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Behm DG, Alizadeh S, Daneshjoo A, Anvar SH, Graham A, Zahiri A, Goudini R, Edwards C, Culleton R, Scharf C, Konrad A. Acute Effects of Various Stretching Techniques on Range of Motion: A Systematic Review with Meta-Analysis. SPORTS MEDICINE - OPEN 2023; 9:107. [PMID: 37962709 PMCID: PMC10645614 DOI: 10.1186/s40798-023-00652-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
Background Although stretching can acutely increase joint range of motion (ROM), there are a variety of factors which could influence the extent of stretch-induced flexibility such as participant characteristics, stretching intensities, durations, type (technique), and muscle or joint tested. Objective The objective of this systematic review and meta-analysis was to investigate the acute effects of stretching on ROM including moderating variables such as muscles tested, stretch techniques, intensity, sex, and trained state. Methods A random-effect meta-analysis was performed from 47 eligible studies (110 effect sizes). A mixed-effect meta-analysis subgroup analysis was also performed on the moderating variables. A meta-regression was also performed between age and stretch duration. GRADE analysis was used to assess the quality of evidence obtained from this meta-analysis. Results The meta-analysis revealed a small ROM standard mean difference in favor of an acute bout of stretching compared to non-active control condition (ES = −0.555; Z = −8.939; CI (95%) −0.677 to −0.434; p < 0.001; I2 = 33.32). While there were ROM increases with sit and reach (P = 0.038), hamstrings (P < 0.001), and triceps surae (P = 0.002) tests, there was no change with the hip adductor test (P = 0.403). Further subgroup analyses revealed no significant difference in stretch intensity (P = 0.76), trained state (P = 0.99), stretching techniques (P = 0.72), and sex (P = 0.89). Finally, meta-regression showed no relationship between the ROM standard mean differences to age (R2 = −0.03; P = 0.56) and stretch duration (R 2 = 0.00; P = 0.39), respectively. GRADE analysis indicated that we can be moderately confident in the effect estimates. Conclusion A single bout of stretching can be considered effective for providing acute small magnitude ROM improvements for most ROM tests, which are not significantly affected by stretch intensity, participants’ trained state, stretching techniques, and sex. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-023-00652-x. The meta-analysis on joint range of motion (ROM) increases revealed a small effect size in favor of an acute bout of stretching compared to the control condition. Subgroup analysis revealed a significant increase in ROM with sit and reach, hamstrings, and triceps surae tests, but no improvement with the hip adductor tests. Whereas all moderating variables presented significant increases in ROM, further subgroup analyses revealed no significant difference in ROM gains with the stretch intensity, trained state of the participants, stretching techniques, and sex. A meta-regression showed no relationship between the effect sizes to age and stretch duration, respectively.
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Affiliation(s)
- David George Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Abdolhamid Daneshjoo
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Shahid Bahonar University of Kerman, Kerman, 76169-13439, Iran
| | - Saman Hadjizadeh Anvar
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Andrew Graham
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Ali Zahiri
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Reza Goudini
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Chris Edwards
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Robyn Culleton
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Carina Scharf
- Institute of Human Movement Science, Sport and Health, Graz University, Mozartgasse 14, 8010, Graz, Austria
| | - Andreas Konrad
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
- Institute of Human Movement Science, Sport and Health, Graz University, Mozartgasse 14, 8010, Graz, Austria.
