The Effects of Serial Stretch Loading on Stretch
Work and Stretch-Shorten Cycle performance
in the Knee Musculature
Chris Benn, MS, PT'
Katie Forman, MS, PT '
Dennis Mathewson, MS, PT1
Melanie Tapply, MS, PT1
Susan Tiskus, MS, PT1
Downloaded from www.jospt.org at on September 21, 2021. For personal use only. No other uses without permission.
Ken Whang, MS, PT1
Peter Blanpied, PhD, PT2
he knee joint, located
Copyright © 1998 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
between the two longest
lever arms in the body, is fully explored. The purpose of this study was to examine the effects of an &week strengthening
well known for its vulner- program of serial stretch loading on stretch work and stretch-shorten cycle performance in the
ability to injury (36,45). quadriceps and hamstring muscles. Thiq-one asymptomatic subjects participated in pre- and post-
This vulnerability is a direct result
of the functional need to balance
mobility with stability. Contributions
to knee joint stability include
passive restraints (ligaments, capsule,
Journal of Orthopaedic & Sports Physical Therapy®
menisci, and joint configuration)
and dynamic restraints (neuromuscu-
lar elements). Unfortunately, the
passive restraints are often damaged
in sports and activities of daily
living involving high velocity move-
ments with quick stopping and turn-
ing (22.52). As the passive restraints
are not easily modified by consena-
tive treatment, protective and
rehabilitative treatments have
focused primarily on modification of
the dynamic neuromuscular system
(32,s1) .
To date, strength and proprio-
ceptive training have been studied as
methods to maximize the dynamic
restraint system, but few researchers
have investigated methods to en-
hance other musculotendinous p r o p even reflexive reactions to be able to
erties. The mechanical properties of
an active muscle constitute the first
Training methods to optimize stretch-shorten cycle performance and an active muscle's
ability to resist a sudden stretch (stretch work) and the relationship between the two have not been
tests of maximum voluntary isometric contractions, stretch work and stretch-shorten cycle trials,
and single-leg vertical jumps. The training portion consisted of progressively resisted isotonic
single-leg squats. One leg exercised against an isotonic load with serial stretch loading, while the
other leg exercised against isotonic load alone. Training resulted in strength gains in both legs
indicated by the increase in weight lifted during training, but not by maximum voluntary isometric
height increased in both legs. In the hamstring stretch work decreased
contractions. Vertical jump
and stretch-shorten cycle performance increased in both legs. In the quadriceps, serial stretch
loading intervention resulted in increased stretch-shorten cycle performance and no significant
change in stretch work. The correlation between stretch-shorten cycle and stretch work was weak
but significant. These findings suggest that the use of serial stretch loading could improve muscular
performance and enhance a muscle's potential for dynamic stabilization.
Key Words: stretch-shorten cycle, stretch work, serial stretch loading, lower extremity
' At the time of this study, Mr. Benn, Ms. Fonnan, Mr. Mathewson, Ms. Tapply, Ms. Tiskus, and Mr. Whang
were students, Physical Therapy Program, University of Rhode Island, Kingston, RI.
Associate Professor, Physical Therapy Program, University of Rhode Island, Independence Square 11, 25 W.
lndependence Way, Kingston, RI 02881-08 10
This study was supported in part by the Graduate Programs Fund, College of Human Science and Services,
University of Rhode Island, Kingston, RI; Alan Halpern, MD, Michigan State University, Kalamazoo, MI; and
the University of Rhode bland Physical Therapy Club, Kingston, RI.
line of defense in a sudden, poten- properties of the musculotendinous
tially injurious displacement of a tissue to resist the displacement (32,
joint (5238). This sudden displace- 54). The response of an active mus-
ment can happen too quickly for cle during the sudden displacement
of a joint is therefore of interest, par-
protect the joint. When this occurs, ticularly if that response can be modi-
the body relies on the mechanical fied through training.
Volume 27 Number 6 June 1998 J O S E

