healthcare
Systematic Review
Strength Training versus Stretching for Improving Range of
Motion: A Systematic Review and Meta-Analysis
José Afonso 1 , Rodrigo Ramirez-Campillo 2,3 , João Moscão 4 , Tiago Rocha 5 , Rodrigo Zacca 1,6,7 ,
Alexandre Martins 1 , André A. Milheiro 1 , João Ferreira 8 , Hugo Sarmento 9
and Filipe Manuel Clemente 10,11, *






Citation: Afonso, J.;
Ramirez-Campillo, R.; Moscão, J.;
Rocha, T.; Zacca, R.; Martins, A.;
Milheiro, A.A.; Ferreira, J.; Sarmento,
H.; Clemente, F.M. Strength Training
versus Stretching for Improving
Range of Motion: A Systematic
Review and Meta-Analysis. Healthcare
2021, 9, 427. https://doi.org/
10.3390/healthcare9040427
Academic Editor: Nandu Goswami
Received: 10 March 2021
Accepted: 1 April 2021
Published: 7 April 2021
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This article is an open access article
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4.0/).
Healthcare 2021, 9, 427. https://doi.org/10.3390/healthcare9040427
1 Centre for Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport of the
University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal; jneves@fade.up.pt (J.A.);
rzacca@fade.up.pt (R.Z.); up201900293@fade.up.pt (A.M.); up201507435@fade.up.pt (A.A.M.)
2 Department of Physical Activity Sciences, Universidad de Los Lagos, Lord Cochrane 1046,
Osorno 5290000, Chile; r.ramirez@ulagos.cl
3 Centro de Investigación en Fisiología del Ejercicio, Facultad de Ciencias, Universidad Mayor, San Pio X, 2422,
Providencia, Santiago 7500000, Chile
4 REP Exercise Institute, Rua Manuel Francisco 75-A 2 ◦ C, 2645-558 Alcabideche, Portugal;
contacto@repinstitute.com
5 Polytechnic of Leiria, Rua General Norton de Matos, Apartado 4133, 2411-901 Leiria, Portugal;
tiago.rocha@ipleiria.pt
6 Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91,
4200-450 Porto, Portugal
7 Coordination for the Improvement of Higher Educational Personnel Foundation (CAPES),
Ministry of Education of Brazil, Brasília 70040-020, Brazil
8 Superior Institute of Engineering of Porto, Polytechnic Institute of Porto, Rua Dr. António Bernardino de
Almeida, 431, 4249-015 Porto, Portugal; 1200638@isep.ipp.pt
9 Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-256 Coimbra, Portugal;
hugo.sarmento@uc.pt
10 Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial
de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
11 Instituto de Telecomunicações, Department of Covilhã, 1049-001 Lisboa, Portugal
* Correspondence: filipeclemente@esdl.ipvc.pt; Tel.: +351-258-809-678
Abstract: (1) Background: Stretching is known to improve range of motion (ROM), and evidence
has suggested that strength training (ST) is effective too. However, it is unclear whether its efficacy
is comparable to stretching. The goal was to systematically review and meta-analyze randomized
controlled trials (RCTs) assessing the effects of ST and stretching on ROM (INPLASY 10.37766/in-
plasy2020.9.0098). (2) Methods: Cochrane Library, EBSCO, PubMed, Scielo, Scopus, and Web of
Science were consulted in October 2020 and updated in March 2021, followed by search within
reference lists and expert suggestions (no constraints on language or year). Eligibility criteria: (P)
Humans of any condition; (I) ST interventions; (C) stretching (O) ROM; (S) supervised RCTs. (3) Re-
sults: Eleven articles (n = 452 participants) were included. Pooled data showed no differences
between ST and stretching on ROM (ES = −0.22; 95% CI = −0.55 to 0.12; p = 0.206). Sub-group
analyses based on risk of bias, active vs. passive ROM, and movement-per-joint analyses showed no
between-protocol differences in ROM gains. (4) Conclusions: ST and stretching were not different in
their effects on ROM, but the studies were highly heterogeneous in terms of design, protocols and
populations, and so further research is warranted. However, the qualitative effects of all the studies
were quite homogeneous.
Keywords: flexibility; mobility; joints; resistance training; plyometrics
1. Introduction
Joint range of motion (ROM) is the angle by which a joint moves from its resting
position to the extremities of its motion in any given direction [1]. Improving ROM is a
https://www.mdpi.com/journal/healthcare
Healthcare 2021, 9, 427 2 of 26

core goal for the general population [2], as well as in clinical contexts [3], such as in treating
acute respiratory failure [4], plexiform neurofibromas [5], recovering from breast cancer-
related surgery [6], and total hip replacement [7]. Several common clinical conditions
negatively affect ROM, such as ankylosing spondylitis [8], cerebral palsy [9], Duchenne
muscular dystrophy [10], osteoarthritis [11] rheumatoid arthritis [12]. Unsurprisingly,
ROM gains are also relevant in different sports [13], such as basketball, baseball and
rowing [14–16]. ROM is improved through increased stretch tolerance, augmented fascicle
length and changes in pennation angle [17], as well as reduced tonic reflex activity [18].
Stretching is usually prescribed for increasing ROM in sports [19,20], clinical settings,
such as chronic low back pain [21], rheumatoid arthritis [22], and exercise performance
in general [23]. Stretching techniques, include static (active or passive), dynamic, or
proprioceptive neuromuscular facilitation (PNF), all of which can improve ROM [2,24–27].
It should be noted that muscle weakness is associated with diminished ROM [28–30].
Strength training (ST) can be achieved through a number of methods, as long as resistance
is applied to promote strength gains, and includes methods as diverse as using free weights
or plyometrics [31]. Although ST primarily addresses muscle weakness, it has been shown
to increase ROM [32]. For example, hip flexion and extension ROM of adolescent male
hurdles was improved using plyometrics [33], while judo fighters improved ROM (shoulder
flexion, extension, abduction and adduction; trunk flexion and extension; and hip flexion
and extension) through resistance training [34]. The ROM gains, using resistance training,
have also been described in relation to healthy elderly people for hip flexion and cervical
extension [35], and isometric neck strength training, with an elastic band, in women
with chronic nonspecific neck pain improved neck flexion, extension, rotation and lateral
flexion [36]. ST that is focused on concentric and eccentric contractions has been shown
to increase fascicle length [37–39]. Improvements in agonist-antagonist co-activation [40],
reciprocal inhibition [41], and potentiated stretch-shortening cycles due to greater active
muscle stiffness [42] may also explain why ST is a suitable method for improving ROM.
Nevertheless, studies comparing the effects of ST and stretching in ROM have pre-
sented conflicting evidence [43,44], and many have small sample sizes [45,46]. Developing
a systematic review and meta-analysis may help summarize this conflicting evidence and
increase statistical power, thus, providing clearer guidance for interventions [47]. There-
fore, the aim of this systematic review and meta-analysis was to compare the effects of
supervised and randomized ST versus stretching protocols on ROM in participants of any
health and training status.

2. Materials and Methods

2.1. Protocol and Registration
The methods and protocol registration were preregistered prior to conducting the
review: INPLASY, no.202090098, DOI:10.37766/inplasy2020.9.0098.

2.2. Eligibility Criteria

Articles were eligible for inclusion if published in peer-reviewed journals, with no
restrictions in language or publication date. The Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines were adopted [48]. Participants, inter-
ventions, comparators, outcomes, and study design (P.I.C.O.S.) were established as follows:
(i) Participants with no restriction regarding health, sex, age, or training status; (ii) ST
interventions supervised by a certified professional. ST was defined as any method focused
on developing strength, ranging from resistance training to plyometrics [31]; no limitations
were placed with regard to intensity, volume, type of contractions and frequency, as it could
excessively narrow the searches; (iii) comparators were supervised groups performing
any form of stretching, including static stretching, passive stretching, dynamic stretching,
and PNF [2], regardless of their intensity, duration or additional features; (iv) outcomes
were ROM assessed in any joint, preferably through goniometry, but standardized tests
such as the sit-and-reach were also acceptable; (v) randomized controlled trials (RCTs).
Healthcare 2021, 9, 427 3 of 26

RCTs reduce bias and better balance participant features between the groups [47], and are
important for the advancement of sports science [49]. There were no limitations regarding
intervention length.
The study excluded reviews, letters to editors, trial registrations, proposals for pro-
tocols, editorials, book chapters, and conference abstracts. Exclusion criteria, based on
P.I.C.O.S., included: (i) Research with non-human animals; (ii) non-ST protocols or ST
interventions combined with other methods (e.g., endurance); unsupervised interventions;
(iii) stretching or ST + stretching interventions combined with other training methods
(e.g., endurance); protocols without stretching; unsupervised interventions; (iv) studies not
reporting ROM; (v) non-randomized interventions.

2.3. Information Sources and Search

Six databases were used to search and retrieve the articles in early October 2020:
Cochrane Library, EBSCO, PubMed (including MEDLINE), Scielo, Scopus, and Web of
Science (Core Collection). Boolean operators were applied to search the article title, abstract
and/or keywords: (“strength training” OR “resistance training” OR “weight training”
OR “plyometric*” OR “calisthenics”) AND (“flexibility” OR “stretching”) AND “range of
motion” AND “random*”. The specificities of each search engine included: (i) Cochrane
Library, items were limited to trials, including articles but excluding protocols, reviews,
editorials and similar publications; (ii) EBSCO, the search was limited to articles in scientific,
peer-reviewed journals (iii) PubMed, the search was limited to title or abstract; publications
were limited to RCTs and clinical trials, excluding books and documents, meta-analyses,
reviews and systematic reviews; (iv) in Scielo, Scopus and Web of Science, the publication
type was limited to article; and (v) Web of Science, “topic” is the term used to refer to title,
abstract and keywords.
An additional search was conducted within the reference lists of the included records.
The list of articles and inclusion criteria were then sent to four experts to suggest addi-
tional references. The search strategy and consulted databases were not provided in this
process to avoid biasing the experts’ searches. More detailed information is available as
supplementary material.
Updated searches: on 8 March 2021, we conducted new searches in the databases. How-
ever, each database has specific approaches to filtering the searches by date. In Cochrane,
we searched for articles entering the database in the previous 6 months. In EBSCO, we
searched for all fields starting from October 2020 onwards. In PubMed, the entry date was
set to 1 October 2020, onwards. In Scielo, Scopus and Web of Science, publication date was
limited to 2020 and 2021.

2.4. Search Strategy

Here, we provide the specific example of search conducted in PubMed:
(((“strength training” [Title/Abstract] OR “resistance training” [Title/Abstract] OR
“weight training” [Title/Abstract] OR “plyometric*” [Title/Abstract] OR “calisthenics”
[Title/Abstract]) AND (“flexibility” [Title/Abstract] OR “stretching” [Title/Abstract]))
AND (“range of motion” [Title/Abstract])) AND (“random*” [Title/Abstract]).
After this search, the filters RCT and Clinical Trial were applied.

2.5. Study Selection

J.A. and F.M.C. each conducted the initial search and selection stages independently,
and then compared result to ensure accuracy. J.F. and T.R. independently reviewed the
process to detect potential errors. When necessary, re-analysis was conducted until a
consensus was achieved.
Healthcare 2021, 9, 427 4 of 26

2.6. Data Collection Process

J.A., F.M.C., A.A.M. and J.F. extracted the data, while J.M., T.R., R.Z. and A.M. in-
dependently revised the process. Data for the meta-analysis were extracted by JA and
independently verified by A.A.M. and R.R.C. Data were available for sharing.

2.7. Data Items

Data items: (i) Population: subjects, health status, sex/gender, age, training status,
selection of subjects; (ii) intervention and comparators: Study length in weeks, weekly
frequency of the sessions, weekly training volume in minutes, session duration in minutes,
number of exercises per session, number of sets and repetitions per exercise, load (e.g., %
1 Repetition Maximum), full versus partial ROM, supervision ratio; in the comparators,
modality of stretching applied was also considered; adherence rates were considered a
posteriori; (iii) ROM testing: joints and actions, body positions (e.g., standing, supine),
mode of testing (i.e., active, passive, both), pre-testing warm-up, timing (e.g., pre- and post-
intervention, intermediate assessments), results considered for a given test (e.g., average of
three measures), data reliability, number of testers and instructions provided during testing;
(iv) Outcomes: changes in ROM for intervention and comparator groups; (vi) funding and
conflicts of interest.

2.8. Risk of Bias in Individual Studies

The risk of bias (RoB) in individual studies was assessed using the Cochrane risk-
of-bias tool for randomized trials (RoB 2) [50]. J.A. and A.M. independently completed
RoB analysis, which was reviewed by F.M.C. Where inconsistencies emerged, the original
articles were re-analyzed until a consensus was achieved.

2.9. Summary Measures

Meta-analysis was conducted when ≥3 studies were available [51]. Pre- and post-
intervention means and standard deviations (SDs) for dependent variables were used
after being converted to Hedges’s g effect size (ES) [51]. When means and SDs were not
available, they were calculated from 95% confidence intervals (CIs) or standard error of
mean (SEM), using Cochrane’s RevMan Calculator for Microsoft Excel [52]. When ROM
data from different groups (e.g., men and women) or different joints (e.g., knee and ankle)
was pooled, weighted formulas were applied [47].

2.10. Synthesis of Results

The inverse variance random-effects model for meta-analyses [53,54] was used to
allocate a proportionate weight to trials based on the size of their individual standard
errors [55], and accounting for heterogeneity across studies [56]. The ESs were presented
alongside 95% CIs and interpreted using the following thresholds [57]: <0.2, trivial; 0.2–0.6,
small; >0.6–1.2, moderate; >1.2–2.0, large; >2.0–4.0, very large; >4.0, extremely large.
Heterogeneity was assessed using the I2 statistic, with values of <25%, 25–75%, and >75%
considered to represent low, moderate, and high levels of heterogeneity, respectively [58].
Data used for meta-analysis is available in a supplementary Excel file.

2.11. Risk of Bias Across Studies

Publication bias was explored using the extended Egger’s test [59], with p < 0.05
implying bias. To adjust for publication bias, a sensitivity analysis was conducted using
the trim and fill method [60], with L0 as the default estimator for the number of missing
studies [61].
Healthcare 2021, 9, 427 5 of 26

2.12. Moderator Analyses

Using a random-effects model and independent computed single factor analysis,
potential sources of heterogeneity likely to influence the effects of training interventions
were selected, including (i) ROM type (i.e., passive versus active), (ii) studies RoB in
randomization, and (iii) studies RoB in measurement of the outcome [62]. These analyses
were decided post-protocol registration.
All analyses were carried out using the Comprehensive Meta-Analysis program
(version 2; Biostat, Englewood, NJ, USA). Statistical significance was set at p ≤ 0.05.
Data for the meta-analysis were extracted by JA and independently verified by A.A.M.
and R.R.C.

2.13. Quality and Confidence in Findings

Although not planned in the registered protocol, we decided to abide by the Grading
of Recommendations Assessment, Development, and Evaluation (GRADE) [63], which
addresses five dimensions that can downgrade studies when assessing the quality of
evidence in RCTs. RoB, inconsistency (through heterogeneity measures), and publication
bias were addressed above and were considered a priori. Directness was guaranteed
by design, as no surrogates were used for any of the pre-defined P.I.C.O. dimensions.
Imprecision was assessed on the basis of 95% CIs.

3. Results
3.1. Study Selection
An initial search returned 194 results (52 in Cochrane Library, 11 in EBSCO, 11 in
PubMed, 9 in Scielo, 88 in Scopus, and 23 in Web of Science). After removal of duplicates,
121 records remained. Screening the titles and abstracts for eligibility criteria resulted in
the exclusion of 106 articles: 26 were not original research articles (e.g., trial registrations,
reviews), 24 were out of scope, 48 did not have the required intervention or comparators,
five did not assess ROM, two were non-randomized and one was unsupervised. Fifteen
articles were eligible for full-text analysis. One article did not have the required interven-
tion [64], and two did not have the needed comparators [65,66]. In one article, the ST and
stretching groups performed a 20–30 min warm-up following an unspecified protocol [67].
In another, the intervention and comparator were unsupervised [68], and in one the stretch-
ing group was unsupervised [69]. Finally, in one article, 75% of the training sessions were
unsupervised [70]. Therefore, eight articles were included at this stage [33,43–46,71–73].
A manual search within the reference lists of the included articles revealed five ad-
ditional potentially fitting articles. Two lacked the intervention group required [74,75],
and two were non-randomized [76,77]. One article met the inclusion criteria [78]. Four
experts revised the inclusion criteria and the list of articles and suggested eight articles
based on their titles and abstracts. Six were excluded: interventions were multicompo-
nent [79,80]; comparators performed no exercise [81,82]; out of scope [83]; and unsuper-
vised stretching group [84]. Two articles were included [85,86], increasing the list to eleven
articles [33,43–46,71–73,78,85,86], with 452 participants eligible for meta-analysis (Figure 1).
Updated searches: in the renewed searches, 28 records emerged, of which two passed the
screening. However, these two records had already been included in our final sample.
Therefore, no new article was included.
Healthcare 2021, 9, 427 6 of 26
Healthcare 2021, 9, x    6  of  27 
 

 
Figure 1. Flowchart describing the study selection process. 
Figure 1. Flowchart describing the study selection process.

3.2. Study Characteristics and Results 
3.2. Study Characteristics and Results
The data items can be found in Table 1. The study of Wyon, Smith and Koutedakis 
[73] required consultation of a previous paper [87] to provide essential information. Sam‐
The data items can be found in Table 1. The study of Wyon, Smith and Koutedakis [73]
ples ranged from 27 [46] to 124 subjects [43], including: Trained participants, i.e., engaging 
required consultation of a previous paper [87] to provide essential information. Samples
in  systematic  exercise  programs  [33,45,72,73],  healthy  sedentary  participants  [44,71,78], 
ranged from 27 [46] to 124 subjects [43], including: Trained participants, i.e., engaging
sedentary and trained participants [86], workers with chronic neck pain [46], participants 
in systematic exercise programs [33,45,72,73], healthy sedentary participants [44,71,78],
with  fibromyalgia  [85],  and  elderly  participants  with  difficulties  in  at  least  one  of  four 
sedentary and trained
tasks:  transferring,  participants
bathing,  toileting, [86],
and workers withSeven 
walking  [43].  chronic neckincluded 
articles  pain [46], partici-
only 
pants
women  [45,73,78,85]  or  predominantly  women  [43,44,46];  three  investigated  only  men one of
with fibromyalgia [85], and elderly participants with difficulties in at least
four tasks: transferring, bathing, toileting, and walking [43]. Seven articles included
[33,86] or predominantly men [71]; and one article had a balanced mixture of men and 
only women [45,73,78,85] or predominantly women [43,44,46]; three investigated only
women [72]. 
men [33,86] or predominantly men [71]; and one article had a balanced mixture of men and
women [72].

 
Healthcare 2021, 9, 427 7 of 26

Table 1. Characteristics of included randomized trials.

Qualitative Results for

Article Population and Common Program Features Strength Training Group Comparator Group(s) * ROM Testing
ROM
Subjects: 161.
Joints and actions: Elbow
Health status: Elderly people dependent on help
(extension), shoulder (abduction),
for performing at least one of four tasks:
hip (flexion and abduction), knee
transferring, n = 81 (60 completed).
(flexion and extension), ankle
bathing, toileting and walking. Weekly volume (minutes): 180.
STRE n = 80 (64 completed). (dorsiflexion) and trunk (flexion,
Gender: ST: 84% women; STRE: 88% women. Session duration in minutes: 60.
Weekly volume (minutes): 180. extension, lateral flexion).
Age: ST: 82.0 ± 6.4; STRE: 82.4 ± 6.3. No. exercises per session: 16.
Session duration in minutes: 60. Positions: Supine (elbow,
Task-Specific Resistance Training status: Not participating in regular No. sets and repetitions: 1*7–8 The ST group had significant
No. exercises per session: N/A. shoulder, hip, knee and ankle);
Training to Improve the strenuous exercise. based on maximum target of improvements in all ROM
No. sets and repetitions: N/A. standing (lumbar spine).
Ability of Activities of Daily Selection of subjects: Seven congregate housing 9 (bed-rise tasks). 1*5 based measures, except hip flexion
Stretching modality: Dynamic. Mode: Active for trunk, passive
Living–Impaired Older facilities. on maximum target of 6 and abduction.
Load: Low-intensity, but for the other joints.
Adults to Rise from a Bed Length (weeks): 12. (chair-rise tasks). The STRE group had no
without a specified criterion. Warm-up: N/A.
and from a Chair. Weekly sessions: 3. Load: Unclear. Loads were significant change in any of
Full or partial ROM: N/A. Timing: Baseline, 6 weeks, 12
[43] Adherence: average 81% of the sessions. incremented if subjects were the ROM values.
Supervision ratio: One weeks.
Funding not feeling challenged
supervisor per group, but Results considered in the tests: N/A.
National Institute on Aging (NIA) Claude Pepper enough.
group size was N/A. Data reliability: ICCs of 0.65 to
Older Adults Independence Center (Grant AG0 Full or partial ROM: N/A.
0.86 for trunk measures.
8808 and NIA Grant AG10542), the Department of Supervision ratio: 1:1.
Unreported for other measures.
Veterans Affairs Rehabilitation Research and
No. testers: N/A.
Development, and the AARP-Andrus Foundation.
Instructions during testing: N/A.
Conflicts of interest: N/A.
Subjects: 45 undergraduate students.
Health status: 30◦ knee extension deficit with the
hip at 90◦ when in supine position. No injuries in Joints and actions: Knee
the lower limbs and no lower back pain. STRE n = 15. (extension).
n = 15.
Gender: 39 women, 6 men. Weekly volume (minutes): Positions: Sitting.
Weekly volume (minutes):
Age: 21.33 ± 1.76 years (ST); 22.60 ± 1.84 years N/A. Mode: Passive.
Stretching versus strength N/A.
(STRE). Session duration in minutes: Warm-up: Yes, but unclear with
training in lengthened Session duration in minutes:
Training status: No participation in ST or STRE N/A. regard to specifications. None of the groups
position in subjects with tight N/A.
programs in the previous year. No. exercises per session: 1. Timing: Baseline, 1-week experienced significant
hamstring muscles: A No. exercises per session: 1.
Selection of subjects: announcements posted at the No. sets and repetitions: 4*30”. post-protocol. improvements in ROM.
randomized controlled trial. No. sets and repetitions: 3*12.
University. Stretching modality: Static. Results considered in the tests:
[44] Load: 60% of 1RM.
Length (weeks): 8. Load: Unclear. mean of three measures.
Full or partial ROM: Partial.
Weekly sessions: 3. Full or partial ROM: Full. Data reliability: High.
Supervision ratio: N/A.
Adherence: N/A. Supervision ratio: N/A. No. testers: 1 (blinded).
Funding Instructions during testing: N/A.
N/A.
Conflicts of interest: N/A.
Healthcare 2021, 9, 427
Article
Group-based exercise at
workplace: short-term effects
of neck and shoulder
resistance training in video
display unit workers with
work-related chronic neck
pain—a pilot randomized
trial.
[46]
A randomized controlled
trial of muscle strengthening
versus flexibility training in
fibromyalgia.
[85]
Population and Common Program Features
Subjects: 35 video display unit workers, 27
completed the program.
Health status: chronic neck pain.
Gender: 27 women, 8 men.
Age: 43 (41–45) in ST; 42 (38.5–44) in STRE.
Training status: N/A.
Selection of subjects: intranet form.
Length (weeks): 7.
Weekly sessions: 2.
Adherence: average 85% of the sessions in ST and
86% in STRE.
Funding
Under “disclosures”, the authors stated “none”.
Conflicts of interest: Under “disclosures”, the
authors stated “none”.
Subjects: 68; 56 completed the program.
Health status: Diagnosed with fibromyalgia (FM).
Gender: Women.
Age: 49.2 ± 6.36 years in ST, 46.4 ± 8.56 in STRE.
Training status: 87% were sedentary. Not engaged
in regular strength training programs.
Selection of subjects: FM patients referred to
rheumatology practice at a teaching university.
Length (weeks): 12.
Weekly sessions: 2.
Adherence: 85% of the initial participants attended
≥13 of 24 classes. N/A for the 46 women that
completed the interventions.
Funding
Individual National Research Service Award
(#1F31NR07337-01A1) from the National
Institutes of Health, a doctoral dissertation grant
(#2324938) from the Arthritis Foundation, and
funds from the Oregon Fibromyalgia Foundation.
Conflicts of interest: N/A.
Table 1. Cont.
Strength Training Group
n = 14.
Weekly volume (minutes): 90.
Session duration in minutes: 45.
No. exercises per session: 10.
No. sets and repetitions:
2–3*8–20. Isometric
contractions up to 30”.
Load: free-weights with a
maximum of 75% MVC and
elastic bands of unspecified
load.
Full or partial ROM: N/A.
Supervision ratio: ~1:8.
n = 28.
Weekly volume (minutes): 120.
Session duration in minutes: 60.
No. exercises per session:
Presumably 12.
No. sets and repetitions: 1*4–5,
progressing to 1*12.
Load: Low intensity. Slower
concentric contractions with
a 4” isometric hold in the
end, and a faster eccentric
contraction.
Full or partial ROM: Full.
Supervision ratio: Presumably
1:28.
Comparator Group(s) *
STRE n = 13.
Weekly volume (minutes): 90.
Session duration in minutes: 45.
No. exercises per session: 11.
No. sets and repetitions: 10*10”.
Stretching modality: Static.
Load: N/A.
Full or partial ROM: N/A.
Supervision ratio: ~1:8.
STRE n = 28.
Weekly volume (minutes): 120.
Session duration in minutes: 60.
No. exercises per session:
Presumably 12.
No. sets and repetitions: N/A.
Stretching modality: Static.
Load: Low intensity.
Full or partial ROM: N/A.
Supervision ratio: Presumably
1:28.
8 of 26
Qualitative Results for
ROM Testing
ROM
Joints and actions: Cervical spine
(flexion, extension, lateral flexion,
rotation).
Positions: Sitting (flexion,
extension, lateral flexion) and
Significant improvements in
supine position (rotation).
both groups for all ROM
Mode: Active.
measurements.
Warm-up: N/A.
No differences between the
Timing: Baseline, 1-week
two groups.
post-protocol.
Results considered in the tests: N/A.
Data reliability: N/A.
No. testers: 1 (blinded).
Instructions during testing: N/A.
Joints and actions: Shoulder (the
authors report on internal and
external rotation, but the
movements used actually
required a combination of
motions).
Positions: Presumably standing.
Both groups had significant
Mode: Active.
improvements in ROM.
Warm-up: N/A.
No differences between
Timing: Baseline, 12 weeks.
groups.
Results considered in the tests: N/A.
Data reliability: Referral to a
previous study, but no values for
these data.
No. testers: 1.
Instructions during testing: Reach
as far as possible.
Healthcare 2021, 9, 427 9 of 26

Table 1. Cont.