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Opara M, Kozinc Ž. Stretching and Releasing of Iliotibial Band Complex in Patients with Iliotibial Band Syndrome: A Narrative Review. J Funct Morphol Kinesiol 2023; 8:74. [PMID: 37367238 DOI: 10.3390/jfmk8020074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Iliotibial band syndrome (ITBS) is one of the most common overuse syndromes causing knee pain; it is especially prevalent in runners and also common in cyclists, rowers, and field athletes, with occasional cases occurring in non-athletes too. ITBS symptoms can negatively affect not only knee function, but also mental and physical aspects of health-related quality of life. Although various conservative treatment options have been investigated and discussed, there is still no consensus on a standard of care for ITBS. Moreover, the literature on the etiology and risk factors of ITBS, which could help in selecting appropriate treatment methods, is conflicting and inconclusive. The role of individual treatment modalities such as stretching and releasing techniques has not been extensively studied and remains unclear. In this article, we will critically review the available evidence for the benefits of ITB stretching and "release" methods in the treatment of ITBS. In addition to the direct evidence (clinical studies examining the effects of ITB stretching and other methods that purportedly stretch or "release" the ITB), we present several additional lines of reasoning that discuss the rationale for ITB stretching/releasing in terms of the etiology of ITBS, the mechanical properties and behavior of the ITB, and the risk factors for ITBS development. We conclude that the current literature provides some evidence for the inclusion of stretching or other "release" methods in the early rehabilitation of ITBS. Long-term interventions typically include ITB stretching; however, it remains unclear to what extent stretching within a multimodal treatment actually contributes to resolving the symptoms. At the same time, there is no direct evidence to suggest that stretching and "release" methods have any negative effects.
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Affiliation(s)
- Manca Opara
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, SI-6000 Koper, Slovenia
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Glänzel MH, Rodrigues DR, Petter GN, Pozzobon D, Vaz MA, Geremia JM. Foam Rolling Acute Effects on Myofascial Tissue Stiffness and Muscle Strength: A Systematic Review and Meta-Analysis. J Strength Cond Res 2023; 37:951-968. [PMID: 36227232 DOI: 10.1519/jsc.0000000000004385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Glänzel, MH, Rodrigues, DR, Petter, GN, Pozzobon, D, Vaz, MA, and Geremia, JM. Foam rolling acute effects on myofascial tissue stiffness and muscle strength: a systematic review and meta-analysis. J Strength Cond Res 37(4): 951-968, 2023-Foam rolling (FR) is widely used in rehabilitation and physical training. However, the effects of FR on myofascial tissue stiffness and muscle strength remain unclear. This study aimed to perform a systematic review with meta-analysis of trials that tested the FR acute effects during warm-up on the myofascial tissue stiffness and muscle strength in healthy adults or athletes. This systematic review (CRD42021227048) was performed according to Cochrane's recommendations, with searches performed in PubMed, Web of Science, Embase, and PEDro databases. Syntheses of included studies' data were performed, and the PEDro scale was used to assess the methodological quality of the studies. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluations approach. Twenty included studies assessed trunk and thigh fascial tissue stiffness, and thigh and calf muscle stiffness, whereas muscle strength was assessed in the knee extensors and flexors, and plantar flexors muscles. Qualitative analysis showed decreases in fascial ( n = 2) and muscle ( n = 5) stiffness after FR. However, the meta-analysis showed no effects of FR on myofascial tissue stiffness. Both qualitative and quantitative analyses showed no effects of FR on isometric muscle strength, eccentric torque, and rate of force development. However, the knee extensor concentric torque increased after FR. Foam rolling increases the knee extensor concentric torque, but it does not acutely change the myofascial tissue stiffness and isometric muscle strength. However, evidence of these studies provides low certainty to state that FR does not change these parameters. Therefore, high methodological quality studies should be performed to better ascertain the effects of FR on the myofascial tissue stiffness and muscle strength.
