THE EFFECTS OF A DAILY STRETCHING PROTOCOL ON PASSIVE GLENOHUMERAL INTERNAL ROTATION IN OVERHEAD THROWING COLLEGIATE ATHLETES

Introduction/Purpose:

Shoulder dysfunction and injury are common in throwing athletes. Loss of internal rotation has been correlated to shoulder pathologies. The purpose of this study was to assess the effects of a stretching protocol on passive internal rotation. The purpose of this study was assess the effects of a stretching protocol on passive internal rotation motion in the throwing shoulders of collegiate baseball players.

Study Design:

Pre-Post, intervention, using a within subjects comparison of a convenience sample.

Methods:

Glenohumeral internal rotation and external rotation of the throwing and non-throwing shoulders of NCAA Division I baseball players were measured using a universal goniometer. Determinations were made as to the degree of Glenohumeral Internal Rotation Deficit (GIRD) in the throwing shoulder. A daily (5 days per week), 12-week posterior capsule stretching program was administered. Post-stretching internal rotation and external rotation measures were again obtained. The coaches and athletic trainers of the included team monitored the players for shoulder injuries and innings of training/competition lost due to shoulder injuries during the 12 week intervention.

Results:

A significant increase in range of motion was found for dominant arm internal rotation (IR) and total range of motion (TOT) following the stretching program. No statistically significant improvement in range of motion was found for external rotation (ER), non-throwing arm internal rotation (NDIR), non-throwing arm external rotation (NDER), and non-throwing arm total motion (NDTOT).

Conclusions:

Implementation of a posterior capsule stretching program may be helpful to facilitate increased passive internal rotation range of motion at the glenohumeral joint. Further research should be performed using a control group not receiving the stretching program in order to more completely establish the impact of stretching on measures of passive glenohumeral range of motion.

Level of Evidence:

1b     

Hamstring length in patellofemoral pain syndrome

Objectives

To investigate whether there was a difference in hamstring length between patients with patellofemoral pain syndrome and healthy asymptomatic controls aged 18 to 35 years.

Design

A cross-sectional observational study measuring hamstring length in patients and asymptomatic controls.

Setting

Hospital physiotherapy department.

Participants

Two groups were tested; one group diagnosed with patellofemoral pain syndrome (mean age 27 years, n = 11, six males, five females) and one group of asymptomatic controls (mean age 25 years, n = 25, 13 males, 12 females).

Main outcome measures

Hamstring length was evaluated using the passive knee extension method to measure popliteal angle.

Results

The mean (standard deviation) values for hamstring length were 145.6 (8.7)° for patients with patellofemoral pain syndrome and 153.7 (10.1)° for the asymptomatic controls. The mean (95% confidence interval) difference between the groups was 8.0 (0.8 to 15.1)°, and analysis with a t-test revealed that this was statistically significant (P < 0.05).

Conclusions

This study found that patients with patellofemoral pain had shorter hamstring muscles than asymptomatic controls. It is not clear whether this is a cause or effect of the condition. Further research is suggested to study how hamstring length changes with rehabilitation, and the relationship with pain.     

Activation of Akt by mechanical stretching in human epidermal keratinocytes

Mechanical stretching represents an important part of the signaling in skin. We have previously demonstrated that mechanical stretching induced proliferative phenotypes in human keratinocytes, as shown in increased 5-bromo-2'-deoxyuridine (BrdU) incorporation, ERK1/2 activation, and keratin K6 induction. Here we have further investigated the antiapoptotic signals in human keratinocytes provoked by mechanical stretching in vitro. Keratinocytes were plated on flexible silicone supports to transmit mechanical stretching to keratinocytes, involving continuous stretching by +20%. Stretching of these cells for 15-30 min caused the phosphorylation and activation of Akt. Inhibition of mitogen and extracellular signal-regulated kinase (MEK1/2) with U0126 and phosphoinositide 3-OH kinase (PI 3-K) with Wortmannin attenuated Akt activation. The epidermal growth factor (EGF) receptor kinase inhibitor, AG1478, and calcium channel inhibitor, gadolinium (Gd3+), also inhibited Akt activation. In summary, our results demonstrate the activation of the Akt signaling pathway by mechanical stretching, generating not only proliferative but also antiapoptotic signals in human keratinocytes.     

The effects of passive stretching on the blood glucose levels of patients with type 2 diabetes

BackgroundType 2 diabetes is characterized by poor glycemic control due to decreased insulin sensitivity. Physical activity plays an important role in the management of diabetes and reduces blood glucose level. The aim of this study was to evaluate the effectiveness of passive stretching (PS) on the blood glucose level (BGL) of diabetic patients.Materials and methodsIn this randomized clinical trial, fifty patients with type 2 diabetes and mean age of 50.7 ± 4.8 years were randomly and equally allocated into control and intervention groups. Patients in the intervention and control groups underwent 20 min of passive stretching (PS) and passive movement (PM), respectively. BGL was measured before and immediately after, 20 min after and 1 h after PS/PM in the two study groups. BGL at the mentioned times was compared between and within the groups.ResultsThe findings showed that when compared with before the PS (195.7 ± 30.1), BGL significantly reduced (p < 0.001) immediately after (178.9 ± 29.7), 20 min after (183.2 ± 29.1), and 1 h after (187.8 ± 29.6) the PS. However, BGL after PM (immediately, 20 min and 1 h after PM) did not significantly change (p > 0.05).ConclusionThe findings of this study indicated that PS has a significant effect on the reduction of the immediate BGL in type 2 diabetic patients. The trend reduced even though the effect remained for 1 h after PS. It is therefore suggested that the effectiveness of these types of activities should be evaluated over a longer duration of study.     

