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D. SCOTT DAVIS, PAUL E. ASHBY, KRISTI L. MCCALE, JERRY A. MCQUAIN, AND JAIME M. WINE
Department of Human Performance and Exercise Science, Division of Physical Therapy, West Virginia University,
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ABSTRACT. Davis, D.S., P.E. Ashby, K.L. McCale, J.A. McQuain, Despite the importance of regular stretching, much con-
and J.M. Wine. The effectiveness of 3 stretching techniques on troversy exists as to which stretching technique and pa-
hamstring flexibility using consistent stretching parameters. J. rameters are the most effective for increasing muscle flex-
Strength Cond. Res. 19(1):27–32. 2005.—This study compares
ibility.
the effects of 3 common stretching techniques on the length of
the hamstring muscle group during a 4-week training program. Several stretching techniques have been described in
Subjects were 19 young adults between the ages of 21 and 35. the literature. Three common stretching techniques in-
The criterion for subject inclusion was tight hamstrings as de- clude static stretching, active self-stretching, and propri-
fined by a knee extension angle greater than 208 while supine oceptive neuromuscular facilitation (PNF) (3, 4, 12–14,
with the hip flexed 908. The participants were randomly as- 21, 23).
signed to 1 of 4 groups. Group 1 (n 5 5) was self-stretching, Static stretching is a common technique used by
group 2 (n 5 5) was static stretching, group 3 (n 5 5) was pro- strength and conditioning specialists and athletes to in-
prioceptive neuromuscular facilitation incorporating the theory
crease muscle length. This type of stretching takes the
of reciprocal inhibition (PNF-R), and group 4 (n 5 4) was control.
Each group received the same stretching dose of a single 30- muscle to its end range and maintains this position for a
second stretch 3 days per week for 4 weeks. Knee extension an- specified duration (4, 12, 14, 21). One of the advantages
gle was measured before the start of the stretching program, at of static stretching may be the facilitation of the Golgi
2 weeks, and at 4 weeks. Statistical analysis (p # 0.05) revealed tendon organ (GTO). Static tension placed on the muscle-
a significant interaction of stretching technique and duration of tendon unit has been shown to activate the GTO, which
stretch. Post hoc analysis showed that all 3 stretching tech- may produce autogenic inhibition of the muscle that is
niques increase hamstring length from the baseline value during stretched (4). Static stretching has been shown to be very
a 4-week training program; however, only group 2 (static
effective at increasing hamstring length (1, 2, 5, 9, 14, 15,
stretching) was found to be significantly greater than the control
at 4 weeks. These data indicate that static stretching 1 repeti- 19, 21, 23).
tion for 30 seconds 3 days per week increased hamstring length Several studies have attempted to determine the most
in young healthy subjects. These data also suggest that active appropriate parameters for static stretching. Duration,
self-stretching and PNF-R stretching 1 repetition for 30 seconds frequency, number of repetitions, daily dose, and length
3 days per week is not sufficient to significantly increase ham- of program are important parameters to consider. Sug-
string length in this population. gested effective durations range from 5 to 60 seconds.
KEY WORDS. proprioceptive, muscle length, daily dose Roberts and Wilson (17) compared nine 5-second static
stretches and three 15-second static stretches with a con-
trol group by using an active static stretch for 5 weeks.
INTRODUCTION They concluded that both durations increased hamstring
uscular flexibility is an important aspect of flexibility when compared with a control, but the 15-sec-
27
28 DAVIS, ASHBY, MCCALE ET AL.
one 30-second static stretch. They reported that all the string flexibility changes during the course of a 4-week
groups increased hamstring length compared with the program.
control, but no difference was found among the different The primary purpose of this investigation was to com-
frequencies or stretching durations. They concluded that pare static stretching, PNF-R stretching, and active self-
one 30-second stretch was just as effective as a 60-second stretching in a randomized controlled trial by using the
stretch performed 3 times per day (2). same stretching parameters during a 2- and 4-week train-
The length of the stretching program is also of great ing program.
