Remedial Loading Programs: Stretch Training

The movements you do and the lifestyle you choose influences the form that tissue takes. 

The movements you do and the lifestyle you choose influences the form that tissue takes. 

Preliminary findings suggest stretch training is a viable way to stimulate architectural adaptation. Changes in the passive elastic properties and range of motion induced by stretch training is due to both neurological increases in stretch tolerance and changes in passive properties of muscle.

These changes induced by stretch training, may have clinical implications for injury prevention and rehabilitation programs.

Stretching for Overhead Athletes

A number of papers have demonstrated the effects of stretch training on tissue stiffness, shoulder internal rotation and horizontal adduction.  

  • 4 weeks of soft tissue mobilization had an affect on tissue stiffness, shoulder internal rotation and horizontal adduction in baseball players with posterior shoulder tightness (Yamauchi et al. 2016).
  • Modified cross body stretch and modified sleeper stretch leads to decreased the stiffness of the teres minor and infraspinatus (Umehara et al. 2017)
  • Instrumented manual therapy with self-stretching significantly reduces ROM risk factors in baseball players with motion deficits (Bailey et al. 2017)
  • A 4-week treatment program of manual therapy or dry needling demonstrated a significant improvement in pain pressure threshold, muscle elasticity, and stiffness of neck and shoulder muscles (De Meulemeester et al. 2017).

Hamstring Stretch Training

Preliminary findings suggest nordic hamstring exercises and stretch training are a viable way to stimulate architectural adaptation. For a more indepth looks at theses changes you may want to check out Greg Lehmans recent post on hamstring stretching -  or these recent studies:

Plantar Flexor Stretching

For a more indepth looks at theses changes you may want to check out these recent studies:

  • 6 weeks of loaded stretch training of the plantar flexors resulted in hypertrophic like adaptations of the gastrocnemius (Simpson et al. 2017)
  • 3 weeks of twice daily stretch training (4 × 30 s) lead to an increase in dorsiflexion range of motion (ROM)  a 28% increase in passive joint moment (Blazevich et al. 2014). 
  • 4-week static stretch training program changes the flexibility of the gastrocnemius muscle tendon unit (Nakamura et al. 2012)
  • 5 min of static stretching was shown to decrease shear elastic modulus in both young and elderly women (Nakamura et al. 2017)

More to Explore

Alonso-Fernandez, D., Docampo-Blanco, P., Martinez-Fernandez, J. (2017). Changes in muscle architecture of Biceps Femoris induced by eccentric strength training with Nordic Hamstring Exercise. Scand J Med Sci Sports.
https://www.ncbi.nlm.nih.gov/pubmed/28314091

Apostolopoulos, N., Metsios, G.S., ... Wyon, M.A. (2015). The relevance of stretch intensity and position-a systematic review. Front Psychol.
https://www.ncbi.nlm.nih.gov/pubmed/26347668

Bailey, L.B., Thigpen, C.A., Hawkins, R.J., Beattie, P.F., Shanley, E. (2017). Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits. Sports Health.
https://www.ncbi.nlm.nih.gov/pubmed/28402756

Bailey, L.B., Shanley, E., Hawkins, R., Beattie, P.F., Fritz, S., Kwartowitz, D., Thigpen, C.A. (2015). Mechanisms of Shoulder Range of Motion Deficits in Asymptomatic Baseball Players. Am J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/26403207

Behm, D.G., Blazevich, A.J., Kay, A.D., McHugh, M. (2016). Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Appl Physiol Nutr Metab.
https://www.ncbi.nlm.nih.gov/pubmed/26642915

Bourne, M.N., Duhig, S.J., ...  Shield, A.J. (2017). Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/27660368

Cheatham, S.W., Lee, M., Cain, M., Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/27713575 

De Meulemeester, K.E., Castelein, B., Coppieters, I., Barbe, T., Cools, A., Cagnie, B. (2017). Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial. J Manipulative Physiol Ther. https://www.ncbi.nlm.nih.gov/pubmed/28017188

Franchi, M.V., Reeves, N.D., Narici, M.V. (2017). Skeletal Muscle Remodeling in Response to Eccentric vs. Concentric Loading: Morphological, Molecular, and Metabolic Adaptations. Front Physiol.  (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/28725197

