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The Journal of Sports Medicine and Physical Fitness
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Effect of stretching-based rehabilitation on pain, flexibility

and muscle strength in dancers with hamstring injury: a
single-blind, prospective, randomized clinical trial
Giwon KIM, Hyangsun KIM, Woo Kyung KIM, Junesun KIM
The Journal of Sports Medicine and Physical Fitness 2017 Oct 24

DOI: 10.23736/S0022-4707.17.07554-5
Article type: Original Article
© 2017 EDIZIONI MINERVA MEDICA
Article first published online: October 24, 2017

Manuscript accepted: October 4, 2017
Manuscript revised: September 15, 2017
Manuscript received: March 9, 2017
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Effect of stretching-based
rehabilitation on pain, flexibility and muscle strength in dancers
with hamstring injury: a single-blind, prospective, randomized
clinical trial
Giwon Kim,1, 2, a Hyangsun Kim,3, a Woo K. Kim,4 Junesun

Kim,1, 2, 5*
1
Department of Physical Therapy, Korea University, Seoul,
2
Korea; Research Institute of Health Sciences, Korea
University College of Health Science, Seoul, Korea;
3
Department of Sport Physiology, Physical Education,
Graduate School of Education, Sungkyunkwan University,
Seoul, Korea; 4Department of Internal Medicine, Graduate
School of Medicine, Dongguk University, Seoul, Korea;
5
Rehabilitation Science Program, Department of Public Health
Science, Graduate School, Korea University, Seoul, Korea
*Corresponding author: Junesun Kim, Rehabilitation Science

Program, Department of Public Health Science, Graduate
School, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul
02841, Korea. E-mail: junokim@korea.ac.kr
1
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ABSTRACT
BACKGROUNDː Hamstring injuries commonly occur in

mainstream sports and occupations that involve physical
activity. We evaluated the effect of a stretching-based
rehabilitation program on pain, flexibility, and strength in
dancers with hamstring injuries.
METHODSː Sixteen Korean traditional dancers with unilateral

hamstring injuries were included and randomly assigned to a
rehabilitation or control group. The rehabilitation group
received stretching-based rehabilitation for 8 weeks, which
comprised simple static stretches and basic range of motion
(ROM) exercises, such as static and active stretching,
concentric and eccentric ROM training, and trunk stabilization
exercises. The control group received conventional treatment
with analgesics and physical therapy. Outcomes were assessed
before and after the interventions in both groups by comparing
the visual analog scale (VAS) score for pain, straight leg raise
ROM test for hamstring muscle flexibility, and isometric
strength test for hamstring muscle strength.
RESULTSː Subjects who underwent rehabilitation showed

significant improvements in VAS score for pain (p = 0.017) and
ROM for flexibility (p < 0.001). Muscle strength also increased
after the rehabilitation program (p < 0.05).
CONCLUSIONSː This rehabilitation program effectively

decreases pain and increases flexibility and strength in patients
with hamstring injury. The data indicate that a stretching-based
rehabilitation program can help promote functional recovery
from hamstring injury.
Key words: flexibility, hamstring injury, muscle strength,

stretching exercise, thigh pain
2
TEXT
Introduction
Athletes and dancers are frequently required to perform intense

physical activity that can cause repetitive musculoskeletal injuries if they
exceed the limits of their anatomic and physiologic capabilities.1,2 The most
prevalent musculoskeletal injuries in athletes and dancers are sprains, strains,
and tendinopathies, primarily affecting the lower extremities and back.1,3,4
The incidence of thigh injury in dancers is reported to be approximately 5% -
20%, with musculoskeletal injuries and pain having even higher incidences.1,4
These injuries often disrupt functional activity and prevent return to pre-injury
levels of physical activity because of limitations in range of motion (ROM),
pain, and weakness.
Hamstring injury is the most common injury in sports medicine,5,6

