Modified Hold-Relax Stretching Technique Combined with Moist Heat Therapy to Improve Neuromuscular Properties in College Students with Hamstring Tightness
Muscle stretching and properties of muscle
Abstract
Introduction: This study aims to evaluate the effect of modified hold-relax stretching combined with moist heat therapy on hamstring muscle flexibility, EMG activity and strength in college students with hamstring tightness.
Materials and Methods: Thirty-eight college students with hamstring tightness were recruited and were divided into two groups. Group 1 received modified hold-relax stretching plus moist heat therapy and Group 2 received moist heat therapy alone, three days a week for four weeks. The knee range of motion (ROM), muscle strength and Electromyography (EMG) activity before and after the treatment protocol were measured.
Results: There was no significant difference between the two groups in demographic characteristics. The knee ROM was significantly different between groups in terms of time (P=0.001) and group (P=0.005) effects, but the strength and EMG activity were not significantly different.
Conclusion: The modified hold-relax technique combined with moist heat therapy is effective in increasing hamstring flexibility, but has no significant effect on the muscle EMG activity and strength.
1. Law RY, Harvey LA, Nicholas MK, Tonkin L, De Sousa M, Finniss DG. Stretch exercises increase tolerance to stretch in patients with chronic musculoskeletal pain: a randomized controlled trial. Physical Therapy.2009; 89(10): 1016-26. [DOI: 10.2522/ptj.20090056]
2. Heiderscheit BC, Sherry MA, SilderA, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. Journal of Orthopaedic &Sports Physical Therapy.2020; 40(2): 67-81. [DOI: 10.2519/jospt.2010.3047]
3. Henderson G, Barnes CA, Portas MD. Factors associated with increased propensity for hamstring injury in English Premier League soccer players. Journal of Science and Medicine in Sport.2010; 13(4): 397-402. [DOI: 10.1016/j.jsams.2009.08.003]
4. Petersen W, Ellermann A, Gösele-Koppenburg A, Best R, Rembitzki IV, Brüggemann GP, Liebau, C. (2014). Patellofemoral pain syndrome. Knee Surgery, Sports traumatology, Arthroscopy.2014; 22(10): 2264-74. [ DOI: 10.1007/s00167-013-2759-6]
5. Halbertsma JP, van Bolhuis AI, Göeken LN. Sport stretching: effect on passive muscle stiffness of short hamstrings. Archives of Physical Medicine and Rehabilitation.1996; 77(7):688-92.[ DOI: 10.1016/s0003-9993(96)90009-x]
6. Spernoga SG, Uhl TL, Arnold B, Gansneder BM. Duration of maintained hamstring flexibility after a one-time, modified hold-relax stretching protocol. Journal of Athletic Training.2001;36(1): 44-48
7.Lewit K, Simons DG. Myofascial pain: relief by post-isometric relaxation. Archives of Physical medicine and rehabilitation. 1984;65(8):452-56.
8.Marek SM, Cramer JT, Fincher AL, Massey LL, Dangelmaier SM, Purkayastha S, Fitz KA, Culbertson JY. Acute effects of static and proprioceptive neuromuscular facilitation stretching on muscle strength and power output. Journal of Athletic Training. 2005;40(2):94-103
9. Osternig LR, Robertson R, Troxel R, Hansen P. Muscle activation during proprioceptive neuromuscular facilitation (PNF)stretching techniques. American Journal of Physical Medicine 1987;66: 298–307.
