Background. Hamstring injuries continue to affect active individuals and although inadequate muscle extensibility remains a commonly accepted factor, little is known about the most effective method to improve flexibility. Purpose. To determine if an isolated neurodynamic sciatic sliding technique would improve hamstring flexibility to a greater degree than stretching or a placebo intervention in asymptomatic subjects with short hamstring syndrome (SHS). Study Design. Randomized double-blinded controlled trial. Methods. One hundred and twenty subjects with SHS were randomized to 1 of 3 groups: neurodynamic sliding, hamstring stretching, and placebo control. Each subject’s dominant leg was measured for straight leg raise (SLR) range of motion (ROM) before and after interventions. Data were analyzed with a mixed model ANOVA followed by simple main effects analyses. Results. At the end of the study, more ROM was observed in the Neurodynamic and Stretching groups compared to the Control group and more ROM in the Neurodynamic group compared to Stretching group. Conclusion. Findings suggest that a neurodynamic sliding technique will increase hamstring flexibility to a greater degree than static hamstring stretching in healthy subjects with SHS. Clinical Relevance. The use of neurodynamic sliding techniques to improve hamstring flexibility in sports may lead to a decreased incidence in injuries; however, this needs to be formally tested. 1. Introduction Injuries to the hamstring musculature are commonplace in many mainstream sports and occupations involving physical activity [1, 2]. They have not declined in recent times and the high rate of recurrence suggests that the current understanding of such injuries remains incomplete [3]. Hamstring muscle strains/tears account for 13–15% of injuries in Australian football [4, 5], 11% of injuries in elite New Zealand cricketers [6], 12–14% of injuries in professional soccer [7, 8], and up to 24% of injuries in Gaelic football [9]. Many predisposing factors for hamstring injury have been suggested within the literature, including insufficient warm-up [10], poor flexibility [11], muscle imbalances [12], neural tension [13], fatigue [14], and previous injuries [15]. Inadequate flexibility within the posterior thigh compartment appears to be one of the more commonly accepted causes of hamstring injuries [2, 16]; however, the evidence for decreased hamstring flexibility as a risk factor remains equivocal [11, 17]. A recent Cochrane review found no evidence for stretching as a sole intervention for prevention of hamstring
References
[1]
R. Bahr and I. Holme, “Risk factors for sports injuries—a methodological approach,” British Journal of Sports Medicine, vol. 37, no. 5, pp. 384–392, 2003.
[2]
D. S. Davis, P. E. Ashby, K. L. McCale, J. A. McQuain, and J. M. Wine, “The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters,” Journal of Strength and Conditioning Research, vol. 19, no. 1, pp. 27–32, 2005.
[3]
D. A. Opar, M. D. Williams, and A. J. Shield, “Hamstring strain injuries: factors that lead to injury and re-injury,” Sports Medicine, vol. 42, no. 3, pp. 209–226, 2012.
[4]
J. Orchard and H. Seward, “Epidemiology of injuries in the Australian Football League, seasons 1997–2000,” British Journal of Sports Medicine, vol. 36, no. 1, pp. 39–44, 2002.
[5]
B. Gabbe, C. Finch, H. Wajswelner, and K. Bennell, “Australian football: injury profile at the community level,” Journal of Science and Medicine in Sport, vol. 5, no. 2, pp. 149–160, 2002.
[6]
W. L. Frost and D. J. Chalmers, “Injury in elite New Zealand cricketers 2002–2008: descriptive epidemiology,” British Journal of Sports Medicine, 2012.
[7]
J. Ekstrand, M. H？gglund, and M. Waldén, “Injury incidence and injury patterns in professional football: the UEFA injury study,” British Journal of Sports Medicine, vol. 45, no. 7, pp. 553–558, 2011.
[8]
G. Henderson, C. A. Barnes, and M. D. Portas, “Factors associated with increased propensity for hamstring injury in English Premier League soccer players,” Journal of Science and Medicine in Sport, vol. 13, no. 4, pp. 397–402, 2010.