frequently occurring in many mainstream sports and occupations that involve
physical activity.2 Dancers provide a good model for injury caused by
overstretching.7,8 Hamstring injuries in professional dancers typically occur
during slow stretching at the end of hip flexion and knee extension, such as
when an individual performs a drop split.1,8 A major problem with hamstring
strains is the high incidence of reinjury, which has been reported to be 12% -
31%.9 Despite this relatively high incidence of hamstring injuries, evidence of
the efficacy of preventive interventions is not yet well established.
The hamstring muscle group comprises three separate muscles:
semitendinosus, semimembranosus, and biceps femoris. Hamstring injury is
defined by the anatomical site of the affected muscle, and the injury must be
present in one or more of the component muscles to be clinically relevant.6
The injury is classified by severity, signs and symptoms, and recovery
period.9-12 Hamstring injuries may also occur during high-speed running and
stretching movements performed to an extreme ROM.7 Therefore, hamstring
muscle flexibility is important for preventing injury and muscular and
postural imbalance, maintaining a full range of joint movement, optimizing
musculoskeletal function, and enhancing sports performance.13
3
Stretching exercises are important elements of fitness and conditioning

programs designed to promote wellness and reduce the risk of injury.14 There
is evidence that stretching is beneficial for improving muscle flexibility and
reducing hamstring injury and pain.15-19 For example, Malliaropoulos et al.20
showed that static stretching, sustained for 30 s and repeated four times per
day, was effective in normalizing ROM and accelerating recovery. In another
research, Fasen et al.21 demonstrated that 8 weeks of passive stretching
increased hamstring muscle flexibility, whereas O’Sullivan et al.18 reported
that warm-up and static stretching increased hamstring muscle flexibility and
reduced hamstring injury. Recently, several studies have suggested that
stretching affects pain relief in various pathological pain conditions, including
diabetic neuropathy, myofascial pain, and knee and back pain.22,23 Amorim et
al.24 and Greenstein et al.25 have also reported beneficial effects of eccentric
stretching, closed-chain stretching or muscle chain stretching on pain.
Various stretch techniques are used in practice, including static,

dynamic, ballistic, and contract–relax proprioceptive neuromuscular
facilitation. Although numerous attempts have been made to develop a
rehabilitation exercise program for hamstring injuries,9,16,21,26 no gold-
standard stretching program has been established till date. Indeed, studies
have shown that all stretching methods effectively enhance ROM,27-30 but no
systematic study has examined the effect of stretching on functional recovery.
In this study, we evaluated the effects of an 8-week, stretching-based

rehabilitation program on pain, flexibility, and strength outcomes in
professional Korean dancers with hamstring injuries.
Materials and methods
Participants
All procedures in this single-blind (participant), prospective,

randomized clinical trial were approved and conducted in accordance with the
guidelines established by the institutional review board of our hospital.
Participants (n = 17) were recruited from among Korean traditional dance
4
groups in the metropolitan areas of Seoul and Gyeonggi, South Korea. The
inclusion criteria were hamstring strains that were unilateral and moderate
(grade 2),10,12 occurred within the last 8 months, and confirmed by a self-
report hamstring injury questionnaire.31 We excluded participants with
current/acute lower extremity injuries or any significant history of hip, knee,
thigh, or lower back injury. Among the 17 participants, one refused to
participate; therefore, the final sample included 16 dancers (5 males and 11
females; age range, 20–27 years). Participants were randomly allocated to
rehabilitation and control groups by drawing labels from randomly ordered
opaque envelopes.
The participants in the rehabilitation group underwent a rehabilitation

program under the supervision of a skilled physical therapist (and assistants).
The participants in the control group were instructed to maintain their normal
lifestyle but received conventional analgesics and physical therapy for pain
control, without exercise treatment. The study lasted 8 weeks in both study
groups. We explained the methods, aims, and risks of involvement in the
study and obtained informed consent from all subjects. In total, three of the 16
subjects did not complete the program: one in the rehabilitation group did not
attend follow-up because of family problems and two in the control group
were excluded because they received additional treatment for pain relief and
functional improvement. Therefore, 13 subjects met the final inclusion criteria
(Figure 1).
Rehabilitation Program
The rehabilitation program was designed and modified based on

previous studies and basic therapeutic exercises (Figure 2) and comprised
simple static stretches and basic ROM exercises, such as static and active
stretching, concentric and eccentric ROM training, and postural stabilization.
Straight leg raise (SLR) maneuvers were done in the supine position
by a skilled physical therapist,9,14 with 30-s holding and 30 s resting and
repeated 10 times (A). Eccentric training was performed through full
flexion/extension of the hip32 with subjects lying in the supine position and
their leg fully extended (B). They pulled and held the ends of a Gold
5
TheraBand™ (Hygenic Corporation, Akron, OH, USA), which was wrapped