10. Cengiz A. EMG and peak force responses to PNF stretching and the relationship between stretching-induced force deficits and bilateral deficits. Journal of Physical Therapy Science. 2015;27(3): 631-34.[DOI: 10.1589/jpts.27.631]
11. Ahmed H, Iqbal A, Anwer S, Alghadir A. Effect of modified hold-relax stretching and static stretching on hamstring muscle flexibility. Journal of Physical Therapy Science.2015; 27(2): 535-38. [DOI: 10.1589/jpts.27.535]
12. Youdas JW, Haeflinger KM, Kreun MK, Holloway AM, Kramer CM, Hollman JH. The efficacy of two modified proprioceptive neuromuscular facilitation stretching techniques in subjects with reduced hamstring muscle length. Physiotherapy Theory and Practice.2010 ;26(4): 240-50. [ DOI: 10.3109/09593980903015292]
13.Eftekhari S, Khayambashi S, Marandi SM, Yosefzadeh M.. To compare immediate, 24 and 48 hours effects of static, dynamic and PNF stretching techniques on hamstring flexibility. Journal of Modern Rehabilitation. 2015; 9(3): 64-71
14. Taylor DC, DaltonJr JD, Seaber AV, Garrett Jr WE. Viscoelastic properties of muscle-tendon units: the biomechanical effects of stretching. American Journal of Sports Medicine.1990; 18:300–09 [DOI: 10.1177/036354659001800314]
15. Knight CA, Rutledge CR, Cox ME, Acosta M, Hall SJ. Effect of superficial heat, deep heat, and active exercise warm-up on the extensibility of the plantar flexors. Physical Therapy. 2001;81(6):1206-14. [ DOI : 10.1093/ptj/81.6.1206 ]
16. Robertson VJ, Ward AR, Jung P. The effect of heat on tissue extensibility: a comparison of deep and superficial heating. Archives of Physical Medicine and Rehabilitation. 2005;86(4):819-25. [DOI: 10.1016/j.apmr.2004.07.353]
17. Cipriani D J, Terry ME, Haines MA., Tabibnia AP, Lyssanova O. Effect of stretch frequency and sex on the rate of gain and rate of loss in muscle flexibility during a hamstring-stretching program: a randomized single-blind longitudinal study. The Journal of Strength & Conditioning Research.2012; 26(8): 2119-29. [DOI: 10.1519/JSC.0b013e31823b862a]
18. Brodowicz GR, Welsh R, Wallis J. Comparison of stretching with ice, stretching with heat, or stretching alone on hamstring flexibility.Journal of Athletic Training.1996; 31(4): 324-27.
19. Gogia PP, Braatz JH, Rose SJ, Norton BJ. Reliability and validity of goniometric measurements at the knee. Physical Therapy. 1987;67(2):192-95.
20. Davis DS, Quinn RO, Whiteman CT, Williams JD, Young CR. Concurrent validity of four clinical tests used to measure hamstring flexibility. The Journal of Strength & Conditioning Research.2008; 22(2): 583-88. [ DOI: 10.1519/JSC.0b013e31816359f2]
21. Luc-Harkey BA, Safran-Norton CE, Mandl LA, Katz JN, Losina E. Associations among knee muscle strength, structural damage, and pain and mobility in individuals with osteoarthritis and symptomatic meniscal tear. BMC Musculoskeletal Disorders.2018; 19(1): 258. [DOI : 10.1186/s12891-018-2182-8]
22. Thorborg K, Bandholm T, Hölmich P. Hip-and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable. Knee Surgery, Sports Traumatology, Arthroscopy.2013; 21(3): 550-55. [DOI: 10.1007/s00167-012-2115-2]
23.Pincivero DM, Aldworth C, Dickerson T, Petry C, Shultz T. Quadriceps-hamstring EMG activity during functional, closed kinetic chain exercise to fatigue. European Journal of Applied Physiology. 2000;81(6):504-09.[DOI: 10.1007/s004210050075]
24. Sethi K, Noohu MM. Scapular muscles strengthening on pain, functional outcome and muscle activity in chronic lateral epicondylalgia. Journal of Orthopaedic Science.2018;23(5):777-82.[DOI: 10.1016/j.jos.2018.05.003]