[9]
J. C. Murphy, E. O'Malley, C. Gissane, and C. Blake, “Incidence of injury in Gaelic football: a 4-year prospective study,” The American Journal of Sports Medicine, vol. 40, no. 9, pp. 2113–2120, 2012.
[10]
M. R. Safran, W. E. Garrett Jr., A. V. Seaber, R. R. Glisson, and B. M. Ribbeck, “The role of warmup in muscular injury prevention,” The American Journal of Sports Medicine, vol. 16, no. 2, pp. 123–129, 1988.
[11]
E. Witvrouw, L. Danneels, P. Asselman, T. D'Have, and D. Cambier, “Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players: a prospective study,” The American Journal of Sports Medicine, vol. 31, no. 1, pp. 41–46, 2003.
[12]
J.-L. Croisier, “Factors associated with recurrent hamstring injuries,” Sports Medicine, vol. 34, no. 10, pp. 681–695, 2004.
[13]
S. E. Turl and K. P. George, “Adverse neural tension: a factor in repetitive hamstring strain?” Journal of Orthopaedic and Sports Physical Therapy, vol. 27, no. 1, pp. 16–21, 1998.
[14]
U. M. Kujala, S. Orava, and M. J？rvinen, “Hamstring injuries. Current trends in treatment and prevention,” Sports Medicine, vol. 23, no. 6, pp. 397–404, 1997.
[15]
G. M. Verrall, J. P. Slavotinek, P. G. Barnes, G. T. Fon, and A. J. Spriggins, “Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging,” British Journal of Sports Medicine, vol. 35, no. 6, pp. 435–439, 2001.
[16]
L. C. Decoster, R. L. Scanlon, K. D. Horn, and J. Cleland, “Standing and supine hamstring stretching are equally effective,” Journal of Athletic Training, vol. 39, no. 4, pp. 330–334, 2004.
[17]
L. Hennessy and A. W. S. Watson, “Flexibility and posture assessment in relation to hamstring injury,” British Journal of Sports Medicine, vol. 27, no. 4, pp. 243–246, 1993.
[18]
E. F. Goldman and D. E. Jones, “Interventions for preventing hamstring injuries,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD006782, 2010.
[19]
T. W. Worrell and D. H. Perrin, “Hamstring muscle injury: the influence of strength, flexibility, warm-up, and fatigue,” Journal of Orthopaedic and Sports Physical Therapy, vol. 16, no. 1, pp. 12–18, 1992.
[20]
C. H. Weppler and S. P. Magnusson, “Increasing muscle extensibility: a matter of increasing length or modifying sensation?” Physical Therapy, vol. 90, no. 3, pp. 438–449, 2010.
[21]
D. S. Butler, The Sensitive Nervous System, Noigroup Publications, Adelaide, Australia, 2000.
[22]
M. Shacklock, “Improving application of neurodynamic (neural tension) testing and treatments: a message to researchers and clinicians,” Manual Therapy, vol. 10, no. 3, pp. 175–179, 2005.
[23]
M. Shacklock, “Neurodynamics,” Physiotherapy, vol. 81, no. 1, pp. 9–16, 1995.
[24]
C. Kornberg and P. Lew, “The effect of stretching neural structures on grade one hamstring injuries,” Journal of Orthopaedic and Sports Physical Therapy, vol. 10, no. 12, pp. 481–487, 1989.
[25]
P. W. M. Marshall, A. Cashman, and B. S. Cheema, “A randomized controlled trial for the effect of passive stretching on measures of hamstring extensibility, passive stiffness, strength, and stretch tolerance,” Journal of Science and Medicine in Sport, vol. 14, no. 6, pp. 535–540, 2011.
[26]
T. Hall, M. Zusman, and R. Elvey, “Adverse mechanical tension in the nervous system? Analysis of straight leg raise,” Manual Therapy, vol. 3, no. 3, pp. 140–146, 1998.
