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Korea Proprioceptive Neuromuscular Facilitation Association (대한고유수용성신경근촉진법학회)
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Effects of Relaxation Techniques on Flexibility and Balance of the Lower Limb in Adults with Hamstring Shortening

넙다리뒤근 단축이 있는 성인에게 이완 기법의 적용이 하지의 유연성과 균형에 미치는 영향

  • Jung-Woo Lee (Department of Physical Therapy, Graduate school of Eulji University) ;
  • Seong-Min Jeon (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Ha-Yeong Kim (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Jong-Yeon Bae (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Song-Chan Son (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Eun-Jin Song (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Sang-Eun Sim (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Hyeong-Uk Lee (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Hye-Kyeong Lee (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Baek-Gwang Jo (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Sung-Bin Jo (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Jin-Hee Joo (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Ha-Yeon Jin (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Jeong-Hyeon Hwang (Department of Physical Therapy, College of Health Science, Eulji University) ;
  • Min-Hee Kim (Department of Physical Therapy, College of Health Science, Eulji University)
  • 이정우 (을지대학교 대학원 물리치료학과) ;
  • 전성민 (을지대학교 물리치료학과) ;
  • 김하영 (을지대학교 물리치료학과) ;
  • 배종연 (을지대학교 물리치료학과) ;
  • 손송찬 (을지대학교 물리치료학과) ;
  • 송은진 (을지대학교 물리치료학과) ;
  • 심상은 (을지대학교 물리치료학과) ;
  • 이형욱 (을지대학교 물리치료학과) ;
  • 이혜경 (을지대학교 물리치료학과) ;
  • 조백광 (을지대학교 물리치료학과) ;
  • 조성빈 (을지대학교 물리치료학과) ;
  • 주진희 (을지대학교 물리치료학과) ;
  • 진하연 (을지대학교 물리치료학과) ;
  • 황정현 (을지대학교 물리치료학과) ;
  • 김민희 (을지대학교 물리치료학과)
  • Received : 2024.03.11
  • Accepted : 2024.04.01
  • Published : 2024.04.30
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Abstract

Purpose: The purpose of this study was to investigate the effects of three relaxation techniques, namely, Static Stretching Exercise (SSE), Eccentric Contraction Exercise (ECE), and Suboccipital Muscle Release (SMR) on the flexibility and balance of the lower limb in adults with hamstring shortening. Methods: The participants were 45 adults in their 20s with hamstring shortening. They performed three exercises (i.e., SSE, ECE, and SMR) for two weeks. We measured flexibility, muscle tone and stiffness, proprioception, and balance before and after the intervention, applying each relaxation technique. Data were analyzed using two-way repeated measures analysis of variance (ANOVA). The significance level was set at α=0.05. Results: Flexibility increased in the SSE, ECE, and SMR groups, with the SSE group showing the greatest improvement. Muscle tone and stiffness decreased in all groups, with the ECE group exhibiting the highest reduction. Proprioception increased in the SSE, ECE, and SMR groups, with SSE demonstrating the greatest enhancement. Balance also increased in all groups, with the ECE group showing the most pronounced improvement. Conclusion: Overall, all three relaxation techniques for hamstring shortening resulted in improved flexibility, muscle tone and stiffness, proprioception, and balance of the lower limb in adults with hamstring shortening. The findings of this study underscore the importance of selecting an appropriate technique according to the purpose of treatment and the condition of the patient.

Keywords

References

  1. Ahmed H, Anwer S, Iqbal A, et al. Effect of modified hold-relax stretching and static stretching on hamstring muscle flexibility. Journal of Physical Therapy Science. 2015;27(2):535-538.
  2. Alexander KM, LaPier TL. Differences in static balance and weight distribution between normal subjects and subjects with chronic unilateral low back pain. The Journal of Orthopaedic and Sports Physical Therapy. 1998;28(6):378-383. https://doi.org/10.2519/jospt.1998.28.6.378
  3. Aparicio EQ, Quirante LB, Blanco CR, et al. Immediate effects of the suboccipital muscle inhibition technique in subjects with short hamstring syndrome. Journal of Manipulative and Physiological Therapeutics. 2009; 32(4):262-269. https://doi.org/10.1016/j.jmpt.2009.03.006
  4. Baek JK. Correlation between functional lower extremity instability on Y-balance test and muscle activity and functional movement of ankle. Korea University. Dissertation of Master's Degree. 2017.