around the heel of the injured leg, with each hand. Then, the subjects were
instructed to bring the injured hip into full flexion by pulling on the elastic
band attached to the foot, using both arms, making sure that the knee
remained locked in full extension at all times. The subjects were instructed to
resist hip flexion by eccentrically contracting the hamstring muscle during the
entire range of hip flexion. Concentric ROM training comprised leg curls (C)
and raises (D) in the prone position (C, D).9 Leg curls were repeated 10 times
per hamstring, using a Gold TheraBand™ (6.5 kg resistance when 100%
elongated) for 10-s holding and 10-s resting intervals. Leg raising was
performed to lift the leg without the band, using the weight of the leg as a
resistance, and was repeated 10 times. The pelvic tilt was performed for
postural stabilization (E).20,33 To achieve pelvic anterior and posterior tilting,
subjects were instructed to move their pelvis anteriorly and posteriorly to give
strength to the waist and abdomen in the sitting position. They maintained this
position for 10-s holding and 10-s resting, repeated 10 times at both pelvic tilt.
Finally, active static stretching was performed in a standing position,
maintaining an anterior pelvic tilt with the stretching leg on a general
examination table 70 mm height (F).20,27,32 This standing static stretch
involved retraction of the shoulders, increase of lumbar lordosis, and
maintenance of horizontal head position while flexing forward as far as
possible without causing pain.
The rehabilitation program was repeated three times a week for 8
weeks in the laboratory under the supervision of a therapist. Stretching was
performed only on the injured leg.
Outcome Measures
Pain
Pain severity was measured using a visual analog scale (VAS) on a 10-
cm horizontal line, with “no pain” and “severe pain” anchored to the left and
right ends, respectively. Subjects were asked to draw a vertical line through
the horizontal line at the point best representing their usual maximal pain
intensity since the injury. The VAS score was calculated by measuring the
6
distance from the “no pain” point to their mark. The test–retest reliability of
VAS has been demonstrated to be high, with interclass correlation coefficients
between 0.70 and 0.8334 and minimum clinically important differences for
pain severity of 1.2 ± 0.3 cm.35 VAS evaluations were performed before and
after the 8-week rehabilitation program.
Hamstring muscle flexibility
Flexibility of the hamstring muscle was measured by an SLR ROM

test,7,15 using an electronic inclinometer (Dualer IQ, JTECH Medical, Midvale,
UT, USA). Subjects were placed in the supine position on the examination
table and fixed with straps placed across the pelvis and contralateral leg. The
electronic inclinometer was placed on the anterior lower leg, in line with the
tibial tubercle of the leg to be measured. When measuring active ROM, the
foot was plantarflexed and the subject slowly raised their leg while
maintaining a straight knee. The subject actively raised their leg until they felt
pain or stretch or there was contralateral knee and hip flexion (Figure 3A).
Passive ROM was determined by the tester lifting the leg to achieve hip
flexion. The endpoint for SLR was determined by the subject’s feeling of pain
and the examiner’s perception of firm resistance (Figure 3B).
Both legs were tested, and the mean of three repetitions was used for
analysis.7,36 All measurements were first completed with active ROM
(AROM) and then with passive ROM (PROM). No warm-up preceded the
flexibility exercises, and the same tester performed all measurements.
Hamstring muscle strength
The isometric strength of the hamstring muscle was assessed using a

hand-held dynamometer (PowerTrack II, JTECH Medical), using the break
method (Figure 4).7,37 Subjects were placed in the prone position and fixed to
the table by placing straps across the pelvis and contralateral leg. Isometric
muscle strength in the knee was measured using a dynamometer, with the
knee bent at a 90° angle. The subject was asked to perform concentric muscle
contraction while resistance was applied for 3 s, and the average of three trials
was used.
Statistical Analysis
7
Values for normally distributed data were expressed as means ±

standard deviations, and values for non-normally distributed data were
reported as medians and ranges. The Shapiro–Wilk and Levene tests were
used to check for normal distributions and variance homogeneity in the data.
The VAS and ROM data had approximately normal distributions; therefore,
we used independent t-tests to compare differences between the two groups.
The distribution of muscle strength was not normal, so the results were
compared with the two-group Mann–Whitney U test. Paired t-tests and
Wilcoxon signed-rank tests were used to compare data before and after the
intervention period in each group. Analysis of only patients with complete
data was also performed. Statistical significance was set at P < 0.05.
Statistical analyses were performed using PASW Statistics for Windows,
Version 18.0 (SPSS Inc., Chicago, IL, USA).
Results
Baseline Characteristics
In total, 16 participants satisfied the eligibility criteria and agreed to

