The effect of heat applied with stretch to increase range of motion: A systematic review

Application of heat to muscle is commonly advocated to enhance the efficacy of stretching. However, the effect of this combined therapy using different methods of heating, applied to different muscles, and after one or multiple treatments, is not known.To perform a systematic review to address the question: Does stretching augmented by heat application result in greater gains in range of motion (ROM) compared to stretch alone?The following databases were searched for original articles that evaluated our question: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, SPORTDiscus and PEDro databases. After title and abstract screening followed by full-text screening, the quality of included articles was assessed and their data was abstracted. Screening, data abstraction and quality assessment was performed and consensus was achieved by two reviewers. Range of motion (ROM) data were synthesized by meta-analyses for overall effect and subgroup analysis according to muscle group, method of heat application, single or multiple treatments, and reported tightness of muscle. Twelve studies were included and reported the effects of stretch with or without heat on ROM of 352 participants. Heat applications included ultrasound, shortwave diathermy and hot packs. Meta-analyses and subgroup analyses demonstrated greater increases in ROM after heat and stretch (H + S) than heat alone. Subgroup analysis of muscle groups and the method of heat application showed some trends, but no significant differences. Multiple treatments (more so than single treatments) showed consistent treatment effects of H + S versus stretch alone amongst subgroups. Muscles described as tight did not show a greater treatment effect in response to H + S compared to muscles not reported as tight.Heating provides an added benefit on stretch related gains of ROM in healthy people.     

The effect of starting or stopping skin cooling on the thermoregulatory responses during leg exercise in humans

To assess the effects of starting or stopping leg cooling on the thermoregulatory responses during exercise, 60 min of cycling exercise at 30% of maximal oxygen uptake was performed under 4 conditions using tube trouser perfused with water at 10 °C; no leg cooling (NC), starting of leg cooling after 30 min of exercise (delayed cooling, DC), continuous leg cooling (CC), and stopping of continuous leg cooling after 30 min of exercise (SC) at an environmental temperature of 28.5 °C. During exercise under the DC conditions, an instantaneous increase in the esophageal temperature (Tes), a suppression of the cutaneous vascular conductance at the forearm (%CVC), and a decrease in the mean skin temperature (Tsk) were observed after leg cooling. The total sweat loss (Δm sw,tot) was lower under the DC than the NC condition. In the SC study, however, the Tes remained constant, while the %CVC increased gradually after leg cooling was stopped, and the Δm sw,tot was greater than that under the CC condition. These results suggest that during exercise, rapid skin cooling of the leg may cause an increase in core temperature, while also enhancing thermal stress. However, stopping skin cooling did not significantly affect the core temperature long-term, because the skin blood flow and sweat rate subsequently increased.     

The effect of age on elbow range of motion in pitchers

BackgroundAlteration of elbow range of motion (ROM) has been observed in baseball pitchers. This study aims to compare dominant elbow ROM between early-puberty, late-puberty, and young–adult pitchers.MethodsWe recruited 62 pitchers, consisting of 17 early-puberty (mean age 13.1 years old), 22 late-puberty (mean age 17.7 years old), and 23 young–adult players (mean age 19.4 years old). Dominant elbow ROMs was measured. One-way ANOVA was used to compare the differences in elbow ROM variables between 3 groups.ResultsLate-puberty pitchers exhibited a significantly lower elbow hyperextension and flexion than early-puberty or young–adult pitchers (P < .05). Valgus angle was significantly lower in young–adult (7.7°±5.5°) versus early-puberty (12.1°±2.3°) and late-puberty pitchers (13.0°±4.1°; P < .05). Young–adult pitchers had the largest forearm supination range (101.2°±18.1°), followed by early-puberty (82.5°±6.5°; P < .05) and late-puberty pitchers (70.6°±15.8°). Elbow flexion-hyperextension total range was smallest in late-puberty pitchers (130.3°±7.4°), followed by young–adult (142.6°±9.3°) and early-puberty pitchers (144.6°±8.3°; P < .05). Forearm pronation–supination total range was also smallest in late-puberty pitchers (142.0°±20.3°), followed by early-puberty (159.8°±9.5°) and young–adult pitchers (177.2°±20.8°; P < .05).ConclusionsThese results indicate that careful monitoring of the elbow and forearm range of motion should be undertaken in adolescent baseball pitchers to prevent and or minimize injury risk.     

