Long-term static stretching can decrease muscle stiffness: A systematic review and meta-analysis

Effects of Stretching or Strengthening Exercise on Spinal and Lumbopelvic Posture: A Systematic Review with Meta-Analysis

BACKGROUND

Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach.

METHODS

A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied.

RESULTS

A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05).

CONCLUSION

Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.

Influence of 8-weeks of supervised static stretching or resistance training of pectoral major muscles on maximal strength, muscle thickness and range of motion

OBJECTIVES

Current research suggests static stretch-induced maximal strength increases and muscle hypertrophy with potential to substitute resistance-training routines. However, most studies investigated the plantar flexors. This study explored the effects of a static stretching program on maximal strength, hypertrophy and flexibility of the pectoralis major and compared the effects with those of traditional resistance training.

METHODS

Eighty-one (81) active participants were allocated to either a static stretching, strength-training or control group. Pectoralis stretching was applied 15 min/day, 4 days per week for 8 weeks, while resistance training trained 3 days per week, 5 × 12 repetitions.

RESULTS

There was an increase in all parameters (strength: p < 0.001, ƞ2 = 0.313, muscle thickness: p < 0.001, ƞ2 = 0.157-0.264, flexibility: p < 0.001, ƞ2 = 0.316) and a time*group interaction (strength: p = 0.001, ƞ2 = 0.154, muscle thickness: p = 0.008-0.001, ƞ2 = 0.117-0.173, flexibility: p < 0.001, ƞ2 = 0.267). Post-hoc testing showed no difference between both intervention groups regarding maximal strength and muscle thickness (p = 0.905-0.983, d = 0.036-0.087), while flexibility increased in the stretching group (p = 0.001, d = 0.789).

CONCLUSION

Stretching showed increases in maximal strength and hypertrophy, which were comparable with commonly used resistance training. Based on current literature, the influence of mechanical tension as the underlying mechanism is discussed. Furthermore, as equipment and comparatively long stretching durations are requested to induce meaningful strength increases in recreationally active participants, practical application seems limited to special circumstances.

Acute and Chronic Effects of Static Stretching on Intramuscular Hamstring Stiffness

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

The effects of static and dynamic stretching on deep fascia stiffness: a randomized, controlled cross-over study

AIM

Previous stretching studies mostly investigated effects on the skeletal muscle but comprehensive explorations regarding the role of the connective tissue are scarce. Since the deep fascia has been demonstrated to be sensitive to mechanical tension, it was hypothesized that the fascia would also respond to stretching, contributing to enhanced range of motion (ROM).

METHODS

Forty (40) recreationally active participants (male: n = 25, female: n = 15) were included in the randomized controlled cross-over trial and allocated to different groups performing 5 min static (STAT) or dynamic (DYN) plantar flexor stretching or control condition (CC) in a random order. Pre- and immediately post-intervention, muscle and fascia stiffness, as well as muscle and fascia thickness were measured using high-resolution ultrasound and strain elastography. ROM was assessed in the ankle joint via the knee to wall test (KtW) and goniometer.

RESULTS

STAT reduced both, muscle and fascia stiffness (d = 0.78 and 0.42, p < 0.001, respectively), while DYN did not reduce stiffness compared to the control condition (p = 0.11-0.41). While both conditions showed significant increases in the KtW (d = 0.43-0.46, p = 0.02-0.04), no significant differences to the CC were observed for the isolated ROM testing (p = 0.09 and 0.77). There was a small correlation between fascia stiffness decreases and ROM increases (r = - 0.25, p = 0.006) but no association was found between muscle stiffness decreases and ROM increases (p = 0.13-0.40).

CONCLUSION

Our study is the first to reveal stretch-induced changes in fascia stiffness. Changes of fascia`s but not muscle`s mechanical properties may contribute to increased ROM following stretching.

Effects of chronic static stretching interventions on jumping and sprinting performance-a systematic review with multilevel meta-analysis

When improving athletic performance in sports with high-speed strength demands such as soccer, basketball, or track and field, the most common training method might be resistance training and plyometrics. Since a link between strength capacity and speed strength exists and recently published literature suggested chronic stretching routines may enhance maximum strength and hypertrophy, this review was performed to explore potential benefits on athletic performance. Based on current literature, a beneficial effect of static stretching on jumping and sprinting performance was hypothesized. A systematic literature search was conducted using PubMed, Web of Science and Google scholar. In general, 14 studies revealed 29 effect sizes (ES) (20 for jumping, nine for sprinting). Subgroup analyses for jump performance were conducted for short- long- and no stretch shortening cycle trials. Qualitative evaluation was supplemented by performing a multilevel meta-analysis via R (Package: metafor). Significant positive results were documented in six out of 20 jump tests and in six out of nine sprint tests, while two studies reported negative adaptations. Quantitative data analyses indicated a positive but trivial magnitude of change on jumping performance (ES:0.16, p = 0.04), while all subgroup analyses did not support a positive effect (p = 0.09-0.44). No significant influence of static stretching on sprint performance was obtained (p = 0.08). Stretching does not seem to induce a sufficient stimulus to meaningfully enhance jumping and sprinting performance, which could possibly attributed to small weekly training volumes or lack of intensity.

