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UBC Theses and Dissertations

A comparison of six methods of stretch on the active range of hip flexion Hartley, Sandra Jean 1976

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A C O M P A R I S O N OF S I X METHODS O F S T R E T C H ON T H E A C T I V E RANGE OF H I P F L E X I O N b y SANDRA J E A N H A R T L E Y B . P . E . , U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1971 A T H E S I S S U B M I T T E D I N P A R T I A L F U L F I L L M E N T O F T H E R E Q U I R E M E N T S F O R T H E D E G R E E O F M A S T E R O F P H Y S I C A L E D U C A T I O N i n t h e S c h o o l o f P h y s i c a l E d u c a t i o n a n d R e c r e a t i o n We a c c e p t t h i s t h e s i s a s c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d T H E U N I V E R S I T Y OF B R I T I S H C O L U M B I A M a y , 1976 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of Brit ish Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my writ ten pe rm i ss i on . Department of f^/.^/rj'j Cttuj'^f/s>J 1/ The University of Brit ish Columbia 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 Date TYlcut.) A B S T R A C T i i B a s i c a l l y a l l m e t h o d s o f s t r e t c h i n g c a n b e t e r m e d A C T I V E o r P A S S I V E i n t e r m s o f t h e t y p e o f t h e r a n g e o f m o t i o n a c q u i r e d . A c t i v e s t r e t c h i n g m e t h o d s r e q u i r e t h a t t h e r a n g e o f m o v e m e n t b e made v o l u n t a r i l y , w h i l e p a s s i v e s t r e t c h i n g m e t h o d s r e f e r t o m o v e m e n t t h r o u g h a r a n g e d u e t o e x t e r n a l f o r c e s u c h a s g r a v i t y o r m a n u a l a s s i s t a n c e . I t w a s t h e p u r p o s e o f t h i s s t u d y t o i n v e s t i g a t e t h e e f f e c t s o f s i x m e t h o d s o f s t r e t c h o n t h e a c t i v e r a n g e o f r i g h t h i p f l e x i o n . T h e s a m p l e c o n s i s t e d o f 1 1 9 v o l u n t e e r c o l l e g e women i n p h y s i c a l e d u c a t i o n a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a . A p p r o x i m a t e l y t w e n t y s u b j e c t s w e r e r a n d o m l y a s s i g n e d t o e a c h o f s e v e n t r e a t m e n t g r o u p s b y p a i r s . I n a d d i t i o n t o t h e C o n t r o l g r o u p , s i x e x e r c i s e g r o u p s w e r e t a u g h t v a r i o u s s t r e t c h i n g r e g i m e n s t o b e p r a c t i c e d t e n m i n u t e s w i t h a p a r t n e r t h r e e t i m e s a w e e k f o r t h r e e w e e k s . A l l s u b j e c t s w e r e m e a s u r e d b e f o r e a n d a f t e r t h e s t u d y a s w e l l a s b e f o r e a n d a f t e r e x e r c i s e o n t h e f i r s t d a y o f e a c h w e e k . T h e a c t i v e r a n g e o f r i g h t h i p f l e x i o n w a s m e a s u r e d b y t h e L e i g h t o n F l e x o m e t e r a n d t h e s t r e n g t h o f h i p f l e x i o n a t t h e h$ d e g r e e a n g l e w a s m e a s -u r e d b y a c a b l e t e n s i o m e t e r . A l l g r o u p s i n c r e a s e d i n a c t i v e r a n g e o f h i p f l e x i o n a s i n d i c a t e d b y t h e m e a n g a i n s , i n c l u d i n g t h e C o n t r o l g r o u p . T h e f o l l o w i n g h y p o t h e s e s w e r e t e s t e d f o r s i g n i f i c a n c e i i i a t t h e .05 l e v e l a n d w e r e r e j e c t e d . 1 . A c t i v e s t r e t c h i n g m e t h o d s g i v e a g r e a t e r i m p r o v e m e n t i n a c t i v e r a n g e o f h i p f l e x i o n t h a n d o p a s s i v e m e t h o d s o f s t r e t c h i n g . 2 . T h e m e t h o d , A c t i v e P r o p r i o c e p t i v e N e u r o m u s c u l a r F a c i l i t a t i o n , g i v e s a g r e a t e r i m p r o v e m e n t i n a c t i v e r a n g e o f r i g h t h i p f l e x i o n t h a n d o e s t h e m e t h o d , B a l l i s t i c a n d H o l d . A c t i v e s t r e t c h i n g m e t h o d s d i d n o t c o n t r i b u t e s i g n i f -i c a n t l y b e t t e r t o a c t i v e r a n g e o v e r p a s s i v e m e t h o d s , n o r d i d t h e A c t i v e P N F m e t h o d a n d B a l l i s t i c a n d H o l d m e t h o d s h o w s i g n i f i c a n t d i f f e r e n c e s i n t h e i r c o n t r i b u t i o n t o a c t i v e r a n g e . S i n c e p a s s i v e m e t h o d s o f s t r e t c h i n g c o n t r i b u t e d a s w e l l a s a c t i v e m e t h o d s t o a c t i v e r a n g e o f h i p f l e x i o n , i t i s a p p a r e n t t h a t t h e o r e t i c a l l y f o r a c t i v e r a n g e o f m o t i o n , i t m a y b e a s i m p o r t a n t t o r e d u c e t h e r e s i s t a n c e o f t h e m u s c l e b e i n g s t r e t c h e d a s t o i n c r e a s e t h e s t r e n g t h o f t h e a c t i v e o p p o s i n g m u s c l e . T h e r e s u l t s o f t h i s s t u d y i n d i c -a t e t h a t b o t h a c t i v e a n d p a s s i v e m e t h o d s o f s t r e t c h i n g a r e e f f e c t i v e i n i n c r e a s i n g a c t i v e r a n g e o f m o t i o n . T h e R e l a x a t i o n m e t h o d c o n t r i b u t e d s i g n i f i c a n t l y b e t t e r t h a n o t h e r p a s s i v e m e t h o d s t o a c t i v e r a n g e o f h i p f l e x i o n a p p a r e n t l y d u e t o a m o r e e f f e c t i v e r e d u c e d r e s i s t -a n c e f r o m t h e c o n t r a c t i l e c o m p o n e n t o f t h e m u s c l e . T h e s t r e n g t h o f h i p f l e x i o n a s m e a s u r e d a t t h e ^ 5 d e g r e e a n g l e w a s n o t d i f f e r e n t i a l l y i m p r o v e d b y t h e v a r i o u s e x e r c i s e t r e a t m e n t s f o r t h e p r o b a b l e r e a s o n t h a t t h e a n g l e a t w h i c h t h e s t r e n g t h w a s m e a s u r e d w a s w e l l b e l o w t h e r a n g e a t w h i c h s p e c i f i c s t r e n g t h g a i n s m i g h t h a v e t a k e n p l a c e . TABLE OF CONTENTS 1 V Page L i s t of Tables v L i s t of Figures..,. v i L i s t of Plates v i i Preface • v i i i Acknowledgements.. • i x CHAPTER I INTRODUCTION TO THE PROBLEM.. 1 II REVIEW OF RELATED LITERATURE 10 III METHODS AND PROCEDURES General Procedures. ij-5 S p e c i f i c Procedures. Jj-7 Instruments of Measurement Experimental Design 50 S t a t i s t i c a l Treatment 51 IV RESULTS AND DISCUSSION 53 Discussion...... • 69 V SUMMARY AND CONCLUSIONS 7^ LITERATURE CITED 78 APPENDIX A. Individ u a l Raw Scores • 95 B. In t e r p r e t a t i o n of the P h y s i o l o g i c a l Mechanisms i n the Six Methods... 1 0 2 C. I n s t r u c t i o n a l Sheets 1 0 5 V L I S T OF T A B L E S T a b l e P a g e 1. O b s e r v e d C e l l M e a n s f o r D a y 1, D a y 11 5* 2. C e l l M e a n s S h o w i n g A c t i v e R a n g e P r e 59 3. D a i l y G a i n i n A c t i v e R a n g e f o r D a y s 60 C e l l M e a n s f o r D a y 1 D a y 11 a n d M e a n 61 LIST OF FIGURES v i Figures Page 1. Theoretical Model to Improve Range of Motion... 3 2. Schematic Diagram of Experimental Design 50 3. Optional Contrast Matrix..*. 51 Improvement Trends f o r A l l Methods 55 5. Improvement Trends f o r Passive Methods.. 62 6. Improvement Trends f o r Active Methods..... 63 7. Improvement Trend f o r Control Group 6k 8. Improvement Trend f o r Passive L i f t , Act. Hold.. 65 9. Improvement Trend f o r Relaxation Method... 66 10. Improvement Trend f o r Passive PNF 67 11, Improvement Trend f o r Prolonged S t r e t c h . . . . . . . . 68 LIST OP PLATES Plates Page 1. Paired stretching working with the clock...... 42 2. The strength apparatus and tensiometer 43 3. Active range of fl e x i b l e subject 44 4. Passive range of flex i b l e subject....... 44 v i i i P R E F A C E A d u a l s t u d y w a s u n d e r t a k e n t o s a t i s f y t h e i n t e r e s t s o f t w o g r a d u a t e s t u d e n t s who w i s h e d t o c o m b i n e t h e i r e f f o r t s i n a n a t t e m p t t o m u l t i p l y t h e v a l u e o f t h e i r r e s e a r c h . I t w a s t h e o p i n i o n o f t h e s t u d e n t s t h a t t h e d u a l a s p e c t o f t h e s t u d y g r e a t l y e n h a n c e d t h e e d u c a t i o n a l v a l u e a n d s t i m u l a t e d d e e p e r u n d e r s t a n d i n g o f t h e t h e s i s t o p i c . O r i g i n a l l y , i t w a s t h e i n t e n t o f e a c h s t u d e n t t o t h o r o u g h l y i n v e s t i g a t e t h r e e s t r e t c h i n g m e t h o d s e a c h a n d p o o l t h e d a t a f r o m t h e C o n t r o l g r o u p . F o l l o w i n g t h e Comm-i t t e e ' s r e c o m m e n d a t i o n , i t w a s t h e n d e c i d e d t h a t , i n t e r m s o f t h e s t a t i s t i c a l a n a l y s i s , i t w o u l d m o r e p r o d u c t i v e t o c o l l a b o r a t e t h e d u a l e f f o r t s e v e n m o r e c l o s e l y . T h u s t h e d a t a f r o m a l l s i x e x e r c i s e s , a s w e l l a s t h e C o n t r o l g r o u p , w a s u t i l i z e d b y b o t h s t u d e n t s , b u t o n e s t u d e n t h a s d e a l t w i t h t h e r e s u l t s f o r t h e a c t i v e r a n g e o f f l e x i b i l i t y , w h i l e t h e o t h e r h a s d e a l t w i t h t h e r e s u l t s f o r t h e p a s s i v e r a n g e . T h i s t h e s i s r e p r e s e n t s o n e h a l f o f t h e t o t a l r e s e a r c h a c c o m p l i s h e d b y t h e d u a l s t u d y . i x A CKNOWLEDGEMENTS A g r a c i o u s t h a n k y o u i s e x t e n d e d t o K e i t h R u s s e l l , who a s " c o m r a d e i n r e s e a r c h " made t h e d u a l a s p e c t o f t h i s s t u d y n o t o n l y p o s s i b l e , n o t o n l y m o r e e n j o y a b l e , b u t i n e v e r y d e c i s i o n t o b e m a d e a l o n g t h e w a y , h e s u b s t a n t i a t e d t h e c l i c h e " t h a t " t w o h e a d s a r e b e t t e r t h a n o n e . " CHAPTER I INTRODUCTION TO THE PROBLEM F l e x i b i l i t y , or j o i n t mobility, appears to be of s i g n i f i c a n c e as an aspect of physical f i t n e s s (DeVries, 19?2j Leighton, i 9 6 0 ) , as a f a c t o r i n successful perform-ance i n c e r t a i n kinds of motor a c t i v i t i e s (Jencks, 197*M Olsen, 1956), and as a f a c t o r i n r e l i e v i n g pain (DeVries, 197^» Grieve, 1971) and reducing i n j u r y (Holt, 1971? Williams, I968). S p e c i f i c types of f l e x i b i l i t y are con-sidered to be advantageous q u a l i t i e s f o r a t h l e t e s (Hartley, 1971j Johnson, 197^1 Tucker, I963) while the needs and demands of a p a r t i c u l a r sport d i c t a t e which j o i n t s must be f l e x i b l e and to what extent. Karpovich (1959*287) states, "Besides f i t n e s s f o r the i n t e n s i t y of the e f f o r t , f i t n e s s f o r the q u a l i t y of the e f f o r t i s of p r a c t i c a l importance." F l e x i b i l i t y may be important to the athlete f o r some or a l l of the following reasons: 1. Freedom of movement and thus greater amplitude over which to apply f o r c e . 2. Movement e f f i c i e n c y ( l e s s resistance to movement) and thus greater economy of work output. 3. Prevention of s o f t tissue damage due to l i m i t e d range of motion. 1 2 4. Aesthetic impression and perceived ease of movement. 5. Mechanical advantage i . e . wrist and hip f l e x i b i l i t y allow a gymnast to place the center of g r a v i t y over the base of support, the hands, i n order to f a c i l i t a t e a p p l i c -a t i o n of force i n the "press to handstand." In c o l l a b o r a t i o n with Russell (1976), the i n v e s t -i g a t o r co-designed the following t h e o r e t i c a l model i n d i c -a t i n g how f l e x i b i l i t y may be increased. Figure 1 shows that there are b a s i c a l l y two approaches to i n c r e a s i n g range of motion, one approach i s to decrease the resistance of the s o f t , supportive tissues of the muscle and j o i n t , and the second approach i s to increase the force (strength) of the opposing muscles to a c t i v e l y move through a range. P h y s i o l o g i c a l l y , resistance can be decreased i n two wayst 1. Actual p h y s i c a l lengthening of the s o f t t i s s u e s ( i . e . muscle, connective tissue, tendon, ligament). 2. Relaxation or i n h i b i t i o n of contraction of the muscle. Increasing strength of the muscles that w i l l a c t i v a t e the range of motion can be accomplished by various muscle load-i n g a c t i v i t i e s as well as by r e f l e x i v e f a c i l i t o r y techniques. In order f o r a c t i v e range of motion to increase, i t seems that at l e a s t one of these p h y s i o l o g i c a l events (reduced resistance or increased strength) must occur. As can be seen i n Figure 1, there are numerous p h y s i c a l and psychol-o g i c a l courses of a c t i o n by which one may a t t a i n the p h y s i o l o g i c a l conditions. .Figure 1 The o r e t i c a l Model of Approaches and Courses of Action . to Improve Range of Motion APPROACH PHYSIOLOGICAL COURSES OF ACTION-" H n T , T m Q PHYSICAL PSYCHOLOGICAL CONDITIONS DECREASE RESISTANCE OF TARGET AREA LENGTHEN a) Prolonged s t r e t c h rnNiMTrrTTVF b ) Contract target ? CONNECTIVE & r e a w h U e u n d e r TISSUE stretch ^ T . v , _ . ., . a) Mind-set ( Gamma RELAX a) Reciprocal bias) I n h i b i t i o n MYOTATIC _ * . , b) Biofeedback (mon-b ) A c c o m m o d a t i o n i t e r e d i n h i D i t i o n ) REFLEX c) Heat, i c e . massage. c ) Relaxation exercise fatigue etc. T r a i n i n g INCREASE STRENGTH OF OPPOSING MUSCLES MUSCLE a) Isometric a) Motivation LOADING b ) Concentric c) Eccentric FACILITATION a) Successive induction a) Learning! r e c r u i t -(proprioceptive ment, coordination, TECHNIQUES neuromuscular synchronization f a c i l i t a t i o n ) i f The p h y s i c a l educator or coach interested i n increas-ing the f l e x i b i l i t y of students or athletes encounters few documented methods that claim to improve s p e c i f i c j o i n t range of motion. B a s i c a l l y a l l methods of s t r e t c h i n g can be designated as ACTIVE or PASSIVE. Active s t r e t c h i n g methods require that a subject move v o l u n t a r i l y through a range of motion, while passive s t r e t c h r e f e r s to movement occurring due to external force such as g r a v i t y or manual assistance. An i n t e r e s t i n g conjecture, which has yet to be resolved, i s which range i s more important to the a t h l e t e . I t i s thought by some that active range i s more valuable to the athlete i n that the range of most movement i s provided by muscular e f f o r t , and f o r that reason, the ac t i v e range simulates more c l o s e l y the athlete's needs i n sport. In t h i s regard DeVries (197*M43*r-) states* I t may be hypothesized that the f l e x i b i l i t y of motion may be of greater importance to p h y s i c a l performance than the a b i l i t y to achieve an extreme degree of f l e x i o n or extension i n the j o i n t ! I t was the i n t e r e s t of t h i s study to determine i f c e r t a i n f l e x i b i l i t y methods do i n f a c t contribute to a c t i v e range of motion. From the previous t h e o r e t i c a l model ( F i g . 1 ) , s i x methods of stretching were selected as the experimental treatments. Represented i n the methods are two t r a d i t i o n a l , two contemporary, and two t h e o r e t i c a l l y sound, but as yet non-researched s t r e t c h i n g exercises. PHYSIOLOGICAL EVENT 5 METHOD Lengthen supportive tissue ^  I n h i b i t c o n t r a c t i l e t i s s u e ^ Muscle loading a c t i v i t y - * ^ F a c i l i t a t i o n of s t r e n g t h ^ The s i x methods of stretch represent a l l four p h y s i o l o g i c a l conditions and i n a l l cases are combinations of at l e a s t two. For a de t a i l e d t h e o r e t i c a l i n t e r p r e t a t i o n behind the s e l e c t i o n of these methods, the reader i s r e f e r r e d to Appendix B. STATEMENT OF THE PROBLEM The purpose of t h i s study was to inv e s t i g a t e the diff e r e n c e s of s i x methods of st r e t c h i n g on the a c t i v e range of r i g h t hip f l e x i o n i n college women. Prolonged Stretch Relaxation Method Passive Propriocep-t i v e Neuromuscular F a c i l i t a t i o n Active Propriocep-t i v e Neuromuscular F a c i l i t a t i o n B a l l i s t i c and Hold Passive L i f t , Active Hold 6 S U B P R O B L E M S 1. W h a t i s t h e e f f e c t o f a c t i v e a n d p a s s i v e s t r e t c h i n g m e t h o d s o n t h e r a t e o f i m p r o v e m e n t i n a c t i v e r a n g e o f h i p f l e x i o n ? 2. I s t h e r e o n e m e t h o d t h a t i s s u p e r i o r t o t h e o t h e r s i n i n c r e a s i n g a c t i v e r a n g e o f h i p f l e x i o n ? T H E H Y P O T H E S E S 1. A c t i v e s t r e t c h i n g m e t h o d s ( A c t i v e P N F , B a l l i s t i c a n d H o l d ) g i v e a g r e a t e r i m p r o v e m e n t i n a c t i v e r a n g e o f f l e x i b i l i t y o v e r p a s s i v e m e t h o d s ( P a s s i v e P N F , P r o l o n g e d S t r e t c h , R e l a x a t i o n M e t h o d ) . R a t i o n a l e : A c t i v e s t r e t c h -i n g m e t h o d s , b y d e f i n i t i o n , i n v o l v e t h e e f f o r t o f t h e f l e x o r m u s c l e s , a n d s t r e n g t h i s a n a p p a r e n t f a c t o r i n v o l u n t a r i l y m o b i l i z i n g t h e l i m b m a x i m a l l y . 2. T h e A c t i v e P N F m e t h o d i s s u p e r i o r t o t h e B a l l i s t i c a n d H o l d m e t h o d i n i n c r e a s i n g a c t i v e r a n g e o f h i p f l e x i o n . R a t i o n a l e i O p t i m u m s o f t t i s s u e l e n g t h e n i n g w i l l b e f a c i l i -t a t e d b y a n i s o m e t r i c c o n t r a c t i o n u n d e r s t r e t c h . 7 D E L I M I T A T I O N S T h e f o u r w e e k s t u d y i n v o l v e d o n e h u n d r e d a n d n i n e t e e n v o l u n t e e r women p h y s i c a l e d u c a t i o n s t u d e n t s a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a . T h e e x p e r i m e n t w a s l i m i t e d t o o n e f l e x i b i l i t y a c t i o n o n l y ; t h e a c t i v e r a n g e o f r i g h t l e g h i p f l e x i o n . T h e s i x m e t h o d s i n v e s t i g a t e d w e r e t h o u g h t t o r e p r e s e n t t h e m a i n m o b i l i z i n g e x e r c i s e s a v a i l a b l e , a l t h o u g h i t i s p o s s i b l e t h a t o t h e r s d o e x i s t t h a t a r e n o t w i t h i n t h e r e a l m o f t h i s s t u d y . L I M I T A T I O N S 1. T h e e x p e r i m e n t e r h a d n o c o n t r o l o f t h e s u b j e c t s ' a c t i v i t i e s o u t s i d e o f t h e t e s t i n g s i t u a t i o n a l t h o u g h s u b j e c t s w e r e s p e c i f i c a l l y r e q u e s t e d t o a v o i d u n u s u a l a c t i v i t y . 2. S i n c e t h e s u b j e c t s w e r e a l l m e m b e r s o f p h y s i c a l e d u c a t i o n c l a s s e s , i t w a s e x p e c t e d t h a t s o m e g a i n s o f m o b i l i t y w o u l d b e a t t r i b u t a b l e t o s u b j e c t s * a c t i v i t i e s i n t h e s e c l a s s e s . A c o n t r o l g r o u p w a s i n c l u d e d i n t h e s t u d y t o d e t e r m i n e t h i s e f f e c t . 3» V e r y f l e x i b l e a n d v e r y i n f l e x i b l e i n d i v i d u a l s w e r e n o t e x c l u d e d f r o m t h e s t u d y , a l t h o u g h t h e p o t e n t i a l o f t h e s e i n d i v i d u a l s t o i m p r o v e t h e i r r a n g e o f m o t i o n 8 w e r e l i k e l y q u i t e d i f f e r e n t . 