[27]
B. S. Boyd, L. Wanek, A. T. Gray, and K. S. Topp, “Mechanosensitivity of the lower extremity nervous system during straight-leg raise neurodynamic testing in healthy individuals,” Journal of Orthopaedic and Sports Physical Therapy, vol. 39, no. 11, pp. 780–790, 2009.
[28]
A. I. De-la-Llave-Rincon, R. Ortega-Santiago, S. Ambite-Quesada et al., “Response of pain intensity to soft tissue mobilization and neurodynamic technique: a series of 18 patients with chronic carpal tunnel syndrome,” Journal of Manipulative and Physiological Therapeutics, vol. 35, no. 6, pp. 420–427, 2012.
[29]
C. L. Brown, K. K. Gilbert, J.-M. Brismee, P. S. Sizer, C. R. James, and M. P. Smith, “The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study,” Journal of Manual and Manipulative Therapy, vol. 19, no. 1, pp. 26–34, 2011.
[30]
Y. Castellote-Caballero, M. C. Valenza, L. Martin-Martin, I. Cabrera-Martos, E. J. Puentedura, and C. Fernández-de-las-Pe？as, “Effects of a neurodynamic sliding technique on hamstring flexibility in healthy male soccer players. A pilot study,” Physical Therapy in Sport, vol. 14, no. 3, pp. 156–162, 2013.
[31]
V. Ferrer, Repercusiones de la Cortedad Isquiosural Sobre la Pelvis y el Raquis Lumbar, Universidad de Murcia, Murcia, Spain, 1998.
[32]
V. Ferrer, F. Santonja, M. Carrion, and L. Martinez, “Comparacion de dos tests (E.P.R. y Popliteo) para el diagnostico del sindrome de isquiosurales cortos,” Archivos de Medicina del Deporte, vol. 11, no. 43, pp. 247–254, 1994.
[33]
R. L. Gajdosik, C. K. Hatcher, and S. Whitsell, “Influence of short hamstring muscles on the pelvis and lumbar spine in standing and during the toe-touch test,” Clinical Biomechanics, vol. 7, no. 1, pp. 38–42, 1992.
[34]
S. S.-C. Hui and P. Y. Yuen, “Validity of the modified back-saver sit-and-reach test: a comparison with other protocols,” Medicine and Science in Sports and Exercise, vol. 32, no. 9, pp. 1655–1659, 2000.
[35]
F. Santonja and I. Martínez, Valoración Médico-Deportiva del Escolar, Secretariado de Publicaciones, Universidad de Murcia, Murcia, Spain, 1992.
[36]
W. D. Bandy, J. M. Irion, and M. Briggler, “The effect of time and frequency of static stretching on flexibility of the hamstring muscles,” Physical Therapy, vol. 77, no. 10, pp. 1090–1096, 1997.
[37]
J. P. K. Halbertsma, I. Mulder, L. N. H. G？eken, and W. H. Eisma, “Repeated passive stretching: acute effect on the passive muscle moment and extensibility of short hamstrings,” Archives of Physical Medicine and Rehabilitation, vol. 80, no. 4, pp. 407–414, 1999.
[38]
P. Mintken, E. Puentedura, and A. Louw, “Neurodynamic interventions and physiological effects: clinical neurodynamics in neck and upper extremity pain,” in Neck and Arm Pain Syndromes, C. Fernández-de-las-Pe？as, J. Cleland, and P. Huijbregts, Eds., pp. 496–515, 2011.
[39]
M. W. Coppieters and D. S. Butler, “Do “sliders” slide and “tensioners” tension? An analysis of neurodynamic techniques and considerations regarding their application,” Manual Therapy, vol. 13, no. 3, pp. 213–221, 2008.
[40]
R. Méndez-Sánchez, F. Alburquerque-Sendín, C. Fernández-de-las-Pe？as et al., “Immediate effects of adding a sciatic nerve slider technique on lumbar and lower quadrant mobility in soccer players: a pilot study,” Journal of Alternative and Complementary Medicine, vol. 16, no. 6, pp. 669–675, 2010.