Qualitative Results for

Article Population and Common Program Features Strength Training Group Comparator Group(s) * ROM Testing
ROM
STRE n = 7. Joints and actions: Shoulder (flexion,
Weekly volume (minutes): extension, abduction
240. and horizontal adduction) elbow (flexion),
Session duration in minutes: hip (flexion and extension), knee (flexion),
Subjects:28 women. n = 7.
60. and trunk (flexion and extension).
Health status: Presumably healthy. Weekly volume (minutes):
No. exercises per session: Positions: Supine (shoulder flexion,
Gender: Women. N/A.
N/A. abduction, horizontal adduction, elbow and
Age: 46 ± 6.5. Session duration in minutes:
No. sets and repetitions: 3*30. hip flexion), prone (shoulder and hip
Training status: Trained in strength and N/A.
Influence of Strength and Stretching modality: extension, and knee flexion) and upright
stretching. No. exercises per session: 8.
Flexibility Training, Dynamic. (trunk flexion and extension) for
Selection of subjects: Volunteers that would No. sets and repetitions: None of the groups
Combined or Isolated, on Load: Stretch to mild goniometric evaluations. Sitting for
refrain from exercise outside the intervention. 3*8–12 during the 1st experienced significant
Strength and Flexibility discomfort. sit-and-reach.
Length (weeks):12. month; 3*6–10RM in the improvements in ROM.
Gains. Full or partial ROM: Full. Mode: Passive for goniometry. Active for
Weekly sessions: 4. Not explicit; 48 sessions 2nd month; 3*10–15RM in
[45] Supervision ratio: N/A. sit-and-reach.
over 12 weeks. the 3rd month.
STRE + ST n = 7. Warm-up: 5- minute walking on treadmill at
Adherence: Minimum was 44 of the 48 sessions. Load: 6–15RM, depending
Completion of both mild to moderate intensity and four
Funding on the month.
protocols. Unknown stretching exercises.
N/A. Full or partial ROM: N/A.
duration. Timing: Baseline, 12 weeks.
Conflicts of interest: N/A. Supervision ratio: N/A.
ST + STRE n = 7. Results considered in the tests: Best of 3 trials.
Completion of both Data reliability: Very high.
protocols in reverse order. No. testers: 1.
Unknown duration. Instructions during testing: N/A.
Subjects: 40 college students.
Health status: No history of lower extremity
STRE n = 20.
injury in the 2 years prior to the study.
Weekly volume (minutes):
Gender: 20 men, 20
n = 20. N/A.
women. Joints and actions: Hip (flexion).
Weekly volume (minutes): Session duration in minutes:
Age: 18–24 years. Positions: Supine.
N/A. N/A.
Training status: participating in exercise 2–3 Mode: Passive.
Effects of Flexibility and Session duration in minutes: No. exercises per session: 4.
times per week. Warm-up: Six-minute warm-up including Men and women in both
Strength Interventions on N/A No. sets and repetitions: 2*15
Selection of subjects: college students. jogging and jumping. groups significantly
Optimal Lengths of No. exercises per session: 4. for dynamic stretching,
Length (weeks): 8. Timing: Baseline, 8 weeks. improved ROM.
Hamstring Muscle-Tendon No. sets and repetitions: 2*40–60” for static
Weekly sessions: 3. Results considered in the tests: Mean of three No differences between
Units. 2–4*8–15. For one exercise, stretching, 3*50” for PNF
Adherence: N/A. trials. groups.
[72] 2*50–60”. and 3*40–50” for foam roll.
Funding Data reliability: Very high.
Load: N/A. Stretching modality: active
Partially supported by the National Natural No. testers: N/A.
Full or partial ROM: N/A. static, dynamic and PNF.
Science Foundation of China (Grant No.: Instructions during testing: N/A.
Supervision ratio: N/A. Load: N/A.
81572212) and the Fundamental Research
Full or partial ROM: N/A.
Fund for the Central Universities, Beijing
Supervision ratio: N/A.
Sport University (Grant No.: 2017XS017).
Conflicts of interest: N/A.
Healthcare 2021, 9, 427
Article Population and Common Program Features
Subjects: 37 college students.
Health status: Healthy.
Gender: 30 men, 12 women; ratio is unclear in
the final sample.
Age: 21.91 ± 3.64 years.
Resistance training vs. Training status: Untrained.
static stretching: Effects on Selection of subjects: Recruited from Physical
flexibility and strength. Education or Exercise Science Classes.
[71] Length (weeks): 5.
Weekly sessions: 3.
Adherence: N/A.
Funding
N/A.
Conflicts of interest: N/A.
Subjects: 69 high-schoolers.
Health status: Healthy, but with a 30◦ loss of
knee extension.
Gender: Men.
Age: 16.45 ± 0.96 years.
Training status: Some sedentary, others
Eccentric training and
involved in exercise programs.
static stretching improve
Selection of subjects: Volunteers with tight
hamstring flexibility of
hamstrings.
high school men.
Length (weeks): 6.
[86]
Weekly sessions: 3 for STRE. N/A for ST.
Adherence: N/A for ST. STRE: subjects missing
>4 sessions were excluded.
Funding
N/A.
Conflicts of interest: N/A.
Table 1. Cont.
Strength Training Group
n = 12.
Weekly volume (minutes):
135–180.
Session duration in minutes:
45–60.
No. exercises per session:
eight in days 1 and 2, four
in day 3.
No. sets and repetitions: 4
sets of unspecified
repetitions.
Load: N/A.
Full or partial ROM: Full.
Supervision ratio: 1:12.
n = 24.
Weekly volume (minutes):
N/A.
Session duration in minutes:
N/A.
No. exercises per session: 1.
No. sets and repetitions: 6
repetitions with 5”
isometric hold between
each.
Load: N/A.
Full or partial ROM: Full.
Supervision ratio:
Description suggests a 1:1
ratio.
Comparator Group(s) *
STRE n = 12.
Weekly volume (minutes):
75–90.
Session duration in minutes:
25–35.
No. exercises per session: 13.
No. sets and repetitions: 1*30”
for most stretches. 3*30”
for one exercise and 3*20”
for two.
Stretching modality: Static.
Load: N/A.
Full or partial ROM: Full.
Supervision ratio: 1:12.
STRE n= 21.
Weekly volume (minutes):
N/A.
Session duration in minutes:
N/A.
No. exercises per session: 1.
No. sets and repetitions:
Unknown number of
repetitions, each lasting
30”.
Stretching modality: Static.
Load: Stretch until a gentle
stretch was felt on the
posterior thigh.
Full or partial ROM: Full.
Supervision ratio:
Description suggests a 1:1
ratio.
10 of 26
Qualitative Results for
ROM Testing
ROM
Joints and actions: Hip (flexion, extension),
knee (extension) and shoulder (extension).
Positions: Supine (knee and hip). Prone
(shoulder).
Both groups had significant
Mode: Passive for hip and knee, active for
improvements in knee
shoulder.
extension, hip flexion and
Warm-up: 5 min of stationary bicycle with
hip extension, but not
minimal resistance.
shoulder extension.
Timing: Baseline, 1-week post-protocol.
No differences between the
Results considered in the tests: N/A.
interventions.
Data reliability: N/A.
No. testers: 1.
Instructions during testing: Technical
instructions specific to each test.
Joints and actions: Knee (extension).
Positions: Supine.
Mode: Passive.
Warm-up: No warm-up.
Timing: Baseline, 6 weeks. Both groups improved ROM.
Results considered in the tests: Two measures No differences between the
for previous reliability calculations, but interventions.
unclear for the groups’ evaluation.
Data reliability: Very high.
No. testers: 2 (1 blinded).
Instructions during testing: N/A.
Healthcare 2021, 9, 427 11 of 26

Table 1. Cont.

Qualitative Results for

Article Population and Common Program Features Strength Training Group Comparator Group(s) * ROM Testing
ROM
STRE n = 8.
Weekly volume (minutes): 320.
Session duration in minutes: 80.
No. exercises per session: 7.
No. sets and repetitions: 5*10”.
Subjects: 34 trained hurdlers.
Stretching modality: Dynamic with 10” Joints and actions: Hip
Health status: No lower extremity injury in the
static hold. (flexion and extension).
previous 30 days.
n = 9. Load: Evolved from low to hard Positions: Supine.
Gender: Men.
Weekly volume (minutes): 320. intensity, but no criteria were provided. Mode: Active.
Effects of flexibility Age: 15 ± 0.7 years.
Session duration in minutes: 80. Full or partial ROM: N/A. Supervision Warm-up: N/A.
combined with plyometric Training status: ≥3 years of experience in All interventions had
No. exercises per session: 4. ratio: N/A. Timing: Baseline, 12 weeks.
exercises vs. isolated hurdle racing. significant improvements in
No. sets and repetitions: 3*30”. STRE+ ST n = 9. Results considered in the tests:
plyometric or flexibility Selection of subjects: Recruited from three ROM.
Load: Evolved from low to Weekly volume (minutes): 320. Best of 3 attempts.
mode in adolescent men athletic teams. No differences between the
hard intensity, but no criteria Session duration in minutes: 80. Data reliability: Referral to a
hurdlers. Length (weeks): 12. interventions.
were provided. No. exercises per session: 11 (4 previous study, but no values
[33] Weekly sessions: 4.
Full or partial ROM: N/A. plyometric; 7 flexibility). for these data.
Adherence: N/A.
Supervision ratio: N/A. No. sets and repetitions: 3*30” for No. testers: 2.
Funding
plyometrics, 5*10” for stretching. Instructions during testing:
No funding.
Stretching modality: Dynamic with 10” N/A.
Conflicts of interest: No conflicts of interest.
static hold.
Load: Evolved from low to hard
intensity, but no criteria were provided.
Full or partial ROM: N/A.
Supervision ratio: N/A.
n = 20. STRE n = 20.
Subjects: 80 women. Weekly volume (minutes): Weekly volume (minutes): N/A. Joints and actions: Hip
Health status: Healthy. N/A. Session duration in minutes: N/A. (flexion) and knee (extension)
Gender: Women. Session duration in minutes: No. exercises per session: N/A. combined.
Age: 35 ± 2.0 (ST), 34 ± 1.2 (STRE), 35 ± 1.8 N/A. No. sets and repetitions: 4*15–60”. Positions: Sitting.
The influence of strength, (ST + STRE), 34 ± 2.1 (non-exercise). No. exercises per session: 8. Duration of each set started at 15” and Mode: Active.
flexibility, and Training status: Sedentary. No. sets and repetitions: 3*8–12 progressed to 60” during the Warm-up: 4 stretching The interventions
simultaneous training on Selection of subjects: Volunteers that were in the 1st and 4th months; intervention. exercises (2*10”). significantly improved ROM.
flexibility and strength sedentary ≥12 months. 3*6–10 in 2nd month; 3*10–15 Stretching modality: Static. Timing: Baseline, 16 weeks. No differences between the
gains. Length (weeks): 16. in 3rd month. Load: Performed at the point of mild Results considered in the tests: interventions.
[78] Weekly sessions: 3. Load: 8–12RM (1st and 4th discomfort. Maximum of 3 attempts.
Adherence: Minimum was 46 of the 48 sessions. months); 6–10RM (2nd Full or partial ROM: N/A. Data reliability: Very high.
Funding month); 10–15RM (3rd Supervision ratio: N/A. No. testers: 1.
N/A. month). ST + STRE n = 20. Instructions during testing:
Conflicts of interest: N/A. Full or partial ROM: N/A. STRE protocol followed by the ST N/A.
Supervision ratio: N/A. protocol.
Healthcare 2021, 9, 427 12 of 26

Table 1. Cont.

Qualitative Results for

Article Population and Common Program Features Strength Training Group Comparator Group(s) * ROM Testing
ROM
Low-intensity STRE n = 13.
Weekly volume (minutes): N/A.
Subjects: 39 dance students, 35 completed. Session duration in minutes: N/A.
n = 11. Joints and actions: Hip
Health status: N/A. No. exercises per session: 5.
Weekly volume (minutes): (flexion).
Gender: Women (39). No. sets and repetitions: N/A, but 10 for
N/A. Positions: Standing.
Age: 17 ± 0.49 years (ST group); 17 ± 0.56 each stretch.
Session duration in minutes: Mode: Active and passive. The three groups
years (low-intensity STRE); 17 ± 0.56 years Stretching modality: Active static.
A comparison of strength N/A. Warm-up: 10 min of significantly improved
(moderate to high intensity STRE). Load: 3/10 perceived exertion.
and stretch interventions No. exercises per session: 1. cardiovascular exercise and passive ROM, without
Training status: Moderately trained dance Full or partial ROM: N/A.
on active and passive No. sets and repetitions: 3*5, lower limb stretches. differences between the
students. Supervision ratio: N/A.
ranges of movement in increasing to 3*10 during the Timing: Baseline, 6 weeks. groups.
Selection of subjects: Recruited from dance Moderate-intensity or high-intensity
dancers: a randomized program. Each repetition Results considered in the tests: The moderate-to-high
college. STRE n = 11.
control trial. included a 3” isometric hold. N/A. intensity STRE group did not
Length (weeks): 6. Weekly volume (minutes): N/A.
[73] Load: Unclear, but using body Data reliability: N/A. improve in active ROM. The
Weekly sessions: 5. Session duration in minutes: N/A.
weight. No. testers: N/A. two other interventions did.
Adherence: N/A. No. exercises per session: 5.
Full or partial ROM: Partial Instructions during testing:
Funding No. sets and repetitions: N/A.
(final 10◦ ). Positioning cues for ensuring
N/A. Stretching modality: Passive.
Supervision ratio: N/A. proper posture.
Conflicts of interest: N/A. Load: 8/10 perceived exertion.
Full or partial ROM: N/A.
Supervision ratio: N/A.
Legend: N/A—Information not available. ST—Strength training. STRE—Stretching. ROM—Range of motion. MVC—Maximum voluntary contraction. PNF—Proprioceptive neuromuscular facilitation.
* Non-exercise groups are not considered in this column.
Healthcare 2021, 9, 427 13 of 26

Interventions lasted between five [71] and 16 weeks [78]. Minimum weekly training
frequency was two sessions [46,85] and maximum was five [73]. Six articles provided in-
sufficient information concerning session duration [44,45,72,73,78,86]. Ten articles vaguely
defined training load for the ST and stretching groups [33,43,46,71,72,85,86], or for stretch-
ing groups [44,45,78]. Six articles did not report on using partial or full ROM during
ST exercises [33,43,45,46,72,78]. Different stretching modalities were implemented: static
active [44,46,71,78,85,86], dynamic [43,45], dynamic with a 10-s hold [33], static active in
one group and static passive in another [73], and a combination of dynamic, static active,
and PNF [72].
Hip joint ROM was assessed in seven articles [33,43,45,71–73,78], knee ROM in
five [43–45,71,86], shoulder ROM in four [43,45,71,85], elbow and trunk ROM in two [43,45],
and cervical spine [46] and the ankle joint ROM in one article [43]. In one article, active
ROM (AROM) was tested for the trunk, while passive ROM (PROM) was tested for the
other joints [43]. In one article, PROM was tested for goniometric assessments and AROM
for hip flexion [45]. In another, AROM was assessed for the shoulder and PROM for the hip
and knee [71]. Three articles only assessed PROM [44,72,86], and four AROM [33,46,78,85],
while one assessed both for the same joint [73].
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved
ROM, and the differences between the groups were non-significant. In one article, the ST
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching
did not lead to improvement in any of the groups [43]. In another article, the three groups
significantly improved PROM, without between-group differences; the ST and the static
active stretching groups also significantly improved AROM [73]. In two articles, none of
the groups improved ROM [44,45].

3.3. Risk of Bias in Individual Studies

Table 2 presents assessments of RoB. Bias arising from the randomization process was
low in four articles [43,45,73,85], moderate in one [46] and high in six [33,44,71,72,78,86].
Bias due to deviations from intended interventions, missing outcome data, and selection
of the reported results was low. Bias in measurement of the outcome was low in six
articles [44–46,78,85,86], but high in five [33,43,71–73].

3.4. Synthesis of Results

Comparisons were performed between ST and stretching groups, involving eleven
articles and 452 participants. Global effects on ROM were achieved pooling data from the
different joints. One article did not have the data required [44], but the authors supplied it
upon request. For another article [45], we also requested data relative to the goniometric
evaluations, but obtained no response. Therefore, only data from the sit-and-reach test
were used. For one article [46], means and SDs were obtained from 95% CIs, while in
another [85], SDs were extracted from SEMs using Cochrane’s RevMan Calculator.
From the five articles, including both genders, four provided pooled data, with no
distinction between genders [43,44,46,71]. One article presented data separated by gender,
without significant differences between men and women in response to interventions [72].
Weighted formulas were applied sequentially for combining means and SDs of groups
within the same study [47]. Two studies presented the results separated by left and right
lower limbs, with both showing similar responses to the interventions [33,73]; outcomes
were combined using the same weighted formulas for the means and SDs. Five articles only
presented one decimal place [33,43,46,72,78], and so all values were rounded for uniformity.
Effects of ST versus stretching on ROM: no significant difference was noted between
ST and stretching (ES = −0.22; 95% CI = −0.55 to 0.12; p = 0.206; I2 = 65.4%; Egger’s test
p = 0.563; Figure 2). The relative weight of each study in the analysis ranged from 6.4% to
12.7% (the size of the plotted squares in Figure 2 reflects the statistical weight of each study).

 the differences between the groups were non‐significant. In one article, the ST  ROM, and the differences between the groups were non‐significant. In one article, the ST
Healthcare 2021, 9, x    Healthcare 2021, 9, x    Healthcare 2021, 9, x
 significant improvements in 8 of 10 ROM measures, while dynamic stretching    Healthcare 2021, 9, x
 
d to improvement in any of the groups [43]. In another article, the three groups  In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved
ly improved PROM, without between‐group differences; the ST and the static  ROM, and the differences between the groups were non‐significant. In one article, the ST
Healthcare 2021, 9, x    3.3. Risk of Bias in Individual Studies
tching groups also significantly improved AROM [73]. In two articles, none of
 
s improved ROM [44,45]. Healthcare 2021, 9, 427
 Bias in Individual Studies      was  low  in  four  articles    active stretching groups also significantly improved AROM [73]. In two articles, none of
  2  presents  assessments  of  RoB.  Bias [33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome
in  four  articles  [43,45,73,85],  group had significant improvements in 8 of 10 ROM measures, while dynamic stretching
ven articles [33,46,71,72,78,85], ST and stretching groups significantly improved  Assessments
2,78,86]. Bias due to deviations from intended interventions, missing outcome  Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  Table 2. Assessments of risk of bias (Cochrane’s RoB 2).
 the differences between the groups were non‐significant. In one article, the ST
selection of the reported results was low. Bias in measurement of the outcome
 significant improvements in 8 of 10 ROM measures, while dynamic stretching  Deviations
ven articles [33,46,71,72,78,85], ST and stretching groups significantly improved
n six articles [44–46,78,85,86], but high in five [33,43,71–73].  3.3. Risk of Bias in Individual Studies  was
Article
d to improvement in any of the groups [43]. In another article, the three groups
Article
 the differences between the groups were non‐significant. In one article, the ST  Table  2  zation Pro‐
ly improved PROM, without between‐group differences; the ST and the static
 significant improvements in 8 of 10 ROM measures, while dynamic stretching
2. Assessments of risk of bias (Cochrane’s RoB 2).  was  low  zation Pro‐
ven articles [33,46,71,72,78,85], ST and stretching groups significantly improved
Alexander, Article
tching groups also significantly improved AROM [73]. In two articles, none of
Galecki,
d to improvement in any of the groups [43]. In another article, the three groups  tended Interventions  Outcome
Alexander, Galecki, Grenier, Nyquist,  Alexander, Galecki, Grenier, Nyquist,
 the differences between the groups were non‐significant. In one article, the ST  Alexander, Galecki, Grenier, Nyquist,
Randomi‐ Deviations from In‐
s improved ROM [44,45].  Nyquist, Hofmeyer,
ly improved PROM, without between‐group differences; the ST and the static  Table Healthcare 2021, 9, x
zation Pro‐
Hofmeyer, Grunawalt, Medell and Fry‐
tended Interventions 
 significant improvements in 8 of 10 ROM measures, while dynamic stretching
Grunawalt, Medell
Alexander, Galecki, Grenier, Nyquist,  and
tching groups also significantly improved AROM [73]. In two articles, none of
ven articles [33,46,71,72,78,85], ST and stretching groups significantly improved
Welch [43]     in  four   articles
d to improvement in any of the groups [43]. In another article, the three groups  Welch [43]
 Bias in Individual Studies 
cess  Fry-Welch
(EAI  1) 
Hofmeyer, Grunawalt, Medell and Fry‐
s improved ROM [44,45].  [43]
 the differences between the groups were non‐significant. In one article, the ST
Aquino, Fonseca, Goncalves, Silva, Oc‐
ly improved PROM, without between‐group differences; the ST and the static  [33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome
Healthcare 2021, 9, x 
Aquino, Welch [43] 
Fonseca,
  significant improvements in 8 of 10 ROM measures, while dynamic stretching
2  presents  assessments   of  RoB.  Bias  arising
tching groups also significantly improved AROM [73]. In two articles, none of
  arino and Mancini [44]      Table 2. Assessments of risk of bias (Cochrane’s RoB 2).
in  four  articles Silva,
 Bias in Individual Studies 
+ [43,45,73,85], 
+ Ocarino
Aquino, Fonseca, Goncalves, Silva, Oc‐
ven articles [33,46,71,72,78,85], ST and stretching groups significantly improved
d to improvement in any of the groups [43]. In another article, the three groups  was
s improved ROM [44,45]. 
 Caputo, Di Bari and Naranjo Orellana 
 
 2,78,86]. Bias due to deviations from intended interventions, missing outcome
2  presents  assessments  Mancini
arino and Mancini [44]  [44]Bias  arising
 the differences between the groups were non‐significant. In one article, the ST
ly improved PROM, without between‐group differences; the ST and the static
of [46]
Healthcare 2021, 9, x      from  Welch [43]
  Article    Alexander, Galecki, Grenier, Nyquist,
selection of the reported results was low. Bias in measurement of the outcome
 significant improvements in 8 of 10 ROM measures, while dynamic stretching  zation Pro‐
in  four Caputo, Di Bari and Naranjo Orellana 
articles 
Caputo,[43,45,73,85], 
 Bias in Individual Studies  Di Bari and
tching groups also significantly improved AROM [73]. In two articles, none of
Jones, Burckhardt, Clark, Bennett and
+
n six articles [44–46,78,85,86], but high in five [33,43,71–73].  Jones, Burckhardt, Clark, Bennett and
d to improvement in any of the groups [43]. In another article, the three groups
s improved ROM [44,45].    [46]
of [46]
 2,78,86]. Bias due to deviations from intended interventions, missing outcome
Orellana
2  presents  assessments  Potempa [85]  arising
ly improved PROM, without between‐group differences; the ST and the static
Alexander, Galecki, Grenier, Nyquist,
in  four  articles Jones, Burckhardt, Clark, Bennett and  Caputo, Di Bari and Naranjo Orellana
selection of the reported results was low. Bias in measurement of the outcome  Caputo, Di Bari and Naranjo Orellana
Jones,[43,45,73,85], 
+ Article 
Burckhardt,
Leite, De Souza Teixeira, Saavedra,  moderate
2. Assessments of risk of bias (Cochrane’s RoB 2). 
 Bias in Individual Studies 
n six articles [44–46,78,85,86], but high in five [33,43,71–73].
tching groups also significantly improved AROM [73]. In two articles, none of
! Hofmeyer, Grunawalt, Medell and Fry‐
s improved ROM [44,45].  Bennett Potempa [85] 
and2021,  
2,78,86]. Bias due to deviations from intended interventions, missing outcome
Leite, Rhea and Simão [45]
Healthcare
  2 Randomi‐ Welch [43] 
Deviations from In‐
presents Leite, De Souza Teixeira, Saavedra, 
assessments  of  RoB.  Bias  Missing
selection of the reported results was low. Bias in measurement of the outcome
Alexander, Galecki, Grenier, Nyquist,  Alexander, Galecki, Grenier, Nyquist,  group had significant improvements in 8 of 10 ROM measures, while dynamic stretching
Li, Garrett, Best, Li, Wan, Liu and Yu
Leite,[43,45,73,85], 
De+Souza Teixeira,
+  Aquino, Fonseca, Goncalves, Silva, Oc‐
2. Assessments of risk of bias (Cochrane’s RoB 2).  Li, Garrett, Best, Li, Wan, Liu and Yu
in  four 
zation Pro‐ articles 
tended Interventions   
Leite, Rhea and Simão [45]
n six articles [44–46,78,85,86], but high in five [33,43,71–73].  moderate
Hofmeyer, Grunawalt, Medell and Fry‐
 Bias in Individual Studies  Saavedra, Leite,
arino and Mancini [44] [72] Rhea Hofmeyer, Grunawalt, Medell and Fry‐
2,78,86]. Bias due to deviations from intended interventions, missing outcome
cess  Li, Garrett, Best, Li, Wan, Liu and Yu 
Randomi‐ (EAI 
Deviations from In‐
Simão
1) 
presents  assessments  Welch [43] 
Morton, Whitehead, Brinkert and Caine 
of  RoB.  Welch [43]
 selection of the reported results was low. Bias in measurement of the outcome
2  Bias  arising  from  the  Table  Welch [43]
+  Caputo, Di Bari and Naranjo Orellana 
+  [72]  Alexander, Galecki, Grenier, Nyquist,
2. Assessments of risk of bias (Cochrane’s RoB 2).  +
zation Pro‐ tended Interventions 
in  four Aquino, Fonseca, Goncalves, Silva, Oc‐
articles  [43,45,73,85], 
Li, Garrett, Best,
n six articles [44–46,78,85,86], but high in five [33,43,71–73].
+ Morton, Whitehead, Brinkert and Caine 
cess 
Randomi‐ (EAI  + Yu
Deviations from In‐
1) 
arino and Mancini [44] 
  Jones, Burckhardt, Clark, Bennett and  Data
  [72] Jones, Burckhardt, Clark, Bennett and
2,78,86]. Bias due to deviations from intended interventions, missing outcome
and
+
Nelson and Bandy [86]  Leite, De Souza Teixeira, Saavedra,
zation Pro‐  Caputo, Di Bari and Naranjo Orellana 
tended Interventions   [71]  Alexander, Galecki, Grenier, Nyquist, Welch [43]
2. Assessments of risk of bias (Cochrane’s RoB 2). 
Potempa [85] 
Morton, Whitehead,
selection of the reported results was low. Bias in measurement of the outcome
 
cess 
+   Racil, Jlid, Bouzid, Sioud, Khalifa,
(EAI  1 )
n six articles [44–46,78,85,86], but high in five [33,43,71–73].
+Caine
 [46] [71] Li, Garrett, Best, Li, Wan, Liu and Yu
Nelson and Bandy [86]  ++arino and Mancini [44]
Randomi‐ and+
Leite, De Souza Teixeira, Saavedra,
Deviations from In‐
  Jones, Burckhardt, Clark, Bennett and
 