4. B y t h e n a t u r e o f t h e f r e e s w i n g i n g d i a l o f t h e L e i g h t o n F l e x o m e t e r , i t w a s d i f f i c u l t t o m a k e a c c u r a t e r e a d i n g s o f t h e a c t i v e r a n g e w h e n t h e m a x i m a l e f f o r t c a u s e d s o m e s u b j e c t s t o e x h i b i t a s h a k i n g o f t h e l e g a t t h e " h o l d " p o s i t i o n . D E F I N I T I O N S F l e x i b i l i t y : A b r o a d d e s c r i p t i v e t e r m , a s i s s t r e n g t h a n d e n d u r a n c e , w h i c h r e f e r s t o t h a t p h y s i c a l c o m p o n e n t d e s c r i b i n g t h e e a s e a n d t h e e x t e n t o f m o v e m e n t a t a g i v e n j o i n t . A m p l i t u d e : A m o r e s p e c i f i c t e r m m e a n i n g t h e t o t a l a n g u l a r d i s p l a c e m e n t o f a b o d y s e g m e n t a r o u n d a g i v e n j o i n t i . e . f l e x i o n a n d e x t e n s i o n c o m b i n e d . R a n g e : T h e m a x i m u m a n g u l a r d i s p l a c e m e n t i n o n e d i r e c t i o n o n l y i . e . r a n g e o f h i p f l e x i o n . T h i s t e r m m u s t b e f u r t h e r q u a l i f i e d i n t o : a ) A c t i v e R a n g e : t h a t r a n g e a c h i e v e d b y v o l u n -t a r y m u s c l e c o n t r a c t i o n . I f t h e c o n t r a c t i o n i s v e r y s t r o n g a n d r e s u l t s i n t h e l i m b b e i n g q u i c k l y p r o p e l l e d t o a n e n d p o i n t , t h e n t h e r a n g e i s t e r m e d t h e f a s t o r d y n a m i c a c t i v e r a n g e . ( T h e c o m m o n l y u s e d t e r m " b a l l i s t i c " f o r t h i s t y p e o f m o v e m e n t i s a n i n c o r r e c t u s a g e o f t h a t 9 w o r d s i n c e b a l l i s t i c r e f e r s t o a n o b j e c t s e p a r a t e d f r o m t h e s o u r c e o f i t s e n e r g y . ) M o m e n t u m i s a c o n t r i b u t o r y f a c t o r t o d y n a m i c a c t i v e r a n g e . I f t h e c o n t r a c t i o n i s s l o w , t h e n t h e r a n g e i s t h e s l o w o r s t a t i c a c t i v e r a n g e . b ) P a s s i v e R a n g e : t h a t r a n g e a c h i e v e d t h r o u g h s o m e e x t e r n a l f o r c e s u c h a s g r a v i t y o r m a n u a l a s s i s t a n c e . A c t i v e S t r e t c h i n g M e t h o d s t r e f e r t o e x e r c i s e r e g i m e n s r e q u i r i n g v o l u n t a r y c o n t r a c t i o n o f t h e a g o n i s t s a t s ome p o i n t d u r i n g t h e r a n g e o f m o t i o n . I n t h e c a s e of h i p f l e x i o n , t h e i l i o p s o a s a n d r e c t u s f e m o r i s o f q u a d r i c e p s a r e a c t i v e i n some p h a s e o f t h e e x e r c i s e . P a s s i v e S t r e t c h i n g M e t h o d s : r e f e r t o e x e r c i s e r e g i m e n s r e q u i r i n g n o v o l u n t a r y e f f o r t o f t h e a g o n i s t m u s c l e s d u r i n g t h e r a n g e o f m o t i o n ( f l e x i o n ) . CHAPTER II REVIEW OF RELATED LITERATURE D e f i n i t i o n F l e x i b i l i t y i s most often defined simply as H t h e range of j o i n t motion" (DeVries, 19?h\ Holland, 1968» Holt, 19711 Johnson, 197*0. As a term extended to muscle s t r e t c h i n animal studies, f l e x i b i l i t y i s described i n the l i t e r a t u r e as e x t e n s i b i l i t y (Fieldman, I960; Gardner, 1972), deformation (Buchtal and Kaiser, 19kk) and compliance (Goubel et a l . , 1971). The return of a muscle to i t s "normal" length has been c a l l e d e l a s t i c i t y or rebound (Wright and Johns, 1962). According to Holland (1968), the term f l e x i b i l i t y implies just f l e x i o n and therefore could be considered a misnomer. Sigerseth (1962t88) claims that the term f l e x i b i l i t y i s derived from the L a t i n " b i l i s " , meaning c a p a b i l i t y , and " f l e c t e r e " , meaning to bend. ...the meaning i n s c i e n t i f i c use pertains to the moving of a r t i c u l a t i n g segments of the body about a j o i n t and can therefore be used to des-c r i b e movement from a p o s i t i o n of extension to that of f l e x i o n or the opposite movement. (1962t88) F l e x i b i l i t y was more s p e c i f i c a l l y defined by D i c k i n -son (1968178), who i n studying the f l e x i o n and extension of 10 11 the human wrist found that flexion and extension of the same joint were not correlated. If the f l e x i b i l i t y i s specific to individual movements of the joint (flexion or extension), then a range of motion (flexion plus extension) would be a combination of two unrelated measure-ments and not applicable to most situations. (1968i78) In addition to the problem of defining f l e x i b i l i t y , there has been surprisingly poor acknowledgement i n the literature of the fact that f l e x i b i l i t y can be expressed i n two formsi active range of motion or passive range of motion. The two ranges were recognized by Glanville and Kreezer (1937) who obtained "norms" based on voluntary and passive movement of joints i n ten normal male adults. Kraus and Weber (19^9) used active and passive measures i n their study of contractures. Fleishman (1961) found by f a c t o r i a l anal-ysis that two s t a t i s t i c a l l y distinct components of f l e x i b i l i t y existed that appeared to depend upon the speed of the range of movement. Thus he expressed the separate components as extent f l e x i b i l i t y (slow or static) and dynamic f l e x i b i l i t y (fast, repetitive). Passive and active ranges of motion were both included i n the extent exercises* while the dynamic exercises were apparently active. Since Fleishman's study, awareness of the active and passive ranges of motion has either been taken for granted, or perhaps naively ignored. F l e x i b i l i t y and Speed of Motion DeVries (1963) hypothesized that f l e x i b i l i t y contri-buted a "looseness factor"" i n speed and oxygen consumption 12 a c t i v i t i e s . He thought that improvement of f l e x i b i l i t y should decrease r e s i s t i v e forces involved i n running and thus improve the speed. However, confirmation of t h i s hypothesis could not be made. Norman (1970) suggested but could not confirm that the v e l o c i t y of l e g extension at the knee may be r e s t r i c t e d by the shortness of tightness of the muscles that cross the knee j o i n t . Despite contrary evidence, i t s t i l l seems l o g i c a l that increased range of motion o f f e r s greater amplitude over which to apply force, and therefore increased v e l o c i t y at the point of force a p p l i c -a t i o n . However, from the l i t e r a t u r e to date, i t seems that f l e x i b i l i t y improvement has l i t t l e , i f any, e f f e c t on speed of movement. Instrumentation Since the World Wars, measurement of f l e x i b i l i t y became important to medical people who needed e f f i c i e n t and accurate instruments to document j o i n t l i m i t a t i o n s f o r purposes of insurance i n v e s t i g a t i o n s and evaluation of patients* progress. A complete review of the inovative creations that were developed i n the e a r l y 1900*s i s beyond the i n t e r e s t of t h i s study, but excellent reviews already do e x i s t . The reader i s referred to Wiechec and Krusen (1939) f o r a review up to the 19^0*s, to Dareus and S a l t e r (1953) and Leighton (195*0 covering up to the mid-1950*s, and to Clarke (1975)» Dickinson (1968) and Johnson and Nelson 13 (197*0 f o r comprehensive reviews up to the current time. Since Leighton*s development of the Flexometer (195^)• numerous studies have adopted t h i s instrument as the most p r a c t i c a l and accurate means of measuring f l e x i b i l i t y . I t could be said that since the early 1960 ,s, the Leighton Flexometer has been the most dominant instrument used i n the f l e x i b i l i t y research f i e l d i n p h y s i c a l education. Interest-i n g l y , the rather simple two arm goniometer, developed e a r l y i n the h i s t o r y of instrumentation, i s s t i l l the preferred method of evaluation i n the f i e l d of r e h a b i l i t a i o n medicine. S p e c i f i c A c t i v i t y and F l e x i b i l i t y Differences Support e x i s t s f o r the idea that j o i n t s which are mobilized i n regular exercises increase to an optimum value s p e c i f i c to the movement patterns of the p a r t i c u l a r a c t i v i t y . I n d i v i d u a l s who are p h y s i c a l l y active tend to be more f l e x -i b l e than i n a c t i v e i n d i v i d u a l s (McCue, 1953)• Highly spec-i a l i z e d performers apparently d i f f e r s i g n i f i c a n t l y from non-s p e c i a l i z e d i n d i v i d u a l s and also from s p e c i a l i s t s i n other a c t i v i t i e s (Lemiere, 1952, Odgers, 19^9i Syverson, 1950). Moderately engaged a c t i v i t y such as a semester of modern dance may make l i t t l e c o n t r i b u t i o n to f l e x i b i l i t y changes (Bennett, 1955i Bushey, 1956), while rigorous strengthening sports such as f o o t b a l l may a c t u a l l y impede the normal ranges of movement ( H a l i s k i and Sigerseth, 1950). Sports such as gymnastics and rowing can cause s i g n i f i c a n t increases and decreases of f l e x i b i l i t y i n c e r t a i n j o i n t s w i t h i n a few Ik-months (Denk, 1971I Kingsley, 1952i Ruhl, 19721 Shaw, 1968). There i s no evidence that f l e x i b i l i t y e x i s t s as a single general c h a r a c t e r i s t i c of the human body (Harris, 1969» Hupprich, 19^91 Lawther, 1956). Each j o i n t and even d i r e c t -i o n of movement (flexion-extension) i s unrelated (Dickinson, 1963). However, since noone can p e r f e c t l y c o n t r o l the a c t -i v i t y and stress endured by each j o i n t , the s t r u c t u r a l makeup f o r each side of the body could be comparatively s i m i l a r at b i r t h , but d i f f e r s i g n i f i c a n t l y due to one-sided use and d i f f -erent p h y s i c a l requirements throughout l i f e . Rather alone i n her c o n f l i c t i n g r e s u l t s i s Spande (195*0. who revealed through f a c t o r i a l a n a l y s i s , that f l e x i b i l i t y v a r i a b l e s do have tendancies toward a general pattern. A high degree of s i m i l a r i t y was shown i n range of movement i n ten out of twelve paired v a r i a b l e s of u n i v e r s i t y women. The issue has not been s u f f i c i e n t l y resolved despite the more recent i n t e r p r e t -a t i o n that s p e c i f i c i t y i s innate. Morphology and F l e x i b i l i t y Controversy s t i l l e x i s t s over the v a l i d i t y of l i n e a r measures as a H f a i r H measure of trunk-leg f l e x i b i l i t y regard-l e s s of limb-trunk r a t i o . Mathews (1957) concluded that f l e x i b i l i t y , as measured by the Kraus-Weber standing toe touch or the Wells s i t and reach, i s independent of lower limb length. Harvey and Scott (19^7) and Laubach and McConville (1966) have had concurring conclusions. Several studies, however, report c o n f l i c t i n g r e s u l t s . Broer and Galles (1958) 15 found that women with extremely long trunks and arms, with short legs were f a c i l i t a t e d on the toe touch t e s t . Wear (1963) obtained the same conclusion f o r men. D i n k h e l l e r (1969) acquired s i g n i f i c a n t r e l a t i o n s h i p s between f i v e anthropometric measures and three f l e x i b i l i t y measures. Data from one hundred and f i v e of the f a t t e s t , t h i n -nest and most muscular college students was c o l l e c t e d by Tyrance (1958) but he f a i l e d to determine a s i g n i f i c a n t r e l a t i o n s h i p of the extreme body types to f l e x i b i l i t y (19 measures over 8 j o i n t s ) . S i m i l a r l y , Laubach and McConville (1966) have concluded that f l e x i b i l i t y i s not r e l a t e d to body f a t as measured by s k i n f o l d c a l i p e r s . Posture Deviant posture apparently cannot be blamed on va r i a b l e s t i f f n e s s or mobility, although imbalanced muscular strength due to hypertension may be a f a c t o r (Hutchins, 1965). Relationships could not be found between s p e c i f i c j o i n t f l e x i b i l i t i e s and round shoulder divergency (Coppock, 1958) or lumbar l o r d o s i s ( F l i n t , 1964). Strength and F l e x i b i l i t y I t was once thought that strength and f l e x i b i l i t y were mutually i n t e r f e r i n g (Morehouse and M i l l e r , 1967). However, i t seems probable that strength and power can both accompany f l e x i b i l i t y gains, even promote gains (Tucker, 1963), 16 and neither i s hindered providing that the exercise takes place i n the en t i r e range of j o i n t motion (Liverman, 1970t Massey and Chaudet, 1956* Taylor. 1928). I t has been demonstrated that the expression of strength can be expected to decrease i n the extreme ranges of j o i n t motion (Clarke and Munroe, 1970, Wehr, 1964). Jensen and others (1971). obtaining measurements of force generated by hip muscle i n hip f l e x i o n , found that normal males gave maximum strength scores a t t h i r t y to t h i r t y - f i v e degrees. Gevlich (1971) emphasized that i t i s important that strength and f l e x i b i l i t y accompany one another i n devel-opment so as to preserve i n t e g r i t y of the j o i n t . Sex and Age Differences The idea that males are l e s s f l e x i b l e than females i s only speculative. Research to t h i s point i n d i c a t e s that males and females often do d i f f e r with respect to m o b i l i t y i n c e r t a i n j o i n t s at p a r t i c u l a r ages, but i t i s not c l e a r whether a c t i v i t y or growth patterns may be more important determinants of d i f f e r e n c e s than genetic sex. Leighton's two studies (195^» 1956) on boys over a range of ages suggest that s p e c i f i c changes i n j o i n t range of motion are more a r e f l e c t i o n of movement pattern c h a r a c t e r i s t i c s than age l e v e l d i f f e r e n c e s . Among elementary school c h i l d r e n , g i r l s have been found to be superior to boys i n f l e x i b i l i t y (Kirchner and Glines, 1957i P h i l l i p s et a l . , 1955). The studies of Buxton (1957). P h i l l i p s et al . ( 1 9 5 5 ) and Schaffer (1959) i n d i c a t e 17 that g i r l s of a l l ages ( s i x to f i f t e e n years) surpassed the boys i n the percentage of i n d i v i d u a l s passing the Kraus-Weber toe touch t e s t . Not a l l studies have concluded that the sexes d i f f e r i n f l e x i b i l i t y . Forbes (1950) found g i r l s were f l e x i b l e i n more j o i n t s at age twelve, but boys were f l e x i b l e i n more j o i n t s at age eighteen. He concluded that boys and g i r l s do not vary g r e a t l y i n the f l e x i b i l i t y of p r i n c i p l e j o i n t s . Holland (1968) has reported on a study by Kendall and Kendall i n v o l v i n g 4,500 c h i l d r e n , kindergarten to highschool age, i n performing the toe touch and forehead to knees t e s t s . At age f i v e , 98 percent of the boys and 86 percent of the g i r l s could perform the toe touch t e s t . Beginning at age s i x , there was a sharp decline i n t h i s percentage, so that by age twelve, only 30 percent of both sexes could pass the t e s t . There i s unanimous agreement that f l e x i b i l i t y , by and large, declines with age (Hupprich, 19^9, Downie, 1970t Wright and Johns, 19621 Sigerseth, 1962) although the degree to which t h i s happens i s variable and depends to some extent on the health of the i n d i v i d u a l and on the degree of p h y s i c a l a c t i v -i t y maintained. There i s l e s s agreement on which age group i s the most f l e x i b l e considering an o v e r a l l evaluation of f l e x i b i l i t y . I t i s quite conclusive that c h i l d r e n become l e s s f l e x i b l e generally as they grow older, reaching a low point during the growth spurt (age ten to twelve f o r g i r l s , l a t e r f o r boys) and then improving somewhat toward young adulthood (Hupprich, 1949i Buxton, 1957, Gurewitch and 18 O ' N e i l l , 1944| Downie, 1970). The age at which f l e x i b i l i t y decline ensues i s l a r g e l y dependent on the age that the c h i l d reduces h i s or her p h y s i c a l a c t i v i t y (Leighton, 195^» 1956). Although the j o i n t suppleness of the younger years i s seldom maintained or regained i n average i n d i v i d u a l s , there i s some opinion that i t should be so. DeVries (197^» 432.) claims that, "considerable evidence i n d i c a t e s that main-tenance of good j o i n t m o b i l i t y prevents, or to a large extent, r e l i e v e s the aches and pains that grow more common with i n -creasing age." Sigerseth (1962,90) states that, "associated with advanced age i s the gradual impairment of movement, des-p i t e increased success i n phy s i c a l a c t i v i t i e s . " Even though f l e x i b i l i t y tends to decline with age, older age groups s t i l l respond very w e l l to strength and mobility programs (J e t t e , I9691 Chapman, 1971). Of a l l age group categories of women, Jervey (1961) found that women age twenty-five to twenty-nine were the most f l e x i b l e . Norms f o r Hip F l e x i o n There i s only l i m i t e d normative data a v a i l a b l e on human range of motion i n spite of the many techniques and t e s t s developed to measure males and females of various ages. Comparisons between studies i s extremely d i f f i c u l t because of numerous uncontrolled v a r i a b l e s operating. Holland (II68155) summarizes the problemi The data which have been c o l l e c t e d involved the use of many d i f f e r e n t t e s t procedures ( f o r some* of which the v a l i d i t y and r e l i a b i l i t y i s questionable), which makes i t d i f f i c u l t to gen-e r a l i z e about the r e l a t i o n s h i p of f l e x i b i l i t y to such va r i a b l e s as sex, age, body type, warmup etc. 19 Normative data that i s relevant to the nature of t h i s study i s a v a i l a b l e from a few sources. Sigerseth (1962) reported norms f o r males and females of ages s i x to eighteen f o r various j o i n t s . For r i g h t l e g f l e x i o n and extension combined, the 50th p e r c e n t i l e was 116 degrees. According to K e l l y (1971), hip f l e x i o n from the anatomical p o s i t i o n can be pa s s i v e l y c a r r i e d through approximately 120 degrees i f the knee j o i n t i s flex e d . L i m i t a t i o n of movement occurs due to contact of the thigh against the abdomen and contract-i l e i n s u f f i c i e n c y . K e l l y (1971t235) claims that, "with the knee extended, the hamstrings generally l i m i t the f l e x i o n range to about 90 degrees." Hupprich (19^9)* Hutchins (1965), and McCue (1953) a l l report comparative angular measures on hip f l e x i o n of young adult women. Respectively, they obtained hip f l e x i o n means of 104.62 degrees, 105.40 degrees, and 119.38 degrees. McCue's subjects ranged i n amplitude of movement from 76 to 120 degrees. Generally, the average young a d u l t woman can be expected to show about 90 to 110 degrees of hip f l e x i o n . Warmup Evidence e x i s t s to state that warmup ( i n terms of pr a c t i c e t r i a l s ) allows subjects to d i s p l a y immediate gains i n f l e x i b i l i t y (Fieldman, 1966; Rochelle et a l . , i 9 6 0 ) . I n terms of heat therapy, warmup can be considered a positve a i d to range of motion (Frey, 1970s Grobaker, 1974i Lehman et a l . , 1970i Wehr, 1964). According to Wear (1963), dynamic 20 f l e x i b i l t y was improved twenty percent by l o c a l warming of a j o i n t to 113 degrees Fahrenheit, and was decreased ten to twenty percent by c o o l i n g to 65 degrees. C o n t r a d i c t i o n e x i s t s f o r c o l d a p p l i c a t i o n . Holt (1971) claimed that d i r e c t i c e a p p l i c a t i o n on the muscle group during s t r e t c h i n g exercise f a c i l i t a t e d improvement i n the range of movement, while others (Frey, 19701 Grobaker, 197*0 have found c o l d a p p l i c a t i o n to be of no s i g n i f i c a n t e f f e c t . Retention of F l e x i b i l i t y F l e x i b i l i t y tends to improve best (Kingsley, 1952) and r e t a i n improvement longer (Hansen, 19^2) i n those a r t i c -u l a t i o n s that have i n i t i a l l y lower ranges of motion. Improved range of motion i s retained up to