Effect of dry needling of gluteal muscles on straight leg raise: a randomised, placebo controlled, double blind trial

Objectives: To use a randomised, double blind, placebo controlled trial to establish the effect on straight leg raise, hip internal rotation, and muscle pain of dry needling treatment to the gluteal muscles in athletes with posterior thigh pain referred from gluteal trigger points.

Results: Magnetic resonance imaging scans revealed normal hamstring musculature in most subjects. Straight leg raise and hip internal rotation remained unchanged in both groups at all times. Visual analogue scale assessment of hamstring pain and tightness and gluteal tightness after running showed improvements immediately after the intervention in both groups (p = 0.001), which were maintained at 24 and 72 hours. The magnitude of this improvement was the same for therapeutic and placebo interventions. Resting muscle pain and tightness were unaffected.

Conclusions: Neither dry needling nor placebo needling of the gluteal muscles resulted in any change in straight leg raise or hip internal rotation. Both interventions resulted in subjective improvement in activity related muscle pain and tightness. Despite being commonly used clinical tests in this situation, straight leg raise and hip internal rotation are not likely to help the therapist assess response to treatment. Patient reports of response to such treatment are better indicators of its success. The mechanisms by which these responses occur and the reasons for the success of the placebo needling treatment are areas for further investigation.

     

The influence of foot position on lower leg muscle activity during a heel raise exercise measured with fine-wire and surface EMG

ObjectiveExercises for lower leg muscles are important to improve function. To examine the influence of foot position on lower leg muscle activity during heel raises.DesignCross-sectional laboratory study.SettingLaboratory.ParticipantsFourteen healthy men participated in this study.Main outcome measuresThe muscle activity levels of the tibialis posterior (TP), peroneus longus (PL), flexor digitorum longus (FDL) and medial gastrocnemius (MG) were measured. The heel raises consisted of three foot positions: 1) neutral, 2) 30° abduction, and 3) 30° adduction. The EMG data for five repetitions of each foot position were normalized to maximum voluntary contraction. One-way repeated measure ANOVA was employed for statistical analysis.ResultsThe muscle activity level of TP, PL and FDL was significantly different between the three foot positions during the heel raises. TP and FDL showed the highest activity level in 30° foot adduction while PL demonstrated the highest activity level in 30° foot abduction.ConclusionsHeel raises with 30° foot adduction and abduction positions can change lower leg muscle activity; These findings suggest that altering foot posture during the heel raise exercise may benefit patients with impaired TP, PL or FDL function.     

The effect of foot orthotic use on exercise related leg pain in cross country athletes

ObjectivesThe purposes of this research were to (1) investigate the effect of foot orthotic use on exercise related leg pain (ERLP) in cross-country (XC) athletes, and (2) determine if an association between foot type and foot orthotic use exists.DesignProspective cohort design.SettingHigh schools and colleges in a Midwestern metropolitan region.Participants213 high school and college XC athletes (107 male, 106 female).Materials/MethodsParticipants were seen before the fall XC season for classification of foot type, visual orthotic inspection, and questionnaire completion regarding foot orthotic use and ERLP. Statistical analysis of relationships (chi-square) was conducted.Results37 of the 213 XC athletes (17.4%) used foot orthotics; 31 of the 37 athletes using foot orthotics (83.8%) reported a history of ERLP. Of these 31 athletes, 17 (54.8%) were using orthotics for ERLP and 15 reported a decrease in ERLP with orthotic use. Fourteen athletes were using orthotics for a reason other than ERLP and only 2 reported a decrease in ERLP with orthotic use. Athletes using orthotics included all three foot types (pronated, neutral, supinated) with no relationship between orthotic use and foot type.ConclusionOne-sixth of the XC athletes used foot orthotics and most using orthotics for ERLP reported a decrease in ERLP symptoms. The majority of athletes using orthotics for reasons other than ERLP reported no change in ERLP symptoms. There was no association between foot type and orthotic use.     