participate, and they were randomized into the rehabilitation (n = 8) or control
(n = 8) group; however, three participants dropped out. Figure 1 summarizes
participant recruitment and retention throughout the study and Table Ⅰ
summarizes the participant demographics at baseline. There were no
significant differences between the groups of participants in the study with
respect to age, gender, height, weight, body mass index, or blood pressure.
Pain
The pain scores for the rehabilitation and control groups before and
after the intervention are shown in Table Ⅱ. The mean VAS scores before
rehabilitation were 4.2 ± 1.2 cm and 4.3 ± 2.8 cm for the rehabilitation and
control groups, respectively, and there was no significant difference. After the
study period, the VAS scores significantly decreased to 2.1 ± 0.9 (P = 0.017,
paired t-test) from baseline in the rehabilitation group. The control group also
showed a slight decrease in the VAS score, which dropped to 3.7 ± 2.2, but
8
there was no significant difference in the values before and after the test (P =
0.581, paired t-test). Although there was a slight difference in the VAS score
between the two groups, the difference in therapeutic pain reduction was
considerable. When considering the maximal possible effect, the rehabilitation
and control groups had pain reductions of 43.3% and 30.5%, respectively.
Flexibility and Strength
All ROM and muscle strength results are shown in Table Ⅲ. Before
the intervention, the AROM and PROM values were not different between the
two groups (P > 0.05). After 8 weeks of rehabilitation exercises, AROM was
slightly increased in both the injured and normal legs, but the difference
before and after the intervention was not significant (P > 0.05). In the control
group, AROM was slightly decreased in both legs, but without significant
difference between the two groups (P > 0.05). In contrast to AROM,
rehabilitation exercise produced a significant increase in PROM of the injured
leg, from 121.9° to 139.6° (14.5%; P < 0.001). In the control group, PROM of
the injured leg only improved by 0.1° (P = 0.949). Moreover, there was a
significant difference in the mean change in PROM of the injured leg between
the rehabilitation and control groups (P < 0.001, independent t-test). In the
normal legs in the rehabilitation group, PROM was 8.7°, and there was no
statistical difference from the pre-intervention values (P = 0.100). The control
group showed a slight but statistically insignificant decrease in PROM (P =
0.840).
Before the intervention, muscle strength was comparable between the

two groups (P > 0.05). After the 8-week program, muscle strength was
significantly increased compared with baseline in the rehabilitation group (P
< 0.05). The control group also showed significant increases in muscle
strength (P < 0.05). However, there was no difference between the two groups.
Discussion
In the present study, we demonstrated that in dancers with hamstring

injuries who received a stretching-based rehabilitation program, their function
9
was effectively restored. Of note, there were significant reductions in pain

coupled with improvements in flexibility (PROM) and strength. These results
are consistent with those of previous studies demonstrating that proper
stretching relieved pain and increased flexibility after hamstring injury.2,6,12
However, these studies failed to investigate the effects of stretching on
functional recovery in patients with hamstring injury.
Pain, flexibility (ROM), and muscle strength are important factors

when evaluating motor function and recovery in physically active people. 7,12
Pain is a common symptom and major cause of devastating reductions in
quality of life in patients with persistent musculoskeletal injuries.1,4,22 Rönkkö
et al.22 demonstrated that the odds of musculoskeletal complaints (pain and
disability, particularly of the hip and knee pain) were increased in retired
dancers compared with the general population (e.g., high odds ratios of
walking difficulty or limping in retired dancers). This suggests that managing
musculoskeletal pain and disability are important factors that affect a dancer’s
ability to continue dancing and performing activities of daily living.
Stretching exercises can increase muscle flexibility and relieve the

pain that occurs because of muscle stiffness.20,38 When performed in the
fibroblastic stage, as part of a rehabilitation program, these exercises can
activate collagen formation, which reduces stiff muscle pain and prevents
tissue damage.20,39 Previous studies have demonstrated that such a
rehabilitation program can decrease pain after hamstring injury.25,39
Greenstein et al.25 reported that treatment with eccentric, closed-chain
hamstring exercises reduced pain by 2.4 cm on the VAS. Although they did
not include a control group, our results are comparable to theirs. In addition,
Croisier et al.39 reported beneficial effects of hamstring muscle isokinetic
strengthening exercises on muscle pain and discomfort scores. Our present
data showed that stretching-based rehabilitation effectively reduced pain
compared with baseline but without significant differences in the VAS scores
between the rehabilitation and control groups. However, a prominent
difference in pain reduction was observed between the two groups when we
compared the pain reduction ratios. The difference in functional quality
10
because of maximal possible effect between the two groups was substantial at
this point, even though the VAS score difference remained significantly
insignificant. When considering that the VAS score has a minimum clinically
importance difference of 1.2 ± 0.3 cm,35 a mean reduction in the VAS score of
2.1 cm after 8 weeks may indicate that our rehabilitation program is clinically
relevant.
In contrast to our findings, previous reports have shown no therapeutic