25.Kumar GP. Comparison of cyclic loading and hold relax technique in increasing resting length of hamstring muscles. Hong Kong Physiotherapy Journal.2011; 29(1): 31-33. [DOI: 10.1016/j.hkpj.2011.03.002]
26. Macefield G, HagbarthKE, Gorman R, Gandevia SC, Burke D.Decline in spindle support to alpha‐motoneurones during sustained voluntary contractions. The Journal of Physiology.1991; 440(1): 497-512. [DOI: 10.1113/jphysiol.1991.sp018721]
27. De Deyne PG. Application of passive stretch and its implications for muscle fibers. Physical Therapy. 2001; 81(2): 819-27. [DOI: 10.1093/ptj/81.2.819]
28. Chalmers G. Strength training: Re‐examination of the possible role of golgi tendon organ and muscle spindle reflexes in proprioceptive neuromuscular facilitation muscle stretching. Sports Biomechanics.2004;3(1): 159-183. [DOI: 10.1080/14763140408522836]
29. Ferber R, Osternig LR, Gravelle DC.Effect of PNF stretch techniques on knee flexor muscle EMG activity in older adults. Journal of Electromyography and Kinesiology. 2002; 12(5): 391-97. [DOI: 10.1016/S1050-6411(02)00047-0]
30. Sharman MJ, Cresswell AG, Riek, S. Proprioceptive neuromuscular facilitation stretchingmechanisms and clinical implications. Sports Medicine.2006; 36(11): 929-39. [DOI: 10.2165/00007256-200636110-00002]
31. Lim KI, Nam HC, Jung, KS. Effects on hamstring muscle extensibility, muscle activity, and balance of different stretching techniques. Journal of Physical Therapy Science.2014; 26(2): 209-13. [DOI: 10.1589/jpts.26.209]
32. Carter AM, Kinzey SJ, Chitwood LF, Cole JL. Proprioceptive Neuromuscular Facilitation Decreases Muscle Activity During the Stretch Reflex in Selected Posterior Thigh Muscles. Journal of Sport Rehabilitation.200; 9(4):269-278.[DOI: 10.1123/jsr.9.4.269 ]
33. Miyahara Y, Naito H, Ogura Y, Katamoto S, Aoki J. Effects of proprioceptive neuromuscular facilitation stretching and static stretching on maximal voluntary contraction. The Journal of Strength & Conditioning Research.2013; 27(1): 195-201. [DOI: 10.1519/JSC.0b013e3182510856]
34. de Lima Costa GV, da Silveira ALB, Di Masi F , Bentes CM, de Sousa MSC, da Silva NJ. Acute effect of different stretching methods on isometric muscle strength. Acta Scientiarum. Health Sciences.2014; 36(1): 51-57. [DOI: 10.4025/actascihealthsci.v36i1.15581].
2. Heiderscheit BC, Sherry MA, SilderA, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. Journal of Orthopaedic &Sports Physical Therapy.2020; 40(2): 67-81. [DOI: 10.2519/jospt.2010.3047]
3. Henderson G, Barnes CA, Portas MD. Factors associated with increased propensity for hamstring injury in English Premier League soccer players. Journal of Science and Medicine in Sport.2010; 13(4): 397-402. [DOI: 10.1016/j.jsams.2009.08.003]
4. Petersen W, Ellermann A, Gösele-Koppenburg A, Best R, Rembitzki IV, Brüggemann GP, Liebau, C. (2014). Patellofemoral pain syndrome. Knee Surgery, Sports traumatology, Arthroscopy.2014; 22(10): 2264-74. [ DOI: 10.1007/s00167-013-2759-6]
5. Halbertsma JP, van Bolhuis AI, Göeken LN. Sport stretching: effect on passive muscle stiffness of short hamstrings. Archives of Physical Medicine and Rehabilitation.1996; 77(7):688-92.[ DOI: 10.1016/s0003-9993(96)90009-x]
6. Spernoga SG, Uhl TL, Arnold B, Gansneder BM. Duration of maintained hamstring flexibility after a one-time, modified hold-relax stretching protocol. Journal of Athletic Training.2001;36(1): 44-48
7.Lewit K, Simons DG. Myofascial pain: relief by post-isometric relaxation. Archives of Physical medicine and rehabilitation. 1984;65(8):452-56.