The effect of tape, braces and shoes on ankle range of motion

Sport injuries are unwanted adverse effects accompanying participation in sports. In a wide variety of sports the most common location of injury is the ankle, frequently resulting from a forced plantar flexed inversion of the foot exceeding the physiological range of motion (ROM). Historically the purpose of external support systems is to prevent acute ankle injuries by restricting abnormal ankle ROM. It is believed that a superior restrictive effect also implies a superior preventive effect. The purpose of this review was to examine the literature regarding the restricting effect of adhesive taping, prophylactic ankle stabilisers (PAS) and high-top shoes on ankle ROM. It has been found that tape restricts ankle eversion and inversion ROM significantly following application. However, tape loosens significantly following standardised exercise and sports activities. Studies regarding PAS reported that both semi-rigid and nonrigid stabilisers give a significant post-application restriction of ankle inversion motion. The nonrigid stabilisers show loosening over time during exercise, while the semi-rigid stabilisers maintain their restrictive effect over the same time span. High-top shoes in comparison to low-top shoes are more effective in restricting mechanically imposed ankle inversion ROM. Low-top shoes, however, also limit mechanically imposed ankle inversion stress with the ankle in the position in which ankle injury occurs most frequently. One must keep in mind, however, that a superior mechanical restriction of ankle ROM does not necessarily imply a superior preventive effect. Only well-controlled randomised studies can show such an effect, and these studies have shown a reduction of ankle injury incidence for all 3 prophylactic measures reviewed.     

Stretching exercise and soccer: effect of stretching on range of motion in the lower extremity in connection with soccer training

Forty-eight players from four senior, male soccer teams were tested for ranges of motion (ROM) in the lower extremity before, immediately after, and 24 h after different forms of soccer training. The players were tested after regular soccer training (A), after soccer training with contract-relax stretching prior to beginning the session (B), and after soccer training with stretching added at the end of the program (C). Each training session lasted 1.5 h. In group A all six ROMs were decreased 24 h after the training. In group B the only change in ROM noted was an increase in knee flexion directly after the training. In group C there was an increase in hip extension, hip flexion, and knee flexion directly after the training.     

The effects of hip- and ankle-focused exercise intervention on lower limb mechanics during single leg squat among physically active females

ObjectivesThere are two types of kinetic chain in dynamic knee valgus (DKV) namely top-down (proximal origins) and bottom-up (distal origins). This study compared the influence of four-week hip- and ankle-focused exercises on lower limb mechanics during single-leg squat (SLS) among physically active females.MethodsThirty-six physically active females with excessive DKV were divided into either HIP, ANKLE, or control groups. The intervention groups completed exercises that focused either on the hip or ankle musculature for 12 sessions over four weeks. The SLS test protocol was performed with 3D motion capture at pre- and post-intervention. Data were analyzed with two-way ANOVA test.ResultsHIP group showed increased dominant knee (F (2.66) = 9.437, P = .001) and ankle (F(2.66) = 16.465, P = .001) sagittal moment during 45° SLS at post-intervention compared to ANKLE and Control groups. HIP group also showed increased hip flexion angle for dominant (F(2.66) = 12.032, P = .001) and non-dominant leg (F(2.66) = 3.618, P = .032) compared to other groups during 60° SLS. No other significant differences were observed on other variables.ConclusionDKV did not show any significant changes during SLS after a four-week exercise intervention focusing on hip and ankle joints.     

The effect of foot structure and range of motion on musculoskeletal overuse injuries.

The purpose of this prospective study was to determine whether an association exists between foot structure and the development of musculoskeletal overuse injuries. The study group was a well-defined cohort of 449 trainees at the Naval Special Warfare Training Center in Coronado, California. Before beginning training, measurements were made of ankle motion, subtalar motion, and the static (standing) and dynamic (walking) characteristics of the foot arch. The subjects were tracked prospectively for injuries throughout training. We identified risk factors that predispose people to lower extremity overuse injuries. These risk factors include dynamic pes planus, pes cavus, restricted ankle dorsiflexion, and increased hindfoot inversion, all of which are subject to intervention and possible correction.     