Amri, Gaied and Coquart [33]  Amri, Gaied and Coquart [33]
Racil, Jlid, Bouzid, Sioud, Khalifa,
Leite, Rhea and Simão [45]
zation Pro‐ tended Interventions 
2. Assessments of risk of bias (Cochrane’s RoB 2). 
Simão, Lemos, Salles, Leite, Oliveira,
Nelson Potempa [85] 
and
+!   Li, Garrett, Best, Li, Wan, Liu and Yu  was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].
cess  (EAI  +++ 1  ) 
Amri, Gaied and Coquart [33]
   Leite, De Souza Teixeira, Saavedra,
Rhea and Reis [78]   
Randomi‐ Deviations from In‐
Simão, Lemos, Salles, Leite, Oliveira,
Racil, Jlid, Bouzid,
zation Pro‐ ++  
Leite, Rhea and Simão [45]
  Wyon, Smith and Koutedakis [73] 
tended Interventions 
Rhea and Reis [78] 
+! Morton, Whitehead, Brinkert and Caine  +
cess  (EAI 
++    Gaied
+     Li, Garrett, Best, Li, Wan, Liu and Yu
Khalifa, Amri, 1 ) 
Coquart [33]
Wyon, Smith and Koutedakis [73]
+ [72]  Racil, Jlid, Bouzid, Sioud, Khalifa,
++      
+++ Article  Alexander, Galecki, Grenier, Nyquist,
1 Effect of assignment to intervention.  1
! Morton, Whitehead, Brinkert and Caine 
   Nelson and Bandy [86] 
Simão, Lemos,  
+   +    Morton, Whitehead, Brinkert and Caine
Oliveira,1 Rhea
+   Racil, Jlid, Bouzid, Sioud, Khalifa, 
+  [71]  Reis Wyon, Smith and Koutedakis [73]
 Effect of assignment to intervention. +
++   Alexander, Galecki, Grenier, Nyquist, 
+++  
  Wyon, + Smith
Amri, Gaied and Coquart [33]  and
 ntion.  ! +Hofmeyer, Grunawalt, Medell and Fry‐
Nelson and Bandy [86] 
  Low risk of bias; 
Koutedakis +     +Nelson and Bandy [86]
  Simão, Lemos, Salles, Leite, Oliveira,
Welch [43]  Simão, Lemos, Salles, Leite, Oliveira,
+++   Alexander, Galecki, Grenier, Nyquist,
+     Racil, Jlid, Bouzid, Sioud, Khalifa, 
 
Alexander, Galecki, Grenier, Nyquist,
sis of Results  +    Hofmeyer, Grunawalt, Medell and Fry‐
Rhea and Reis [78] 
+  Aquino, Fonseca, Goncalves, Silva, Oc‐
Hofmeyer, Grunawalt, Medell and Fry‐
Amri, Gaied and Coquart [33]  +
  !   +
+   
arino and Mancini [44] 
Wyon, Smith and Koutedakis [73]
  Simão, Lemos, Salles, Leite, Oliveira,
++  
parisons were performed between ST and stretching groups, involving eleven
  Caputo, Di Bari and Naranjo Orellana  Simão, Lemos, Salles, Leite, Oliveira,
+ +
Aquino, Fonseca, Goncalves, Silva, Oc‐
d 452 participants. Global effects on ROM were achieved pooling data from the
   
  +   Rhea and Reis [78] 
+ Rhea and Reis [78]
 
+  [46] arino and Mancini [44]  [46]  [46]  !
  Wyon, Smith and Koutedakis [73] 
+  
oints. One article did not have the data required [44], but the authors supplied
1 Effect of assignment to intervention.
  Jones, Burckhardt, Clark, Bennett and  Leite, De Souza Teixeira, Saavedra,
+   Caputo, Di Bari and Naranjo Orellana
Caputo, Di Bari and Naranjo Orellana
quest. For another article [45], we also requested data relative to the goniometric  [72]    Jones, Burckhardt, Clark, Bennett and
+    ++   ++Rhea and Reis [78]
 s, but  obtained no 
  Potempa [85] 
response. Therefore,
+    +only
  1 Effect of assignment to intervention.    1 Effect of assignment to intervention.
  Leite, De Souza Teixeira, Saavedra, 
+   Li, Garrett, Best, Li, Wan, Liu and Yu
+   +  
Jones, Burckhardt, Clark, Bennett and
     ++   
Leite, Rhea and Simão [45]  ++Rhea and Reis [78]
 
  + +
ntion.  + +  Li, Garrett, Best, Li, Wan, Liu and Yu 
Low risk of bias;  +  
 
Leite, De Souza Teixeira, Saavedra,
  + Comparisons were performed between ST and stretching groups, involving eleven
  +   
Morton, Whitehead, Brinkert and Caine 
sis of Results  evaluations, but
Li, Garrett, Best, Li, Wan, Liu and Yu  obtained no
ntion.  + +  Low risk of bias;  +
+   [71]  Simão, Lemos, Salles, Leite, Oliveira,  +  +    [71]  Wyon, Smith and Koutedakis [73]
 
parisons were performed between ST and stretching groups, involving eleven  [72]    [72] [71]  [71]    Simão, Lemos, Salles, Leite, Oliveira,
+   Racil, Jlid, Bouzid, Sioud, Khalifa,
 
+ Morton, Whitehead, Brinkert and Caine
Morton, Whitehead, Brinkert and Caine  +Nelson and Bandy [86]  Amri, Gaied and Coquart [33]  Rhea and Reis [78]
d 452 participants. Global effects on ROM were achieved pooling data from the
sis of Results  Nelson and Bandy [86] 
ntion.  +  Low risk of bias;   ! Some concerns; 
oints. One article did not have the data required [44], but the authors supplied
+ +
parisons were performed between ST and stretching groups, involving eleven
  Racil, Jlid, Bouzid, Sioud, Khalifa,
 
 
quest. For another article [45], we also requested data relative to the goniometric
+   +  Rhea and Reis [78]  +    Rhea and Reis [78]
d 452 participants. Global effects on ROM were achieved pooling data from the
sis of Results    Amri, Gaied and Coquart [33]  Nelson and Bandy [86]
s, but  obtained no 
+ response. Therefore,  !
oints. One article did not have the data required [44], but the authors supplied
ntion.  Low risk of bias;  Some concerns;
parisons were performed between ST and stretching groups, involving eleven
+  
Simão, Lemos, Salles, Leite, Oliveira,  Simão, Lemos, Salles, Leite, Oliveira,
+ Racil, Jlid, Bouzid, Sioud, Khalifa,
quest. For another article [45], we also requested data relative to the goniometric
 
d 452 participants. Global effects on ROM were achieved pooling data from the
  Rhea and Reis [78]  Rhea and Reis [78]
sis of Results 
s, but  obtained no  response. Therefore,  only  data from the  3.4. Synthesis of Results
oints. One article did not have the data required [44], but the authors supplied
+ !
Simão, Lemos, Salles, Leite, Oliveira,  1
ntion.  Low risk of bias; 
Wyon, Smith and Koutedakis [73]  Some concerns;  1  Effect of assignment to intervention.
parisons were performed between ST and stretching groups, involving eleven
quest. For another article [45], we also requested data relative to the goniometric
d 452 participants. Global effects on ROM were achieved pooling data from the
s, but  obtained no  response. Therefore,      only  data from the    articles and 452 participants. Global effects on ROM were achieved pooling data from the
sis of Results  Wyon, Smith and Koutedakis [73]
Wyon, Smith and Koutedakis [73]  3.4. Synthesis of Results
oints. One article did not have the data required [44], but the authors supplied
1 Effect of assignment to intervention.  1 Effect of assignment to intervention.
parisons were performed between ST and stretching groups, involving eleven
quest. For another article [45], we also requested data relative to the goniometric  it upon request. For another article [45], we also requested data relative to the goniometric
d 452 participants. Global effects on ROM were achieved pooling data from the    articles and 452 participants. Global effects on ROM were achieved pooling data from the
s, but  obtained no  response. Therefore,  3.4. Synthesis of Results
oints. One article did not have the data required [44], but the authors supplied  different joints. One article did not have the data required [44], but the authors supplied
quest. For another article [45], we also requested data relative to the goniometric  it upon request. For another article [45], we also requested data relative to the goniometric
s, but  obtained no  response. Therefore,  only  data from the  evaluations, but
Figure 2. Forest
(CI). The size of theevaluations, but  plotted squares
Figure 2. Forest plot of changes
vals (CI). The
 
did not lead to improvement in any of the groups [43]. In another article, the three groups
active stretching groups also significantly improved AROM [73]. In two articles, none of  ROM, and the differences between the groups were non‐significant. In one article, t
significantly improved PROM, without between‐group differences; the ST and the static
  the groups improved ROM [44,45].  the groups improved ROM [44,45].
active stretching groups also significantly improved AROM [73]. In two articles, none of  In seven articles [33,46,71,72,78,85], ST and stretching groups significantly imp
the groups improved ROM [44,45].
Healthcare 2021, 9, x    3.3. Risk of Bias in Individual Studies
 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved
Table  2  presents  assessments  Table
3.3. Risk of Bias in Individual Studies  the groups improved ROM [44,45].
ROM, and the differences between the groups were non‐significant. In one article, the ST  the groups improved ROM [44,45].
was  low  in  four  articles  was  was low [43,45,73,85],
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching
Table 
Healthcare 2021, 9, x 
Healthcare 2021, 9, x    2    presents  group had significant improvements in 8 of 10 ROM measures, while dynamic stretching
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome  27  Bias  group had significant improvements in 8 of 10 ROM measures, while dynamic stret
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved
did not lead to improvement in any of the groups [43]. In another article, the three groups  active stretching groups also significantly improved AROM [73]. In two articles, n
data, and selection of the reported results was low. Bias in measurement of the outcome
ROM, and the differences between the groups were non‐significant. In one article, the ST
arising  from  the  randomization  ROM, and the differences between the groups were non‐significant. In one article, the ST
significantly improved PROM, without between‐group differences; the ST and the static
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].
Healthcare 2021, 9, x 
Healthcare 2021, 9, x      was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].
    moderate  in  one  [46]    and group had significant improvements in 8 of 10 ROM measures, while dynamic stretching
active stretching groups also significantly improved AROM [73]. In two articles, none of
data, and selection of the reported results was low. Bias in measurement of the outcome  was  low  [43,45,73,85],  in   four  moderate  group had significant improvements in 8 of 10 ROM measure
did not lead to improvement in any of the groups [43]. In another article, the three groups  of risk of
the groups improved ROM [44,45].  the groups improved ROM [44,45].
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].
Healthcare 2021, 9, x    ROM, and the differences between the groups were non‐significant. In one article, the ST
significantly improved PROM, without between‐group differences; the ST and the static
 
active stretching groups also significantly improved AROM [73]. In two articles, none of
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  low  in  four  articles
Randomization3.3. Risk of Bias in Individual Studies
the groups improved ROM [44,45].  Intended the groups improved ROM [44,45].
Article  Process
Healthcare 2021, 9, x 
Healthcare 2021, 9, x    Randomi‐
    in  cess
3.3. Risk of Bias in Individual Studies
Grenier,
Alexander, Galecki, Grenier, Nyquist, 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome
Missing  Measurement  (EAI 1Randomi‐
2  presents  significantly improved PROM, without between‐group differences; the ST and the static
Hofmeyer, Grunawalt, Medell and Fry‐
Hofmeyer, Grunawalt, Medell and Fry‐
Outcome 
Healthcare 2021, 9, x  Article
of the Out‐
data, and selection of the reported results was low. Bias in measurement of the outcome  2  presents
was  low 
Welch [43]
Welch [43]  Table 2. Assessments of risk of bias (Cochrane’s RoB 2).
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].
Data  come  3.3. Risk of Bias in Individual Studies
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome
Aquino, Fonseca, Goncalves, Silva, Oc‐
Aquino, Fonseca, Goncalves, Silva, Oc‐
Alexander, Galecki, Grenier, Nyquist,
Healthcare 2021, 9, x 
Healthcare 2021, 9, x 
Goncalves, from 
    the  randomization  Alexander, Galecki, Grenier, Nyquist,
data, and selection of the reported results was low. Bias in measurement of the outcome  2  presents
arino and Mancini [44]
arino and Mancini [44]  Table 2. Assessments of risk of bias (Cochrane’s RoB 2).
moderate  in  one  [46]
Hofmeyer, Grunawalt, Medell and Fry‐
and +
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].  +
 
Caputo, Di Bari and Naranjo Orellana
Caputo, Di Bari and Naranjo Orellana  cess  (EAI  Caputo, Di Bari and Naranjo Orellana  1cess  Data  (EAI  1 )   come
RoB. 
Healthcare 2021, 9, x 
[46]  the  !
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  Table 2. Assessments of risk of bias (Cochrane’s RoB 2). group had significant improvements in 8 of 10 ROM measures, while dynamic stret
Aquino, Fonseca, Goncalves, Silva, Oc‐
moderate 
Naranjo in  one  [46]  Aquino, Fonseca, Goncalves, Silva, Oc‐
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved  four
Jones, Burckhardt, Clark, Bennett and 
Hofmeyer, Grunawalt, Medell and Fry‐
+ +
arino and Mancini [44]
 
RoB.  Bias ROM, and the differences between the groups were non‐significant. In one article, the ST
from  Randomi‐
Potempa [85]
Potempa [85]
Welch [43]
Alexander, Galecki, Grenier, Nyquist,
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching  Caputo, Di Bari and Naranjo Orellana
Clark, in  zation Pro‐
Leite, De Souza Teixeira, Saavedra,
Leite, De Souza Teixeira, Saavedra,  [46]  and was  low in
Aquino, Fonseca, Goncalves, Silva, Oc‐
+  
Hofmeyer, Grunawalt, Medell and Fry‐
Potempa
9, x [85]
FOR Leite, Rhea and Simão [45] 
Leite, Rhea and Simão [45] 
PEER arino and Mancini [44]
REVIEW
did not lead to improvement in any of the groups [43]. In another article, the three groups
arising  from  Welch [43]
Measurement
Jones, Burckhardt, Clark, Bennett and  the  randomization  Selection of the
significantly improved PROM, without between‐group differences; the ST and the static
Li, Garrett, Best, Li, Wan, Liu and Yu 
Caputo, Di Bari and Naranjo Orellana
+   in 
Aquino, Fonseca, Goncalves, Silva, Oc‐
active stretching groups also significantly improved AROM [73]. In two articles, none of  +zation Pro‐
Outcome  one
Article
of the Out‐
Potempa [85]  was
and [72]
arino and Mancini [44]
the groups improved ROM [44,45].  [72]
[45] Data 
Leite, De Souza Teixeira, Saavedra,
Missing  come
Measurement  sults  cess  cess
Morton, Whitehead, Brinkert and Caine 
Morton, Whitehead, Brinkert and Caine 
Jones, Burckhardt, Clark, Bennett and
Caputo, Di Bari and Naranjo Orellana
Alexander, Galecki, Grenier, Nyquist,
Leite, Rhea and Simão [45]  +
Outcome  Article  Article
of the Out‐
Aquino, Fonseca, Goncalves, Silva, Oc‐
moderate  in  one  !
[71] 
Li,
[46]  Wan, Liu [71]
Hofmeyer, Grunawalt, Medell and Fry‐
Hofmeyer, Grunawalt, Medell and Fry‐
Potempa [85]
3.3. Risk of Bias in Individual Studies
Li, Garrett, Best, Li, Wan, Liu and Yu
+arino and Mancini [44] 
Missing 
 
Measurement  sults
+ Table 
Nelson and Bandy [86] 
Nelson and Bandy [86]  2  presents  Leite, De Souza Teixeira, Saavedra,
  Welch [43] 
Alexander, Galecki, Grenier, Nyquist,
Outcome  [72] From
of the Out‐
Caputo, Di Bari and Naranjo Orellana
was 
Brinkert Leite, Rhea and Simão [45] 
low  in 3.3. Risk of Bias in Individual Studies
Potempa [85]  articles
Aquino, Fonseca, Goncalves, Silva, Oc‐
Aquino, Fonseca, Goncalves, Silva, Oc‐
Morton, Whitehead, Brinkert and Caine  !
Hofmeyer, Grunawalt, Medell and Fry‐
Hofmeyer, Grunawalt, Medell and Fry‐
Data 
Racil, Jlid, Bouzid, Sioud, Khalifa,
Racil, Jlid, Bouzid, Sioud, Khalifa,  come
Leite, De Souza Teixeira, Saavedra,
Missing 
arino and Mancini [44] 
  Measurement
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome
Amri, Gaied and Coquart [33] Welch [43]
Welch [43]  Welch [43]
Alexander, Galecki, Grenier, Nyquist,
Jones, Burckhardt, Clark, Bennett and
Leite, Rhea and Simão [45] 
data, and selection of the reported results was low. Bias in measurement of the outcome
Bandy
Outcome  Article
Article
of the Out‐
Caputo, Di Bari and Naranjo Orellana
Caputo, Di Bari and Naranjo Orellana 
Aquino, Fonseca, Goncalves, Silva, Oc‐
Aquino, Fonseca, Goncalves, Silva, Oc‐
Simão, Lemos, Salles, Leite, Oliveira,
Simão, Lemos, Salles, Leite, Oliveira, 
[86] Nelson and Bandy [86] 
Hofmeyer, Grunawalt, Medell and Fry‐
Potempa [85]
++  
Morton, Whitehead, Brinkert and Caine 
+
Li, Garrett, Best, Li, Wan, Liu and Yu
Data  [46]  come
  Rhea and Reis [78]
arino and Mancini [44]
arino and Mancini [44] 
Rhea and Reis [78] 
Welch [43]
Leite, De Souza Teixeira, Saavedra,
Missing  Measurement  within
Racil, Jlid, Bouzid, Sioud, Khalifa,  same
[72]  Alexander, Galecki, Grenier, Nyquist, 
Alexander, Galecki, Grenier, Nyquist,
Jones, Burckhardt, Clark, Bennett and
Jones, Burckhardt, Clark, Bennett and  [72]    Alexander, Galecki, Grenier, Nyquist,
Caputo, Di Bari and Naranjo Orellana
Caputo, Di Bari and Naranjo Orellana 
Sioud,
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).
Aquino, Fonseca, Goncalves, Silva, Oc‐lower
Leite, Rhea and Simão [45] 
Wyon, Smith and Koutedakis [73] 
Wyon, Smith and Koutedakis [73] 
Outcome 
Amri, Gaied and Coquart [33] 
and +
Morton, Whitehead, Brinkert and Caine Article
of the Out‐
++Nelson and Bandy [86] 
Hofmeyer, Grunawalt, Medell and Fry‐
Hofmeyer, Grunawalt, Medell and Fry‐
Data 
Potempa [85]
   Potempa [85]
[46]
arino and Mancini [44]  [46]
Li, Garrett, Best, Li, Wan, Liu and Yu
[71] 
Simão, Lemos, Salles, Leite, Oliveira,
Welch [43]
Welch [43]
Leite, De Souza Teixeira, Saavedra,
Leite, De Souza Teixeira, Saavedra, 
Jones, Burckhardt, Clark, Bennett and
Jones, Burckhardt, Clark, Bennett and 
Caputo, Di Bari and Naranjo Orellana
+ [72]  +
  Rhea and Reis [78]
1
zation Pro‐
+++Nelson and Bandy [86]  Article
Article    Alexander, Galecki, Grenier, Nyquist,
 Effect of assignment to intervention.
 Effect of assignment to intervention.  Rhea and Reis [78]
Salles, Aquino, Fonseca, Goncalves, Silva, Oc‐
Aquino, Fonseca, Goncalves, Silva, Oc‐
Leite, Leite, Rhea and Simão [45] 
Leite, Rhea and Simão [45] 
Potempa [85]
  Potempa [85]
Amri, Gaied and Coquart [33]    Aquino, Fonseca, Goncalves, Silva, Oc‐
Hofmeyer, Grunawalt, Medell and Fry‐
Hofmeyer, Grunawalt, Medell and Fry‐
+ arino and Mancini [44]
arino and Mancini [44] 
 
Li, Garrett, Best, Li, Wan, Liu and Yu
andLi, Garrett, Best, Li, Wan, Liu and Yu 
[78]
Leite, De Souza Teixeira, Saavedra,
Leite, De Souza Teixeira, Saavedra, 
Simão, Lemos, Salles, Leite, Oliveira,
Jones, Burckhardt, Clark, Bennett and
3.4. Synthesis of Results  [71]
Racil, Jlid, Bouzid, Sioud, Khalifa,
Welch [43]  Effects
Alexander, Galecki, Grenier, Nyquist,
Alexander, Galecki, Grenier, Nyquist, 
+++ Article 
Article 
Caputo, Di Bari and Naranjo Orellana
Caputo, Di Bari and Naranjo Orellana  [72]
Leite, Rhea and Simão [45] 
Leite, Rhea and Simão [45]  [72]
   Rhea and Reis [78]  Alexander, Galecki, Grenier, Nyquist,
Amri, Gaied and Coquart [33]  Aquino, Fonseca, Goncalves, Silva, Oc‐
Potempa [85]
Aquino, Fonseca, Goncalves, Silva, Oc‐
Comparisons were performed between ST and stretching groups, involving eleven
Hofmeyer, Grunawalt, Medell and Fry‐
Hofmeyer, Grunawalt, Medell and Fry‐
! Morton, Whitehead, Brinkert and Caine 
3.4. Synthesis of Results  [46]
Morton, Whitehead, Brinkert and Caine 
Some concerns; 
[73]
1 Effect of assignment to intervention.
Li, Garrett, Best, Li, Wan, Liu and Yu
Li, Garrett, Best, Li, Wan, Liu and Yu 
+arino and Mancini [44] 
Leite, De Souza Teixeira, Saavedra,  High risk of bias.
Wyon, Smith and Koutedakis [73] 
Welch [43]  0.563;
Welch [43]  Simão, Lemos, Salles, Leite, Oliveira,
articles and 452 participants. Global effects on ROM were achieved pooling data from the
[71]
[72]
Leite, Rhea and Simão [45]  [71]
   Rhea and Reis [78]
Racil, Jlid, Bouzid, Sioud, Khalifa,
+++ Comparisons were performed between ST and stretching groups, involving eleven
Jones, Burckhardt, Clark, Bennett and
Jones, Burckhardt, Clark, Bennett and  relative
Caputo, Di Bari and Naranjo Orellana
Aquino, Fonseca, Goncalves, Silva, Oc‐
Aquino, Fonseca, Goncalves, Silva, Oc‐
 
Potempa [85]
Potempa [85]
Amri, Gaied and Coquart [33]  +
different joints. One article did not have the data required [44], but the authors supplied
articles and 452 participants. Global effects on ROM were achieved pooling data from the
1Morton, Whitehead, Brinkert and Caine 
Morton, Whitehead, Brinkert and Caine 
Effect of+ assignment
Nelson and Bandy [86] 
Nelson and Bandy [86] 
Li, Garrett, Best, Li, Wan, Liu and Yu  +
it upon request. For another article [45], we also requested data relative to the goniometric  ! risk
+Welch [43] 
++arino and Mancini [44] 
arino and Mancini [44] 
Wyon, Smith and Koutedakis [73] 
Welch [43]  [46]
   1 Effect of assignment to intervention.
Leite, De Souza Teixeira, Saavedra,
Leite, De Souza Teixeira, Saavedra, 
evaluations, but  [71]
Jones, Burckhardt, Clark, Bennett and
different joints. One article did not have the data required [44], but the authors supplied
Racil, Jlid, Bouzid, Sioud, Khalifa,
Racil, Jlid, Bouzid, Sioud, Khalifa, 
+
Caputo, Di Bari and Naranjo Orellana
Caputo, Di Bari and Naranjo Orellana 
Aquino, Fonseca, Goncalves, Silva, Oc‐
it upon request. For another article [45], we also requested data relative to the goniometric
Leite, Rhea and Simão [45] 
Leite, Rhea and Simão [45] 
 
