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A comparison of six methods of stretch on the passive range of hip flexion Russell, Keith Wayne 1977

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A COMPARISON OF SIX METHODS OF STRETCH ON THE PASSIVE RANGE OF HIP FLEXION by KEITH WAYNE RUSSELL B.P.E., University of B r i t i s h Columbia, 1973 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PHYSICAL EDUCATION i n the School °f Physical Education and Recreation We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA MAY, 1977 (c) Keith Wayne Russell 1977 i In presenting th i s thesis in pa r t i a l fu l f i lment of the requirements for an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree l y ava i l ab le for reference and study. I fur ther agree that permission for extensive copying of th i s thes is for scho lar ly purposes may be granted by the Head of my Department or by his representat ives. It is understood that copying or pub l i ca t ion of th is thesis for f i nanc ia l gain sha l l not be allowed without my writ ten permission. Department of Physical Education The Univers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date May 4 , 1977 i i ABSTRACT A t h e o r e t i c a l model s t a t i n g that one must decrease r e s i s t a n c e i n a t a r g e t area (area to he stretched) or increase the a b i l i t y to overcome that r e s i s t a n c e (strength) i n order to p o s i t i v e l y a l t e r range of j o i n t movement was designed and an experiment set up to begin t e s t i n g t h i s model. I t was discussed that there are two d i s t i n c t ranges of j o i n t move-ments PASSIVE being that range a t t a i n e d w i t h the a i d of some ex t e r n a l f o r c e (a partner or g r a v i t y ) and ACTIVE being t h a t range a t t a i n e d by vol u n t a r y muscle c o n t r a c t i o n . I t was a l s o discussed that most methods o f s t r e t c h i n g could l i k e w i s e be c l a s s i f i e d as e i t h e r ACTIVE METHODS or PASSIVE METHODS. I t was the purpose of t h i s study to research the e f f e c t s of s i x methods of s t r e t c h on the passive range of r i g h t h i p f l e x i o n of 1 19 v o l u n t e e r c o l l e g e women. Approximately 20 s u b j e c t s were randomly assigned to each one of seven t r e a t -ment groups. A l l subjects were measured before treatments were i n i t i a t e d and a f t e r treatments had ceased at the end of the study. S i x of the groups were each assigned to a s t r e t c h i n g regimen which was p r a c t i c e d i n a l a b ten minutes a day, three days a week f o r three weeks. A l l s u b j e c t s , i n c l u d i n g the c o n t r o l group, were tes t e d pre and post treatment on the f i r s t day of each week. The methods th a t were tes t e d were d i v i d e d i n t o j a c t i v e methods i n which the subject a c t i v e l y m o b i l i z e d t h e i r i i i l e g ( A c t i v e P.N.F. and Spring S t r e t c h ) ; passive methods i n which the partner mobilized the subjects l e g ( R e l a x a t i o n , Passive P.N.F. and Prolonged S t r e t c h ) ; and a combination method i n which the partner m o b i l i z e d the subjects l e g and then the subject a c t i v e l y t r i e d to maintain the range a t t a i n e d (Passive L i f t - A c t i v e Hold). A l l treatment groups showed a s i g n i f i c a n t increase i n t h e i r range of h i p f l e x i o n though the mean increase of the treatment groups was s i g n i f i c a n t l y g r eater than the mean increase of the c o n t r o l group. The three passive methods (R e l a x a t i o n , Passive P.N.F. and Prolonged S t r e t c h ) and the combination method (Passive L i f t - A c t i v e Hold) were a l l e q u a l l y e f f e c t i v e i n i n c r e a s i n g passive range (only 1.3° between highest and lo w e s t ) . The mean g a i n of the three passive methods was s i g n i f i c a n t l y g r e a t e r than the mean g a i n of the two a c t i v e methods. i v TABLE OF CONTENTS Page Ab s t r a c t 1 1 Table of Contents i v L i s t of Tables v L i s t of Figures v i L i s t of P l a t e s V 1 1 Preface v i i i Acknowledgements l x CHAPTER I INTRODUCTION TO THE PROBLEM 1 I I REVIEW OF RELATED LITERATURE 1 2 I I I METHODS AND PROCEDURES 3 5 General Procedures 3 5 S p e c i f i c Procedures f o r each treatment . group Experimental Design S t a t i s t i c a l Treatment ^ 2 IV RESULTS AND DISCUSSION i + 6 V SUMMARY AND CONCLUSIONS 57 APPENDIX A. I n d i v i d u a l Raw Scores ? 3 B. I n t e r p r e t a t i o n o f the P h y s i o l o g i c a l q Mechanisms i n the S i x Methods C. I n s t r u c t i o n a l Sheets ^3 V LIST OF TABLES Page 1. C o e f f i c i e n t s f o r the 6 Pre-Planned Orthogonal Contrasts ^ 5 2. Means f o r Treatment Groups at each T e s t i n g Session 4-6 3. ANOVA Table f o r Helmert Contrast: C o n t r o l versus Experimental 4-8 4. Means f o r Ranges a t t a i n e d on Pre-Exercise Measurements f o r the Co n t r o l Group Versus the 6 Experimental Groups ^ 9 5 . Means and M u l t i v a r i a t e F f o r A c t i v e Versus Passive Methods 50 6 . Mean increases i n range on Te s t i n g Days and Between T e s t i n g Days f o r a l l Groups 5 2 7. Pre-Experiment (Day 1) and Post Experiment (Day 11) D i f f e r e n c e s 53 v i LIST OF FIGURES Page 1 . Schematic Representation of T h e o r e t i c a l Model of Improving F l e x i b i l i t y 6 2. E x e r c i s e Sequence f o r a l l p a i r s of Subjects ^0 3. Schematic Diagram of Experimental Design 44 4 . Pre-Planned orthogonal Contrasts used to t e s t Hypotheses 4 5 5 . Graph of Means f o r Treatment Factor at each Testing Session 4 7 6 . Graph of Means f o r Ranges a t t a i n e d on Pre Ex e r c i s e measurements f o r the C o n t r o l Group Versus the 6 Experimental Groups ^ 9 ?. Graph of Trends of Improvement 51 v i i LIST OF PLATES Page 1 and 2. E x e r c i s e Session i n Progress 37 3. E x e r c i s e Session Showing Clock and 38 Metronome 4-. Demonstration of Flexometer Placement ^8 PREFACE This study represents one half of a larger dual study conducted by Keith W. Russell and Sandra J. Hartley. These experimenters pooled t h e i r subjects and aided each other i n data c o l l e c t i o n . They also shared a common com-mittee and experimental design, but each drew d i f f e r e n t data from the experiment and each wrote a separate thesis. ACKNOWLEDGEMENTS A very special thank-you i s extended to Sandra Hartley who, i n the d i f f i c u l t position of co-researcher, proved that the pooling of e f f o r t s and knowledge can indeed be b e n i f i c i a l and rewarding. CHAPTER I STATEMENT OF THE PROBLEM I n t r o d u c t i o n F l e x i b i l i t y i s an area of study that r e c e i v e s l i t t l e a t t e n t i o n c o n s i d e r i n g i t s importance. I t has been described by Johnson et al.(1975) as one of the four q u a l i t i e s b a s i c to p h y s i c a l f i t n e s s (along w i t h c i r c u l o - r e s p i r a t o r y c a p a c i t y , muscular endurance and s t r e n g t h ) . I t s importance i s a l s o a l -luded to by other authors such as de V r i e s (197^ : ^ 3 2 ) who po i n t s out that " . . . g r a c e f u l movement i n walki n g and running are u n l i k e l y without i t . " Davis, Logan and Mckinney ( I 9 6 5 ) p o s t u l a t e that i n j u r y prevention would ensue development of optimum ranges of f l e x i b i l i t y , while other authors such as Cureton and Morehouse are c r e d i t e d by de V r i e s ( 1 9 7 ^ ) as being proponents of the importance, of f l e x i b i l i t y i n general f i t n e s s . Lack of adequate f l e x i b i l i t y , i s a concern of some researchers i n that i t can often presage medical problems such as lower back pain (Kraus and H i r c h l a n d , 195^? Johnson et a l . , 1 9 6 6 ) . Kraus and Raab ( I 9 6 I ) c r e d i t poor f l e x i b i l i t y as being d i r e c t l y r e l a t e d to the general t e n s i o n syndrome ( r e s i d u a l neuromuscular tension) and again to lower back pain. On t h i s subject of medical problems, de V r i e s (1974S432) s t a t e s : . . .maintenance of good j o i n t m o b i l i t y prevents or to a l a r g e extent r e l i e v e s the aches and pains t h a t grow more common w i t h i n c r e a s i n g age. 2 and that " . . . stretching aids i n r e l i e f of acute muscular dis t r e s s i n athletes." I t i s on thi s subject of f l e x i b i l i t y for athletes that t h i s study i s directed. That i s , f l e x i b i l i t y as i t pertains to athletes and sport and most p a r t i c u l a l y the sport of gym-nastics, i n which good f l e x i b i l i t y i s c l e a r l y one of the most important physical a t t r i b u t e s necessary/ f o r success. I t now appears, mainly through Leighton's studies ( i 9 6 0 ) , that each sport demonstrates p a r t i c u l a r movement patterns that manifest themselves i n p a r t i c u l a r f l e x i b i l i t y patterns unique to that sport and that: . . . i t may not be possible to develop s k i l l s to a high degree without l a y i n g the groundwork of a proper f l e x i b i l i t y .pattern f o r the s k i l l . (Leighton, i 9 6 0 : 7 0 ) Thus i t appears that f l e x i b i l i t y can, indeed, help the athlete achieve greater success. Below i s a l i s t of some of the advantages an athlete can expect to enjoy, by posses-sing optimal f l e x i b i l i t y : 1. The p o s s i b i l i t y of mastering s k i l l s that are dependent on a certain range of -Qoint movement, (walkovers i n gymnastics). 2. Less resistance to movement, thus greater move-ment e f f i c i e n c y . 3. Prevention of soft tissue damage due to lim i t e d range of movement. 4. Increased amplitude thus enhancement of aesthetic impression and perceived ease of movement. 5. Mechanical advantages: a. Greater range over which to apply force, (shoulder hyperextension i n v o l l e y b a l l spike). b. Placing the body i n a position such as to f a c i l i t a t e a p p l i c a t i o n of forces, (wrist and hip f l e x i b i l i t y needed fo r straight arm press to handstand i n gymnastics). The advantages enjoyed by f l e x i b l e athletes are numerous yet r e l a t i v e l y few studies have been conducted i n the area and those completed have been intermittent and, i n most cases, unrelated to each other. Even the terms of reference for the area are not yet c l e a r l y established. The term f l e x -i b i l i t y i t s e l f , for example, implies only f l e x i o n (Holland, 1968), and i t has only been through common usage that t h i s term has come to be associated with maximum range of j o i n t movement. The terms "amplitude", "range", and " j o i n t .excursion are a l l used rather interchangeably. As Holland ( 1 9 6 8 : 5 8 ) . stated:and Clarke (1975»"!)•* Reiterated: There appears to be l i t t l e agreement with regards to the d e f i n i t i o n and l i m i t s of so c a l l e d normal f l e x i b i l i t y , and what contstitutes hypo-or hyper- f l e x i b l e j o i n t range of motion. This lack of uniformity^and--established -,te:rms >ofv. reference i s also apparent with respect to the methods by which j o i n t range can be increased. There i s no unanimity as to which methods are best, and l i t t l e research has been conducted on the e f f e c t s of various methods. L i t t l e i s known about the minimum requirement f o r producing gains on f l e x i b i l i t y . (Johnson et a l . , 1 9 7 5 * 1 0 2 ) The question of which methods are most advanta-geous f o r improving range of motion has received very-l i t t l e attention, (de Vries,197^:^36) Most researchers have compared one method against another. No where i n the l i t e r a t u r e i s there a comprehensive comparison of four or more methods. Methods such as s t a t i c .: stretch and spring stretch ( b a l l i s t i c ) have been compared by-Weber and Kraus (19^9). Logan and Egstrom (196l) and de Vries S (1962). The consensus of opinions i s that both methods are equally e f f e c t i v e but that the spring stretch methods are more l i k e l y to cause soft tissue injury. Since dancers u t i l i z e "controlled spring stretching" continuously and are generally considered to be the epitome of f l e x i b l e performers, it«is desirable to study these two methods s t i l l further. Incorporated i n many of the prolonged stretching methods i s an element of mental and/or physical relaxation. Williams (1968) compared s t a t i c stretch with a relaxation method and found the s t a t i c stretch method increased range s i g n i f i c a n t l y over the relaxation method. The stretching periods, however, were only 10 seconds i n length and Bates (1971) found that 10 seconds was not s u f f i c i e n t stretching time to e l i c i t a s i g n i f i c a n t change i n range of movement. Also, Rathbone (1959) suggested improving f l e x i b i l i t y using relaxation techniques and Bates (197*0 suggested using "cybernetic or mind-set" techniques to enhance f l e x i b i l i t y . Neither of these authors advanced any experimental data to back up t h e i r claims and thus i t appears desirable to inves-tigate t h i s area further. 