Increased range of motion after static stretching is not due to changes in
muscle and tendon structures

Andreas Konrad, Markus Tilp

PII: S0268-0033(14)00098-9
DOI: doi: 10.1016/j.clinbiomech.2014.04.013
Reference: JCLB 3785

To appear in: Clinical Biomechanics

Received date: 23 January 2014

Revised date: 28 April 2014
Accepted date: 28 April 2014

Please cite this article as: Konrad, Andreas, Tilp, Markus, Increased range of motion
after static stretching is not due to changes in muscle and tendon structures, Clinical
Biomechanics (2014), doi: 10.1016/j.clinbiomech.2014.04.013

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 ACCEPTED MANUSCRIPT

Increased range of motion after static stretching is not

due to changes in muscle and tendon structures

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Konrad Andreas, MSc1; Tilp Markus, Assoc. Prof. Dr.1

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Graz University (Austria)

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Corresponding author: MA
Assoc. Prof. Dr. Markus Tilp

Institute of Sports Science

Graz University
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Mozartgasse 14

A-8010 Graz
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Austria
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Mail: markus.tilp@uni-graz.at

Tel: +43 316 380 83 32

Fax: +43 316 380 97 90

Word count for the abstract: 220 words

Word count for the main text: 3960 words

Number of tables: 1

Number of figures: 4

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Abstract

Background: It is known that static stretching is an appropriate means of increasing the range of

motion, but information in the literature about the mechanical adaptation of the muscle-tendon unit

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is scarce. Therefore, the purpose of this study was to investigate the influence of a six-week static

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stretching training program on the structural and functional parameters of the human gastrocnemius

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medialis muscle and the Achilles tendon.

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Methods: A total of 49 volunteers were randomly assigned into static stretching and control groups.

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Before and following the stretching intervention, we determined the maximum dorsiflexion range of

motion with the corresponding fascicle length and pennation angle. Passive resistive torque and
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maximum voluntary contraction were measured with a dynamometer. Muscle-tendon junction

displacement allowed us to determine the length changes in tendon and muscle, and hence to
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calculate stiffness. Fascicle length, pennation angle, and muscle tendon junction displacement were
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measured with ultrasound.

Findings: Mean range of motion increased significantly from 30.9 (5.3) to 36.3 (6.1) in the
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intervention group, but other functional (passive resistive torque, maximum voluntary contraction)
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and structural (fascicle length, pennation angle, muscle stiffness, tendon stiffness) parameters were
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unaltered.

Interpretation: The increased range of motion could not be explained by the structural changes in the

muscle-tendon unit, and was likely due to increased stretch tolerance possibly due to adaptations of

nociceptive nerve endings.

Key words: Stiffness, ultrasound, static, passive resistive torque, maximum voluntary

contraction, range of motion

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1. Introduction

The three most common stretching methods are static, ballistic, and proprioceptive neuromuscular

facilitation (PNF) stretching (Magnusson et al., 1996a). All the methods are used for both acute (a

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single stretching training) and short-term (repeated stretching training for three to eight weeks)

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stretching and are able to increase the range of motion (RoM) (Magnusson et al., 1998; Mahieu et

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al., 2007; 2009; Nakamura et al., 2012). Various authors have reported that short-term static

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stretching training does not affect the passive torque-angle curve (Magnusson et al., 1996b; Gajdosik

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et al., 2005; Weppler and Magnusson, 2010) or the joint angle at the same, standardized passive

torque (Folpp et al., 2006; Law et al., 2009; Ben and Harvey, 2010; Weppler and Magnusson, 2010) in
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the pre- and post-intervention. Others, however, have identified decreased PRT, and therefore

changes in the torque-angle curve, after a prolonged static stretching regime (Kubo et al., 2002;
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Guissard and Duchateu, 2004; Mahieu et al., 2007; Nakamura et al., 2012). Furthermore, there is
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some evidence that short-term static stretching does not alter maximal isometric torque (MVC, Kubo

et al., 2002) or tendon stiffness (defined as force-length relationship during an isometric ramp
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contraction with maximal voluntary effort (Kubo et al., 2002; Mahieu et al., 2007)) following a three-
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to six-week training period. However, several structural parameters which might affect and explain
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RoM changes, such as muscle and tendon stiffness during passive movements (Konrad et al., 2014),

as well as fascicle length and pennation angle (Morse et al., 2008; Konrad et al., 2014), were not

analyzed by these authors (Kubo et al., 2002; Mahieu et al., 2007; Nakamura et al., 2012).