three hours a f t e r the s t r e t c h i n g exercise (Hansen, 19^2) but the e f f e c t s of a t r a i n i n g program can p e r s i s t f o r a considerable p e r i o d of time (McCue, 1953) depending upon the duration and extent of the exercise program. The Role of Relaxation Muscles, providing they are kept passive and relaxed, are known to cause l i t t l e resistance to s t r e t c h . There i s a f a i r amount of evidence i n d i c a t i n g that inducing r e l a x a t i o n i s i n harmony with the goals of f l e x i b i l i t y , and therefore r e l a x a t i o n can be considered to be an important component of f l e x i b i l i t y improvement. Levine (1954.218) s t a t e s i When r e l a x a t i o n occurs, a measurable increase i n range r e s u l t s i simultaneously, there i s a decrease as w e l l i n the resistance to i n i t i a t i n g the passive movement. Along the same l i n e , Jacobsen (1967<7) explains! Tension means f o r us muscular contraction, whether gross l y v i s i b l e or microscopic. Accord-i n g l y , r e l a x a t i o n means muscular lengthening when t h i s occurs as a common, natural physio-l o g i c a l process... Jacobsen*s Progressive Relaxation (1938) describes a method that has p o t e n t i a l a p p l i c a t i o n to f l e x i b i l i t y i n that i t aims to make the i n d i v i d u a l i n c r e a s i n g l y observant of muscular contractions i n various parts of the body. C u l t i v a t i o n of a muscle-sense occurs because sensations from contracting muscles are taught with care to be distinguished from those a r i s i n g i n j o i n t s . Frequent r e p e t i t i o n s tend to make the i n d i v i d u a l f a m i l i a r with the p e c u l i a r q u a l i t i e s of the exper-ience of j o i n t sensations i n contrast with those a r i s i n g i n contracting muscles which can v o l u n t a r i l y be relaxed. (1938*37) Progressive r e l a x a t i o n i s apparently a p r a c t i c a l means of obtaining muscle quiescence and eliminating muscle tension (Best and Taylor, 1966). In describing the e s s e n t i a l s f o r proper movement, Rathbone (1959*12) states: For proper movement, as f a r as the muscular system i s involved, several conditions are necess-ary* the complete p o s s i b i l i t y of motion i n a l l j o i n t s , a b i l i t y to relax any muscle while i t s antagonist contracts, and a b i l i t y of c e r t a i n muscles to hold the r i g h t degree of tension to make c e r t a i n j o i n t s stable so that others may be f r e e f o r move-ment. Awkwardness i n movement i s assigned by Rathbone to e i t h e r abnormality i n j o i n t shape l i m i t i n g f l e x i b i l i t y , or to muscle spasm preventing r e c i p r o c a l r e l a x a t i o n ( i n h i b i t i o n ) 22 of antagonistic muscles. Her main point i s that "one's j o i n t s do not become relaxed, nor one's muscles f l e x i b l e " (1959.13). Autogenic therapy, as designed by Schultz i n the e a r l y 1920*3 and documented i n h i s j o i n t l i t e r a r y work with Luthe (1969), i s another form of muscle r e l a x a t i o n that i s based upon regular mental concentration exercises. The approach i s apparently not r e l a t e d to sleep or deep hypnotic states although Jencks, a follower of Schultz, describes autogenic t r a i n i n g as a "psycholophysiological method of self-hypnosis" ( 1 9 7 3 » 1 ) . The Jencks Exercise Manual i s based upon the s i x standard exercises developed by Schultz to be used i n the management of stress by s e l f - r e l a x a t i o n . Van Anne (1962) studied the r e l a t i o n s h i p between neuromuscular hypertension and f l e x i b i l i t y i n c o l l e g e women electromyographically. She found small c o r r e l a t i o n s showing some a s s o c i a t i o n of increased f l e x i b i l i t y of the ankle, hip and shoulder j o i n t with decreased r e s i d u a l tension i n the gastrocnemius, biceps femoris and p e c t o r a l i s major. Recently, Bates (197^) proposed a new method of t r a i n -ing f o r f l e x i b i l i t y i n h i s paper "Mind over Matter" c a l l e d cybernetic s t r e t c h . This method uses "cybernetics or s e l f -image to set the boundaries of i n d i v i d u a l accomplishment. Expand the self-image and you expand the area of the p o s s i b l e " (1974*6). By use of the imagination, mental images are set up that the servo-mechanism works to f u l f i l l . "Thus before every d i r e c t f l e x i b i l i t y practice i t i s a b s o l u t e l y necess-ary that you set aside time to get a new mental p i c t u r e 23 of yourself, f o r example, •making i t f l a t * i n the s p l i t s " (1974t8). The i m p l i c a t i o n i s that cybernetics alone w i l l accomplish a new range of motion, but that s t r e t c h i n g i n conjunction with cybernetic mind-set i s even more e f f e c t i v e . I n t e r e s t i n g l y , Bates doesn't support these claims with research, although he does make reference to evidence docu-mented i n Bernstein and Borkovec's 1974 p u b l i c a t i o n , Progressive Relaxation Training. Bernstein and Borkovec (1974) claim that l e v e l s of arousal or tension are p h y s i o l o g i c a l events that can be descriminated and dealt with through the a p p l i c a t i o n of progressive r e l a x a t i o n . B a s i c a l l y the method i s to develop strong isometric tension by simultaneous c o n t r a c t i o n of both agonists and antagonists of a s p e c i f i e d body part, followed by concentrated p h y s i c a l and mental r e l a x a t i o n . Bernstein and Borkovec do c i t e research supporting s i g n i f i c a n t decreases i n muscle tension, heart rate and r e s p i r a t i o n with t h i s kind of r e l a x a t i o n t r a i n i n g . However, d i r e c t a p p l i c a t i o n to j o i n t m o b i l i t y was not t h e i r concern. Relaxation, i n terms of reduction of a l o c a l myotatic s t r e t c h r e f l e x , can occur through biofeedback t r a i n i n g , and c o n t r o l of muscle a c i t v i t y has obvious i m p l i c a t i o n s f o r reducing the resistance i n f l e x i b i l i t y t r a i n i n g . In the 1970's Basmajian has become a s i g n i f i c a n t pioneer i n the area of i n d i v i d u a l muscle motor unit t r a i n i n g claiming that "man can c o n t r o l h i s i n d i v i d u a l muscles" (1973*257). There i s no doubt that i t can be done since "...electrorayographers have 24 c l e a r l y demonstrated that a voluntary muscle can be complete-l y relaxed by a small e f f o r t of the w i l l " (1973*259). According to Zappala (1970), previous t r a i n i n g i s a p o s i t i v e f a c t o r i n enabling i n d i v i d u a l s to i s o l a t e and to c o n t r o l sing l e motor u n i t s i f o r unexplained reasons, a l a r g e r pro-p o r t i o n of males than females respond more favourably to b i o -feedback t r a i n i n g . To conclude t h i s section, i t i s i n t e r e s t i n g to note that DeVries (1972) found that following exercise a t a heart rate of 100, e l e c t r i c a l a c t i v i t y i n the musculature was lowered by twenty percent. Although the psychol o g i c a l manipulation of man has apparently much to o f f e r i n promoting a relaxed state f o r f l e x i b i l i t y , the exercise modality should not be overlooked when a t r a n q u i l i z e r e f f e c t i s des i r e d . Introduction to the Physiology of Stretch To a large extent, man responds and adapts to move-ment automatically and without conscious concern. Proprio-ceptive i n t e r a c t i o n and s t a b i l i z i n g mechanisms automatically operate whenever man moves. Proprioceptive r e f l e x mechanisms are outside of conscious c o n t r o l much of the time, and yet appear to be of great s i g n i f i c a n c e i n f a c i l i t a t i n g and l i m i t -i n g j o i n t m o b i l i t y i i t i s only to our be n e f i t that we l e a r n to operate i n a l l i a n c e with, and not against these n a t u r a l r e f l e x e s . As Rathbone explains (1959*14)* . . . i t must be remembered that f l e x i b i l i t y i s a c h a r a c t e r i s t i c of j o i n t s and that r e l a x a t i o n , c o n t r a c t i o n and tonus are c h a r a c t e r i s t i c of the neuromuscular mechanism. 25 I t i s because the complex neural and proprioceptive response to s t r e t c h i s not well understood at the c e l l u l a r l e v e l even today, that p r a c t i c a l a p p l i c a t i o n to human exercise i s i n i t s beginning stages* This section deals with the basics of neuromuscular physiology i n order to review the "grass roots" machinery of muscle stretch, and i t s implications f o r the area of f l e x i b i l i t y . What i s Stretched? The term " s t r e t c h " , as applied to increased j o i n t amplitude i n humans, may be thought of as a temporary p h y s i c a l change i n length of c e r t a i n muscle and j o i n t t i s s u e s . The i n t e r e s t i n g question then, i n regard to t h i s semi-permanent change i n tissue length i s , "What i s stretched?" General opinion seems to agree that i t i s not the c o n t r a c t i l e elements of the muscle, f o r relaxed muscle filaments can be stretched to almost twice t h e i r r e s t i n g length without damage or l o s s of t h e i r a b i l i t y to return to a normal r e s t i n g length (Banus and Z e t l i n , 1938). The main l i m i t i n g f a c t o r s are thought to be due to the various connective t i s s u e s (tendons, ligaments, f a s c i a e and scar tissue) according to Ramsey and Stree t (19^0). These t i s s u e s do not have the r e l a x a t i o n and c o n t r a c t i l e properties of the nerve supplied muscle filaments, and thus appear to o f f e r the main r e s i s t i v e force to s t r e t c h . Evidence seems to indicate that i n i t i a l tension produced by the muscle when e x t e r n a l l y stretched i s p r a c t i c a l l y a l l due to the connective t i s s u e and not to the c o n t r a c t i l e elements of the muscle. (Banus and Z e t l i n , 1938*^03) 26 Wright and Johns (1962) progressively severed the t i s s u e l a y e r s of a cat's wrist to determine that the j o i n t capsule contributed 47 percent, passive motion of the muscles 41 percent, the tendons 10 percent, and the s k i n 2 percent to the t o t a l torque (resistance) required to move the j o i n t i n i t s mid-range. The r e s t r a i n i n g e f f e c t s of tendons apparently become more important toward the extremes of j o i n t motion, since passive s t r e t c h on a r e s t i n g excised muscle gives greater r e s i s t i v e forces, the greater i t i s lengthened (Ramsey and Street, 1940). I t i s therefore probable that short-term changes i n j o i n t mobility through sport t r a i n i n g do not involve a semi-permanent length change i n the con-t r a c t i l e apparatus of the muscle, p a r t i c u l a r l y i f they are i n a relaxed state. More c e r t a i n l y , the f a s c i a l sheaths ( e p i , endo, and perimysium) surrounding the muscle filaments and bundles are undergoing the actual change i n p h y s i c a l length. Force A p p l i c a t i o n of a Stretched Muscle I t i s well known that a muscle under a s l i g h t s t r e t c h can produce a greater force ( B i l l i g , 19511 Cavagna et a l . , 19711 Inman et a l . , 1952) and a f a s t e r r e a c t i o n time (Schmidt, 1967). But i n reference to h i g h l y stretched vertebrate muscle f i b r e s , Gordon and others (1966a, 1966b) found that tension development f a i l e d almost completely when f r o g muscle f i b r e s were stretched to s t r i a t i o n spacings of 3.65 microns. The explanation f o r t h i s was based upon Huxleyls overlapping filament theory i n v o l v i n g a c t i n and myosin crossbridges. When a part of a f i b r e with uniform s t r i a t i o n spacing i s stretched so f a r that there i s presum-ably no overlap of filaments, the tension developed i s very small. (Gordon et a l . , 1966bil42) Although i t i s doubtful that human muscle i n an i n vivo s i t u a t i o n would accomplish t h i s degree of s t r e t c h , the phenomenon may help to explain why athletes f i n d they cannot generate large isometric forces at the ends of movement range. Tonus and Adaptive Shortening Adaptive shortening of muscle, as i t occurs i n normal i n d i v i d u a l s , plays a r o l e as a l i m i t i n g f a c t o r i n maintaining and regaining range of motion. Excessive r e s i d u a l tension, prolonged i n a c t i v i t y , aging and poor c i r c u l a t i o n are thought to contribute to somewhat "perm-anent" l o s s e s of f l e x i b i l i t y c a l l e d "passive i n s u f f i c i e n c y " (Bourne, i 9 6 0 ) . The tonus of s t r i a t e d muscle i n man was of i n t e r e s t to Edmund Jacobsen (1938, 1967). who with rather i n s e n s i t i v e equipment, inaccurately concluded that a state of s l i g h t c o n traction was maintained i n healthy muscle during a state of r e s t . More recently, evidence has been accumulated to show that complete quiescience does e x i s t i n r e s t i n g muscle. Most neurophysiologists now agree that e l e c t r o -myography shows con c l u s i v e l y the complete r e l a x a t i o n of normal human s t r i a t e d muscle at r e s t . . . (Basmajian, 1974) However, i n more serious conditions of mechanical 28 r e s t r a i n t s , p a r a l y s i s or muscle spasm, contractures can r e s u l t . Contractures, or the excessive and prolonged shortening of s k e l e t a l muscle, i s associated with changes i n i t s p roperties whereby muscle becomes set at a new length and f a i l s to r e t u r n to i t s o r i g i n a l length during r e l a x a t i o n (Hajek et a l . , 19^7). Permanent changes a f f e c t i n g m o b i l i t y can also occur i n the j o i n t as Akeson suggests thatt The p r o l i f e r a t i o n of connective t i s s u e newly formed would create a mechanical obstruction to f u l l contraction and r e l a x a t i o n of an a f f e c t e d muscle and would be expected to r e s t r i c t j o i n t m o b i l i t y . (Akeson, 1961,1033) Furthermore, he established that mucopolysaccharides, the l u b r i c a t i n g elements of collagen bundles, are r a p i d l y l o s t i n r e s t r i c t e d j o i n t s , so that cross-linkage formation of the collagen f i b r e s i s f a c i l i t a t e d . Most a u t h o r i t i e s agree that j o i n t s which do not experience f u l l amplitude of movement, and muscles which are never lengthened f u l l y , lose t h e i r m o b i l i t y and e l a s t i c i t y . Even animals are wise to t h i s point, as B i l l i g (1951»1*0 reminds usi ...cats i n s t i n c t i v e l y s t r e t c h or loosen up upon a r i s i n g by s t r e t c h i n g l u x u r i o u s l y i n a l l d i r e c t i o n s . The Reflex Control of Movement The postural duty of the hip j o i n t requires i t to be the most s e n s i t i v e j o i n t i n the body i n detecting small angular changes. Incredibly, 0.2 to 0.4 degrees are detected by the proprioceptive mechanisms so long as the movement i s 29 not slower than three degrees per second.(Gardner, 1972). A most remarkable and e a r l y understanding of the sensory apparatus of movement was achieved by Sherrington (1898), who designated as proprioceptors, those end organs located i n the muscle so as to e f f e c t i v e l y secure inside information, cooperation and coordination of movement. The sensory organs maintaining the "unconscious c o n t r o l of movement" were iden-t i f i e d as muscle spindles and Golgi tendon organs, both of which are incorporated i n t o the gross structure of the muscle. The Stretch Reflex The so-called myotatic stretch r e f l e x i s a c t u a l l y more complex than previously thought, and i s w e l l documented by Best and Taylor (1966), DeVries (1974), Gardner (1972), Guyton (1974) and Ruch and Patton (1965, 1966). The sense organ that i s responsible f o r producing the s t r e t c h r e f l e x i s the muscle spindle. When a stretched muscle with an i n t a c t nerve supply i s stretched, i t contracts. This response i s c a l l e d the stre t c h r e f l e x . The stimulus that i n i t i a t e s the r e f l e x i s s t r e t c h of the muscle, and the response i s contraction of the muscle being stretched. (Ganong, 1973»66) Muscle str e t c h r e s u l t s i n widespread and complex changes about the j o i n t involved. Muscle spindles arei . . . s e n s i t i v e to muscle length, responding by changes i n impulse frequency to both v e l o c i t y of imposed stre t c h (phasic resonse) and to the extent of a constant length (tonic response). Their a c t i v i t y produces e x c i t a t i o n (contraction) of the muscles i n which they l i e . (Gardner, 196913) The spindles act as "brakes" to lengthening of muscle by evoking contraction i n t h e i r own muscle and i t s syner-g i s t s as well as r e c i p r o c a l l y i n h i b i t i n g the antagonists. This automatic mechanism i s operating at a l l times c o n t r o l -l i n g the lengthening a b i l i t y within i t s own muscle. Ganong (1973) describes the muscle spindles as c o n s i s t i n g of 2 to 10 muscle f i b r e s enclosed i n a connective ti s s u e capsule. They are c a l l e d i n t r a f u s a l f i b r e s to d i s -t i n g u i s h them from the extra f u s a l f i b r e s , the c o n t r a c t i l e u n i t s of the muscle which surround and l i e p a r a l l e l to the s p l i n d l e s . The two ends of the i n t r a f u s a l f i b r e are con-t r a c t i l e but the middle p o r t i o n i s f i l l e d with n u c l e i (nuclear bag region) and i s probably non-contractile. In the nuclear region, the primary or annulospiral endings, which are large a f f e r e n t sensory nerves, are located. These nerve endings form the Primary af f e r e n t (la) component i n the c l a s s i f i c a t i o n scheme f o r sensory f i b r e s and are the receptors f o r the s t r e t c h r e f l e x . The impulses o r i g i n a t i n g i n the spindle are conducted to the CNS v i a these large and f a s t conducting f i b r e s which pass d i r e c t l y to the motor neurons (alpha system to the ext r a f u s a l tissue\ gamma system back to the spindle) of the same muscle. On e i t h e r side of the annulospiral endings are the secondary or flower spray endings, which are the receptor ends belonging to the group II sensory f i b r e category. The secondary af f e r e n t s also respond to st r e t c h , but i n a l e s s s e n s i t i v e way as explained by Matthews (1964t245)« 31 ...When a muscle i s toeing stretched the muscle spindle endings s i g n a l tooth the instantaneous length of the muscle and the v e l o c i t y at which i t i s toeing stretched, while the secondary end-ings s i g n a l mainly the instantaneous length. Although the e f f e c t of the secondary a f f e r e n t s i s not well understood, i t i s toelieved toy some (Ganong, 1973* Patton, 1971) that t h e i r e x c i t a t i o n f a c i l i t a t e s f l e x o r muscles and i n h i b i t s extensor muscles regardless of the type of muscle i n which they l i e . The muscle spindles also have a motor supply of t h e i r own c a l l e d the gamma loop or gamma ef f e r e n t system. The motor neurons of the gamma efferent system are regulated to a large degree toy decending t r a c t s from a number of areas i n the bra i n . V i a these pathways, the s e n s i t i v i t y of the muscle spindles and hence the threshold of the str e t c h r e f l e x e s i n various parts of the body can be adjusted... (Ganong. 