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Affiliation(s)
- Marcelo H Glänzel
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, Brazil; and
- Biomechanics and Kinesiology Research Group, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Deivid R Rodrigues
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, Brazil; and
- Biomechanics and Kinesiology Research Group, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo N Petter
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, Brazil; and
- Biomechanics and Kinesiology Research Group, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniel Pozzobon
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, Brazil; and
| | - Marco A Vaz
- Biomechanics and Kinesiology Research Group, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jeam M Geremia
- Biomechanics Laboratory, Federal University of Santa Maria, Santa Maria, Brazil; and
- Biomechanics and Kinesiology Research Group, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Park JJ, Lee HS, Kim JH. Effect of Acute Self-Myofascial Release on Pain and Exercise Performance for Cycling Club Members with Iliotibial Band Friction Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315993. [PMID: 36498062 PMCID: PMC9740901 DOI: 10.3390/ijerph192315993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 05/13/2023]
Abstract
Cycling is a popular sport, and the cycling population and prevalence of related injuries and diseases increase simultaneously. Iliotibial band friction syndrome is a common chronic overuse injury caused by repetitive knee use in cycling. Self-myofascial release using foam rollers is an effective intervention for this syndrome; however, studies reporting positive results on self-myofascial release in cycling are limited. Therefore, this study investigated the effect of self-myofascial release on pain and iliotibial band flexibility, heart rate, and exercise performance (cadence, power, and record) in adult male cyclists with iliotibial band friction syndrome. We evaluated the pain and exercise ability of the control (n = 11) and self-myofascial release (n = 11) groups before and after cycling twice. Significant differences were observed in the pain scale, the iliotibial band flexibility, and cycling pain and power. The posterior cadence of the self-myofascial release group was 3.2% higher than that of the control group. The control group's record time increased by 74.64 s in the second cycling session compared to the first cycling session, while that of the self-myofascial release group decreased by 30.91 s in the second cycling session compared to the first cycling session. Self-myofascial release is effective in relieving pain and may improve cycling performance by increasing the iliotibial band flexibility.
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Affiliation(s)
- Jong Jin Park
- GYMNOW Fitness, Seoul 04417, Republic of Korea
- Department of Physical Education, College of Performing Arts and Sport, Hanyang University, Seoul 04763, Republic of Korea
| | - Hae Sung Lee
- Department of Physical Education, College of Performing Arts and Sport, Hanyang University, Seoul 04763, Republic of Korea
- BK21 FOUR Human-Tech Convergence Program, Hanyang University, Seoul 04763, Republic of Korea
| | - Jong-Hee Kim
- Department of Physical Education, College of Performing Arts and Sport, Hanyang University, Seoul 04763, Republic of Korea
- BK21 FOUR Human-Tech Convergence Program, Hanyang University, Seoul 04763, Republic of Korea
- Correspondence: ; Tel.: +82-2-2220-1325
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Konrad A, Nakamura M, Paternoster FK, Tilp M, Behm DG. A comparison of a single bout of stretching or foam rolling on range of motion in healthy adults. Eur J Appl Physiol 2022; 122:1545-1557. [PMID: 35298696 PMCID: PMC9197890 DOI: 10.1007/s00421-022-04927-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Stretching and foam rolling are common warm-up exercises and can acutely increase the range of motion (ROM) of a joint. However, possible differences in the magnitude of change on ROM between these two interventions on the immediate and prolonged effects (e.g., 10 min after the intervention) are not yet well understood. Thus, the purpose of this review was to compare the immediate and prolonged effects of a single bout of foam rolling with a single bout of stretching on ROM in healthy participants. METHODS In total, 20 studies with overall 38 effect sizes were found to be eligible for a meta-analysis. For the main analysis, subgroup analysis, we applied a random-effect meta-analysis, mixed-effect model, respectively. The subgroup analyses included age groups, sex, and activity levels of the participants, as well as the tested muscles, the duration of the application, and the study design. RESULTS Meta-analyses revealed no significant differences between a single stretching and foam rolling exercise immediately after the interventions (ES = 0.079; P = 0.39) nor a difference 10 min (ES = - 0.051; P = 0.65), 15 min (ES = - 0.011; P = 0.93), and 20 min (ES = - 0.161; P = 0.275) post-intervention. Moreover, subgroup analyses revealed no other significant differences between the acute effects of stretching and foam rolling (P > 0.05). CONCLUSION If the goal is to increase the ROM acutely, both interventions can be considered as equally effective. Likely, similar mechanisms are responsible for the acute and prolonged ROM increases such as increased stretch tolerance or increased soft-tissue compliance.
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Affiliation(s)
- Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, Graz, Austria ,Associate Professorship of Biomechanics in Sports, Technical University of Munich, Munich, Germany
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Florian K. Paternoster
- Associate Professorship of Biomechanics in Sports, Technical University of Munich, Munich, Germany
| | - Markus Tilp
- Institute of Human Movement Science, Sport and Health, Graz University, Graz, Austria
| | - David G. Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, A1C 5S7 Canada
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