Relationship between pectoralis major stiffness and shoulder extension range of motion

This study aimed to investigate the correlation between the passive muscle stiffness of the pectoralis major muscle pars clavicularis (PMc) and shoulder extension range of motion (ROM) in both male and female participants. Thirty-nine (23 male/16 female) physically active and healthy participants volunteered in this study. After a standardized warm-up, the PMc stiffness was tested via shear wave elastography at a slightly stretched position (long muscle length) and in a non-stretched position (short muscle length). Additionally, a custom-made device and 3D motion capture assessed the active shoulder extension ROM. We found a significant moderate and negative relationship between shoulder extension ROM and PMc stiffness at long muscle length (rs = -0.33; p = 0.04) but not at short muscle length (r = -0.23; p = 0.17). Additionally, there was no significant difference between male and female participants in the correlation analyses at both elbow angles. The moderate correlation between PMc stiffness at a slightly stretched position and shoulder extension ROM suggests that additionally, other structures such as nerves/fascia stiffness or even stretch tolerance might be factors that can be related to shoulder extension ROM.

The non-local effects of 7-week foot sole static stretching and foam rolling training on shoulder extension range of motion

Static stretching and foam rolling can increase the range of motion (ROM) of a joint acutely as well as chronically. Although studies have reported ROM increases of a non-stretched heterologous muscle (non-local) following an acute static stretching or foam rolling session, these effects have not been studied for long-term training interventions. Therefore, the purpose of this study was to investigate the effects of a comprehensive 7-week static stretching and foam rolling training program of the foot sole on shoulder extension ROM. A total of 33 healthy, physically active participants (20 male) were assigned to either the intervention (n = 19) or control (n = 14) group. The intervention group performed a 7-week combined static stretching and foam rolling intervention comprising three sessions a week, including three exercises of the foot sole for 5 min each. Before and after the intervention period, the shoulder extension ROM was tested with three-dimensional (3D) motion caption. The level of significance for all statistical analyses was set to ρ ≤ 0.05. There was no significant time (p = 0.70, F1, 31 = 0.157; η2 = 0.005) or time×group effect (p = 0.38, F1, 31 = 0.785; η2 = 0.025) in shoulder extension ROM, indicating no ROM changes in the intervention or the control group. Although previous studies on the acute effects of stretching and foam rolling reported non-local increases in ROM in heterologous muscles, this study could show that such effects do not occur after chronic SS and foam rolling training for 7 weeks. Consequently, if the goal is to chronically increase the ROM of a specific joint, it is recommended to directly treat the muscles of interest.

Effects of a Home-Based Stretching Program on Bench Press Maximum Strength and Shoulder Flexibility

Recent research showed significant stretch-mediated maximum strength increases when performing stretching between 5 to 120 minutes per day with the calf muscle. However, since the practical applicability of these long stretching durations was questioned and studies exploring the transferability to the upper body are scarce, the aim of this study was to investigate the possibility of using a home-based stretching program to induce significant increases in maximum strength and flexibility. Therefore, 31 recreationally active participants (intervention group: 18, control group: 13) stretched the pectoralis major for 15min/day for eight weeks, incorporating three different stretching exercises. The maximum strength was tested isometrically and dynamically in the bench press (one-repetition maximum: 1RM) as well as shoulder range of motion (ROM) performing bilateral shoulder rotation with a scaled bar. Using a two-way analysis of variance (ANOVA) with repeated measures, the results showed high magnitude Time effects (ƞ² = 0.388-0.582, p < 0.001) and Group*Time interaction (ƞ² = 0.281-0.53, p < 0.001-0.002), with increases of 7.4 ± 5.6% in 1RM and of 9.8 ± 5.0% in ROM test in the intervention group. In the isometric testing, there was a high-magnitude Time effect (ƞ² = 0.271, p = 0.003), however, the Group*Time interaction failed to reach significance (p = 0.75). The results are in line with previous results that showed stretch-mediated maximum strength increases in the lower extremity. Future research should address the underlying physiological mechanisms such as muscle hypertrophy, contraction conditions as well as pointing out the relevance of intensity, training frequency and stretching duration.