5 E.N.F. ( p r o p r i o c e p t i v e neuromuscular f a c i l i t a t i o n ) techniques f o r i n c r e a s i n g ranges of j o i n t movement are now widely used i n r e h a b i l i t a t i o n medicine and i n s p o r t . Tanigawa (1972) and H o l t et a l . (1970) have researched these methods, but t h e i r s t r e t c h i n g techniques d i f f e r e d and they d i d not compare a P.N.F. method w i t h many other methods. Again, i t i s d e s i r a b l e to i n v e s t i g a t e t h i s area i n more d e t a i l . F i n a l l y , a method that i s f a i r l y commonly used i n the sport of gymnastics i s the passive l i f t - a c t i v e hold method, which has not yet been experimentally compared to other methods. I t was t h e r e f o r e the i n t e n t of t h i s study to compare these v a r i o u s methods and to advance standardized terminology (see d e f i n i t i o n s ) . In a d d i t i o n , the l a c k of a t h e o r e t i c a l model i n the area of f l e x i b i l i t y i s recognized and one i s developed. That model i s described below: To increase the amplitude of a j o i n t , one of two events must occur. F i r s t l y , the r e s i s t a n c e to the; movement must be decreased and/or secondly, the f o r c e (strength) required to overcome the r e s i s t a n c e must be increased. These w i l l be termed the MECHANICAL OBJECTIVES. In order to a t t a i n these mechanical o b j e c t i v e s , c e r t a i n PHYSIOLOGICAL CONDITIONS, such as elongating the connective t i s s u e or l o a d i n g the muscle must be met. These p h y s i o l o g i c a l c o n d i t i o n s , i n t u r n , are met by u t i l i z i n g c e r t a i n COURSES OF ACTION or c e r t a i n p h y s i c a l or psyche-logical techniques. Figure 1 s c h e m a t i c a l l y i l l u s t r a t e s the model. 6 MECHANICAL OBJECTIVES PHYSIOLOGICAL CONDITIONS COURSES OF ACTION PHYSICAL PSYCHOLOGICAL R D E I E S N C I A R S T R E T A E A A R A v S N G E C E E T ELONGATE CONNECTIVE TISSUE a) Prolonged s t r e t c h b) Contract t a r g e t area while under s t r e t c h . a) Mind-set: l e a r n to set muscle spindle a t longer s t a r t i n g l e n g t h (gamma bias) RELAX CONTRACTILE TISSUE^., a) R e c i p r o c a l I n h i b i t i o n b) Accomodation cj Post C o n t r a c t i o n Depression -a) I n h i b i t i o n by Mon-i t o r e d feedback, (biofeedback) b) R e l a x a t i o n Training (autogenic, progre;-. s s i v e r e l a x a t i o n ) I I S, N N T I c R o R E P A E N P ":R A G 0 E S T s ; ; A E H. I- ,.' N .' G . •' MUSCLE' LOADING a) Isometric b) Concentric c) E c c e n t r i c a) M o t i v a t i o n FACILITATION TECHNIQUES a) Co-contraction (successive i n d u c t i o n a) Learning (recruitment, synchronization) Figure 1. Schematic Representation of T h e o r e t i c a l Model. 7 The Problem The purpose of t h i s study i s to compare the ef f e c t s of s i x methods of stretching on reducing the resistance to passive hip f l e x i o n and thus begin t e s t i n g the aforementioned t h e o r e t i c a l model. Sub Problem 1 To determine i f any one of the experimental methods exceeds the others i n increasing passive range. Sub Problem 2 To determine i f passive methods increase passive range better than active methods. D e f i n i t i o n s F l e x i b i l i t y . A broad descriptive term which refers to that physical component describing the ease and the extent of movement i n a given j o i n t . Amplitude. A s p e c i f i c term meaning the t o t a l angular displacement of a body segment around a given j o i n t . For example: maximum extension tomaximum f l e x i o n of the leg. Range. The maximum angular displacement of a body segment i n one d i r e c t i o n only. For example: range of hip f l e x i o n , range of arm extension. This term must be further q u a l i f i e d into active range and passive range. (1) Active Range i s that range achieved by voluntary muscle contraction. I f the contraction i s very strong and r e s u l t s in the limb being quickly propelled to an end point, then the range i s termed fast or dynamic active  range. (Momentum i s a contributing f a c t o r ) . I f the contraction i s slow and held at the end point, then the range i s termed slow or s t a t i c active range. These two terms can be l o g i c a l l y shortened to simply s t a t i c and dynami c rang es. (2) Passive Range i s that range achieved by u t i l i z i n g some external force such as gravity or a partner's assistance. This range represents the maximum l i m i t s of a j o i n t . Passive Stretching Methods. Those methods in which a partner applies a force to the limb. 9 Active Strething Methods. Those methods i n which the limb i s mobilized by i t s own muscle contractions. The Hypotheses 1. Passive stretching methods re s u l t i n a greater improvement i n passive range than do active methods. Rationale; The limb i s mobilized through a f a r greater range with passive methods. 2. The "relaxation" method res u l t s i n a greater improvement i n passive range than do other passive methods. Rationale? There should be an optimum increase not only i n soft tissue e x t e n s i b i l i t y due to stretch, but also i n muscle e x t e n s i b i l i t y due to decreased r e f l e x i v e muscle contraction. Delimitations 1. The study was conducted over a four week period using 119 female physical education students from the University of B r i t i s h Columbia. 2. Only the r i g h t hip was exercised and tested f o r hip f l e x i o n . 3. Only the eff e c t s of the exercise on the passive range was studied. For the ef f e c t s on active' range see Hartley (19?6). Limitations 1. No attempt was made to regulate a c t i v i t i e s outv side the study other than to ask subjects not to purposely stretch the hip extensors during the course of the experiment. Subjects exercised under the supervision of the 10 experimenter but were mobilized by a partner. There was some v a r i a b i l i t y i n the s k i l l displayed by these partners. 3. Extremely f l e x i b l e subjects were not eliminated from the study yet they had very l i t t l e p o tential for improve-ment . 4 . Subjects were taken from physical education act-i v i t y classes and i t could be expected that some of t h e i r increase i n range of movement was due to these classes. Significance of the Study A thorough review of the l i t e r a t u r e indicates that there i s a need to c l a r i f y the differences among stretching methods i n t h e i r e f f e c t on active and passive ranges. Indeed, no study to date has distinguished between these two ranges i n t h e i r measurements. Also, to date there has not been a study u t i l i z i n g or comparing more than three methods of stretching. Many studies are vague i n terms of equalizing the time spent actually stretching by each method and the time r e s t i n g . A l l exercise and re s t time are equated i n t h i s study. This i s one of the few studies that has not introduced experimenter bias by having the experimenter manually manipulate subjects in either the exercise or the testing sessions. Most studies i n the past have s t a b i l i z e d the leg and achieved hip f l e x i o n by rotating the hip around the head of the femur (thus using abdominal contractions to bend forward, as in the s i t and reach tests and the standing toe touch tests (Wells and D i l l o n , 1 9 5 2 ? Fieldman, 1 9 6 8 ) . In thi s study hip f l e x i o n was tested by rotating the leg i n the acetabulum and thus requiring the use of the rectus femoris and il i o p s o a s muscles. It i s hoped that t h i s study, by comparing a l l of the most commonly used stretching methods, w i l l give both the therapist and the physical educator more information by which to select t h e i r exercise battery. CHAPTER II REVIEW OF RELATED LITERATURE This chapter w i l l be organized under the following headingsi FLEXIBILITY DEFINED TISSUE RESPONSES TO STRETCH METHODS - OF INCREASING FLEXIBILITY METHODS OF MEASURING FLEXIBILITY RELATIONSHIP OF FLEXIBILITY TO OTHER FACTORS-FLEXIBILITY DEFINED Sigerseth (1965«88) reports that the term f l e x i b i l i t y is derived from the Latin " b i l i s " meaning capability and "flectere" meaning to bend. This origin is reflected in the typical dictionary definition which invariably describes f l e x i b i l i t y as ease of flexion or ease of bending. Despite this dictionary definition and the original meaning of the word, authors persist in refering to f l e x i b i l i t y as the range of joint movement. (Holt, 1971J de Vries, 197 ;^ Johnson et a l , 197*H Clarke, 1975) . Leighton (196o»27) gave a more expanded definition than is usualt The potential and existing ranges of such movement have come to be called " f l e x i b i l i t y " of the body and i t s various parts. ..Common practice has established the use of the term with reference to range of movement only, although by i t s nature the term might apply to many other factors of movement such as muscle v i s c o s i t y . Holland (1968:4-9) further c r i t i c i z e s the common usage of the term f l e x i b i l i t y : . . . i t should be noted that the term f l e x i b i l i t y implies just f l e x i o n and therefore should be considered a misnomer and replaced with a more appropriate designation. He did not, however, suggest a more appropriate term. Since f l e x i b i l i t y or range of j o i n t movement i s generally agreed to be a highly j o i n t - s p e c i f i c factor (Hupperich and Sigerseth, 1950» Leighton, I 9 6 0 ; Harris, 1 9 6 9 ) and since there i s even l i t t l e r e l a t i o n s h i p between f l e x i o n and extension of the same j o i n t (Dickinson, I 9 6 8 ) i t appears pointless to continue defining f l e x i b i l i t y as "the range of jo i n t movement". Fleishman ( 1 9 6 1 ) found through factor analytic studies that there were two factors involved i n so-called f l e x i b i l i t y . One, "extent f l e x i b i l i t y ^ , was the a b i l i t y to extend or stretch a body part as f a r as possible i n various d i r e c t i o n s (referred to in the study as range). The other factor was referred to as "dynamic f l e x i b i l i t y 1 and was to do with the a b i l i t y to perform repeated movements (ease of movement). The term " f l e x i b i l i t y " i s perhaps best thought of as the a b i l i t y or ease i n f l e x i n g or extending and i s synonymous with the term suppleness. The actual t o t a l angular displacement of a joi n t i s best referred to as "amplitude" ( G l a n v i l l e and Kreezer, 1 9 3 7 ) while the actual angular displacement in a given d i r e c t i o n i s suggested by the present study to best be referred to as "range", for example, range of hip flexion or range of shoulder abduction .(see definitions) Finally, i f we define f l e x i b i l i t y as a general term and range as the actual angular displacement in a given direction, then we must consider range as being either actively or passively attained. (Barnett, Davies, 1962). That i s , active range is the range attained with voluntary muscle contraction and passive range is the range attained with the aid of some external force. TISSUE RESPONSES TO STRETCH I f f l e x i b i l i t y is to be enhanced, that i s , the range of movement in some joint increased, then changes must take place in the soft tissue surrounding that joint. The typical synovial joint consists of two, cartilage covered bone ends which are surrounded by a fibrous capsule and anchored together by various ligaments. Passing over the joint and attaching at close proximity to i t are tendons of various muscles. The interior aspect of"the joint (inside the capsule) contains a fl u i d that is secreted by the synovial membrane which lines the capsule. The amplitude of movement exhibited by a given joint is ". . . determined by the geometry of the bone surfaces and the constraints on bone movement imposed by the fibrous capsule, the ligaments and the muscle-tendon connections" (Boudreau and Tsuchitani, 19?3»123). A look at each of these tissue's response to stretch w i l l follow these few definitions. "Any physical deformation of matter caused by any kind of load acting on i t . " is how Frost (1973»^0) describes the term "strain". He goes on to discuss the term "mechanical stress" as being "the resistance of the intermolecular bonds in a substance to physical deformation by externally applied forces (Frost 1973*3 )^• These two terms "mechanical stress" and "strain" are important in accurately describing the response of various tissues to stretch. Mechanical stress, then, is the tissues' resistance to different strains, be theyt a) tension strain which i s elongation or stretch, b) compression strain which is shortening or squashing or, c) shear strain which is a cutting or tearing strain. This paper deals only with tension strain. E l a s t i c i t y and plasticity (Wright and Johns, 1959} Remington, 1957) are terms used for tension strain at a cellular level. The former refers to the a b i l i t y of fibers to be elongated and then to return to their original length. The latter refers to the a b i l i t y of fibers to be elongated but not to return to original length. 