Morton, Whitehead, Brinkert and Caine 
+ +
Nelson and Bandy [86] 
Nelson and Bandy [86] 
  Potempa [85]
Amri, Gaied and Coquart [33] 
Amri, Gaied and Coquart [33] 
+   1 Effect of assignment to intervention.
arino and Mancini [44] 
evaluations, but 
Li, Garrett, Best, Li, Wan, Liu and Yu
Li, Garrett, Best, Li, Wan, Liu and Yu 
+  
Wyon, Smith and Koutedakis [73] 
Simão, Lemos, Salles, Leite, Oliveira,
Simão, Lemos, Salles, Leite, Oliveira, 
+   +
Jones, Burckhardt, Clark, Bennett and
Jones, Burckhardt, Clark, Bennett and 
Racil, Jlid, Bouzid, Sioud, Khalifa,
Racil, Jlid, Bouzid, Sioud, Khalifa, 
Leite, Rhea and Simão [45] 
  Rhea and Reis [78]
3.4. Synthesis of Results 
Nelson and Bandy [86]  +    !
[46]    [46]  Potempa [85]
Potempa [85]
data from the
Amri, Gaied and Coquart [33] 
Amri, Gaied and Coquart [33]  Potempa [85]
Morton, Whitehead, Brinkert and Caine 
Morton, Whitehead, Brinkert and Caine  ! Li, Garrett, Best, Li, Wan, Liu and Yu    +   High risk of bias.  !+ + Some concerns;    +     !High risk of bias.    + +
  Simão, Lemos, Salles, Leite, Oliveira, 
+   Li, Garrett, Best, Li, Wan, Liu and Yu
Leite, De Souza Teixeira, Saavedra,
Leite, De Souza Teixeira, Saavedra, 
Jones, Burckhardt, Clark, Bennett and 
Simão, Lemos, Salles, Leite, Oliveira,
Wyon, Smith and Koutedakis [73] 
Wyon, Smith and Koutedakis [73] 
+   [71]  Leite, De Souza Teixeira, Saavedra,
Comparisons were performed between ST and stretching groups, involving eleven
Racil, Jlid, Bouzid, Sioud, Khalifa,    [71]
Leite, Rhea and Simão [45] 
Leite, Rhea and Simão [45] 
Potempa [85] 
Potempa [85]    [72]
 Rhea and Reis [78]  +    + +++  ++    [72]
articles and 452 participants. Global effects on ROM were achieved pooling data from the  ++     ++   +++[72]
Amri, Gaied and Coquart [33] 
3.4. Synthesis of Results 
Nelson and Bandy [86] 
Nelson and Bandy [86]    Amri, Gaied and Coquart [33]
Morton, Whitehead, Brinkert and Caine    Amri, Gaied and Coquart [33]
Morton, Whitehead, Brinkert and Caine  +
different joints. One article did not have the data required [44], but the authors supplied  obtained no  evaluations, but
Li, Garrett, Best, Li, Wan, Liu and Yu
! Li, Garrett, Best, Li, Wan, Liu and Yu 
Leite, De Souza Teixeira, Saavedra, 
Simão, Lemos, Salles, Leite, Oliveira,
Some concerns; +  Effect of assignment to intervention.
Wyon, Smith and Koutedakis [73] 
Wyon, Smith and Koutedakis [73]    Li, Garrett, Best, Li, Wan, Liu and Yu
1   1 Effect of assignment to intervention.
Racil, Jlid, Bouzid, Sioud, Khalifa,
Racil, Jlid, Bouzid, Sioud, Khalifa, 
+   [71]  +
it upon request. For another article [45], we also requested data relative to the goniometric    +
[72]   Leite, Rhea and Simão [45] 
Leite, Rhea and Simão [45]  [72]
+   Rhea and Reis [78] 
articles and 452 participants. Global effects on ROM were achieved pooling data from the
Amri, Gaied and Coquart [33] 
Amri, Gaied and Coquart [33] 
Morton, Whitehead, Brinkert and Caine 
Morton, Whitehead, Brinkert and Caine 
Li, Garrett, Best, Li, Wan, Liu and Yu 
! Some concerns;  +Nelson and Bandy [86]  Nelson and Bandy [86]
different joints. One article did not have the data required [44], but the authors supplied
  1 Effect of assignment to intervention.
+  Effect of assignment to intervention.
Wyon, Smith and Koutedakis [73]  +       +High risk of bias.  ++     + + +       + High risk of bias.
1
Simão, Lemos, Salles, Leite, Oliveira,
+Rhea and Reis [78]  +    Racil, Jlid, Bouzid, Sioud, Khalifa,
it upon request. For another article [45], we also requested data relative to the goniometric
   Rhea and Reis [78]
Nelson and Bandy [86] 
evaluations, but 
Amri, Gaied and Coquart [33]  obtained no
  1 Effect of assignment to intervention.
[71] 
Wyon, Smith and Koutedakis [73] 
Wyon, Smith and Koutedakis [73] 
[71]  Simão, Lemos, Salles, Leite, Oliveira,          +
+
Simão, Lemos, Salles, Leite, Oliveira,
Racil, Jlid, Bouzid, Sioud, Khalifa,
Racil, Jlid, Bouzid, Sioud, Khalifa, 
 
  Nelson and Bandy [86] 
Amri, Gaied and Coquart [33] 
Amri, Gaied and Coquart [33]  Rhea and Reis [78]
only  data from the      test
1 1  Effect of assignment to intervention.
 Effect of assignment to intervention.
Simão, Lemos, Salles, Leite, Oliveira, 
Racil, Jlid, Bouzid, Sioud, Khalifa, 
Wyon, Smith and Koutedakis [73] 
+  
Amri, Gaied and Coquart [33] 
Amri, Gaied and Coquart [33]  Rhea and Reis [78]       +          +articles and 452 participants. Global effects on ROM were achieved pooling data fro
Simão, Lemos, Salles, Leite, Oliveira, 
Wyon, Smith and Koutedakis [73] 
Wyon, Smith and Koutedakis [73]  High risk of bias.
Rhea and Reis [78]   
Rhea and Reis [78] 
1 Effect of assignment to intervention.
only  data from the 
1 Effect of assignment to intervention.
1 Effect of assignment to intervention.  3.4. Synthesis of Results
Comparisons were performed between ST and stretching groups, involving eleven
articles and 452 participants. Global effects on ROM were achieved pooling data from the
different joints. One article did not have the data required [44], but the authors supplied
it upon request. For another article [45], we also requested data relative to the goniometric
    plot of changesarticles and 452 participants. Global effects on ROM were achieved pooling data from the
  size of the plotted  
   
   
 
active stretching groups also significantly improved AROM [73]. In two articles, none of  ROM, and the differences between the groups were non‐sign
active stretching groups also significantly improved AROM [73]. In two articles, n
active stretching groups also significantly improved AROM [73]. In two articles, none of  ROM, and the differences between the
active stretching groups also significan
 
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching    Healthcare 2021, 9, x 
group had significant improvements in 8 of 10 ROM measures, while dynamic stret   14  of  27 
group had significant improvements in 8 of 10 ROM measure group had significant improvements in 14  of  27  1
 
  the groups improved ROM [44,45].    the groups improved ROM [44,45].    the groups improved ROM [44,45]. 
did not lead to improvement in any of the groups [43]. In another article, the three groups  In seven articles [33,46,71,72,78,85], ST and stretching gro
did not lead to improvement in any of the groups [43]. In another article, the three g
did not lead to improvement in any of the groups [43]. In anot In seven articles [33,46,71,72,78,85
did not lead to improvement in any of t
 
ROM, and the differences between the groups were non‐significant. In one article, t
significantly improved PROM, without between‐group differences; the ST and the static  ROM, and the differences between the groups were non‐sign
significantly improved PROM, without between‐group differences; the ST and the
significantly improved PROM, without between‐group differ ROM, and the differences between the
significantly improved PROM, withou
 
3.3. Risk of Bias in Individual Studies 
Healthcare 2021, 9, x    Healthcare 2021, 9, x  3.3. Risk of Bias in Individual Studies 
  Healthcare 2021, 9, x    14  of  27  3.3. Risk of Bias in Individual Studies  14  of  27  1
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching 
 
  group had significant improvements in 8 of 10 ROM measures, while dynamic stret
active stretching groups also significantly improved AROM [73]. In two articles, none of 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
  group had significant improvements in 8 of 10 ROM measure
active stretching groups also significantly improved AROM [73]. In two articles, n
active stretching groups also significantly improved AROM [
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly imp
  In seven articles [33,46,71,72,78,85], ST and stretching gro group had significant improvements in
active stretching groups also significan
In seven articles [33,46,71,72,78,85
 
Table  2  of 2 
presents  presents 
RoB.  Bias  assessments 
arising 
assessments  Table  from 
of 
did not lead to improvement in any of the groups [43]. In another article, the three groups  2 
of 
RoB. presents 
RoB. 
the  Bias  Bias 
assessments 
randomization 
arising  arising 
did not lead to improvement in any of the groups [43]. In another article, the three gfrom  from 
process  of 
the 
did not lead to improvement in any of the groups [43]. In anot RoB. 
the  Bias 
randomization 
randomization  arising 
Table 
did not lead to improvement in any of t 2 from 
process  presents 
process  assessments  of pR
the  randomization 
 
 
ROM, and the differences between the groups were non‐significant. In one article, the ST  the groups improved ROM [44,45]. 
ROM, and the differences between the groups were non‐significant. In one article, t
ROM, and the differences between the groups were non‐sign the groups improved ROM [44,45]. 
ROM, and the differences between the
 
low  in  in  four  four  moderate 
articles articles 
was  low 
[43,45,73,85], 
significantly improved PROM, without between‐group differences; the ST and the static in  one 
[43,45,73,85],  in  four  [46]  moderate 
articles 
and  high 
moderate 
significantly improved PROM, without between‐group differences; the ST and the [43,45,73,85], 
in  in 
one  in one 
significantly improved PROM, without between‐group differ six 
[46]  [46]  was 
moderate 
and  and  low 
high  high 
significantly improved PROM, withou in 
in  in  six six 14
four 
one  [46]  of 26
articles  and [43,45,73
high  i
 
 
assessments 
Healthcare 2021, 9, x  14 of 
  of RoB. 
arising  from  the 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome  group had significant improvements in 8 of 10 ROM measure
randomization 
Healthcare 2021, 9, x 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome    process  group had significant improvements in
[33,44,71,72,78,86]. Bias due to deviatio 14  of  14  27  of  27  1
 
3.3. Risk of Bias in Individual Studies 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
did not lead to improvement in any of the groups [43]. In another article, the three groups 
[43,45,73,85],  moderate    active stretching groups also significantly improved AROM [
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly imp
3.3. Risk of Bias in Individual Studies  and In seven articles [33,46,71,72,78,85], ST and stretching gro
in  one  [46]  3.3. Risk of Bias in Individual Studies  high  in  six  3.3. Risk of Bias in Individual Studies 
did not lead to improvement in any of the groups [43]. In another article, the three g
did not lead to improvement in any of the groups [43]. In anot active stretching groups also significan
In seven articles [33,46,71,72,78,85
did not lead to improvement in any of t
 
data, and selection of the reported results was low. Bias in measurement of the outcome 
the groups improved ROM [44,45].  data, and selection of the reported results was low. Bias in measurement of the ou
data, and selection of the reported results was low. Bias in measurement of the outcome 
the groups improved ROM [44,45].  the groups improved ROM [44,45].  data, and selection of the reported resu
the groups improved ROM [44,45]. 
 
 
 
Table  process  2  presents  assessments  ROM, and the differences between the groups were non‐significant. In one article, t
significantly improved PROM, without between‐group differences; the ST and the static 
Table  2  of presents 
RoB.  Bias  ROM, and the differences between the groups were non‐sign
significantly improved PROM, without between‐group differences; the ST and the
significantly improved PROM, without between‐group differ
assessments 
arising 
Table from  2  presents  of  RoB.  Bias ROM, and the differences between the
significantly improved PROM, withou
assessments 
the  randomization  arising 
Table  2 from  of 
presents 
process RoB. 
the Bias  assessments 
arising  from 
randomization  of pR
 
 
Healthcare 2021, 9, x  14   of  27  was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].  Healthcare 2021, 9, x    was low in six articles [44–46,78,85,86], 14  of  14  27  of  27  1
 
 
was  low in in six 
high  four  articles  group had significant improvements in 8 of 10 ROM measures, while dynamic stret
active stretching groups also significantly improved AROM [73]. In two articles, none of 
active stretching groups also significantly improved AROM [73]. In two articles, n
active stretching groups also significantly improved AROM [
articles 
was  low  [43,45,73,85], 
in 
in  one  four [46]  group had significant improvements in
active stretching groups also significan
articles 
was 
moderate 
and  low  [43,45,73,85], 
high  in 
in  in  four 
one  six [46] 
articles 
moderate and [43,45,73
high 
in  on i
Table 2. 3.3. Risk of Bias in Individual Studies 
bias (Cochrane’s RoB
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly imp
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
3.3. Risk of Bias in Individual Studies 
did not lead to improvement in any of the groups [43]. In another article, the three groups  2).
3.3. Risk of Bias in Individual Studies 
did not lead to improvement in any of the groups [43]. In another article, the three g
did not lead to improvement in any of the groups [43]. In anot In seven articles [33,46,71,72,78,85
3.3. Risk of Bias in Individual Studies 
did not lead to improvement in any of t
 
 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  the groups improved ROM [44,45]. 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome  the groups improved ROM [44,45]. 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
[33,44,71,72,78,86]. Bias due to deviations from intended inte
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  the groups improved ROM [44,45]. 
[33,44,71,72,78,86]. Bias due to deviatio
Table 2. Assessments of risk of bias (C
 
 
Healthcare 2021, 9, x  14  2  of presents 
27 Healthcare 2021, 9, x  ROM, and the differences between the groups were non‐significant. In one article, t
ROM, and the differences between the groups were non‐significant. In one article, the ST 
significantly improved PROM, without between‐group differences; the ST and the static 
Table  significantly improved PROM, without between‐group differences; the ST and the
assessments  Table    2  of presents 
RoB.  significantly improved PROM, without between‐group differ
Bias 
assessments 
Healthcare 2021, 9, x  arising 
Table    from 
2  presents  of  RoB.  Bias ROM, and the differences between the
significantly improved PROM, withou
assessments 
the  randomization  arising 
Table  2 from  of 
presents 
14 RoB. 
process  the 
of  27 Bias 
assessments 
arising  from 
randomization  of p1R
data, and selection of the reported results was low. Bias in measurement of the outcome 
data, and selection of the reported results was low. Bias in measurement of the ou
  group had significant improvements in 8 of 10 ROM measures, while dynamic stretching 
    data, and selection of the reported results was low. Bias in m data, and selection of the reported resu
 
Randomi‐ Randomi‐ Randomi‐ from
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching 
group had significant improvements in 8 of 10 ROM measures, while dynamic stret
active stretching groups also significantly improved AROM [73]. In two articles, none of 
Deviations from In‐ active stretching groups also significantly improved AROM [73]. In two articles, n
Deviations from In‐
Missing 
Deviations from In‐ Randomi‐
Measurement  active stretching groups also significantly improved AROM [
Deviations from In‐
Missing 
Missing Selection of the  Measurement  Measurement  group had significant improvements in
active stretching groups also significan
 
was  low 
[43,45,73,85], 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].  in  four  moderate 
articles 
was  low  [43,45,73,85], 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly imp
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
3.3. Risk of Bias in Individual Studies 
Missing 3.3. Risk of Bias in Individual Studies 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].  in 
in  one  four  [46] 
Measurement3.3. Risk of Bias in Individual Studies 
was low in six articles [44–46,78,85,86], but high in five [33,43 articles 
was  Missing 
moderate 
and Selection of the 
ofSelection of the 
low  [43,45,73,85], 
high 
In seven articles [33,46,71,72,78,85
Selection
was low in six articles [44–46,78,85,86], Randomi‐
in Measurement 
in  in 
four 
one  six 
of[46]  Deviations fro
articles 
moderate 
the and  Selection 
[43,45,73
high 
in  on i
 
did not lead to improvement in any of the groups [43]. In another article, the three groups 
did not lead to improvement in any of the groups [43]. In another article, the three groups 
the groups improved ROM [44,45].  did not lead to improvement in any of the groups [43]. In another article, the three g
the groups improved ROM [44,45].  did not lead to improvement in any of t
the groups improved ROM [44,45]. 
Article 
presents  assessments  tended Interventions 
Table  Article 
zation Pro‐
zation Pro‐
of 2  presents 
RoB.  Bias  tended Interventions 
Outcome 
tended Interventions 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
assessments 
arising 
1 ) Table  from  zation Pro‐
of the Out‐
2 
of presents 
RoB. 
the  Bias tended Interventions 
Outcome 
Outcome  Reported Re‐
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
ROM, and the differences between the groups were non‐significant. In one article, the ST  assessments 
randomization  arising 
Table from  Article 
of the Out‐
2 
process  of the Out‐
[33,44,71,72,78,86]. Bias due to deviations from intended inte
ROM, and the differences between the groups were non‐significant. In one article, t
ROM, and the differences between the groups were non‐significant. In one article, the ST  Outcome Data the Outcome
presents 
of  RoB.  Bias  Outcome 
assessments 
the  randomization  Reported Re‐
Reported Re‐
arising 
Table  2 from  Reported zation Pro‐
[33,44,71,72,78,86]. Bias due to deviatio
ROM, and the differences between the of  of the Out‐
presents 
process RoB. Results
the Bias  tended Interven
assessments  Reported
arising  from 
randomization  of pR
  Interventions
Deviations from In‐ (EAI
Missing 
significantly improved PROM, without between‐group differences; the ST and the static 
significantly improved PROM, without between‐group differences; the ST and the static 
Healthcare 2021, 9, x  14   1cess 
of  Measurement  Selection of the 
significantly improved PROM, without between‐group differences; the ST and the significantly improved PROM, withou
 
four   articles  [43,45,73,85], 
low  in )  27 
data, and selection of the reported results was low. Bias in measurement of the outcome 
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching 
(EAI  cess 
was  Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
four moderate  Data 
articles 
was  (EAI 
low (EAI  1
[43,45,73,85], 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
1 cess 
one 
Healthcare 2021, 9, x 
data, and selection of the reported results was low. Bias in measurement of the ou
in ) come 
in  ) of the Out‐  four  Data 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
[46] moderate 
articles 
was 
and  Data  low  sults 
high 
data, and selection of the reported results was low. Bias in m
group had significant improvements in 8 of 10 ROM measures, while dynamic stret
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching  (EAI 
[43,45,73,85], 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly imp in 
in 
1)  come data, and selection of the reported resu
in come 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
one  four 
six  [46] 
In seven articles [33,46,71,72,78,85], ST and stretching gro group had significant improvements in
articles 
was 
moderate 
and Data 
low  sults  sults 
[43,45,73,85], 
high 
In seven articles [33,46,71,72,78,85
14  of 
Table 2. Assessments of risk of bias (C
in 
in  in 
14 
cess 
four 
of come 
27 
one 
27 
six [46] 
articles 
moderate  (EAI 
and [43,45,73
high 
in 
1) 1
sults on i
 
active stretching groups also significantly improved AROM [73]. In two articles, none of 
active stretching groups also significantly improved AROM [73]. In two articles, none of 
3.3. Risk of Bias in Individual Studies 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].  Reported Re‐
active stretching groups also significantly improved AROM [73]. In two articles, n
3.3. Risk of Bias in Individual Studies  3.3. Risk of Bias in Individual Studies 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
did not lead to improvement in any of the groups [43]. In another article, the three groups  was low in six articles [44–46,78,85,86], but high in five [33,43
did not lead to improvement in any of the groups [43]. In another article, the three g
did not lead to improvement in any of the groups [43]. In another article, the three groups  active stretching groups also significan
3.3. Risk of Bias in Individual Studies 
was low in six articles [44–46,78,85,86],
did not lead to improvement in any of t
 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome  Alexander, Galecki, Grenier, Nyquist, 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
ROM, and the differences between the groups were non‐significant. In one article, the ST  [33,44,71,72,78,86]. Bias due to deviations from intended inte
ROM, and the differences between the groups were non‐significant. In one article, t
ROM, and the differences between the groups were non‐sign [33,44,71,72,78,86]. Bias due to deviatio
ROM, and the differences between the
Selection of the 
cess  the groups improved ROM [44,45].  ) 
the groups improved ROM [44,45].  Deviations from In‐
Data 
the groups improved ROM [44,45].  Randomi‐
come  Deviations from In‐
Missing  sults  Randomi‐ Measurement  Deviations from In‐
Missing 
Selection of the 
the groups improved ROM [44,45].  Randomi‐ Measurement  Deviations fro
Missing 
Selection  Me
 
assessments 
  Table  significantly improved PROM, without between‐group differences; the ST and the
significantly improved PROM, without between‐group differences; the ST and the static  significantly improved PROM, withou
 
  + Healthcare 2021, 9, x 
  Reported Re‐ +14 of 
Hofmeyer, Grunawalt, Medell and Fry‐
 
RoB.  + Bias 
of +27 Healthcare 2021, 9, x 
Article 
 zation Pro‐
assessments 
arising 
+ Table  +from 
data, and selection of the reported results was low. Bias in measurement of the outcome 
tended Interventions 
2 
of presents 
   +zation Pro‐
Article   
RoB. 
the  Bias 
assessments 
+randomization  +arising 
Table 
Hofmeyer, Grunawalt, Medell and Fry‐
data, and selection of the reported results was low. Bias in measurement of the ou
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching  from 
2 +presents 
process 
group had significant improvements in 8 of 10 ROM measure
Healthcare 2021, 9, x 
    +   Article 
tended Interventions 
Outcome    +zation Pro‐  
of  RoB. 
data, and selection of the reported results was low. Bias in m
group had significant improvements in 8 of 10 ROM measures, while dynamic stret of the Out‐
Bias 
assessments 
the  randomization  arising 
Table 
data, and selection of the reported resu
group had significant improvements in
+  + zation Pro‐
tended Interventions 
Outcome 
Reported Re‐
2 from 
  +of 
presents 
process RoB. 
the Bias 
+of 
of the Out‐
14 
assessments 
arising 
randomization 
27   tended Interven
Outcome  14  of from 
of 
+27 
Reported +of pR
1
 
 
in  four  moderate 
articles  Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
active stretching groups also significantly improved AROM [73]. In two articles, none of 
was  [43,45,73,85], 
low 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
active stretching groups also significantly improved AROM [73]. In two articles, n
active stretching groups also significantly improved AROM [73]. In two articles, none of 
was  In seven articles [33,46,71,72,78,85], ST and stretching groups significantly imp
low 
[43,45,73,85], 
in  one  in   four  [46] moderate 
articles 
was 
and  low 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
did not lead to improvement in any of the groups [43]. In another article, the three groups  high 
[43,45,73,85], 
Welch [43]  in 
in  in one  four 
was low in six articles [44–46,78,85,86], but high in five [33,43
did not lead to improvement in any of the groups [43]. In another article, the three g
did not lead to improvement in any of the groups [43]. In anot six  [46]  articles 
was 
moderate 
and Table 2. Assessments of risk of bias (C
active stretching groups also significan
low  [43,45,73,85], 
high 
In seven articles [33,46,71,72,78,85
was low in six articles [44–46,78,85,86],
did not lead to improvement in any of t in 
in  in  four 
one  six [46] 
articles 
moderate and [43,45,73in   on
high  i
 
3.3. Risk of Bias in Individual Studies 
sults 
the groups improved ROM [44,45]. 
the groups improved ROM [44,45].  cess  3.3. Risk of Bias in Individual Studies 
(EAI 
the groups improved ROM [44,45]. 
1)  cess  Data  (EAI  1cess 
)  come  3.3. Risk of Bias in Individual Studies 
Data  (EAI 
the groups improved ROM [44,45].  sults  1) cess  come  Data  (EAI  sults
1) 
 
+  Aquino, Fonseca, Goncalves, Silva, Oc‐ + Randomi‐ [33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
+  
ROM, and the differences between the groups were non‐significant. In one article, the ST 
significantly improved PROM, without between‐group differences; the ST and the static 
  [33,44,71,72,78,86]. Bias due to deviations from intended inte
ROM, and the differences between the groups were non‐significant. In one article, t
ROM, and the differences between the groups were non‐significant. In one article, the ST  Aquino, Fonseca, Goncalves, Silva, Oc‐
significantly improved PROM, without between‐group differences; the ST and the
Deviations from In‐ Randomi‐ +Randomi‐
  significantly improved PROM, without between‐group differ
Deviations from In‐
Missing   
Measurement  [33,44,71,72,78,86]. Bias due to deviatio
ROM, and the differences between the
significantly improved PROM, withou
Deviations from In‐
Missing 
Selection of the  Randomi‐ Measurement  Deviations fro
Missing 
Selection  Me
 