Therefore, the objective of this study was to analyze the effects of a short-term static stretching

program on the functional and structural parameters of the plantar flexor muscle-tendon unit. Since

tendon, like muscle tissue, undergoes substantial structural changes as a result of a number of

chronic processes, such as aging (Narici et al. 2008), chronic use (Csapo et al., 2010), disuse (Reeves

et al., 2003), exercise (Kubo et al., 2002), and PNF stretching (Konrad et al., 2014), we also expected

changes as a result of the static stretching training.

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Due to the findings in the literature, we hypothesized to observe a gain in RoM, a decrease in PRT,

but no change in MVC following a six-week static stretching training program. Moreover, we

expected that the static stretching training would also result in structural changes, i.e. more

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compliant muscle or tendon tissue, as well as longer fascicle length and/or smaller pennation angles.

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2. Methods

2.1. Experimental design

A total of 49 police cadets participated in the study, and they were randomly assigned to a static

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stretching group (N=25) and a control group (N=24). All the subjects were asked to maintain their

normal physical activities during the study. Teachers of the police school were informed about the

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study and were asked to maintain the intensity and extent of physical activities during their lessons

(two per week). The static stretching group undertook a collective static stretching training program

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five times a week for six weeks, in the morning before education in the police school started.

Investigators controlled the stretching training at least once a week by random and unannounced
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visits to ensure the accomplishment of the stretching training. Since the static stretching exercise

(standing wall push) is rather simple and due to the observations during the visits we can assume a
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proper execution of the program in non-monitored sessions. Furthermore, subjects were asked to
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keep a diary of their stretching performance, which was collected at the end of the study. All
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measures were taken before and after the six-week static stretching intervention.
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2.2. Subjects

Thirty-five healthy male (mean (SD): 23.3 (2.9) years, 178.6 (5.5) cm, 76.1 (7.2) kg) and 14 healthy
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female (mean (SD): 22.5 (2.5) years, 171.8 (4.2) cm, 61.8 (5.6) kg) police cadets participated in this

study. Each subject was informed about the testing procedure but not about our hypotheses, and

they each gave written consent to participate in the study. Competitive athletes and participants

with a history of lower-leg injuries were excluded. The Ethical Committee of the University of Graz

approved the study.

2.3. Measures

To ensure a high scientific standard, all measurements were undertaken by the same investigator.

Pre- and post-training tests were executed at the same time of day, and the temperature in the

laboratory was kept constant at around 20.5 °C. Measurements were performed without any warm
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up and in the following order: 1. range of motion (10-min break); 2. passive resistive torque (1-min

break); 3. maximum voluntary contraction (see Figure 1).

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----------Figure 1------------------------------------------------------------------------------------------------------------------

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2.3.1. Range of motion (RoM) measurement

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Dorsiflexion RoM was measured with an electronic goniometer (Biovision, Wehrheim, Germany)

fixed to the foot and shank with Leukotape® (BSN medical S.A.S., Vibraye, France). The axis of the

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goniometer was aligned with the estimated axis of rotation of the ankle at the malleolus lateralis.
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The shanks of the goniometer were carefully fixed to the foot (from the axis of rotation to the

metatarsophalangeal joint) and the shank (from the axis of rotation alongside the fibula). Participants
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were first instructed to stay upright in a neutral position, with the ankle joint angle at 90°. They were
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then asked to step back with one leg and bring the ankle joint to maximum dorsiflexion, keeping their

heel on the ground. The knee of the testing leg had to remain fully extended, and the knee of the
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opposite leg flexed. Both feet were kept in a parallel position, and hands could be placed on a wall to
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ensure balance. Special attention was paid to the appropriate position of the stretched leg during the
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measurement, to avoid any pronation of the foot. If some pronation was visually observed, the

measurement was repeated. The difference between the maximum dorsiflexion and the position in

rest (neutral position) was the dorsiflexion RoM.