1. FIBROUS CONNECTIVE TISSUEi The joint capsule, ligaments, tendons and the investing sheaths of muscle fibers (endomysium, perimysium, epi m ysium) are a l l basically com-posed of the same material with similar basic functions and mechanical as well as biological properties (Frost, 1973)• This material, fibrous connective tissue, consists of elastin fibers, r e t i c u l i n fibers and collagen fibers with the most abundant being the fibrous, c r y s t a l l i n e protein, collagen. I t i s collagen which supplies the "strength and r i g i d i t y in tension . . ." (Frost, 1973*238)• That i s , collagen has great capacity to maintain i t s o r i g i n a l dimension under tension s t r a i n . The following are three properties of collagen f i b e r s as outlined by Frost (1972): a. Great strength to tension loads aligned p a r a l l e l to the long axis of the f i b e r . b. A b i l i t y to a l i g n i n d i v i d u a l f i b e r bundles p a r a l l e l with tension loads and thus produce (1) thread-like or rope l i k e structures (tendons, ligaments), (2) f a b r i c - l i k e structures (interosseous membrane, f a s c i a l sheaths, etc. c. A b i l i t y to adapt and match t h e i r size (thus t h e i r strength) with tension loads they c h a r a c t e r i s t i c a l l y carry. In addition to the above, l i v i n g fibrous connective tissue also displays the following properties: (Smith, 195^-; Frost, 1973) • a. Ligament and tendon can be temporarily stretched and return to t h e i r o r i g i n a l length {20% stretch i n the case of ligament and 10% stretch i n the case of tendon. (Frost, 1973 s 2kl) . b. Stretch hypertrophy i s a property of tendon and ligament whereby regular, intermittent stretch causes collagen tissue to hypertrophy, u n t i l the r e s u l t i n g increase in strength eliminates elongation at that tension. c. Stretch-creep i s a property of tendon and ligament whereby constant gentle tension results i n non-elastic yet non 17 weakening elongation. From the preceeding i t can be seen that the fibrous connective tissue responds to tension s t r a i n (stretch) f i r s t by elongating s l i g h t l y , then by exhibiting a slow adaptation (over time) to the force being applied (creep) r e s u l t i n g i n a permanent elongation. 2. MUSCLE TISSUE: Muscle can. be elongated up to double i t s r e s t i n g length and return to normal without any apparent damaging e f f e c t s . I t i s , therefore, an e l a s t i c tissue closely resembling rubber. (Remington, 1957)• Besides being able to temporarily stretch, i t also has the a b i l i t y to permanently increase length as evidenced i n normal growth. As the bones grow, so must the muscle and this i s accomplished by adding new sarcomeres s e r i a l l y to the ends of existing myofibrils (Goldspink, 1972) . This s e r i a l addition of sarcomeres has also been shown to occur in muscles that have been immobilized i n an elongated position for several weeks (Tabary et a l . , 1972). Conversely, a reduction in the number of sarcomeres has been shown in muscles that have been immobilized i n a shortened position, (Williams and Goldspink, 1971? Tabary et a l . , 1972). I t appears then, that increased range can be attributed to both fibrous connective tissue elongation (creep) and muscle elongation ( s e r i a l addition of sarcomeres). These physiolog-i c a l responses to stretch have been considered, however, i n absence of any reference to the nervous system. The following section w i l l therefore deal with the innervation of the afore-18 mentioned tissues and the physiological responses to stretch which result. 3. NEUROMUSCULAR RESPONSES TO STRETCH» There are two main considerations when studying the neuromuscular response to stretchi a. the response of the muscle spindle to stretch and b. the influence of the spindle prior to stretch. A brief description of the structure and mechanisms of the neuromuscular spindle w i l l f i r s t be reported. Imbedded in skeletal muscle (extrafusal fibers) are the neuromuscular spindles which are fluid f i l l e d capsules, (2 x 20 m.m.) enclosing 2 to 10 specialized muscle fibers called intrafusal fibers (Ganong, 1973)• These intrafusal fibers are contractile at their poles but not contractile in the center portion where there are many nuclei. There are two kinds of afferent innervation leaving these spindlest the primary afferent (la) neurons originate in "annulospiral endings" in the central nuclear regions and the secondary afferents (II)) originate in "flower-spray endings" in the polar con-trac t i l e regions (Olkowski and Manocha, 1972). When the muscle in which the spindle is embedded is stretched, likewise the spindle is stretched thus e l i c i t i n g a discharge from the annulospiral and flower-spray receptors and sending impulses along the l a and II neurons. While primary afferents signal both rate of stretch (phasic or dynamic) and length of stretch (tonic or static), the secondary afferents signal only tonic stretch (Ganong, .1973) • <> In addition to the above mentioned afferent fibers, 19 there are 7-25 efferent neurons innervating; each intrafusal spindle.For the most part, these are gamma motor neurons and they evoke contraction of the polar ends of the intrafusal fibers, which in turn causes stretch of the nuclear area and the resultant excitation of the stretch receptors in that area (Matthews, 196*H Polak, 1970). Returning to the main consideration, that of neuro-muscular response to stretch, let us consider a. the response of the spindle to stretch. As a skeletal muscle is lengthened, the spindles signal this lengthening by f i r i n g phasically or tonically or both. The impulses are carried via the afferent neurons to the spinal cord where they excite motor neurons of the extrafusal fibers of the same muscle. That i s , there i s a monosynaptic pathway between the intrafusal and the extrafusal fibers of the same muscle and« W'hen stimulated by stretch of i t s endings, the primary afferent neuron fires signals into the central nervous system which evoke a contraction just sufficient to relieve the stretch. (Gardner and O'Connell (1972«200) ) The frequency of f i r i n g is related directly to the velocity of stretch. When stretching ceases, the frequency drops to a lower level appropriate to the new length. Thus fast or " b a l l i s t i c " (spring) stretch w i l l induce a greater reflexive contraction of the muscle being stretched than w i l l slow-prolonged stretch. The second consideration to be discussed under neuro-muscular response to stretch is b. the influence of the spindle prior to stretch, Since the intrafusal fibers are supplied with efferent innervation, i t is possible to pre set their length. This pre setting is done via the gamma motor 'neurons and is called "gamma bias". It is the gamma bias mechanism which allows spindle sensitivity to be con-tinuously maintained. For example, i f a limb i s passively moved so as to shorten a given muscle, the spindle would subsequently be ineffective at registering stretch u n t i l the original length was surpassed. The gamma outflow, however, causes contraction of the intrafusal fibers thus "taking up the slack" and re-establishing spiniale sensitivity. This i s the so called "shortening reaction". A similar "lengthening re-action" occurs when a muscle is stretched. At f i r s t the stretching causes a reflexive contraction (myotatic reflex) but as the gamma bias is re set at this new length, the l a discharge returns to the resting rate. (Gardner and O'Connell, 1972). It is important to note that resistance to stretch can occur even i f the muscle is in a shortened position. Since these gamma motor neurons inter-connect with higher centers (Granit et. a l . , 1955) the influence of volition is important to increasing range of movement. Impulse t r a f f i c from higher brain centres impinges on both the alpha motor neurons (to extrafusal fibers) and the gamma motor neurons. ~ It would: seem that, rif alpha motor /neurons are inhibited (as in muscle quiescence, Basmajian, 1973) and i f gamma bias is "set" at the very limit of myofibril extensibility, then maximum range w i l l result. If, on the other hand, gamma bias is set so that there is s t i l l considerable myofilament overlap and/or i f there i s not complete i n h i b i t i o n of the extrafusal f i b e r s , then there w i l l not be maximum elongation. In the sedentary i n d i v i d u a l who never moves his/her limbs through a f u l l range of movement, the "habitual" l i m i t of gamma bias set may well be le s s than the "physiological" stretch l i m i t . >^ NEURO-TENDINOUS RESPONSE TO STRETCH: In the neuro-muscular response to stretch, the myotatic refl e x causes a muscle to contract when i t i s stretched. The opposite i s true of the tendon or inverse myotatic refl e x (autogenic i n h i b i t i o n ) . As the tendon i s stretched, receptors c a l l e d g o l g i tendon organs f i r e i n response to th i s stretch. Golgi tendon organs may be excited by strong passive stretch but are much less s e n s i t i v e than the muscle spindles. They are, however, highly sensitive to the stretch imposed upon them by the contraction of the muscle in which they l i e . (Gardner and O'Connell, 1972:207)'. Ganong (1973) explains that there i s l i t t l e response from the g o l g i tendon organ 1D passive stretch because the more e l a s t i c muscle fi b r e s take up much of the str e t c h . During contraction, however, the tendons are quickly stretched with the concomitant f i r i n g from the g o l g i tendon organ. An example of t h i s r e f l e x is the sudden release of muscle contraction that can be seen during arm wrestling (Gardner and O'Connell, 1972) 5. NEURO-CAPSULAR RESPONSE TO STRETCH: The j o i n t capsule, skin and ligaments are a l l supplied with sensory receptors, some of which are slowly adapting (sensitive only to position) and some are fast adapting (sensitive to movement). 22 As a limb is being mobilized and stretching of these tissues is taking place, there is the resultant outflow of afferent impulses, which as well as register kinesthetic sensations also influence some of the reflexes mentioned previously. Since the afferent neurons of these joint receptors interconnect at the spinal cord with interneurons of broad distribution, their influence is more diffuse than that of muscle proprioceptors. (Gardner and 0*Connell, 1972» 210) . METHODS OF INCREASING FLEXIBILITY One of the earliest written accounts of the benefits and techniques of increasing f l e x i b i l i t y was written in 1589 by St. Archange Tuccaro - "Dialogue on the Acrobatics of Jumping" (cited by Holland, 1968). Many studies have subsequently been performed and i t is now well known that the modiflability of f l e x i b i l i t y is easily demonstrated. In fact, many methods have proven to positively alter f l e x i b i l i t y . ( B i l l i g , 1951* Weber and Kraus, 19^9j McCue, 1952» Riddle, 1956; de Vries, 1962; Fieldman, 1966} Bates, 1971* Liverman, 1970i Norman, 1970). The methods that have been studied can be generally grouped under the following headings! 1. Static (passive), 2. Spring ( b a l l i s t i c ) , 3. Relaxation and/or Mindset, 4 . P.N.F. (pro-prioceptive neuromuscular f a c i l i t a t i o n ) . 1. and 2. Passive Stretch and Spring Stretch. Weber and Kraus (19^9) compared spring and passive stretch and found the former to be slightly better. Other studies, however, found both methods to be equally effective (de Vries, 1962) Logan and Egstrom, 1961). These lattertwo studies plus others (Young, 1950j Stafford and Kelly, 19581 Rathborne, 1959; Bates, 1971) have expressed a concern over the potential danger of the spring stretch methods. It is the consensus of opinions that i f the two methods are similarily effective, then the passive methods should be chosen because of the reduced l i k e l i -hood of injury. 3. Relaxation Methods, that i s , passive methods in conjunction with some form of relaxation training, have been used for many years in yoga training though no controlled research comparing the effectiveness of yoga relaxation training and other methods for gaining f l e x i b i l i t y have been published. It seems, however, intuitively plausible that relaxation w i l l be beneficial to enhancing f l e x i b i l i t y for several reasons. One,the gamma bias w i l l "be set longer" than i f some movement is anticipated. Two, resistance to stretch w i l l be less,, due to muscle quiescence " . . . electromyographic studies have clearly demonstrated that voluntary muscle can be completely relaxed by a small effort of the w i l l " , (Basmajian, 1973i259). Both Rathbone (19.