hematol. 2017; 28(3): 42–49. doi: https://doi.org/10.1111/sms.12957
Apostolopoulos N, Metsios GS, Flouris AD, Koutedakis Y, Wyon MA. The relevance of stretch intensity and position—a systematic review. Front Psychol. 2015; 6: 1-25. doi: http://dx.doi.org/10.3389/fpsyg.2015.01128
Thomas E, Bianco A, Paoli A, Palma A. The relation between stretching typology and stretching duration: The Effects on Range of Motion. Int J Sports Med. 2018; 39(4): 243–254. doi: http://dx.doi.org/10.1055/s-0044-101146
Behm DG, Blazevich AJ, Kay AD, McHugh M. Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: A systematic review. Appl Physiol Nutr Metab. 2015; 41(1): 1–11. doi: http://dx.doi.org/10.1139/apnm-2015-0235
Magnusson SP. Passive properties of human skeletal muscle during stretch maneuvers. A review. Scand
J Med Sci Sports. 1998; 8(2): 65-77. doi: http://dx.doi.org/10.1111/j.1600-0838.1998.tb00171.x
Birinci T, Razak Ozdincler A, Altun S, Kural C. A structured exercise programme combined with proprioceptive neuromuscular facilitation stretching or static stretching in posttraumatic stiffness of the elbow: a randomized controlled trial. Clin Rehabil. 2019; 33(2): 241–252. doi: http://dx.doi.org/10.1177/0269215518802886
Marek SM, Cramer JT, Fincher L, Massey L, Dangelmaier S, Purkatastha S, et al. Acute effects of static and proprioceptive neuromuscular facilitation stretching on muscle strength and power output. J Athl Train. 2005; 40(2): 94–103.
Roberts JM, Wilson K. Effect of stretching duration on active and passive range of motion in the lower extremity. Br J Sports Med. 1999; 33(4): 259–263. doi: http://dx.doi.org/10.1136/bjsm.33.4.259
Page P. Current concepts in muscle stretching for excersice and rehabilitation. Int J Sports Phys Ther. 2012; 7(1): 109–119.
Mateus-Arias OE, Santos-Gómez AF, Suarez-Caicedo AM, Morales-Gonzáles Y, Martínez-Torres J. Eficacia de la técnica sostener relajar en comparación con el estiramiento dinámico sobre la flexibilidad de los isquiotibiales. Med UPB. 2023; 42(2): 17–25. doi: https://doi.org/https://doi.org/10.18566/medupb.v42n2.a03
Iwata M, Yamamoto A, Matsuo S, Hatano G, Miyazaki M, Fukaya T, et al. Dynamic stretching has sustained effects on range of motion and passive stiffness of the hamstring muscles. J Sport Sci Med. 2019; 18(1): 13–20. doi: https://pubmed.ncbi.nlm.nih.gov/30787647/
Su H, Chang N-J, Wu W-L, Gou L-Y, Chu I-H. Acute effects of foam rolling, static stretching, and dynamic stretching during warm-ups on muscular flexibility an strength in young adults. J Sport Rehabil. 2016; 26(6): 469–477. doi: https://dx.doi.org/10.1123/jsr.2016-0102
Thompson PD, Arena R, Riebe D, Pescatello LS; American college of sports medicine. ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep. 2013; 12(4): 215-217. doi: http://dx.doi.org/10.1249/JSR.0b013e31829a68cf
Williams C. Flexibility training: incorporating all components of fitness. Perform Train J. 2011; 10(1): 4–11.
Quintana Aparicio E, Alburquerque Sendín F. Evidencia científica de los métodos de evaluación de la elasticidad de la musculatura isquiosural. Osteopat Cient. 2008; 3(3): 115–124. doi: http://dx.doi.org/10.1016/S1886-9297(08)75760-6
Mansournia MA, Higgins JPT, Sterne JAC, Hernan MA. Biases in randomized trials: A conversation between trialists and epidemiologists. Epidemiology. 2017; 28(1): 54–59. doi: https://doi.org/10.1097/EDE.0000000000000564
Younis Aslan HI, Buddhadev HH, Suprak DN, San Juan JG. Acute effects of two hip flexor stretching techniques on knee joint position sense and balance. Int J Sports Phys Ther. 2018; 13(5): 846–859.
Moustafa IM, Ahbouch A, Palakkottuparambil F, Walton LM. Optimal duration of stretching of the hamstring muscle group in older adults: a randomized controlled trial. Eur J Phys Rehabil Med. 2021; 57(6): 931–939. doi: http://dx.doi.org/10.23736/S1973-9087.21.06731-9
Park S, Lim W. Effects of proprioceptive neuromuscular facilitation stretching at lowintensities with standing toe touch on developing and maintaining hamstring flexibility. J Bodyw Mov Ther. 2020; 24(4): 561–567. doi: https://dx.doi.org/10.1016/j.jbmt.2020.08.003
Osailan A, Jamaan A, Talha K, Alhndi M. Instrument assisted soft tissue mobilization (IASTM) versus stretching: A comparison in effectiveness on hip active range of motion, muscle torque and power in people with hamstring tightness. J Bodyw Mov Ther. 2021; 27: 200–206. doi: http://dx.doi.org/10.1016/j.jbmt.2021.03.001
Hill KJ, Robinson KP, Cuchna JW, Hoch MC. Immediate effects of PNF stretching programs compared to passive stretching programs for hamstring flexibility: a critical appraised topic. J Sport Rehabil. 2016; 26(6): 567–572. doi: http://dx.doi.org/10.1123/jsr.2016-0003
Bonnar P, Deivert R, Gould T. The relationship between isometric contraction durations during hold-relax stretching and improvement of hamstring flexibility. J Sports Med Phys Fitness. 2004; 44(4): 258–261.
Gonzalez-Rave JM, Sanchez-Gomez A, Santos-Garcia DJ. Efficacy of 2 different stretch training programs (passive vs PNF) on shoulder and hip ROM in older people. J Strength Cond Res. 2012; 26(4): 1045–1051. doi: http://dx.doi.org/10.1519/JSC.0b013e31822dd4dd
Wicke J, Gainey K, Figueroa M. A comparison of self-administered propioceptive neuromuscular facilitation to static stretching on range of motion and flexibility. J strength Cond Res. 2014; 28(1): 168–172. doi: http://dx.doi.org/10.1519/JSC.0b013e3182956432
Weppler CH, Magnusson SP. Increasing muscle extensibility: A matter of increasing length or modifying sensation? Phys Ther. 2010; 90(3): 438–449. doi: http://dx.doi.org/10.2522/ptj.20090012
Chan SP, Hong Y, Robinson PD. Flexibility and passive resistance of the hamstrings of young adults using two different static stretching protocols. Scand J Med Sci Sports. 2001; 11(2): 81–86. doi: http://dx.doi.org/10.1034/J.1600-0838.2001.011002081.X
Yildirim MS, 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. 2016; 33(1): 89–94. doi: http://dx.doi.org/10.5604/20831862.1194126
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Oscar Eduardo Mateus-Arias, Andersson Gómez-Sanabria, Catalina Parra-Ardila, Javier Martínez-Torres, Sonia Carolina Mantilla-Toloza