efficacy with stretching-based rehabilitation programs. After a 4-week passive
stretching program in healthy subjects, Marshall et al.40 demonstrated
reductions in stretch tolerance of 0.7 cm from baseline in both the intervention
and control groups. However, in the present study, we included dancers with
hamstring injuries and measured hamstring pain directly. In the study by
Marshall et al.,40 healthy subjects were included and an instrumented SLR test
was used. Therefore, it is difficult to compare these two studies.
We observed an increase in passive ROM after the stretching-based

rehabilitation program. Improvement in muscle flexibility may result from
muscle lengthening and greater ROM and could reduce the risk of
musculotendinous injury during physical activity.19 Fasen et al. also stressed
the importance of proper stretching to increase flexibility.21 In the present
study, rehabilitative treatment with stretching resulted in an increase in PROM
of 14.5% in the experimental group, which is consistent with previous results
showing the positive effects of stretching on hamstring muscle flexibility.32,40
Nelson and Bandy32 compared the therapeutic effects of eccentric and static
stretching on hamstring muscle flexibility. They showed that hamstring
muscle flexibility in high school males with limited knee extension ROM was
significantly improved by both eccentric and static stretching compared with a
control group. O’Sullivan et al.18 also compared static and dynamic stretching
for those with hamstring strains and reported increased hamstring muscle
flexibility after static stretching. Finally, Marshall et al.40 showed that
hamstring muscle flexibility increased by 15.9° (20.9%) with an instrumented
SLR test after a passive stretching program for 5 days per week for 4 weeks.
These results are comparable because both studies used exercise programs
11
that included several stretching exercises, rather than simply comparing

stretching methods.
Different authors have proposed different methods, durations, and

periods for stretching interventions.7,9,20 However, a recent systematic
literature review concluded that it is difficult to identify an optimal hamstring
stretching method.16 In a research by Shirer et al.,38 it was reported that
beneficial effects could be obtained by multiple stretching interventions.
Therefore, we used a stretching rehabilitation program that employed multiple
exercises (e.g., lying SLR, eccentric ROM, prone leg curl, leg raising while
prone, anterior and posterior pelvic tilts, and static stretching in a standing
position) to promote functional recovery after hamstring injury. Similar to our
result, Sainz de Baranda and Ayala15 recently found that PROM increased
after stretching using the SLR test. They also performed flexibility training
with multiple (seven) stretching techniques in healthy adult subjects. Their
control group’s mean PROM also decreased over 12 weeks.
Flexibility and muscle strength are critical for muscle performance and
are often used to determine when an individual can return to performing full
activity.7 A reduction in muscle flexibility can cause a decrease in muscle
length and force that may lead to a decrease in muscle strength.14 People who
have suffered hamstring injuries reduce their movement of the injured leg
because of fear of further injury, highlighting the importance of developing a
suitable muscle stretching exercise program. In the present study, muscle
strength significantly increased in both groups after the intervention period.
Increased muscle strength is associated with load; therefore, stretching alone
will not result in muscle strengthening.40 In this study, we used the Gold
TheraBand™ as the load in the concentric and eccentric exercises. Nelson and
Bandy32 reported that the effect of eccentric training and static stretching
were similar, and when comparing training methods for muscle strengthening,
other researchers have found eccentric training to be effective in improving
muscle strength.26,41 Many researchers have compared strength gain after
eccentric and concentric training, concluding that eccentric muscle actions are
more efficient than concentric contractions.36,41,42 However, the preventive
12
role of eccentric exercise has not been clearly defined, despite evidence of the
protective effect of muscle strengthening on the occurrence of hamstring
strains.11 Increased muscle strength in the present study was considered to be
responsible for the reduction in pain and improvement in flexibility.
There are several limitations that should be considered in this study.
First, although the sample size is similar to that in a previous study18 and
although the numbers per group are consistent with those in another study,39
the sample size is still small. Second, the investigator was not blinded to the
rehabilitation program being performed, although this was unavoidable.
However, we think that this bias was minimized by using independent
assessors to complete the measurement and analysis. Third, more specific and
objective measurement techniques were not used. Nevertheless, further study
will be required with a larger sample size and objective measurement
techniques, such as electromyography, of a particular muscle.
Conclusions
In conclusion, a stretching-based rehabilitation program can