^ 3) and Scott (see Williams 1968i4) have stated that the ab i l i t y to relax muscles surrounding a joint should increase range of movement at that joint. Re-laxation methods such as Jacobsen's Progressive Relaxation (1938, 1967) and Shultz's Autogenic Therapy (Shultz and Luthe, 1969s Jencks, 1973* 197*0 have not been thoroughly studied as to their effectiveness in increasing range of joint motion. One study by Van Anne (1962) did show small positive correlations between increased f l e x i b i l i t y of ankle, hip and shoulder with decreased residual tension of the gastrocnemius, biceps femoris and pectoralis major muscles. Yet another study, however, by Williams (1968) showed that static stretching alone was better than progressive relaxation and progressive relaxation plus static stretch. She did not, however, state whether the pro-gressive relaxation training was done before, during or after the stretching procedure. The relationship between relaxation and stretching to increase range of joint movement is in need of further research. Also under the catagory of relaxation methods is the "mind-set" or "cybernetic stretch" suggested by Bates (197*0. Although no experimental work has been done on this area u n t i l this study, i t again seems a plausible method. By training the mind (Psychocybernetics, Maitz, (1970) to imagine a position of elongation greater than is normally possible, one should be able to excert a volition or cerebral influence over lower motor neurons (such as gamma efferents to muscle spindles) thus manipulating a gamma bias or gamma set which in turn w i l l determine rat what point the myotatic reflex is e l i c i t e d . There have recently been many experiments in the area of bio-feedback (Brown, 1975) that clearly demonstrate our a b i l i t y to override or have volitional control over many so called "visceral functions. It seems possible that many persons are, in fact, well within their physiological limits when they reach an "end-point" in joint range. Instead, they have 25 reached a limit determined by gamma bias and that i t is possible to extend that limit by volition or mind-set. 4. P.N.F. Methods. Neuromuscular f a c i l i t a t i o n refers to techniques which w i l l f a c i l i t a t e or enhance the a b i l i t y of muscles to contract or to relax. Three techniques or principles of f a c i l i t a t i o n were f i r s t established by Sherrington in 1898. These were (Griffin, 1974)* a. Immediate induction - agonists and synergists are facilitated to contract at the beginning of a movement. b. Reciprocal innervation - antagonists are inhibited from contracting at the beginning and during a movement. c. Successive induction - antagonists are facilitated to contract at the end of a movement. Proprioceptive neuromuscular f a c i l i t a t i o n refers more specifically to* . . . promoting or hastening the response of the neuromuscular mechanisms through stimulation of the proprioceptors. (Knott and Voss in Tanigawa, 1972$725) Gellhorn (1949) experimentally demonstrated proprio-ceptive f a c i l i t a t i o n in several techniques* a. Resistance increases the response of muscle to voluntary contraction. The effects seem to be based on the interaction of the proprioceptive impulses with those elicite d by cortical stimulation, resulting in an increased number of discharging motor units (Gellhorn, 1949*35). b. Stretch of a muscle prior to voluntary contraction 26 f a c i l i t a t e s that contraction (also Cavagna et a l , 1971). c. Stimulation and excitation of reflexes w i l l f a c i l i t a t e voluntary contraction of the same muscle group. In addition to Sherrington's and Gellhorn's experi-mental work, and the c l i n i c a l work of Kabat (1952) which a l l support P.N.F. techniques, Knuttson (1973) also mentions post  contraction depression which is the depression of the stretch reflex for about 4- seconds after a contraction ( starting 1 to 2 seconds after end of contraction). Although utili z e d mainly for therapeutic work in muscle strengthening, P.N.F. methods have also been studied with respect to increasing joint range of movement. Holt, Travis and Okita (1970) compared one P.N.F. method (described as "active P.N.F." in appendix of this study) with spring stretch and passive stretch and found that the P.N.F. method they used resulted in increases of nearly three times that of the other two methods (which each had very similar results). Tanigawa (1972) u t i l i z e d a different P.N.F. method (described as "Passive P.N.F." in appendix of this study) and compared i t with a passive stretch method. The P.N.F. method resulted in 5.4 times greater gain in range. Holt (no date) published a book, Scientific Stretching  for Sport in which he describes a method which i s , in effect, a combination of passive P.N.F. and active P.N.F. Again, more experimental work i s needed to determine exactly which methods are best suited to which conditions. 27 METHODS OF MEASURING FLEXIBILITY Many unique arid innovative methods have been developed for measuring the range of joint movement. These methods have been reported in other reviews by Wiechec and Krusen, 1939; Darcus and Salter, 1953; Leighton, 1954: Moore, 1959; Dickinson, 1963s and Clarke, 1975. The most common method used in present day rehabilitation medicine and in research prior to 1955 was the protractor goniometer. In 1955. Leighton introduced a pendulum goniometer which has become known as the Leighton Flexometer, and which has become very widly used in research. More recently, an electrogoniometer (elgon) has been developed and is becoming increasingly popular as a research instrument 'for measuring...dynamic" range (Adrian et a l . , 1963). THE RELATIONSHIP OF FLEXIBILITY TO OTHER FACTORS 1. Age and Sex 2. Morphological and anthropometrical variables 3. Warm-up 4. Posture 5. Performance 6. Retention 7. Adaptive shortening 1. AGE AND SEX: Generally, f l e x i b i l i t y declines with age (Wright and Johns, 19(59; Sigerseth,. 1965r Downie, 1970). The pattern of decline differs somewhat between males and females and between different age groups. With respect to males, Forbes (1950) studied 400 boys from 10-18 years of age and found that the boys g e n e r a l l y l o s t f l e x i b i l i t y up to and through adolescence and then gained u n t i l age 18. Leighton (195^. 1956) found l i t t l e change between boys of 6 to 10 years of age but then noted a steady downward trend from 10 to 18. He suggested ( i960) that s p e c i f i c , h a b i t u a l patterns of move-ment were more important than age w i t h respect to changes i n f l e x i b i l i t y . Odgers (I969) s t u d i e d 6-13 year o l d males and found a gradual increase u n t i l age 12 and then a d e c l i n e at adolescence (13). He found 11 and 12 year olds to be the most f l e x i b l e and 6-9 year olds to be the l e a s t f l e x i b l e . The only c o n s i s t e n t trend seems to be a decrease i n f l e x i b i l i t y d uring the adolescent growth s p u r t . With respect to females, Hupprich and S i g e r s e t h (1950) studied 6, 9 , 12, 15 and 18 year olds and found a general increase from 6 to 12 years o l d and then a d e c l i n e . Leighton ( i960) compared h i s data on adolescent males w i t h the data of Hupprich and S i g e r s e t h on adolescent females and found that during t h e i r r e s p e c t i v e growth spurts the males g e n e r a l l y decreased w h i l e the females stayed the same. Downie (1965. 1970) found that , 6 - 1 0 year o l d g i r l s g e n e r a l l y showed no change, while 10 year olds increased i n approximately h a l f of t h e i r t e s t s w hile remaining the same i n the other h a l f . The 12 year o l d s showed s i m i l a r trends towards increased f l e x i b i l i t y . Thus, u n l i k e males, there does not appear to be any sharp d e c l i n e during the adolescent growth s p u r t . S e v e r a l s t u d i e s have compared males and females and of these, the g r e a t e s t m a j o r i t y concluded that females were more 29 f l e x i b l e than males at any given age ( P h i l l i p s et a l . , 1955s Buxton, 1957? Kirchner and Glines, 1957? Shaffer, 1959). Some studies, however, did not corroborate these findings. Forbes (1950) found that at age 12, g i r l s had greater range of move-ment i n more jo i n t s than did boys, but that the reverse was true at age 18. Kendall and Kendall (19^8) using two tests (toe touch and forehead to knees i n s i t t i n g position) found that at age 5» 98 percent of the boys and 86 percent of the g i r l s could perform the toe touch. Beginning at age 6 however, there was a sharp decline i n t h i s percentage and by age 12 only 30 percent of each sex could perform the t e s t . The forehead-to-knee test produced opposite r e s u l t s with the number of g i r l s successful at age 5 being 15 percent and boys being only 5 per-cent. This percentage did not change appreciably through to age 17. Whether the difference between males and females or between ages are b i o l o g i c a l or environmental i n nature i s not clear. I t does seem clear, however, that i n a c t i v i t y i n the form of r e s t r i c t e d j o i n t movement does promote decreased range of movement in those j o i n t s . Ak.eson (1961) established that r e s t r i c t e d j o i n t s lose mucopolysaccharides and as a resu l t there i s more "cross linkage" of collagen f i b e r s and thus less e l a s t i c i t y . The patterns witnessed above may, in fact, be as Leighton ( i960) pointed out? due to the d i f f e r e n t movement patterns which are c h a r a c t e r i s t i c of a given age or sex. 2. MORPHOLOGICAL AND ANTHROPOMETRICAL VARIABLES: After Kraus and Hr.rschland (195*0 reported the comparison of f i t n e s s l e v e l s "between American and European children, there were several "schools of thought" as to the cause of these differences I n a c t i v i t y , as mentioned previously, was c e r t a i n l y one p o s s i b i l i t y but so were possible population differences such as stature and s i z e . Many studies followed the Kraus and Hirschland report and a great many of these looked at the f i t n e s s item which caused greatest f a i l u r e s i n American children - f l e x i b i l i t y McCue, ( l952) t j Perbix, (195*+):. Lauback and McConville, (1966j all-studied the r e l a t i o n s h i p between f l e x i b i l i t y and somatotype and a l l concurred that there was no s i g n i f i c a n t r e l a t i o n s h i p . Tyrance (1958), however, studied the extremes of the three somatotypes and found a s l i g h t trend towards the endomorphs being more f l e x i b l e . Likewise, Shaffer (I962, cited by Clarke, 1975) reported that t a l l overweight subjects were most f l e x i b l e while short under and overweight subjects were le a s t f l e x i b l e . With respect to anthropomorphic measurements, again the consensus of opinions i s that there i s no s i g n i f i c a n t r e l a t i o n -ship with f l e x i b i l i t y (Mathews, Shaw and Bohnen, 1957? Mathews, Shaw and Woods, 1959; Lauback andMcConville, 1966; Harvey and Scott, 1967! Dinkheller, 1969). ~- Twov studies that do indicate s i g n i f i c a n t relationships between anthropomorphic measurements and f l e x i b i l i t y are Br® er, and Galles (1958) and Wear (1963) . 3 ' WARM-UP: Range of j o i n t movement can be increased by warm-up in the form of practice t r i a l s (Lukes, 195*+s Rochelle, i960? Fieldman, 1966). Angle (1963) reported that a general warm-up i n the form of re l a x e d r i d i n g on a b i c y c l e ergometer r e s u l t e d i n an increase i n the range of most j o i n t s s t u d i e d . Warm-up i n the form of heat a p p l i c a t i o n has been found by some i n v e s t i g a t o r s to l i k e w i s e enhance range of movement (Wear, 1963s Wehr, 1964? Frey, 1970s Lehman et a l . , 1970; Grobaker, 1974). The e f f e c t of co l d a p p l i c a t i o n , however, has not yet been researched s u f f i c i e n t l y to allow a d e f i n i t i v e statement. Frey (1970) and Grobaker (1974) found cold a p p l i c a t i o n to have no s i g n i f i c a n t e f f e c t while Hol't (1971) claimed t h a t the a p p l i c a t i o n of i c e enhanced range of movement. Wear (1963), on the other hand, claimed t h a t c o o l i n g a j o i n t decreased the range of move-ment . 4. POSTURE; S e v e r a l s t u d i e s have looked at the r e l a t i o n -s h i p of posture and f l e x i b i l i t y and once again the c o l l e c t i v e r e s u l t s i n d i c a t e l i t t l e or no r e l a t i o n s h i p (Coppock, 1958; F l i n t , 1963. 1964? Hutchins, 1965). 