Patellar Base Support Technique During Manipulation Under Anesthesia for Knee Arthrofibrosis Limits the Risk of Iatrogenic Complications

Knee extension contracture is a common postinjury and postsurgical complication, which decreases knee joint flexion. Many techniques have been described in the literature to restore knee flexion, with the most common one being an arthroscopic lysis of adhesions. However, in severe cases, additional intra- and extra-articular procedures are needed to restore full knee flexion. Manipulation under anesthesia (MUA) is one of them. Unfortunately, it may lead to devastating complications, such as iatrogenic rupture of the patellar tendon or fractures of the patella or tibial tuberosity. Therefore, the purpose of this report is to present a safer modification of MUA for knee extension contracture in cases in which excessive force is demanded to achieve flexion. The key aim of the "patellar base support" technique (PBS technique) is to stretch the contracted quadriceps muscle with controlled and decreased tension on the patella, patellar tendon, and tibial tuberosity.

Acute and Long-Term Effects of Static Stretching on Muscle-Tendon Unit Stiffness: A Systematic Review and Meta-Analysis

Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in the range of motion after static stretching. However, to date, the effects of acute and long-term static stretching on MTS are not well understood. The purpose of this meta-analysis was to investigate the effects of acute and long-term static stretching training on MTS, in young healthy participants. PubMed, Web of Science, and EBSCO published before January 6, 2023, were searched and finally, 17 papers were included in the meta-analysis. Main meta-analysis was performed with a random-effect model and subgroup analyses, which included comparisons of sex (male vs. mixed sex and female) and muscle (hamstrings vs. plantar flexors) were also performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on MTS. For acute static stretching, the result of the meta-analysis showed a moderate decrease in MTS (effect size = -0.772, Z = -2.374, 95% confidence interval = -1.409 - -0.325, p = 0.018, I2 = 79.098). For long-term static stretching, there is no significant change in MTS (effect size = -0.608, Z = -1.761, 95% CI = -1.284 - 0.069, p = 0.078, I2 = 83.061). Subgroup analyses revealed no significant differences between sex (long-term, p = 0.209) or muscle (acute, p =0.295; long-term, p = 0.427). Moreover, there was a significant relationship between total stretching duration and MTS in acute static stretching (p = 0.011, R2 = 0.28), but not in long-term stretching (p = 0.085, R2 < 0.01). Whilst MTS decreased after acute static stretching, only a tendency of a decrease was seen after long-term stretching.

Which muscles exhibit increased stiffness in people with chronic neck pain? A systematic review with meta-analysis

Introduction

Chronic neck pain (CNP) substantially impacts quality of life, posing both personal challenges and economic strains. This systematic review sought to discern muscle-specific stiffness differences between CNP patients and individuals without CNP.

Methods

We searched the PubMed, Scopus, and PEDro databases for studies using ultrasound elastography or myotonometry to compare muscle stiffness between CNP patients and asymptomatic controls. Using a meta-analysis with a random-effects model, we derived the pooled effect as standardized mean difference (SMD).

Results

Out of the six studies selected, the adjusted Newcastle-Ottawa rating scale for cross-sectional studies denoted three as moderate-quality and three as high-quality. Our findings indicate that the upper trapezius (UT) stiffness was elevated in CNP patients compared to their counterparts without CNP (SMD = 0.39, 95% CI = 0.05 to 0.74; p = 0.03; small effect size). The data for other muscles remained inconclusive.

Discussion

Given the case-control design of all reviewed studies, a direct causative link between UT stiffness and CNP is yet to be confirmed. As such, recommending a reduction in trapezius muscle stiffness as a primary rehabilitation strategy for CNP patients is still inconclusive and further research is needed.

The Effect on Flexibility and a Variety of Performance Tests of the Addition of 4 Weeks of Soleus Stretching to a Regular Dynamic Stretching Routine in Amateur Female Soccer Players

The purpose of this study was to investigate the effects of 4 weeks of soleus stretching on ankle flexibility and dynamic balance, as well as selected monitoring and performance tests in soccer. Forty-five healthy female soccer players were randomly divided into a regular stretching group, a regular stretching group with soleus stretching, and a control group. Dynamic stretching protocols were performed for 4 weeks during three sessions per week as part of routine exercises. The regular group stretched three muscle groups (i.e., gastrocnemius, quadriceps, and hamstrings), while the regular + soleus group also stretched the soleus muscle. Before and after the stretching intervention, the ankle range of motion test, Y-balance test, drop jump test, dynamic knee valgus test, and Illinois Agility Running Test were performed. Ankle ROM, Y-balance, and DJ significantly improved in both intervention groups compared to controls. Only the regular + soleus group showed improvement in the Illinois Agility Running Test. Additionally, athletes performing the additional soleus stretching had greater improvements in ankle ROM and DJ but not in DKV or Y-balance. The results showed that adding soleus stretching into regular protocols can provide benefits for female soccer players in terms of performance parameters.