concern. Studies have recommended 1 day to 8 weeks (1,
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stretching program with a control and found that both effectiveness of 3 common stretching techniques during a
groups were equally effective at increasing hamstring 4-week training program. The design allowed for the in-
length. It remains unclear if shorter stretching programs vestigation of possible interaction effects of technique and
are effective at increasing hamstring muscle length. duration of training. The dependent variable was ham-
Proprioceptive neuromuscular facilitation is another string length as measured by the knee extension angle
common stretching technique. Theoretically, PNF (KEA), and the 2 independent variables included stretch-
stretching uses muscle inhibition techniques before the ing technique and duration of the stretching program. Be-
stretch to enhance the effectiveness of the stretch (12). fore recruiting the subjects, the investigation was ap-
This type of stretching uses the theories of autogenic and proved by the West Virginia University Institutional Re-
reciprocal inhibition to ‘‘relax’’ the muscle before the view Board for Human Subjects. The subjects were ran-
stretch (12). However, some researchers have questioned domly assigned to 1 of 3 treatment groups or a control.
the ability of these techniques to actually inhibit muscle The primary investigator was blinded to subject assign-
activity (14, 15). Lack of standardized parameters and ment throughout the investigation.
consistent terminology has created confusion when at-
Subjects
tempting to compare the effectiveness of PNF stretching
techniques (4, 7, 12, 13, 15, 21). Nineteen individuals (age 5 23.1 6 1.5 years) volun-
Only 1 type of PNF stretching will be discussed here teered to participate in this study. To be included in the
to both avoid confusion and confine the discussion to the investigation, participants were required to have tight
techniques used in this investigation. Concentric contrac- hamstring as defined by a 208 KEA with the hip in 908 of
tion of the opposing muscle is theorized to result in recip- hip flexion. Participants were also required to be between
rocal inhibition of the muscle that is stretched. The tech- 18 and 40 years of age. Subjects were excluded from the
nique is sometimes referred to as agonist contraction (12); investigation if they had previous history of lower-ex-
however, to avoid confusion, this form of PNF stretching tremity pathology, which may adversely affect hamstring
will be operationally defined as PNF-R. flexibility length. Each participant signed a consent form
On the basis of the electromyogram (EMG) results of approved by the West Virginia University Institutional
Moore and Hutton (14) and Osternig and colleagues (15), Review Board for Human Subjects, and the rights of hu-
the theory by which PNF stretching works has been man subjects were protected.
called into question. Both investigations found an in-
crease in EMG activity during the stretching phase of the Knee Extension Angle
PNF techniques. Despite the apparent lack of muscle in- Measurements were performed throughout the study by
hibition associated with these techniques, PNF stretching the same examiner (D.S.D.), who had 13 years of clinical
has been shown to be an effective method of increasing experience as a physical therapist. The examiner was
hamstring flexibility (14, 19). blinded to group assignment throughout the investiga-
It is extremely difficult to determine the most effica- tion. Measurements were taken with subjects in the su-
cious hamstring stretching program in the current liter- pine position on a treatment plinth. Bilateral KEA mea-
ature. Inconsistent parameters resulting in different surements were obtained in sequence (Figure 1). The test-
stretching doses and a lack of direct comparison with a ed extremity was placed in a 908 hip and 908 knee position
control make determination impossible. Therefore, con- with the contralateral lower extremity placed flat on the
troversy remains regarding which stretching technique is table. Two Velcro straps were placed on the distal leg
the most effective and what the frequency, length of pro- above the malleoli and 2 were placed on the distal thigh
gram, speed of stretch, and the intensity of stretch for above the patella to hold gravity inclinometers. The in-
these various techniques should be. clinometers were consistently placed at the level of the
Research conducted by Bandy and Irion (1) and Bandy medial malleoli and the superior pole of the patella. The
et al. (2, 3) has provided a gold standard for duration and examiner used the inclinometer on the thigh to maintain
frequency of static stretching. Unfortunately, the same is 908 of hip flexion. Pelvic position was monitored by pal-
not available for PNF techniques. Therefore, no study has pation of the anterior superior iliac spine and lumbar spi-
compared the 3 PNF inhibition techniques with one an- nous processes to maintain a neutral pelvic position.