5* PERFORMANCEt The va r i o u s performance f a c t o r s w i l l be considered under the f o l l o w i n g subsections« a. Motor F i t n e s s b. P h y s i c a l A c t i v i t y Patterns c. Strength a. Motor f i t n e s s items (running, jumping, throwing, etc.) have been studied w i t h respect to f l e x i b i l i t y and the r e s u l t s have been c o n t r a d i c t o r y . McCue (1953) , and Odgers (1969») both reported that the superior groups of performers on t h e i r respective motor f i t n e s s tests were also the groups exhibiting the best ranges of movement ( p a r t i c u l a r i l y trunk and hip flexion/extension). Dintiman (1964) found stretching exercises improved 1,performance times on the 50 yard s p r i n t . Other researchers, however, have reported contrary findings. Nelson (I960) and de V r i e s (1963) both found no s i g n i f i c a n t difference in running times a f t e r stretching exercises while Davies(l957) and Burley (I96I) each reported low correlations between motor fi t n e s s it;ems and f l e x i b i l i t y measurements. Also under the d i v i s i o n of motor performance, Norman (1970) could not prove that v e l o c i t y of knee extension could be increased by enhancing the e x t e n s i b i l i t y of muscles crossing the knee j o i n t . b. Physical a c t i v i t y patterns such as would be expected from extensive p a r t i c i p a t i o n in s p e c i f i c a c t i v i t i e s (employment or sport) r e s u l t in unique patterns of j o i n t f l e x i b i l i t y (Kingsley, 1952; Bennet, 1956; Leighton, 1957a, 1957b; V i l l a , 1958; Bateman, 1962; Sterner, 1963; Leighton, I960; Shaw, I968; Denk, 1971; Ruhl, 1972). A summary of the findings of several of the above mentioned studies can be found i n Clarke (1975). c. Strength t r a i n i n g and i t s e f f e c t on f l e x i b i l i t y i s yet another area in which there s t i l l i s divided opinion amongst researchers. Studies by Massey and Chaudet (I956) and Chapman (1971) - showed decreases i n range of movement as a r e s u l t of strength t r a i n i n g . Wickstrom (1963), 33 Brigham (1963) Gardner (19°3) a l l reported no s i g n i f i c a n t changes in range of movement a f t e r strength t r a i n i n g . Tucker (1963) reported an o v e r a l l increase i n the amplitude of the shoulder j o i n t but no significance was reported in any single range while other studies actually reported increases i n range of movement following strength t r a i n i n g (Taylor, 1928 -cited i n Forbes, 1950» Wilson, 19^5; Wickstrom, 1963). The l a t t e r investigator reported that a f t e r heavy strength t r a i n i n g , f l e x i b i l i t y changes were extremely varied with a trend for those s t a r t i n g with poorest f l e x i b i l i t y to make l a r g e s t gains and vice versa. In a similar area, Liverman (1970) found that there was no s i g n i f i c a n t decrease in the explosive powers of the leg following a 6 week stretching regimen which s i g n i f i c a n t l y increased range of movement. It would appear from the preceeding that strength t r a i n i n g done through a f u l l range of movement has l i t t l e chance of causing a decrease i n range and that one's state of f l e x i b i l i t y p r i o r to beginning strength t r a i n i n g may be of some importance. 6. RETENTION; The retention of newly attained ranges of movement following t r a i n i n g has received r e l a t i v e l y l i t t l e research attention. Hansen (1962) studied the l a s t i n g e f f e c t of a single regimen of stretching and concluded thatt (38) ... an i n i t i a l gain a f t e r stretching by a l l subjects l a s t i n g f or three hours followed by a gradual decrease in mean score values. The c r i t i c a l decline seems to occur between three and twenty-four hours a f t e r stretching but i s greatest i n magnitude between the six and twenty-four hour period. 34 McCue (1953) reported that changes brought about by stretching exercises p e r s i s t for up to eight weeks, while Bates (1971) concluded that the rate of loss depends on the amount of time spent stretching at each exercise period (60 seconds per day, f i v e days a week f o r three weeks was better than 10 seconds, 30 seconds, 90 seconds and 120 seconds). Both Bates and Kingsley (1952) state that improvement i s more dramatic in those subjects s t a r t i n g with lower ranges of movement. 7. ADAPTIVE SHORTENING s Decreasing the range of move-ment around a jo i n t can also occur. Lockhart (1972) r e l a t e s as to how adaptive shortening or "passive i n s u f f i c i e n c y " can occur i n muscles by simply wearing shoes which have high heels. There i s an adaptive, permanent shortening of the gastrocnemius and soleus muscles. Another s i t u a t i o n which can cause a reduction i n range of movement i s brought about by excessive r e s i d u a l muscle tension. Van Anne (1962) found small negative correlations between decreases i n muscle residual tension and increases in joint ranges of movement. Increasing age has been mentioned e a r l i e r as yet another factor that contributes to decreasing f l e x i b i l i t y . S i m i l a r i l y , i n a c t i v i t y with i t s resultant lack of movement of limbs through t h e i r f u l l ranges, could cause adaptive shortening of the soft tissues around j o i n t s (Goldspink, 1972; Lockhart, 1972; Tabary et a l . , 1972). CHAPTER III METHODS AND PROCEDURES Subjects The sample consisted of 119 female subjects enrolled i n Physical Education at the University of B r i t i s h Columbia. Their mean age was 20.19 years, t h e i r mean height was I . 6 5 metres and t h e i r mean weight was 60.15 kilograms. A l l sub-jects were f i r s t paired with another g i r l i n the same class then these pairs were randomly assigned to one of seven groups (six treatment groups and one control group). The experiment ran from mid January to mid February, 1976. Time of Exercise and Duration of Study Each subject received f i v e minutes of exercise, three times each week fo r three weeks. In addition, there was one t e s t i n g day at the beginning and end, thus .summing to eleven days spread over four weeks. Exercise was always done under the supervision of the experimenter between 8:00 a.m. and 6:30 p.m. A l l methods consisted of s i x t y seconds of exercise followed by sixt y seconds of rest, then s i x t y seconds excercise etc., f o r a t o t a l time of ten minutes. Space, Personnel and Equipment The exercising area consisted of a f l a t carpeted surface on which the subjects l a i d supine. While being tested each subject had her l e f t leg anchored to the f l o o r by means of a strap placed proximal to the knee. The r i g h t leg was held straight by the use of a padded 3" x 18" x 3/8" plywood s p l i n t firmly fastened to the anterior aspect of the leg (the middle of the s p l i n t juxtaposition to the p a t e l l a ) . A l l straps were made secure by the use of s t r i p s of 2" wide velcro A l l measurements were taken by the experimenter and a l l exercise assistance was done by partners who kept time by the use of a large sweep-hand timer. Exercise rhythm and timing was further f a c i l i t a t e d by the use of an audible electronic metronome calibrated to one beat per second. A Leighton Flexometer, with 2" wide velcro glued to the back, was e a s i l y applied to the strap on the l a t e r a l side of the r i g h t leg s p l i n t . The Flexometer was set at zero when each subject was l y i n g supine. This instrument has a test r e t e s t r e l i a b i l i t y of greater than .90 (Leighton, 1955) . Test Procedures and Instructions Days 1 and 11 were s t r i c t l y measurement days. Sub-jects wore gymnastics leotards or track s u i t s and were f i r s t tested f o r active range and then passive range. This testing order was maintained throughout the experiment because- i t was f e l t that active range measurements would not a f f e c t Plates 1 and 2: Exercise Session in Progress Plate 4: Demonstration of Flexometer Placement 39 passive range measurements but that the converse was not true. On each of the testing days, the subject l a i d supine with the l e f t leg anchored and the r i g h t leg held s t r a i g h t by the use of the s p l i n t . The flexometer was attached and set at zero, and the subject was asked to slowly rai s e her r i g h t leg as far as possible and hold i t there. A reading on the Flex-ometer was taken as soon as an end point was reached. For the passive measurement, the partner was instructed to mobilize the subject's leg by grasping i t behind the heel and c a l f and slowly raise i t u n t i l an end point was attained (subject indicated when pain-free range had been reached). No warm-ups were allowed and only one measurement was taken f o r each range. A c o r r e l a t i o n matrix was calculated to determine the r e l i a b i l i t y of taking one measure as compared to taking three measurements. Seventeen subjects were used and the lowest r attained was .93 between a f i r s t and a t h i r d measure-ment. Thus i t was decided to use only the one measurement. After measurements were taken on day 1, subjects were instructed and allowed to practice t h e i r randomly as-signed method. Practice was limited to learning the tech-niques of the method and the a s s i s t i n g . Hand-outs were given explaining the techniques and the rationale behind t h e i r p a r t i c u l a r methods. The subjects then met three times a week for three weeks. On days 4, 7 and 10 they were measured before and a f t e r exercise using the same sequence as day 1 and 11. Figure 2 i s an outline of the sequence of exercise. 40 Subject 1 Subject 2 60 seconds exercise a s s i s t partner a s s i s t partner 60 seconds exercise 60 seconds exercise a s s i s t partner a s s i s t partner 60 seconds exercise 60 seconds exercise a s s i s t partner a s s i s t partner 60 seconds exercise 60 seconds exercise a s s i s t partner a s s i s t partner 60 seconds exercise Figure 2. Exercise Sequence fo r a l l Pairs of Subjects. S p e c i f i c Procedures for each Treatment Group A detailed description of each method can be seen i n the APPENDIX. The following i s an account of the s p e c i f i c procedures used f o r each treatment group: 1. Control: This group was measured on days 1 , 4 , 7 1 1 0 , 11. They did not appear on the other days. 2. Passive L i f t - A c t i v e Hold: The subject's l e g was raised by the partner to the end point and held there for 6 seconds, then i t was released and the subject t r i e d to hold i t at that point by contracting the hip flexors-again fo r 6 seconds. This procedure was repeated 5 times i n the 60 seconds and then the partners changed positions. 3. Active 1 P:.N.;F. : The subject a c t i v e l y l i f t e d r i g ht leg and held i t at the end point f o r 6 seconds. The partner held the l e g at that point while the subject exerted a max-imum contraction of the hip extensors (isometric contraction) fo r 6 seconds. The subject then a c t i v e l y held the l e g for another 6 seconds, followed by a 6 second isometric contrac-t i o n etc. f o r a-.total of 66 seconds "before the partners changed places. 4. Spring Stretch and Hold ( b a l l i s t i c ) : Subjects did not need a partner f o r t h i s method. St a r t i n g at 45 degrees, the right l e g was swung to i t ! s maximum range ;4' times and then held at the end point f o r 6 seconds. This procedure was repeated 6 times i n the minute a f t e r which the subject rested f o r 60 seconds before repeating the sequence. Note: This method i s often referred to as " b a l l i s t i c stretch" i n the l i t e r a t u r e . This investigator does not wish to perpet-uate t h i s term since " b a l l i s t i c " refers to a p r o j e c t i l e separated from i t s source of energy. 5. Relaxation: The subject's r i g h t l e g was passively l i f t e d to i t s maximum range and held there f o r 60 seconds. During t h i s time, the subject practised relaxation and "mind-set", which was a technique of mentally imagining themselves i n a position of much greater stretch than they were capable.- ., For example, they were shown a very f l e x i b l e g i r l and t o l d to "imagine" themselves to be able to achieve the same range. 6. Passive P.N.F.: The subject's r i g h t l e g was passively l i f t e d to i t s maximum range and held there f o r 6 seconds. The partner then r e s i s t e d (held the l e g firm i n that position) while the subject contracted the hip extensors maximally fo r 6 seconds. This procedure was repeated 5 times i n the 60 seconds then the partners changed positions. 4'2 7. Prolonged Stretch* The subject's leg was passively l i f t e d to i t s maximum range and held there f o r 60 seconds. The partners then changed positions. Experimental Design A 7x5 randomized group, f a c t o r i a l design with repeated measures on the second factor was used. The two independent variables were At the treatment factor containing 7 l e v e l s and B: the time factor containing 5 l e v e l s . The dependent variable was the measurement of passive range. The treatment factor was the six stretching methods and the control group, while the time factor was the 5 measurement days. Days 1 and 11 constituted pre experiment and post experiment measurements, while days 4 , 7 and 10 constituted pre exercise and post exercise measurements on a given day. I t was hoped that days 1 and 11 comparison would indicate the success of each method while days 4 , 7 and 10 comparison would indicate trends of improvement. Each treatment c e l l contained between 15 and 20 subjects. Figure 3 i s a schematic diagram of the experimental design. S t a t i s t i c a l Treatment A multivariate analysis of variance was used and pre-planned orthogonal comparisons were set up to test the hypotheses. The contrasts were designed so as to compare* 1. The control versus a l l treatment methods. 