1973*6?) The Inverse Stretch Reflex "Up to a point, the harder a muscle i s stretched, the stronger i s the r e f l e x contraction" (Ganong, 1973*68). However, a contraction can suddenly cease and the muscle r e l a x i f the tension developed i s strong enough to stimulate the inverse myotatic r e f l e x . This r e l a x a t i o n i n response to strong s t r e t c h i s also c a l l e d autogenic i n h i b i t i o n and i s regulated by sensory f i b r e s c a l l e d Golgi tendon organs. The a f f e r e n t f i b r e s from these organs are c l a s s i f i e d as group l b sensory nerves. Unlike the spindles, the tendon organs i n h i b i t the muscle, i n which they l i e . Located at 32 the musculotendinous junction i n s e r i e s with the c o n t r a c t i l e f i b r e s , the Golgi tendon organs can be excited by strong passive s t r e t c h (Stuart et a l . , 1970), but are i n c r e a s i n g l y stimulated as c o n t r a c t i l e tension mounts (Libet et a l . , 1955). The reason f o r t h i s i s given by Gariong (1973»69)» The degree of stimulation by passive s t r e t c h i s not great because the more e l a s t i c muscle f i b r e s take up much of the stretch, and t h i s i s why i t takes a strong stretch to produce r e l a x a t i o n . However, discharge i s r e g u l a r l y produced by con-t r a c t i o n of the muscle, and i t now appears that the Golgi tendon organ functions as a transducer i n a feedback c i r c u i t which regulates muscle ten-sion i n a fashion analogous to the spindle feed-back c i r c u i t which regulates muscle length. P r a c t i c a l A p p l i c a t i o n of Neurophysiological Theory P h y s i c a l therapists have found neurophysiological support f o r much of t h e i r successful therapeutic procedure. Therapeutic exercise i s based to a large extent on three basic p h y s i o l o g i c a l p r i n c i p l e s f i r s t established by Sherrington (1898) and summarized by G r i f f i n (1974). These p r i n c i p l e s are immediate induction, r e c i p r o c a l innervation and successive induction. These three p r i n c i p l e s form a r e f l e x b a s i s f o r normal movements! as movement begins and proceeds, agonists and synergists are f a c i l i t a t e d (immediate induction) and antagonists are i n h i b i t e d ( r e c i p r o -c a l innervation), at the end of the movement, the antagonists are f a c i l i t a t e d (successive induction) promoting movement i n the opposite d i r e c t i o n . ( G r i f f i n , 1974i1073) A therapeutic technique c a l l e d proprioceptive neuro-muscular f a c i l i t a t i o n (PNF) was developed by Kabat (1958) to restore muscle function through the u t i l i z a t i o n of 33 r e f l e x e s to augment the voluntary response of h i s p a t i e n t s . Kabat used the term "r e v e r s a l of antagonists" to describe the phenomenon of successive induction. Others such as Knott and Voss (1968), Holt (1971) and Tanigawa (1972) have also applied the t h e o r e t i c a l r o l e of the s t r e t c h r e f l e x to p r a c t i c a l s i t u a t i o n s of limb m o b i l i z a t i o n . In a d d i t i o n to the f a c i l i t a t e d contraction that successive induction provides f o r the opposing muscle group, i t appears also that greater muscle r e l a x a t i o n occurs a f t e r a s i g n i f i c a n t contraction. Knuttson (1973*168) r e f e r s to an unpublished paper by Jungwirth and Myrenberg that found that a f t e r a maximal v o l i t i o n a l contraction, the s t r e t c h r e f l e x e s i n the previously a c t i v e muscles were depressed about 4 seconds, s t a r t i n g 1-2 seconds a f t e r the end of con-t r a c t i o n . This post-contraction depression, which i s the basis f o r the "hold-relax" technique i n PNF, i s often ascribed to an autogenetic i n h i b i t i o n due to the m o b i l i z a t i o n of Golgi tendon organs.•.Although i n h i b i t o r y e f f e c t s on the s t r e t c h r e f l e x e s of t h i s duration might quite p o s s i b l y be due to a sustained primary a f f e r e n t depolarization, there are no f i n d i n g s to support such a mechanism. (Knuttson, 1973*168) The u t i l i z a t i o n of the p r i n c i p l e of successive induction to f a c i l i t a t e increased range of motion has met with a great deal of success i n some studies as s h a l l be seen i n the sec-t i o n of "Methods of Stretching". C o r t i c a l Control of the Stretch Reflex There i s some reason to believe that the s u b c o r t i c a l 3* c o n t r o l of the myotatic r e f l e x can be overcome by v o l i t i o n from higher neural centers ( A r l i b , 1972; Glaser and Higgins, 1968i Gray, 1971i Smith e t . a l . , 1972, Zappala, 1970). Basmajian (1973) has shown that electromyography makes poss-i b l e f o r man, with a small e f f o r t of w i l l , to completely r e l a x i n d i v i d u a l motor u n i t s of voluntary s k e l e t a l muscle. V o l i t i o n may also play a r o l e i n maintaining c o n t r a c t i o n under extreme tension despite the p r o t e c t i v e influence of the Golgi tendon organs. Gardner (1969,11) statest I f as seems l i k e l y , a l l contractions a c t i v a t e tendon organs, t h e i r i n h i b i t o r y e f f e c t upon t h e i r own muscles must be o f f s e t by voluntary e f f o r t . When v o l i t i o n ceases, these receptors probably become responsible f o r the immediate r e l a x a t i o n of the muscle. I t appears that v o l i t i o n has the a b i l i t y to dominate to some extent, but not always, as i s evidenced by the "breaking point" of collapse i n Indian arm w r e s t l i n g . The l o s s of the contest usually occurs abruptly, when mounting tendon organ i n h i b i t i o n f i n a l l y overcomes the voluntary e f f o r t (Gardner, 1972). Thus the human b r a i n has an im-portant, but not t o t a l l y dominating c o n t r i b u t i o n to make i n overcoming the proprioceptive r e f l e x . I t i s possible that the neural complexity of the cortex makes i t possible f o r i n t e l l i g e n c e , motivation and perhaps even s k i l l of move-ment to contribute to the c o n t r o l of muscle a c t i o n . Gamma Bias An i n t e r e s t i n g phenomenon, with implications f o r 35 changing man's muscle lengthening a b i l i t y , has been c a l l e d "gamma bias" (Eldred, 1953« Gardner, 1959» Granit, 1955). This can best be described as an an t i c i p a t o r y length s e t t i n g of the muscle spindles which are judgmentally governed to keep f i r i n g l e v e l s at a minimum u n t i l some c r i t i c a l p o s i t i o n of movement i s reached. The cerebral cortex i s considered to be the dominant s t a t i o n f o r sensimotor i n t e g r a t i o n (Herman,1970). For f a s t movements, p a r a l l e l connections of alpha ( c t ) , which go to the extrafusal muscle f i b r e s , and gamma ( T T ) , which go to the i n t r a f u s a l (spindle) f i b r e s , are linked to cont r o l behaviour (Shambes, 19691 Smith et al . , 1 9 7 2 ) . In other words, f o r quick movements, both the contracting muscle and i t s sensory equipment are n o t i f i e d simultaneously about the command. In t h i s way the gamma loop contributes to the precise timing of the movement and sets i t s " c r i t i c a l length" to what i s expected based upon past experience (Gardner, 1972). Gamma bias i s a consideration i n f l e x i b i l i t y l i m i t -a t i o n i n that i t i s conceivable that the judgement mechanisms p r o t e c t i v e l y and h a b i t u a l l y underestimate the extent of j o i n t m o b i l i t y . E a r l y onset of the myotatic r e f l e x i s perceived as an uncomfortable "tightness" and i s a reminder that the j o i n t does have l i m i t a t i o n s . However, i t has not been determined how early i n the str e t c h i n g movement that warning signals are given. I t may be speculated that gamma bias operates very e a r l y i n i n d i v i d u a l s who are i n a c t i v e and 36 inexperienced with t h e i r p o t e n t i a l range of motion. These i n d i v i d u a l s do not know t h e i r l i m i t a t i o n s and could be adapt-i v e l y s e t t i n g to a much reduced and u n r e a l i s t i c range. Yet to be ascertained i s how accurate gamma bias i s , and how i t i s affected by motivation, learning and high l e v e l s of phys-i c a l t r a i n i n g . Gamma bias does seem to play some part, how-ever, i n the area of f l e x i b i l i t y as an a n t i c i p a t o r y response to range, speed and force a p p l i c a t i o n . Methods of Stretching The question of which methods are considered superior f o r improving range of motion has received l i t t l e a t t e n t i o n , e s p e c i a l l y i n comparison to the s c i e n t i f i c evidence evaluating various strength and endurance programs. H i s t o r i c a l l y , two s t y l e s of stre t c h i n g have been i d e n t i f i e d : the slow, s t a t i c , prolonged stretch as opposed to the f a s t , b a l l i s t i c , dynamic type of s t r e t c h . Weber and Kraus (19^9) worked with poor posture and poliomyelitus cases s i x to twelve years old and found that "spring" s t r e t c h (dynamic) was three degrees better on an average than " p l a i n " s t r e t c h ( s t a t i c ) i n improving hip f l e x i o n . Pathological subjects were only able to obtain a mean improvement of one degree with the " p l a i n " stretch! Several recommendations e x i s t supporting slow, s t a t i c stretch (Anderson, 19?1; Bates, 1971; Rathbone, 1959t Young, 1950) and p a r t i c u l a r l y f o r c e r t a i n j o i n t movements such as hip f l e x i o n (Riddle, 1956). Rathbone (1959) says 37 that slow stretch methods such as found i n Hatha Yoga are desirable to avoid the stretch r e f l e x . When i t comes to a c t u a l l y increasing f l e x i b i l i t y , a d i s t i n c t i o n i s made between rapid motions of a swinging character, and slow ones which demand precise stretching of j o i n t structures a t the l i m i t of the motion. The l a t t e r are more e f f e c t i v e . . . when a muscle i s stretched suddenly, i t r e f l e x l y contracts. Stretching must be maintained f o r an i n t e r v a l of time to be e f f e c t i v e . (Rathbone, 1959» 100) S t a f f o r d (1958) voiced s i m i l a r concern over "bobbing active i t y " . While he admitted that rebounding stretch was d i s -t i n c t l y e f f e c t i v e , caution i n i t s use was suggested. "The jerks must be no greater than the e x t e n s i b i l i t y of the muscle" (Stafford,1958). A comparative study of three s t r e t c h i n g methods was conducted by Holt, Travis and Okita (1970). Along with the dynamic and the s t a t i c s t r e t c h i n g exercises, a proprioceptive neuromuscular f a c i l i t a t i o n technique (PNF) was included as a new approach to increasing range of motion. A c t u a l l y the method was a modified version of Rabat's (1958) therapeutic PNF» rather than working limb mobilizations i n diagonal patterns as i s emphasized i n the writings of Knott and Voss (1968), movement and exercise occurred i n one plane. The modified method was referred to i n Holt's study as IA-CA dep i c t i n g the pattern, Isometric contraction of the Antagon-i s t , Concentric contraction of the Agonist. Two exercises f o r each method were practiced, f o r equal i n t e r v a l s of time. 38 Holt's procedure f o r one minute i s described* The IA-CA exercises were administered with assistance from one of the i n v e s t i g a t o r s . The f i r s t exercise was performed with the S l y i n g i n a supine p o s i t i o n . S was t o l d to keep both knees extended throughout the exercise. He then was t o l d to r a i s e one l e g upward (hip f l e x i o n ) u n t i l he could f e e l s t r e t c h on the hip extensor muscles. E positioned himself securely behind S's upraised l e g and placed one hand on the a c h i l l e s tendon and the other on the a n t e r i o r aspect of the knee. S was then t o l d to extend h i s hip, causing an i s o -metric contraction of the hip extensors against E's hand. The contraction was to gradually increase u n t i l a maximum e f f o r t was reached. Immediately following t h i s contraction (5 to 6 seconds), S was t o l d to contract h i s hip f l e x o r s c o n c e n t r i c a l l y i n order to increase the range of motion of the hip extensors. (1970»6l4) Holt does not state how the range of motion was measured. A f t e r a three week period, i t was concluded with a p<,001, that d i f f e r e n c e s did e x i s t among the methods i n inc r e a s i n g range of motion. The mean improvement f o r the s t a t i c s t r e t c h exercise was j/k inch, f o r the dynamic s t r e t c h 3/4 inch, and f o r the IA-CA method 2.1 inches. F a c i l i t a t i o n methods were o r i g i n a l l y adopted to r e h a b i l i t a t e f o r strength, but i n that very sense are applicable to the f a c i l i t a t i o n of active f l e x i b i l i t y . Holt's promising r e s u l t s with the PNF method prompted i t s a p p l i c a t i o n to sport i n a much broader way and stimulated i n v e s t i g a t i o n of the underlying t h e o r e t i c a l mechanisms of f a c i l i t a t i o n by other p h y s i c a l educators. A summary of the theory of s t r e t c h as reviewed by Holt can be found i n the 1971 manual c a l l e d S c i e n t i f i c Stretching For Sport. An i n v e s t i g a t i o n using a f a c i l i t a t i o n technique 39 to promote passive range of motion was conducted by Tanigawa (1972). I t was demonstrated that male subjects r e c e i v i n g the PNF Hold-relax procedure (described as Passive PNF i n Appendix C) increased t h e i r range of passive s t r a i g h t l e g r a i s i n g to a greater degree and at a f a s t e r rate than sub-j e c t s r e c e i v i n g passive mobilization. Tanigawa d i d not examine active range. He explained the greater e f f e c t s of the PNF s t r e t c h to be due to a greater lengthening of the connective t i s s u e as i t i s under the dual s t r e t c h of i n t e r n a l isometric contraction and external lengthening. Duration of Stretch The optimal time period to spend i n a p o s i t i o n of maximal st r e t c h ( s t a t i c ) i s 60 seconds according to Bates (1971). Individuals already at a high l e v e l of f l e x i b i l i t y were able to improve equally well i n a p o s i t i o n held only 30 seconds, while l e s s f l e x i b l e i n d i v i d u a l s needed the longer time period to improve maximally. The PNF methods have u s u a l l y been conducted i n s i x second i n t e r v a l s of a l t e r n a t i n g d i r e c t i o n of motion, and the a l t e r n a t i o n of e f f o r t i s repeated f o r up to a minute or more. The designation of timing has been apparently based on the k second post-contraction depression, one to two seconds following a maximal v o l i t i o n a l contraction (Knuttson, 1973). The minute duration of str e t c h i n g exercise i s supported by the f i n d i n g s of Bates (1971) above. CHAPTER III METHODS AND PROCEDURES Sample Selected The sample consisted of one hundred and nineteen volunteer p h y s i c a l education women students a t the Univ-e r s i t y of B r i t i s h Columbia. The women ranged, i n age from seventeen to thirty-one years, averaging 20.19 years. The mean height of the t o t a l group was I . 6 5 meters, and the mean weight was 60.15 kilograms. The subjects were paired i n t h e i r classes and randomly assigned by p a i r s to a t r e a t -ment group. Time and Duration of the Study The study took place between mid-January and mid-February, 1976. Over a four week period the subjects were seen eleven times1 the f i r s t and l a s t sessions were i n i t i a l and f i n a l measure days, and the middle nine sessions were exercise days. A l l subjects established regular time s l o t s with t h e i r partner three times per week. Series of h a l f hour sessions were held d a i l y between 8100 a.m. and 1*30 p.m. A few subjects came twice a week at a 6:30 p.m. time as w e l l a t a noon hour. 40 41 W o r k i n g i n p a i r s , s u b j e c t s c o u l d c o m p l e t e t h e e x e r c i s e t r e a t m e n t i n t e n m i n u t e s . E v e r y a t t e m p t w a s m a d e b y p h o n e t o r e m e d y a b s e n t s u b j e c t s b y a r r a n g i n g a " m a k e - u p " t i m e f o r t h e v e r y n e x t d a y s o t h a t a l l s u b j e c t s w o u l d h a v e ~ e q u a l e x e r c i s e p r o g r a m s . P e r s o n n e l P r i o r t o t h e s t u d y , s e v e r a l g r a d u a t e s t u d e n t s w e r e t r a i n e d t o a s s i s t t h e e x p e r i m e n t e r o n t h e t e s t i n g d a y s . A l t h o u g h t h e e x p e r i m e n t e r p e r s o n a l l y r e a d a n d r e c o r d e d a l l t h e f l e x i b i l i t y m e a s u r e s , t h e a s s i s t a n t s w e r e h e l p f u l i n o r g a n i z i n g t h e s u b j e c t s , f i x a t i n g t h e k n e e s p l i n t a n d s t a b i l i z i n g t h e l e f t l e g t o t h e f l o o r . T e s t i n g A r e a a n d E q u i p m e n t F o u r t e s t i n g s i t e s w e r e e s t a b l i s h e d i n o r d e r t o m e e t t h e s u b j e c t s i n a r e a s c l o s e t o t h e i r c l a s s e s . M a t s o r c a r p e t i n g p r o v i d e d a f i r m p a d d e d s u r f a c e o n w h i c h s u b -j e c t s l a y s u p i n e . T h e l e f t l e g w a s s t a b i l i z e d i n a l e g s t r a p p l a c e d a t m i d - t h i g h s o t h a t t h e l e g w o u l d n o t b e d i s p l a c e d f r o m t h e f l o o r d u r i n g t h e s t r e t c h . T h e r i g h t l e g w a s s p l i n t e d s t r a i g h t b y a p a d d e d 3"x 1 8 " x 3/8" w o o d s l a t s t r a p p e d a b o v e a n d b e l o w t h e k n e e w i t h v e l c r o . T h e L e i g h t o n F l e x o m e t e r w a s a t t a c h e d t o t h e p r o x i m a l e n d o f t h e s p l i n t s t r a p o n t h e l a t e r a l s i d e o f t h e r i g h t t h i g h w i t h t w o i n c h v e l c r o . T h e v e l c r o f a c i l i t a t e d t h e e a s e o f 42 a t t a c h m e n t f r o m o n e s u b j e c t t o a n o t h e r . P l a t e 1. P a i r e d s t r e t c h i n g w o r k i n g w i t h t h e c l o c k i A s i x t y m i n u t e t i m e r w i t h a s i x t y s e c o n d s w e e p h a n d a n d b u z z e r w a s p l a c e d i n a p o s i t i o n v i s i b l e t o a l l s u b j e c t s . I n a d d i t i o n , a m e t r o n o m e w a s s e t a t a o n e s e c o n d p a c e t o a s s i s t t h e s u b j e c t s i n c o u n t i n g t h e s i x s e c o n d s t r e t c h i n g i n t e r v a l s . *3 A hip f l e x i o n strength apparatus was constructed out of a s o l i d bench, plywood and metal braces so that the subject could l i e supine with the r i g h t l e g r e s t i n g at an i n c l i n e of 45 degrees. A 3/32 inch cable and tensiometer ran from the thigh at a 90 degree angle through a hole i n the i n c l i n e d s e c t i o n to attach to the metal support on the f l o o r . The cable length was adjustable to account f o r differences i n l e g s i z e . Plate 2. The hip f l e x i o n strength apparatus and cable tensiometer P l a t e k. P a s s i v e r a n g e o f a f l e x i b l e s u b j e c t 45 General Procedures At the beginning of the study, the paired subjects were randomly assigned a f l e x i b i l i t y exercise. Often the treatment required manual assistance, and the partners could then alternate every minute between e x e r c i s i n g and a s s i s t i n g i n the same method of s t r e t c h . Once attendance was taken, and the timing devices were running, the experi-menter was free to supervise and correct the q u a l i t y of the exercises. There were nine treatment days, preceded and follow-ed by a measurement day. A three week treatment period with three sessions per week was designed i n order to provide adequate time f o r a l l of the treatments to take e f f e c t with-out l o s i n g motivation of the subjects. A three week time period allowed Holt ( 1 9 7 0 ) to obtain highly s i g n i f i c a n t d i f f -erences between methods. On Day 1, subjects were measured i n the order a c t i v e