A more common joint displace-
ment, such as knee motion during
loading response during walking, also
involves lengthening of an active
muscle as the first phase of a natural
pattern of muscle action called the
stretchshorten cycle (SSC). The en-
ergy produced during this initial
lengthening or eccentric contraction
of the muscle is stored for later use
during the subsequent shortening or
concentric contraction of the SSC
( 1 1,12,41,43).It is this storage and re-
lease of elastic energy in musculotendi-
nous tisues that contributes, in part, to
increased force production in the con-
centric phase a q well as increased e%-
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ciency of movement (21,42).
When an active muscle is length-
ened by a stretch, the muscle fibers
and tendons resist that stretch with
an increase in force. This increase in
force has traditionally been measured
5 a linear response termed muscle
Copyright © 1998 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
a
stiffness. Operationally, stiffness is
defined as the change in force over
the change in muscle length (A F/A
L) (24,25,30,34,35).Intrinsic stiffness
refers to the resistance to stretch pro-
vided by the active muscle's fibers
and tendons prior to the changes in
activation levels caused by reflex
loops.
Journal of Orthopaedic & Sports Physical Therapy®
Although muscle stiffness is an
accepted and widely used linear mea-
sure, nonlinear data are often ob-
tained by researchers investigating an
active muscle's ability to resist sudden
perturbations (1437). Therefore, a
more comprehensive measure of this
property may be stretch work, the
summation of torque produced over
a given range of angular displace-
ment.
Many theories exist about the
relationship between stretch work
and SSC performance; however, only
preliminary conclusions have been
drawn from the available research
data. Researchers, in general, have
attempted to determine how the level
of muscle stiffness effects factors such
as the rate at which internal forces
are developed, the magnitude of
force produced in different types of
JOSPT Volume 27 Number 6 June 1998
contractions, and the efficiency of
force transmission across structures.
Goslow et al studied the elastic p r o p
erties of cat tissues and identified
that tendons with a high degree of
stiffness may transfer energy more
rapidly to the attached muscle fibers,
resulting in earlier activation of the
stretch reflex and, thus, more rapid
contraction of the muscle (16). More
recent human studies have also re-
vealed that a stiffer musculotendi-
nous unit may result in an increased
rate of concentric force development
and faster transmission of forces to
the skeletal system (50). Whether or
not these findings translate into en-
hanced SSC performance might de-
pend on the movement or activity
being analyzed. Wilson et al found
that, in a heavily loaded bench press
Stretch work was
measured during the
first 176 msec
following the onset
of stretch.
maneuver, decreased musculotendi-
nous stiffness resulted in enhanced
SSC performance because the muscu-
lotendinous unit could theoretically
store more elastic energy (49). By
contrast, several other authors have
suggested that the rapid concentric
force production and improved re-
covery of elastic energy that poten-
tially result from increased musculo-
tendinous stiffness may outweigh the
benefit of increased storage of poten-
tial energy and enhance SSC perfor-
mance in activities such as sprint run-
ning (5,7,8,27,28,33).
In addition to enhancement of
SSC performance, muscle stretch
work may also play an important role
in joint stability and injury preven-
tion. One study has suggested that
ligamentous failure can occur very
RESEARCH STUDY
quickly during injury, occurring as
quickly as 35-70 msec, which is too
rapid for volitional muscle response
to help prevent ligamentous rupture
(54). McNair et al suggest that stiffer
hamstring muscles may reduce ante-
rior tibia1 translation during sudden,
forceful movements and thereby de-
crease the risk of anterior cruciate
ligament (ACL) failure (32). Train-
ing techniques to increase hamstring
stretch work may therefore be more
useful than standard strength and
proprioceptive training programs in
the rehabilitation of patients with
ACL repairs.
Training techniques that specifi-
cally increase or decrease muscle
stretch work for the purpose of en-
hanced SSC performance or im-
proved joint stability have not yet
been identified. Plyometrics is one
training method that has been used
in the past to optimize SSC perfor-
mance; however, its effects on muscle
stretch work have not been investi-
gated. Plyometrics involves ballistic
exercises such as repetitive jumping
which specifically incorporate and
train the SSC pattern of muscle ac-
tion (13). Although plyometrics fol-
lows the specificity of training princi-
ple and can improve functional
performance, the types of ballistic
movements that this training tech-
nique entails are inappropriate for
early knee rehabilitation. Another
disadvantage of plyometric exercises
is that the amount of joint excursion
cannot be controlled.
A less ballistic and more con-
trolled training method which has
the potential to modify how a muscle
responds to a sudden stretch is serial
stretch loading (SSL) (18-20). The
SSL training method utilizes the SSC
by applying a series of mechanical