2.3.2. Passive resistive torque (PRT) measurement

To investigate PRT, an isokinetic dynamometer (CON-TREX MJ, CMV AG, Duebendorf, Switzerland)

was used, and the standard setup for ankle joint movement of the dynamometer was adjusted to the

subjects. Subjects lay prone with their knee fully extended on a bench, and were secured with a strap

on the upper body to exclude any evasive movement. The foot was fixed barefooted with a strap to

the foot plate of the dynamometer. The ankle joint was carefully aligned with the axis of the

dynamometer to avoid any heel displacement. The dynamometer moved the ankle joint from a 10°
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plantar flexion to a dorsiflexion position, which corresponded to 95% of the individual maximum

dorsiflexion RoM previously measured in the RoM measurement. Since maximum dorsiflexion

positions differed between pre- and post-intervention, we compared PRT at the smaller of these two

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positions. The ankle joint was moved passively for three cycles. During pilot measurements, we

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recognized a conditioning effect during the first two passive movements, similar to the active

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conditioning reported by Maganaris (2003). Therefore, measurements were taken during the third

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cycle to avoid the conditioning effect. Similar to the studies by Kubo et al. (2002) and Mahieu et al.

(2009), the velocity of the dynamometer was set at 5°/s to exclude any reflexive muscle activity.

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Participants were asked to relax during the measurements.

2.3.3. Maximum voluntary contraction (MVC) measurement

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MVC measurements were performed with the dynamometer at a neutral ankle position (90°).
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Participants were instructed to perform three isometric MVCs of the plantar flexors for 5 s, with rest
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periods of at least 1 min between the measurements, to avoid any fatigue. The attempt with the

highest MVC value was used for the further analysis.

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2.3.4. Electromyography (EMG)

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Muscular activity was monitored by EMG (myon 320, myon AG, Zurich, Switzerland) during PRT and
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MVC measurements. Surface electrodes (Blue Sensor N, Ambu A/S, Ballerup, Denmark) were placed

on the muscle bellies of the GM and the tibialis anterior. In the PRT measurements, the EMG

(normalized to plantar flexor MVC) was monitored post hoc to ensure that the subject was relaxed,

i.e. did not show any EMG activity. Sample rate was 2000 Hz. The EMG signals were high-pass filtered

(10 Hz, Butterworth) and root-mean-square (RMS, 50 ms window) values were calculated.

2.3.5. Measurement of elongation of the muscle-tendon structures

A real-time ultrasound apparatus (mylab 60, Esaote S.p.A., Genova, Italy) with a 10 cm B-mode

linear-array probe (LA 923, Esaote S.p.A., Genova, Italy) was used to obtain a longitudinal ultrasound

image of the GM.

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During the PRT and MVC measurement, the ultrasound probe was placed on the distal end of the GM

(Figure 2), where the muscle is connected to the Achilles tendon, i.e. the muscle-tendon junction

(MTJ, Kato et al., 2010). The ultrasound probe was secured with a standard orthopedic stocking to

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prevent a displacement of the probe. To determine the muscle displacement during PRT

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measurement, the echoes of the MTJ in the ultrasound videos were manually tracked (Kato et al.,

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2010). In some cases during MVC measurements the ultrasound probe lost skin contact above the

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MTJ due to the deformation of the muscle which led to minor quality of this area in the videos. Thus,

the muscle displacement was determined by manually tracking the echoes of a fascicle insertion at

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the deep aponeurosis near the MTJ (Kubo et al., 2002). Similar to the approach used by other authors

(Morse et al., 2008; Kato et al., 2010), the cadaveric regression model of Grieve et al. (1978) was
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used to obtain the percentage length changes of the MTU of the GM during passive movements.