The effect of four different vibratory stimuli on dynamic range of motion of the hamstrings

ObjectiveThe purpose of this study was to investigate the influence of four different segmental vibratory stimulation (VS) loads on dynamic range of motion (ROM) of the hamstrings.DesignThis study used a randomised cross-over design.ParticipantsTen male club level athletes (age 22.7±3.6 yr, height 181.2±6.51 cm, mass 84.9±12.3 kg) volunteered to participate.Outcome measuresA two factor repeated measures ANOVA (intervention × time) with post hoc comparisons was used to determine whether any vibration setting produced a significantly greater ROM change (p⩽0.05).ResultsA significant increase in dynamic ROM was found for three out of the four vibration loads (1.6–2.1%). VS using load parameters of 5 mm amplitude, 44 Hz, 49.4 m s⁻² resulted in the greatest mean ROM improvement, however, this was not significantly different to the increases observed for the other loading parameters. The VS treatment effects (effect sizes ∼1.2 and greater) in these studies were for the most part larger than the treatment effects found in research using more traditional stretching methods.ConclusionsSegmental vibration in combination with various stretching techniques may offer interesting options in terms of improving ROM in the short and long term.     

The effect of knee position on blood loss and range of motion following total knee arthroplasty

Purpose  

This study prospectively assessed the effects of knee position on blood loss and range of motion after primary total knee arthroplasty (TKA).     

The stiffness of the liver and spleen on ARFI Imaging pre and post TIPS placement: a preliminary observation

PurposeTo prospectively assess the stiffness of the liver and spleen with acoustic radiation force impulse (ARFI) imaging pre and post transjugular intrahepatic portosystemic shunt (TIPS) placement.Material and methodsBetween February, 2011 and September, 2011, we prospectively measured stiffness of the liver and spleen with mean shear wave velocity (MSV, m/s) on ARFI imaging in 10 healthy volunteers (mean age 32.2±10.3 years, age range 23-53 years) and 10 patients (mean age, 38.6±6.4 years, age range 30-48 years) who underwent TIPS placement for treatment of portal hypertension (PHTN). The portal vein pressure was measured while placing the TIPS. To assess the changes in the stiffness of the liver and spleen following TIPS placement, we measured MSV of the liver and spleen one day before TIPS insertion and 4-9 days after TIPS placement (mean interval 5.9±2.0 days, interval range 5 to 10 days).ResultsThere was significant difference in portal vein pressure pre (27.67±5.86 mmHg) and post (18.00±6.93 mmHg) TIPS insertion (P<.01). The MSV of the liver in healthy subjects, patients with PHTN pre TIPS and patients with PHTN post TIPS measured 1.16±0.06 m/s, 2.48±0.39 m/s, and 2.37±0.28 m/s, respectively. The MSV of the spleen in healthy subjects, patients with PHTN pre TIPS and patients with PHTN post TIPS measured 2.22±0.22 m/s, 3.65±0.32 m/s, and 3.27±0.30 m/s, respectively. There were significant differences in MSV of the liver and spleen between healthy subjects and patients with PHTN (all P<.001). There was no significant difference in MSV of the liver pre and post TIPS placement (P>.05). However, a statistically significant difference in MSV of the spleen pre and Post TIPS placement(P<.001) was demonstrated. In addition, we observed a significant difference in spleen index between healthy subjects and patients with PHTN (P<.001), as well as between pre and post TIPS placement (P<.01).ConclusionThe MSV of the spleen measured with ARFI correlates well with portal vein pressure. Hence, the spleen stiffness by means of MSV on ARFI imaging can be used as a quantitative marker in monitoring the portal vein pressure as the function of the TIPS.     

The effect of leg length discrepancy upon load distribution in the static phase (standing)

Leg length discrepancy (LLD) is commonly recognised as a complication of total hip arthroplasty. Some patients with only minor LLD complain of major difficulties. The effect of LLD has been described in the dynamic phase, but not static phase. The aim of this project was to investigate the effect of leg length discrepancy on static limb loading (i.e. Standing). A pedobarograph was used to measure the limb loading of 20 normal volunteers whilst changing the height of the other foot thus simulating a LLD. With both feet at the same level, the left limb took 54% of the load. When the right foot was lower, (simulating a long left leg), the left leg took 39% of the load. When the right foot was higher, (simulating a long right leg), the left leg took 65% of the load. A paired t-test comparison of the simulation with the level load showed a significant difference with P = 0.002. Our results show that weight distribution increased in the shorter limb when LLD was simulated. This uneven distribution is likely to lead to premature fatigue when standing and may explain why some patients with LLD post hip arthroplasty have poorer outcomes.     