range, passive range and then strength of hip f l e x i o n , since i t was f e l t that the passive range would inf l u e n c e " the ac t i v e range i f performed f i r s t . Following the measures, each p a i r of subjects were taught t h e i r assigned s t r e t c h i n g method and given a handout to read to thoroughly f a m i l i a r i z e them with t h e i r p a r t i c u l a r exercise. Subjects were t o l d not to p r a c t i c e at home with the treatment and i t was empha-sized that i t was extremely important that a l l subjects had to attend a l l the scheduled sessions so that the e q u a l i t y of the performances would be maintained. A f t e r the i n i t i a l i n s t r u c t i o n on Day 1, the exercise treatment f o r any i n d i v i d u a l took ten minutes (60 seconds exercise, 60 seconds r e s t , f i v e times each). This time i n t e r v a l was chosen based on the evidence of Bates (1971) study that 60 seconds i s the optimum time to acquire maximal gains i n range of motion. Excessive measuring could con-s t i t u t e a t r a i n i n g e f f e c t , thus measures were l i m i t e d to Days 1, 4, 7, 10 and 11. The method was timed so that the actual time of exercise and r e s t f o r each method was standardized. SUBJECT 60 seconds stretch A s s i s t or r e s t 60 seconds str e t c h A s s i s t or r e s t 60 seconds str e t c h A s s i s t or r e s t 60 seconds str e t c h A s s i s t or r e s t 60 seconds str e t c h A s s i s t i f necessary PARTNER A s s i s t i f necessary 60 seconds s t r e t c h A s s i s t or r e s t 60 seconds s t r e t c h A s s i s t or r e s t 60 seconds s t r e t c h A s s i s t or r e s t 60 seconds s t r e t c h A s s i s t or r e s t 60 seconds s t r e t c h The c o n t r o l subjects were seen once a week i n order to be measured i n the same way as a l l the others, and two sets of measures (pre and post exercise) were made but without any intervening exercise. During a l l measurements of the range of motion, the subject's l e f t l e g was s t a b i l i z e d to the f l o o r by a strap and the r i g h t l e g was s p l i n t e d s t r a i g h t . During the exercise sessions, t h i s equipment was only used **7 with subjects who had d i f f i c u l t y i n keeping the l e f t l e g on the f l o o r and the r i g h t l e g s t r a i g h t . S p e c i f i c Procedures f o r Methods The s i x s t r e t c h i n g exercise treatments along with the Control group comprised the seven l e v e l s of the inde-pendent variable (Treatments). Detailed descriptions of each method as they were given to the subjects may be found i n Appendix C. The following b r i e f l y outlines the main points of each procedure. Passive l i f t and active holdt The subject's r i g h t l e g i s l i f t e d by the partner and taken slowly to the end-point (6 seconds). At the end-point, the subject a c t i v e l y holds the p o s i t i o n f o r the next 6 seconds by a c t i v e l y contracting the hip f l e x o r s . Passive pressure and a c t i v e holding alternate every 6 seconds f o r one minute : ( f i v e times). Active PNFi The subject v o l u n t a r i l y l i f t s her r i g h t l e g as f a r i n t o f l e x i o n as possible i n 6 seconds. On the next 6 seconds, the subject eases into a maximum isometric contraction down against the manual resistance of the partner. The voluntary l i f t and extensor con-t r a c t i o n alternate so that each occur f i v e times i n one minute. B a l l i s t i c and holdt S t a r t i n g from approximately a 45 degree angle, four l e g bounces are made to f l e x the hip and on the fourth bounce and active hold i s made to stop the l e g at the end-point. Each l e g bounce takes one second, and the "hold" i s maintained f o r 6 seconds. The whole combination i s repeated f i v e times i n one minute. Relaxation methodt The method i s simply the prolonged stre t c h i n g technique, but i n addition, subjects apply a mental r e l a x a t i o n and mind-set technique. Passive PNFt The subject's r i g h t l e g i s taken p a s s i v e l y to the end-point i n 6 seconds. On the next 6 seconds, the subject eases in t o a maximum isometric contraction of the extensors against the manual resistance of the partner. The passive l i f t and extensor contraction alternate so that each i s done f i v e times i n one minute. Prolonged Stretch: The subject's r i g h t l e g i s l i f t e d p a s s i v e l y and i s taken to the end-point slowly. The end p o s i t i o n i s to be held passively f o r one minute ju s t below the pain threshold. Instruments of Measurement The primary dependent variable was the a c t i v e range of r i g h t hip f l e x i o n . This was measured from the supine p o s i t i o n i n degrees by the Leighton Flexometer. The g r a v i t y weighted d i a l of the Flexometer i s known to take the angular reading with a r e l i a b i l i t y well above .90 (Leighton, 1955)* E a r l y i n the study, a r e l i a b i l i t y t e s t was made on the f i r s t seventeen subjects to determine i f i t was necessary to take three angular readings f o r each subject t r i a l . Since r=.95 between the f i r s t and second 49 measures of active range, and r=.95 between the f i r s t and t h i r d measures, the experiment was conducted with one read-i n g being made on each subject. A secondary dependent variable was the isometric strength of r i g h t hip f l e x i o n measured at the 45 degree angle by a 3/32 inch cable tensiometer. This second dependent variable was added to the study i n the b e l i e f that a concurring change i n hip f l e x i o n strength might o f f e r i n s i g h t to the changes i n active range. The strength of hip f l e x i o n was measured only twice, before and a f t e r the three week treatment period. Since the cable tensirometer has a r e l i a b i l i t y of .9^7 f o r hip f l e x i o n of college women according to Clarke and Munroe (1970), only one reading was made of the maximal e f f o r t . 50 Experimental Design A 7 x 5 f a c t o r i a l design with one dependent measure (active range) was used as the i n i t i a l framework. A second dependent variable (strength) was measured before and a f t e r the study. The two independent v a r i a b l e s weret A. Treat-ment f a c t o r containing seven l e v e l s and B. Time f a c t o r containing f i v e l e v e l s . In addition, post-exercise measure-ments were made on the middle three t e s t i n g days to see the d a i l y e f f e c t of the treatment. Each c e l l contained between f i f t e e n and twenty subjects. Figure 2 Schematic Diagram of Experimental Design A= Treatment Factor B= Time Factor B l B2 B3 B4 B5 Day 1 Day 4 Day 7 Day 10 Day 11 A l Act.Range, Strength Pre-Act. Post-Act. Pre-Act. Post-Act. Pre-Act. Post-Act. Act.Range Strength A2 II I I II H II A3 II II I I II A4 II II •I H A5 II II II <i n A6 II II II A7 •I II i •1 II u 51 The S t a t i s t i c a l Treatment A multivariate analysis of variance was performed using the program MULTIVAR. In order to t e s t the hypotheses, preplanned orthogonal comparisons were made between the seven treatment l e v e l s as given below i I ~ 1 : :  Control Passive L. Active H. Active PNF B a l l i s t i c Relaxation ! L P r o l . Stretch METHODS 1 2 1 4 5. 6 1 +6 -1 -1 -1 - l -1 -1 6 - 5 +1 +1 +i +1 •••1 0; 0 +3 +3 -2 -2 -2 0 0 • l - l 0 0 0 b 0 0 0 +2 -1 -1 0 0 0 0 0 +1 -1 Figure 3. Contrast Matrix of Treatment E f f e c t s 52 Four transformation matrices tested the hypotheses i 1. A transformation matrix on the time f a c t o r reduced the f i r s t ( i n i t i a l day) and f i f t h ( f i n a l day) l e v e l s to a "difference" score i n order to show the t o t a l change that occurred f o r the two dependent va r i a b l e s (active range, strength). 2. A second matrix looked at each f i r s t and f i f t h l e v e l measures i n d i v i d u a l l y to show i n i t i a l and f i n a l d i f f -erences between the group means (active range and strength), 3« T h i r d l y , Helmert contrasts were made between each day's pre-exercise active group mean against the average of a l l the r e s t of the following active measures. 4. A fourth matrix contrasted group means on each of eight dependent measures f o r active range: Day 1, Day 4 (pre and post exercise), Day 7 (pre and post exer c i s e ) , Day 10 (pre and post exercise) and Day 11. CHAPTER IV RESULTS AND DISCUSSION O r i g i n a l l y , 140 women volunteered f o r the study. This number was dropped to 125 subjects i n the organiz-a t i o n a l stages of the study because of problems with students f i n d i n g time to attend a l l three weekly sessions. During the study, the a t t r i t i o n rate was remarkably low, six subjects dropped from the study f o r various reasons of sport i n j u r y and miscellaneous outside accidents. One hundred and nineteen women completed the study. The treatment and t e s t i n g sessions were productive and organized. Trained a s s i s t a n t s were h e l p f u l on the busier measuring days, but a l l a c t i v e range measurements were made by the experimenter. The study was of adequate duration to accomplish s i g n i f i c a n t gains i n a c t i v e range by a l l methods (F=s 4 4 9 . 0 , p=.0001), although the l i n e a r nature of the change showed no signs of plateauing. The Amount of Improvement i n Active Range Difference scores between the means f o r Day 1 and Day 11 represent the actual change (gain) i n active 53 54 range of r i g h t hip f l e x i o n that occurred during the study and can be seen i n Table 1. Each and every one of the treatments contributed more than 15 degrees of mean improvement i n active range. Table 1 Observed C e l l Means f o r the Active Range of Right Hip Fl e x i o n on Day 1 , Day 11, and the Improvement (difference) Between Day 1 and Day 11 Treatment Group Active Range (degrees) Day 1 Day 11 Gain 1. Control 85.8 102.7 16.9 2 . Pas. L i f t , Act. Hold 88.7 108 .2 19.5 3 . Active PNF 82 . 0 9 8 . 7 16.6 4. B a l l i s t i c and Hold 89 . 3 107.4 18 . 1 5 . Relaxation 81 . 7 103.1 21.4 6. Passive PNF 87.4 105.1 17.7 ?. Prolonged Stretch 91.6 107.0 15.4 X of a l l Treatments (2-7) 8 6 . 8 104 . 9 18 . 1 X of Active Methods (3,4) 85.7 103.1 17.4 1 of Passive Methods ( 5 f 6 , 7 ) 8 6 . 9 105.1 18 . 2 As can be seen i n Figure 4 , a l l s i x treatment groups contributed to active range i n s i m i l a r amount and manner over the study. The Prolonged Stretch group began the study with the highest s t a r t i n g a c t i v e range of a l l groups, and f i n i s h e d the study with the second highest range, but o v e r a l l , showed the l e a s t improvement i n active range (15.4 degrees). The Relaxation method had the lowest active range of a l l .55 J—.-.J. F i g u r e i • • : •- j n T h e . . I m p r o v e m e n t T r e n d s f o r S i x M e t h o d s ""; o f S t r e t c h o v e r a F o u r W e e k " P e r i o d : C o n t r o l 0 0 0 » c o P a s s i v e L i f t . A c t , . H o l d • B a l l i s t i c a n d H o l d x * "* A c t i v e P N F — . n _ R e l a x a t i o n ;_ P a s s i v e P N F P r o l . S t r e t c h 1 1 0 «> c . •H ~P» 3 CO • • S - ! o U . . . I. -o V 100 "c" ' 7 o •H . x -t— 9) P. w ** 90 - © - — r l5f Q 8 0 1 T r e a t m e n t D a y s 56 groups to begin with and caught up with some of the groups over the study to accomplish the greatest gain i n a c t i v e range (21.4 degrees). The Passive L i f t , Active Hold group (the combination method) showed the second greatest active range improvement over the study (19 . 5 degrees) and also accomplished the highest f i n a l a c t i v e range (108.2 degrees). The Control group improved comparatively well i n active range, and i n f a c t , showed no s i g n i f i c a n t d i f f e r e n c e s f o r the dependent variable as compared to the average improvement of the treatment groups (Table 1). The Hypotheses The f i r s t hypothesis stated that active methods of s t r e t c h i n g would give a greater improvement i n active range over passive methods. This hypothesis was not supported since s i g n i f i c a n t d i f ferences between a c t i v e and passive methods could not be obtained at the . 0 5 l e v e l of s i g n i f i c a n c e (F<1 .01 p-i6 7 ) . The second hypothesis stated that the Active PNF method would increase a c t i v e range of hip f l e x i o n b e t t e r than B a l l i s t i c and Hold method. No s i g n i f i c a n t d i f f e r -ences were obtained between the two methods at the . 0 5 l e v e l and thus the second hypothesis was not supported. (F<1 . 0 ; p= . 6 5 ) . Other comparisons (as determined by the contrast 5? matrix, Figure 3) were made of the change i n a c t i v e range between the i n i t i a l and f i n a l means. None of these contrasts showed s i g n i f i c a n c e , although there was a strong tendency f o r the Relaxation group to improve a c t i v e range better than the other passive methods (F=3.4 i p s . 0 6 ) . This car.-be seen i n Table 1 which shows that Relaxation subjects improved 21.4 degrees i n active range while Passive PNF and Prolonged Stretch subjects improved 17.7 and 15.4 degrees r e s p e c t i v e l y , or an average of 16.6 degrees. The I n i t i a l and F i n a l Means I n i t i a l measurements on active range were tested to see how equal the groups were to s t a r t with. The orthogonal comparisons permitted numerous contrasts of the means, only one of which showed that one group was s i g -n i f i c a n t l y lower than the others i n i t i a l l y i n a c t i v e range. The Relaxation group (81 . 7 degrees) was i n i t i a l l y lower than the other passive methods (86.9 degrees) at l e s s than the . 0 5 l e v e l of significance.(F =4. 3 1 p=.04). Figure 5 shows that by the end of the study, the Relax-a t i o n group was within two degrees of the other passive methods, and was no longer s i g n i f i c a n t l y d i f f e r e n t from them. At the end of the study the treatments were not s i g n i f i c a n t l y d i f f e r e n t as contrasted, although the Active PNF with 98 . 7 degrees, was somewhat lower than the B a l l i s t i c method with 107.4 degrees (F= 3 . 3 i p=,07). 58 Rate of Active Range Improvement Although the treatments were not s i g n i f i c a n t l y -d i f f e r e n t i n the t o t a l change i n active range, i t was considered to be of value to t e s t the nature of the change over the f i v e t e s t i n g sessions. The f i v e "pre-exercise" active measures (Day 1, 4, 7, 10, 11) were compared (one against the average of a l l the r e s t ) to give four t e s t s of rate of improvement. Figure 4 shows that a l l treatments improved i n a s i m i l a r manner over the study. The rate of improvement i n the Control group was not s i g n i f i c a n t l y d i f f e r e n t from the average trend of the treatment groups, although i t can be seen (Figure 4) that there was a tendency f o r them to gain very l i t t l e a f t e r Day 4 compared to the treatment groups. Figure 5 shows that the Relaxation method pro-duced a s i g n i f i c a n t l y greater change i n a c t i v e range over the other passive methods from Day k on (p=5»95t p=.02). The two active methods tended to improve i n a l i n e a r way i n a c t i v e range with no i n d i c a t i o n s of plateauing. Table 2 l i s t s the a c t i v e range means f o r each day. Pre and Post Exercise Changes i n Active Range The s i x active range means in c l u d i n g three "pre" exercise and three "post" exercise measures (Days 4 , 7, 10) were contrasted to see i f any groups d i f f e r e d i n terms of "immediate" improvement i n active range (due to tissu e lengthening or warmup e f f e c t ) . I t should be noted that Table 2 Observed C e l l Means f o r Active Range of Right Hip Fle x i o n Pre and Post Exercise on Days 4 , 7, 10 Pre-Exercise Active Range (degrees) Days* 1 4 7 10 11 Groups 1 . 85.8 92.7 94.6 9 8 . 9 102.7 2 . 8 8 . 9 9 1 . 5 100.2 107 . 1 108 .2 ?• 82 . 0 8 9 . 5 9 2 . 9 98.1 9 8 . 6 4 . 8 9 . 3 9 4 . 6 9 9 . 2 102.5 107.4 5- 81 . 7 86.2 97.8 98.2 103.1 6 . 87.4 9 3 . 9 9 6 . 6 101.3 105.1 7. 91.6 9 4 . 8 101.0 104 . 3 107.0 A l l 8 6 . 8 91 . 8 9 8 . 0 101.9 104 . 9 Active 85.7 92.1 96.1 100.3 103.1 Passive 8 6 . 9 91.6 9 8 . 5 101.3 105.1 Days: Post-•Exercise Active Range (degrees) 4 7 10 Groups* • 1 . 9 3 . 3 9 6 . 2 99.7 2 . 98.1 101.1 105.9 3 . 88.4 9 3 . 4 97.4 4 . 9 5 . 0 9 8 . 8 105.1 J - 9 2 . 9 9 4 . 3 9 9 . 9 6 . 9 6 . 3 101.5 101.7 7. 9 8 . 9 104 . 7 104 . 9 A l l 9 4 . 9 9 9 . 0 102.5 Active 92.1 96.1 101.3 Passive 9 6 . 0 100.2 102.2 * Method Groups are l i s t e d as follows: 1• Control 2 . Passive L i f t , Active Hold 3 . Active PNF 4 . B a l l i s t i c and Hold 5 . Relaxation 6 . Passive PNF 7. Prolonged Stretch A l l : The mean of a l l the exercise treatments (2-7) Active: The mean of the ac t i v e methods ( 3 . 4 ) Passive: The mean of the passive methods ( 5 . 6 , 7 ) 60 because of the f a t i g u i n g nature of the hip f l e x o r a c t i v i t y i n the active methods, the d a i l y gains i n Active PNF and the B a l l i s t i c methods were often negative or minimal. The fatigue e f f e c t i s seen i n Table 3. Even the Control group gained on the average 1.0 degree on t h e i r second d a i l y measure of active range. The treatments, on an average, improved active range of hip f l e x i o n 1.6 degrees. The Relaxation group gave the greatest single d a i l y gain i n the study (6.8 degrees on Day 4), while the Prolonged Stretch method gave the greatest average d a i l y gain (2.8 degrees). Table 3 The Difference Between Pre and Post Exercise Means f o r Active Range on Days 4,7,10 Treatment Groups Days Da i l y Gain Mean Gain (degrees) (degrees). 1. Control 4 0.641 + 1.0 7 1.53 10 0.82J 2. P.L., Act. Hold 4 6.60} +2 . 0 7 0.93 10 -1.26J 0 . A 3. Active PNF 4 £1.12) - 0.5 c 7 0.47 ( t 10 -0.76) 0 ( i 4. B a l l i s t i c 4 0.38 7 -0.38 10 2.56) + 0.9° ) v e 5. Relaxation 4 6.79} +1.7 . „ 7 -3.53 I 10 1.79- a 6. Passive PNF 4 2.35) + 2.6 s 7 4.82 10 0.50-7. Prolonged Stretch 4 4.16} + 2.8 J v 7 3.67 10 0 . 6 l J « X of A l l Treatments > + 1 . 6 61 Strength of Hip Fle x i o n Hip f l e x i o n strength, as measured at the 45 degree angle, improved 5*9 units, or approximately 12 pounds of force on the average f o r a l l seven groups, but not i n a s i g n i f i c a n t l y d i f f e r e n t way as seen i n Table 4 . An explanation of t h i s r e s u l t w i l l be made i n the d i s -cussion. Table 4 Observed C e l l Means f o r Hip F l e x i o n Strength on Day 1 , Day 11 and Difference (Gain) Between Day 1 and 11 Treatment Group Hip F l e x i o n Strength (units) Day 1 Day 11 Gain 1 . Control 50.0 54.7 4 . 7 2 . Pas. L i f t , Act. Hold 51.1 55.7 4 . 6 3 . Active PNF 4 9 . 4 56.2 6.8 4 . B a l l i s t i c and Hold 48 . 0 5 4 . 0 6 . 0 5 . Relaxation 47.1 53.2 6.1 6 . Passive PNF 46 . 9 52.7 5 . 8 7. Prolonged Stretch 4 9 . 1 56.6 7 . 5 6 2 i _ F i g u r e 5 } ' . i T h e I m p r o v e m e n t T r e n d s f o r P a s s i v e M e t h o d s - i n - A c t i v e R a n g e o v e r t h e F o u r W e e k s — i n F i v e M e a s u r e s F i g u r e 6 i " " : ;?; The Improvement Trends f o r A c t i v e Methods • i n A c t i v e Range over the Four Weeks I ; i n Pre and Post E x e r c i s e Measures 63 .Figure ? • ^ . . - i -^-J i.-i_J ! !__„ ! JThe Improvement Trend i n Active Range "over a Four Week Period Pre and Post r Exercise f o r the Control Group CONTROL GROUP ' - A Figure 8 The Improvement Trend i n Active Range over a Four Week Period Pre and Post Exercise f o r Passive L i f t , Active Hold — — I -Figure 9 _-:-_-..-._;-.-...:_„____• . __!___] The Improvement Trend i n Active Range over a Four Week Period Pre and Post -Exercise f o r the Relaxation Group j : Treatment Days • 67 : I Figure 10 i- -The Improvement Trend i n Active Range over a Four Week Period Pre and Post Exercise f o r the Passive PNF Group ' : ~ • Figure 11 [ ' ~~\ _ ; ~ ~ The Improvement Trend i n Active Range ~ over a Four Week Period Pre and Post _... '•.