Original total MTU lengths were measured with a tape measure according to Grieve et al. (1978) to
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calculate absolute length changes of the MTU. The difference between the MTU length change and
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the displacement of the muscle was defined as the tendon displacement.

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----------Figure 2------------------------------------------------------------------------------------------------------------------
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During RoM measurement, the length of the GM fascicle and its pennation angle with the deep

aponeurosis were determined from the ultrasound videos. The ultrasound probe was placed at 50%

of the GM muscle length (Morse et al., 2008). The fascicle length and the pennation angle were

measured at a neutral position of the ankle joint (90°) and at maximum dorsiflexion.

The ultrasound images were recorded at 25 Hz, with an image depth resolution of 74 mm. During

PRT and MVC measurement, the videos were synchronized with the measured torque, joint angle,

and EMG data via the signals of a function generator (Voltkraft®, Hirschau, Germany). The videos

were cut and digitized in VirtualDub open-source software (version 1.6.19, www.virtual dub.org) and

were analyzed in ImageJ open-source software (version 1.44p, National Institutes of Health, USA).

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Each video was analyzed by two investigators, and the mean values of both measurements were

used for further analysis of the muscle-tendon structure. Except for the principal investigator, the

investigators were not informed about the hypotheses of the study or the group allocation and

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subjects’ names. During the analysis of the PRT measurement, every fifth frame, and for MVC

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measurement every second frame, were measured by the investigators, corresponding to a time

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resolution of 0.2 and 0.08 s, respectively.

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2.3.6. Calculation of muscle/tendon force, passive muscle/tendon stiffness, active tendon stiffness,

and muscle-tendon stiffness

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Similar to the studies of Kubo et al. (2002) and Mahieu et al. (2007; 2009) the muscle force of the GM
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was estimated by multiplying the measured torque by the relative contribution of the physiological

cross-sectional area (18%) of the GM within the plantar flexor muscles, and dividing by the moment
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arm of the triceps surae muscle (MA), which was measured individually as the distance between the
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malleolus lateralis and the Achilles tendon at rest (neutral position) by tape. The mean value of the

moment arm was 4.51 cm and the range was 3.5–6.0 cm.
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Active tendon stiffness was calculated by linear regression between the active force and the related
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tendon length changes during the MVC measurements over the whole range of force (0–100% MVC).
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Passive tendon stiffness, muscle stiffness, and muscle-tendon stiffness were obtained from

dynamometer and ultrasound measurements during passive movements between neutral ankle

position (90°) to maximum dorsiflexion. Parameters were calculated by linear regressions between

the force during passive movements (which reached about 0–25% of MVC) and the related tendon

length, muscle length, and joint angle changes, respectively. Please note that the term “passive

tendon stiffness” was used for the force-length relationship during MVC measurement in previous

studies (Mahieu et al., 2007; 2009). To distinguish between the force-length relationships from

passive measurements performed in our study, we have defined ”passive tendon stiffness” from the

studies of Mahieu et al. (2007; 2009) as “active tendon stiffness” throughout the text. The quality of

the linear regressions was assessed with the Pearson correlation coefficient.

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2.4. Static stretching program

Subjects of the static stretching group were asked to stretch their plantar flexor muscles. The

stretching was done five times a week for a six-week period. Each subject was informed about the

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stretching procedure. Subjects were instructed to undertake the stretching of the plantar flexors in a

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standing wall push position, and to stretch until a point of discomfort was reached. One stretching

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intervention consisted of a 30 s static stretch of the lower leg. This procedure was repeated four

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times during each stretching session, alternating both legs, with no rest in between, resulting in a

total stretch period of 120 s for each muscle. This protocol was chosen because it was reported that

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4x30 s of static stretching decreases muscle-tendon unit stiffness (Ryan et al., 2008).
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2.5. Statistical analyses

SPSS (version 20.0, SPSS Inc., Chicago, Illinois) was used for all the statistical analyses. To determine
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the inter-rater reliability of the muscle-tendon displacement measurements, an intraclass correlation

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coefficient (ICC) was used. A Kolmogorov-Smirnov test was used to test the normal distribution of all

the parameters. To test the homogeneity between the baseline characteristic of both groups, t-tests
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were performed. To assess the validity of our methods, paired t-tests were performed to test if the

mean values of the pre- and post-measurements of the control group were equal. Subsequently, we
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performed paired t-tests to test the effect of the stretching protocol in the intervention group.