stretches to an isotonically contract-
ing muscle or muscle group as the
joint moves through a partial or f ~ d l
range of motion. These stretches are
applied by a pulse force generator
which is attached to either an open
or closed kinetic chain exercise de-
vice. A training program which a p
 RESEARCH STUDY
plies SSL to a closed kinetic chain
exercise device, such as the standing
squat machine, approaches the func-
tional level of plyometrics while still
retaining the advantage of increased
safety. In addition, this training can
be done in a controlled manner
which may allow it to be used safely,
very early in the rehabilitation pro-
cess, and may result in protection
from a knee injury that traditional
strength and proprioceptive training
alone may not provide.
Theoretically, the SSL training
method may increase the muscle's
stretch work so that it can react with
more resistance to sudden perturba-
Downloaded from www.jospt.org at on September 21, 2021. For personal use only. No other uses without permission.
tions. Not only could an increase in
muscle stretch work contribute to
increased knee joint stability, but it
could also enhance the stretch-
shorten cycle performance in activi-
ties of daily living. To date, few stud-
Copyright © 1998 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
ies have been conducted to deter-
mine if muscle stretch work can be
increased in humans and/or if a true
correlation exists between muscle
stretch work and SSC performance.
The purpose of this study was to
examine the effects of an %week, se-
rial stretch loading program involving
single-leg squats on the stretch work
Journal of Orthopaedic & Sports Physical Therapy®
and SSC performance of the quadri-
ceps and hamstring muscles in nor-
mal subjects. Additionally, the
strength of the association between
stretch work and SSC performance
was assessed in the quadriceps.
METHODS
Subjects
Thirty-one healthy male and fe-
male individuals (nine males, 22 fe-
males), ranging in age from 22 to 38
years old (mean = 25.52 years, SD =
? 3.54 years), volunteered to partici-
pate in this study. The activity levels
of the volunteers ranged from seden-
tary to recreational athletics, and all
subjects agreed not to modify their
current exercise regimens through-
out the course of the study. Prior to
testing, subjects completed a general
health questionnaire which indicated
they were asymptomatic for back and
lower extremity pathologies. In addi-
tion, all subjects read and s i p e d an
informed consent form that was a p
proved by the Institutional Review
Board of the University of Rhode Is-
land, Kingston, RI.
Instrumentation
A computercontrolled isokinetic
dynamometer (Kin-Coma, Chattecx
Company, Chattanooga, TN) was
used to obtain analog signals repre-
senting torque, angle position, and
angular velocity. The Kin-Com was
used to obtain isokinetic measures of
stretch work and SSC performance.
Quadriceps and hamstring mus-
cle activities were sensed through sur-
face electromyographs (EMG), using
onsite electrode/preamplifier mod-
ules which were hardwired to the
main differential amplifiers (Model
EMG-67, Therapeutics Unlimited,
Iowa City, IA). The bipolar electrodes
were made of silver/silver chloride
and had a fixed intraelectrode dis-
tance of 2 cm. The signals were sent
to the main differential amplifiers
(input impedance = 15 Megohms at
100 Hz, frequency response = 40-
40,000 Hz, common mode rejection
ratio = 87 d b at 60 Hz) where the
signals were amplified (gain = 500-
10,000). An oscilloscope (Model
2232, Tektronix, Inc., Beaverton,
OR) was used to check the raw EMG
signals for noise and artifact. Data
acquisition and reduction were com-
pleted using the EGAA hardware and
software system (RC Electronics,
Goleta, CA) and a personal computer
(Compu286, CompUtopia, Warwick,
RI). The analog to digital conversion
rate was 1,000 samples per second.
A single-leg vertical jump test was
used in an attempt to assess the sub-
ject's SSC performance using a more
functional movement. A rectangular,
plywood jumping platform (4' X 2' X
4") was constructed to a.sess each
FIGURE 1. Subject position and set-up for the single-
leg verticaljump. Subject stands on one leg, using the
opposite toe for balance. A tape measure extends from
the waist belt to the jumping platform.
subject's performance of a single-leg
vertical jump (Figure 1). The height
of the vertical jump was determined
using a tape measure which ran
freely from the base of the platform
and attached to a leather belt around
the subject's waist (4).
Each subject w a s trained on a
modified standing squat machine
(Figure 2) with an attached serial
stretch loader (SSL) developed by
Halpern (Orthopaedic Development,
Inc., Kalamazoo, MI). The SSL con-
sisted of a geared down, 1.5Hp elec-
tric motor which, through an electro-
mechanical clutch, superimposed
brief mechanical impulses upon the
isotonically loaded sled (18). The
clutch was controlled with software to
provide regular, short duration im-
pulses throughout the exercise range
of motion. Initially, the impulses
were applied at a cycle of 100 msec
on/300 msec off. This cycle was
changed to 200 msec on/200 msec
off at the beginning of the third
week of training to increase the mag-
nitude of the stretches as the subjects
got stronger. Without resistance, a
single impulse of 100 msec resulted
Volume 27 Number 6 June 1998 JOSPT
 RESEARCH STUDY