  5. Beier Z, Earp I, Korak JA. Self-Myofascial Release Does Not Improve Back Squat Range of Motion, Alter Muscle Activation, or Aid in Perceived Recovery 24-Hours Following Lower Body Resistance Training. International Journal of Exercise Science. 2019;12(3):839-846.
  6. Bong EB, Kwak JS, Jung HJ, et al. The Effects of Nordic hamstring exercise on the different surface to muscle strength, proprioception and postural sway in healthy adult. International Journal of Psychosocial Rehabilitation. 2020;24(7):1602-1610.
  7. Boukabache A, Preece SJ, Brookes N. Prolonged sitting and physical inactivity are associated with limited hip extension: A cross-sectional study. Musculoskeletal Science and Practice. 2021;51:102282.
  8. Bourne MN, Timmins RG, Opar DA, et al. An Evidence-Based Framework for Strengthening Exercise to Prevent Hamstring Injury. Sports Medicine. 2018;48(2):251-267. https://doi.org/10.1007/s40279-017-0796-x
  9. Byun HY. The Effect on Elderly Female Osteoarthritis Patients' Static Balance, Walking Function, and Pain of an Underwater Remedial Exercise Program. Kyungpook National University. Dissertation of Master's Degree. 2015.
  10. Cadellans-Arroniz A, Lopez-de-Celis C, Perez-Bellmunt A, et al. Effects of Diacutaneous Fibrolysis on Passive Neuromuscular Response and Mechanosensitivity in Athletes with Hamstring Shortening: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2021;18(12):6554.
  11. Cadellans-Arroniz A, Lopez-de-Celis C, Rodriguez-Sanz J, et al. Immediate effects of diacutaneous fib rolysis in athletes with hamstring shortening. A randomized within-participant clinical trial. PLOS ONE. 2022;17(7):e0270218.
  12. Cho SH, Kim SH, Park DJ. The comparison of the immediate effects of application of the suboccipital muscle inhibition and self-myofascial release techniques in the suboccipital region on short hamstring. Journal of Physical Therapy Science. 2015;27(1):195-197. https://doi.org/10.1589/jpts.27.195
  13. Cuthbert M, Ripley N, McMahon JJ, et al. The Effect of Nordic Hamstring Exercise Intervention Volume on Eccentric Strength and Muscle Architecture Adaptations: A Systematic Review and Meta-analyses. Sports Medicine. 2020;50(1):83-99. https://doi.org/10.1007/s40279-019-01178-7
  14. Davis DS, Ashby PE, McCale KL, et al. The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. Journal of Strength and Conditioning Research. 2005;19(1):27-32.
  15. Ditroilo M, De Vito G, Delahunt E. Kinematic and electromyographic analysis of the Nordic Hamstring Exercise. Journal of Electromyography and Kinesiology. 2013;23(5):1111-1118. https://doi.org/10.1016/j.jelekin.2013.05.008
  16. Faul F, Erdfelder E, Lang AG, et al. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007;39(2):175-191.
  17. Frey M, Poynter A, Younge K, et al. The relationship between lumbopelvic flexibility and sitting posture in adult women. Journal of Biomechanics. 2019;84:204-210. https://doi.org/10.1016/j.jbiomech.2018.12.048
  18. Ghaffarinejad F, Taghizadeh S, Mohammadi F. Effect of static stretching of muscles surrounding the knee on knee joint position sense. British Journal of Sports Medicine. 2007;41(10):684-687. https://doi.org/10.1136/bjsm.2006.032425
  19. Hamid MS, Ali MR, Yusof A. Interrater and Intrarater Reliability of the Active Knee Extension (AKE) Test among Healthy Adults. Journal of Physical Therapy Science. 2013;25(8):957-961.