effectively decrease pain and increase flexibility and strength in injured
hamstrings. This suggests that with a suitable combination of multiple
stretching exercises in a formal rehabilitation program, motor function can be
restored in patients with hamstring injury by decreasing pain and increasing
flexibility.
13
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15
a
Authors’ contributions: These two authors contributed
equally to this work.
Conflict of Interest: There are no conflicts of interest,
financial or otherwise, in this study.
16
TABLE TITLES
Table I. Baseline Demographics of the Control and

Rehabilitation Groups*
Table Ⅱ. The VAS Scores of the Rehabilitation and Control
Groups Before and After the Intervention
Table Ⅲ. Distribution of Changes in ROM and Muscle Strength
in the Rehabilitation and Control Groups after the Intervention
FIGURE TITLES
Figure 1. Participant flow diagram. This is a CONSORT flow

diagram for participant recruitment and retention.
Figure 2. The rehabilitation program. A, SLR; B, eccentric
ROM training; C, leg curl; D, leg raising; E, anterior and posterior
pelvic tilt; and F, static stretching in a standing position.
Abbreviations: SLR, straight leg raising; ROM, range of motion.
Figure 3. Measurement of SLR. A, Active ROM and B,
passive ROM. Abbreviations: SLR, straight leg raising; ROM, range
of motion.
Figure 4. Measurement of muscle strength.
17
Table Ⅰ. Baseline Demographics of the Control and Rehabilitation Groups*

Rehabilitation
Control group(n=6) P Value
group(n=7)
Age, y 25(21-27) 22.9 ± 2.3 .139†
Gender(M/F), n 1/5 2/5
Height, cm 161.5 ± 4.1 162(158-184) .387†
Weight, kg 54.8 ± 6.2 54.2 ± 8.7 .888
BMI, kg/m2 26.5 ± 4.8 21.4 ± 4.3 .068
SBP, mmHg 107.0 ± 7.0 115.6 ± 8.8 .082
DBP, mmHg 77.3 ± 9.2 80.9 ± 12.3 .576
Abbreviations: M, male; F; female; BMI, body mass index; SBP, systolic blood pressure;
DBP, diastolic blood pressure.
*
Values are mean ± SD except for age and height, which is median (range).
†
Mann-Whitney U test for data not normally distributed.
Table Ⅱ. The VAS Scores of the Rehabilitation and Control Groups Before and After the
Intervention
Before intervention After intervention
VAS(0-10cm)*
Rehabilitation group 4.2±1.2 2.1±0.9
Control group 4.3±2.8 3.7±2.2
Within group difference from baseline†
Rehabilitation group -2.1(0.5, 3.7) ‡
Control group -0.7(-2.3, 3.7)
Between group in change score† -1.5 (-4.3, 1.4)
Abbreviations: VAS, visual analogue scale.