and 3) land on both feet straddling

the central portion of the platform.
Each subject was given one or two
practice trials to learn how to execute
this sequence correctly. The subject
then performed three to five consec-
utive maximal effort jumps with each
leg, with a 3 k e c o n d rest between
Mccharncal Stop jumps. The tape measure lengthened
with each jump and the new value at
Cornputcr the base of the platform was re-
Foot (controls clutch)
corded. The procedure of tightening
Plate
the tape measure and recording the
initial standing height was then re-
peated. A mean of the first three
jump trials was obtained.
The Kin-Com testing pha.e as-
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sessed stretch work and SSC perfor-

mance in isolated muscle groups.
Pulsc Forcc
Gcncrator
\ u The skin overlying the quadriceps
\\ mud Control and hamstring muscles was shaved (if
\
necessary) and scrubbed with an a l c e
\
\ hol wipe. Electromyographic surface
Copyright © 1998 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

electrodes were then applied using

doublesided tape and reinforced
with prewrap and athletic tape. To
target the quadriceps, an electrode/
preamplifier assembly was aligned
longitudinally over the muscle fibers
of the vastus lateralis one-third the
distance from the anterior superior
iliac spine to the fibular head. To
Journal of Orthopaedic & Sports Physical Therapy®

I Flywheel Pulsc Forcc Gcncrator

target the hamstring, another elec-
trode/preamplifier assembly was
FIGURE 2. Diagram of the modified standing squat machine (weights not shown). aligned longitudinally over the biceps
femoris one-half the distance from
in a sled movement of 11 cm initially, jumping platform and was outfitted the ischial tuberosity to the posterior
and a 200 msec impulse resulted in a with a waist belt placed just above the knee joint line. The reference elec-
sled movement of 15.5 cm. iliac crest.. The tape measure, dis- trode was placed on the skin overly-
persed freely from the base of the ing either ulnar styloid process and
platform, was attached to the front held in place by an elastic strap.
Testing Procedures
portion of the waist belt and tight- For each lower extremity, six tests
Both legs of all subjects were ened. The subject then balanced on were conducted on the Kin-Com to
tested prior to and upon completion the foot of the jumping leg using the measure: I) maximum isometric
of the training period. First, a single- opposite toe for balance, and the strength of the quadriceps, 2) maxi-
leg vertical jump was conducted to standing height in this position w a mum isometric strength of the ham-
assess SSC performance using a func- recorded from the attached tape string, 3) quadriceps stretch work,
tional movement. Second, the Kin- measure where it emerged from the 4) quadriceps SSC performance,
Com was used to determine the isoki- platform. Next, the subject was in- 5) hamstring stretch work, and
netic stretch work and SSC structed to perform the following 6) hamstring SSC performance. The
performance of isolated muscle motions in the stated order: 1) lift order in which these tests were con-
groups. the supporting toe off the platform; ducted on each side and between
In the single-leg vertical jump 2) perform a single-leg vertical jump sides was randomized. Subject. per-
test (6), the subject stood on the with both arms held behind the back; formed stretching exercises for the

JOSPT Volume 27 Number 6 June 1W8

 RESEARCH STUDY
lower extremity musculature before
and after testing on the KinCom.
To measure the maximum iso-
metric strength of the quadriceps
and hamstring muscles, the subject
was stabilized in sitting on the Kin-
Com, with the knee in 45" of flexion
and the axis of rotation of the tib-
iofemoral joint approximating that of
the Kin-Com's actuator arm. The dis-
tal pad was placed proximal to, so as
not to interfere with motion of, the
ankle joint. During this test, the sub-
ject gradually increased force in knee
extension or flexion against the fixed
actuator arm. Two submaximal effort
trials were performed with both the
Downloaded from www.jospt.org at on September 21, 2021. For personal use only. No other uses without permission.
quadriceps and hamstrings to evalu-
ate the EMG signals and warm up the
muscles. When maximal effort testing
began, loud verbal encouragement
was provided and the subject held
each maximum voluntary isometric
contraction (MVIC) for 3-5 seconds.
Copyright © 1998 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Three MVIC test trials were recorded
for the quadriceps and hamstring
muscles, and the mean of the three
trials was used for later analyses. The
subject then relaxed the lower ex-
tremity musculature so that a base-
line trial (ie., baseline EMG activity as
indicated by traces on the oscillo-
scope) could be recorded for both
Journal of Orthopaedic & Sports Physical Therapy®
muscle groups.
Stretch work was assessed with a
protocol on the Kin-Com designed to
impose a sudden stretch on an active
muscle group when a preset applied
force limit was reached (10). The
subject was stabilized in sitting for
the quadriceps test and in prone for
the hamstring test with the knee in
45" of flexion. In each position, the
subject performed a gradually in-
creasing voluntary isometric muscle
contraction against a fixed actuator
arm. When the applied force reached
the preset force limit (200 N for the
quadriceps, 125 N for the ham-
string), the actuator arm moved sud-
denly at a velocity setting of 200°/sec.
The actuator arm moved from 45 to
90" of knee flexion in the quadriceps
test and from 45 to 10" of knee flex-
ion in the hamstring test to stretch
the respective muscle groups. The
speed at which the subject steadily
increased the force was controlled to
approximately 50 N/sec by visual
feedback of force on the Kin-Com
computer screen. The subjects were
instructed not to anticipate the
stretch, but to relax as soon as they
felt their limb move. Several practice
sessions were conducted until profi-
ciency was demonstrated. Five test
trials for the quadriceps and ham-
string muscles were then recorded on
the computer, and the mean was
used for later analyses.
To measure the SSC perfor-
mance of the quadriceps and ham-
string muscles, a Kin-Com protocol
was developed to measure knee ex-
tension or flexion contractions in a
continuous passive mode (21,42). For
the quadriceps, the subject was stabi-
lized in sitting and the knee was re-
peatedly flexed and extended from 0
to 80°, with the lever arm moving at
a speed of 60°/sec into flexion and
120°/sec into extension. The subject
initiated an eccentric quadriceps con-
traction at approximately 60" of knee
flexion, immediately followed by a
maximal concentric contraction into
full knee extension. For the ham-
string muscles, the subject was stabi-
lized in prone on the Kin-Com and
the knee was repeatedly flexed and
extended in the same range (0-80°),
except the lever arm moved at
120°/sec into flexion and 60°/sec
into extension. The subject per-
formed an eccentric hamstring con-
traction from 20 to 0" of knee flex-
ion, immediately followed by a
maximal concentric contraction from
0 to 80" of knee flexion. The SSC
performance trials were executed
with visual and verbal feedback,
which cued the subject when to initi-
ate muscle contractions. Several prac-
tice trials were performed at a sub-
maximal effort level until proficiency
was demonstrated. The subject then
relaxed the lower extremity muscula-
ture, while inertial and baseline EMG
data were recorded on the computer.
For both the quadriceps and ham-
string muscle groups, five maximal
effort test trials were executed with
loud verbal encouragement and re-
corded on the computer.
Training Procedures
Subjects began the training phase
1-3 days after completion of the pre-
test. The subjects each served as their
own control and were randomly
placed into either a right- or left-leg
control group. In total, there were 16
left-leg control subjects and 15 right-
leg control subjects.
The subjects trained with supervi-
sion using the modified squat ma-
chine two to three times per week for
8-10 weeks for a minimum of 20 ses-
sions. The subjects performed single-
leg squats from 0 to 60" of knee flex-
ion against a resistance load deter-
mined using the Daily Adjustable
Progressive Resistance Exercise
(DAPRE) protocol (26). The subjects
were prevented from going beyond
60" of knee flexion by a mechanical
stop on the machine which was set
according to goniometric measure-
ments taken during the first training
session. In addition, verbal cues and
a mirror were provided to ensure
proper form and achievement of the
full 60" range of motion during the
exercise. Timing was regulated by a
metronome to 4 seconds to complete
a repetition.
During each training session, sub-
jects alternated sets between the con-
trol and SSL legs. The control leg
received the standard isotonic load,
while the SSL leg received the stan-
dard isotonic load plus serial stretch
loading. The SSL superimposed a
series of brief mechanical impulses
over the background isotonic load
supplied by the weighted sled. Each
impulse caused the knee to flex a p
proximately 2" during both the low-
ering and lifting phases of the exer-
cise; the subject experienced approx-
imately 10 impulses per repetition.
The perturbations caused by the im-
pulses decreased (relative to nonSSL
Volume 27 Number 6 June 1998 JOSPT
 RESEARCH STUDY