  20. Han HG, Choe YJ, Jeong SH, et al. Inter-and intra-rater reliabilities of Myotonometric Measurement of the erector spinae muscles in the young and old age groups. Journal of The Korean Society of Integrative Medicine. 2021;9(1):193-202.
  21. Han HG, Choe YJ, Jeong SH, et al. Inter-and Intra-rater Reliabilities of Myotonometric Measurement of the Erector Spinae Muscles in the Young and Old Age Groups. Journal of The Korean Society of Integrative Medicine. 2021;9(1):193-202.
  22. Heo J. Effects of rectus abdominis relaxation intervention on low back pain and muscle elasticity in office workers. Eulji University. Dissertation of Master's Degree. 2022.
  23. Hody S, Croisier JL, Bury T, et al. Eccentric Muscle Contractions: Risks and Benefits. Frontiers in Physiology. 2019;10:536.
  24. Hyun JM. Effects of Proprioception Training on the Functions and Position Sense of the Knee Joints in the Patients with Anterior Cruciate Injury. Daegu University. Dissertation of Master's Degree. 2013.
  25. Itotani K, Kawahata K, Takashima W, et al. Myofascial Release of the Hamstrings Improves Physical Performance-A Study of Young Adults. Healthcare(Basel, Switzerland). 2021;9(6):674.
  26. Jandre Reis FJ, Macedo AR. Influence of Hamstring Tightness in Pelvic, Lumb ar and Trunk Range of Motion in Low Back Pain and Asymptomatic Volunteers during Forward Bending. Asian Spine Journal. 2015;9(4):535-540. https://doi.org/10.4184/asj.2015.9.4.535
  27. Jeon HN. Immediate effect of Kaltenborn-Evjenth, proprioceptive neuromuscular facilitation, and static stretching on flexibility, proprioception, and dynamic balance of hamstring muscles in healthy subjects. Konyang University. Dissertation of Master's Degree. 2019.
  28. Jung DW. Comparison of Dynamic Control Ratio and Lower Extremity Muscle Activity During Eccentric Hamstring Exercises. Catholic University of Pusan. Dissertation of Master's Degree. 2022.
  29. Jung MG, Kim NW, Lee YW. Immediate effect of hip hinge exercise stretching on flexibility of lower limb, pelvic tilting angle, proprioception and dynamic balance in individual with hamstring tightness. Physical Therapy Rehabilitation Science. 2022;11(2):259-268. https://doi.org/10.14474/ptrs.2022.11.2.259
  30. Kim CG. A Comparison of subjective discomfort, joint kinematics, muscle activation, and pressure distribution according to foot position in prolonged sitting posture. Honam University, Dissertation of Master's Degree. 2022.
  31. Kim GW, Lee JH. Hamstring foam roller release and sole self myofascial release for improving hamstring muscles flexibility in participants with hamstring shortness. Journal of the Korean Society of Physical Medicine. 2020;15(4):1-9.
  32. Kim JH, Kim TH. Immediate Effects of Stretching on Hamstring Stiffness. The Journal of Korean Society of Physical Therapy. 2010;22(1):1-7.
  33. Kim JW, Nam GE, Huh Y, et al. Association between Sitting Time and Hyperuricemia in Korean Adults: Results from the 2016-2018 Korea National Health and Nutrition Examination Survey. Korean Journal of Family Practice. 2020;10(6):469-473. https://doi.org/10.21215/kjfp.2020.10.6.469
  34. Kim SJ. Evaluation of functional ability of functional ankle instability athletes through three types of Hope test and Y-balance test. Kyung Hee University, Dissertation of Master's Degree. 2013.
  35. Kim TE, Choi BR. The Immediate Effects of Hamstring Eccentric Exercise and Static Stretching on Trunk Forward Bending. Physical Therapy Korea. 2019;26(3):32-41. https://doi.org/10.12674/ptk.2019.26.3.032
  36. Kim TH, Goo BO, Yun SW, et al. Effect of suboccipital muscle inhibition and combination technique on the flexibility of hamstring in individuals with shortened hamstring. Journal of Korea Proprioceptive Neuromuscular Facilitation Association. 2015;13(1):31-37.