2. The combination method (passive l i f t - a c t i v e hold) versus a l l the other treatment methods. 3. Active methods versus passive methods. k. One active method versus the other active method. (Active P.N.F. versus spring s t r e t c h ) . 5. The relaxation method versus the other two passive methods, (passive P.N.F. and prolonged s t r e t c h ) . 6. One passive method versus the other passive method. (Passive P.N.F. versus prolonged s t r e t c h ) . Figure 4 shows the pre-planned orthogonal contrasts and Table 1 shows the c o e f f i c i e n t s f o r the contrasts. This s t a t i s t i c a l treatment u t i l i z e d the computer programme MULTIVARIANCE-VERSION 4-JUNE, 1968-by J.D. Finn. 44 B l DAY 1 B2 DAY 4 B 3 ' DAY 7 B4' DAY 10 B 5 ! D A Y 11 Control N=l? Pas. L i f t Act. Hold N=15 A 3 Active P.N.F. N=17 : \ Spring Stretch N=l6 A 5 Relaxation N=19 A 6 Passive P.N'.F. N=17 A ? Prolonged Stretch N=18 Figure 3. Schematic Diagram of Experimental Design A=Treatments B=time Table 1. C o e f f i c i e n t s f o r the 6 Pre-planned Orthogonal Contrasts. +6 -1 -1 -1 -1 -1 -1 0 -5 1 l l 1 1 0 0 3 3 -2 -2 -2 0 0 l - l 0 0 0 0 0 0 0 2 -1 -1 0 0 0 0 0 1 -1 Control , Passive L i f t - A c t i v e Hold ] Active P. N...F-. , Spring' Stretch Relaxation" Passive P.N.-F. Prol..- Stretch Figure 4. Pre-Planned Orthogonal Contrasts Used to Test the Hypotheses. CHAPTER IV RESULTS AND DISCUSSION The r e s u l t s are reported i n three s u b d i v i s i o n s s o v e r a l l e f f e c t s ; trends of improvement and pre-experiment versus post-experiment d i f f e r e n c e s . O v e r a l l E f f e c t s Table 2 l i s t s the means from a l l t e s t i n g sessions and Figure 5 graphs these means. Table 2. Means f o r Treatment Groups at each T e s t i n g Session ( i n degrees) Treatment P r e Exercise Method Day 1 Day 4 Day 7 Day 10 Day 11 1. 107.4 114.2 114.9 118 .5 118.7 2. Pas L i f t Act Hold. 101.3 113-3 119.0 122.9 129.0 3. A c t i v e P.N.F 95 . 5 104.6 109.6 113.4- 115.^ 4. Spring S t r e t c h . . . . 101.9 110.3 115.3 117.3 124.8 5. 100.6 112 .5 120.3 123.5 127 . 5 6 Passive P.N.F 103.5 113.4 120.4 125.8 130.9 7. Prolonged S t r e t c h . 108.1 115.1 122.7 129.3 134-.6 Post Post Post E x e r c i s e E x e r c i s e E x e r c i s e 1 115.9 115.7 119.5 2 122.4 125.9 132.3 3 110.6 115.2 118 .4 ^ 117.8 120.9 126.2 5. 122.5 122.3 129.1 6 123.6 127.4 133.2 7. 125.2 132.4 134.3 M M T .... 1 - "4 1 i j c n r t r 0 1 JL a . I i f t I 2 I SSI e 1 .cxive r c A c i I i • • • • 1 Ii y s I 1 i r S XT •e i n F e 1 av a"t ,ior 1 1 6 f t T" Ir 'ass 3 "V i I N . J 7 I >r •c nged [ ?!1-T>otr>V 7 1 t ) o L ^ < - i i a 2 i L 5 « I A j 9 I • 0 / -> IT 1 s. 0 <> r rr* 0 »_i_ i u -10 s i > ••• t p * 3 •- — o M I 9 1 M -, 1 .c . S : -i > . --0 . / / / -.-' / / *5 / / / I V -IOC / ) / r f K ) T i Da: • 3a; 10 3aj I i; f Tl L I I jai: 5 9 : rU. - i vie f c Tl v-» /^v "4- 7v\ o 5. r i reaxiTien 1 , L 5e ( r' r> 31 _ . j P 3 at r ac h re a IJ g SB 10 1 • _L I TLX : t j 1 I t J T 48 Trends of Improvement A l l groups showed an increase i n passive range. The experimental groups, however, showed s i g n i f i c a n t l y greater day to day improvements than did the control group (multivariate F = 4 . 3 4 , P = .0002). The only exception to t h i s trend was between days 7 and 10 where the control groups displayed gains equal to those of the mean of the experimental groups. Table 3 displays these trends. Table 3 . ANOVA Table f o r Helmert Contrast 1 Control Versus Experimental Test Univariate P less Days F . Than 1 versus 4,7,10,11 12.91 0 .0005 4 versus 7, 10, 11 14.59 0 .0003 7 versus 10 and 11 1.91 0.17 10 versus 11 4.69 0 .03 As can be seen from Table 4, the greatest improvement occurred between days 1 and 4, and although the control group plateaued between days 4 and 7 and again between days 10 and 11, the experimental groups showed no signs of plateauing (see Figure 6 ) . 49 Table 4 . Means f o r Ranges Attained on Pre Exercise Measurements for the Control Groups versus the 6 Experimental Groups Test Day Means for Means f o r Control Group Experimental Groups 1 107.35° 101.84° 4 114.18° 1 1 1 . 5 ^ ° 7 114 .94° 117.88° 10 118 .47° 122 .01° 11 118 . 7 1 ° 127.03° Figure 6. Graph of Means f o r Ranges Attained on Pre Exercise Measurements for the control group versus the 6 Experimental Groups 50 With respect to the passive methods versus the .active methods, the groups t r a i n i n g under passive methods showed s i g n i f i c a n t l y g r e a t e r ranges on a l l days wi t h the exception of day 1. Table 5 demonstrates t h i s t r e n d . Table 5. Means and M u l t i v a r i a t e F f o r A c t i v e Versus Passive Methods. x f o r x f o r Test a c t i v e passive U n i v a r i a t e P l e s s Day methods methods F than Day 1 98.7° 104 . 1 ° 2.29 0.13 Day 4 1 0 7 . 5 ° 1 1 3 . 7 ° 3.69 0.06 Day 7 1 1 2 . 5 ° 1 2 1 . 1 ° 6.35 0.01 Day 10 115.4° 1 2 6 . 2 ° 11.6 0.001 Day 11 1 2 0 . 1 ° 1 3 1 . 0 ° 11.39 0.001 F i g u r e 7 and Table 6 show there i s a l s o a d e f i n i t e trend f o r the increase w i t h i n a given day, that i s pre ex e r c i s e compared to post e x e r c i s e measurement, to be gre a t e r than the increase between pre exe r c i s e measurements of tha t same day and pre ex e r c i s e measurements of the subsequent t e s t i n g day, even though the l a t t e r measurement followed three treatment days. 1 Table §, Mean Increases i n Range on Testing Days and Between Testing Days for a l l groups Mean Increases pre and post Exercise -'Mean Increases Between Testing Days On Day 4 On Day 7 On Day 10 7 . 8 ° 5 . 4 ° 6.0° Between Days 1,4 9 . 3 ° Between Days 4 ,7 5 .8° Between Days 7,10 4 . 0 ° Between Days 10,11 4 . 3 ° Pre Experiment and Post Experiment Differences A l l methods, except Prolonged Stretch, achieved the greatest range on the post exercise measurement of day 10. It. was, however, the day 11 measurement (no warm-up) that was compared with the day 1 measurement to calculate the mean increase i n range. Table 7 l i s t s the pre experiment versus post experiment differences. The control group gained s i g -n i f i c a n t l y l e s s (F=25.79, P<.0001) than the mean of the 6 treatment groups. The active methods showed s i g n i f i c a n t l y lower (F=5-9» P<0.01) mean increase i n range than did passive methods, which as a group showed uniform mean increases of 26.9° for Relaxation; 2 7 . 4 ° f o r Passive P.N.F. and 26 .4° for Prolonged Stretch. Passive L i f t - A c t i v e Hold showed the greatest mean improvement with 2 7 . 7 ° . There was no s i g -n i f i c a n t difference between the Relaxation method and the mean of the other two passive methods. 53 Table 7. Pre Experiment (day 1) and Post Experiment (day 11) Differences. 2. Passive L i f t - A c t i v e Hold 3„ .Active P.N.F 4. Spring Stretch 5. Relaxation 6. Passive P.N.F 7. Prolonged Stretch 1. Control • • • • 1 1 . 4 ° 2 7 . 7 ° 1 9 . 9 ° 22 .9° 26 .9° 2 7 . 4 ° 26 .4° Discussion I t appears from t h i s study that a substantial i n -crease i n passive range can be e a s i l y and quickly acquired. Five, 60 second stretching periods, 3 times per week for three weeks resulted i n J0% of the subjects i n the treatment groups (30 out of 101 g i r l s ) increasing-their, range 30° or more.. This increase could, i n part, be a t t r i b u t e d to t h e i r concom-it a n t p a r t i c i p a t i o n i n a c t i v i t y courses although the control group had a mean increase of only 1 1 . 4 ° much of which could be a t t r i b u t e d to the fact that they were measured 8 times. As was seen i n Figure 6, a l l methods except Prolonged Stretch showed a gradual tapering i n the amount of gain betweemeaeh t e s t i n g session. The decrease i n amount of gains was not substantial enough, however, to suggest that further exercise would not r e s u l t i n further gains. Quite the contrary, the decreases may well have been motivational i n nature since 4 of the 7 groups showed an upswing on the l a s t day [of testing,, -(Hawthorne E f f e c t . ... . . > .\ , -54 I t i s int e r e s t i n g to note i n Table 6 the positive e f f e c t that the exercise sessions had on the post exercise scores. The fact that the differences were greater between pre-post scores on day 7 and day 10 than between pre scores a f t e r three days of exercising (between days 4 and 7, between days 7 and 1 0 ) , suggests that there i s a neuromuscular warm-up eff e c t (gamma bias resetting or habituation of the spindle f i r i n g ) or that there i s physical lengthening of the connective t i s s u e . The fact that the increase i s so quick (af t e r only 5 minutes of exercise) and that only a portion of i t p e r s i s t s , indicates that neuromuscular mechanisms are probably the dominant factors. The difference between active and passive methods could, i n part, be attributed to the fac t that the passive methods maintain a position of maximum stretch f o r the f u l l 60 seconds. The active methods alternate between maximum stretch and some f a c i l i t a t o r y technique. This l a t t e r condition was, however, also true of Passive L i f t - A c t i v e Hold which was the method showing the greatest improvement. The three passive methods did not d i f f e r s i g n i f i c a n t l y from each other between pre and post experiment scores. A l -though the Relaxation and Passive L i f t - A c t i v e Hold methods showed the greatest i n i t i a l improvements of a l l methods (12° between days 1 and 4) the Prolonged Stretch method showed the least plateau e f f e c t . With respect to the hypotheses, one was substantiated and the other was not. The f i r s t hypothesis that passive methods would show a better increase i n passive range than would active methods was accepted. I t was found i n the other half of t h i s study (Hartley, 1976) that the converse was not true, active methods did not give a better increase i n active range over passive methods.Iri fact, the passive method Relax-ation gave the greatest increase i n active range. The second hypothesis that the Relaxation method would be better than the other passive methods was rejected. I t i s noteworthy that the res u l t s of t h i s study are i n d i r e c t opposition to those of Holt et a l . (1970) who found that Active P.N.F. was the best of three studied,( a s t a t i c , a dynamic and a P.N.F. method). In this-study, Active P„N.F. was the lea s t successful method, as i t was i n Hartley's study. The reason f o r these opposite r e s u l t s may be a t t r i b u t e d to the difference i n exercise time and rest time. Holt et a l . had t h e i r subjects rest f o r 10 seconds a f t e r every 20 seconds of stretch (repeated 4 times). Tanigawa (1972) found that a passive P&N..E-V method (hold-relax) resulted i n a greater gain i n passive range than did a passive stretch. This study does not support that f i n d i n g and again i t may be at t r i b u t e d to the fact that the subjects i n Tanigawa*s study were stretched f o r only 7 seconds at a time then rested f o r 5 seconds,(repeated k times) I t appears that P.N.F. methods develop a greater range than s t a t i c stretching methods when the exercise period i s short but when the exercise periods are increased up to at leas t one minute duration then the s t a t i c methods (Prolonged Stretch and Relaxation) equal or surpass the P.N.F. methods i n "both active and passive range. The difference "between the re s u l t s of the two P.N.F. methods u t i l i z e d i n t h i s study was conspicuous and further research between these and other " f a c i l i t a t i o n " techniques i s warranted. In his book S c i e n t i f i c  Stretching f o r Sport, Holt describes a P.N.F. method that i s e s s e n t i a l l y the same as the Active P.N.F. method used i n t h i s study except that the partner aids with " s l i g h t pressure" on the active l i f t phase. I t would seem that t h i s i s a combina- v ti o n of active and passive and should be compared with the other methods. The Passive L i f t - A c t i v e Hold method improved most f o r passive range and was ranked second f o r active range (see Hartley, 1976). I t i s easier to administer than the P.N.F. methods and requires less teaching than does the relaxation method. The reason f o r t h i s method's success can perhaps be at t r i b u t e d to the fact that i t i s 1) a passive method thus stretching i s occuring at maximum range and 2) the active hold phase e l i c i t s r e c i p r o c a l i n h i b i t i o n of the hip extensors that may^ Mei£itate% : lessening the myotatie r e f l e x when passive stretch i s again