training) the maximum training
weight capable to be overcome by the
SSL leg during the lifting phase. Use
of the DAPRE adjustment method
ensured that maximum training
weights were employed by both legs.
Data Reduction and Analysis
Three subjects were excluded
from the quadriceps and hamstring
stretch work analyses and one subject
was excluded from the quadriceps
SSC performance analysis secondary
to lost data sets. A subject's vertical
displacement in each single-legjump
was determined by taking the differ-
Downloaded from www.jospt.org at on September 21, 2021. For personal use only. No other uses without permission.
Using the working weights re- QUADRICEPS
STRETCH WORK
corded for each subject, mean maxi-
mal training weight at the initial and
final training session was calculated
for both the control and SSL legs.
These data served as another mea-
sure of the strength gains made by
subjects.
The effects of training on the
control and experimental legs were
determined by a two-way repeated
measures analysis of variance
(ANOVA) for single-leg vertical jump,
MVIC, stretch work, SSC perfor-
mance, and training weight. Post hoc PRETEST
testing was done by multiple compar-
isons using four paired t tests (Bon- FIGURE 3. Average stretch work over five trials (N =
281 for the quadricqps muscle group in pretest and

ence between the initial and final
values recorded from the tape mea-
sure (4). Mean vertical displacement
was then computed for each leg us-
ing the subject's first three jumping
trials.
With the kinetic data, mean
Copyright © 1998 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
ferroni correction) on the data that posttest phases. The serial stretch loaded leg trained
showed significant interaction effects. with serial stretch loading, while the control leg
The correlation between stretch work trained isotonically. Stretch work decreased in the
and SSC performance in the quadri- control leg only.
ceps of the SSL leg (posttest data)
was examined using a Pearson prod-
uct moment.

for the hamstrings. These values indi-

MVIC was calculated for the quadri-
ceps and hamstring muscles of each
leg using the three maximal effort
test trials. Stretch work in joules was
then determined for both muscle
groups by integrating the torque sig-
nal over the joint angle moved fol-
lowing the onset of the stretch (as
indicated by the sharp rise in the ve-
Journal of Orthopaedic & Sports Physical Therapy®
Test-retest reliability was assessed
through a substudy involving seven
subjects. Subjects performed single-
leg vertical jump, MVIC, stretch
work, and SSC performance trials in
the manner described above. They
were allowed 24-72 hours of rest be-
fore the retest session to minimize
the effects of fatigue and muscle
cate acceptable test-retest reliability
of the measures.
Quadriceps Muscle Group
A statistically significant (P <
0.05) test by leg interaction occurred
in both the stretch work (Figure 3)

and SSC performance (Figure 4)