Experience with the skin stretching device

The skin stretching device was designed to harness the biomechanical properties of the skin in order to close large cutaneous defects by direct closure, without the need of other more complicated techniques such as skin grafts or flaps. The authors present their experience with 31 patients in whom the device was used to repair defects produced by excision of lesions of different nature, size, and body areas, six cases are presented. The main defect of the method, i.e. the increase of intraoperative time to allow for tissue stretching, should be avoidable most of the time by applying the device preoperatively under local anesthesia. The importance of not undermining during this procedure is stressed; the objective parameters to evaluate are analyzed, such as colour and tension of the skin. The complication rate was very acceptable, there was only one infection and one marginal necrosis that healed without further interventions. The described technique appears safe and easy to perform, and produces a good short-term result.     

理筋正骨手法联合易化牵伸术治疗陈旧性踝关节扭伤30例

目的 观察中医理筋正骨手法联合易化牵伸术治疗陈旧性踝关节扭伤的疗效。方法 采用随机对照的方法,将60例陈旧性踝关节扭伤患者随机分为治疗组和对照组,每组30例,治疗组采用理筋正骨手法联合易化牵伸术治疗,对照组采用电磁波治疗仪照射和针刺治疗,治疗2个疗程后分别比较患者Baird- Jackson踝关节功能评分、疼痛视觉模拟评分（visual analogue scale,VAS）以及压痛程度评分的差异。结果 治疗后2组患者VAS评分、压痛程度评分、Baird- Jackson踝关节功能评分较本组治疗前显著改善（P＜0.05）,且治疗组各评价指标改善程度显著大于对照组（P＜0.05）。结论 理筋正骨手法联合易化牵伸术可以改善陈旧性踝关节扭伤患者症状,提高临床疗效。     

Conservative Management of Congenital Muscular Torticollis: An Evidence-Based Algorithm and Preliminary Treatment Parameter Recommendations

ABSTRACT

Purpose: To present an algorithm with accompanying treatment parameters for the management of congenital muscular torticollis (CMT) based on the best available literature. Methods: A systematic search of PubMed, MEDLINE, CINHAL, and Cochrane databases was conducted to identify evidence to guide the conservative management of CMT. Results: An evidence-based algorithm was created based on three prognostic factors that influence treatment duration and outcome, including a sternocleidomastoid fibrotic mass, passive range of motion rotation deficit, and age at initiation of treatment. Preliminary treatment parameter recommendations for clinic and home programming accompany the algorithm. Conclusion: Use of the proposed evidence-based algorithm with accompanying preliminary treatment parameter recommendations may improve consistency of care and outcomes for infants with CMT. While a higher level of evidence supports the three prognostic factors utilized in the algorithm, research gaps continue to exist with regards to treatment parameters.     

CURRENT CONCEPTS IN MUSCLE STRETCHING FOR EXERCISE AND REHABILITATION

Stretching is a common activity used by athletes, older adults, rehabilitation patients, and anyone participating in a fitness program. While the benefits of stretching are known, controversy remains about the best type of stretching for a particular goal or outcome. The purpose of this clinical commentary is to discuss the current concepts of muscle stretching interventions and summarize the evidence related to stretching as used in both exercise and rehabilitation.     

Effects of equibiaxial mechanical stretch on extracellular matrix‐related gene expression in human calvarial osteoblasts

Mechanical stretch commonly promotes craniofacial suture remodeling during interceptive orthodontics. The mechanical responses of osteoblasts in craniofacial sutures play a role in suture remodeling. Moreover, the extracellular matrix (ECM) produced by osteoblasts is crucial for the transduction of mechanical signals that promote cell differentiation. Therefore, we aimed to investigate the effect of mechanical stretch on cell viability and ECM‐related gene‐expression changes in human osteoblasts. Human calvarial osteoblasts (HCObs) were subjected to 2% deformation. Caspase activity, MTT, and cell viability assays were used to estimate osteoblast apoptosis, proliferation, and viability, respectively. Real‐time RT‐PCR (RT²‐PCR) arrays were used to assess expression of cytoskeletal‐, apoptosis‐, osteogenesis‐, and ECM‐related genes. We found that mechanical stretch significantly increased osteoblast viability and cell proliferation, and decreased the activities of caspases 3 and 7. Moreover, the expression of 18 genes related to osteoblast differentiation, apoptosis, and ECM remodeling changed by more than two‐fold in a time‐dependent manner. Therefore, mechanical stretch promotes HCOb viability and alters expression of genes that are closely related to suture remodeling under mechanical stretch.