[41]
J. P. Weir, “Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM,” Journal of Strength and Conditioning Research, vol. 19, no. 1, pp. 231–240, 2005.
[42]
P. W. Stratford, “Getting more from the literature: estimating the standard error of measurement from reliability studies,” Physiotherapy Canada, vol. 56, no. 1, pp. 27–30, 2004.
[43]
J. Cohen, Statistical Power Analysis for the Behavioural Sciences, Lawrence Erlbaum Associates, Hillsdale, NJ, USA, 1988.
[44]
D. E. Hartig and J. M. Henderson, “Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees,” The American Journal of Sports Medicine, vol. 27, no. 2, pp. 173–176, 1999.
[45]
N. Malliaropoulos, S. Papalexandris, A. Papalada, and E. Papacostas, “The role of stretching in rehabilitation of hamstring injuries: 80 athletes follow-up,” Medicine and Science in Sports and Exercise, vol. 36, no. 5, pp. 756–759, 2004.
[46]
E. J. Puentedura, P. A. Huijbregts, S. Celeste et al., “Immediate effects of quantified hamstring stretching: hold-relax proprioceptive neuromuscular facilitation versus static stretching,” Physical Therapy in Sport, vol. 12, no. 3, pp. 122–126, 2011.
[47]
H. W. Wallmann, C. B. Gillis, and N. J. Martinez, “The effects of different stretching techniques of the quadriceps muscles on agility performance in female collegiate soccer athletes: a pilot study,” North American Journal of Sports Physical Therapy, vol. 3, no. 1, pp. 41–47, 2008.
[48]
H. W. Wallmann, J. A. Mercer, and J. W. McWhorter, “Surface electromyographic assessment of the effect of static stretching of the gastrocnemius on vertical jump performance,” Journal of Strength and Conditioning Research, vol. 19, no. 3, pp. 684–688, 2005.
[49]
M. N. Samuel, W. R. Holcomb, M. A. Guadagnoli, M. D. Rubley, and H. Wallmann, “Acute effects of static and ballistic stretching on measures of strength and power,” Journal of Strength and Conditioning Research, vol. 22, no. 5, pp. 1422–1428, 2008.
[50]
J. B. Feland and H. N. Marin, “Effect of submaximal contraction intensity in contract-relax proprioceptive neuromuscular facilitation stretching,” British Journal of Sports Medicine, vol. 38, no. 4, article E18, 2004.
[51]
J. Mendiguchia, E. Alentorn-Geli, and M. Brughelli, “Hamstring strain injuries: are we heading in the right direction?” British Journal of Sports Medicine, vol. 46, no. 2, pp. 81–85, 2012.
[52]
B. J. Gabbe, C. F. Finch, K. L. Bennell, and H. Wajswelner, “Risk factors for hamstring injuries in community level Australian football,” British Journal of Sports Medicine, vol. 39, no. 2, pp. 106–110, 2005.
[53]
é. Q. Aparicio, L. B. Quirante, C. R. Blanco, and F. A. Sendín, “Immediate effects of the suboccipital muscle inhibition technique in subjects with short hamstring syndrome,” Journal of Manipulative and Physiological Therapeutics, vol. 32, no. 4, pp. 262–269, 2009.
[54]
D. Hopper, S. Deacon, S. Das et al., “Dynamic soft tissue mobilisation increases hamstring flexibility in healthy male subjects,” British Journal of Sports Medicine, vol. 39, no. 9, pp. 594–598, 2005.
[55]
S. M. Weldon and R. H. Hill, “The efficacy of stretching for prevention of exercise-related injury: a systematic review of the literature,” Manual Therapy, vol. 8, no. 3, pp. 141–150, 2003.
[56]
H. Folpp, S. Deall, L. A. Harvey, and T. Gwinn, “Can apparent increases in muscle extensibility with regular stretch be explained by changes in tolerance to stretch?” Australian Journal of Physiotherapy, vol. 52, no. 1, pp. 45–50, 2006.