locity signal) to 176 msec later. This
time envelope was chosen to analyze
the active muscle's intrinsic response
to the stretch prior to the influence
of short and long latency reflexes
and volitional responses (44,51,52).
Stretch work trials were discarded if,
on visual inspection of the trial data,
the subject was judged to have antici-
pated the stretch (as revealed by a
drop in EMG activity just prior to the
sudden perturbation) or excessively
cocontracted the quadriceps and
hamstring muscles (9,lO). Approxi-
mately 3% of trials were so discarded.
In general, the mean of five trials was
used in subsequent analyses. Finally,
SSC performance was determined for
the quadriceps and hamstring bilater-
ally by calculating the mean concen-
tric torque (minus inertia) in the five
maximal effort test trials.
soreness. An intraclass correlation analyses. Post hoc multiple compari-
coefficient (2,3) was calculated for
the single-leg vertical jump and
MVIC data, and an ICC (2.5) was
QUADRICEPS STRETCHSHORTEN
computed for the stretch work and CYCLE PERFORMANCE
SSC performance data. 140 -
I T r 1
Test-Retest Reliability
The intraclass correlation coeffi-
cients (2.3) for the test-retest vertical
jump, quadricep MVIC, and ham-
string MVIC were .98, .94, and .82,
respectively. The intraclass correla-
tion coefficient (2,5)for the test- FIGURE 4. Average concentric torque over five
retest stretch work was .87 for the stretch-shortencycle trials (N = 3 1) for the quadriceps
quadriceps and .95 for the ham- musclegroup in pretest and posttest phases. The serial
stretch loaded leg trained with serial stretch loading,
strings, while the SSC performance while the control leg trained isotonically. Stretch-
intraclass correlation coefficients shorten cycle performance increased for the serial
were .98 for the quadriceps and .95 stretch loaded leg only.

JOSFT Volume 27 Number 6 June 1998

 RESEARCH STUDY

TABLE. Descriptive data for maximal voluntary isometric contraction (MVIC), training weights, and vertical jumps. The training weights occurred during the initial
(shown in pretest column) and final (shown in the posttest column) training session. The serial stretch loaded leg trained with serial stretch loading while the control
leg trained isotonically. Values are shown as mean 2 standard deviation, N = 3 1, see text for statistically signiticant differences.

son testing of the stretch work data
indicated that the SSL leg did not
change from pre- to post-test (p >
0.05). Quadriceps stretch work in the
control leg wa.. higher than the SSL
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Strength
No significant differences were
found in the pre- vs. post-test analyses
of the average MVIC of the quadri-
Although no significant differ-
ences in open chain MVIC were
found, the average load lifted by the
SSL leg increased by 732.3 N, a 330%
difference. The average increase for

leg at pretest, decreased from pre- to
post-test, and was lower than the SSL
leg at posttest (all p < 0.05). Post
hoc multiple comparison testing of
the quadriceps SSC performance data
indicated the average concentric
Copyright © 1998 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
ceps or the hamstring muscles (p > the control leg was 686.6 N, a 226%
0.05) (Table). Statistical analysis indi- improvement.
cated that the average load lifted dur-
ing the initial training session was
Single-leg Vertical Jump
significantly lower than the load
lifted during the final training session Subject. increased their single-leg

torque increased between pre- and
post-tests for the SSL leg only (p <
0.05).
Hamstring Muscle Group
A significant main effect for test
(p < 0.05) indicated a small decrease
in the average stretch work between
Journal of Orthopaedic & Sports Physical Therapy®
in both legs (p < 0.05). The SSL leg
lifted less weight than the control leg
at pretest and posttest (p < 0.05)
(Table). The test by leg interaction
term wa.. not statistically significant
(p > 0.05).
vertical jump height by an average of
1.4 cm (Table), which was statistically
significant (main effect for test p <
0.05). The control leg jumped
slightly higher (main effect for leg
p < 0.05), but the test by leg interac-

pretest (mean 2 standard deviation:

39.7 2 6.8 J ) and posttest (38.5 2 6.6 Raw Data
J ) in both legs. The test by leg inter-
action term was not statistically signif-
icant (p > 0.05). The significant
main effect for test indicated that the
hamstring SSC performance signifi-
cantly increased (p < 0.05) between
+
pretest (53.5 29.7 Nm) and post-
+
test (57.5 29.7) in both legs.
Again, the test by leg interaction
term was not statistically significant
(p > 0.05).

Stretch Work and SSC Relationship

The relationship between quadri-
ceps stretch work and SSC perfor-
mance in the experimental leg was
statistically significant (p < 0.05), but
the magnitude of the relationship FIGURE 5. Illustration of the contribution of inertia to measured stretch work in the quadriceps. The torque
was not particularly strong ( r = generated during a stretch trial when the muscles were relaxed was subtracted from the measured response. The
0.39). result (measured - inertia) was dominated by muscular influence and was quite nonlinear.