8.Marek SM, Cramer JT, Fincher AL, Massey LL, Dangelmaier SM, Purkayastha S, Fitz KA, Culbertson JY. Acute effects of static and proprioceptive neuromuscular facilitation stretching on muscle strength and power output. Journal of Athletic Training. 2005;40(2):94-103
9. Osternig LR, Robertson R, Troxel R, Hansen P. Muscle activation during proprioceptive neuromuscular facilitation (PNF)stretching techniques. American Journal of Physical Medicine 1987;66: 298–307.
10. Cengiz A. EMG and peak force responses to PNF stretching and the relationship between stretching-induced force deficits and bilateral deficits. Journal of Physical Therapy Science. 2015;27(3): 631-34.[DOI: 10.1589/jpts.27.631]
11. Ahmed H, Iqbal A, Anwer S, Alghadir A. Effect of modified hold-relax stretching and static stretching on hamstring muscle flexibility. Journal of Physical Therapy Science.2015; 27(2): 535-38. [DOI: 10.1589/jpts.27.535]
12. Youdas JW, Haeflinger KM, Kreun MK, Holloway AM, Kramer CM, Hollman JH. The efficacy of two modified proprioceptive neuromuscular facilitation stretching techniques in subjects with reduced hamstring muscle length. Physiotherapy Theory and Practice.2010 ;26(4): 240-50. [ DOI: 10.3109/09593980903015292]
13.Eftekhari S, Khayambashi S, Marandi SM, Yosefzadeh M.. To compare immediate, 24 and 48 hours effects of static, dynamic and PNF stretching techniques on hamstring flexibility. Journal of Modern Rehabilitation. 2015; 9(3): 64-71
14. Taylor DC, DaltonJr JD, Seaber AV, Garrett Jr WE. Viscoelastic properties of muscle-tendon units: the biomechanical effects of stretching. American Journal of Sports Medicine.1990; 18:300–09 [DOI: 10.1177/036354659001800314]
15. Knight CA, Rutledge CR, Cox ME, Acosta M, Hall SJ. Effect of superficial heat, deep heat, and active exercise warm-up on the extensibility of the plantar flexors. Physical Therapy. 2001;81(6):1206-14. [ DOI : 10.1093/ptj/81.6.1206 ]
16. Robertson VJ, Ward AR, Jung P. The effect of heat on tissue extensibility: a comparison of deep and superficial heating. Archives of Physical Medicine and Rehabilitation. 2005;86(4):819-25. [DOI: 10.1016/j.apmr.2004.07.353]
17. Cipriani D J, Terry ME, Haines MA., Tabibnia AP, Lyssanova O. Effect of stretch frequency and sex on the rate of gain and rate of loss in muscle flexibility during a hamstring-stretching program: a randomized single-blind longitudinal study. The Journal of Strength & Conditioning Research.2012; 26(8): 2119-29. [DOI: 10.1519/JSC.0b013e31823b862a]
18. Brodowicz GR, Welsh R, Wallis J. Comparison of stretching with ice, stretching with heat, or stretching alone on hamstring flexibility.Journal of Athletic Training.1996; 31(4): 324-27.
19. Gogia PP, Braatz JH, Rose SJ, Norton BJ. Reliability and validity of goniometric measurements at the knee. Physical Therapy. 1987;67(2):192-95.