Tendon, muscle, and muscle-tendon stiffness calculations were controlled with a Pearson correlation

coefficient. An alpha level of P=0.05 was defined for the statistical significance of all the tests.

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3. Results

3.1. Data exclusion and measurement quality

Due to subject drop-out and the poor quality of the ultrasound videos, five(six) subjects of the RoM

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measurement, six(nine) subjects of the PRT measurement, and four(four) subjects of the MVC

measurement of the static stretching (control) group, respectively, had to be excluded from the

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study (Figure 1). The subject drop-outs were all due to injuries. In the ultrasound videos with poor

quality, fascicle insertion points at the deep aponeurosis (MVC measurement) or the MTJ (PRT

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measurement) were not identifiable with the necessary precision. Drop-outs and data exclusion did

not change the homogeneity of the groups.

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The mean (range) ICC of the ultrasound video analysis of both investigators was 0.99 (0.978–0.998),

0.96 (0.842–0.999), and 0.95 (0.801–0.999) for pennation angle and fascicle length during the RoM
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measurement, MTJ displacement during PRT measurement, and MTJ displacement during MVC
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measurements, respectively. Values above 0.90 are classified as high (Vincent and Weir, 2012).
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The mean values of the Pearson correlation coefficients of the linear regression were 0.99, 0.96,
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0.89, and 0.96, with ranges of 0.88–0.99, 0.81–0.99, 0.78–0.96, and 0.94–0.98, with all P <0.05, for

passive tendon stiffness, active tendon stiffness, muscle stiffness, and muscle-tendon stiffness,
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respectively.

3.2. Range of motion (RoM) and the related structural muscle parameters

Following the six-week stretching intervention, the static stretching group had a significantly

increased dorsiflexion RoM (P=0.00, see Table 1A). Fascicle length and pennation angle did not

change in the neutral or maximum dorsiflexion position. No parameter changes were observed in the

control group.

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3.3. Passive resistive torque (PRT) and the related structural muscle-tendon parameters

There was no significant effect on PRT at the same maximum ankle joint angle for the pre- and post-

session data (Table 1B). Figure 3 shows the relationship between ankle joint angle and the

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corresponding PRT of the static stretching group. No significant differences were observed in any

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joint angle. Moreover, muscle-tendon stiffness, and passive tendon and muscle stiffness did not

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change after the static stretching intervention. No parameter changes could be found in the control

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group.

In Figure 4 (A, B) the elongation of muscle and tendon in relationship to the PRT data is shown in

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steps of 5° from 0° to 25°. Moreover, Figure 4 (C, D) shows the elongation of the tendon and muscle
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as a function of the ankle angle.
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3.4. Maximum voluntary contraction (MVC) and tendon stiffness

Plantar flexor MVC was the same after the short-term stretching intervention. Active tendon stiffness

calculated from the MVC measurements did not change in both the static stretching and control

groups (see Table 1C).

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4. Discussion

The functional parameters investigated in this study were RoM, PRT, muscle-tendon stiffness, and

MVC. Similar to previous studies (Guissard and Duchateau, 2004; Mahieu et al., 2007; Nakamura et

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al., 2012), the maximum dorsiflexion RoM increased significantly after the short-term static

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stretching training. The amount of dorsiflexion RoM increase in the current study (5.4°) was greater

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than the results of Mahieu et al. (2007), who reported an increase of 2.6°, and was less than the

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results of Guissard and Duchateau (7.6°, 2004) and Nakamura et al. (6.7°, 2012). These differences

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could be due to the total stretching time, which varied between the studies, or stretch intensity,

which is difficult to standardize. Muscle-tendon stiffness and PRT did not change after the repeated
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static stretching, which is in accordance with several other studies (Magnusson et al., 1996b;

Gajdosik et al., 2005; Folpp et al., 2006; Law et al., 2009; Ben and Harvey, 2010; Weppler and
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Magnusson, 2010). Others, however, reported a decreased PRT following a short-term static
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stretching training (Kubo et al., 2002; Guissard and Duchateu, 2004; Mahieu et al., 2007; Nakamura

et al., 2012). Again, these controversial findings could be due to the different stretching intensities
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and total stretching time.