Volr~me27 Number 6 June 1998 JOSF'T


tion term was not significant ( p>
0.05).
DISCUSSION
Stretch Work
As summarized in the Results
section, the most significant findings
in this study relate to stretch work or
an active muscle's ability to resist a
sudden change in length. Stretch
work is a measurement that more
accurately describes an active mus-
cle's nonlinear response to a sudden
stretch than does muscle stiffness, a
linear measurement that has been
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used in previous research (10,14,37,
38,46), Figure 5 graphically illustrates
the nonlinear behavior of the quadri-
ceps while being quickly stretched.
Both the quadriceps and hamstring
muscle groups consistently behaved
Copyright © 1998 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
in the pattern seen in this graph: an
immediate, rapid rise in torque force,
then a short drop, followed by a sec-
ond more gradual rise in torque.
This second rise then gradually de-
creases in slope, returning to near
the original torque.
The repeatability of the shape of
the stretch work graph supports the
Journal of Orthopaedic & Sports Physical Therapy®
findings of past researchers (37,38).
It is possible that the initial torque
rise may physiologically represent
tendon elongation and the myosin
heads being forced backward against
their natural tendency (23). As the
bonds are broken, the muscle yields
and there is a temporary drop in
muscle force (1-3,25). The myosin
heads then recover and begin their
normal cross-bridging cycles, which
may represent the second rise in
force on the graph. In this study, the
recovery point in the quadriceps oc-
curred at approximately 40 msec af-
ter the onset of stretch compared
with 60 msec that Allum and Mauritz
reported in the triceps surae (1).
The final sloping drop in torque
which ends near the original isomet-
ric torque is a new behavior not pre-
viously observed. The magnitude of
stretch used in this study (-32") was
JOSPT Volume 27 Number 6 June 1998
large compared with previous work,
which may explain this behavior
(1,10,37).
Stretch work was measured dur-
ing the first 176 msec following the
onset of stretch. This time envelope
captures the intrinsic contributions to
stretch work and is comprised of a
70-msec stretch reflex delay com-
bined with a lO&msec electrome-
chanical delay (44,51,52). The stretch
reflex delay represents the time
needed for completion of the reflex
loop and the electromechanical delay
represents the time between the on-
set of EMG activity and the subse-
quent increase in muscle tension.
The electromechanical delay results
from the time required for the physi-
ologic excitationcontraction coupling
within the muscle fibers to occur (51,
52). Even though inertia and other
factors certainly contributed to the
resistance to stretch seen during this
study, the nonlinear nature and the
magnitude of the response was
caused primarily by the muscles (31).
To illustrate the contribution of iner-
tia to measured stretch work, the
torque generated during a stretch
trial when the muscles were relaxed
(checked by inspection of the EMG
record) was subtracted from the mea-
sured response. Figure 5 shows that
the result (meamred - inertia) was
dominated by muscular influence
and was quite nonlinear.
Muscle stiffness normally de-
creases with strengthening exercise
and hypertrophy of type 11 fibers,
which have been shown to be less
stiff than type I fibers (10,17,29,46,
47). Decreased muscle stiffness as a
result of strength training would lead
to a decrease in stretch work, as dem-
onstrated by the quadriceps of the
control leg and the hamstrings of
both legs in this study. The results of
this study show that stretch work in
the SSL leg quadriceps was main-
tained through SSL training on a
modified squat machine despite in-
creases in strength. When the mus-
cle's ability to resist sudden perturba-
tions is decreased, its ability to serve
RESEARCH STUDY
as a dynamic stabilizer becomes im-
paired. Preserving this characteristic
is therefore beneficial in terms of
injury prevention. Maintenance of
stretch work with SSL enhanced
strengthening exercise may have oc-
curred because the neuromuscular
activation patterns experienced with
repeated stretches could differ from
those of normal isotonic training.
Serial stretch loader training may
also have caused morphological
changes in type I1 fibers which allow
for preservation of stretch work with
concurrent strength increases.
The inability of SSL training to
preserve stretch work in the ham-
string muscles may be related to their
mostly biarticulate nature. Because
the biarticular hamstrings simulta-
neously shorten and lengthen over
the hip and knee, the pulses from
the serial stretch loader may have
been less effective in producing ham-
string muscle length changes during
training. Conversely, the mostly uni-
articulate quadriceps may have expe-
rienced the SSL effects to a greater
extent, resulting in preservation of
stretch work.
Result was dominated
by muscular influence
and was quite
nonlinear.
SSC Performance
In the hamstring muscles, the
increase in SSC performance in both
legs can be attributed to general
strengthening effects. Muscle groups
hypertrophied through training can
naturally produce more concentric
torque than untrained muscles. The
SSL training, however, did not signifi-
cantly increase hamstring SSC perfor-
mance over isotonic strengthening
alone. This may be explained by the
decreased ability of the SSL pulses to
 RESEARCH STUDY
cause a length change in the mostly
biarticulate hamstring muscle group.
In the primarily uniarticulate quadri-
ceps, the SSL training was more ef-
fective in producing a significant in-
crease in SSC performance,
indicating the SSL training caused
physiological changes other than