applied. At t h i s point i t i s ap-propriate to conjecture that' a passive stretching technique such as Prolonged Stretch combined with an active contraction of the hip flexors (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 re s u l t i n maximum stretch and maximum relaxation of the target area. CHAPTER V SUMMARY AND CONCLUSIONS Summary F l e x i b i l i t y i s an area of study that has received r e l a t i v e l y l i t t l e attention and has s t i l l no un i v e r s a l l y accepted terms of reference or t h e o r e t i c a l model. In addition, there has so .far been no comprehensive study of many of the methods that are commonly used to increase j o i n t amplitude. It was the purpose of t h i s study to forward standard termin-ology (see def i n i t i o n s ) and a t h e o r e t i c a l model as well as to conduct an experiment that tested the e f f e c t of s ix d i f f e r e n t stretching methods on passive range of hip f l e x i o n . The t h e o r e t i c a l model stated that one must decrease resistance i n a target area (area to be stretched) or increase the a b i l i t y to overcome that resistance (strength) i n order to p o s i t i v e l y a l t e r f l e x i b i l i t y . Several physiological cond-i t i o n s which would allow f o r these above objectives were l i s t e d as well, as several courses of action which would s a t i s f y the physiological conditions. A•sample of 119 university aged females were paired and randomly assigned to one of seven ..groups•(6 treatment groups and 1 control group).. They were measured on day 1, and ., then exercised 3 days a week f o r 3 weeks and measured again on day 11. In addition, measurements were taken before and-after exercise on days 4, 7 and 10. A l l measurements were taken by the experimenter using a Leighton Flexometer. The methods that were tested were divided into: active methods i n which the subject a c t i v e l y mobilized t h e i r l e g (Active P.N.F... and Spring Stretch); passive methods i n which the partner mobilized the subjects l e g ( Relaxation, Passive P.N.F. and Prolonged Stretch); and a combination method i n which the partner mobilized the subjects l e g and then the subject a c t i v e l y t r i e d to maintain the range attained (Passive L i f t - A c t i v e Hold). S t a t i s t i c a l treatment consisted of a multivariate analysis of variance with pre planned orthogonal contrasts• and the res u l t s were reported as:,; o v e r a l l e f f e c t s ; trends of improvement and pre experiment versus post experiment d i f -ferences. Conclusions 1. Substantial increases i n range of hip f l e x i o n are e a s i l y and quickly achieved. 2. A l l methods studied resulted i n s i g n i f i c a n t i n -creases over the control group. 3. The passive methods employed i n t h i s study were s i g n i f i c a n t l y better than the active methods used. 4. Further study i s necessary to d i f f e r e n t i a t e bet-ween the ef f e c t s of the d i f f e r e n t P.N.F. techniques that are presently used in'sport and therapy. 59 5. 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Therapy Review. 3 0 s l 3 4 . 72 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 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 001 098 104 110 125 110 127 122 137 118 136 123 134 122 136 111 129 40 . 0 50 . 0 002 099 120 102 120 104 130 110 125 110 124 108 138 114 140 110 130 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 C6? 104 085 117 084 114 084 110 085 108 090 114 090 120 100 118 55-0 59 . 0 005 082 102 095 114 096 113 100 122 ICO 116 095 115 095 115 103 122 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 00? 093 115 107 130 110 130 102 125 102 125 110 134 113 131 103 125 4 3 . 0 46 . 0 008 075 105 080 108 081 109 0?8 090 079 096 078 105 077 100 085 110 4 7 . 0 66.5 009 085 102 087 110 087 110 086 102 086 100 098 108 097 106 097 104 6I.5 66 . 0 010 090 095 097 105 C93 103 094 103 091 099 ICO 105 092 104 106 106 4 ? . 0 46.5 O i l O89 108 091 110 086 110 C88 113 091 111 100 12? 106 122 110 119 54.0 53.5 012 077 084 084 094 083 102 094 105 090 107 091 095 090 096 093 113 4 4 . 0 43.5 013 103 145 110 135 110 137 117 144 125 153 130 150 130 157 130 146 68.5 69.5 014 Od5 103 087 106 090 110 085 10? 090 104 100 11? 100 119 103 115 59.0 65.5 015 080 088 077 105 080 105 086 111 087 111 085 110 086 110 090 113 54 . 0 55 . 0 016 080 122 091 128 090 130 085 120 092 123 087 120 090 116 09? 125 62 . 0 61.5 01? 070 098 091 108 096 113 085 104 089 109 085 102 090 113 097 11? 33,0 4 4 . 0 E H CO En O O cm Z w « w EH c c CO a. CO rH rH cm E H < O Q <«; CO < a . EH o o rH < >H CO < << Q a , EH o < CO < a ,EH o r>- << Q X CO < < O Q O HX E H O > << E H CO O < <J E H E H O CM J- < M •-3 >H CO << Q ct, M E H CO O CO < < OH CO << 1 rH Ok CM >H E H <: a a Q < o • o o 2; o o u->tr\vno movn>Aoo>AO>n CO tOfOCC W ^ H O r - H 4 - 4 - \ T \ H ( V H-c^ -vo vXd/ vrwAvo - H - xoxo^nvwo o- co O O O O O O O O O O O O V O i O O V^COCOMD CM CM <M ^ C O ONO r>cj- O- CM MO lAUSVTiJ- VOvO ^j- Ah J - covovrvvo co CM O O VOMD ^J- ^ 4 CO vO CO C*- CO -H/ CD n r i H o h \ o r^ w h- ^ H H r l O r l H H d r l H r l H H H r i C V O O O c M v O C M O C O T - H O vo^OCOvO rH 000 o o \ c ^ n H H O H o r > o \ o r H O O O O r H r H r H r H r H r H O r H O r H f - o o o r i ^ A O ^ o j o ^ c ^ i n o vnco CO . H - rHONCM^O^CM^-CMCMCM^H- COjj-H H H O r i H H H H H r l H H r t H vr^ vr\MD 0 o-voc^-roo c^ -co*nco .3- co O O O N O O C M N O H C O H C O N O C V ) r H r H O O O r H r H O r H I — I H O r t H H l O O O ^ H N ^ X J O v O J - H ^O-^" O v O n n o OHJ-J- H n H n r i n H N H H H O H H H H r l H H H H r l H O O l T i O J N O N n ( N O W » C O * A f ^ O H O O O \ C M M ( M ^ O O W C O C M O N i—I rH TH O O 1—I rH O rH t—I rH O rH CD rH O H H ; N C^-VO MD ^OJH- O N r l C O VOCO CO0OTH CO O ^O - H - O J - CM CM cm-.co.cocm r l H H O H H H H t H H H H n r l H r n c^ - o v o o N r H C O O c o o u ^ r ^ r H O C M OC^ O C O C O C M C M C O t - H C O O O N C M O N r H r H O r H O O r H r H O r H O r H O r H O r H H 4 - O V A N O C O N C*\0 W COM3 CM CO cm cm 0 co o n n TH cm «-h c o c m H H H O O d H d d r l H H H H H roo-co n v r \ \ A O O O H U^ MO vno 0 O O N O C O C O < N - 3 - C O O C O C 7 \ C N O O O r H O O O O r H r H O r H O O O r H r H r H v A c o c ^ - o v O r H v n o c M O C M O O - v n c o CMCM^ONOU-\COCMCOrHCOrHCM-=}-CO r l H O O H H H H H H r l H H H r i tooo ino >Avo_h- n i t i o O C O C O O N C O C M r H O r H C ^ O C O O C J s r H rH O O O O rH rH O rH O rH O rH O rH 0 o-vncomd oo\r>o h n h c o \ o o P J H C N N O ^ N O C M N H O t H N r l H H O O O H H i H r l H H H H r l H ^A^H- VOcM COCO O O- C -^-3- rH CM CM O OO O C O C O C ^ - C O C M O C O O N C O C O C O O O N O O O O O O r H r H O O O O O r H O r H vrwo j t ^ r \ r \ O d - H H \ o o ^ r i N O ONCv-C^-ONj- C O O rH O ON ON O CM O r H O O O O r H r - l O r H O O O O r H r H vnoo o n o o c o o n h w c o o c^-.h- «h onc^-c^-mo ocMOc^-or-cocooNCOO O O O O O r H r H O r H O O O O O r H VOvO O - CO ON O rH CM CO J - VO\o c^-CO o vo to vrwo u~\vO M3MDMDvOMDMDvOvOMD O O O O O O O O O O O O O O O Group 3 - ACTIVE PNF 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 087 075 095 088 111 088 113 100 124 097 125 095 120 088 121 098 123 5 5 . 5 62.0 088 060 083 072 087 065 082 075 097 080 100 084 106 087 106 082 09? 52.0 74 . 0 089 073 073 080 084 077 096 080 092 082 105 080 102 085 103 075 093 48.0 52.0 090 075 120 081 119 085 136 086 125 093 130 094 104 091 12? 089 107 50.0 53.0 091 083 090 095 090 093 102 07? 097 085 105 101 102 098 107 097 104 43.0 41 . 5 092 086 097 098 106 106 127 102 118 100 120 102 115 100 120 097 124 52.0 5 9 . 5 093 090 110 102 104 095 103 099 102 104 121 102 108 105 118 115 140 5 9 . 5 6 0 . 0 094 079 100 08? 110 088 110 088 115 085 109 102 126 095 126 097 129 39.0 ^ 5 . 5 095 085 097 097 106 090 109 095 110 095 117 10? 112 108 120 115 112 5^. 5 6C.0 096 102 101 115 128 108 125 115 125 117 126 120 12? 107 113 120 134 42 . 5 50.0 097 109 092 085 097 080 100 090 095 085 102 098 102 105 111 090 105 50.0 6 6 . 5 098 090 12? 100 135 095 140 096 130 100 133 105 136 105 147 103 138 *+9.5 5 ^ . 0 099 103 121 100 117 108 137 110 126 111 140 113 140 110 145 120 138 4 9 . 0 6 0 . 0 100 080 103 093 113 095 130 110 121 100 124 105 128 100 134 110 120 48 . 0 6 0 . 0 101 068 070 076 085 080 088 095 105 083 097 090 100 096 110 095 098 5 5 . 5 5 8 . 0 102 071 068 0?0 083 0?2 082 075 083 075 090 080 089 085 095 082 095 3 5 . 0 3 9 . 0 103 065 076 082 103 077 100 086 098 095 114 090 110 090 110 092 104 5 8 . 0 6 0 . 5 EH X CO E H o o a , z w w 00 . a , << a , >H EH o Q < 00 a . EH o o T-l < >H 00 Q E H o 00 cu EH O «< 00 < Q P-. a <*: Q 00 o < X CM Q 6H O <; < o >H 00 < <«: eh Q a . 00 n EH w" a < PQ 00 1 rH -=f >H EH O ft Q < 3 O • u o o oooo^oo»noo»no>r\iAoo cocovo o-vpioj r-i CM VTNCO O N rH n o CM > A v^ voxo-o V O ^ H - V N VTN VN, xr\ VN, vr\ oooo>A»noo>AiAo^ovriO^ H O v O O-JH- N O M D CO CO 0 0 0 C^rHvO 04 N O vr.r\4- -3- ^ _j- vnj- O ^ V T V ncNO\ovo v^ -^- o o o co o V A V D vp\O CM C"NCM H W N N C M H N H O ^ C M C N C M ^TN, O N OCT\Ow^)iAo\nooo v^o>n O H O N O H w o o ^ o o o o o N o n H r i O H H r i H O H H H H rH rH rH rH o-co O-N CM co co oNOirnA« M 3 M T i O l M C M r H C M-3 ' r H C M r H C M r H C M C M C M C ' " N V ^ C O O O O O r H O O O O O O O O r H C T N , O H H r l H H H H r l H r l H r l H H H H 4 - 4 - \ 0 O N N O 4 - C 0 r l O C 0 ON 00 H H N O N N O W H O r 4 N H H W r \ V^CO O C M H N O O - O - O - U"N.U~\CO -3" CM CM O N C O r H O O r H O C ^ O O N O O N C N O N r H C M O O r H r H r H r H r H O r H O r H O O O r H r H r>N n o 0--3- 'ooo H- cv^f H " n H o n r H \ O C M r H C M C M O r H O O r H C M C M C M C M - 3 -CM O O rH vnco o ^ vno-vo rvs- o„ O r H O O r H r H O O O O O O O r H r H r H co r°\CNo r^^j- ONCM r \ 0 C N O - O - rH c^ co O VN.CM O r H O O O O r H O C M O C M C M C ^ H d H r l H H H H H r l r l r l H H H r l vr^o CM O CO MO rH vr\ Q I A O N O O O O S O N O O V O O O O N O O M ^ O O O O H C M O O r H O O r H r H O O O O r H O r H r H r H r>o O N Q N - ^ N O N O ^ r N . O N-3- C N O O CO CM V N H ^ H O H H H H O O O N N H N t ^ H H H O H H r t r l r l H r i r t r l r l r l r l H O ovn^cM^ A r ^ N r ^ r ^ c M O r H O N O ^ O N O O C ^ O O O O N C N O O O N O ON O rH O r H O O O r H O O O O O O r H O r H r H VP\ O- O NO rH rH CM ^ C O CO CO CN C*S O NO CM O J - H O H r l O O O O O r l O H H f n r l H H O H H H H O H O H H H H H r H C ^ - O O V N C ^ C M O O C^NO O- NO CM O CM ONONONC^-O O ON ON CN ON ONCO ON ON rH rH O O O O r H r H O O O O O O O O r H r H CN-0-VO,{>-C<NCMc}--d- O r^VfN.O-rH O N C M r H O N O r H O C O 000 O O ON O ON CM O r H r H O r H r H r H O O O O r H O r H O r H r^o^o o ^ H \ O N N r^r^c^NM^c^Nr^ON C N O ON OO CO O ON N O CTNCO CO CO O - O c O rH O r H O O O r H O O O O O O O O O r H jH/ u^\o O-CO ON O T-H CM rsst ^ N O O-CO ON O O O O O O r H r H r H r H r H r H r H r H r H r H 77 o o o v o o v o o v o v o v o o v o o o vo vr> vo vo o ^ o \ o VOVOCO_H- o O \ o (>r-i t^co NVO N H C\ _H;\C v o v o v o j - v o j - vovo-j- vo vr\ VOMD vo MO -3" -H/ o o o o o o o o o v o o v o v o v o o o o o v o N H \ 0 O N OvOMD COMO VO.J- OMD J " O ^ O- CO vn^t vo j - r \ r \ > A m^j- vo t o vo vo_j- vo r o r o c n o \ C M 4 ro o CM H H N O N O O _H- CM CM VO CM rH CM rO-j" C O O rH CM H ^ t COVOrOCOT-ICM CM -Hf r H r H r H r H r H r H r H r H r H r H r H r H r H r H r H r H r H r H T H ^ • r - i c J - v o o v o r o o o v o r M O vo^t vo O CM CM r o Q C O N O H H O O O O O H C O H H H O W H ONChN O O rH rH rH rH O O r H O r H r H r H r H r H r H O O r H O S CM M O CM rH rH O O- C O C O CO rH O-VO COCO VOCX) ON C\] rH C O CO V O . H - O rH CM rH CO CM -3" .j- CM rH CM CO^J-r l H H H r l r l H H r t r l H H H H H r l H r l H COvO M D O v O O O C M C M O COVOvO -d" O - J - VO VO VO O I C O O r - t r - t O C O C ^ - O O N O N O r H O r H O C D O C M O O r H r H r H r H O O r H O O r H r H r H r H r H O r H r H O ^ J - C \ j O O M 3 0 0 J - 0 0 VOCO O O- CM VO CM CM C M O C M C O J - r O O N r H r O C M ^ } - r H r O c } - r H r H O co.;}-r H r H r H r H r H r - t O r - H r H r H r - l r H l - H r H T H T H T H r H T H O C ^ C ^ C ^ O C ^ C O V O O \ O V O O O V O O C O O C M M 3 00 C O O O O O C ^ C O r H C O O O C M O N r H O N C O O r H O O O r H r H r H O O r H O r H r H r H O r H O O T - t r - H V O V O O V P \ O C O C O C M COONCO O H M O - \ O co^t O O C M C O V O r H O s O C M r H ^ C M ^ } - C M r H T H O COjj-T H r H r H r H T H r H O r H T H r H r H r H r - H T H T - l r H r H r H T H ^ • O V O O C M M O O v O V O O r O O - C O O C O C M V O O O C ^ O D O r - H O O C O M D O C O r H O r H O O O C O O C M O O O r H O O O O r H O r H O r H O O r H O r H r H O i X I C M O - r - H C M V O O O C M C O V O vOvO C^CO O CM O r H O C M r H V O C M O O C M O j H - C M ^ rH O rH rH CO CO H H H H H H O r i H H H H H H H H H H r l o - o . - i c o r - . H - o o vo c o o v o v o c o v o o v o o C O O O O rH O O M O O C - r H O r H O O O O O O O O O r H r H r H O O r H O r H r H r H r H r H r H O r H r H co v o o v o j - c ^ r H C ^ v n o v o c v o v o c M covoao r o r H r H r H r H r H r H r H r H T H r H T H r H T H T H T H r H T H T H r - H C ^ - O v O C O o- oo v o v o o VOCO VO.H- O- CM O CM VO O-o c o o o o c ^ - v n o o-CM O rH O O O C O C O T H O O O O O O O O r H O r H r H r H O O r H O O r H O • 5H CO CO CM VO 00 VO CM rH CO VO CO O VO CM O O rH O CO o HH «J O O r H r H C M C M O O r H O r O r H C O C M O O C O O-d" gH Q CL, r H r H r H T H r H r H T H r H r H T H r H r H T H T H T H r H O O X £ H vovniCOcM CM O V O V O O C O VOCM V O O O O CM COVO <£, O C^-CO C O C O O O O-M0 O f>- O O O O O O^O CO O << O O O O O O O O O O O r H r H O O O O O w rr; to o VT>UOCM C^-MO rH o o Af o CM v o v o v o r o v o c o o O C T ) rH O O C O O C O rH Ov CM rH CM CM O O C O M O CM I rH 0-1 O O r H r H r H O O O r H O r H r H r H r H r H O O O VO >H EH C O O M O VOO CM O O CM VOvO -d" VO00 -d" O-vO T H O O - O - C C C O C O C*- C O vo O vO C O C O O O O CO M3 O- o Q O O O O O O O O O O O O r H O O O O O 3 O • \ O C - - - C O O O r H C M C O _ H - VOvO O- CO O O rH CM CO^ H-U O r o r o c o r o ^ j - _H- _d _H- _d: _d _d- _d _d v o v o v o v o v o u z: 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 £ H X CO EH o O CM W (X W EH CO OH CO rH << rH OH >H EH < O a CO < OH EH o rH < >H CO «< Q OH &H o •< CO OH EH O -< >H CO < Q OH EH CO << CO < OH EH O -H- < >   <  OH EH   CO << rH OH >  EH O Q < • o Group 6 - PASSIVE PNF 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 070 090 112 097 120 112 125 HO 123 114 134 111 145 U 3 148 118 147 52.0 49.0 071 101 106 111 126 125 145 118 140 125 150 11? 