 
Healthcare 2021, 9, x Table 
Table  2 
process 
 
+presents  Alexander, Galecki, Grenier, Nyquist, 
assessments 
assessments  Table 
data, and selection of the reported results was low. Bias in measurement of the outcome of  2  Alexander, Galecki, Grenier, Nyquist, 
of presents 
RoB.  RoB.  Bias  Bias 
assessments 
Healthcare 2021, 9, x  +arising 
arising 
data, and selection of the reported results was low. Bias in measurement of the ou from    +from + of 
14  of RoB. 
the 
data, and selection of the reported results was low. Bias in m
+ Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  the 
27  Bias 
randomization 
randomization  arising 
Table 
+  +process 
data, and selection of the reported resu 2 
from 
14  presents 
process 
14  27 
of  the 
of  assessments 
27  randomization  + of  p1R
 
 
arino and Mancini [44]   
Article 
zation Pro‐   + Article 
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching 
group had significant improvements in 8 of 10 ROM measures, while dynamic stret
Article    group had significant improvements in 8 of 10 ROM measures, while dynamic stretching 
active stretching groups also significantly improved AROM [73]. In two articles, none of   +zation Pro‐
    +   active stretching groups also significantly improved AROM [
 +   Article 
arino and Mancini [44] 
    In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
tended Interventions  tended Interventions 
Outcome  zation Pro‐   +  +  active stretching groups also significan
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
active stretching groups also significantly improved AROM [73]. In two articles, n of the Out‐ group had significant improvements in
Table 2. Assessments of risk of bias (C
tended Interventions 
Outcome 
Reported Re‐  + of the Out‐
zation Pro‐     +  tended IntervenOutcome  Reported + of
 
and was low  low 
high  in 
Hofmeyer, Grunawalt, Medell and Fry‐in in  four  four 
six 
3.3. Risk of Bias in Individual Studies 
3.3. Risk of Bias in Individual Studies 
articles articles 
was 
Hofmeyer, Grunawalt, Medell and Fry‐ low 
[43,45,73,85], 
[43,45,73,85], 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
+ in  four 
3.3. Risk of Bias in Individual Studies 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
did not lead to improvement in any of the groups [43]. In another article, the three groups  + moderate 
articles 
moderate 
Hofmeyer, Grunawalt, Medell and Fry‐ [43,45,73,85], 
in 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly imp
+ in 
one  one  [46] 
In seven articles [33,46,71,72,78,85], ST and stretching gro
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
was low in six articles [44–46,78,85,86], but high in five [33,43
+
did not lead to improvement in any of the groups [43]. In another article, the three g
did not lead to improvement in any of the groups [43]. In another article, the three groups  + + [46]  was 
moderate 
and  and  low 
high  high 
In seven articles [33,46,71,72,78,85
3.3. Risk of Bias in Individual Studies 
was low in six articles [44–46,78,85,86],
+
did not lead to improvement in any of t + in 
in  + in 
four 
one 
six 
+ six [46] 
articles  and + [43,45,73
high 
+ + i
the groups improved ROM [44,45]. 
  Caputo, Di Bari and Naranjo Orellana  the groups improved ROM [44,45].  the groups improved ROM [44,45].     the groups improved ROM [44,45]. 
+   Randomi‐   Missing  1 )  cess 
+    ROM, and the differences between the groups were non‐sign
Data   (EAI   )  come    sults 
 
 
cess      Deviations fro
Data    sults
(EAI  1 ) 
Randomi‐ Deviations from In‐ ROM, and the differences between the groups were non‐significant. In one article, the ST 
Deviations from In‐
+   Welch [43]  Randomi‐
Measurement  Deviations from In‐
Missing 
Selection of the  +Randomi‐ Measurement  Deviations from In‐
Missing 
Selection of the  Randomi‐ Measurement  Missing 
Selection  Me
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
Table 
Table  2 
[46]    Alexander, Galecki, Grenier, Nyquist,  + 2 
presents 
process  ! ! [33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
ROM, and the differences between the groups were non‐significant. In one article, the ST 
Welch [43]  ROM, and the differences between the groups were non‐significant. In one article, t
  significantly improved PROM, without between‐group differences; the ST and the static 
randomization    presents 
significantly improved PROM, without between‐group differences; the ST and the static 
significantly improved PROM, without between‐group differences; the ST and the
assessments 
assessments 
  Outcome  + Table +
  Article 
 Alexander, Galecki, Grenier, Nyquist,  of  + 2 
of 
RoB. presents 
RoB. 
+ !Bias 
 [46] group had significant improvements in 8 of 10 ROM measures, while dynamic stretching  Bias 
assessments 
arising 
+ arising 
+
  Alexander, Galecki, Grenier, Nyquist, 
  of the Out‐
Welch [43] 
from 
    Article  + from 
+
[46] 
  group had significant improvements in 8 of 10 ROM measure
 of 
the  RoB. 
+
  of the Out‐
  the  + Bias [33,44,71,72,78,86]. Bias due to deviatio
ROM, and the differences between the
significantly improved PROM, withou
14 arising 
randomization 
randomization  Table 
of +14  27 +of 
   data, and selection of the reported resu 2 
from 
process 
  zation Pro‐ + presents 
process 
27 
  of the Out‐ ! the  + assessments 
randomization 
     tended Interven + of 
+ p
 of R
Article  tended Interventions  Article 
zation Pro‐ tended Interventions 
data, and selection of the reported results was low. Bias in measurement of the outcome  zation Pro‐ tended Interventions 
Outcome  Reported Re‐
data, and selection of the reported results was low. Bias in measurement of the ou
data, and selection of the reported results was low. Bias in measurement of the outcome 
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  zation Pro‐
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  tended Interventions 
Outcome 
Reported Re‐
group had significant improvements in
Table 2. Assessments of risk of bias (C Outcome  Reported
was 
and was low  low 
high  in  in in  four 
 
six  Aquino, Fonseca, Goncalves, Silva, Oc‐
active stretching groups also significantly improved AROM [73]. In two articles, none of 
articles  active stretching groups also significantly improved AROM [73]. In two articles, n
active stretching groups also significantly improved AROM [73]. In two articles, none of 
articles 
was  low 
[43,45,73,85], 
[43,45,73,85], 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
3.3. Risk of Bias in Individual Studies  in  four  Aquino, Fonseca, Goncalves, Silva, Oc‐
moderate 
articles 
moderate  [43,45,73,85], 
in 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly imp
3.3. Risk of Bias in Individual Studies  in 
3.3. Risk of Bias in Individual Studies  one  one  [46]  [46]  active stretching groups also significan
was 
moderate 
and  and  low 
high  high 
In seven articles [33,46,71,72,78,85
3.3. Risk of Bias in Individual Studies  in 
in  in  four 
one 
six six [46] articles  and [43,45,73
high  i
cess  Jones, Burckhardt, Clark, Bennett and 
Hofmeyer, Grunawalt, Medell and Fry‐
+
(EAI  1)  cess  Hofmeyer, Grunawalt, Medell and Fry‐
Data 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
!   the groups improved ROM [44,45].  +   (EAI  + Jones, Burckhardt, Clark, Bennett and 
did not lead to improvement in any of the groups [43]. In another article, the three groups 
Hofmeyer, Grunawalt, Medell and Fry‐
cess 
1) come  Data 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].  + sults (EAI  + 1cess 
)  come  + +
Data  (EAI  +
sults 
was low in six articles [44–46,78,85,86], + 1) cess  come  + +
Data  (EAI + 1+) 
sults
 
did not lead to improvement in any of the groups [43]. In another article, the three groups 
+   
arino and Mancini [44] 
the groups improved ROM [44,45].  did not lead to improvement in any of the groups [43]. In another article, the three g
+  
arino and Mancini [44] 
the groups improved ROM [44,45]. 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
 
the + randomization  ROM, and the differences between the groups were non‐significant. In one article, the ST 
ROM, and the differences between the groups were non‐significant. In one article, the ST 
+ 2   presents +   did not lead to improvement in any of the groups [43]. In anot
arino and Mancini [44] 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
ROM, and the differences between the groups were non‐significant. In one article, t
+ significantly improved PROM, without between‐group differences; the ST and the static    ++from   of   ++the  did not lead to improvement in any of t
the groups improved ROM [44,45]. 
 + randomization 
 assessments  +   + 2 
[33,44,71,72,78,86]. Bias due to deviatio
ROM, and the differences between the    RoB. +       from  +   pR
 
 
 
 
Deviations from In‐
Table  process 
Potempa [85] 
  Alexander, Galecki, Grenier, Nyquist, Randomi‐
Welch [43]   presents   +Alexander, Galecki, Grenier, Nyquist, 
  assessments + Table 
Deviations from In‐
Missing    Welch [43] 
significantly improved PROM, without between‐group differences; the ST and the static   +2 
+ Measurement  Randomi‐
of    RoB. +   Bias  +arising 
assessments   +Potempa [85] 
Deviations from In‐
Missing 
Selection of the 
Table 
significantly improved PROM, without between‐group differences; the ST and the   2 
Welch [43]  +Measurement 
Randomi‐ presents 
    RoB. 
significantly improved PROM, without between‐group differ
Alexander, Galecki, Grenier, Nyquist,    Bias  Deviations from In‐
Missing 
Selection of the 
arising 
Table 
 significantly improved PROM, withou  +of 
Randomi‐
from    +the 
Measurement 
presents 
process    +Bias    Deviations fro
Missing 
assessments 
arising 
randomization  + Me
Selection  of 
 
data, and selection of the reported results was low. Bias in measurement of the outcome 
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching  Caputo, Di Bari and Naranjo Orellana 
data, and selection of the reported results was low. Bias in measurement of the ou
data, and selection of the reported results was low. Bias in measurement of the outcome 
group had significant improvements in 8 of 10 ROM measures, while dynamic stret
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved 
In seven articles [33,46,71,72,78,85], ST and stretching groups significantly improved  data, and selection of the reported resu
group had significant improvements in
one 
Article 
 
 
high 
tended Interventions 
+ ++ Article 
in six 
zation Pro‐
Leite, De Souza Teixeira, Saavedra,  four  articles 
was  Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
low 
[43,45,73,85], 
tended Interventions 
Outcome  Article  in  four 
zation Pro‐
+of the Out‐
moderate 
articles 
was  low 
tended Interventions 
Outcome 
active stretching groups also significantly improved AROM [73]. In two articles, none of  [43,45,73,85], 
+   Article 
Reported Re‐ in 
in  of the Out‐
zation Pro‐ one  four [46]  articles 
was 
moderate 
and  low 
tended Interventions 
Outcome 
Reported Re‐ [43,45,73,85], 
high  in 
in  in 
zation Pro‐ four 
one  six [46] 
articles 
moderate and Reported
!   +  tended Interven
of the Out‐ Outcome  [43,45,73
high 
in  of on i
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Aquino, Fonseca, Goncalves, Silva, Oc‐
Hofmeyer, Grunawalt, Medell and Fry‐ Aquino, Fonseca, Goncalves, Silva, Oc‐
active stretching groups also significantly improved AROM [73]. In two articles, none of 
++!   
Hofmeyer, Grunawalt, Medell and Fry‐
++ ROM, and the differences between the groups were non‐significant. In one article, the ST 
3.3. Risk of Bias in Individual Studies 
3.3. Risk of Bias in Individual Studies  ++  
3.3. Risk of Bias in Individual Studies  ++!Leite, De Souza Teixeira, Saavedra, 
Aquino, Fonseca, Goncalves, Silva, Oc‐
active stretching groups also significantly improved AROM [73]. In two articles, n
active stretching groups also significantly improved AROM [
Hofmeyer, Grunawalt, Medell and Fry‐ ++[46]  Table 2. Assessments of risk of bias (C
active stretching groups also significan
+   +!  +  3.3. Risk of Bias in Individual Studies  +++ (EAI  +++ +++1  ) cess  +   + + + + 
 
[46] 
cess 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
+     was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
(EAI  + 1   ) [46] 
 
ROM, and the differences between the groups were non‐significant. In one article, the ST 
Leite, Rhea and Simão [45] 
arino and Mancini [44] 
the groups improved ROM [44,45]. 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
Data 
the groups improved ROM [44,45]. 
    +  ++[46] 
did not lead to improvement in any of the groups [43]. In another article, the three groups 
did not lead to improvement in any of the groups [43]. In another article, the three g
did not lead to improvement in any of the groups [43]. In another article, the three groups 
+    (EAI 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
+cess  arino and Mancini [44] 
the groups improved ROM [44,45]. 
1  ) come 
  +     Leite, Rhea and Simão [45] 
cess    ++ sults 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
arino and Mancini [44]     (EAI 
the groups improved ROM [44,45].  + ++    1cess    ) +come 
[33,44,71,72,78,86]. Bias due to deviations from intended inte
+Data    +   was low in six articles [44–46,78,85,86],
Data     +sults 
did not lead to improvement in any of t
[33,44,71,72,78,86]. Bias due to deviatio
the groups improved ROM [44,45].  15        +
of +27    +    Data 
come  +    +sults
+ (EAI  1+   ) 
 
 
 
Table 
Table  2 Welch [43] 
 
Randomi‐
process  Randomi‐
Jones, Burckhardt, Clark, Bennett and 
2 
presents  presents  assessments 
assessments  Welch [43] 
significantly improved PROM, without between‐group differences; the ST and the static 
significantly improved PROM, without between‐group differences; the ST and the
significantly improved PROM, without between‐group differences; the ST and the static 
Deviations from In‐
Deviations from In‐
Jones, Burckhardt, Clark, Bennett and 
Table  of 2  Randomi‐
of presents 
RoB.  RoB.  Bias  Bias  Deviations from In‐
Missing 
Missing 
Jones, Burckhardt, Clark, Bennett and 
assessments 
arising  arising  Welch [43] 
from  Measurement 
from  Measurement 
of 
the RoB.  the  Bias significantly improved PROM, withou
Missing 
randomization 
randomization  Selection of the 
Selection of the 
arising 
Table process  Randomi‐
2 
from  Measurement 
presents 
process  Deviations fro
assessments 
the  randomization  Selection  of pR
group had significant improvements in 8 of 10 ROM measures, while dynamic stretching 
data, and selection of the reported results was low. Bias in measurement of the outcome 
Alexander, Galecki, Grenier, Nyquist,  data, and selection of the reported results was low. Bias in measurement of the ou
Alexander, Galecki, Grenier, Nyquist,  data, and selection of the reported results was low. Bias in m
Alexander, Galecki, Grenier, Nyquist,  data, and selection of the reported resu
 
+[46]  Li, Garrett, Best, Li, Wan, Liu and Yu 
Caputo, Di Bari and Naranjo Orellana 
+zation Pro‐ +Caputo, Di Bari and Naranjo Orellana 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Aquino, Fonseca, Goncalves, Silva, Oc‐
+in 
Li, Garrett, Best, Li, Wan, Liu and Yu 
Caputo, Di Bari and Naranjo Orellana 
+ moderate 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Aquino, Fonseca, Goncalves, Silva, Oc‐
+[43,45,73,85], 
active stretching groups also significantly improved AROM [73]. In two articles, none of  +Potempa [85] 
Aquino, Fonseca, Goncalves, Silva, Oc‐
active stretching groups also significantly improved AROM [73]. In two articles, n
active stretching groups also significantly improved AROM [73]. In two articles, none of  +in  + of the Out‐ +[46]  +[46]  + high 
active stretching groups also significan +in 
Table 2. Assessments of risk of bias (C +   in  + six  +[46]  + Reported+ +  i
 
Article 
 
 
and was low  low 
high 
Reported Re‐ in 
Potempa [85] 
  in four 
Article 
zation Pro‐ four 
six  articles 
  articles 
was  low 
[43,45,73,85], 
tended Interventions 
tended Interventions 
did not lead to improvement in any of the groups [43]. In another article, the three groups 
did not lead to improvement in any of the groups [43]. In another article, the three groups 
  ++  [72]  
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].   Potempa [85]  in    four    moderate 
articles 
tended Interventions 
Outcome 
Outcome 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
3.3. Risk of Bias in Individual Studies 
++   +  ++[46]  [43,45,73,85], 
in    one 
Article 
of the Out‐   one   
was low in six articles [44–46,78,85,86], but high in five [33,43
+  ++   ++[72]      was 
moderate 
and  and  low 
high 
Outcome 
Reported Re‐
Reported Re‐   in 
zation Pro‐
was low in six articles [44–46,78,85,86], four 
one 
six 
of the Out‐
    articles  and  [43,45,73
tended Interven
    high 
 
 
 
[46]  + Hofmeyer, Grunawalt, Medell and Fry‐
3.3. Risk of Bias in Individual Studies 
   Leite, De Souza Teixeira, Saavedra, 
arino and Mancini [44]   [46] 
the groups improved ROM [44,45]. 
the groups improved ROM [44,45].   +!   
Hofmeyer, Grunawalt, Medell and Fry‐
arino and Mancini [44] 
the groups improved ROM [44,45].  +!   3.3. Risk of Bias in Individual Studies 
  Hofmeyer, Grunawalt, Medell and Fry‐
3.3. Risk of Bias in Individual Studies  arino and Mancini [44]  ++   1   +!   ++   3.3. Risk of Bias in Individual Studies 
[46]  ++   + ++ ++       +!    + +   +   +
+ + ++ 
 
 
 
significantly improved PROM, without between‐group differences; the ST and the static 
significantly improved PROM, without between‐group differences; the ST and the static 
Selection of the  Randomi‐ Randomi‐   (EAI 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
(EAI 
Leite, De Souza Teixeira, Saavedra, 
Deviations from In‐
Deviations from In‐
1)  1 )  cess  
Randomi‐ Data  Data   (EAI 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome  Leite, De Souza Teixeira, Saavedra, 
Deviations from In‐
Missing 
Missing  Measurement  come  )  come the groups improved ROM [44,45]. 
Measurement  [33,44,71,72,78,86]. Bias due to deviatio
Data 
Missing 
Selection of the 
Selection of the  sults  sults  Randomi‐ cess 
Measurement  come   Deviations fro   sults
(EAI 
Selection 
1 ) 
 
Morton, Whitehead, Brinkert and Caine 
Jones, Burckhardt, Clark, Bennett and 
randomization  process  2  presents  Table 
assessments 2 Table 
presents 
Welch [43] 
Jones, Burckhardt, Clark, Bennett and  2 
of  assessments 
Morton, Whitehead, Brinkert and Caine 
presents 
RoB.  Bias 
assessments 
arising 
Table  of Welch [43] 
Jones, Burckhardt, Clark, Bennett and  RoB.  from 
2  Bias 
presents 
of  RoB. 
the  arising  Bias  from 
assessments 
randomization  arising 
Table  the  2 
from  of randomization 
presents 
process RoB. 
the  Bias 
assessments  process 
arising 
randomization  from 
of 
 
 
were used. +
Caputo, Di Bari and Naranjo Orellana  +Caputo, Di Bari and Naranjo Orellana 
data, and selection of the reported results was low. Bias in measurement of the outcome 
+
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  + + +
Caputo, Di Bari and Naranjo Orellana 
data, and selection of the reported results was low. Bias in measurement of the ou
data, and selection of the reported results was low. Bias in measurement of the outcome 
+
active stretching groups also significantly improved AROM [73]. In two articles, none of 
active stretching groups also significantly improved AROM [73]. In two articles, none of 
Alexander, Galecki, Grenier, Nyquist, 
Leite, Rhea and Simão [45] 
For one article Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Leite, Rhea and Simão [45]  Alexander, Galecki, Grenier, Nyquist, 
Leite, Rhea and Simão [45]  + + +
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  + +
data, and selection of the reported resu +
Table 2. Assessments of risk of bias (C + + + + + +pR
 
[46] 
and 
Reported Re‐
was  low 
high 
++in 
Aquino, Fonseca, Goncalves, Silva, Oc‐  was 
Article 
zation Pro‐
zation Pro‐
in  four 
six  +! [46],   means
Aquino, Fonseca, Goncalves, Silva, Oc‐
articles 
was  low + and
++in   Potempa [85] 
tended Interventions 
tended Interventions 
low  four 
[43,45,73,85],  in 
++zation Pro‐ SDs
++!   were
articles 
four 
  + obtained
tended Interventions 
Outcome 
Outcome 
[43,45,73,85], 
moderate 
articles 
was  ++low 
Aquino, Fonseca, Goncalves, Silva, Oc‐   Article 
++in 
[43,45,73,85],  ++   of the Out‐
of the Out‐
in 
one 
from
moderate   
+!  ++[46] 
four 
95%
articles 
was 
moderate 
and 
CIs,
Outcome 
in  Reported Re‐
Reported Re‐
low  one 
++[43,45,73,85],   
high  +while
zation Pro‐
++in 
in 
++[46] 
in 
four +! in
of the Out‐
one 
and 
six  +
+[46] 
articles 
moderate and +
+
tended Interven
high  Reported
in  +
+
[43,45,73 ++  on
six 
high 
in 
 
[71] 
 
 
[46] 
 
  [85], SDs Potempa [85]   [71] 
3.3. Risk of Bias in Individual Studies 
3.3. Risk of Bias in Individual Studies     
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
the groups improved ROM [44,45]. 
the groups improved ROM [44,45]. 
Hofmeyer, Grunawalt, Medell and Fry‐ [46] 
  cess       
3.3. Risk of Bias in Individual Studies 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73].    SEMs [46] 
1 ) using +    Cochrane’s
Hofmeyer, Grunawalt, Medell and Fry‐
Potempa [85]  [71] 
[46] 
  + +RevMan  
  1 )  come     
3.3. Risk of Bias in Individual Studies 
was low in six articles [44–46,78,85,86],
    Calculator.   + +   cess      
   +        
    i
another   Li, Garrett, Best, Li, Wan, Liu and Yu 
were
+ +  Randomi‐   extracted Li, Garrett, Best, Li, Wan, Liu and Yu 
from + (EAI  + 1 +)  Randomi‐ Li, Garrett, Best, Li, Wan, Liu and Yu 
 ++ from   +   [33,44,71,72,78,86]. Bias due to deviatio
+sults  +Selection 
  +sults
1+
come 
 
Selection of the 
arino and Mancini [44]  cess   assessments    (EAI 
 +Jones, Burckhardt, Clark, Bennett and 
arino and Mancini [44] 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome  cess 
 presents  Data 
+ [33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
Deviations from In‐ +Data 
Deviations from In‐
Missing 
arino and Mancini [44] 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou   (EAI  Randomi‐   come 
Measurement 
  RoB. 
[33,44,71,72,78,86]. Bias due to deviations from intended inte Data 
Deviations from In‐
Missing 
Selection of the   +sults  Randomi‐     + come 
Measurement 
 +presents    Deviations fro
Missing 
  randomization  (EAI  Me  ) pR
 
assessments 
Table 
Table  +
Jones, Burckhardt, Clark, Bennett and 
2  of 
Nelson and Bandy [86]  2 
presents 
++articles, presents 
RoB.  Leite, De Souza Teixeira, Saavedra, 
Bias  assessments 
arising  Table 
++   both from 
of  + 2 
of 
RoB.  RoB. 
the  Leite, De Souza Teixeira, Saavedra, 
Jones, Burckhardt, Clark, Bennett and 
Bias 
assessments 
randomization 
Bias  arising  arising 
Nelson and Bandy [86]  from +
process 
++[72]  of 
the  the  Bias 
randomization 
randomization  arising 
Table  + + 2 
from 
process  process  the  assessments + + of +
 
Article 
the five Welch [43] 
   Caputo, Di Bari and Naranjo Orellana    [72] data, and selection of the reported results was low. Bias in measurement of the outcome 
  zation Pro‐
Alexander, Galecki, Grenier, Nyquist, 
Reported Re‐   
including ++[72] 
+ Article    Caputo, Di Bari and Naranjo Orellana 
genders, Welch [43] 
   Article 
++    data, and selection of the reported results was low. Bias in m
four+ ++ provided
Alexander, Galecki, Grenier, Nyquist,  ++   of the Out‐    ++ pooled   ++    tended Interventions 
data, ++   +with  +++    in    +no   + +    tended Interven   + + ++ +   of
 
 
four 
 
was  was low  + Article 
[43,45,73,85], 
low  in 
Potempa [85] 
 Aquino, Fonseca, Goncalves, Silva, Oc‐ in 
 four  four  articles 
tended Interventions 
 ++Caputo, Di Bari and Naranjo Orellana 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Leite, Rhea and Simão [45]  articles 
was   low  in  +one 
data, and selection of the reported results was low. Bias in measurement of the outcome 
+ 3.3. Risk of Bias in Individual Studies  +[43,45,73,85], 
[43,45,73,85], 
 Potempa [85] 
zation Pro‐ +[46] 
four 
tended Interventions 
Outcome 
in     Morton, Whitehead, Brinkert and Caine 
and   +high 
data, and selection of the reported results was low. Bias in measurement of the ou
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Leite, Rhea and Simão [45] 
   moderate  Leite, Rhea and Simão [45] 
   moderate 
articles 
moderate     +in  zation Pro‐
[43,45,73,85], 
in 
Potempa [85]  one +in     six 
  one  +[46]    +[46]    and 
was 
Outcome 
moderate 
and 
Reported Re‐
low 
high  + high     zation Pro‐
data, and selection of the reported resu ++in 
Table 2. Assessments of risk of bias (C
in 
of the Out‐
+ six 
  one 
  four six     +[46] 
Outcome 
articles 
  and 
+ Reported
+ +
   high 
[43,45,73   i
Morton, Whitehead, Brinkert and Caine 
+ Morton, Whitehead, Brinkert and Caine 
+ + Aquino, Fonseca, Goncalves, Silva, Oc‐
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
! + ! + + + ! + + + + ! + +
distinction
 
 
[46]  Hofmeyer, Grunawalt, Medell and Fry‐
between genders
Racil, Jlid, Bouzid, Sioud, Khalifa, 
sults  cess  [43,44,46,71].
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
   Li, Garrett, Best, Li, Wan, Liu and Yu 
++Randomi‐  [46]     Deviations from In‐ (EAI 
  ++  ++[46] 
+  +Li, Garrett, Best, Li, Wan, Liu and Yu  One
1 )  Hofmeyer, Grunawalt, Medell and Fry‐
article
cess  presented
Racil, Jlid, Bouzid, Sioud, Khalifa, 
Data 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
  Bias  (EAI 
  +++    randomization 
++Leite, De Souza Teixeira, Saavedra, 
++ from 
Li, Garrett, Best, Li, Wan, Liu and Yu  [46]  data
++Measurement 
1cess 
   was low in six articles [44–46,78,85,86], but high in five [33,43 )  come separated Data 
     +   +   was low in six articles [44–46,78,85,86],
++process 
by
(EAI  gender,
sults 
  +++ +Randomi‐
1 cess 
)  come 
     +    +   
  +++Measurement  Data    + +
(EAI + sults
1
+ ) 
 