The effect of leg length discrepancy upon load distribution in the static phase (standing)

Leg length discrepancy (LLD) is commonly recognised as a complication of total hip arthroplasty. Some patients with only minor LLD complain of major difficulties. The effect of LLD has been described in the dynamic phase, but not static phase. The aim of this project was to investigate the effect of leg length discrepancy on static limb loading (i.e. Standing). A pedobarograph was used to measure the limb loading of 20 normal volunteers whilst changing the height of the other foot thus simulating a LLD. With both feet at the same level, the left limb took 54% of the load. When the right foot was lower, (simulating a long left leg), the left leg took 39% of the load. When the right foot was higher, (simulating a long right leg), the left leg took 65% of the load. A paired t-test comparison of the simulation with the level load showed a significant difference with P = 0.002. Our results show that weight distribution increased in the shorter limb when LLD was simulated. This uneven distribution is likely to lead to premature fatigue when standing and may explain why some patients with LLD post hip arthroplasty have poorer outcomes.     

The effect of a physical activity education programme on physical activity, fitness, quality of life and attitudes to exercise in obese females

Obesity has reached epidemic proportions worldwide. Decline in physical activity has occurred simultaneously or before the increase in obesity. The aim of this pilot study was to investigate the effect of a physical activity group-based education programme delivered by a Physiotherapist on weight, physical activity, cardiovascular fitness, quality of life and attitudes to exercise in obese females. A sample of 18 obese Irish females (mean age 37.6 years, mean weight 117.9kg), took part in this study. The participants attended four physical activity education sessions in groups of 6-8, 1 month apart. Outcome measures were Cardiorespiratory fitness (CRF) measured by the Incremental Shuttle Walk test (ISWT) International Physical Activity Questionnaire-Short Form (IPAQ-Short) Impact of Weight on Quality of Life Questionnaire-Short Form (IWQOL-Lite), and a questionnaire adapted from the EU survey on Consumer Attitudes to Physical Activity. There were no significant decreases in participants' weight (p=0.444) and there were no significant improvements in IPAQ (p=0.496) and IWQOL-Lite scores (p=0.337). There were significant improvements in CRF (p<0.0002). Attitudes towards exercise improved as shown by decreased barriers to exercise, i.e. decreased shyness (17%) and increased energy (22%) and increased enjoyment (22%). A group education programme focusing on physical activity alone demonstrated a significant increase in CRF (ISWT) and had a positive influence on attitudes to exercise. Longer duration interventions may allow participants to make the necessary lifestyle changes to achieve weight loss.     

The effect of crank rate on physiological responses and exercise efficiency using a range of submaximal workloads during arm crank ergometry

This study examined the effects of variations in crank rate on physiological responses during submaximal arm ergometry. Fifteen non-specifically trained male subjects volunteered to participate in this study. Each subject undertook a discontinuous arm crank ergometry test (30, 50, 70, 90 W) on three separate occasions using crank rates of 50, 70, and 90 rev.min(-1). Respiratory parameters and heart rate were continuously monitored. An 80-microL capillary blood sample was obtained immediately following each exercise bout for the determination of whole blood lactate. Measures of efficiency were calculated using specific caloric equivalents of oxygen consumption (V(O2)). Heart rate was lowest (p < 0.05) at 30, 50, and 70 W using 50 rev.min(-1). Values of gross and net efficiency tended to be higher (p < 0.05) using 50 rev.min (-1) at the lower absolute workloads, but no differences (p > 0.05) were observed between the three crank rates at 90 W. No differences (p > 0.05) were observed between crank rates for delta efficiency. This study confirms that variations in crank rate can influence gross and net values of V(O2) and exercise efficiency at low absolute workloads, but crank rate ceases to be an influential factor at moderate workloads. Further research is required to identify the specific mechanisms underpinning the observations reported in the present study relating to the interaction between crank rate, workload, and exercise efficiency during arm crank ergometry.