—;—•• Exercise f o r the Prolonged „ Stretch Group , ...L.L..S.i_ 6 9 DISCUSSION The r e s u l t s indicate that a c t i v e range of hip f l e x i o n i s promoted comparatively well by both passive and active s t r e t c h i n g methods. In addition, none of the stretching methods appear to s i g n i f i c a n t l y d i f f e r i n t h e i r c o n t r i b u t i o n to strength of hip f l e x i o n as measured at the 45 degree angle. Several i n t e r p r e t a t i o n s may help to explain the r e s u l t : 1. The comparable improvement of the Control group i n active range r e f l e c t s the conditioning e f f e c t that a l l groups were undergoing i n t h e i r d a i l y p h y s i c a l education classes as well as i n the weekly t e s t i n g sessions. I t i s possible that both of these a c t i v i t i e s were vigorous enough to act as an i n f l u e n t i a l " t r a i n i n g e f f e c t . " 2. A more important consideration i s the p o s s i b i l -i t y that the angle of 45 degrees was not appropriate i n measuring the strength of hip f l e x i o n . I t i s almost incon-ceivable that the B a l l i s t i c and Hold method did not make a more appreciable c o n t r i b u t i o n to strength considering the muscular e f f o r t that the subjects were required to make. However i t i s known that the 45 degree angle of strength measure was well below the angle of the actual average a c t i v e range on the i n i t i a l day (84.5 degrees), and most c e r t a i n l y was f u r t h e r from the f i n a l day's average active p o s i t i o n (104.6 degrees). The p o s s i b i l i t y e x i s t s that the hip f l e x -i o n strength measure was made at an angle too f a r from the 70 p o s i t i o n where the actual strength gains took place. 3. The passive methods, most notably the Relax-a t i o n method, appear to o f f e r some p o s i t i v e q u a l i t y to act i v e range other than increased strength. This i s a most i n t e r e s t i n g f i n d i n g considering the premises outlined i n the introduction. In order f o r a c t i v e range to improve s u b s t a n t i a l l y without c o i n c i d i n g strengthening exercise, i t seems l o g i c a l to assume that the active force was being applied to a reduced resistance. In other words, Relax-a t i o n subjects apparently learned to reduce the r e f l e x contractions of the stretched hamstrings, and t h i s e f f e c t i n combination with the phy s i c a l lengthening exercise, was as e f f e c t i v e as increasing the strength of the hip f l e x o r s . Active range of motion appears to be highly dependent on lowering the resistance of the extending muscles, perhaps more so than increasing the strength of the f l e x i n g muscles. The f i n d i n g s reveal that the Active PNF method i s not as valuable to active range of motion as indicated i n Holt's (1970) study. One consideration i s that the standardiz-a t i o n of time f o r the exercise regimens may have been a f a c t o r i n equalizing the e f f e c t s of the treatments. F i n a l l y , i t should be noted that the Relaxation method showed e r r a t i c tendencies i n that i t gave the great-est o v e r a l l gain i n ac t i v e range of hip f l e x i o n , but the improvement trend was not a smooth t r a n s i t i o n . Apparently t h i s method has much to o f f e r i n d i v i d u a l s i f the proper 71 conditions e x i s t f o r the subject to acquire the appropriate frame of mind. The r e s u l t s from the other h a l f of t h i s study (Russell. 1976) comparing the six methods of stre t c h on passive range of hip f l e x i o n are summarized here to en-l i g h t e n the reader on the j o i n t f i n d i n g s . In passive range, the Control group gained s i g n i f i c a n t l y l e s s (F=25.8, p=.0001) than the mean of the six exercise groups. As hypothesized, the active s t r e t c h i n g methods (Active PNF with 19•9 degrees gain and B a l l i s t i c and Hold with 22.9 degrees gain) showed s i g n i f i c a n t l y lower mean increase i n passive range than did passive methods (which showed mean increases of 26.9 degrees f o r Relaxation, 27.4 degrees f o r Passive PNF and 26,4 degrees f o r Prolonged Stretch) (F=5.9, p=.01). Passive L i f t - A c t i v e Hold showed the greatest mean improvement f o r passive range with 27.7 degrees. The second hypothesis that the Relaxation method would be b e t t e r than other passive methods was rejected. R u s s e l l found that the exercise sessions had an im-portant immediate e f f e c t on passive range improvement. In f a c t , there was a trend f o r the d a i l y increase i n passive range to be greater than the weekly increase. This p o s i t i v e immediate e f f e c t was suggested to be due to a neuromuscular warmup e f f e c t (gamma bias r e s e t t i n g or habituation of the spindle f i r i n g ) or due to actual p h y s i c a l lengthening of the connective t i s s u e . 72 In j o i n t perspective, the Passive L i f t - A c t i v e Hold method stands out as the one method best able to contribute to active and passive ranges of motion. This method ranked f i r s t f o r passive range of hip f l e x i o n (see R u s s e l l , 1976) and second f o r active range i n t h i s study. In add-i t i o n , t h i s method was easier to teach and administrate than PMF;or Relaxation methods. The Prolonged Str e t c h and Relaxation methods also contributed well to both ranges, and these combined with an ac t i v e contraction of the hip f l e x o r s (to e l i c i t r e c i p r o c a l i n h i b i t i o n ) would appear to r e s u l t i n a maximum s t r e t c h and maximum r e l a x a t i o n of the targe t mus-c l e s . The r e s u l t s of the dual study prompted the experi-menters to co r r e l a t e i n d i v i d u a l active and passive range measures on the i n i t i a l and f i n a l days, and also to c o r r e l a t e the gains made i n each range. The c o r r e l a t i o n s showed f a i r -l y high r e l a t i o n s h i p ( r = . 7 0 ) between i n d i v i d u a l a c t i v e and passive measures both before and a f t e r the study. Indiv-i d u a l s high i n one range tended to also be high i n the other and s i m i l a r l y f o r the low measuring i n d i v i d u a l s . A l s o i n d i v -i d u a l s high i n one range to s t a r t the study tended to be high to end the study ( r=.77 f o r a c t i v e , r = . 6 8 f o r p a s s i v e ) . However, the c o r r e l a t i o n between active range and passive range improvement scores was not high (r=.37). The low c o r r e l a t i o n i n d i c a t e s that gains d i d not c o n s i s t a n t l y occur together i . e . the improvement scores were highly v a r i a b l e and gains i n one range have l i t t l e r e l a t i o n s h i p to gains i n 73 the other. There i s some r e l a t i o n s h i p between the two ranges of motion (active and passive) but one cannot pr e d i c t that improvement i n one range w i l l coincide with a s i m i l a r improvement i n the other. CHAPTER V SUMMARY AND CONCLUSIONS The phy s i c a l educator or coach i n t e r e s t e d i n increasing the f l e x i b i l i t y of students or a t h l e t e s encounters few documented methods that claim to improve s p e c i f i c j o i n t range of motion. Increased range of motion i s l a r g e l y dependent upon the condition of the sof t t i s s u e s surrounding the j o i n t . The supporting t i s s u e s can be p h y s i c a l l y lengthened through various s t r e t c h i n g maneuvres, and the muscles on opposite sides of the j o i n t can play an important r o l e i f c e r t a i n f a c i l i t a t i n g techniques are applied to a s s i s t appropriate r e l a x a t i o n and contraction. B a s i c a l l y a l l methods of s t r e t c h i n g can be termed ACTIVE or PASSIVE. Active s t r e t c h i n g methods require that the range of movement be made v o l u n t a r i l y , while passive stretching methods r e f e r to movement through a range due to external force such as g r a v i t y or manual assistance. I t was the purpose of t h i s study to investigate the e f f e c t s of s i x methods of s t r e t c h on the active range of r i g h t hip f l e x i o n . 74 75 The sample consisted of 119 volunteer c o l l e g e women i n p h y s i c a l education at the U n i v e r s i t y of B r i t i s h Columbia. Approximately twenty subjects were randomly assigned to each of seven groups by p a i r s . In a d d i t i o n to the Control group, s i x exercise groups were taught various s t r e t c h i n g regimens to be practiced ten minutes with a partner. The exercise groups attended sessions three times a week f o r three weeks. A l l subjects were measured before and a f t e r the study as well as before and a f t e r exercise on the f i r s t day of each week. The a c t i v e range of hip f l e x i o n was measured by the Leighton Flexometer and the strength of hip f l e x i o n at the 45 degree angle was measured by a cable tensiometer. A l l groups increased i n a c t i v e range of hip f l e x i o n as indicated by the mean gains, i n c l u d i n g the Control group. Active stretching methods did not contribute s i g n i f i c a n t l y better to a c t i v e range over the passive methods as hypothesized. The r e s u l t s indicate that the h i g h l y rated Active PNF method and the i l l - r e p u t e d B a l l i s t i c method were not s i g n i f i c a n t l y d i f f e r e n t i n t h e i r c o n t r i b u t i o n to active range. Since passive methods of s t r e t c h i n g contributed as w e l l as a c t i v e methods to active range of hip f l e x i o n , i t i s apparent that t h e o r e t i c a l l y , i t seems to be more important to reduce the resistance of the s o f t tissuerberng stretched than to increase the strength of the a c t i v e c o n t r a c t i n g 76 tissue (agonists). Since the Relaxation group c o n t r i -buted s i g n i f i c a n t l y better than other passive methods to ac t i v e range of hip f l e x i o n , t h i s method appears to be o f f e r i n g something more than just s o f t tissue lengthening. The reduced resistance i n the Relaxation method may be also a t t r i b u t e d to the a b i l i t y of the subjects to reduce the s t r e t c h r e f l e x upon lengthening, thus allowing minimal resistance from the c o n t r a c t i l e apparatus of the muscle. The strength of hip f l e x i o n as measured at the 45 degree angle was not s i g n i f i c a n t l y nor d i f f e r e n t i a l l y improved by the various exercise treatments despite the vigour of the e f f o r t required by the active s t r e t c h i n g methods. The angle at which the strength was measured apparently was a poor i n d i c a t o r i n that i t was well below the range at which s p e c i f i c strength gains might have taken place. The Relaxation group was more e r r a t i c i n i t s improvement trend i n a c t i v e range. I t appeared that subjects were better able to concentrate on some days more than others i n d i c a t i n g that the method has good p o t e n t i a l depending upon the frame of mind. Since a l l of the passive methods made substantial contributions to active range, i t i s apparent that reducing the r e s i s t -ance of the s t r e t c h i n g tissues i s a viable approach to increa s i n g active range. 77 Recommendations For Further Study 1. Evidence from t h i s dual study i n d i c a t e s that three weeks i s adequate time to gain s u b s t a n t i a l l y i n both a c t i v e and passive range of motion, but that more time be allowed i n a further study to e s t a b l i s h how soon, and by which methods a plateau e f f e c t w i l l occur, 2 # I t would be of i n t e r e s t to see i f a c t i v e range of motion can eventually "catch up" to passive range of motion i n terms of i t s f i n a l maximum range. 3. Some ingenuity i s needed to solve the problem of measuring s p e c i f i c i n d i v i d u a l hip f l e x i o n strength and to c o r r e l a t e strength gains with active range gain to see how important the strength component r e a l l y i s i n accom-p l i s h i n g a c t i v e range of motion. CONCLUSIONS 1. Active s t r e t c h i n g methods give no greater improvement i n ac t i v e range of hip f l e x i o n than do passive methods. 2. The Active PNF method and the B a l l i s t i c and Hold method do not d i f f e r s i g n i f i c a n t l y i n t h e i r o v e r a l l c o n t r i b u t i o n to a c t i v e range of hip f l e x i o n . 3. I f strengthening of the hip f l e x o r s occurs i n " a c t i v e " s t r e t c h i n g exercises, then i t must occur i n a more s p e c i f i c l o c a t i o n at the end of the range of motion. LITERATURE CITED Akeson, W.H. 1961. An experimental study of j o i n t s t i f f n e s s . J . of Bone and J o i n t Surg.. 43At1022-1034. 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Unpublished Master's Thesis, U n i v e r s i t y of C a l i f o r n i a . Laubach, L.L. and McConville, J.T. 1 9 6 6 . Muscle strenght, f l e x i b i l i t y and body s i z e of adult males. Research Quarterly. 3 7 » 3 8 4 - 3 9 2 . 87 Lawther, J.D., 1956. F l e x i b i l i t y f o r what? J . of Hlth. Phys. Educ. and Rec.. 27:23. Lehman, J.F., Masock, A.J., Warren, G. and 1970. Koblanski, J.N. E f f e c t of therapeutic temperature on tendon e x t e n s i b i l i t y . Arch, of Phys. Med., 51:481. Leighton, J.R. 1954. An i n v e s t i g a t i o n of the f l e x i b i l i t y c h a r a c t e r i s t i c s of three age groups and f i v e s p e c i a l i z e d s k i l l groups among males twelve to sixteen years of age and college age a t h l e t e s . Doctoral Diss., U n i v e r s i t y of Oregon. Leighton, J.R. 1955* An instrument and technic f o r the measure-ment of range of j o i n t motion. Arch, of  Phys. Med, and Rehab.. 36$571. Leighton, J.R. 1956. F l e x i b i l i t y c h a r a c t e r i s t i c s of males s i x to ten years of age. J . Ass. Phys. Ment. Rehab.. 18:19-25. Leighton, J.R. i960. On the s i g n i f i c a n c e of f l e x i b i l i t y f o r p h y s i c a l educators. J . of Hlth. Phys.  Educ. and Rec.. 31:27, 28, 70. Lemiere, 0. 1952. F l e x i b i l i t y of shot putters and discus throwers. Unpublished Master's Thesis, U n i v e r s i t y of Oregon. Levine, M.G., Kabat, H. and Knott, M. 1954. Relaxation of s p a s t i c i t y by p h y s i o l o g i c a l techniques. Arch. Phys. Med.. 35:214-223. L i b e t , B., F e i n s t e i n , B. and Wright, E.W. J r . 1955* Tendon afferents i n autogenic i n h i b i t i o n . Federation Proc.. 14:92. Liverman, .M.N. 1970. The r e l a t i o n s h i p of f l e x i b i l i t y and power i n the lower limb. Unpublished Master's Thesis, U n i v e r s i t y of I l l i n o i s . 88 Logan, G.A. and Egstrom, G.H. 1961. E f f e c t s of slow and f a s t s t r e t c h i n g on the s a c r o - f e m o r a l a n g l e . J . o f Assn. of Phys. and Ment. Rehab., 15 :85 . Massey, B.H., and Chaudet, N.L. 1956. E f f e c t s of s y s t e m a t i c heavy r e s i s t a n c e e x e r c i s e on range of j o i n t movement i n young male a d u l t s . Research Q u a r t e r l y , 27:41-51. Mathews, D.K., Shaw, V. and Bohnen, M. 1957. Hip f l e x i b i l i t y o f c o l l e g e women as r e l a t e d t o l e n g t h o f body segments. Research Q u a r t e r l y , 28(4) : 3 5 2 . Matthews, P.B.C. 1964. Muscle s p i n d l e s and t h e i r motor c o n t r o l . P h y s i o l . Review. 44:219-288. McCue, B.F. 1953. F l e x i b i l i t y o f c o l l e g e women. Research  Q u a r t e r l y . 24 :316. M i l l e r , C.J. 1954. The r e l a t i o n s h i p o f f l e x i b i l i t y i n boys to age. Unpublished Master's T h e s i s , U n i v e r s i t y o f Maryland. Morehouse, L.E. and M i l l e r , A.T. 1967. P h y s i o l o g y of E x e r c i s e , S t . L o u i s * C.V. Mosby co. Norman, S.R. 1970. The i n f l u e n c e o f f l e x i b i l i t y on v e l o c i t y of l e g - e x t e n s i o n a t the knee. Unpublished Master's T h e s i s , U n i v e r s i t y o f I l l i n o i s . Odgers, T.W. I 9 6 9 . A study o f the r e l a t i o n s h i p s between f l e x i b i l i t y measures, s k i l l performances and c h r o n o l o g i c a l ages of s i x to t h i r -t e e n y e a r o l d boys. Unpublished Master's T h e s i s , U n i v e r s i t y of Oregon. Olsen, B.H. 1956. An i n v e s t i g a t i o n of the r e l a t i o n s h i p of a n k l e , knee, trunk and shoulder f l e x i b i l -i t y to g e n e r a l motor a b i l i t y . U npublished M a s t e r ' s T h e s i s , U n i v e r s i t y of Oregon. 89 Pattern, N.J. and Mortensen, O.A. 1971. An electromyographic study of r e c i p r o c a l a c t i v i t y of muscles. Anat. Record. 1 7 0 ( 3 ) « 2 5 5 - 2 6 8 . P i c k i n s , W.L. 1952. A study of f l e x i b i l i t y i n swimmers. Unpublished Master*s Thesis, U n i v e r s i t y of Oregon. P h i l l i p s , M., Bookwalter, C , Denman, C , McAuley, J.., 1955* Sherwin, H., Summers, D. and Yeakel, H. Analysis of r e s u l t s from the Kraus-Vtfeber t e s t of minimum muscular f i t n e s s i n c h i l d r e n . Research Quarterly. 26t3 1 4 . Polak, 0. 1970. Extrapyramidal r i g i d i t y : An electromyographic and pathophysiological study of the tonic s t r e t c h and shortening r e f l e x e s . Acta. Univ.  Carolinae. Med. Monol.. 42 M 5 - 1 3 3 . Ramsey, R.W. and Street, S. 1940. The isometric length tension diagram of i s o l a t e d s k e l e t a l muscle f i b r e s of the f r o g . J . of C e l l , and Comp. Phy s i o l . . 15:11. Rathbone, J.L. I 9 4 3 . Relaxation. New York: Teacher*s College, Columbia U n i v e r s i t y . Rathbone, J.L. 1959. Corrective P h y s i c a l Education, P h i l a d e l p h i a : W.B. Saunders Co. Riddle, C.S. 1956. A comparison of three methods f o r increasing f l e x i b i l i t y of the trunk and hip j o i n t s . Doctoral Diss., U n i v e r s i t y of Oregon. R i t c h i e , J.M. and Wilkie, D.R. 1956. The dynamics of muscular contraction. J . P h y s i o l . , 143:104-111. Rochelle, R.H., Skubic, V. and Michael, E.D. 1960. Performance as affected by incentive and preliminary warmup. Research Quarterly. 3 1 . ^ 9 9 . 90 Ruch, T'.C. and P a t t o n , H.D. 1965. P h y s i o l o g y and B i o p h y s i c s . P h i l a d e l p h i a : W.B. Saunders Co. Ruch, T.C., P a t t o n , H.D., Woodbury, J.W., fowe, A.L. 1966. Neurophysiology. P h i l a d e l p h i a : W.B. Saunders Co. Ruhl, P.F. 1972. Changes i n s t r e n g t h , f l e x i b i l i t y , b a l ance, movement time and dance technique o c c u r -r i n g d u r i n g U n i v e r s i t y o f Kansas gym-n a s t i c s season. Unpublished M a s t e r ' s T h e s i s , U n i v e r s i t y o f Kansas. R u s s e l l , K. ' 1976. A comparison o f s i x methods of s t r e t c h on p a s s i v e range o f h i p f l e x i o n . U n p u b l i s h e d Master's T h e s i s , U n i v e r s i t y o f B r i t i s h Columbia. Sage, G.H. 1971. I n t r o d u c t i o n to Motor Behaviour. Don M i l l s : Addison-Wesley Pub. Co. Schmidt, R.A. 1967. E f f e c t s of p o s i t i o n a l t e n s i o n i n g and s t r e t c h on r e a c t i o n l a t e n c y and c o n t r a c -t i o n speed of muscle. Research Q u a r t e r l y . 38:494. S h a f f e r , O.K. 1959. V a r i a b l e s a f f e c t i n g Kraus-Weber f a i l u r e s among j u n i o r h i g h s c h o o l g i r l s . Research  Q u a r t e r l y . 30:75. S h a f f e r , G.K. 1962. Some f a c t s about f l e x i b i l i t y . The P h y s i c a l  E d ucator, 19«l4. S c h u l t z , J.H. and Luthe, W. 1969. Autogenic Therapy, New York: Grune and S t r a t t o n . Shambes, J.M. 1968. The i n f l u e n c e o f the gamma motor system on stance and v o l i t i o n a l movement i n normal man. D o c t o r a l .Diss -., U n i v e r s i t y o f W i s c o n s i n . 