 
[71]  + Table 
  2  presents 
Selection of the  ++   assessments 
 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
Leite, De Souza Teixeira, Saavedra, 
Table  2  presents 
arino and Mancini [44]   
Randomi‐
[71]     
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing ou
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
of  ++RoB. 
Leite, De Souza Teixeira, Saavedra, 
assessments  of 
  +
Deviations from In‐ RoB. 
Bias 
 + arising 
Randomi‐
[71]    arising 
  from  + the 
Deviations from In‐
Missing 
Missing 
arino and Mancini [44]    ++[71] 
the  +
Measurement    randomization 
[33,44,71,72,78,86]. Bias due to deviatio
process 
Missing  +
Selection of the 
Selection of the            Deviations fro
  + ++  
+Selection 
+
 
 
Amri, Gaied and Coquart [33] 
  Alexander, Galecki, Grenier, Nyquist,      between
 +Alexander, Galecki, Grenier, Nyquist,   ++inWelch [43] 
  Amri, Gaied and Coquart [33] 
 
 
without
[72] 
was  + was  low 
significant +differences
Jones, Burckhardt, Clark, Bennett and 
 
Leite, Rhea and Simão [45] 
low 
in  in  zation Pro‐
four  four   [72]  articles  +    men
Jones, Burckhardt, Clark, Bennett and 
data, and selection of the reported results was low. Bias in measurement of the outcome 
   tended Interventions 
Leite, Rhea and Simão [45] 
[43,45,73,85], 
 ++   and
[72]  + women
Alexander, Galecki, Grenier, Nyquist, 
Jones, Burckhardt, Clark, Bennett and 
data, and selection of the reported results was low. Bias in measurement of the ou
data, and selection of the reported results was low. Bias in measurement of the outcome     moderate     Outcome 
Leite, Rhea and Simão [45] 
in 
 response
  [46] 
one  +[72]  ++     +   to
 [46] 
  + and   ++high 
interventions ++    ++ ++   [72].
  data, and selection of the reported resu
high  in  six 
   +    +   tended Interven +
+    + + + +  
 
 
 
 
Weighted
   
Reported Re‐ +articles 
 Aquino, Fonseca, Goncalves, Silva, Oc‐
Article 
zation Pro‐
Caputo, Di Bari and Naranjo Orellana 
+ Hofmeyer, Grunawalt, Medell and Fry‐
Simão, Lemos, Salles, Leite, Oliveira, 
formulas were
Nelson and Bandy [86] 
Potempa [85] 
+  
[43,45,73,85], 
+applied
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
  sequentially
Nelson and Bandy [86] 
Hofmeyer, Grunawalt, Medell and Fry‐
+  
moderate 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
tended Interventions 
Potempa [85]  +zation Pro‐
in  one 
tended Interventions 
Outcome 
Caputo, Di Bari and Naranjo Orellana 
+ Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
+Simão, Lemos, Salles, Leite, Oliveira, 
+Potempa [85] 
Aquino, Fonseca, Goncalves, Silva, Oc‐
for   combining
Nelson and Bandy [86] 
Hofmeyer, Grunawalt, Medell and Fry‐  
Article 
+ +of the Out‐
+means  
and 
of the Out‐
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
    and  
in Table 2. Assessments of risk of bias (C
Outcome 
SDs +six 
Reported Re‐
Reported Re‐
of
  zation Pro‐
  +groups +    of the Out‐
  +  +   + Reported
  + +  
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
+!Li, Garrett, Best, Li, Wan, Liu and Yu  +   +++   was low in six articles [44–46,78,85,86],
 
 
[46] 
 
 
++ [33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
+
  the
++ +  cess 
Morton, Whitehead, Brinkert and Caine 
+
   Li, Garrett, Best, Li, Wan, Liu and Yu 
sults    ! cess 
    [46] 
arino and Mancini [44] 
Rhea and Reis [78] 
Morton, Whitehead, Brinkert and Caine 
[33,44,71,72,78,86]. Bias due to deviations from intended interventions, missing outcome 
    + (EAI 
   Leite, De Souza Teixeira, Saavedra,  ++ 1  +++)  1   )  cess 
  (EAI 
  Welch [43]  ++!     Data  ++    (EAI 
Morton, Whitehead, Brinkert and Caine 
++Data 
Li, Garrett, Best, Li, Wan, Liu and Yu 
  +++ Welch [43] 
arino and Mancini [44]    ++[46] 
Rhea and Reis [78] 
+++  come  1 +
     ) +come      by Data 
+++sults     ++sults  + +++   cess 
  ++ right     +! come  +
    +
+     + (EAI 
  + 1++ ) 
++sults
+  
 
 
[71] 
study Welch [43] 
Leite, De Souza Teixeira, Saavedra, 
Selection of the  + Randomi‐[71] 
Racil, Jlid, Bouzid, Sioud, Khalifa,  [47]. Two   +Randomi‐
studies
Deviations from In‐
Racil, Jlid, Bouzid, Sioud, Khalifa, 
data, and selection of the reported results was low. Bias in measurement of the outcome 
data, and selection of the reported results was low. Bias in measurement of the outcome  presented
++[72] 
Randomi‐
[71]    Deviations from In‐
  the results
Leite, De Souza Teixeira, Saavedra, 
Deviations from In‐
Missing 
Racil, Jlid, Bouzid, Sioud, Khalifa,    ++separated
Randomi‐
[71]  Measurement 
  Missing 
    Measurement 
left ++ and
Deviations from In‐
Missing 
Selection of the    ++Randomi‐ Measurement 
      Selection of the 
  +Selection 
+
Deviations fro
Missing    + Me
+ +  
+
 
 
 
Jones, Burckhardt, Clark, Bennett and  [72]         
Alexander, Galecki, Grenier, Nyquist, 
Jones, Burckhardt, Clark, Bennett and    [72]                       
 
+ Article 
 
+
Caputo, Di Bari and Naranjo Orellana  +
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Aquino, Fonseca, Goncalves, Silva, Oc‐
  limbs, with ++both +zation Pro‐ + + +
Caputo, Di Bari and Naranjo Orellana 
tended Interventions 
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
Aquino, Fonseca, Goncalves, Silva, Oc‐ Aquino, Fonseca, Goncalves, Silva, Oc‐ + + + Outcome  + + of the Out‐ +
Table 2. Assessments of risk of bias (C + + + Reported Re‐ + + +
 
Leite, Rhea and Simão [45] 
Wyon, Smith and Koutedakis [73] 
Reported Re‐    +!showing
+ zation Pro‐
++ +   Article 
+++ was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
was low in six articles [44–46,78,85,86], but high in five [33,43,71–73]. 
Amri, Gaied and Coquart [33] 
Morton, Whitehead, Brinkert and Caine   +!     
similar
Leite, Rhea and Simão [45] 
  Amri, Gaied and Coquart [33] 
++    + Article 
tended Interventions 
Morton, Whitehead, Brinkert and Caine  responses
++   +++zation Pro‐
to the
+    ++ Wyon, Smith and Koutedakis [73] 
tended Interventions 
Outcome 
  Morton, Whitehead, Brinkert and Caine 
interventions
++  +++1Potempa [85] 
Leite, Rhea and Simão [45] 
   Amri, Gaied and Coquart [33]     Article 
+zation Pro‐
  +[46] 
   +   +   [33,73];
++   of the Out‐
++    tended Interventions 
Outcome  ++ outcomes
Reported Re‐ + ++    of the Out‐
  + zation Pro‐       tended Interven
 +        ++!      +
+ Reported
Outcome     + ++ ++  
+   of
 
 
 
 
 
were
come 
combined
Nelson and Bandy [86] 
Hofmeyer, Grunawalt, Medell and Fry‐
Potempa [85] 
   [46] 
arino and Mancini [44] 
Li, Garrett, Best, Li, Wan, Liu and Yu 
using
sults  the+cess  same
Nelson and Bandy [86] 
  cess 
  +Li, Garrett, Best, Li, Wan, Liu and Yu 
arino and Mancini [44] 
weighted (EAI   +[71]  1  )  cess 
formulas +!     for Nelson and Bandy [86] 
Hofmeyer, Grunawalt, Medell and Fry‐
(EAI    ++ )    (EAI 
+Data 
arino and Mancini [44] 
Li, Garrett, Best, Li, Wan, Liu and Yu 
the means ++  1cess      +    Data 
)  and
come    SDs.Data  Five ++ (EAI     ++come 
sults    ++1Measurement 
+articles cess 
)  come  ++     sults  + (EAI 
Data    + 1+  
 
Randomi‐
[71] 
 
 
 
 
Deviations from In‐ +
Simão, Lemos, Salles, Leite, Oliveira, 
Randomi‐
  Jones, Burckhardt, Clark, Bennett and Randomi‐
+   [72] 
Welch [43] 
Leite, De Souza Teixeira, Saavedra,  [71]    +
Simão, Lemos, Salles, Leite, Oliveira, 
Deviations from In‐
Missing 
Deviations from In‐
+   
Randomi‐
Measurement 
++[72] 
Simão, Lemos, Salles, Leite, Oliveira, 
Deviations from In‐
Missing 
Missing Selection of the 
  Jones, Burckhardt, Clark, Bennett and 
  +
Measurement 
  + +   
++ Welch [43] 
Leite, De Souza Teixeira, Saavedra,  [71]  + Measurement      Missing 
Selection of the 
Selection of the  + +Randomi‐
++    ++ ++       +   +   
+   + + ) 
Deviations fro
+
+
Selection  sults
+
 
Racil, Jlid, Bouzid, Sioud, Khalifa, 
Alexander, Galecki, Grenier, Nyquist, 
+ +
Caputo, Di Bari and Naranjo Orellana 
+ !
Table 2. Assessments of risk of bias (Cochrane’s RoB 2). 
only++ presented   one decimal + Racil, Jlid, Bouzid, Sioud, Khalifa, 
place +
Caputo, Di Bari and Naranjo Orellana 
+
Table 2. Assessments of risk of bias (Cochrane’s RoB 2).  [33,43,46,72,78],   ! ! Racil, Jlid, Bouzid, Sioud, Khalifa, 
Caputo, Di Bari and Naranjo Orellana 
+ 
  and   + [72]  +     !   +   +   + +  
 
 
 
 
 
Low risk of bias; 
1   ++ ++Alexander, Galecki, Grenier, Nyquist, 
 Article    !     tended Interventions 
 Effect of assignment to intervention. 
tended Interventions 
+++zation Pro‐zation Pro‐ Some concerns;    ++ +of the Out‐
Rhea and Reis [78] 
Low risk of bias; 
Low risk of bias; 
tended Interventions 
Outcome     High risk of bias. 
zation Pro‐ ++ Some concerns; 
Some concerns;  ++so
Alexander, Galecki, Grenier, Nyquist, 
Low risk of bias; 
1 all  values
Rhea and Reis [78] 
 Effect of assignment to intervention. 
tended Interventions 
Outcome 
Outcome  Reported Re‐    Article 
 ++Potempa [85]  of the Out‐ of the Out‐ were
++  High risk of bias. 
   ++High risk of bias.   rounded
 + Some concerns;  Outcome 
Reported Re‐
Reported Re‐ ++   ++ zation Pro‐ for uni-
+   of the Out‐
  + High risk of bias. 
  ++ Low risk of bias; 
  tended Interven
  ++ +
+ Reported +   
 
 
Leite, Rhea and Simão [45] 
+ Morton, Whitehead, Brinkert and Caine +    1cess 
Nelson and Bandy [86] 
Potempa [85] 
Amri, Gaied and Coquart [33] 
[46]  Nelson and Bandy [86]   +[46] 
+1 ++) 
Amri, Gaied and Coquart [33]  Aquino, Fonseca, Goncalves, Silva, Oc‐
Leite, Rhea and Simão [45] 
+!     Amri, Gaied and Coquart [33] 
Nelson and Bandy [86] 
+  ++Measurement 
  Morton, Whitehead, Brinkert and Caine    !   +++ +     ++  ++      +!    ++    
 
formity.
cess  + +     Wyon, Smith and Koutedakis [73] 
Hofmeyer, Grunawalt, Medell and Fry‐
(EAI 
Randomi‐
Randomi‐ +
arino and Mancini [44] 
   ) [46]  cess  +
Deviations from In‐
!   Data 
Deviations from In‐
+ (EAI 
Morton, Whitehead, Brinkert and Caine 
Hofmeyer, Grunawalt, Medell and Fry‐
     (EAI  +     Hofmeyer, Grunawalt, Medell and Fry‐
1 ) come 
cess 
Missing 
  +Missing 
  Data  +Data 
Measurement   
arino and Mancini [44] 
     (EAI 
sults  +[46]  ++  come 
1 )  come 
  +   + Selection of the 
Selection of the       Data  ++sults    +sults  +   +   cess 
     + come    +    +++ (EAI 
   ++sults
1+
+ ) 
 
 
 
 
 
   
Li, Garrett, Best, Li, Wan, Liu and Yu 
Low risk of bias; 
Simão, Lemos, Salles, Leite, Oliveira, 
Welch [43] 
Jones, Burckhardt, Clark, Bennett and 
3.4. Synthesis of Results 
3.4. Synthesis of Results 
Racil, Jlid, Bouzid, Sioud, Khalifa, 
Wyon, Smith and Koutedakis [73] 
+   [71] +Jones, Burckhardt, Clark, Bennett and 
Leite, De Souza Teixeira, Saavedra, 
+ Welch [43]  Some concerns;  +  
Simão, Lemos, Salles, Leite, Oliveira, 
3.4. Synthesis of Results 
Racil, Jlid, Bouzid, Sioud, Khalifa, 
  +[71]   
Wyon, Smith and Koutedakis [73] 
Li, Garrett, Best, Li, Wan, Liu and Yu 
High risk of bias.  +   +[71] 
+Leite, De Souza Teixeira, Saavedra, 
Simão, Lemos, Salles, Leite, Oliveira, 
Jones, Burckhardt, Clark, Bennett and 
Racil, Jlid, Bouzid, Sioud, Khalifa,  +    +     3.4. Synthesis of Results  +   + +      +     +    + +  
of ST versus stretching on Welch [43] 
ROM: no significant Welch [43] 
difference was noted between
 
 
 
 
 
+++   tended Interventions 
zation Pro‐
zation Pro‐
++    Caputo, Di Bari and Naranjo Orellana 
+    [72] 
Leite, Rhea and Simão [45] 
Rhea and Reis [78]  +   ++tended Interventions  ++  ++ Outcome 
   Amri, Gaied and Coquart [33] 
Alexander, Galecki, Grenier, Nyquist, 
++Outcome  ++  ++ of the Out‐
of the Out‐
Caputo, Di Bari and Naranjo Orellana 
 +     Aquino, Fonseca, Goncalves, Silva, Oc‐
+Rhea and Reis [78]    Leite, Rhea and Simão [45]      +[72] 
 +Potempa [85] 
Rhea and Reis [78]  +++    ++Reported Re‐    ++    
Reported Re‐ +++   ++ ++  +++      + +     +     +
+    +
+ + 
+ + + 
 
Potempa [85] 
Amri, Gaied and Coquart [33] 
 Aquino, Fonseca, Goncalves, Silva, Oc‐
 
ST and stretching ! +  (EAI   Potempa [85] 
Aquino, Fonseca, Goncalves, Silva, Oc‐
Comparisons were performed between ST and stretching groups, involving eleven 
+(ES =+!−0.22; 95% 1)  CI    Amri, Gaied and Coquart [33] 
Comparisons were performed between ST and stretching groups, involving e
Comparisons were performed between ST and stretching groups, involving eleven 
1=
) ++ −0.55 to ! 0.12; p++=+1 Effect of assignment to intervention. 
+0.206; +I  2   =+65.4%; +   ++ +test
Comparisons were performed bet
Egger’s +      p =+ Some concerns;  + + 
 
[46]  + + Morton, Whitehead, Brinkert and Caine 
 
 
 
Nelson and Bandy [86] 
Hofmeyer, Grunawalt, Medell and Fry‐
cess  cess 
+   [46]    +
1 Effect of assignment to intervention. 
Li, Garrett, Best, Li, Wan, Liu and Yu 
+   arino and Mancini [44]  +    
Leite, De Souza Teixeira, Saavedra,    
Nelson and Bandy [86] 
(EAI  +
Low risk of bias; 
  Simão, Lemos, Salles, Leite, Oliveira, 
Leite, De Souza Teixeira, Saavedra, 
  +   Data 
+ !+ Nelson and Bandy [86] 
Hofmeyer, Grunawalt, Medell and Fry‐
Data 
+  Low risk of bias; come 
Morton, Whitehead, Brinkert and Caine 
1 Effect of assignment to intervention.  Some concerns; 
 +     Li, Garrett, Best, Li, Wan, Liu and Yu 
   +
 +      +    
Leite, De Souza Teixeira, Saavedra, 
  come 
+ [46]  + ! + ++ Some concerns; 
+sults 
High risk of bias.  sults 
Low risk of bias;  +
  +    articles and 452 participants. Global eff
  +    + +          +    
+ +!!High risk of bias. 
++   + +    + ++   
Low risk of bias;  +
 
 
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
arino and Mancini [44] 
Wyon, Smith and Koutedakis [73]  Wyon, Smith and Koutedakis [73]  Simão, Lemos, Salles, Leite, Oliveira, 
articles and 452 participants. Global effects on ROM were achieved pooling data fro
arino and Mancini [44]  arino and Mancini [44] 
Wyon, Smith and Koutedakis [73] 
 
 
 
 
 
[72]  +    Figure 2). The +++ Welch [43] 
 
 
Jones, Burckhardt, Clark, Bennett and 
Caputo, Di Bari and Naranjo Orellana  +     [72] 
Racil, Jlid, Bouzid, Sioud, Khalifa, 
Leite, Rhea and Simão [45]    weight
[71]   ++ Racil, Jlid, Bouzid, Sioud, Khalifa,  of++ each  ++   study
+Rhea and Reis [78] 
   Leite, Rhea and Simão [45] 
+   in++ the
  ++     +[72] 
Jones, Burckhardt, Clark, Bennett and 
+ Racil, Jlid, Bouzid, Sioud, Khalifa, 
  +  ++    Aquino, Fonseca, Goncalves, Silva, Oc‐
   Leite, Rhea and Simão [45] 
analysis
+ Welch [43]  [71]  ++   ++ ranged
+         from ++  ++ +6.4%
 ++    different joints. One article did not hav
+ +to
+    +  ++        +     +    
+   + +
+   + + +   
 
12.7%
 
 
 
Rhea and Reis [78] 
 
different joints. One article did not have the data required [44], but the authors supplied 
different joints. One article did not have the data required [44], but the authors supplied 
Caputo, Di Bari and Naranjo Orellana 
+
Aquino, Fonseca, Goncalves, Silva, Oc‐
(the size of the
+
3.4. Synthesis of Results 
Potempa [85] 
Amri, Gaied and Coquart [33] 
+ +  +    Low
 
+
plotted   +   squares + in
3.4. Synthesis of Results 
+     ! + Some
Amri, Gaied and Coquart [33]    Figure  +  2 reflects+ Rhea and Reis [78] 
different joints. One article did not have the data required [44], but the authors sup
Caputo, Di Bari and Naranjo Orellana  Caputo, Di Bari and Naranjo Orellana 
+
3.4. Synthesis of Results 
  the
Potempa [85] 
Amri, Gaied and Coquart [33] 
+ Nelson and Bandy [86] 
+ofit upon request. For another article [45], we also requested data relative to the goniom
+Li, Garrett, Best, Li, Wan, Liu and Yu 
+ +    High   + +  
    !risk +
statistical     weight
3.4. Synthesis of Results 
+bias. +
++   + ++     ! +  
+ it upon request. For another article [45] + of
+   + each  +   +   +++    ++ ++ 
to Morton, Whitehead, Brinkert and Caine 
intervention. [46] 
Nelson and Bandy [86] 
 
bias;
it upon request. For another article [45], we also requested data relative to the goniometric 
it upon request. For another article [45], we also requested data relative to the goniometric 
Li, Garrett, Best, Li, Wan, Liu and Yu  Li, Garrett, Best, Li, Wan, Liu and Yu  Morton, Whitehead, Brinkert and Caine 
!  
concerns;   + + of    
 
 
study). +    Wyon, Smith and Koutedakis [73] 
arino and Mancini [44] 
1 Effect of assignment to intervention. 
++ +   [71] 
+   Low risk of bias; 
+ +    [46]   Wyon, Smith and Koutedakis [73]    ++  ++[46]     !+Simão, Lemos, Salles, Leite, Oliveira, 
+1 Effect of assignment to intervention.  +   Low risk of bias; 
 +    ++[46] 
+ 1 Effect of assignment to intervention. 
arino and Mancini [44] 
Some concerns; 
Wyon, Smith and Koutedakis [73] 
+only 
!+ + Low risk of bias; 
+     +High risk of bias.    
+   Some concerns; 
+   +  +      !High risk of bias.  +  Some concerns; 
+ Low risk of bias;    + +  
 
 
 
[71] 
[72] 
+obtained no  Leite, De Souza Teixeira, Saavedra, 
 
  Jones, Burckhardt, Clark, Bennett and 
Jones, Burckhardt, Clark, Bennett and 
evaluations, but 
response. Therefore, 
evaluations, but    [72]   +Jones, Burckhardt, Clark, Bennett and 
obtained no 
obtained no  +only 
Comparisons were performed between ST and stretching groups, involving eleven 
Simão, Lemos, Salles, Leite, Oliveira,       response. Therefore, 
evaluations, but  data from the 
response. Therefore,  +obtained no 
   ++only 
Leite, De Souza Teixeira, Saavedra, 
Comparisons were performed between ST and stretching groups, involving e
Simão, Lemos, Salles, Leite, Oliveira,   +[72]  sit‐and‐reach 
Jones, Burckhardt, Clark, Bennett and    response. Therefore, 
+   test 
Comparisons were performed between ST and stretchin
   Caputo, Di Bari and Naranjo Orellana  [71] 
data from the 
data from the 
[72]    +       evaluations, but  sit‐and‐reach 
sit‐and‐reach  +only  + + + test 
Comparisons were performed bet
  +  data from the 
+test 
     +obtained no 
+ response
sit‐and‐reac
+ ++ 
 
 
+ Racil, Jlid, Bouzid, Sioud, Khalifa, 
+
Caputo, Di Bari and Naranjo Orellana 
+
 
Leite, Rhea and Simão [45]  + + + +
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
    + + Racil, Jlid, Bouzid, Sioud, Khalifa, 
+ +
Leite, Rhea and Simão [45] 
articles and 452 participants. Global effects on ROM were achieved pooling data fro
  + +
articles and 452 participants. Global effects on ROM were ach
  + +
articles and 452 participants. Global eff +   + + + + + 
  Rhea and Reis [78] 
Potempa [85] 
Morton, Whitehead, Brinkert and Caine 
+   +   Rhea and Reis [78] 
Morton, Whitehead, Brinkert and Caine  + + +     +   Rhea and Reis [78] 
+
Morton, Whitehead, Brinkert and Caine 
+ +     +     +   + +    +   + + + +      +   +   + +  
  + +
 
  3.4. Synthesis of Results 
+  Low risk of bias;  +
Nelson and Bandy [86] 
Potempa [85] 
Amri, Gaied and Coquart [33] 
+     [46]  ! !
  !    Some concerns;    + 3.4. Synthesis of Results 
+  Low risk of bias; + + Potempa [85]    ++ !   +3.4. Synthesis of Results 
! Some concerns; 
    High risk of bias. 
    +data from the  Nelson and Bandy [86]  +
Potempa [85] 
 +   Amri, Gaied and Coquart [33] 
    + [46]  +   +   +   3.4. Synthesis of Results 
+ !+  + Some concerns; + +  
  ++     + +  ++    !High risk of bias.      !   +  
+ Some concerns;    + +  
 
 
+obtained no 
Leite, De Souza Teixeira, Saavedra, 
[71] 
response. Therefore, 
1 Effect of assignment to intervention. 
  Li, Garrett, Best, Li, Wan, Liu and Yu 
+   [71] 
Wyon, Smith and Koutedakis [73]      only   ++[71] 
different joints. One article did not have the data required [44], but the authors supplied 
1 Effect of assignment to intervention. 
Wyon, Smith and Koutedakis [73]   ++     [71] 
  + 1 Effect of assignment to intervention. 
sit‐and‐reach 
different joints. One article did not have the data required [44], but the authors sup
Low risk of bias; 
  Li, Garrett, Best, Li, Wan, Liu and Yu 
Wyon, Smith and Koutedakis [73] 
+    test 
+     High risk of bias. 
different joints. One article did not have the data required [44   different joints. One article did not hav
Low risk of bias;    
  + Low risk of bias; 
+   + +  
 
  Leite, De Souza Teixeira, Saavedra, 
+ +  
Leite, De Souza Teixeira, Saavedra, 
+
Comparisons were performed between ST and stretching groups, involving eleven 
Simão, Lemos, Salles, Leite, Oliveira, 
+    [72]     +   +  
Leite, De Souza Teixeira, Saavedra, 
+
Comparisons were performed between ST and stretching groups, involving e   + +
Comparisons were performed between ST and stretchin
Simão, Lemos, Salles, Leite, Oliveira,  +     +  
Comparisons were performed bet + +     +     + + +
 
 
Racil, Jlid, Bouzid, Sioud, Khalifa,    + +     Jones, Burckhardt, Clark, Bennett and 
it upon request. For another article [45], we also requested data relative to the goniometric 
[72] Leite, Rhea and Simão [45]  + +     [72] 
Racil, Jlid, Bouzid, Sioud, Khalifa, 
it upon request. For another article [45], we also requested data relative to the goniom
  it upon request. For another article [45], we also requested dat
    it upon request. For another article [45]  +           ++    + + 
 