other and with static stretching by using consistent pa- Next, the examiner passively extended the knee to the
rameters. On the basis of the literature, it is clear that point of a ‘‘strong, but tolerable stretch’’, as reported by
further research is needed to compare PNF techniques the subject. The primary examiner read the angle of the
with static stretching in a randomized controlled trial inclinometer while a second investigator recorded the val-
with consistent parameters. It is also clear that further ue. Measurements were repeated on the opposite limb by
investigation is needed to better understand how ham- the same procedure. The angle that was used for statis-
STRETCHING AND HAMSTRING FLEXIBILITY 29
strings, the right hip was passively flexed to 908 and the
knee passively extended until the subject reported a
strong but tolerable stretch. The contralateral extremity
remained flat on the plinth. The static stretch was main-
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thirty 1-second stretches twice daily during a 6-week gation, strength and conditioning specialists are encour-
stretching program. aged to use one 30-second static stretch 3 days per week
This investigation contradicts the findings of previous for at least 4 weeks with their athletes and clients who
investigators (14, 15, 19) who found PNF inhibition tech- have tight hamstrings. Also, strength and conditioning
niques to be more effective than static stretching. One of specialists should recognize that intensity, dose, frequen-
the most likely reasons for the difference in findings was cy, and program duration are just as important with mus-
that this investigation used a 30-second static stretch, as cle stretching as with strength training.
suggested by Bandy and Irion (1), as compared with a 6-
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74:845–850. 1994.
conceivable to ask why static stretching was the only 2. BANDY, W.D., J.M. IRION, AND M. BRIGGLER. The effect of time
stretching technique effective at increasing hamstring and frequency of static stretching on flexibility of the ham-
length. It has been theorized that a slow static stretch string muscles. Phys. Ther. 77:1090–1096. 1997.
facilitates the GTO, which may produce inhibition of the 3. BANDY, W.D., J.M. IRION, AND M. BRIGGLER. The effect of static
muscle that is stretched. Self-stretching and PNF-R re- stretch and dynamic range of motion training on the flexibility
quire an active contraction of the opposing muscle (quad- of the hamstring muscles. J. Orthop. Sports Phys. Ther. 27:295–
riceps), which, according to Moore and Hutton (14) and 300. 1998.
Osternig et al. (15), actually facilitates the hamstring 4. BANDY, W.D., AND B. SANDERS. Therapeutic Exercise: Tech-
muscles. Therefore, the mechanism by which PNF func- niques for Intervention. Philadelphia: Lippincott Williams &
tions may not be related to the long-held theory of neural Wilkins, 2001.
inhibition associated with prestretch contractions. The 5. CHAN, S.P., Y. HONG, AND P.D. ROBINSON. Flexibility and pas-
sive resistance of the hamstrings of young adults using two
authors speculate that other mechanisms such as me-
different static stretching protocols. Scand. J. Med. Sci. Sports
chanical elongation or creep of the connective-tissue com- 11:81–86. 2001.
ponents of the muscle while in the presence of inhibition 6. CIPRIANI, D., B. ABEL, AND D. PIRRWITZ. A comparison of two
of the GTO during passive static stretching may be the stretching protocols on hip range of motion: Implications for
overriding difference. total daily stretch duration. J. Strength Cond. Res. 17:274–278.
This investigation clearly outlines the parameters and 2003.
procedures used with each stretching technique. Previous 7. CORNELIUS, W.L. Modified PNF stretching: Improvement in
investigations have been inconsistent with terminology, hip flexion. Natl. Strength Cond. Assoc. J. 12:44–45. 1990.
used inconsistent stretching parameters, and failed to ad- 8. HALBERTSMA, J.P., I. MULDER, L.N. GOEKEN, AND W.H. EISMA.
equately describe the stretching procedures for the PNF Repeated passive stretching: Acute effects on the passive mus-
stretching techniques (4, 12, 14, 15, 21, 22). cle moment and extensibility of short hamstrings. Arch. Phys.
One of the limitations of this investigation is the sam- Med. Rehabil. 80:407–414. 1999.