Freitas, S.R., Mendes, B., Le Sant, G., Andrade, R.J., Nordez, A., Milanovic, Z. (2017). Can chronic stretching change the muscle-tendon mechanical properties? A review. Scand J Med Sci Sports.
https://www.ncbi.nlm.nih.gov/pubmed/28801950

Freitas, S.R., Mil-Homens, P. (2015).  Effect of 8-week high-intensity stretching training on biceps femoris architecture. J Strength Cond Res.
https://www.ncbi.nlm.nih.gov/pubmed/25486299

Goode, A.P., Reiman, M.P., ...Taylor, A.B. (2015). Eccentric training for prevention of hamstring injuries may depend on intervention compliance: a systematic review and meta-analysis. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/25227125

Haab, T., Wydra, G. (2017). The effect of age on hamstring passive properties after a 10-week stretch training. J Phys Ther Sci.
https://www.ncbi.nlm.nih.gov/pubmed/28626322

Hopper, D., Deacon, S., Das, S., Jain, A., ..., Briffa K. (2005). Dynamic soft tissue mobilisation increases hamstring flexibility in healthy male subjects. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/16118294/

Kim, S.Y., Ko, J.B., Farthing, J.P., Butcher, S.J. (2015). Investigation of supraspinatus muscle architecture following concentric and eccentric training. J Sci Med Sport.
https://www.ncbi.nlm.nih.gov/pubmed/24969812

Mine, K., Nakayama, T., Milanese, S., Grimmer, K. (2016). Effectiveness of Stretching on Posterior Shoulder Tightness and Glenohumeral Internal Rotation Deficit: A Systematic Review of Randomised Controlled Trials. J Sport Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/27632891

Muanjai, P., Jones, D.A., ... Kamandulis, S. (2017). The effects of 4 weeks stretching training to the point of pain on flexibility and muscle tendon unit properties. Eur J Appl Physiol.
https://www.ncbi.nlm.nih.gov/pubmed/28647867

Nakamura, M., Ikezoe, T., Nishishita, S., Umehara, J., Kimura, M., Ichihashi, N. (2017).  Acute effects of static stretching on the shear elastic moduli of the medial and lateral gastrocnemius muscles in young and elderly women. Musculoskelet Sci Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28988152

Nakamura, M., Ikezoe, T., Takeno, Y., Ichihashi, N. (2012). Effects of a 4-week static stretch training program on passive stiffness of human gastrocnemius muscle-tendon unit in vivo. Eur J Appl Physiol.
https://www.ncbi.nlm.nih.gov/pubmed/22124523

Nordez, A., Gross, R., Andrade, R., Le Sant, G., Freitas, S., Ellis, R., McNair, P.J., Hug, F. (2017). Non-Muscular Structures Can Limit the Maximal Joint Range of Motion during Stretching. Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/28255938 

Simpson, C.L., Kim, B.D., Bourcet, M.R., Jones, G.R., Jakobi, J.M. (2017). Stretch training induces unequal adaptation in muscle fascicles and thickness in medial and lateral gastrocnemii. Scand J Med Sci Sports.
https://www.ncbi.nlm.nih.gov/pubmed/28138986

Thompson, W. R., Scott, A., Loghmani, M. T., Ward, S. R., & Warden, S. J. (2016). Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy. 
https://www.ncbi.nlm.nih.gov/pubmed/26637643 (OPEN ACCESS)

Umehara, J., Hasegawa, S., Nakamura, M., Nishishita, S., Umegaki, H., Tanaka, H., . . . Ichihashi, N. (2017). Effect of scapular stabilization during cross-body stretch on the hardness of infraspinatus, teres minor, and deltoid muscles: An ultrasonic shear wave elastography study. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/27847244

Umehara, J., Nakamura, M., Fujita, K., Kusano, K., Nishishita, S., Araki, K., Tanaka, H., Yanase, K., Ichihashi, N. (2017). Shoulder horizontal abduction stretching effectively increases shear elastic modulus of pectoralis minor muscle. J Shoulder Elbow Surg.
https://www.ncbi.nlm.nih.gov/pubmed/28169137

Weppler, C.H., Magnusson, S.P. (2010). Increasing muscle extensibility: a matter of increasing length or modifying sensation? Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/20075147 

Yamauchi, T., Hasegawa, S., Nakamura, M., Nishishita, S., Yanase, K., