Hall Sam by x9t8D0

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									                Individual Enquiry

             Research Paper 2009



Title: A comparison of the efficacy of Dynamic and
       Static Stretching on hamstring flexibility and
       Retention of those effects.

Author: Sam Hall



Supervisor: Ben Calvert-Painter
              BTEC Health Studies and BSc (Hons) in Osteopathy




       The British School of Osteopathy
     275, Borough High Street, London SE1 1JE




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                      ACKNOWLEDGMENTS


           “Failing to prepare is preparing to fail” – Benjamin Franklin


I want to take the opportunity to thank all the people who helped me all the way
through the quest to complete my dissertation; it would not be the article it is
without every one of you.


Special Thanks to:


       My family for being at my beckon call for proof reading, and support

       In alphabetical order - Hillary Abbey, Ben Calvert-Painter, Danny Church,
       Phil Heeps and Melanie Wright, for your support and feedback no-matter
       the time of night or state of fatigue, and converting the world of statistics
       into what almost sounded like English.

       All the volunteers who participated in my study

       Finally and most importantly my girlfriend Samantha Carey who helped
       me curb my natural tendency to use several hundred words when one
       would do, and for the late night chocolate runs. She maintained what little
       sanity I still have.




                                                                                   1
Abstract

Objective: The aim of this study was to compare the effects of dynamic and static

stretching on hamstring flexibility and the retention of their effects.



Design: A randomised controlled trial



Subjects: A convenience sample of 29 active asymptomatic volunteers were

selected, 12 male and 17 female



Setting: British School of Osteopathy and The Castle Gym Windsor



Method: Participants completed the short form IPAQ questionnaire and were

randomly divided into one of three experimental groups – dynamic stretch, static

stretch and control (no stretch). The two stretch groups performed their stretching

routines over 4 weeks. All groups were given an exercise diary to fill out what

other exercise they performed over the trial period so confounding factors

(changes) and stretch adherence could be monitored. Bilateral baseline flexibility

measures were taken using a straight leg raise hamstring stretch and goniometer

to measure hamstring flexibility prior to intervention. Participants were measured

every 2 weeks for 8 weeks.



Results: At the end of the 4 week stretching period, both stretching groups

showed significant increases in flexibility but the control group did not. The




                                                                                 2
dynamic stretching group showed a significantly greater increase than the static

stretching group. After 8 weeks, the dynamic stretching group retained significant

increases from baseline but the change in the static stretching group was no

longer significantly different from the control group.



Conclusion: There was a greater increase in flexibility at 4 weeks and retention of

flexibility at 8 weeks in the dynamic stretching group compared to the static

stretching and control groups. This suggests that dynamic stretching has the

greatest effect upon flexibility of the hamstring muscles over a 4 week period of

stretching and in retention of flexibility changes over an additional 4 week period.

Recommendations for further research are variations of dynamic stretching

repetitions and time to produce optimal results, comparison of static progressive

stretching, proprioceptive neuromuscular facilitation, ballistic and dynamic

stretching, the effects of different activity levels upon the outcome of comparison

between stretches, utilising a combination of static and dynamic stretching

compared to each on their own and a control on flexibility, performance, injury

prevention and retention.



Keywords: Stretching, Static, Dynamic, Flexibility, Retention




                                                                                   3
Introduction

The aim of this study was to compare the effectiveness of dynamic (DS) and

static stretching (SS) on the flexibility of the hamstring muscles and to see how

long their effects were retained.



This study is important especially to therapists such as Osteopaths who utilise

stretch prescription as a primary management tool. Further research in this area

will allow more effective management and better patient care outcomes from

health care practitioners.



The three most commonly used techniques in sports and therapy are static

stretching, dynamic stretching and proprioceptive neuromuscular facilitation

(PNF). Ballistic stretching (BS) could also be considered as DS; however the

effects and technique differ. For the purpose of this study when talking about DS,

BS will not be included and PNF will not be investigated here.



The purpose of stretching varies greatly from reduction of hypertonicity and risk

of injury, to improving flexibility and athletic performance. Which stretches should

be used to effectively achieve the desired goal, how they work anatomically and

are these benefits really attainable; are avenues where further research is

needed.




                                                                                  4
SS is the most commonly used technique as it is the easiest to perform and has

the lowest potential for trauma Roberts & Wilson, (1999). Because of this there is

a far wider range of studies investigating the effects of SS and improvement on

flexibility. “SS is the slow and progressive lengthening of a muscle to its maximal

perceived tension then holding it to induce a stretch.” Alter (1988, p 85).



Variances of SS have been shown to improve both active and passive range of

motion (ROM) (Roberts & Wilson 1999), this adds to studies such as Bandy &

Irion (1994) focusing on duration and frequency of SS. Flexibility improved

following a 6 week training programme when compared with the control group.

(Bandy & Irion 1994, Bandy et al (1997).



SS relies on subjective measures to ascertain the degree of stretch, thus

dictating individual progression. The commonly used definition of stretch is the

onset of discomfort, while stretch-tolerance may be argued as one of the defining

factors in a muscles ability to stretch (Feland et al, 2001). The degree of stretch

is largely perceptive and therefore reduces reliability as quantifiable scientific

measures cannot be obtained.



Flaws identified in previous studies include small samples, preventing results

being applicable to the general population. Many appear to lack researcher

blinding during measurements which introduces confounding factors. Both these




                                                                                 5
points are true for (Sady et al. 1982). Studies have not investigated the long term

effects of stretching, especially following the cessation of stretching.



30 seconds duration is an effective amount of time to sustain a hamstring muscle

stretch in order to increase ROM. No further increase in flexibility occurred when

the duration of stretching was increased from 30 to 60 seconds or when

frequency of stretching was increased from one to three times per day (Bandy,

Irion, Briggler 1997). Eight to twelve repetitions of a dynamic stretch is the

optimum number in order to achieve flexibility gaines (Alter,1988), this takes

approximately thirty seconds when the speed/rate of dynamic stretching is

controlled. This may be coincidence or it may be that the repetitions are not the

optimal frequency and it is the 30 second time frame which is optimal, however

that has been little or no research on this factor and may be an opportunity/sight

for continued research.



SS has shown to significantly reduce passive resistive torque of the muscle-

tendon unit but had no effect on tendon stiffness, whereas BS did significantly

decrease tendon stiffness (Mahieu et al 2007, Wittvrouw et al, 2007). It was

concluded that SS and BS have varied effects on the musculo-tendinous unit;

where BS has greater effect upon the tendon and SS greater effect upon the

contractile components of muscle. DS may affect the tendon by eliciting the

stretch reflex and causing eccentric stretch to be resolved within the tendon

rather than the contractile components. Eccentric exercise has a similar effect on




                                                                                 6
muscle tendons as DS; therefore both may be effective in the treatment and

rehabilitation of tendon injuries.



“DS is an effort to propel the muscle into an extended range of motion not

exceeding one's static-passive stretching ability. Anything beyond this range of

motion becomes BS.” (http://en.wikipedia.org/wiki/Dynamic_stretching accessed

3/3/09). DS has been shown to “significantly increase tendon elasticity” (Witrouw

et al, 2007, pp. 224). This increased elasticity within the muscle-tendon unit

increases the ability of the tendon to absorb force, reducing the risk of injury and

reducing transmission through the muscle fibres. The ability of muscles to absorb

force is dependant upon both active (contractile) and passive (connective tissue)

components (Saffron et al 1989). When the ability of these components to

accommodate forces is exceeded damage occurs; it is this overstretching which

may allow the development of both static and dynamic flexibility. "If we accept the

word overloading as related to building strength in muscle…overstretching

should be accepted in building flexibility" (Doherty, 1971). By causing local

trauma and damage to tissues, the body must repair it stronger in response to

demand so it will not be damaged under the same stress next time, thus reducing

risk of injury.



“BS is the dynamic motion of a body part to and beyond its normal accepted

range of motion to induce stretch”, (Alter 1988, p 85). It causes a maximal

stretching of a muscle resulting in the muscle spindle detecting the maximal




                                                                                  7
stretch and resulting in reflex contraction. If the muscular contraction is during

consecutive movements an eccentric load is placed through the muscle and

forces are placed upon the tendon rather than the contractile elements, if the

musculo-tendinous unit is unable to dissipate forces sufficiently the result is

commonly tendon injury (Safran et al, 1989).



DS, within dynamic flexibility ranges, should cause a maximal stretch through

both the contractile fibres and if done under control will not initiate the stretch

reflex, so a longitudinal stretch is exerted on the muscle belly and at the peak of

that range the forces are resolved in the muscle tendon as eccentric load.

Limited research has been conducted on this type of stretching; primarily studies

have focused on BS or SS. In theory, if done appropriately DS will offer a

combination of the benefits of static and BS.




                                                                                 8
Method:

A convenience sample of physically active, asymptomatic students at the British

School of Osteopathy and members of The Castle Gym Windsor were recruited.



Inclusion criteria:

 Age between 16 and 69 - based on the optimum age range for the IPAQ.

 Must exercise four times weekly (minimum), this will be gauged using the

   IPAQ.

 Subjects may be either sex

 Subjects were required to read and sign a PIS/consent form prior to

   participation.

 Subjects must be healthy with no injuries which may be exacerbated by

   performing either intervention or in testing.



Exclusion Criteria:

 Any disability effecting the normal physiology or function (functional use) of

   the lower extremity

 Any perceived condition which may bring into doubt the ability of the

   participant to accurately perform stretches taught to them

 History of injury in or around the area being tested in the past six months,

   such as bruises, muscle tears, fractures, history of operations etc…

 Currently receiving any form of manual treatment which may affect the

   experiment



                                                                                   9
 Participant is unable to commit to fortnightly flexibility retesting or stretching

   minimum four times a week to follow normal exercise

 Participant does not train a minimum of four times a week.



Inclusion and exclusion criteria were based on the generally accepted criteria for

intervention studies of a similar nature to this one, the age criteria was based

upon the age range for the IPAQ questionnaire (Appendix1).



SS and DS were the chosen outcome measures over BS and PNF, as BS has

the greatest risk of injury and PNF requires an experienced operator.



A pilot study was performed to compare the accuracy of measurement between

the research assistants when performing the chosen outcome measure. Each

used the goniometer to measure 10 volunteers from a group of volunteer BSO

students; neither was allowed to see the others’ technique or results.



The results were recorded and compared to identify accuracy and reliability of

results. Conclusions made were that the research assistants should use the

midline of the thigh and the floor as the angles of measurement, as the top or

bottom of the thigh would be variable depending on the physiology of the

individual. All other factors appeared to be within accepted parameters.




                                                                                       10
The design was a randomised controlled trial set at the British School of

Osteopathy and The Castle Gym Windsor. A convenience sample of 29 active

asymptomatic volunteers were selected, 12 male and 17 female.



Participants were given patient information sheet (PIS appendix 2) to read prior

to signing a consent form (appendix 3), after they were invited to complete the

short form IPAQ questionnaire (Appendix 1) to assess current activity level. All

suitable participants were randomly divided into one of three experimental

groups; DS, SS and control (no stretch).



Participants in the two intervention groups were given a fact sheet and tutorial on

their designated stretch (see appendix 4 and 5). All groups were given an

exercise diary (appendix 6) to fill out details of other exercise they performed

over the trial period so confounding factors (changes) and stretch adherence

could be monitored and were collected at the final flexibility measurement.



The two stretch groups performed their stretching routines for 4 weeks, and then

stopped all addition stretching assigned by the experimenter over an additional 4

week period. Bilateral baseline flexibility measures were taken by a trained

research assistant (trained Personal Trainers) using a straight leg raise

hamstring stretch and goniometer to measure hamstring flexibility prior to

intervention. Participants were measured every 2 weeks over a 2 month period.




                                                                                11
Both interventions were performed once over 30 seconds on training days as it

was found to be the optimum duration and frequency of SS according to studies

performed by Bandy, Irion, Briggler (1997). DS should be performed 8-12

repetitions for the optimal flexibility results to be obtained, Norris (Complete

Guide To Stretching 2002).



Confidentiality and anonymity were maintained using several methods. The use

of random number generation was used for each participant in place of names

and random number allocation for group placement. Data was recorded only on

one laptop which was password protected and only accessible to the Author.



As with the baseline measure straight leg raise testing for hamstring flexibility

was taken as the chosen measure, as it is the most reliable and safe way of

measuring the flexibility of the hamstrings. All measurements were performed in

a private treatment room so there could be no competition or embarrassment at

the results obtained.



Each research assistant was a trained personal trainer and blinded to the authors

hypothesis, reducing any risk of conflicting interests biasing the results.




                                                                              12
Hypothesis

Hypothesis 1: Dynamic stretching will be more effective than static stretching at

increasing flexibility of the hamstring muscles.



Hypothesis 2: Changes in flexibility obtained by dynamic stretching will be

retained for longer than those obtained from static stretching or the control group.



Ethical Considerations:

Ethical approval for this study was granted by the British School of Osteopathy

Research Ethics Committee. All participants received a Participant Information

Sheet (PIS) (Appendix 2), and consent form (appendix 3). No pain, adverse

effects or discomfort should have been experienced by any participants as they

were given appropriate education on their allocated intervention by trained

research assistants, inclusion criteria stated that participants must already

exercise which would include stretching, reducing the risk of intervention as it is

not a new stimulus. If any participants reported adverse reactions to the

stretching routine they were asked on the PIS to contact the study supervisor for

advice. All measurements were done in isolation in a private treatment room by a

blinded trained research assistant and all information received was anonymous.




                                                                                 13
Results

Table 1: Dermographic Data
                     Static               Dynamic              Control
Male     % (n)       55% (5)              36% (4)              41% (3)
Female % (n)         45% (6)              64% (7)              59% (4)
Median age           3      (1-5)         3     (1-4)          1    (1-3)
Range                (38-47)              (38-47)              (18-27)

Table 1 shows there was a greater percentage of female patients in the dynamic

stretching group and the control group were younger than the other two groups.

A Chi 2 test showed there was no significant difference in distribution of male and

female in the three groups (X2=1.96, df =2, p=0.91). A Kruskal Wallis test showed

there was no significant difference in age group between the three groups

(X2=5.20, df=2, p=0.07)


Table 2: Descriptive Statistics for baseline and experimental measures
                         Static               Dynamic          Control
                         Mean       SD        Mean     SD.     Mean    SD.
0 Weeks L(Baseline)        87.27 11.91         91.55    12.89    81.71     8.38
0 Weeks R(Baseline)        87.55     9.14      92.09    10.21    83.00     5.89
2 Weeks L                  93.00 12.26        104.27     9.77    81.43     8.73
2 Weeks R                  95.00 10.32        106.36     9.04    82.57     6.45
4 Weeks L                100.27 12.03         117.64    10.45    81.57     8.48
4 Weeks R                102.64 10.31         118.91     8.80    83.14     6.44
6 Weeks L                  96.36 11.25        111.82    10.67    82.00     8.64
6 Weeks R                  96.91     9.28     112.82    9.834    84.14     6.77
8 Weeks L                  90.73 10.84        105.27     11.3    82.14     8.75
8 Weeks R                  91.73     9.22     106.09     10.6    83.86     6.04
Change L                     3.45    5.11      13.73     5.16     0.43     2.51
Change R                    4.18     5.44      14.00     2.86     0.86     2.04

As the data was found to be a normal distribution, a series of independent T tests

was used to assess differences at baseline (0 weeks). This showed that there

was no significant difference between the 3 groups in L&R measures at 0 Weeks


                                                                                14
Independent T tests results.
                               Static VS Dynamic
Base Left                   T= -0.81                     P= 0.43
Base Right                  T= -1.10                     P= 0.28

                                Static VS Control
Base Left                   T= 1.07                      P= 0.30
Base Right                  T= 1.17                      P= 0.26

                              Dynamic VS Control
Base Left                   T= 1.78                      P= 0.009
Base Right                  T= 2.13                      P= 0.05

Table 3: Within group differences
                         Static             Dynamic             Control
                         Mean       SD      Mean    SD          Mean     SD
Week 0 L                 87.27      11.91     91.55 12.879         81.71   8.381
Week 0 R                 87.55      9.14      92.09 10.212         83.00   5.888
Week 8 L                 90.73      10.84    104.27   9.77         81.43    8.73
Week 8 R                 91.73      9.22     106.36   9.04         82.57    6.45
Difference L             3.45       5.11      13.91   4.81          0.43    2.51
Difference R             4.18       5.44      13.64   2.98          0.86    2.04
T Value L                -2.24              -8.83               -.045
T Value R                -2.55              -16.22              -1.11
P Value L                0.049*             <0.001*             0.67
P Value R                0.03*              <0.001*             0.31
* = significant at p<0.05


Table 3 shows that changes from week 0 to week 8 were greatest for the

dynamic stretching group. Paired sample T tests showed that within group

increases in flexibility between 0 and 8 weeks were significant for the static (L&R)

and dynamic (L&R) stretching groups but not for the control group.




                                                                                 15
Table 4: Between group differences
                              Static VS Dynamic
Change Left                T= -4.95                     P= <0.001
Change Right               T= -1.10                     P= <0.001

                                 Static VS Control
Change Left                  T= 1.15                    P= 0.17
Change Right                 T= 1.54                    P= 0.14

                               Dynamic VS Control
Change Left                  T= 6.81                    P= <0.001
Change Right                 T= 9.93                    P= <0.001

Table 4 shows that the dynamic changes (L&R) were significantly different to

both static and control groups at Week 8 but the static group was not significantly

different from the control group.


Table 5: Within-group greatest gain
                        Static              Dynamic             Control
                        Mean      Std.      Mean      Std.      Mean    Std.
Week 0 L                87.27     11.91      91.55    12.879      81.71   8.381
Week 0 R                87.55     9.14       92.09    10.212      83.00   5.888
Week 4 L                100.27 12.03        117.64    10.452      81.57   8.482
Week 4 R                102.64 10.31        118.91      8.803     83.14   6.440

Table 6: Between-group greatest gain difference
                             Static VS Dynamic
Biggest Gain Left         T= -6.89                      P= <0.001
Biggest Gain Right        T= -5.55                      P= <0.001

                                 Static VS Control
Biggest Gain Left            T= 10.06                   P= 0.17
Biggest Gain Right           T= 6.90                    P= 0.14

                               Dynamic VS Control
Biggest Gain Left            T= 12.33                   P= <0.001
Biggest Gain Right           T= 14.00                   P= <0.001




                                                                                16
Tables 5 & 6 showed that there was a significant difference between week 0 and

week 4 (the end of the stretching routine and therefore the point of greatest gain)

in the static and dynamic groups but not in the control group.



Further tests showed there were no differences between male and female

participants at baseline or in overall change. There were no relationships

between flexibility measures and age at baseline or in changes within the 3

groups.




                                                                                 17
Discussion

The aim of this study was to investigate if a difference existed between the

efficacy of flexibility gains obtained by performing dynamic and static stretching

over a 4 week period, and whether the flexibility changes were retained over a

further 4 week period once stretching intervention was ceased.



29 participants completed the full 8 week course of this experiment, 12 male and

17 female. There was no significant difference between males and females at

baseline or overall change. There was also no correlation between age and

baseline flexibility or changes seen in the 3 groups.



Hypothesis 1: Dynamic stretching will be more effective than static stretching at

increasing flexibility of the hamstring muscles. Paired sample T test showed

there was a significant difference where p <0.001, therefore hypothesis 1 was

accepted. Flexibility changes from baseline measures to greatest gain were

significant over the first 4 weeks in both intervention groups over the control

group, with the greatest improvement being the DS group.



Hypothesis 2: Changes in flexibility obtained by dynamic stretching will be

retained for longer than those obtained from static stretching or the control group.

Independent paired T test showed a significant difference where P<0.001 in the

change from week 0 to 8 in the dynamic group. Therefore hypothesis 2 was




                                                                                  18
accepted. There was no significant change from weeks 0 to 8 in either the static

or control groups.



SS is the most commonly used method as it is the easiest to perform and has the

lowest potential for trauma (Jennifer M Roberts & Karen Wilson, 1999). If DS is

performed accurately within dynamic flexibility ROM then there should be no

increased risk of injury and the pendular motion utilising weight and gravity could

give an overall greater degree of stretch on one or more components of the

muscle, therefore proving to be a more effective and beneficial stretch.



Results of this study show DS was the most effective method to achieve long

term flexibility improvements. In light of previous research DS may also reduce

muscle hypertonicity, offer greater improvement to sporting performance and

reduce the risk of injury. This may be a more effective type of stretching in the

long term for patients with adequate function and ROM . The effects of stretching

are specific, therefore the stretch which is best suited and safest should be

selected depending on the desired outcome and individual it is prescribed for.



Detrimental effects of stretching primarily SS as part of a sportspecific warm-up

have been documented (Small et al, 2008). This includes reduced sporting

performance especially in explosive activities and increased risk of injury due to

laxity and loss of integrity across a joint. This causes reductions in proprioception

delaying onset of the protective stretch reflexes (Alter 1988, Norris 2002).




                                                                                    19
It is possible to negate any detrimental effects of DS as part of a sportspecific

warm-up by including secondary warm-up, however additional warm-up made no

difference to SS negative effects (Pearce., et al 2009). DS had a greater

improvement on performance compared SS and no stretch (Samuel et al 2008).

DS has also shown improved isolated dynamic skill performance such as a golf

swing when compared to no beneffical gain shown by not stretching or by SS

(Moran et al 2009). An active warm-up incorporating sport specific dynamic

flexibility routines has been shown as a protective factor against muscular strain

during sports performance (Glein & McHugh, 1997). DS alone and in

combination with warm-up routines has been shown to increaese sustained

improvments in power, strength, muscular endurance, anaerobic capacit, agility

gains (Herman & Smith 2008, Manoe et al 2008).



Both types of stretch should be combined for the training and rehabilitation of a

patient, as they effect different components of muscle Mahieu., et al (2007). The

advantages and disadvantages vary so each may be used as an effective tool

when applied appropriately to the patient depending on treatment goal among

many other factors.



The results are more reliable than the contradicting papers due to the lack of

confounding variables, there were no significant differences between baseline

measures, gender and age between all groups. This study recruited from a wide




                                                                                    20
age range, unlike previous research. The intervention time and intensity was

controlled therefore one group did not receive a greater overall intervention

allowing the results to be compared on even ground. Measurements were taken

by blinded and fully trained research assistants.



The majority of research has been performed in relation to stretching gains on

improving performance and reducing the risk of injury, rather than on flexibility

gains and retention. There is plenty of evidence based support for DS over SS on

athletes concerning performance and injury reduction. There is limited research

on DS, the focus has been on BS compared to SS on its flexibility effects. There

is no clear definition between DS and BS and there is debate as to whether these

terms should be use synonymously.



Many studies only focus on the effects of stretching on the hamstring muscles, it

has been suggested that the hamstring muscles are the most responsive to

flexibility benefits of stretching, Sady et al, (1982). However these results cannot

be generalised to all muscles based upon findings specific to the hamstring

muscle groups (Bandy et al 1997).



Possilbe confounding factors from this study are the intensity of exercise

performed by the participants outside of the study. As this was not controlled, the

potential effects cannot be considered here, this could be a topic for further

research. Unpercieved variances such as illness, training intensities, external




                                                                                    21
factors altering training routine and intensity could not be controlled they have

been considered as potential impact upon the results. However, analysis of

exercise diaries showed each of the three groups had a similar amount of

variance around their stated baseline activity level and report adhearing to their

allocated stretch routines.



Conclusion

DS showed significant differences for improving flexibility and retaining these

effects upon ceasation of stretching. SS improved flexibility significantly but does

not retain those bennefits once stretching is stopped. Therefore DS is the best

stretching modality for prescription to appropriate patients and will give them

greater flexibilty gains long term. A programme incorporating all modalities could

offer the greatest benefit in terms of patient management or prescription for

athletes.



Future research involving DS is needed to investigate the repetitions or time

needed to produce optimal results with a larger sample size. These then need to

be compared with that of static progressive, proprioceptive neuromuscular

facilitation and ballistic stretching.




                                                                                    22
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 Moran KA., MrGrath T., Marshall BM., Wallace ES., Dynamic stretching and
  golf swing performance, International Journal of Sports Medicine, 2009
  Feb;30(2):113-8

 Norris, C. M. The Complete Guide To Stretching, 2002 Biddles Ltd, Guilford and King’s
 Lynn

 Pearce AJ., Kidgell DJ., Zois J., Carlson JS., Effects of secondary warm-up following
 stretching, European Journal of Applied Physiology, 2009 Jan; 105(2):175-83

 Roberts JM, Wilson K. Effect of stretching duration on active and passive range
  of motion in the lower extremity: British Journal Sports Med. 1999
  Aug;33(4):259-63




                                                                                      24
 Sady SP, Wortman M, Blanke D. Flexibility training: ballistic, static or
  proprioceptive neuromuscular facilitation? Archive of Phys Med Rehabilitation.
  1982 Jun; 63(6):261-3.


 Samuel MN., Holocomb WR., Guadagnoli MA., Rubley MD., Wallman H., Acute effects
 of static and ballistic stretching on measures of strength and power, Journal of
 Strength Conditioning, 2008 Sep;22(5):1422-8

 Shrier. I, Gossal, K. Myths and Truths of Stretching, Individualized
  Reccomendations for Healthy Muscles, The Physician and Sports-medicine
  2000– Vol 29 – No. 8 – August

 Small K., Mc Naughton L,. Mathews M., A systematic review into the efficacy of
  static stretching as part of warm-up for prevention of exercise-related injury.,
  Res Sports Medcine, 2008 Jul-Sep;16(3):213-3

 Taylor DC, Dalton JD Jr, Seaber AV, Garrett WE Jr. Viscoelastic properties of
  muscle-tendon units. The biomechanical effects of stretching. Am J Sports
  Med. 1990 May-Jun;18(3):300-9.


 Webright WG, Randolph BJ, Perrin DH, Comparrison of nonballistic active knee
  extension in neural slump position and static stretch techniques on hamstring
  flexibility, Journal of Orthopaedic Sports Physical Therapy. 1997 Jul: 26(1):7-13

 Wiktorsson-moller, M, Oberg. B, Ekstrand. J, Gillquist. J, Effects of warming up,
  massage, and stretching on range of motion and muscle strength in the lower
  extremity, American Journal Of Sports Medicine, 1983 vol 11 no 4 92-608

 Williford HN, East JB, Smith FH, Burry LA. Evaluation of warm-up for
  improvement in flexibility, American Journal of Sports Medicine. 1986 Jul-
  Aug;14(4):316-9

 Winters MV, Blake CG, Trost JS, Marcello-Brinker TB, Lowe LM, Garber MB,
  Wainner RS. Passive versus active stretching of hip flexor muscles in subjects
  with limited hip extension: a randomized clinical trial: Physical Therapy. 2004
  Sep;84(9):800-7

 Wiktorsson-moller M., Oberg B., Ekstrand J., Gillquist J., Effects of warming up,
  massage, and stretching on range of motion and muscle strength in the lower
  extremity, American Journal Of Sports Medicine vol 11 no 4 1983 92-608

 Witvrouw E, Mahieu N, Roosen P, McNair P. The role of stretching in tendon
  injuries: Br J Sports Med. 2007 Apr;41(4):224-6. Epub 2007 Jan



                                                                                    25
Appendix1:
Short form International Physical Activity Questionnaire (IPAQ)
Please tick boxes as appropriate.
Please answer questions A-B if you are comfortable to disclose this information or just
complete questions 1-7.
This questionnaire is anonymous; please do not write your name on it.
A) Age: □ 18-27    □ 28-37 □ 38-47 □ 48-57 □ 58+
B) Gender: □ Male         □ Female


We are interested in finding out about the kinds of physical activities that people do as part of
their everyday lives. The questions will ask you about the time you spent being physically active
in the last 7 days. Please answer each question even if you do not consider yourself to be an
active person. Please think about the activities you do at work, as part of your house and yard
work, to get from place to place, and in your spare time for recreation, exercise or sport.

Think about all the vigorous activities that you did in the last 7 days. Vigorous physical
activities refer to activities that take hard physical effort and make you breathe much harder than
normal. Think only about those physical activities that you did for at least 10 minutes at a time.

1. During the last 7 days, on how many days did you do vigorous physical
activities like heavy lifting, digging, aerobics, or fast bicycling?

_____ days per week

No vigorous physical activities Skip to question 3

2. How much time did you usually spend doing vigorous physical activities on one of those
days?

__ / __ hours / minutes per day
□ Don’t know/Not sure

Think about all the moderate activities that you did in the last 7 days. Moderate activities refer to
activities that take moderate physical effort and make you breathe somewhat harder than normal.
Think only about those physical activities that you did for at least 10 minutes at a time.

3. During the last 7 days, on how many days did you do moderate physical
activities like carrying light loads, bicycling at a regular pace, or doubles tennis? Do not include
walking.
_____ days per week

No moderate physical activities Skip to question 5
4. How much time did you usually spend doing moderate physical activities on one of those
days?

__ / __ hours / minutes per day
□ Don’t know/Not sure

Think about the time you spent walking in the last 7 days. This includes at work and at
home, walking to travel from place to place, and any other walking that you might do
solely for recreation, sport, exercise, or leisure.

5. During the last 7 days, on how many days did you walk for at least 10 minutes
at a time?
_____ days per week


                                                                                                 26
No walking Skip to question 7

6. How much time did you usually spend walking on one of those days?

__ / __ hours / minutes per day
□ Don’t know/Not sure

The last question is about the time you spent sitting on weekdays during the last 7
days. Include time spent at work, at home, while doing course work and during leisure
time. This may include time spent sitting at a desk, visiting friends, reading, or sitting or
lying down to watch television.

7. During the last 7 days, how much time did you spend sitting on a week day

__ / __ hours / minutes per day
□ Don’t know/Not sure

(Not distributed to participants)
At A Glance
IPAQ Scoring Protocol (Short Forms)

Continuous Score
Expressed as MET-min per week: MET level x minutes of activity/day x days per week
Sample Calculation
MET levels MET-minutes/week for 30 min/day, 5 days
Walking = 3.3 METs 3.3*30*5 = 495 MET-minutes/week
Moderate Intensity = 4.0 METs 4.0*30*5 = 600 MET-minutes/week
Vigorous Intensity = 8.0 METs 8.0*30*5 = 1,200 MET-minutes/week
___________________________
TOTAL = 2,295 MET-minutes/week
Total MET-minutes/week = Walk (METs*min*days) + Mod (METs*min*days) + Vig
(METs*min*days)

Categorical Score- three levels of physical activity are proposed:

1. Low
• No activity is reported OR
• Some activity is reported but not enough to meet Categories 2 or 3.

2. Moderate
Either of the following 3 criteria
• 3 or more days of vigorous activity of at least 20 minutes per day OR
• 5 or more days of moderate-intensity activity and/or walking of at least 30 minutes
per day OR
• 5 or more days of any combination of walking, moderate-intensity or vigorous intensity
activities achieving a minimum of at least 600 MET-minutes/week.

3. High
Any one of the following 2 criteria
• Vigorous-intensity activity on at least 3 days and accumulating at least 1500
MET-minutes/week OR
• 7 or more days of any combination of walking, moderate- or vigorous-intensity
activities accumulating at least 3000 MET-minutes/week




                                                                                                27
Appendix 2:
                                   Participant Information Sheet.
Title of Project: Comparison of the efficacy and retention of flexibility changes upon the hamstring muscle
group caused by a course of static or dynamic stretch techniques.

You are invited to take part in a research study. Before you decide it is important for you to understand why
the research is being done and what it will involve. Please take time to read the following information
carefully and discuss it with others if you wish. Ask us if there is anything that is not clear or if you would like
further information. Take time to decide whether or not you wish to take part. Thank you for reading this.

What is the purpose of this project?
The purpose of this study is to discover which of the two most common stretch methods is the most effective
and which has the longer lasting effects. This project is part of an Osteopathy degree at the British School of
Osteopathy. The results will help give a better understanding to which type of stretching is the most
beneficial. This will aid Osteopaths in the management of patients.

Why have I been chosen?
You are one of 60 participants who will be taking part in this study. You have been chosen because you are
an active person or BSO student and the interest you stated was gratefully received.

What does it involve?
If you decide to take part in this project, you are required to fill out a questionnaire which contains questions
about activity levels and a little information about your past injuries; in which you are required to say if you
have had any injuries effecting your lower back or legs. You can retain this information sheet; completion of
the questionnaire along with a consent form will be taken as your acceptance onto the study. Your decision
to take part or not is entirely voluntary and you have the right to withdraw from the study at anytime, no
questions asked..

What do I have to do?
Complete the questionnaire on a single occasion; this will take approximately 10 minutes. Completed
                                                                                 st
questionnaires need to be returned to Sam Hall by post, email or in person by 1 November 2008.
A meeting will be arranged when your initial flexibility will be measured and you will be taught how to do the
stretch method you have been assigned, this should take no longer than 15 minutes. An information sheet
will be included detailing the technique you have been assigned.

The Risks!
There is a small chance as with any exercise or stretching that you could cause damage to your muscles. All
the information sheets and education you will be given is designed to reduce that risk. Should you be injured
you will be referred to the project supervisor, a fully qualified Osteopath, for management and advice.

Will my taking part in the study remain confidential?
Yes, all questionnaires, test results and personal information given will only be available to the researcher
and research team at the British School of Osteopathy.

What will happen to the results of the study?
Results will be published once the project is completed and a copy made available in the BSO library. If you
would like an additional summary of the results, our contact details are below.

Thank you for taking the time to read the information sheet. Our contact details are given below
should you have any questions or want further information.
Researcher
Sam Hall                                                   Supervisor
British School of Osteopathy                               Ben Calvert-Painter
275 Borough High St., London,                              British School of Osteopathy
SE1 1JE                                                    275 Borough High St., London, SE1 1JE
Email: s.hall@bso.ac.uk                                    Email: B.Calvert-Painter@bso.ac.uk
Tel: 077 363 1 858 3                                       Tel:




                                                                                                                28
Appendix 3:




              29
Appendix 4:


Hamstring Stretch – static seated

Description

   1. Stretches should be performed on each leg once
      daily following normal warm-up and exercise
      routine
   2. Sit on the floor with the leg to be stretched
      extended, and the other leg bent with the foot

      towards your body.
   3. Draw your tummy into your spine, Reach out with
      your hands, lean your upper body forward, and
      bring your chest towards your thigh.
   4. Make sure you don't round the upper back, and
      your lower back should be slightly curved.
   5. Get to the point of a mild stretch and hold for 30
      seconds.
   6. Repeat for each leg




                                                           30
Appendix 5:

Hamstring Stretch – Dynamic

Description

   1. Stretches should be performed on each leg once
      daily following normal warm-up and exercise
      performed

   2. Standing in a split stance gently swing your leg in
      front of you, ensuring you keep the leg straight

   3. Allowing the weight of the leg to cause the down
      swing

   4. Stretching should get progressively bigger till you
       reach your own perceived end of range

   5. A mild stretch should be felt in the back of the leg
      and the pendular swing should be repeated 10
      times each leg, taking 30 seconds per side.




                                                             31
Appendix 6:
Exercise Diary


Week 1           Exercise     Type           Stretch       Comments
Day              Y/N?                        Y/N?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday


Week 2           Exercise     Type           Stretch       Comments
Day              Y/N?                        Y/N?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday


Week 3           Exercise     Type           Stretch       Comments
Day              Y/N?                        Y/N?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday


Week 4           Exercise     Type           Stretch       Comments
Day              Y/N?                        Y/N?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Example            Exercise     Type                   Stretch   Comments
Monday             Y            Cardio/Kickboxing      Y         Stretch felt hard
                                or
                                Resistance/Weights




                                                                                     32
Week 5      Exercise     Type           Stretch       Comments
Day         Y/N?                        Y/N?
Monday                                  N/A
Tuesday                                 N/A
Wednesday                               N/A
Thursday                                N/A
Friday                                  N/A
Saturday                                N/A
Sunday                                  N/A


Week 6      Exercise     Type           Stretch       Comments
Day         Y/N?                        Y/N?
Monday                                  N/A
Tuesday                                 N/A
Wednesday                               N/A
Thursday                                N/A
Friday                                  N/A
Saturday                                N/A
Sunday                                  N/A


Week 7      Exercise     Type           Stretch       Comments
Day         Y/N?                        Y/N?
Monday                                  N/A
Tuesday                                 N/A
Wednesday                               N/A
Thursday                                N/A
Friday                                  N/A
Saturday                                N/A
Sunday                                  N/A


Week 8      Exercise     Type           Stretch       Comments
Day         Y/N?                        Y/N?
Monday                                  N/A
Tuesday                                 N/A
Wednesday                               N/A
Thursday                                N/A
Friday                                  N/A
Saturday                                N/A
Sunday                                  N/A

Example       Exercise     Type                   Stretch     Comments
Monday        Y            Cardio/Kickboxing      No          Stretch felt hard
                           or                     stretches
                           Resistance/Weights     this week




                                                                                  33

								
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