9. HALBERTSMA, J.P., A.I. VAN BOLHUIS, AND L.N. GOEKEN. Sport
ple size. Despite the limited sample size, the response to
stretching: Effect on passive muscle stiffness of short ham-
stretching was great enough in the static stretching group strings. Arch. Phys. Med. Rehabil. 77:688–692. 1996.
to identify a statistically significant difference between 10. HARTIG, D.E., AND J.M. HENDERSON. Increasing hamstring
the interaction of stretching technique and time at the flexibility decreases lower extremity overuse injuries in mili-
level of significance (p , 0.05). Power analysis revealed tary basic trainees. Am. J. Sports Med. 27:173–176. 1999.
ample power (1-b 5 0.96) for the interaction of stretching 11. HRELJAC, A., R.N. MARSHALL, AND P.A. HUME. Evaluation of
technique and time. It is also important to keep in mind lower extremity overuse injury potential in runners. Med. Sci.
that the sample included only healthy young adults, and Sports Exerc. 32:1635–1641. 2000.
the results of this investigation should not be generalized 12. KISNER, C., AND L.A. COLBY. Therapeutic Exercise: Foundations
to persons outside the sample population. Additionally, and Techniques. Philadelphia: F.A. Davis Co., 2002.
because the hamstring muscles were the only muscles 13. MAGNUSSON, S.P., E.B. SIMONSEN, P. AAGAARD, P. DYHRE-
tested, it would be inappropriate to generalize the results POULSEN, M.P. MCHUGH, AND M. KJAER. Mechanical and phys-
iological responses to stretching with and without preisometric
of this investigation to other muscles or muscle groups.
contraction in human skeletal muscle. Arch. Phys. Med. Reh-
Further investigation in this area is needed to compare abil. 77:373–378. 1996.
other forms of PNF stretching with static stretching by 14. MOORE, M.A., AND R.S. HUTTON. Electromyographic investi-
using consistent parameters and to determine the most gation of muscle stretching techniques. Med. Sci. Sports Exerc.
effective parameters for PNF stretching. 12:322–329. 1980.
15. OSTERNIG, L.R., R.N. ROBERTSON, R.K. TROXEL, AND P. HAN-
PRACTICAL APPLICATIONS SEN. Muscle activation during proprioceptive neuromuscular
The purpose of this study was to compare 3 common facilitation (PNF) stretching techniques. Am. J. Phys. Med. 66:
stretching techniques by using the same stretching pa- 298–307. 1987.
rameters on the hamstring muscle group in healthy 16. OSTERNIG, L.R., R.N. ROBERTSON, R.K. TROXEL, AND P. HAN-
SEN. Differential response to proprioceptive neuromuscular fa-
young subjects and to determine if a stretching program
cilitation (PNF) stretching techniques. Med. Sci. Sports Exerc.
of 2 and 4 weeks is capable of producing significant gains
22:106–111. 1990.
in hamstring flexibility. The results of this investigation 17. ROBERTS, J.M., AND K. WILSON. Effect of stretching duration
revealed that static stretching of the hamstrings is more on active and passive range of motion in the lower extremity.
efficacious than self-stretching and PNF stretching that Br. J. Sports Med. 33:259–263. 1999.
incorporates the theory of reciprocal inhibition when us- 18. ROSS, M. Effect of lower-extremity position and stretching on
ing a 30-second stretching dose applied 3 days per week hamstring muscle flexibility. J. Strength Cond. Res. 13:124–
for 4 weeks. On the basis of the results of this investi- 129. 1999.
32 DAVIS, ASHBY, MCCALE ET AL.
19. SADY, S.P., M. WORTMAN, AND D. BLANKE. Flexibility training: 24. WILLY, R.W., B.A. KYLE, S.A. MOORE, AND G.S. CHLEBOUN. Ef-
Ballistic, static or proprioceptive neuromuscular facilitation? fect of cessation and resumption of static hamstring muscle
Arch. Phys. Med. Rehabil. 63:261–263. 1982. stretching on joint range of motion. J. Orthop. Sports Phys.
20. SAFRAN, M.R., A.V. SEABER, AND W.E. GARRETT. Warm-up and Ther. 31:138–144. 2001.
muscular injury prevention: An update. Sports Med. 8:239–249. 25. ZACHAZEWSKI, J.E., D.J. MAGEE, AND W.S. QUILLEN. Athletic
1989. Injuries and Rehabilitation. Philadelphia: WB Saunders Co.,
21. SHELLOCK, F.G., AND W.E. PRENTICE. Warming-up and stretch- 1996.
ing for improved physical performance and prevention of
sports-related injuries. Sports Med. 2:267–278. 1985. Acknowledgments
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