*
Values are mean ± SD.
†
Values are mean and in parentheses are 95% confidence interval.
‡
Statistically significant differences (p<0.05).
Table Ⅲ. Distribution of Changes in ROM and Muscle Strength in the Rehabilitation and Control Groups after the Intervention
Injured leg Normal leg
Before After Before After
intervention intervention intervention intervention
AROM,°
Rehabilitation group 104.7±17.2 108.1±10.5 104.6±17.5 105.6±11.2
Control group 109.7±11.2 108.0±11.8 112.5±8.6 109.0±14.0
Within group difference from
baseline†
Rehabilitation group 3.4(-5.5,12.4) 1.0(-10.1, 12.1)
Control group -1.7(-9.1, 5.7) -3.5(-13.3, 6.3)
Between group in change score† 5.1(-5.4, 15.6) 4.5(-8.8, 17.8)
PROM,°
Rehabilitation group 121.9±8.4 139.6±5.9 123.0±7.5 131.7±7.5
Control group 128.2±3.9 128.3±8.5 129.8±5.2 129.0±8.5
Within group difference from
baseline†
Rehabilitation group 17.7(11.6, 23.8)‡ 8.7(-2.3, 19.7)
Control group 0.2(-6.3, 6.6) -0.8(-10.9, 9.3)
Between group in change score† 17.5(9.7, 25.4)‡ 9.5(-3.8, 22.9)
MS, Ibs
20.0(9.0-21.0) 20.0(10.5-21.5)
Rehabilitation group
17.7±4.4 24.8±3.6 18.3±3.7 26.3±3.9
Control group 16.4±1.6 23.6±3.3 16.8±2.8 24.0±2.8
Within group difference from baseline
Rehabilitation group§ -2.4‡, 7.1(3.6,10.5) -2.4‡, 8.0(4.4, 11.6)
Control group 7.2(4.7,9.6)‡ 7.3(2.5,12.0)‡
Between group in change score∥ 20.0 20.0
Abbreviations: AROM, active range of motion; PROM, passive range of motion; MS, muscle strength.
*
Values are mean ± SD except for before intervention MS of rehabilitation group , which is median (range).
†
Values are mean and in parentheses are 95% confidence interval.
‡
Statistically significant differences (p<0.05).
§
Values are Wilcoxon’s Z and mean and in parentheses are 95% confidence interval .
∥
Values are Mann-Whitney’s U.

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The Journal of Sports Medicine and Physical Fitness

EDIZIONI MINERVA MEDICA

Effect of stretching-based rehabilitation on pain, flexibility

The Journal of Sports Medicine and Physical Fitness 2017 Oct 24

Article type: Original Article

© 2017 EDIZIONI MINERVA MEDICA

Article first published online: October 24, 2017

Subscription: Information about subscribing to Minerva Medica journals is online at:

EDIZIONI MINERVA MEDICA

Giwon Kim,1, 2, a Hyangsun Kim,3, a Woo K. Kim,4 Junesun

*Corresponding author: Junesun Kim, Rehabilitation Science

BACKGROUNDː Hamstring injuries commonly occur in

METHODSː Sixteen Korean traditional dancers with unilateral

RESULTSː Subjects who underwent rehabilitation showed

CONCLUSIONSː This rehabilitation program effectively

Key words: flexibility, hamstring injury, muscle strength,

Athletes and dancers are frequently required to perform intense

Hamstring injury is the most common injury in sports medicine,5,6

Stretching exercises are important elements of fitness and conditioning

Various stretch techniques are used in practice, including static,

In this study, we evaluated the effects of an 8-week, stretching-based

Materials and methods

All procedures in this single-blind (participant), prospective,

The participants in the rehabilitation group underwent a rehabilitation

The rehabilitation program was designed and modified based on

TheraBand™ (Hygenic Corporation, Akron, OH, USA), which was wrapped

Hamstring muscle flexibility

Flexibility of the hamstring muscle was measured by an SLR ROM

Hamstring muscle strength

The isometric strength of the hamstring muscle was assessed using a

Values for normally distributed data were expressed as means ±

In total, 16 participants satisfied the eligibility criteria and agreed to

Flexibility and Strength

Before the intervention, muscle strength was comparable between the

In the present study, we demonstrated that in dancers with hamstring

was effectively restored. Of note, there were significant reductions in pain

Pain, flexibility (ROM), and muscle strength are important factors

Stretching exercises can increase muscle flexibility and relieve the

In contrast to our findings, previous reports have shown no therapeutic

We observed an increase in passive ROM after the stretching-based

that included several stretching exercises, rather than simply comparing

Different authors have proposed different methods, durations, and

In conclusion, a stretching-based rehabilitation program can

1. Deleget A. Overview of thigh injuries in dance. J Dance Med Sci. 2010;14(3):97-102.

ed controlled trial. BMC Musculoskelet Disord. 2014;15:137.

Table I. Baseline Demographics of the Control and

Figure 1. Participant flow diagram. This is a CONSORT flow

Table Ⅰ. Baseline Demographics of the Control and Rehabilitation Groups*

Before intervention After intervention

Rehabilitation group 4.2±1.2 2.1±0.9

Control group 4.3±2.8 3.7±2.2

Within group difference from baseline†

Rehabilitation group -2.1(0.5, 3.7) ‡

Control group -0.7(-2.3, 3.7)

Between group in change score† -1.5 (-4.3, 1.4)

Abbreviations: VAS, visual analogue scale.

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