++ +!    +  ++   Leite, Rhea and Simão [45] 
Leite, Rhea and Simão [45]  + + + ++  ++    +++    +Leite, Rhea and Simão [45] 
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
Rhea and Reis [78] 
3.4. Synthesis of Results 
Nelson and Bandy [86]  articles and 452 participants. Global effects on ROM were achieved pooling data fro
3.4. Synthesis of Results 
Nelson and Bandy [86] 
  +  + +++    ++  + +   3.4. Synthesis of Results 
++Potempa [85] 
++Rhea and Reis [78] 
articles and 452 participants. Global effects on ROM were ach
3.4. Synthesis of Results 
Nelson and Bandy [86]  +  + ++  ++ + +++      +
articles and 452 participants. Global eff +   +     + +  
 
 
 
 
evaluations, but 
sit‐and‐reach  +     test 
Amri, Gaied and Coquart [33] 
+ +Morton, Whitehead, Brinkert and Caine      obtained no       
evaluations, but response. Therefore,  obtained no 
evaluations, but 
   +only 
Amri, Gaied and Coquart [33] 
   +   Morton, Whitehead, Brinkert and Caine   response. Therefore, 
  data from the     
    obtained no    evaluations, but 
sit‐and‐reach 
  +only  response. Therefore, 
    + data from the    obtained no 
test  +   sit‐and‐reac
+only 
response data
 
  !Li, Garrett, Best, Li, Wan, Liu and Yu 
  Low risk of bias; 
Li, Garrett, Best, Li, Wan, Liu and Yu  +  Low risk of bias; 
different joints. One article did not have the data required [44], but the authors supplied 
1 Effect of assignment to intervention.    High risk of bias. 
+  Low risk of bias; 
different joints. One article did not have the data required [44], but the authors sup
Some concerns;  1 Effect of assignment to intervention. 
different joints. One article did not have the data required [44
Some concerns;  1 Effect of assignment to intervention.    different joints. One article did not hav
Low risk of bias;  + Some concerns; 
Low risk of bias; 
 
+ + + + + + + + +
 
 
 
 
Comparisons were performed between ST and stretching groups, involving eleven 
Simão, Lemos, Salles, Leite, Oliveira, 
[71]    Wyon, Smith and Koutedakis [73] 
 
Racil, Jlid, Bouzid, Sioud, Khalifa,   
++   ++ Racil, Jlid, Bouzid, Sioud, Khalifa, 
Leite, De Souza Teixeira, Saavedra, 
Comparisons were performed between ST and stretching groups, involving e
      + Wyon, Smith and Koutedakis [73] 
  Comparisons were performed between ST and stretchin
Simão, Lemos, Salles, Leite, Oliveira, 
+ +   +   +  +[71] 
Racil, Jlid, Bouzid, Sioud, Khalifa,  ++     +    Comparisons were performed bet
          ++   + ++  +
 
 
[72] 
Leite, Rhea and Simão [45] 
 
it upon request. For another article [45], we also requested data relative to the goniometric 
  +it upon request. For another article [45], we also requested data relative to the goniom
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
Rhea and Reis [78]       
it upon request. For another article [45], we also requested dat
  ++     +Leite, Rhea and Simão [45]  ++     [72] 
+Rhea and Reis [78] 
articles and 452 participants. Global effects on ROM were achieved pooling data fro
    articles and 452 participants. Global effects on ROM were ach
    +   ++++     ++ ++  +++       ++    +   
++       +   +   it upon request. For another article [45]
articles and 452 participants. Global eff +    + + ++   
 
3.4. Synthesis of Results 
Nelson and Bandy [86] 
 
3.4. Synthesis of Results      Amri, Gaied and Coquart [33] 
3.4. Synthesis of Results 
Nelson and Bandy [86]          3.4. Synthesis of Results          
evaluations, but 
+
Morton, Whitehead, Brinkert and Caine 
 
Morton, Whitehead, Brinkert and Caine  response. Therefore, 
+
different joints. One article did not have the data required [44], but the authors supplied  + obtained no 
evaluations, but 
+
Morton, Whitehead, Brinkert and Caine  +only 
different joints. One article did not have the data required [44], but the authors sup response. Therefore, 
data from the +
different joints. One article did not have the data required [44 + obtained no 
+ evaluations, but 
sit‐and‐reach  +only 
response. Therefore, 
+
different joints. One article did not hav data from the 
+ obtained no 
test  + sit‐and‐reac
only 
response+data+
 
 
 
 
 
High risk of bias.   
Simão, Lemos, Salles, Leite, Oliveira, 
1 Effect of assignment to intervention. 
Wyon, Smith and Koutedakis [73] 
[71]  + ++  [71] 
+  Low risk of bias; 
+  Simão, Lemos, Salles, Leite, Oliveira, 
+ + Low risk of bias;  + +[71] 
!Li, Garrett, Best, Li, Wan, Liu and Yu 
   ! Some concerns;  +  Low risk of bias;    
    +Simão, Lemos, Salles, Leite, Oliveira, 
Some concerns;  + +Comparisons were performed between ST and stretchin
1 Effect of assignment to intervention. 
+ Wyon, Smith and Koutedakis [73] 
+   +  +[71] 
!   Some concerns; 
  High risk of bias. 
++High risk of bias.  +    Comparisons were performed bet       +  Low risk of bias; 
+  + + +      + High risk of bias. 
  ++   + + 
 
  Comparisons were performed between ST and stretching groups, involving eleven 
+
Racil, Jlid, Bouzid, Sioud, Khalifa, 
+ + Comparisons were performed between ST and stretching groups, involving e
it upon request. For another article [45], we also requested data relative to the goniometric 
+ +   +
Racil, Jlid, Bouzid, Sioud, Khalifa, 
it upon request. For another article [45], we also requested data relative to the goniom  
it upon request. For another article [45], we also requested dat
+ +   +   + +
it upon request. For another article [45]
+ + +   +   +     
 
[72]        
Rhea and Reis [78] 
+   
 
 [72] 
  Rhea and Reis [78]     
+      obtained no 
+data from the 
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
  Rhea and Reis [78]    [72]       
    +         articles and 452 participants. Global eff
  articles and 452 participants. Global effects on ROM were ach
+  +only 
articles and 452 participants. Global effects on ROM were achieved pooling data fro
+only 
+      obtained no 
+  data from the          + + +
+  
  evaluations, but 
response. Therefore, 
Amri, Gaied and Coquart [33] 
Nelson and Bandy [86] 
Morton, Whitehead, Brinkert and Caine 
3.4. Synthesis of Results 
3.4. Synthesis of Results    obtained no 
  evaluations, but 
only  response. Therefore, 
3.4. Synthesis of Results      evaluations, but 
sit‐and‐reach 
Amri, Gaied and Coquart [33] 
Morton, Whitehead, Brinkert and Caine 
+  response. Therefore, 
data from the    test 
obtained no 
  +   evaluations, but 
sit‐and‐reach 
3.4. Synthesis of Results  response. Therefore, 
  + test     sit‐and‐reac
+ only 
response data
 
+   Wyon, Smith and Koutedakis [73] 
+
 
Nelson and Bandy [86] 
+ Low risk of bias; 
+ Low risk of bias; 
different joints. One article did not have the data required [44], but the authors supplied  ! Wyon, Smith and Koutedakis [73] 
+   ! Some concerns;  Nelson and Bandy [86] 
+ Low risk of bias;  +     + High risk of bias. 
different joints. One article did not have the data required [44], but the authors sup
  different joints. One article did not have the data required [44
!  + Some concerns;   + + +   +  + Low risk of bias; 
  different joints. One article did not hav +   + +
 
 
High risk of bias.  1 Effect of assignment to intervention. 
+ Some concerns; 
1 Effect of assignment to intervention. 
 
    +    + +  
 
Racil, Jlid, Bouzid, Sioud, Khalifa,     +   +   ++Comparisons were performed between ST and stretching groups, involving e
Comparisons were performed between ST and stretching groups, involving eleven 
Comparisons were performed between ST and stretching groups, involving eleven     +   +  +   + [71] 
    +  +   +Simão, Lemos, Salles, Leite, Oliveira,      +   Comparisons were performed bet    
 
 
+   Racil, Jlid, Bouzid, Sioud, Khalifa, 
it upon request. For another article [45], we also requested data relative to the goniometric 
+  +     Racil, Jlid, Bouzid, Sioud, Khalifa, 
it upon request. For another article [45], we also requested data relative to the goniom
it upon request. For another article [45], we also requested dat
+Rhea and Reis [78]  it upon request. For another article [45]
 
+        +    ! obtained no    +  ++     ++   +  + +  3.4. Synthesis of Results    sit‐and‐reach 
+  +  +     +  
+only  +      obtained no  ++   + + 
 
 
High risk of bias. 
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
3.4. Synthesis of Results 
  3.4. Synthesis of Results 
Nelson and Bandy [86] 
evaluations, but 
response. Therefore, 
Amri, Gaied and Coquart [33] 
+  
1 Effect of assignment to intervention. obtained no  articles and 452 participants. Global effects on ROM were achieved pooling data fro
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
3.4. Synthesis of Results 
evaluations, but 
+only  response. Therefore, 
+  Amri, Gaied and Coquart [33] 
Low risk of bias;  +data from the 
+   ++ Some concerns; 
1 Effect of assignment to intervention. 
+
Nelson and Bandy [86] 
evaluations, but 
sit‐and‐reach  +only 
+  Amri, Gaied and Coquart [33] 
+  response. Therefore, 
+data from the 
+ 1 Effect of assignment to intervention. 
Low risk of bias;  +    test  !+  + Some concerns; 
obtained no    evaluations, but 
+High risk of bias. 
Low risk of bias; 
+  + + data from the 
articles and 452 participants. Global eff
+response. Therefore,  +   !test  + Some concerns; 
    ++data
sit‐and‐reac
only 
response
+ Low risk of bias; 
High risk of bias. 
+ 
+ 
 
       
different joints. One article did not have the data required [44], but the authors supplied 
Wyon, Smith and Koutedakis [73]         
different joints. One article did not have the data required [44], but the authors sup
different joints. One article did not have the data required [44], but the authors supplied  Wyon, Smith and Koutedakis [73]          +      
different joints. One article did not hav      
 
 
+
  Simão, Lemos, Salles, Leite, Oliveira, 
Racil, Jlid, Bouzid, Sioud, Khalifa, 
  + +
Comparisons were performed between ST and stretching groups, involving eleven 
  Simão, Lemos, Salles, Leite, Oliveira, 
  + + + +
    Simão, Lemos, Salles, Leite, Oliveira,  +
Comparisons were performed between ST and stretching groups, involving e
Comparisons were performed between ST and stretching groups, involving eleven  Racil, Jlid, Bouzid, Sioud, Khalifa, 
      +       +   +
Comparisons were performed bet   +   +     + + 
it upon request. For another article [45], we also requested data relative to the goniometric 
+ +  +    + + 
it upon request. For another article [45], we also requested data relative to the goniom
it upon request. For another article [45], we also requested data relative to the goniometric  + + + it upon request. For another article [45]
  + + ++   + ++   + +
 
3.4. Synthesis of Results 
Amri, Gaied and Coquart [33]  +Rhea and Reis [78] 
+     +  +    +     Amri, Gaied and Coquart [33] 
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
     +3.4. Synthesis of Results   + +   +  ++             3.4. Synthesis of Results 
+Rhea and Reis [78] 
articles and 452 participants. Global effects on ROM were achieved pooling data fro
  articles and 452 participants. Global effects on ROM were achieved pooling data from the  +3.4. Synthesis of Results  +   ++     +  +           
articles and 452 participants. Global eff   + +  
 
evaluations, but 
evaluations, but 
sit‐and‐reach    obtained no 
+ obtained no 
+   response. Therefore, 
evaluations, but response. Therefore,  ! ! obtained no 
+   only  only  response. Therefore, 
data from the 
data from the  ! evaluations, but 
sit‐and‐reach 
sit‐and‐reach  only  data from the 
test  obtained no 
test 
+ sit‐and‐reac
response
 
 
High risk of bias.  different joints. One article did not have the data required [44], but the authors supplied 
Wyon, Smith and Koutedakis [73] 
1  Effect of assignment to intervention.  different joints. One article did not have the data required [44], but the authors sup
different joints. One article did not have the data required [44], but the authors supplied 
Low risk of bias; 
Low risk of bias; 
Comparisons were performed between ST and stretching groups, involving eleven  Some concerns; 
Some concerns; Low risk of bias; 
1  Effect of assignment to intervention. 
Comparisons were performed between ST and stretching groups, involving e High risk of bias. 
High risk of bias.  different joints. One article did not hav
Some concerns;  High risk of bias. 
Low risk of bias; 
Simão, Lemos, Salles, Leite, Oliveira, 
Wyon, Smith and Koutedakis [73] 
+   + Wyon, Smith and Koutedakis [73]  + +  +Comparisons were performed between ST and stretchin
Simão, Lemos, Salles, Leite, Oliveira, 
+     +   +   + it upon request. For another article [45]
Wyon, Smith and Koutedakis [73]  Comparisons were performed bet ++   + +
it upon request. For another article [45], we also requested data relative to the goniometric 
  it upon request. For another article [45], we also requested data relative to the goniometric 
    +  
it upon request. For another article [45], we also requested data relative to the goniom   + ++   +
+   ++     +  +         +      + + 
Rhea and Reis [78]    ++     +  +     ++    +articles and 452 participants. Global effects on ROM were ach
articles and 452 participants. Global effects on ROM were achieved pooling data from the   +   +  +      +  +   articles and 452 participants. Global eff
  +Rhea and Reis [78]   
3.4. Synthesis of Results 
evaluations, but 
evaluations, but 
sit‐and‐reach  test  obtained no 
obtained no  3.4. Synthesis of Results 
evaluations, but response. Therefore, 
response. Therefore,  + obtained no  only  only  response. Therefore, 
! data from the 
data from the  3.4. Synthesis of Results 
evaluations, but 
sit‐and‐reach 
sit‐and‐reach  only  data from the 
test  obtained no 
test  sit‐and‐reac
response
different joints. One article did not have the data required [44], but the authors supplied 
 Effect of assignment to intervention.  + different joints. One article did not have the data required [44], but the authors sup
! +
Low risk of bias;  different joints. One article did not have the data required [44
Some concerns;  ! + different joints. One article did not hav
High risk of bias.  ! +
 
+
1  Effect of assignment to intervention. 
Wyon, Smith and Koutedakis [73] 
+ + + Low risk of bias; 
+  Effect of assignment to intervention. 
1
+ + Some concerns; 
Low risk of bias; 
+  Effect of assignment to intervention. 
1
+ Wyon, Smith and Koutedakis [73] 
+ + + High risk of bias.  Some concerns; 
Low risk of bias;  High risk of bias. 
Some concerns; 
Low risk of bias; 
Comparisons were performed between ST and stretching groups, involving eleven 
Comparisons were performed between ST and stretching groups, involving e
Comparisons were performed between ST and stretching groups, involving eleven 
it upon request. For another article [45], we also requested data relative to the goniometric 
          +it upon request. For another article [45], we also requested data relative to the goniom
  +         +    +it upon request. For another article [45], we also requested dat
    +    +         it upon request. For another article [45] ++    +  +   +    
+   Comparisons were performed bet + + 
evaluations, but 
sit‐and‐reach  test  obtained no  articles and 452 participants. Global effects on ROM were achieved pooling data fro
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
evaluations, but 
3.4. Synthesis of Results  response. Therefore,    obtained no  evaluations, but  only  response. Therefore, 
data from the  obtained no  articles and 452 participants. Global eff
evaluations, but 
sit‐and‐reach  only 
response. Therefore,  data from the  obtained no 
test  sit‐and‐reac
only 
response data
+ Low risk of bias;  ! + Some concerns;  3.4. Synthesis of Results 
+ Low risk of bias;  ! + Low risk of bias; 
!High risk of bias. 3.4. Synthesis of Results  ! Some concerns; 3.4. Synthesis of Results  + Low risk of bias; 
 
different joints. One article did not have the data required [44], but the authors supplied 
+  Effect of assignment to intervention. 
1
+   +different joints. One article did not have the data required [44], but the authors sup
different joints. One article did not have the data required [44], but the authors supplied 
Low risk of bias;  +   + Some concerns; 
+    Effect of assignment to intervention. 
Some concerns;  1 High risk of bias. 
High risk of bias.  different joints. One article did not hav
+   +   High risk of bias. 
Comparisons were performed between ST and stretching groups, involving eleven 
Comparisons were performed between ST and stretching groups, involving eleven 
Comparisons were performed between ST and stretching groups, involving e  
Comparisons were performed between ST and stretchin   Comparisons were performed bet
it upon request. For another article [45], we also requested data relative to the goniom
it upon request. For another article [45], we also requested data relative to the goniometric  it upon request. For another article [45]
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
articles and 452 participants. Global effects on ROM were achieved pooling data fro
articles and 452 participants. Global effects on ROM were ach articles and 452 participants. Global eff
 
 
3.4. Synthesis of Results 
evaluations, but 
evaluations, but 
sit‐and‐reach  +test 
+ Low risk of bias;  obtained no 
obtained no 
Low risk of bias;  3.4. Synthesis of Results 
evaluations, but  ! Some concerns; 
! response. Therefore, 
response. Therefore, 
Some concerns;  obtained no  only  only  response. Therefore, 
High risk of bias.  data from the 
data from the 
High risk of bias.  3.4. Synthesis of Results 
evaluations, but 
sit‐and‐reach 
sit‐and‐reach  only  data from the  test  obtained no 
test  sit‐and‐reac
response
different joints. One article did not have the data required [44], but the authors supplied 
different joints. One article did not have the data required [44], but the authors sup
different joints. One article did not have the data required [44 different joints. One article did not hav
 
Comparisons were performed between ST and stretching groups, involving eleven 
Comparisons were performed between ST and stretching groups, involving e
Comparisons were performed between ST and stretching groups, involving eleven  Comparisons were performed bet
  articles and 452 participants. Global effects on ROM were achieved pooling data from the 
it upon request. For another article [45], we also requested data relative to the goniometric   
it upon request. For another article [45], we also requested data relative to the goniom
it upon request. For another article [45], we also requested dat it upon request. For another article [45]
3.4. Synthesis of Results 
3.4. Synthesis of Results 
 
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
articles and 452 participants. Global effects on ROM were achieved pooling data fro articles and 452 participants. Global eff
sit‐and‐reach  test  evaluations, but 
obtained no  evaluations, but  obtained no 
response. Therefore,  response. Therefore, 
obtained no 
evaluations, but  only  response. Therefore, 
data from the  obtained no  only  data from the 
evaluations, but 
sit‐and‐reach  only 
response. Therefore,  data from the  sit‐and‐reach 
obtained no 
test  sit‐and‐reac
only  test 
response data
 
different joints. One article did not have the data required [44], but the authors supplied 
different joints. One article did not have the data required [44], but the authors sup
different joints. One article did not have the data required [44], but the authors supplied 
Comparisons were performed between ST and stretching groups, involving eleven 
Comparisons were performed between ST and stretching groups, involving eleven  different joints. One article did not hav
 
it upon request. For another article [45], we also requested data relative to the goniometric 
it upon request. For another article [45], we also requested data relative to the goniom
it upon request. For another article [45], we also requested data relative to the goniometric  it upon request. For another article [45]
 
in ROM after participating in stretching-based
articles and 452 participants. Global effects on ROM were achieved pooling data from the 
    compared to Scheme 95. confidence intervals
obtained no  evaluations, but 
theresponse. Therefore, 
evaluations, but  obtained no 
obtained no  evaluations, but 
only 
different joints. One article did not have the data required [44], but the authors supplied 
different joints. One article did not have the data required [44], but the authors supplied 
reflects statistical weight of response. Therefore, 
the data from the 
study. obtained no 
response. Therefore,  sit‐and‐reach 
only  only  response. Therefore, 
data from the 
data from the  test  evaluations, but  sit‐and‐reach 
sit‐and‐reach  only  data from the  test  obtained no 
test  sit‐and‐reac
response
init upon request. For another article [45], we also requested data relative to the goniometric 
ROM after participating in stretching-based compared to Scheme 95. confidence inter-
it upon request. For another article [45], we also requested data relative to the goniometric 
evaluations, but 
squares
evaluations, but 
  reflects theobtained no 
obtained no  statistical weight
  response. Therefore,  of the study.
response. Therefore,    only only  data from the 
data from the  sit‐and‐reach  sit‐and‐reach  test  test 
3.5. Additional
  Analyses  
Effects of ST versus stretching on ROM, moderated by study RoB in randomization: No
significant sub-group differences in ROM changes (p = 0.256) was found when programs
2
Healthcare 2021, 9, 427 15 of 26

Healthcare 2021, 9, x    16  of 

 

3.5. Additional Analyses

Effects of ST versus stretching on ROM, moderated by study RoB in randomization: No
Healthcare 2021, 9, x    16  of
  significant sub-group differences in ROM changes (p = 0.256) was found when programs
Group by with high RoBStatistics(6
forstudies;
each study ES = −0.41; 95% CI = −1.02
Hedges's
to g0.20;
and 95%within-group
CI I2 = 77.5%)
RoB random were compared to programs with low RoB (4 studies; ES = −0.03; 95% CI = −0.29 to 0.23;
Hedges's Standard Lower Upper
g within-group I2 = limit
error Variance 0.0%)limit(Figure
Z-Value3).p-Value

High
Group by -0.409 0.310 0.096 for
Statistics -1.016 0.198
each study -1.322 0.186 Hedges's g and 95% CI
RoB random
Low -0.027 Standard
Hedges's 0.132 0.017 -0.286
Lower 0.231
Upper -0.206 0.836
g error Variance limit limit Z-Value p-Value

High -0.409 0.310 0.096 -1.016 0.198 -1.322 0.186

-1.50 -0.75 0.00 0.75 1.50
Low -0.027 0.132 0.017 -0.286 0.231 -0.206 0.836

-1.50
Favours -0.75
stretching 0.00Favours0.75
strength 1.50

 
Figure 3. Forest plot of changes in ROM after participating in stretching‐based compared to Scheme 95. confidence inter‐
Favours stretching Favours strength
vals (CI). 
Figure 3. Forest plot of changes in ROM after participating in stretching-based compared to Scheme 95. confidence
intervals (CI).  
Effects  of  ST  versus  stretching  on  ROM,  moderated  by  study  RoB  in  measurement  of t
Figure 3. Forest plot of changes in ROM after participating in stretching‐based compared to Scheme 95. confidence inter‐
outcome: No significant sub‐group difference in ROM changes (p = 0.320) was found wh
vals (CI).  Effects of ST versus stretching on ROM, moderated by study RoB in measurement of the
programs with high RoB (5 studies; ES = −0.04; 95% CI = −0.31 to 0.24; within‐group I
outcome: No significant sub-group difference in ROM changes (p = 0.320) was found when
8.0%) were compared to programs with low RoB (6 studies; ES = −0.37; 95% CI = −0.95
programs with of 
high = −ROM,  CI = −0.31
Effects  ST RoB (5 studies;
versus  ES on 
stretching  0.04; 95%
moderated  to 0.24;
by  study  within-group
RoB  in  measurement  of 
I2 0.22; within‐group I
= 8.0%) were compared 2 = 77.3%) (Figure 4). 
to programs with low RoB (6 studies; ES = −0.37; 95% CI = −0.95
outcome: No significant sub‐group difference in ROM changes (p = 0.320) was found wh
to 0.22; within-group I2 = 77.3%) (Figure 4).
programs with high RoB (5 studies; ES = −0.04; 95% CI = −0.31 to 0.24; within‐group 
Group by
8.0%) were compared to programs with low RoB (6 studies; ES = −0.37; 95% CI = −0.95
Statistics for each study Hedges's g and 95% CI
RoB measure 0.22; within‐group I2 = 77.3%) (Figure 4). 
Hedges's Standard Lower Upper
g error Variance limit limit Z-Value p-Value

High -0.038 0.139 0.019 -0.310 0.235 -0.271 0.787

Group by
Low -0.365 0.299 Statistics
0.089 for-0.952
each study
0.221 -1.222 0.222 Hedges's g and 95% CI
RoB measure
Hedges's Standard Lower Upper
g error Variance limit limit Z-Value p-Value
-1.25 -0.63 0.00 0.63 1.25
High -0.038 0.139 0.019 -0.310 0.235 -0.271 0.787

Low -0.365 0.299 0.089 -0.952 0.221 -1.222 0.222

Favours stretching Favours strength

-1.25 -0.63 0.00 0.63 1.25

Figure 4. Forest plot of changes in ROM after participating in stretching-based compared to Scheme 95. confidence
 
intervals (CI).
Figure 4. Forest plot of changes in ROM after participating in stretching‐based compared to Scheme 95. confidence inter‐
Favours stretching Favours strength
vals (CI).  Effects of ST versus stretching on ROM, moderated by ROM type (active vs. passive): No
significant sub-group difference in ROM changes (p = 0.642) was found after training
programs that assessed active (8 groups; ES = −0.15; 95% CI = −0.65 to 0.36; within-group  
Effects of ST versus stretching on ROM, moderated by ROM type (active vs. passive): N
2 = 78.7%) compared to passive ROM (6 groups; ES = −0.01; 95% CI = −0.27 to 0.24;
I significant sub‐group difference in ROM changes (p = 0.642) was found after training pr
Figure 4. Forest plot of changes in ROM after participating in stretching‐based compared to Scheme 95. confidence inter‐
vals (CI).  within-group I2 = 15.3%) (Figure 5).
grams that assessed active (8 groups; ES = −0.15; 95% CI = −0.65 to 0.36; within‐group I
78.7%) compared to passive ROM (6 groups; ES = −0.01; 95% CI = −0.27 to 0.24; withi
Effects of ST versus stretching on ROM, moderated by ROM type (active vs. passive): 
group I2 = 15.3%) (Figure 5). 
significant sub‐group difference in ROM changes (p = 0.642) was found after training p
grams that assessed active (8 groups; ES = −0.15; 95% CI = −0.65 to 0.36; within‐group 
78.7%) compared to passive ROM (6 groups; ES = −0.01; 95% CI = −0.27 to 0.24; with
group I2 = 15.3%) (Figure 5). 
 Healthcare 2021, 9, x    17  o
 