those resulting from standard iso-
tonic strengthening alone. Unlike
conventional strength training, SSL
training follows the principle of spec-
ificity in neuromuscular training by
superimposing a series of SSCs upon
the lower extremity (18). Serial
stretch loader training may signifi-
cantly enhance SSC performance by
Downloaded from www.jospt.org at on September 21, 2021. For personal use only. No other uses without permission.
adapting the musculotendinous tis-
sues in such a manner to allow for
increased storage and release of elas-
tic energy. In addition, SSL training
may cause neural adaptations (eg.,
more efficient reflex potentiation)
Copyright © 1998 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
which could also increase the force
production during the concentric
phase of the SSC (48). This specific-
ity argument may explain why
changes were seen in the SSL leg and
not in the control leg.
Relationship Between Stretch Work
and SSC
Journal of Orthopaedic & Sports Physical Therapy®
This study determined that a
weak but significant correlation exists
between SSC and stretch work ( r =
0.39). It is proposed that this correla-
tion exists because the maintenance
of stretch work through SSL training
enhances the ability of the muscle to
store and transfer energy, which also
contributes to SSC performance. A
stronger correlation may have existed
in the data but was not detectable
given the analysis envelopes used in
this study. Stretch work was recorded
over a joint displacement of 30" fol-
lowing the sudden stretch of an ac-
tive muscle group, whereas the SSC
performance was recorded over a
joint displacement of 80". Because
the SSC analysis envelope was over a
greater range of motion and hence a
greater time period, the effects of
reflex potentiation and volitional
control may have influenced the
data.
Strength
This study also attempted to mea-
sure strength gains after training on
the modified squat machine with and
without SSL. Although subjects made
impressive strength gains as deter-
mined by changes in training
weights, there was no change in
MVIC in the muscle groups of inter-
est. While the possibility exists that
the initial maximal training weight
was slightly underestimated, the af-
fect of the s u b j e c ~especially
, during
later training sessions, strongly sug-
gested an intensive strengthening
stimulus was used. The lack of MVIC
gain appears to be a contradictory
result; however, other researchers
have found that open chain isoki-
netic movements do not always reveal
strength gains made after closed
chain exercise training (39,40,53).
This difference in training and test-
ing modes may explain why subjects
in this study made considerable in-
creases in their training weight on
the closed kinetic chain squat ma-
chine, but MVICs, tested in open
chain, did not change. Another possi-
ble explanation for the lack of signifi-
cance in the MVIC data may be that
the single-leg squat training signifi-
cantly strengthened other muscles in
the closed kinetic chain (eg., back
extensors or gluteal muscles) that
were not specifically tested (6,l5).
Single-Leg Vertical Jump
The above-mentioned strengthen-
ing could be supported by the results
of the single-leg vertical jump test, in
which the average jump height in-
creased for both legs. This test could
be viewed as a closed kinetic chain
strength measurement in which the
strength gains are reflected in the
increased concentric work, resulting
in the higher jump. However, previ-
ous research has suggested that jump
performance is influenced not so
much by hamstring and quadriceps
muscle conditioning but by predic-
tors such as take-off velocity, peak hip
extensor power, and ankle/knee/hip
coordination (4). Consequently, the
SSL training technique may have re-
sulted in enhanced SSC performance,
but this improvement may have been
undetectable in the vertical jump test
because of the many other factors
that predict the performance of this
activity.
CLINICAL RELEVANCE
This study has shown that single-
leg squat training with SSL signifi-
cantly enhances the SSC performance
of the quadriceps over isotonic
strengthening alone. This finding has
clinical relevance since enhanced
SSC performance results in increased
concentric force production and in-
creased efficiency of movement.
These results would be desirable in
any sport o r activity of daily living.
Serial stretch loader squat train-
ing also increases quadriceps strength
while maintaining the muscle's ability
to resist a sudden perturbation. This
finding could have important impli-
cations for injury rehabilitation and
prevention. Maintenance of stretch
work may result in improved dynamic
stabilization of a joint such as the
knee and, therefore, increased pro-
tection of ligaments.
CONCLUSIONS
The following conclusions are
made from this study: 1 ) closed kinetic
chain single-leg squat training caused
an increase in SSC performance in
both the hamstring and quadriceps
muscle groups; 2) serial stretch loader
training preserved the stretch work
capacity of the quadriceps but not the
hamstring muscles, this difference pos-
sibly caused by differences in stretch
magnitudes experienced by the m u -
cles; and 3) stretch work and SSC per-
formance were weakly correlated, the
strength of the correlation might
Volume 27 Number 6 June 1998 JOSPT

have been affected by measurement
concerns. JOSFT
ACKNOWLEDGMENTS
The authors would like to thank
Alan Halpern, MD, Kalamazoo Cen-
ter for Medical Studies, Michigan
State University, Kalamazoo. MI, for
donating the standing squat machine
and serial stretch loader and Scott
Chapin and Ricky Berndt, Fabri-tec
Engineering, for their help in modi-
fjing the squat machine.
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Volume 27 Number 6 June 1998 JOSPT