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Background Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach. Methods A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied. Results A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05). Conclusion Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.
Background Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach. Methods A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied. Results A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05). Conclusion Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.
IntroductionBalance is a multifactorial construct with high relevance in, e.g., everyday life activities. Apart from sensorimotor control, muscle strength and size are positively linked with balance performance. While commonly trained for via resistance training, stretch training has emerged as a potential substitution in specific conditions. However, no review has investigated potential effects of stretching on balance, yet.MethodsPubMed, Web of Science and Scopus were searched with inception to February, 2024. Studies were included if they examined acute and/or chronic effects of any stretching type against passive and/or active controls on balance parameters – without any population-related restrictions concerning sex/gender, age, health status, activity level. Methodological quality was assessed using PEDro scale. Meta-analyses were performed if two or more studies reported on the same outcome. Certainty of evidence was determined based on GRADE criteria.ResultsEighteen acute and eleven chronic effect studies were included. Stretching studies exhibited significant improvements for sway parameters with eyes open against passive controls of moderate magnitude for chronic (ES: 0.63, p = 0.047) and of small magnitude for acute studies (ES: 0.21, p = 0.032). Most other subgroups against passive controls as well as actively-controlled comparisons resulted in trivial and/or non-significant effects.ConclusionEven though some pooled effects slightly reached the level of significance, the overall results are biased by (very) low certainty of evidence (GRADE criteria downgrading for risk of bias, imprecision, publication bias). Moderators suggested by literature (strength, muscle size, flexibility, proprioception) were rarely assessed, which prevents conclusive final statements and calls for further, high quality evidence to clarify potential mechanisms–if any exist.
Dynamic stretching (DS) is performed as a warm-up to improve the range of motion and athletic performance. However, the effect of different amounts of DS on muscle performance remains unclear. This study investigated the effects of DS repetitions with one or four sets of 30 s on musculotendinous extensibility and muscle strength. Fourteen healthy men (23.6 ± 1.5 years) underwent DS to ankle plantar flexors for one set (fifteen repetitions) or four sets after warm-up. The maximal ankle dorsiflexion angle, musculotendinous stiffness (MTS), passive torque, peak plantarflexion torque during maximal isometric contraction, and muscle temperature were measured before and after stretching. A significant effect of time was observed on the maximal ankle dorsiflexion angle, MTS, passive torque, and muscle temperature (p < 0.001). However, no interactions or effects between the conditions were observed. After DS, the maximal ankle dorsiflexion angle and muscle temperature significantly increased (p < 0.01), while the MTS and passive torque significantly decreased (p < 0.01). The maximal muscle strength showed no significant effects or interactions (p = 0.198−0.439). These results indicated that one and four sets of DS effectively increased musculotendinous extensibility. Thus, one set of DS may have similar effects as a warm-up before four sets of DS.
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