  37. Kim YJ, Park JH, Kim JH, et al. Effect of High-frequency Diathermy on Hamstring Tightness. Korean Research Society of Physical Therapy. 2021;28(1):65-71. https://doi.org/10.12674/ptk.2021.28.1.65
  38. Kim YR. The effects of trunk stabilization exercise, respiratory exercise with joint mobilization on muscle tone of shoulder joint, upper limb function and postural alignment. Young In University. Dissertation of Doctorate Degree. 2017.
  39. Kim YW, Chang WH, Kim NY, et al. Effect of Extracorporeal Shock Wave Therapy on Hamstring Tightness in Healthy Subjects: A Pilot Study, Yonsei Medical Journal. 2017;58(3):644-649.
  40. Kisner C, Colby LA, Borstad J, Therapeutic Exercise, 7th ed, FA Davis, 2020.
  41. Korea Disease Control and Prevention Agency. 2005 National Health Statistics, 2012.08.30.
  42. Korea Disease Control and Prevention Agency. 2020 National Health Statistics, 2022.01.28.
  43. Krause F, Wilke J, Niederer D, et al. Acute effects of foam rolling on passive tissue stiffness and fascial sliding: study protocol for a randomized controlled trial. Trials. 2017;18(1):114.
  44. Kumar GP. Comparison of cyclic loading and hold relax technique in increasing resting length of hamstring muscles. Hong Kong Physiotherapy Journal. 2011;29(1):31-33. https://doi.org/10.1016/j.hkpj.2011.03.002
  45. Lee HR, Shim JH, Oh DW. Effects of High-frequency Diathermy Integrated into Suboccipital Release on Tenderness and Neck Mobility and Disability in People with Chronic Tension-type Headache. Physical Therapy Korea. 2017;24(2):37-47.
  46. Lee SY. Proprioception. The Asian Journal of Kinesiology. 2014;2014(0):55-57.
  47. Lexell J, Flansbjer UB. Muscle strength training, gait performance and physiotherapy after stroke. Minerva Medica. 2008;99(4):353-68.
  48. Lim SK. The Relationship between Pain Level and Hamstring Flexibility and the Validity of Hamstring Flexibility and Hip Mobility Test using ASLR Test in Middle-aged Women with Chronic Low Back Pain. Journal of Coaching Development. 2021;23(3):240-246.
  49. Lim WT. Influence of successive active knee extension tests on hamstring flexibility. Korean Physical Therapy Science. 2021;28(1):76-84.
  50. Medeiros DM, Cini A, Sb ruzzi G, et al. Influence of static stretching on hamstring flexibility in healthy young adults: Systematic review and meta-analysis. Physiotherapy Theory and Practice. 2016;32(6):438-445. https://doi.org/10.1080/09593985.2016.1204401
  51. Meerits TA, Bacchieri ST, Paasuke MT. Acute effect of static and dynamic stretching on tone and elasticity of hamstring muscle and on vertical jump performance in track-and-field athletes. Acta Kinesiologiae Universitatis Tartuensis. 2014;20:48-59. https://doi.org/10.12697/akut.2014.20.05
  52. Nagamori A, Valero-Cuevas FJ, Finley JM. Unilateral Eccentric Contraction of the Plantarflexors Leads to Bilateral Alterations in Leg Dexterity. Frontiers in Physiology. 2016;30(7):582.
  53. Nam KW. The Analysis on Relation between Hamstring Length and Static Uprighting Balance. Journal of Korean Physical Therapy Science. 2011;18(1):51-60.
  54. Nelson RT, Bandy WD. Eccentric Training and Static Stretching Improve Hamstring Flexibility of High School Males. Journal of Athletic Training. 2004;39(3):254-258.
  55. Neumann DA, Kinesiology of the Musculoskeletal System, 3rd ed, Mosby Inc, 2016.
  56. Park JA. Relationship between Static Balance Ability and Cognitive Function in College Students. The Journal of the Korean Association on Developmental Disabilities. 2014;18(1):1-17.