20. Davis DS, Quinn RO, Whiteman CT, Williams JD, Young CR. Concurrent validity of four clinical tests used to measure hamstring flexibility. The Journal of Strength & Conditioning Research.2008; 22(2): 583-88. [ DOI: 10.1519/JSC.0b013e31816359f2]
21. Luc-Harkey BA, Safran-Norton CE, Mandl LA, Katz JN, Losina E. Associations among knee muscle strength, structural damage, and pain and mobility in individuals with osteoarthritis and symptomatic meniscal tear. BMC Musculoskeletal Disorders.2018; 19(1): 258. [DOI : 10.1186/s12891-018-2182-8]
22. Thorborg K, Bandholm T, Hölmich P. Hip-and knee-strength assessments using a hand-held dynamometer with external belt-fixation are inter-tester reliable. Knee Surgery, Sports Traumatology, Arthroscopy.2013; 21(3): 550-55. [DOI: 10.1007/s00167-012-2115-2]
23.Pincivero DM, Aldworth C, Dickerson T, Petry C, Shultz T. Quadriceps-hamstring EMG activity during functional, closed kinetic chain exercise to fatigue. European Journal of Applied Physiology. 2000;81(6):504-09.[DOI: 10.1007/s004210050075]
24. Sethi K, Noohu MM. Scapular muscles strengthening on pain, functional outcome and muscle activity in chronic lateral epicondylalgia. Journal of Orthopaedic Science.2018;23(5):777-82.[DOI: 10.1016/j.jos.2018.05.003]
25.Kumar GP. Comparison of cyclic loading and hold relax technique in increasing resting length of hamstring muscles. Hong Kong Physiotherapy Journal.2011; 29(1): 31-33. [DOI: 10.1016/j.hkpj.2011.03.002]
26. Macefield G, HagbarthKE, Gorman R, Gandevia SC, Burke D.Decline in spindle support to alpha‐motoneurones during sustained voluntary contractions. The Journal of Physiology.1991; 440(1): 497-512. [DOI: 10.1113/jphysiol.1991.sp018721]
27. De Deyne PG. Application of passive stretch and its implications for muscle fibers. Physical Therapy. 2001; 81(2): 819-27. [DOI: 10.1093/ptj/81.2.819]
28. Chalmers G. Strength training: Re‐examination of the possible role of golgi tendon organ and muscle spindle reflexes in proprioceptive neuromuscular facilitation muscle stretching. Sports Biomechanics.2004;3(1): 159-183. [DOI: 10.1080/14763140408522836]
29. Ferber R, Osternig LR, Gravelle DC.Effect of PNF stretch techniques on knee flexor muscle EMG activity in older adults. Journal of Electromyography and Kinesiology. 2002; 12(5): 391-97. [DOI: 10.1016/S1050-6411(02)00047-0]
30. Sharman MJ, Cresswell AG, Riek, S. Proprioceptive neuromuscular facilitation stretchingmechanisms and clinical implications. Sports Medicine.2006; 36(11): 929-39. [DOI: 10.2165/00007256-200636110-00002]
31. Lim KI, Nam HC, Jung, KS. Effects on hamstring muscle extensibility, muscle activity, and balance of different stretching techniques. Journal of Physical Therapy Science.2014; 26(2): 209-13. [DOI: 10.1589/jpts.26.209]
32. Carter AM, Kinzey SJ, Chitwood LF, Cole JL. Proprioceptive Neuromuscular Facilitation Decreases Muscle Activity During the Stretch Reflex in Selected Posterior Thigh Muscles. Journal of Sport Rehabilitation.200; 9(4):269-278.[DOI: 10.1123/jsr.9.4.269 ]
33. Miyahara Y, Naito H, Ogura Y, Katamoto S, Aoki J. Effects of proprioceptive neuromuscular facilitation stretching and static stretching on maximal voluntary contraction. The Journal of Strength & Conditioning Research.2013; 27(1): 195-201. [DOI: 10.1519/JSC.0b013e3182510856]
34. de Lima Costa GV, da Silveira ALB, Di Masi F , Bentes CM, de Sousa MSC, da Silva NJ. Acute effect of different stretching methods on isometric muscle strength. Acta Scientiarum. Health Sciences.2014; 36(1): 51-57. [DOI: 10.4025/actascihealthsci.v36i1.15581].
| Files | ||
| Issue | Vol 16 No 3 (2022) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v16i3.10147 | |
| Keywords | ||
| Hamstring tightness Electromyography Muscle stretching exercises Flexibility Hold-relax technique | ||
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How to Cite
1.
Rani Khan A, Sethi K, Noohu MM. Modified Hold-Relax Stretching Technique Combined with Moist Heat Therapy to Improve Neuromuscular Properties in College Students with Hamstring Tightness. jmr. 2022;16(3):235-243.