91 Shambes, J.M. 1 9 6 9 . i n f l u e n c e of the f u s i m o t o r system on stance and v o l i t i o n a l movement i n normal man. Amer. J . o f Phys. Med.. 1 8 ( 5 ) s 2 2 5 - 2 3 6 . S h e r r i n g t o n , G. I 8 9 8 . Decerebrate r i g i d i t y and r e f l e x c o o r d -i n a t i o n of movement. J . P h y s i o l . . 2 2 : 3 1 9 . S h e r r i n g t o n , S i r C. 1 9 2 3 . I n t e g r a t i v e A c t i o n of the Nervous System. New Haven, Yale U n i v e r s i t y P r e s s . S h e r r i n g t o n , S i r C. 1 9 3 9 . S e l e c t e d W r i t i n g s o f S i r C h a r l e s  S h e r r i n g t o n , e d i t e d by D.D. Brown, London: Hamish Hamilton M e d i c a l Books. Shaw, T.M. 1 9 6 8 . Changes i n the f l e x i b i l i t y o f s e l e c t e d j o i n t s o f crewman f o l l o w i n g a season of rowing. Unpublished Master's T h e s i s , U n i v e r s i t y o f Oregon. S i g e r s e t h , P.O. F l e x i b i l i t y . P h y s i c a l F i t n e s s : An  I n t r o d u c t i o n to Measurement,in P h y s i c a l  E d u c a t i o n , I n d i a n a p o l i s : P h i E p s i l o n Kappa F r a t e r n i t y . Smith, J.L., Roberts, E.M. and A t k i n s , E . 1 9 7 2 . Fusimotor neuron b l o c k and v o l u n t a r y arm movement i n man. Amer. J . o f Phys. Med.. 5 K 5 ) : 2 2 5 - 2 3 7 . Spande, M.S. 1 9 5 ^• A f a c t o r i a l a n a l y s i s o f body f l e x i b i l i t y i n u n i v e r s i t y women. D o c t o r a l D i s s . , U n i v e r s i t y o f New York. S t a f f o r d , G.T. and K e l l y , E.D. 1 9 5 8 . P r e v e n t a t i v e and C o r r e c t i v e P h y s i c a l  E d u c a t i o n , New York: Ronald P r e s s Co, S t u a r t , D.G., Goslow, G.E., Mosher, C.G., and 1 9 7 0 . R e i n k i n g , R,M. S t r e t c h r e s p o n s i v e n e s s o f g o l g i tendon organs. Exp. B r a i n Res. 10:463-76. 92 Syverson, M. 1 9 5 0 . A study o f f l e x i b i l i t y i n b a s e b a l l p l a y e r s . Unpublished Master's T h e s i s , U n i v e r s i t y of Oregon. Tanigawa, M.C. 1 9 7 2 . M o b i l i z a t i o n on i n c r e a s i n g muscle l e n g t h . Phys. Therapy. 5 2 ( 7 ) » 7 2 5 - 7 3 5 . T a y l o r , L. 1 9 2 8 . S t u d i e s i n f l e x i b i l i t y . U n p ublished Master's T h e s i s , S p r i n g f i e l d C o l l e g e . T i p t o n , R. J r . 1 9 7 6 . F l e x i b i l i t y : A s t r r r e e e t c h i n g e x p e r i e n c e . Gymnast, 1 8:64 - 6 5 (Jan.) Tucker, N.M. 1 9 6 3 . Changes i n the range of movement of the arm f o l l o w i n g i s o t o n i c and i s o m e t r i c work to s t r e n g t h e n the musculature around the sacrohumeral j o i n t . U n published Master's T h e s i s , U n i v e r s i t y of Oregon. Tyrance, H.J. 1 9 5 8 . F l e x i b i l i t y i n r e l a t i o n to body types. Research Q u a r t e r l y . 2 9 : 3 4 9 . Van Anne, N.M. 1 9 6 2 . An electromyographic study of the r e l a t i o n -s h i p between neuromuscular h y p e r t e n s i o n and f l e x i b i l i t y i n c o l l e g e women. D o c t o r a l D i s s . , U n i v e r s i t y of Oregon. Wear, C L . 1 9 6 3 . The r e l a t i o n s h i p o f f l e x i b i l i t y to l e n g t h of body segments. Research Q u a r t e r l y , 3 4 : 2 3 4 . Weber, S. and Kraus, H. 1949. P a s s i v e and a c t i v e s t r e t c h i n g o f the muscles. Phys. Therapy Review. 2 9 : 4 0 7 . Wehr, R.W. 1 9 6 4 . The r e l a t i o n s h i p between s e l e c t e d j o i n t a n g l e s of s e l e c t e d movements and human s t r e n g t h v a l u e s . Unpublished Master's T h e s i s , F l o r i d a S t a t e U n i v e r s i t y . 9 3 W e l l s , K.F. and D i l l o n , E.K. 1952. The s i t and r e a c h - A t e s t o f back and l e g f l e x i b i l i t y . Research Q u a r t e r l y , 23:118. Wiechec, F. and Krusen, F. 1939. A new method o f j o i n t measurement and a review o f the l i t e r a t u r e . Amer. J . o f  Surgery, 43:660. W i l l i a m s , J.G.P. i960. Medical A s p e c t s of S p o r t and P h y s i c a l . F i t n e s s , Oxford: Pergamon P r e s s . W i l l i a m s , M.C. 1968. E f f e c t o f r e l a x a t i o n t r a i n i n g on f l e x i b i l i t y . Unpublished Master's T h e s i s , U n i v e r s i t y o f I l l i n o i s . Wright, V. and Johns, R.J. 1962. P h y s i c a l f a c t o r s concerned w i t h the s t i f f n e s s o f normal and d i s e a s e d j o i n t s . Johns Hopkins Hosp. B u l l . , 106:215-231. Young, D. 1950* S t r e t c h i n g f o r r e l a x a t i o n . Phys. Therapy  Review, 30:134. Zappala, A. 19?0. I n f l u e n c e of t r a i n i n g and sex on the i s o l a t i o n and c o n t r o l o f s i n g l e motor u n i t s . Amer. J . o f Phys. Med., 49(6)1348-361. APPENDIX APPENDIX A INDIVIDUAL RAW SCORES Group 1 - CONTROL F l e x i b i l i t y i n degrees DAY 1 DAY 4 DAY 7 DAY 10 DAY 11 STRENGTH NO. ACT PAS ACT PAS ACT PAS ACT PAS ACT PAS ACT PAS ACT PAS ACT PAS PRE POST 001 098 104 110 125 110 127 122 137 118 I36 123 I34 122 I 3 6 111 129 40 .0 5 0 . 0 002 099 120 102 120 104 130 110 125 HO 124 108 I38 114 140 110 130 46 .0 47.5 003 096 130 086 116 096 120 100 123 100 125 100 126 100 132 111 126 57.0 52,5 004 067 104 085 117 084 114 084 110 O85 108 090 114 090 120 100 118 55.0 59.0 005 082 102 095 114 096 113 100 122 100 116 095 H 5 095 H 5 103 122 3 8 . 0 62 .0 006 090 100 095 110 090 108 093 113 100 119 101 114 103 115 100 100 40 .0 42 .0 007 093 115 10? 130 110 130 102 125 102 125 110 134 113 131 1 0 3 125 43 .0 . 46 .0 008 0?5 105 080 108 081 109 078 090 079 096 078 105 077 100 085 110 4 7 . 0 66.5 009 085 102 08? 110 08? 110 086 102 086 100 098 108 097 106 097 104 61.5 66.0 010 090 095 097 105 093 103 094 103 091 099 100 105 092 104 106 106 4 7 . 0 46.5 011 089 108 091 110 086 110 088 113 091 H I 100 12? 106 122 110 119 54 .0 53.5 012 077 084 084 094 083 102 094 105 090 10? 091 095 090 096 093 H3 4 4 . 0 43.5 013 103 145 110 135 110 137 H 7 144 125 153 130 150 130 157 130 146 68.5 69.5 014 085 103 087 106 090 110 085 10? 090 104 100 11? 100 119 103 115 59 .0 65.5 0 1 5 080 088 07? 105 080 105 086 111 087 111 085 HO 086 110 090 113 54 .0 55.0 016 080 122 091 128 090 130 085 120 092 123 08? 120 090 116 09? 125 6 2 .0 61.5 017 070 098 091 108 096 113 085 104 089 109 085 102 090 113 097 117 3 3 . 0 44 .0 Group 2 - PASSIVE LIFT, ACTIVE HOLD DAY 1 DAY 4 DAY NO. ACT PAS ACT PAS ACT PAS ACT PAS 055 095 1 0 5 095 120 105 125 103 121 056 078 096 084 117 088 123 097 124 057 070 074 085 095 082 097 098 100 058 067 074 072 073 09**- 090 083 085 059 090 093 083 096 085 106 085 097 060 120 143 128 150 127 151 125 1^9 061 108 130 100 129 110 135 1^0 158 062 079 094 087 103 095 120 080 102 063 101 111 097 120 110 132 106 133 064 072 091 084 121 075 HO 081 110 065 088 096 081 117 105 132 095 112 066 080 090 082 101 084 110 096 123 067 097 095 102 113 107 127 105 116 068 084 121 090 126 095 1^5 100 132 069 101 107 103 119 n o 133 109 123 7 DAY 10 DAY 11 STRENGTH ACT PAS ACT PAS ACT PAS ACT PAS PRE POST 103 130 110 135 105 137 117 132 65.O 7 2 . 0 097 131 100 132 105 149. 099 130 53.0 6 5 . 0 100 114 105 105 096 118 089 110 58.0 S3.5 085 087 092 091 090 093 090 095 56.0 48 . 5 089 107 097 112 097 125 092 116 42.0 5 5 . 5 121 156 120 145 125 150 136 164 52.0 51.0 128 146 132 148 127 1 5 ^ 132 155 62.0 6 0 . 5 080 105 093 HO 093 122 110 114 45.0 47.0 113 144 107 136 110 140 113 138 48.0 5 1 . 5 080 120 100 114 087 125 101 116 49.0 5 4 . 5 105 127 125 131 113 123 n o 133 3 0 . 0 5 4 . 0 093 121 088 115 085 125 095 127 53.0 55.0 121 138 1 2 5 134 128 140 1 3 5 143 54 . 5 61 . 5 090 135 093 HO 104 135 098 124 67.0 72.0 112 128 120 126 123 148 106 138 32.0 3 ^ . 5 Group 3 - ACTIVE PNF DAY 1 DAY 4 DAY NO. ACT PAS ACT PAS ACT PAS ACT PAS 087 075 095 088 111 088 113 100 124 088 060 083 072 087 065 082 075 097 089 073 073 080 084 07? 096 080 092 090 075 120 081 119 085 136 086 125 091 083 090 095 090 093 102 077 097 092 086 097 098 106 106 127 102 118 093 090 110 102 104 095 103 099 102 094 079 100 087 110 088 110 088 115 095 085 097 097 106 090 109 095 HO 096 102 101 115 128 108 125 115 125 097 109 092 085 097 080 100 090 095 098 090 127 100 135 095 140 096 130 099 103 121 100 117 108 137 110 126 100 080 103 093 113 095 130 110 121 101 068 070 076 085 080 088 095 105 102 071 068 070 083 072 082 075 083 103 065 076 082 103 077 100 086 098 7 DAY 10 DAY 11 STRENGTH ACT PAS ACT PAS ACT PAS ACT PAS PRE POST 097 125 095 120 088 121 098 123 5 5 . 5 62.0 080 100 084 106 087 106 082 097 5 2 . 0 74.0 082 105 080 102 085 1 0 3 . 0 7 5 093 ^ 8 . 0 5 2 . 0 093 130 0 9 ^ 104 091 127 089 107 5 0 . 0 5 3 . 0 085 105 101 102 098 107 097 104 4 3 . 0 41 . 5 100 120 102 115 100 120 097 124 5 2 . 0 5 9 . 5 104 121 102 108 105 118 1 1 5 140 5 9 . 5 60.O 085 109 102 126 095 126 097 129 3 9 . 0 4 5 . 5 095 117 107 112 108 120 115 112 54 . 5 6-0.0 117 126 120 127 107 113 120 134 42 . 5 5 0 . 0 085 102 098 102 105 111 090 105 5 0 . 0 6 6 . 5 100 133 105 136 105 14? 103 138 4 9 . 5 5 ^ . 0 111 140 113 140 110 145 120 138 4 9 . 0 6 0 . 0 100 124 105 128 100 134 110 120 48 . 0 6 0 . 0 083 097 090 100 096 110 095 098 5 5 . 5 5 8 . 0 0 ? 5 090 080 089 085 095 082 095 3 5 . 0 3 9 .0 095 114 090 110 090 110 092 104 5 8 . 0 6 0 . 5 98 o o o o >no o u^o o loo VTWAO o oocovor>-u"\.cMrHCM *nco O H r \ o N > O V N N O .3- jj- V A V O X O V O vpy^t vN.VN.vr\.\r\.VN.\r\. O O O O V T \ \ T \ 0 O W O V A O v\o vn HOVO O - ^ J - V O V O COOOW^ONOOC -^rHNOCM N O ^ ^ ^ - ^ vrvj^-^ ^ c^\r\ C " \ 0 s 0 v 0 \ 0 W^ j- O O O CO O VN.VO VTNO CM C"NCM rHrHCMCMCMrHCMrH CNCM C°\CM » A HrtHHHiHrliHHtHHHHHHH O CM O 0 \ O N V 0 > T \ O » A O 0 N O > O O i r > O d O \ O r l N O O \ O O O O O N O ( n rlrtOHHHHOHrlHrlrtHiHH o-oo CN.CM oo oo o\c ^ - O N^Avr\vnoN^ OCMCMrHCM-lJ-rHCMrHCMrHCMCMCM C N V N . HrlrtrlHHHtHHrliH HH rl H H oo CM r\t^o O N V N . C N . V O o n o o rH v r \ n COOOOOrHOOOOOOOOrHfN OHHrlHHHrlHHHHdHHH Hd-d-vOONC^OJ-COrlOCOONj'OO rtr(NONNONHOrl(MHHNr\ rtrlrtHHrlWrlHHrlHtHrlHH V N C O O N W N O M N I N V N V N o O 3" CM CM ON 00 rHOOrHOONOONOONONONt-HCM OOriHHrlHOHOHOOOHH ncM n o C ^ - ^ J - V O O O J - N 4 ^ ^ n o r \ H V O N t H C M C \ j O H O O H C M C M C M N 4 -HHHrlHHrlHHHHHHrlHH u>o N O O H U N C O o v^\r>c^\o C N ^ J - o OO O N O N O rH ON00 O N O N O N O N O N O rH CM OrHOOrHrHOOOOOOOrHrHrH C O C M ^ O O M N i n O i n N N H C«"\00 O VN.CM O r l O O O O d O N O M O i n rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH VN.MD CM O CO M 0 rH VNjj- C O VTNO C^- O O O ONONOONONOOONONONONOOOOrHCM O O rH O O rH rH O O O O rH O rH rH rH Q i-l c/3 n o o N O N z t ^ o v o v A c n o N j * n c o CO CM >A O rH VN,rH ONrH rH TH rH O O O CM CM rH CM n X OH rH rH rH O Q e-» rH o o V O I O C M v ^ n n n c M o rH o v o ^ j -S O ONO O N C ^ O N O O N O N ON O N ON O N O ONO rH -3" OrHOOOrHOOOOOOrHOrHrH o >H c/3 V A C ^ O M O rH *H CM vnoooo oo n n o v o CM M •< -oj 0 ^ 3 " rH ON rH rH O O ONO ONrH O rH rH n EH Q OH HrirlOHHHrlOrlOrH t/3 t-« t>-o o v^ncM o o n \ o C^-vO CM O CM O O N O N O N C^ -O O O N O N O N O N O N CO O N O N rH |JJ «< OOOOrHtHOOOOOOOOrH O N CM rH O N O rH O 00 O N O O O N O O N O O N C M OrHrHOrHrHrHOOOOrHOrHOrH novoo>OrH>A(NN nnnvN.nnoN O N O O N O O 00 O O N N O O N C O CO C O O - O N 00 rH P, Q <J OrHOOOrHOOOOOOOOO O • 4- >T\ \0 N00 0 \ 0 H N n4- >AVO NCO ON U O OOOOOOrldHHrlHHH ' ' O 2 HrlrlHHHHrlHHHHrlrl E H c/3 EH O O OH Z w CC W EH « CO PHc/3 rH < rH OH >H E H < O Q •< c/3 <*: PH EH O a rH << JH C/3 < Q OH E H O < C/3 «< PH EH O «>- << >H 0 0 <; «: Q OH EH O < C/3 PH E H O <: 0 3 < Q PH EH  <; c/3 rH PH EH «< O  o 99 ooo*Ao*nov^xn\novr\oo *r\\rwr\vno - 3 - O V O O O M D O n vT\0O CM \o CM r i o . j - s o v r » v r » v r \ ^ - u"\\r\.3- \ r \ v r s \ A \ o s o s o -3/ ooooooooo^no^nvnv^oooov^ C M H S O O C M O S O S O mso ^ » o s o O N.* c*- rs. vrs..^- u ^ j-^j- fNCAvrsv/V j - »nvrsvr\vr\_3- v r\cAC\ O O O N O C V I J - I ^ O V W H H N O N O O J - N N ^ CM rl CM CV -^ f^OriNH^ OA V\ CA CA r l CM CM -d" T H - 3 - v r\o>nno\o V A N O ^ 4 ^ O P O N C ^ C C O O H H O Q D ( O H O O H H H O ( \ J H O N O \ N OOrlrlrlrlOOrlOrlrlrlrlrlrlOOrl ocvjvo CM r i r i o o- C A O O c A r i c*-so C A C A V A O O O CM r l CACAVA-3" OHPiH CACM - 3 - CM r l CM cv^-CAsOsO O v O O O CM CM O CAVAsO C^^J- V A ^ A V A O O C O O H H O O O N O O M > O H O H O O O O ( \ 1 OOrlrlrlrlOOrlOOrlrlrlrlrlOrtrl O i N O O \ O O O j - 0 0 VAOO O O-CM *ACM CM CM O CM CA-3" C A O r l CACM - 3 " rt CA.^- H H O CA-H/ ON^OON00«>O\0«AOO»r\O00ON\0 O O C O O O O O O - a O r H G O O O C M O H O O O O rl OOOrlrlrlOOrlOrlrlrlOrlOOrlrt O O N n > T i i H ( > O N H ^ N . d - ( M H H O HHHrlHHOrlHHrtHrlHHHHHH 4'0>OOOJVOO>A>AOriNnOCON»AOO N0O OH O\CA00vO OOOi-lOHOONOajOPJ OOOrlOOOOrlOrlOrlOOrlOrlrH O Q O N t S H t M ^ O O C M CO *T\ VAsO1 O- CD O CM O H O W H VACM 0 \ O N O J - ( M 4 H O H H C A C A H H rl H rt H O rt rtrtrtrlrtrtrtrti-lrlrl o-o r-t CD (s-^ j- o o w^ jj- no>T\>An>no<AO 00 O O O rl O OSO OC^rlOrlOOOOOO OOOrlrlrlOOrlOrtrlrlrlrlrlOrlrl 00 >T>0.VOJ* > - H C ^ > A O » r M N O » f l N C A ^ A O O C A 0H(MN^H00NH»0N44-Hrl004 HHHHrlHrlrtrlrlHrlrlHrlrlrlrlH o-ovoco c^ao > A » n o X A C A V A . ^ - N C M O N ^ N N O C O O O N O \ N > A O C^CVl O H O N O V O O O O O H OOOOOOOOrlOrlrlriOOrlOOrl 25 o >H co C A C M *ooo V>CM ri C A V S - C O o V A C M O O «-I ooo o M <t, << O O r t H N N O O H O r \ r i r \ c g O O ( D O \ 4 EH P PH rlHHrtrlrlHrlHHHrtHrlrlHOOH X EH U " S » A C A C M CM O >nvno oo V A C M V A O o o CM C A V S o C^ -00 00 00 o\ OC--so O C ^ - O O O O O N O V O CO o t-3 < OOOOOOOOOOOrtrlOOOOOrt w os co o > A > A N N \ O H o v o j ' o N »A»n>nr\iA(]o o O00 rH O O CO O00 rl O C M H CM CM O O O O SO CM OOrlrlrlOOOrlOrHrlrlrlrlOOOtH V A >H EH f A O s O ^ A O C M O O C M W O - 3 " 0^0 O-sO rl O < O r-r-oo ao co cs-co vnoso co co o o o o o s o c-o P , Q O O O O O O O O O O O O rl O O O O O rH O • SO C-00 O O rt CM CAJ± WO CV0O O O rl CM CA- j -U O C A C A C A C A . 3 - . J - JH- . 3 - J - ^ ^ J - jH; V A V A V A V A X A O 25 o o o o o o o o o o o o o o o o o o o EH X CO E H o O 25 W 04 W EH « CO PH CO rl rl Ok > H EH O o «< CO < EH o O rl «< CO «< Q EH O < CO PH EH O < CO P EH O CO < PkE H O > H CO  P E H O< CO rl PH EH  O P < • O 25 O O V N V A O O O O O O O V N V N O o o o ONO CACM H H r l O CA.* j j - CM O H N ( M £N- V N VA_H- V N . * vrwo MO MO vn^j- MO VN_J. O O O O O O O O O O O V A O O O O O CM - ^ O O v n C N C O - ^ C O C M - d - C^-C^ - t H C M C M C M VA \0 VAV\*.* C M - * J - M O VT\J3- ^  V N C A * C A O - C 0 M 0 CM »AcM V N C N - j f r C A M O v O V N . * - V A ^ J - v O - j - VACM -*CMrAcMCAt-4rHC«NCMrH\OrHCMCM CO VNCMMD CM CO r-t V A C M V N V A C M O ON MO VNVN HCNONNONO^CAH OONOHinnNCOO r H r H O r H O O O r H O Q r H r H r H r H O O r H CD MO O r-t WN^J- VO O-MO > A C v - r H » A C M r H V O < M - * - 3 - C A V A C A C A C M C A C A O C M C A r H V 0 C M C M C A CAVAO O UNO vT\vO VN.rH 4 N N 0 3 O H ( M rH r-t ON CAOO COONOOONOOO CAOO CO O riHOHOOOHHOHrlrtrtOOrt VN^t CMOCOVN,\AOCOVN,VACAVACMO V A VN. ^ t ^ t C M - d / C M C M C M n r H O N C M C M r H V O r H r H r W r H CN- O ^J- CM V N v O 0 0 O M 0 O . * CVO-OCM-* r H r H O v C M O N O O O N O O O s O O O CAC-CO O r H r H O r H O O O r H r H O r H r H r H r H O O r H 4/OCO C*-VT\vO O-M0 ON MO 00 CO O VN.vrN.vO v O C A V A CM ON CM CM rH C A rH ON <A rH C M M0 rH CM r H - 3 - V N O C M C M V N C ^ r H V N J - V A V N V A O O V A O r H C M r H r H C O O N O O r H O N O N O N O N O J - O O C O O r H r H r H r H O O O r H O O O O r H r H O O r H H O V N 0 O 0 O V N C A r H C M C O V O M O ^ O V N V A O O CM -3" r H CM r H CM r H C A r H 00 CM r H r H > A O CM r H H r t H H H W r i H r l O r l H H H r l H H O 00 O O O VA O J * V T \O O VNO C^-CM O-O r H r H O N r H C ^ - C O O N O O N O N O O N O C M CN-CO O r H r H O r H O O O r H O O r H O r H r H O O TH VAVN.CN- VAcM v O V N O O O C M r H O O C M C N - O ^ J -CM - * r H C A r H r H C A CM ON CM ON M 0 O CM r H CM V A V N V A O CAVNvO M N O O *AcM N O C O r H CM CO O CO ON 00 O ON 00 r H ON 0 0 CAC^-00 0 0 r H r H O r H O O O r H O O r H O O r H O O O OVO-* t V M O CM O VN.O CM V N C A C M C A C M O r H CM CM r H O O f A O CM O CO r H r H O V A r H CM O r H r H r H r H r H r H r H r H r H O H r H r H r H r H r H r H C ^ - r H C 0 C 0 O C A C ^ - C M O O O C^- CV C A C M C A O ON r H CO O CO O N 0 0 r H O 0 0 ON CO ON CM CO CO C^-O r H O r H O O O r H r H O O O O r H O O O CM MO r H ON V U j - VArHOOVAcMOOO VY4-r H O O O O O O r H r H 0 0 r H O O - * O O O H r l O r l O r t O r l H O H O H r l O H r l O r H O O C A O V A V N , V A O M0 VNC^-OO C A C M N O ONOMO OC^-CO ON O CO CO CO O r H O-00 ON O r H O r H O O O O O O O O O r H O O O O r H C M C A * V A v O O - C 0 ON O r H C M ( A . * VN.NO c^r^c^-c^-c^-c^-c^-CN-c^-c^oooooooooooooo O O O O O O O O O O O O O O O O O 101 OOVAVAVAOOOOOO VT\<T\^\AO VTiO CM O O CM O-MDsO CACMMD J^- CArl CAJ- 03 -3" -d" vO V A V A V A . ^ ^J- vr\^. c^ vO C S - V A V A V A V A V A S O V A O O O VT\0 VAO O VAVAO o » A O o o o V A rl CM SO CM CM VACO CM VA.^ - O O CO O VA OMD SO V A V A C A . ^ - ifr-d- C A V A S O V A . ^ - . ^ - V A V A . ^ - V A V A O O O O C M H V A O C A C A C M o- V A O O V A V A V A V A C M O n j 1 C A r-i O v A c f TH CM H C M NV0 4- rt»A<r\xrt N O O C O O D C ^ H N V A C ^ ^ O c s - r ^ c o H n o ^ t O CM 0 00 OCAO OOOOOCMOrlCArlrl r l r l r l O O r l r l O O O O r l r l O r l r l r l r t VAJ- CM OSO OssO HNO V A C M O O-CO V A V A ^ --d-VACMCMOsOCArlCMCMCMCMO--3-rl.3-.3-tA O-VAsO O-.3 CAVA CM 0 0 SO OO O CM O-OCAVA r-i CM O N 0 0 00 -3-o0 O N O N O N O N 0-3 OO CM r-i O N r l r l O O O r l O O O O O O r l O r l r l r l O -3- 0 0 O CM VACM O CO r-i OsO VAO CA00 ONC>--3 CACM O VTufr O H H H N VA-3 rl -3 -3 r-i r-i r-i r-i r-i r-i ri r-i r-i r-i r-i rl r-i r-i r-i r-i r-i r-i r-i VAO--3 CA3" O CAVA VACM s o CA-3 N N N H V T v H rl O O O O (AO OOOCOOCM OO CM r-i 0 0 r l r l r l O O r l r l O O O O r t r l O r l r l r l O _3 SO OOO V A C S - 4 - 4 - v n O C M S O C M CAOO VA VACACACM r-i VACArl O rl C A CM SO CACM VA-3 CA rH r l r l r l r l r l r l r l r l r l r l r i r l r l r l r l r l r l O O- O 3" CA.3 VAVAOcMOVAcMVAOjH-OOrl O rl O O O O r lOOOOOO-3 OCM CM O rl r l r l r l O O r l O O O O O r l r l O r l r l r l r l Cs-SQ O-C0Os0VAOO-OOOOcMOcM-3O-CM (Ar! rl O VACM rl O O rl rl SO CArl -3 CACM r l H H r l H r l H . H O H H H r l H H H r l H OMM^OOO O O00 VAO O O O VAOO O rl rl O 000 CMOCOOOCOO-OCAOrlCMOrl r l r l r l O O r l O O O O O r l r l O r l r l O r l X CO CM vAr-100 CM OsO-3 O-O rl VAO VAVACAOO rl CO < -3 CM rl O O VACM O O rl CM CM SO CM rl VA-3 CA EH pL, r l r l r l r l r l r l r l r l O W 0C E H OCs-sO O VArivAVAcM CM VACAO VAvAVAri V A E H CO O rl O O O CO rlOO 0-0 000 OCM CO O CM rl rt CO •«< r l r l O O O r l O O O O O O r l O r l Q >i CO CM CM 0 0 O O CAOO NNOOOvOONNHN W < < CM CM O OOCArl O OO rl rl VArl 0-3 CArl O Q ft r l H H O O H H H O H r l d r l r i O 2 5 O E-l CM O VACM O V A c M SO O VAVAVA^ J-O 0 0 VAC^ -VA t-3 CO O rl O O O 0 0 O O 0 - 0 0 0 0 0 OrlOO CO CM 30 rl O •< rl rl O O O rl O O O O O O rl O O rl O ft, CO O CM rH VAsO VAOO-3-3-O CM *AO VAO--3 V A CM rl O O O - (AO CO O OOO VA rl O CM rl O r l H H r l O r l r l O O H H r l H r l O r l r l r i VACM vN-O VAO CM V A V A C A O O vAO-VACAOsO O w O O O O O O - rl O O - C O O- O-00 CM 0 0 O rl 0 0 O P, Q -< Or lOOOr lOOOOOOr lOOr lOrH O • 00 OO rl CM CA-3 VASO O-OO OO rl CM CA-3 VA U O rl rl CM CM CM CM CM CM CM CM CM CM CACACACACACA O 25 O O O O O O O O O O O O O O O O O O E H X CO E-i O O o-25 W 05 w E H 05 CO a . CO rl rl >* E H < o Q <: co < cm E H O o rl > H CO < •< Q PL. E H o -< co a . E H CO o- < CO < -< Q P - . E H O <: < PL, E H -3" -< -< -<  P - . H < rl P H > H E H < O «<  o  APPENDIX B INTERPRETATION OP PHYSIOLOGICAL MECHANISMS UNDERLYING THE SIX METHODS 102, A l l of the f o l l o w i n g methods are assumed to have an e f f e c t on the lengthening of s o f t t i s s u e . However, each method has a unique approach to the problem of i n c r e a s i n g range of motion* Prolonged Stretcht I t i s w e l l known that the myotatic r e f l e x d e c l i n e s over time. . The prolonged p o s i t i o n of s t r e t c h i s thought to introduce fatigue and/or accommodation i n the t o n i c s t r e t c h receptors. In prolonged s t r e t c h , the phasic component of the myotatic response i s . e f f e c t i v e l y eliminated and thus the r e f l e x to contract the stretched muscle i s p o t e n t i a l l y reduced. Relaxation and Prolonged Stretch I t can be reasoned that the a b i l i t y of muscle f i b r e s to lengthen i s dependent upon t h e i r state of r e l a x a t i o n * Mindset techniques as w e l l as progressive r e l a x a t i o n deal with t h i s goal i n terms of tension awareness* I f a relaxed state can be induced i n combination with the prolonged s t r e t c h exercise, the f o l l o w i n g i s expectedt 1• Reduction of the myotatic r e f l e x due to accommodation 2. Voluntary i n h i b i t i o n of the r e f l e x due to te n s i o n aware-ness 103 3* Later onset of the r e f l e x due to gamma bias accomplished by mind-set. Passive PNF The p h y s i o l o g i c a l bases f o r t h i s method i s that the s o f t t i s s u e undergoing passive lengthening w i l l undergo even greater s t r e t c h , p a r t i c u l a r l y a t the tendinous junctions, during the isometric extensor co n t r a c t i o n phase. The max-imal extensor c o n t r a c t i o n also f a c i l i t a t e s the r e l a x a t i o n of the extensors when they cease c o n t r a c t i o n . Active PNF The p h y s i o l o g i c a l bases f o r the Active PNF method appear to bet a) f a c i l i t a t i o n of f l e x o r c o n t r a c t i o n f o l l o w i n g extensor c o n t r a c t i o n (successive induction) b) f a c i l i t a t i o n of extensor r e l a x a t i o n due to i n h i b i t i o n of the s t r e t c h r e f l e x f o l l o w i n g extensor c o n t r a c t i o n c) f a c i l i t a t i o n of extensor r e l a x a t i o n due to the c o n t r i b u t i o n of the tendon r e f l e x (inverse myotatic r e f l e x ) . B a l l i s t i c The r a t i o n a l e f o r " b a l l i s t i c and hold" i s that the "hold" introduces a q u a l i t y of c o n t r o l at the j o i n t l i m i t that may prevent t i s s u e damage which has been a concern with t h i s method. The dynamics of t h i s a c t i v i t y allows i t to contribute to f l e x o r strength and f a s t lengthening a c t i o n of the extensors as i s required f o r sport movements. 