Group by Statistics for each study Hedges's g and 95% CI
HealthcareROM type9, 427
2021, 16 of 26
Hedges's Standard Lower Upper
g error Variance limit limit Z-Value p-Value

Active -0.145 0.257 0.066

-0.650 0.359 -0.565 0.572
Group by Statistics for each study Hedges's g and 95% CI
Passive ROM type -0.011 0.130 0.017 -0.266 0.244 -0.086 0.931
Hedges's Standard Lower Upper
g error Variance limit limit Z-Value p-Value

Active -0.145 0.257 0.066 -0.650 0.359 -0.565 0.572-1.00 -0.50 0.00 0.50 1.00

Passive -0.011 0.130 0.017 -0.266 0.244 -0.086 0.931

Favours
-1.00 stretching
-0.50 Favours
0.00 strength
0.50 1.00

 
Figure 5. Forest plot of changes in ROM after participating in stretching‐based compared to Scheme 95. confidence inter‐
Favours stretching Favours strength
vals (CI). 
Figure 5. Forest plot of changes in ROM after participating in stretching-based compared to Scheme 95. confidence
 
intervals (CI). Effects of ST versus stretching on hip flexion ROM: Seven studies provided data for hip 
Figure 5. Forest plot of changes in ROM after participating in stretching‐based compared to Scheme 95. confidence inter‐
flexion ROM (pooled n = 294). There was no significant difference between ST and stretch‐
vals (CI).  Effects of ST versus stretching on hip flexion ROM: Seven studies2 provided data for
ing interventions (ES = −0.24; 95% CI = −0.82 to 0.34; p = 0.414; I  = 80.5%; Egger’s test p = 
hip flexion ROM (pooled n = 294). There was no significant difference between ST and
0.626; Figure 6). The relative weight of each study in the analysis ranged from 12.0% to 
stretching interventions (ES = −0.24; 95% CI = −0.82 to 0.34; p = 0.414; I2 = 80.5%; Egger’s
Effects of ST versus stretching on hip flexion ROM: Seven studies provided data for 
17.4%  p (the  size  of  the 
Figure 6).plotted  squares 
The relative in  Figure 
weight of each6 study
reflects  the analysis
in the statistical 
testflexion ROM (pooled n = 294). There was no significant difference between ST and stret
= 0.626; weight 
ranged fromof  each 
study). 
12.0% to 17.4% (the size of the plotted squares in Figure 6 reflects the statistical weight of
ing interventions (ES = −0.24; 95% CI = −0.82 to 0.34; p = 0.414; I2 = 80.5%; Egger’s test
each study).
0.626; Figure 6). The relative weight of each study in the analysis ranged from 12.0%
Study name
17.4%  (the  size  of  the  plotted  squares  in  Figure 
Statistics for each study
6  reflects  the  statistical  weight  of  e
Hedges's g and 95% CI

Hedges's
study). 
Standard Lower Upper
g error Variance limit limit Z-Value p-Value

Alexander et al. (2001) 0.103 0.179 0.032 -0.247 0.453 0.577 0.564
Study
Leite et al. name
(2015) -0.229 0.502 0.252Statistics
-1.214for each study -0.457
0.755 0.648 Hedges's g and 95% CI

Li et al. (2020) Hedges's 0.318

-0.616 Standard 0.101 -1.239 Lower
0.006 Upper-1.942 0.052
g error Variance limit limit Z-Value p-Value
Morton et al. (2011) 0.456 0.400 0.160 -0.328 1.239 1.140 0.254
Alexander et al. (2001) 0.103 0.179 0.032 -0.247 0.453 0.577 0.564
Racil et al. (2020) 0.301 0.464 0.215 -0.609 1.210 0.648 0.517
Leite et al. (2015) -0.229 0.502 0.252 -1.214 0.755 -0.457 0.648
Simão et al. (2011) -1.922 0.377 0.142 -2.661 -1.183 -5.096 0.000
Li et al. (2020) -0.616 0.318 0.101 -1.239 0.006 -1.942 0.052
Wyon et al. (2013) 0.247 0.357 0.127 -0.453 0.947 0.691 0.489
Morton et al. (2011) 0.456 0.400 0.160 -0.328 1.239 1.140 0.254
-0.240 0.294 0.086 -0.816 0.336 -0.816 0.414
Racil et al. (2020) 0.301 0.464 0.215 -0.609 1.210 0.648 0.517
Simão et al. (2011) -1.922 0.377 0.142 -2.661 -1.183 -5.096 -2.50
0.000 -1.25 0.00 1.25 2.50
Wyon et al. (2013) 0.247 0.357 0.127 -0.453 0.947 0.691 0.489
-0.240 0.294 0.086 -0.816 0.336 -0.816 0.414
Favours stretching Favours strength
-2.50
Figure 6. Forest plot of changes in hip flexion ROM after participating in stretching-based -1.25
compared 0.00to strength-based
1.25 2.50  

training interventions. Values shown are effect sizes (Hedges’s g) with 95% confidence intervals (CI). The size of the plotted
Figure 6. Forest plot of changes in hip flexion ROM after participating in stretching‐based compared to strength‐based 
squares reflects the statistical weight of the study. Favours stretching Favours strength
training interventions. Values shown are effect sizes (Hedges’s g) with 95% confidence intervals (CI). The size of the plot‐
ted squares reflects the statistical weight of the study. 
Effects of ST versus stretching on hip flexion ROM, moderated by study RoB in randomization: 
No significant sub-group difference in hip flexion ROM changes (p = 0.311) was found
Figure 6. Forest plot of changes in hip flexion ROM after participating in stretching‐based compared to strength‐based 
when Effects of ST versus stretching on hip flexion ROM, moderated by study RoB in randomiza‐
programs with high RoB in randomization (4 studies; ES = −0.46; 95% CI = −1.51 to
training interventions. Values shown are effect sizes (Hedges’s g) with 95% confidence intervals (CI). The size of the plot‐
tion: No significant sub‐group difference in hip flexion ROM changes (p = 0.311) was found 
0.58; within-group I2 = 86.9%) were compared to programs with low RoB in randomization
ted squares reflects the statistical weight of the study. 
when programs with high RoB in randomization (4 studies; ES = −0.46; 95% CI = −1.51 to 
(3 studies; ES = 0.10; 95% CI = −0.20 to 0.40; within-group I2 = 0.0%) (Figure 7).
0.58; within‐group I2 = 86.9%) were compared to programs with low RoB in randomization 
Effects of ST versus stretching on hip flexion ROM, moderated by study RoB in random
(3 studies; ES = 0.10; 95% CI = −0.20 to 0.40; within‐group I2 = 0.0%) (Figure 7). 
tion: No significant sub‐group difference in hip flexion ROM changes (p = 0.311) was fou
when programs with high RoB in randomization (4 studies; ES = −0.46; 95% CI = −1.51
0.58; within‐group I2 = 86.9%) were compared to programs with low RoB in randomizat
(3 studies; ES = 0.10; 95% CI = −0.20 to 0.40; within‐group I2 = 0.0%) (Figure 7). 

 
 Healthcare 2021, 9, x    18  of  27 
 
Healthcare 2021, 9, x    18  o
 
Healthcare 2021, 9, 427 17 of 26

Group by Statistics for each study

RoB random
Hedges's Standard Lower Upper
Group by g error Statistics
Variance limitstudylimit Z-Value p-Value
for each
RoB random
High -0.462 0.532 0.283 -1.506 0.581 -0.868 0.385
Hedges's Standard Lower Upper
Low
g 0.099error 0.152Variance limit limit Z-Value
0.023 -0.200 0.397 0.648
p-Value
0.517

High -0.462 0.532 0.283 -1.506 0.581 -0.868 0.385

Low 0.099 0.152 0.023 -0.200 0.397 0.648 0.517 -2.00 -1.00 0.00 1.00 2.00

-2.00 -1.00 0.00 1.00 2.00

Favours stretching Favours strength

 
Favours stretching Favours strength
Figure 7. Forest plot of changes in hip flexion ROM after participating in stretching‐based compared to strength‐based 
training interventions with high versus low RoB in randomization. Values shown are effect sizes (Hedges’s g) with 95% 
Figure 7. Forest plot of changes in hip flexion ROM after participating in stretching-based compared to strength-based
confidence intervals (CI). 
training interventions with high versus low RoB in randomization. Values shown are effect sizes (Hedges’s g) with 95%  
confidence intervals (CI).
Figure 7. Forest plot of changes in hip flexion ROM after participating in stretching‐based compared to strength‐based 
Effects  of  ST  versus  stretching  on  hip  flexion  ROM,  moderated  by  ROM  type  (active  vs. 
training interventions with high versus low RoB in randomization. Values shown are effect sizes (Hedges’s g) with 95% 
passive): No significant sub‐group difference in hip flexion ROM changes (p = 0.466) was 
confidence intervals (CI).  Effects of ST versus stretching on hip flexion ROM, moderated by ROM type (active vs.
found after 
passive): the  programs assessed 
No significant sub-group difference active  (4  groups; 
in hip ES  = −0.38; 95% 
flexion ROM changes (p CI  =  −1.53 
= 0.466) wasto  0.76; 
within‐group I 2 = 87.1%) compared to passive ROM (4 groups; ES = 0.08; 95% CI = −0.37 to 
found after the programs assessed active (4 groups; ES = −0.38; 95% CI = −1.53 to 0.76;
Effects 2of  ST  versus 
0.52; within‐group I stretching  on  hip  flexion  ROM,  moderated  by  ROM  type  (active 
2 = 56.5%) (Figure 8). 
within-group I = 87.1%) compared to passive ROM (4 groups; ES = 0.08; 95% CI = −0.37
passive): No significant sub‐group difference in hip flexion ROM changes (p = 0.466) w
to 0.52; within-group I2 = 56.5%) (Figure 8).
found after  the  programs assessed  active  (4  groups;  ES  = −0.38; 95%  CI  =  −1.53  to  0.
Group by within‐group I
Statistics for = 87.1%) compared to passive ROM (4 groups; ES = 0.08; 95% CI = −0.37
2
each study Hedges's g and 95% CI
ROMtype
0.52; within‐group I
Hedges's Standard Lower Upper
2 = 56.5%) (Figure 8). 
g error Variance limit limit Z-Value p-Value

Active -0.382 0.583 0.340 -1.525 0.761 -0.655 0.512

Group byPassive 0.075 0.228 Statistics

0.052for each
-0.373
study 0.522 0.328 0.743 Hedges's g and 95% CI
ROMtype
Hedges's Standard Lower Upper
g error Variance limit limit Z-Value p-Value -2.00 -1.00 0.00 1.00 2.00

Active -0.382 0.583 0.340 -1.525 0.761 -0.655 0.512

Passive 0.075 0.228 0.052 -0.373 0.522 0.328 0.743

Favours stretching Favours strength

Figure 8. Forest plot of changes in hip flexion ROM after participating in stretching-based
-2.00 -1.00 compared
0.00 to strength-based
1.00 2.00
 
training interventions assessing active or passive ROM. Values shown are effect sizes (Hedges’s g) with 95% confidence
Figure 8. Forest plot of changes in hip flexion ROM after participating in stretching‐based compared to strength‐based 
intervals (CI).
training interventions assessing active or passive ROM. Values shown are effect sizes (Hedges’s g) with 95% confidence 
intervals (CI).  Effects of ST versus stretching on knee extension ROM: Four studies provided data for
Favours stretching Favours strength
knee extension ROM (pooled n = 223). There was no significant difference between ST and
stretching Effects of ST versus stretching on knee extension ROM: Four studies provided data for 
interventions (ES = 0.25; 95% CI = −0.02 to 0.51; p = 0.066; I2 = 0.0%; Egger’s
test p = 0.021; Figure 9). After the application of the trim and fill method, the adjusted  
knee extension ROM (pooled n = 223). There was no significant difference between ST and 
valuesstretching interventions (ES = 0.25; 95% CI = −0.02 to 0.51; p = 0.066; I
2 = 0.0%; Egger’s test 
Figure 8. Forest plot of changes in hip flexion ROM after participating in stretching‐based compared to strength‐based 
changed to ES = 0.33 (95% CI = 0.10 to 0.57), favoring ST. The relative weight of
p = 0.021; Figure 9). After the application of the trim and fill method, the adjusted values 
training interventions assessing active or passive ROM. Values shown are effect sizes (Hedges’s g) with 95% confidence 
each study in the analysis ranged from 11.3% to 54.2% (the size of the plotted squares in
intervals (CI).  Figurechanged to ES = 0.33 (95% CI = 0.10 to 0.57), favoring ST. The relative weight of each study 
9 reflects the statistical weight of each study).
in  the analysis  ranged  from  11.3%  to 54.2% (the  size  of  the  plotted  squares  in  Figure  9 
reflects the statistical weight of each study). 
Effects of ST versus stretching on knee extension ROM: Four studies provided data 
knee extension ROM (pooled n = 223). There was no significant difference between ST a
stretching interventions (ES = 0.25; 95% CI = −0.02 to 0.51; p = 0.066; I2 = 0.0%; Egger’s t
p = 0.021; Figure 9). After the application of the trim and fill method, the adjusted valu
changed to ES = 0.33 (95% CI = 0.10 to 0.57), favoring ST. The relative weight of each stu
in  the analysis  ranged  from  11.3%  to 54.2% (the  size  of  the  plotted  squares  in  Figur
  reflects the statistical weight of each study). 
 Healthcare 2021, 9, x    19  of  27 
 
Healthcare 2021, 9, 427 18 of 26

Study name Statistics for each study Hedges's g and 95% CI

Hedges's Standard Lower Upper

g error Variance limit limit Z-Value p-Value

Alexander et al. (2001) 0.420 0.181 0.033 0.066 0.774 2.324 0.020

Aquino et al. (2010) 0.087 0.355 0.126 -0.610 0.784 0.245 0.807

Morton et al. (2011) -0.139 0.395 0.156 -0.912 0.635 -0.351 0.725

Nelson & Bandy (2004) 0.101 0.294 0.086 -0.475 0.677 0.344 0.731

0.245 0.133 0.018 -0.016 0.505 1.840 0.066

-2.00 -1.00 0.00 1.00 2.00

Favours stretching Favours strength

Figure 9. Forest plot of changes in knee extension ROM after participating in stretching-based compared to strength-based
 
training interventions (all assessed passive ROM). Values shown are effect sizes (Hedges’s g) with 95% confidence intervals
Figure 9. Forest plot of changes in knee extension ROM after participating in stretching‐based compared to strength‐based 
(CI). The size of the plotted squares reflects the statistical weight of the study.
training interventions (all assessed passive ROM). Values shown are effect sizes (Hedges’s g) with 95% confidence inter‐
vals (CI). The size of the plotted squares reflects the statistical weight of the study. 
One article behaved as an outlier in all comparisons, favoring stretching [78], but after
sensitivity analysis the results remained unchanged (p > 0.05), with all ST versus stretching
One article behaved as an outlier in all comparisons, favoring stretching [78], but af‐
comparisons remaining non-significant.
ter  sensitivity  analysis  the  results  remained  unchanged  (p  >  0.05),  with  all  ST  versus 
3.6. Confidence in Cumulative Evidence
stretching comparisons remaining non‐significant. 
Table 3 presents GRADE assessments. ROM is a continuous variable, and so a high
3.6. Confidence in Cumulative Evidence 
degree of heterogeneity was expected [88]. Imprecision was moderate, likely reflecting
the fact that ROM is a continuous variable. Overall, both ST and stretching consistently
Table 3 presents GRADE assessments. ROM is a continuous variable, and so a high 
promoted ROM gains, but no recommendation could be made favoring one protocol.
degree of heterogeneity was expected [88]. Imprecision was moderate, likely reflecting the 
fact that ROM is a continuous variable. Overall, both ST and stretching consistently pro‐
moted ROM gains, but no recommendation could be made favoring one protocol. 

 
Healthcare 2021, 9, 427 19 of 26

Table 3. GRADE assessments for the certainty of evidence.

Quality of
Outcome Study Design RoB 1 Publication Bias Inconsistency Indirectness Imprecision Recommendation
Evidence
Randomization—low in four
articles, moderate in one, and 9 RCTs showed
improvements in Moderate recommendation
high in six.
ROM in both groups. for either strength training
Deviations from intended 2 RCTs showed no or stretching 4 .
11 RCTs, 452
interventions—Low. changes in ROM in No serious Moderate. No recommendation for
ROM participants in No publication bias. Moderate. 3
meta-analysis. either group. indirectness. ⊕⊕⊕ choosing one of the
Missing outcome data—Low.
11 RCTs protocols over the other, as
Measurement of the outcome—low showed effects of their efficacy in ROM gains
in six articles and high in five. equal magnitude for was statistically not
ST and stretching. 2 different.
Selection of the reported
results—Low.
1—Meta-analyses moderated by RoB showed no differences between studies with low and high risk. 2—Because ROM is a continuous variable, high heterogeneity was expected. However, this heterogeneity is
mostly between small and large beneficial effects. No adverse effects were reported. 3—Expected because ROM is a continuous variable. Furthermore, imprecision referred to small to large beneficial effects.
4—Both strength training and stretching presented benefits without reported adverse effects.
Healthcare 2021, 9, 427 20 of 26

4. Discussion
4.1. Summary of Evidence
The aim of this systematic review and meta-analysis was to compare the effects of
supervised and randomized ST compared to stretching protocols on ROM, in participants
of any health and training status. Qualitative synthesis showed that ST and stretching
interventions were not statistically different in improving ROM. However, the studies
were highly heterogeneous with regard to the nature of the interventions and moderator
variables, such as gender, health, or training status. This had been reported in the original
manuscripts as well. A meta-analysis, including 11 articles and 452 participants, showed
that ST and stretching interventions were not statistically different in active and passive
ROM changes, regardless of RoB in the randomization process, or in measurement of the
outcome. RoB was low for deviations from intended interventions, missing outcome data,
and selection of the reported results. No publication bias was detected.
High heterogeneity is expected in continuous variables [88], such as ROM. However,
more research should be conducted to afford sub-group analysis according to character-
istics of the analyzed population, as well as protocol features. For example, insufficient
reporting of training volume and intensity meant it was impossible to establish effective
dose-response relationships, although a minimum of five weeks of intervention [71], and
two weekly sessions were sufficient to improve ROM [46,85]. Studies were not always clear
with regard to the intensity used in ST and stretching protocols. Assessment of stretching in-
tensity is complex, but a practical solution may be to apply scales of perceived exertion [73],
or the Stretching Intensity Scale [89]. ST intensity may also moderate effects on ROM [90],
and ST with full versus partial ROM may have distinct neuromuscular effects [81] and
changes in fascicle length [37]. Again, the information was insufficient to discuss these
factors, which could potentially explain part of the heterogeneity of results. This precludes
advancing stronger conclusions and requires further research to be implemented.
Most studies showed ROM gains in ST and stretching interventions, but in two studies,
neither group showed improvements [44,45]. Although adherence rates were unreported
by Aquino, Fonseca, Goncalves, Silva, Ocarino and Mancini [44], they were above 91.7% in
Leite, De Souza Teixeira, Saavedra, Leite, Rhea and Simão [45], thus providing an unlikely
explanation for these results. In the study by Aquino, Fonseca, Goncalves, Silva, Ocarino
and Mancini [44], the participants increased their stretch tolerance, and the ST group
changed the peak torque angle, despite no ROM gains. The authors acknowledged that
there was high variability in measurement conditions (e.g., room temperature), which
could have interfered with calculations. Leite, De Souza Teixeira, Saavedra, Leite, Rhea
and Simão [45] suggested that the use of dynamic instead of static stretching could explain
the lack of ROM gains in the stretching and stretching + ST groups. However, other studies
using dynamic stretching have shown ROM gains [33,43]. Furthermore, Leite, De Souza
Teixeira, Saavedra, Leite, Rhea and Simão [45] provided no interpretation for the lack of
ROM gains in the ST group.
Globally, however, both ST and stretching were effective in improving ROM. We asked
what the reason for ST to improve ROM in a manner that is not statistically distinguishable
from stretching? A first thought might be to speculate that perhaps the original studies
used sub-threshold stretching intensities and/or durations. However, the hypothesis that
ST has intrinsic merit for improving ROM should also be considered. ST with an eccentric
focus demands the muscles to produce force on elongated positions, and a meta-analysis
showed limited-to-moderate evidence that eccentric ST is associated with increases in
fascicle length [91]. Likewise, a recent study showed that 12 sessions of eccentric ST
increased fascicle length of the biceps femoris long head [38]. However, ST with an
emphasis in concentric training has been shown to increase fascicle length when full ROM
was required [37]. In a study with nine older adults, ST increased fascicle length in both the
eccentric and concentric groups, albeit more prominently in the former [92]. Conversely,
changes in pennation angle were superior in the concentric group (35% increase versus 5%
increase). Plyometric training can also increase plantar flexor tendon extensibility [42].
Healthcare 2021, 9, 427 21 of 26

One article showed significant reductions in pain associated with increases in

strength [46]. Therefore, decreased pain sensitivity may be another mechanism by which
ST promotes ROM gains. An improved agonist-antagonist coactivation is another possible
mechanism promoting ROM gains, through better adjusted force ratios [40,73]. Also, some
articles included in the meta-analysis assessed other outcomes in addition to ROM, and
these indicated that ST programs may have additional advantages when compared to
stretching, such as greater improvements in neck flexors endurance [46], ten repetition
maximum Bench Press and Leg Press [45,78], and countermovement jump and 60-m sprint
with hurdles [33] which may favor the choice of ST over stretching interventions.

4.2. Limitations
After protocol registration, we chose to improve upon the design, namely adding two
dimensions (directness and imprecision) that would provide a complete GRADE assess-
ment. Furthermore, subgroup analyses were not planned a priori. There is a risk of multiple
subgroup analyses generating a false statistical difference, merely to the number of analyses
conducted [47]. However, all analyses showed an absence of significant differences and
therefore provide a more complete understanding that the effects of ST or stretching on
ROM are consistent across conditions. Looking backwards, perhaps removing the filters
used in the initial searches could have provided a greater number of records. Notwith-
standing, it would also likely provide a huge number of non-relevant records, including
opinion papers and reviews. Moreover, consultation with four independent experts may
hopefully have resolved this shortcoming.
Due to the heterogeneity of populations analysed, sub-group analysis according to sex
or age group were not possible, and so it would be important to explore if these features
interact with the protocols in meaningful ways. Moreover, there was a predominance
of studies with women, meaning more research with men is advised. There was also a
predominance of assessments of hip joint ROM, followed by knee and shoulder, with the
remaining joints receiving little to no attention. In addition, dose-response relationships
could not be addressed, mainly due to poor reporting. However, the qualitative findings of
all the studies were very homogeneous, with statistical significance tests failing to show
differences between ST and stretching protocols.

5. Conclusions
Overall, ST and stretching were not statistically different in ROM improvements,
both in short-term interventions [71], and in longer-term protocols [78], suggesting that
a combination of neural and mechanical factors is at play. However, the heterogeneity of
study designs and populations precludes any definite conclusions and invites researchers
to delve deeper into this phenomenon. Notwithstanding this observation, the qualitative
effects were quite similar across studies. Therefore, if ROM gains are a desirable outcome,
both ST and stretching reveal promising effects, but future research should better explore
this avenue. In addition, the studies included in this review showed that ST had a few
advantages in relation to stretching, as was explored in the discussion. Furthermore,
session duration may negatively impact adherence to an exercise program [93]. If future
research confirms that ST generates ROM gains similar to those obtained with stretching,
clinicians may prescribe smaller, more time-effective programs when deemed convenient
and appropriate, thus eventually increasing patient adherence rates. Alternatively, perhaps
studies using stretching exercises should better assess their intensity and try to establish
minimum thresholds for their efficacy in improving ROM.

Supplementary Materials: The following are available online at https://www.mdpi.com/article/10

.3390/healthcare9040427/s1.
Author Contributions: We followed ICJME guidelines. Therefore, all authors have provided sub-
stantial contributions for the conceptualization and design of the study, acquisition, analysis and
interpretation of data, as well as drafting and revising the manuscript critically. J.A., R.R.-C. and
Healthcare 2021, 9, 427 22 of 26

F.M.C. conceptualized the work and were actively involved in all stages of the manuscript. A.M.,
A.A.M., J.F., J.M., T.R. and R.Z. were more deeply involved in the methods and results. H.S. was more
deeply invested in the rationale and discussion. All authors have read and agreed to the published
version of the manuscript. Furthermore, all authors agree to be accountable for all aspects of the
work. Contributors that did not meet these parameters are not listed as authors but are named in the
acknowledgements.
Funding: No funding to declare.
Institutional Review Board Statement: Not applicable, since it was a review.
Informed Consent Statement: Not applicable, since it was a review.
Data Availability Statement: Our data were made available with the submission.
Acknowledgments: Richard Inman: language editing and proof reading. Pedro Morouço: pre-
submission scientific review of the manuscript. Daniel Moreira-Gonçalves and Fábio Nakamura,
plus two experts that chose to remain anonymous: Review of inclusion criteria and included articles,
and proposal of additional articles to be included in the systematic review and meta-analysis. Filipe
Manuel Clemente: This work is supported by Fundação para a Ciência e Tecnologia/Ministério da
Ciência, Tecnologia e Ensino Superior through national funds and when applicable co-funded EU
funds under the project UIDB/50008/2020.
Conflicts of Interest: J.M. owns a company focused on Personal Trainer’s education but made no
attempt to bias the team in protocol design and search process, and had no role in study selection or
in extracting data for meta-analyses. The multiple cross-checks described in the methods provided
objectivity to data extraction and analysis. Additionally, J.M. had no financial involvement in this
manuscript. The other authors have no conflict of interest to declare.

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