  57. Park SR. The effects of selective self stretching on muscle elasticity, flexibility and dynamic balance of hamstring. Kangwon National University. Dissertation of Master's Degree. 2018.
  58. Perret C, Serge Poiraudeau, Jacques Fermanian et al. Validity, reliability, and responsiveness of the fingertip-to-floor test. Archives of Physical Medicine and Rehabilitation. 2001;82(11):1566-1570. https://doi.org/10.1053/apmr.2001.26064
  59. Ramesh M, Sivasankar P. Comparison of Three Different Physiotherapeutic Interventions in Improving Hamstring Flexibility in Individuals with Hamstring Tightness. International Journal of Health Sciences & Research. 2014;4(6):129-134.
  60. Ribeiro-Alvares JB, Marques VB, Vaz MA, et al. Four Weeks of Nordic Hamstring Exercise Reduce Muscle Injury Risk Factors in Young Adults. Journal of Strength and Conditioning Research. 2018;32(5):1254-1262. https://doi.org/10.1519/JSC.0000000000001975
  61. Sadler SG, Spink MJ, Ho A, et al. Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskeletal Disorders. 2017;18(1):179.
  62. Seo HK, Kim EH, Choi YJ. Comparison of the Immediate Effects of the Static Stretching and Suboccipital Muscle Release on Pain and Hamstring Flexibility in Low Back Pain Patients with Short Hamstring Syndrome. Journal of Korean Society for Rhythmic Exercises. 2017;10(2):25-34.
  63. Shamsi M, Mirzaei M, Shahsavari S, et al. Modeling the effect of static stretching and strengthening exercise in lengthened position on balance in low back pain subject with shortened hamstring: a randomized controlled clinical trial. BMC Musculoskeletal Disorders. 2020;21(1):809.
  64. Shin SY, Health behavior and sitting time effects of single-person households on obesity: A comparative analysis of educational levels. Journal of the Korea Contents Association. 2022;22(7):395-404.
  65. Song SH. The effects of eccentric muscle contraction program on walking and balance ability of children with brain lesion disorder. The Asian Journal of Kinesiology. 2019;21(1):46-54. https://doi.org/10.15758/ajk.2019.21.1.46
  66. Stamatakis E, Gale J, Bauman A, et al. Sitting Time, Physical Activity, and Risk of Mortality in Adults. Journal of the American College of Cardiology. 2019;73(16):2062-2072. https://doi.org/10.1016/j.jacc.2019.02.031
  67. Takeuchi K, Nakamura M. Influence of High Intensity 20-Second Static Stretching on the Flexibility and Strength of Hamstrings. Journal of Sports Science and Medicine. 2020;19(2):429-435.
  68. Torres R, Duarte JA, Cabri JM. An Acute Bout of Quadriceps Muscle Stretching has no Influence on Knee Joint Proprioception. Journal of Human Kinetics. 2012;34:33-39.
  69. Uysal O, Delioglu K, Firat T. The effects of hamstring training methods on muscle viscoelastic properties in healthy young individuals. Scandinavian Journal of Medicine & Science in Sports. 2021;31(2):371-379. https://doi.org/10.1111/sms.13856
  70. Weppler CH, Magnusson SP. Increasing muscle extensibility: a matter of increasing length or modifying sensation? Physical Therapy. 2010;90(3):438-449. https://doi.org/10.2522/ptj.20090012
  71. Wesam SA, Mohamed A. The effect of combining plyometrics exercises and balance exercises in improving dynamic balance among female college athletes: A randomized controlled trial. The Journal of Injury, Function, and Rehabilitation. 2021;10(1002):1-11.
  72. Wisdom KM, Delp SL, Kuhl E. Use it or lose it: multiscale skeletal muscle adaptation to mechanical stimuli. Biomechanics and Modeling in Mechanobiology. 2015;14(2):195-215. https://doi.org/10.1007/s10237-014-0607-3
  73. Yuksel HS, Sahin FN, Maksimovic N, et al. School-Based Intervention Programs for Preventing Obesity and Promoting Physical Activity and Fitness: A Systematic Review. International Journal of Environmental Research and Public Health. 2020;17(1):347.