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Similar to other short-term studies of static stretching (Kubo et al., 2002; Guissard and Duchateau,
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2004), an unchanged maximal isometric torque was observed after the intervention at neutral ankle

joint position. Thus, it seems that short-term static stretching does not have a detrimental effect on

MVC. However, on the basis of our measurements we cannot exclude possible changes of MVC in the

region of maximum dorsiflexion, although we are not aware of any literature on this topic.

In addition to the functional parameters, several structural parameters (muscle stiffness, tendon

stiffness, fascicle length, pennation angle) which might explain the increased RoM were investigated

in this study. To the best of our knowledge, to date, only Kubo et al. (2002) and Mahieu et al. (2007)

have investigated the effect on active tendon stiffness following a three-week or six-week static

stretching training program, respectively. Similar to the present study, these authors could not find

an effect on active tendon stiffness. This is in contrast to previous studies about ballistic (Mahieu et

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al., 2007) and PNF stretching (Konrad et al., 2014), where the gain in RoM could also be partly

explained by a decrease in tendon stiffness. One could speculate that these different effects on

tendon stiffness might be due different mechanical stimuli. It can be assumed, that both during

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ballistic and PNF stretching techniques the forces acting on the tendon are greater compared to

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static stretching due to movement dynamics and muscle contractions, respectively. In addition to the

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results on active tendon stiffness obtained by Kubo et al. (2002) and Mahieu et al. (2007), the current

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study revealed that muscle and tendon stiffness during passive movements, as well as fascicle length

and pennation angle at the RoM measurement, were not altered after the static stretching

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intervention.

Mahieu et al. (2007) assumed that the decreased PRT in their short-term static stretching group was
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due to an increasing number of sarcomeres in series, based on the findings in animal studies

(Coutinho et al., 2004). However, since fascicle length remained unaltered in the present study
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following the six weeks of static stretching, we cannot support this hypothesis. Unchanged fascicle
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lengths were also reported by Nakamura et al. (2012) following a four-week static stretching training
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program. Therefore, it seems improbable that static stretching in humans induces similar effects in
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the muscle structure to those seen in the stretching interventions done in animal studies.

The stretching duration was based on the studies of Ryan et al. (2008) which showed decreasing
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muscle-tendon stiffness of the plantar flexor muscles following four stretches for 30 seconds.

However, Ryan and coworkers focused on acute and not short-term effects of stretching. A possible

reason for the lack of changes in the MTU despite an increase of RoM might be that the stretching

duration and/or intensity might have been too short or low respectively. However, on one hand

Nakamura et al. (2012) reported decreases in PRT with less overall stretching duration (3360 sec

compared to 3600 sec) than in the present study. On the other hand our intention was not primarily

to induce structural adaptations but to increase the RoM in the ankle joint and then analyze if this

adapted RoM might be explained by structural adaptations. Since the RoM increased following the

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stretching intervention but remained the same in the control group it is fair to assume that the

duration and intensity of the stretching program was appropriate for the present study.

In conclusion, the current study indicates that a short-term static stretching leads to an increase in

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RoM, but no significant changes in the measured structural parameters of the MTU.

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A probable explanation for the results of the current study could be that the increased RoM following

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stretching is due to an altered perception of stretch, and pain or stretch tolerance (Halbertsma et al.,

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1996; Magnusson et al., 1996a; 1996b), rather than altered muscular or tendon structures.