144 115 146 135 158 64.0 70.0 072 060 091 088 114 085 117 090 115 110 128 090 122 090 130 092 126 50.0 53.5 073 100 109 108 107 105 135 110 128 112 137 124 140 130 151 126 142 50.0 52.5 074 o?3 095 080 106 080 112 0?0 118 082 125 092 128 085 135 092 125 45.0 41.0 075 080 104 093 132 093 146 085 125 095 126 085 125 080 134 098 132 49.0 51.0 076 075 095 087 100 085 115 090 113 087 117 096 125 095 126 091 125 28.0 41.0 077 095 111 112 125 106 130 104 131 111 136 108 130 106 137 115 137 44.0 50.0 078 095 110 100 100 097 120 095 112 095 119 100 118 105 136 092 114 48.0 63.O 079 080 080 080 082 087 090 090 088 094 096 096 095 091 105 095 113 62.0 64.0 080 086 115 090 115 110 142 100 126 095 138 100 125 104 12? 105 136 54.0 64.0 081 035 092 087 113 090 121 095 116 095 118 104 123 107 131 112 126 47.5 52,5 082 097 100 097 102 085 098 100 114 105 120 107 115 107 U 5 110 U 5 47.0 40.5 083 118 140 123 153 132 162 127 150 140 165 137 162 138 162 139 164 51.0 61.0 084 073 090 082 112 077 107 0?2 105 080 U 5 0?0 110 080 121 0?6 115 32.0 54.0 085 082 105 083 120 080 120 087 125 O85 126 082 115 081 126 085 124 42.0 47.0 086 096 104 0?9 101 088 114 100 118 100 116 104 115 102 132 105 126 32.0 42.0 e-i o o v o v o v o o o o o o o v n t o t o v o o t o o x co EH O W O O O J O - M O M O C O C M \ C - d COrH CO^t CO .H- _H-O CM vo v r \ v n v A 4 4 ^ j - c^vo cvir\>Ti»rivnvovo >r\ z; W O O O V O O V O O O v o v o o O V O O O O O t o os . . . . . . . . . . . . . . . . . . EH CC rH C M M O (\I CM V O C O (\! V O . H " O O C O O V O O M 0 M 3 CO O , V O V O C O . H » j$ ^ C O V O M O vo.j- tovo^H/ \r\vo CO CO CO CM rH VOOCOCOcM O- VOCO VOtOvOvr>CM o rH < n j - O VT\H- H N H O O N \ f l 4 - H ^ i A ^ rH CX, r H r H r H r H r H r H r H r H r H r H ^ H r H r H r H r H r H r H r H >H E H O-CO CO 0 0 C O rH CM t O O - O - O N N C O H ( ^ i O J ; •< O O CM O C O C O O O V O O O O CM O rH COrH rH Q «< r H r H r H O O r H r H O O O O r H r H O r H r H r H r H CO vO_d" CM O MO O M O TH O- O VO CM O O- CO tO vO.Hf ^ vn CM CM O MO CO rH CM CM CM CM .H; rH ^ .3- C O E H O- V O V O O- -H^ C O t O CM CO MO O O O CM O- O C O V O O C J rH CM O C O CO J H - O O O O O O O J " O O CM rH O rH <C| r H r H O O O r H O O O O O O r H O r H r H i - H O >H CO -3" CO O CM tOcM O CO rH O MO to O coco o o - o --< «< 4 - 4 - C O CM O VO_H; O rH rH rH CM VO_j- H 4 4 H Q PL, T H r H r H r H r H r H r H r H r H r H r H r H r H r H r H r H r - t r H EH V O O - J - C O J - O rOVOVOOJMO COjj- O - O - O - T H V O O H H O O C O C O O O O O CO O CM O O CM rH CO •< rH rH rH O O rH rH O O O O rH rH O rH T H TH O CO - d MO O O O V O O - jfr - j - J - V O O CMMO CM COCO vo V O C O C O CM rH VO CO rH O rH CO CM MO CO CM VO-Hf CO CL, H H H r l H . H H H H H r i H H H H H H H £ H O O - ' O -j- cOjH> VO V O O CM O VOCM V O O d t t ) H CJ O r H O O C O r H O O O O O O ^ t O C M C M O r H O- -< r H r H r H O O r H O O O O O H H O H H H r i >H CO C^MO O- CO O MO V O O O- O O O O CM O CM -d* O -«i •< CM C O rH rH O VOCM rH O O rH rH MO CO rH ^J" CO CM Q -CM T H r H r H r H r H r H r H r H O r H T H r H r H r H r H r H T H r H E H O O - C M V O O O O O O 0 0 V O O O O O V O C O O O rH t-H O O C O CM O CO 0 0 CO O- O CO O rH CM O rH <£, r H r H r H O O r H O O O O O r H r H O r H r H O r H X CO CM VO rH CO CM 0 \ 0 -d" O- O rH vo O VOVO COCO rH O << + N H O O VOCM O O rH CM CM MO CM rH VOjH; CO E H CL, r H r H r H r H r H r H r H r H O r H r H r H r H r H r H r - H r H r H W CC E H O O-MO O VO rH V O V O CM CM VO CO O VO V O V O rH V O £ H O O rH O C O CO rH 00 O - O O C O O CM CO O CM rH rH CO - d r H r H O O O r H O O O O O O r H O r H r H r H r H Q >H CO C M C M 0 0 O O C O C O O - O - O O O O O O - C M r H O -W •< << CM CM O O O C O r H O O O rH rH VO rH O-Cfr CO rH O Q CM T H r H r H O O r H r H r H O r H r H r H r H r H O r H r H r H O E H CM O VOCM O VOCM MO O to vovojj- O CO V O C > - V O t-1 CJ O rH O C O CO O O C ^ O C O O O O r H C O O O CM 0 0 rH O < r H r H O O O r H O O O O O O r H O O r H O r H OS CM CO O CM rH VOMO VOCO J " J - O CM J " V O O V O O - ^ } - V O CM rH O O O- COO CO O O O O VO rH O CM rH O I rH CM H H H H O H H O O r t H H r l H O H H H r - >H EH V O CM O- O V O O CM VO VO COCO V O O - VO C O O M 0 O << O O O O C O O r H O O ' O O O - O - C O C M C O O r H C O O CX Q <, O r H O O O r H O O O O O O r H O O r H O r H 3 O CO O O rH CM CO_d- VOM0 O- CO O O rH CM CO vo U O r H r H N C M C M C M C M C M C M C M C M C M C O C O C O C O C O C O o 2: O O O O O O O O O O O O O O O O O O APPENDIX B INTERPRETATION OF PHYSIOLOGICAL MECHANISMS UNDERLYING THE SIX METHODS 80 A l l of the following methods are assumed to have an effect on the lengthening of soft tissue. However, each method has a unique approach to the problem of increasing range of motion. Prolonged Stretch» I t i s well known that the myotatic reflex declines over time. The prolonged position of stretch i s thought to introduce fatigue and/or accommodation i n the tonic stretch receptors. In prolonged stretch, the phasic component of the myotatic response i s effectively eliminated and thus the reflex to contract the stretched muscle i s potentially reduced. Relaxation and Prolonged Stretch I t can be reasoned that the a b i l i t y of muscle fibres to lengthen i s dependent upon their state of relaxation. Mindset techniques as well as progressive relaxation deal with this goal i n terms of tension awareness. I f a relaxed state can be induced i n combination with the prolonged stretch exercise, the following i s expected: 1. Reduction of the myotatic reflex due to accommodation 2. Voluntary in h i b i t i o n of the reflex due to tension aware-ness 3. Later onset of the reflex due to gamma bias accomplished by mind-set. Passive PNF The physiological bases for this method i s that the soft tissue undergoing passive lengthening w i l l undergo even greater stretch, particularly at the tendinous junctions, during the isometric extensor contraction phase. The max-imal extensor contraction also f a c i l i t a t e s the relaxation of the extensors when they cease contraction. Active PNF The physiological bases for the Active PNF method appear to bei a) f a c i l i t a t i o n of flexor contraction following extensor contraction (successive induction) b) f a c i l i t a t i o n of extensor relaxation due to inh i b i t i o n of the stretch reflex following extensor contraction c) f a c i l i t a t i o n of extensor relaxation due to the contribution of the tendon reflex (inverse myotatic re f l e x ) . B a l l i s t i c The rationale for " b a l l i s t i c and hold" i s that the "hold", introduces a quality of control at the joint l i m i t that may prevent tissue damage which has been a concern with this method.; The dynamics of this a c t i v i t y allows i t to contribute to flexor strength and fast lengthening action of the extensors as i s required for sport movements. 82 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 reciprocal in h i b i t i o n (relaxation) of the extensors by active contract-ion of the flexors when the hip flexors (iliopsoas and rectus femoris) are actively called upon i n terms of strength to hold the leg i n a position of maximal extension. 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 h i p f l e x i o n over the next four weeks. I t i s appropriate t h a t 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). T h i s means that i f we are meeting three times a week with yeur 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. 84 INSTRUCTIONS FOR PASSIVE LIFT, ACTIVE HOLD METHOD 1. While l y i n g on your back, just relax and l e t your p a r t n e r 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 t h a t 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 six second m o b i l i z a t i o n of the l e g , the part-ner w i l l slowly release her support on the l e g and i t i s then up t o 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 six second i n t e r v a l , the partner w i l l give you support a g a i n , and move you slowly to at 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 six seconds, a t o t a l o f 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 e x e r c i s e 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 85 "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 also 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 time? 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 poss 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 res 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. 86 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 six 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 contraction ( i . e . the partner w i l l r e s i s t the down movement) f o r six 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 si 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 v/hen the subject commences to exercise. 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 bracing her legs, 87 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. I n 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 contraction 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 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 3ALLISTIC 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 dov/n. 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 88 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 six 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 'fl 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 act-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 addition, there w i l l be some "thinking" processes attached to your method. Please read the fol 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 89 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 s t 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 relax, the l e s s palin you w i l l f e e l because the muscle v / 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 in.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 part-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 RELAX7.. : the stretched muscle. 90 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 ( proprioceptive neuro-muscular f a c i l i t a t i o n ) . Please read the fol 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 relax 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 exercise. 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 to 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 whe^e 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 six 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 rel 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 in t o the st 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 pa 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 stretches, f i v e push downs i n one minute). You w i l l be active 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. 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 six 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 dov/nward l e g push of the subject. In order to stop a l l movement down-ward and make the con t r a c t i o n 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 twi s t i n g of the hips. NAME The s t r e t c h i n g method that you have been assigned t o 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 important to keep the r i g h t l e g s t r a i g h t throughout the exe r c i s e . 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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