104 Passive L i f t and Active Hold This method not only employs the passive lengthening of the extensors, but i s thought to f a c i l i t a t e r e c i p r o c a l i n h i b i t i o n (relaxation) of the extensors by a c t i v e c o n t r a c t -i o n of the f l e x o r s when the hip f l e x o r s ( i l i o p s o a s and rectus femoris) are a c t i v e l y c a l l e d upon i n terms of strength to hold the l e g i n a p o s i t i o n of maximal extension. 105 APPENDIX C INSTRUCTIONAL SHEETS ON THE METHODS NAME. The group that you have been assigned to i n t h i s experiment i s c a l l e d the CONTROL GROUP. B a s i c a l l y t h i s means that you w i l l not be a c t i v e i n terms of e x e r c i s i n g but that you w i l l be a f u l l p a r t i c i p a n t i n terms of a l l measurements to be made. In t h i s sense you w i l l be part of a group that act as a "standard" that w i l l be used as a performance comparison f o r the exercise groups. For t h i s reason, i t i s very important that you not take s p e c i f i c a c t i o n to mobilize or strengthen the r i g h t l e g i n hip f l e x i o n over the next four weeks. I t i s appropriate that you continue with your normal a c t i v i t i e s as usual. As a c o n t r o l group member, you w i l l be required to attend only the measuring sessions ( Days 1. 4, 7» 10, 11). This means that i f we are meeting three times a week with your c l a s s or group, then you w i l l be required on the same day of the week f o r four weeks, and then also on the next c l a s s day r i g h t a f t e r that. NAME The s t r e t c h i n g method that you have been assigned to i s c a l l e d PASSIVE LIFT AND ACTIVE HOLD. Please read the f o l l o w i n g i n s t r u c t i o n s c a r e f u l l y p r i o r to p r a c t i c i n g with your partner. 106. INSTRUCTIONS FOR PASSIVE LIFT. ACTIVE HOLD METHOD 1. While l y i n g on your back, just relax and l e t your partner r a i s e your r i g h t l e g slowly. The l e f t l e g remains on the f l o o r with the knee extended, and i t i s important to keep the r i g h t l e g s t r a i g h t throughout the exercises. Over a s i x second period, the partner w i l l take your l e g to the l i m i t of your pain-free range ( i . e . a p o s i t i o n of s t r e t c h that you can maintain f o r the remainder of the s i x seconds) and w i l l support the l e g i n the p o s i t i o n where you say "stop." 2. A f t e r the s i x second m o b i l i z a t i o n of the l e g , the p a r t -ner w i l l slowly release her support on the l e g and i t i s then up to you to hold the l e g i n the p o s i t i o n where i t i s released. I f the l e g s l i p s back a l i t t l e , t r y very hard to stop i t as soon as you can, A c t i v e l y hold your l e g t h i s way f o r s i x seconds. 3. On the next s i x second i n t e r v a l , the partner w i l l give you support again, and move you slowly to a t l e a s t your o r i g i n a l p o s i t i o n of l i m i t a t i o n . I f i t i s p o s s i b l e to go f u r t h e r than before, l e t your l e g be moved to a new pos-i t i o n before you say "stop." 4 . The procedure i s continued with the passive l i f t and a c t i v e hold phases a l t e r n a t i n g every s i x seconds, a t o t a l of f i v e times i n one minute. A f t e r one minute the subject changes over to a s s i s t the partner i n her s t r e t c h . The exercise w i l l take place i n ten minutes (5 minutes exercise, 5 minutes r e s t ) . ASSISTING PARTNER The partner stands f a c i n g the subject on the p l a t -form that s t a b i l i z e s the subject's l e f t l e g . Taking hold 107 behind the subject's r i g h t ankle, the partner slowly e l e -vates the l e g . The knee can be supported a l s o i f i t i s bending. The l e g i s to be mobilized to the l i m i t of the subject's pain-free range i n the 6 second i n t e r v a l . The partner then releases pressure on the l e g very gradually so that the subject can maintain that p o s i t i o n on her own f o r 6 seconds. The partner then resumes her p o s i t i o n supporting the ankle (and knee i f necessary) and mobilizes the l e g to i t s o r i g i n a l p o s i t i o n ( i f the l e g has slipped back), or to a new range i n the next s i x second i n t e r v a l . A l l movements i n passive s t r e t c h i n g are slow and gentle -since the subject w i l l be working at her end-point most of the time. Remember that your assistance i s prim-a r i l y to maintain the end-point p o s i t i o n of the l e g so that the subject can r e s t there at l e a s t part of the timei mob-i l i z i n g the subject's l e g to a new passive p o s i t i o n w i l l not be p o s s i b l e every time, e s p e c i a l l y as she approaches her maximum range. The whole procedure w i l l take 10 minutes (5 minutes of exercise and 5 minutes of r e s t a l t e r n a t i n g i n one minute i n t e r v a l s ) . I t i s recommended that you go easy on the f i r s t day. NAME The s t r e t c h i n g method that you have been assigned to i s c a l l e d the ACTIVE PNF method (proprioceptive neuro-muscular f a c i l i t a t i o n ) . Please read the f o l l o w i n g i n -s t r u c t i o n s c a r e f u l l y p r i o r to p r a c t i c i n g with your partner. • 10® INSTRUCTIONS FOR ACTIVE PNF METHOD 1, While l y i n g on your back, you w i l l f i r s t be required to slowly l i f t your r i g h t l e g upward, keeping i t s t r a i g h t , d i r e c t l y p u l l i n g i t toward your face as hard as you p o s s i b l y can. The l e f t l e g remains s t a b i l i z e d on the f l o o r during the exercise with the knee extended. You w i l l have s i x seconds, to l i f t the l e g and hold i t i n i t s maximal p o s i t i o n . Your partner w i l l then step i n and support your s t r e t c h i n g l e g f o r the next s i x second phase. 2. Next, you w i l l gradually t r y to push your l e g back down to the f l o o r as hard as you can, and t h i s w i l l be an isometric c o n t r a c t i o n ( i . e . the partner w i l l r e s i s t the down movement) f o r s i x seconds. 3* You now l i f t your l e g again, to a new p o s i t i o n i f p o s s i b l e , or at l e a s t maintain your present p o s i t i o n f o r s i x seconds. 4 . This a l t e r n a t i n g l i f t and isometric push-down are repeated u n t i l one minute i s up ( f i v e times each per minute). Then you can r e s t your l e g and a s s i s t your partner f o r the next 60 seconds. Altogether you w i l l be e x e r c i s i n g f o r f i v e minutes and r e s t i n g f o r f i v e minutes. I t i s recom-mended that you go easy on the f i r s t day. ASSISTING PARTNER The partner i s positioned so that she serves as an immovable object when the subject commences to exer c i s e . She w i l l stand f a c i n g the subject on the platform that s t a b i l i z e s the subject's l e f t l e g . The partner must be prepared to r e s i s t the downward force when the subject i s i n the push-down phase. She does t h i s by b r a c i n g her legs, 109 s l i g h t l y flexed, and supports the back of the ankle with her hands or shoulder. The partner must r e s i s t completely a l l movement downward i n order to make the subject's con-t r a c t i o n isometric. In the s i x second l i f t up phase, the partner does not a s s i s t the subject, but follows the movement and pre-pares f o r the next isometric c o n t r a c t i o n down from the new end-point. There are f i v e r e s i s t i v e down phases i n a one minute period, and the t o t a l exercise w i l l take ten minutes ( f i v e minutes exercise and f i v e minutes r e s t i n g i n a l t e r -nating onemminute i n t e r v a l s ) . NAME The.stretching method that you have been assigned to i s c a l l e d the BALLISTIC AND HOLD method. Please read the f o l l o w i n g i n s t r u c t i o n s c a r e f u l l y p r i o r to p r a c t i c i n g with your partner. INSTRUCTIONS FOR BALLISTIC AND HOLD METHOD 1. While l y i n g on your back, r a i s e your r i g h t l e g d i r e c t -l y forward to approximately a 45 degree angle and use t h i s p o s i t i o n as a s t a r t i n g point f o r the exercise. The exer-c i s e i s c a l l e d " b a l l i s t i c " but a better d e s c r i p t i o n of what we want you to do i s " a c o n t r o l l e d bounce." You can use the momentum of your l e g swing to gain f l e x i b i l i t y i f you swing your l e g i n a c o n t r o l l e d way at and past your o r i g i n a l end-point. You are required to swing the r i g h t l e g upward from the elevated s t a r t i n g p o s i t i o n four times up and down. I t i s recommended that you go easy u n t i l you know where your end-point i s , and then t r y to surpass your l i m i t gradually • 110 with gentle momentum. On the fourth swing, you go up to the end-point and hold the l e g there without bouncing back f o r s i x seconds. Try your best not to l e t the l e g drop from that end-point. 2. A f t e r the l e g hold, the l e g i s moved back to the 45 degree angle once more and you proceed with the four l e g swings upward again. Altogether the b a l l i s t i c swings and the hold are repeated s i x times i n one minute. In t o t a l the exercise w i l l take f i v e minutes, a l t e r n a t i n g with f i v e one minute r e s t i n t e r v a l s . The l e f t l e g i s kept extended and s t a b i l i z e d on the f l o o r while the r i g h t l e g i s kept s t r a i g h t during the a c t -i v i t y . Go as f a r as you with a s t r a i g h t l e g , and take i t easy on the f i r s t day. NAME... The s t r e t c h i n g method that you have been assigned to i s c a l l e d the RELAXATION method. A c t u a l l y you and your partner w i l l follow the same p h y s i c a l i n s t r u c t i o n s as the PROLONGED STRETCH group, but i n addit i o n , there w i l l be some "thinking" processes attached to your method. Please read the f o l l o w i n g i n s t r u c t i o n s c a r e f u l l y p r i o r to p r a c t i c i n g with your partner. INSTRUCTIONS FOR RELAXATION METHOD This method has not been researched and your under-standing of i t i s most important. F i r s t l y , i t involves a "mind-set" or a mental p i c t u r e of the goal you are aiming f o r . Once you can v i s u a l i z e what you want to do, you can 111 b e t t e r i n h i b i t or over-ride r e f l e x e s that are preventing you from achieving t h i s goal. For example, when you st r e t c h a limb past i t s usual (everyday) range, the muscle has a b u i l t i n r e f l e x that says, "Whoa! You are s t r e t c h i n g me f u r t h e r than I u s u a l l y go, so I'm l e t t i n g you know." This i s c a l l e d the myotatic r e f l e x . In e f f e c t , the muscle being stretched w i l l a c t u a l l y contract or t i g h t e n when normal range i s exceeded! You are then t r y i n g to s t r e t c h a contracted muscle and the tightness and p a i n are due to the f a c t that you have reached the physio-l o g i c a l l i m i t of s t r e t c h . I f you could " i n h i b i t " or over-r i d e t h i s myotatic r e f l e x , you could move your limb much fu r t h e r . To do t h i s , you f i r s t need a mental p i c t u r e of where you want to be, and then you need to concentrate very hard on t h i s p i c t u r e when you s t r e t c h . You are concentrating on r e l a x i n g the stretched muscle and the more you r e l a x , the l e s s p a i n you w i l l f e e l because the muscle w i l l stop con-t r a c t i n g . This i s of course what i s done i n some yoga nethods minus the s c i e n t i f i c jargon. I t must be appreciated that i n hip f l e x i o n there i s no anatomical reason why you cannot be "very f l e x i b l e , " In f a c t , i n a c t i v i t y i s the prime reason f o r lack of f l e x i b i l i t y . Make sure that you do not allow your partner to s t r e t c h you so much that you are r e a l l y uncomfortable. You cannot p o s s i b l y "relax" i f t h i s occurs. Instead, have your p a r t -ner stop j u s t as you f e e l a tightness behind the l e g and then "concentrate" on r e l a x i n g the muscle being stretched. As you relax, tightness w i l l subside and you can have the partner increase the s t r e t c h . Remember t h i s method c a l l s f o r more "mental e f f o r t " than p h y s i c a l , and you must CONCENTRATE on your desired goal and on RELAXING the stretched muscle. 112 NAME .. The s t r e t c h i n g method that you have been assigned to i s c a l l e d the PASSIVE PNF method ( prop r i o c e p t i v e neuro-muscular f a c i l i t a t i o n ) . Please read the f o l l o w i n g i n s t r u c -t i o n s c a r e f u l l y p r i o r to p r a c t i c i n g with your partner. INSTRUCTIONS FOR PASSIVE PNF METHOD 1. While l y i n g on your back, just r e l a x your r i g h t l e g and l e t your partner r a i s e i t slowly. The l e f t l e g remains s t a b i l i z e d on the f l o o r with the knee extended and the r i g h t l e g must remain s t r a i g h t throughout the exerc i s e . Over a s i x second period, the partner w i l l take your l e g to the l i m i t of your pain-free range ( i . e . a p o s i t i o n which you can t o l e r a t e f o r several seconds) and w i l l support the l e g i n the p o s i t i o n where you say "stop." 2. When the s i x seconds are up the partner w i l l say "push" and you w i l l then gradually t r y to push your l e g back down to the f l o o r as hard as you can against your partner's r e s i s t a n c e . This i s a s i x second e f f o r t and should be a maximal isometric c o n t r a c t i o n ( as hard as you can with no movement occ u r r i n g ) . 3. You can r e l a x your r i g h t l e g on the next s i x seconds, so that the partner can gently take your l e g i n t o the s t r e t c h again. At the l i m i t of your pain-free range you again say "stop" and l e t her hold your l e g at that p o s i t i o n , keeping the l e g s t r a i g h t . You may f i n d that f o l l o w i n g each i s o -metric push down that you can be p a s s i v e l y moved to a s l i g h t l y greater range each time ( f i v e s tretches, f i v e push downs i n one minute). You w i l l be a c t i v e f o r f i v e minutes altogether with f i v e minutes of r e s t i n t e r v a l s . -Take i t easy on your f i r s t day. 113 ASSISTING PARTNER The partner i s positioned f a c i n g the subject so that she serves as an immovable object when the subject commences to exercise. She w i l l be standing on the platform that s t a b i l i z e s the subject's l e f t l e g . Taking hold behind the subject's r i g h t ankle, the partner slowly elevates the l e g d i r e c t l y upward through the subject's pain-free range. At the l i m i t , the subject says "stop" and the partner holds the l e g i n t h i s maximal p o s i t i o n keeping the l e g s t r a i g h t i f necessary by holding above the knee with one hand and behind the ankle with the other. A f t e r the s i x second period a l l o t t e d to the above movement, the partner prepares to r e s i s t the downward l e g push of the subject. In order to stop a l l movement down-ward and make the contraction an isometric one, the partner braces her legs s l i g h t l y f l e x e d while supporting the ankle with her hands or shoulder. The partner must take care that the subject's l e g i s mobilized i n d i r e c t l i n e with the body, and at no time should there be t w i s t i n g of the h i p s . NAME The s t r e t c h i n g method that you have been assigned to i s c a l l e d the PROLONGED STRETCH method. Please read the f o l l o w i n g i n s t r u c t i o n s c a r e f u l l y p r i o r to p r a c t i c i n g with your partner. INSTRUCTIONS FOR PROLONGED STRETCH METHOD 1. While l y i n g on your back, just r e l a x and l e t your partner r a i s e your r i g h t l e g slowly. The l e f t l e g remains s t a b i l i z e d on the f l o o r with the knee extended, and i t i s 114 important to keep the r i g h t l e g s t r a i g h t throughout the exercise. The partner w i l l take your l e g to the l i m i t of your pain-free range ( i . e . a p o s i t i o n of s t r e t c h that you can maintain f o r a minute) ans w i l l support the l e g i n the p o s i t i o n where you say "stop." I f you have mis-judged the p o s i t i o n and experience discomfort, you can ask your partner to ease o f f a l i t t l e u n t i l you are i n a more comfortable p o s i t i o n . 2. The s t r e t c h p o s i t i o n i s held by your partner ( p a s s i v e l y on your part) f o r one minute. A f t e r the minute, you change over with your partner and mobilize her r i g h t l e g i n the same way. Altogether you w i l l be e x e r c i s i n g f i v e minutes and r e s t i n g f i v e minutes. ASSISTING PARTNER The partner stands f a c i n g the subject on the p l a t -form that s t a b i l i z e s the subject's l e f t l e g . Taking hold behind the subject's r i g h t ankle, the partner slowly elevates the l e g to the l i m i t of the subject's pain-free mage. The partner holds the r i g h t l e g i n i t s maximal p o s i t i o n , keeping i t s t r a i g h t i f necessary by holding above the knee and behind the ankle f o r the minute p e r i o d . The subject then lowers the l e g . Take care to insure that the l e g i s mobilized i n d i r e c t l i n e with the body. I t i s recommended that a l l subjects go easy on the f i r s t day. 

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