Magnusson et al. (1996b) assumed that adaptations of nociceptive nerve endings may be a possible

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explanation for the altered stretch tolerance. Additionally, Björklund et al. (2001) speculated that

mechanoreceptors and proprioceptors which showed a reduced firing following an acute stretch may
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also have an impact on the sensory adaption. However, the present study might not have

investigated all the structural parameters which affect RoM. Recently, a study by Akagi and
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Takahashi (2013) investigated the hardness (transverse muscle stiffness) in the gastrocnemii muscles
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following a five-week static stretching training program. The results of this study revealed a decrease
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in the hardness of the gastrocnemius medialis and lateralis, in other words, a structural adaptation in
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the muscle. The results presented by Akagi and Takahashi (2013) could be a possible explanation for

the gain in RoM in the current and other studies (Kubo et al., 2002; Mahieu et al., 2007).
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There are some limitations to this study. Firstly, the persons taking measurements were not all blind

to the intervention. Therefore, a bias in the results cannot be completely excluded, although the

inter-rater reliability was excellent (mean ICC: 0.95–0.99). Secondly, the method of measuring the

moment arm of the ankle joint in vivo was quite simple. However, values obtained in this study were

very similar to others using magnetic resonance imaging (MRI) data (Rugg et al., 1990) or ultrasound

(Lee and Piazza, 2009). The measurement of the moment arm at rest probably underestimates the

moment arm during MVC by 22-44% (Maganaris, 2004) and probably also in maximum dorsiflexion

position and therefore overestimates tendon force and its related parameters. However, since the

study focused on the relative changes due to static stretching rather than absolute values, the main

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outcomes are not affected by this limitation. Thirdly, we did not take into consideration possible

gender differences when subjects were assigned to intervention and control groups although

differences in absolute values could have been expected. An ANOVA with gender as covariate (data

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not presented) showed that absolute values of MVC, active tendon stiffness, and pennation angle in

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neutral and maximal dorsiflexion position were significantly different between males and females

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(P<0.05) but no significant gender effects on relative changes were observed (P>0.05).

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5. Conclusion

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This study has shown that a six-week static stretching program of the calf muscles increases

dorsiflexion RoM but has no effect on muscle and tendon tissue. Therefore, altered tolerance to
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stretching, possibly due to adaptations of nociceptive nerve endings, seems to be the main

explanation for gains in RoM. However, further studies including other structural parameters such as
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muscle hardness, which might give an additional explanation for the gain in RoM, should be
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undertaken. Furthermore, future studies should include follow-up measurements to estimate the

decline in the RoM change.

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Acknowledgement
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Financial support was provided by the Austrian Science Fund (FWF, project P 23786-B19).
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References

Akagi, R., Takahashi, H., 2013. Effect of a 5‐week static stretching program on hardness of the

gastrocnemius muscle. Scand. J. Med. Sci. Sports.

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Table legend

Table 1: (A) Results of maximum dorsiflexion RoM, as well as changes in fascicle length and pennation angle during RoM

measurement. (B) Results of PRT, passive tendon stiffness, muscle stiffness, and muscle-tendon stiffness during passive

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measurements. (C) Results of MVC torque and active tendon stiffness during MVC measurements. * = significant

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difference between pre- and post-session data, mean (SD).

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Figure legends

Figure 1: Schematic representation of the study and subject flow. DO= drop-outs, PQ= poor quality of the ultrasound

videos.

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Figure 2: Images showing the displacement of the MTJ during a passive movement from neutral position (A) of the ankle

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joint to maximum dorsiflexion (B).

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Figure 3: Relationship between passive resistive torque and ankle joint angle before and after the static stretching

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intervention (N= 19), mean (S.E.M). 0° represents neutral ankle position.

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Figure 4: Relationship between passive resistive torque and tendon (A) and muscle displacement (B) during passive

movement before and after the static stretching intervention. Displacement of the tendon (C) and the muscle (D) during

passive dorsiflexion in relation to ankle angle (0° represents neutral ankle position.) before and after the static stretching
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intervention (N= 19), mean (S.E.M).
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Table 1

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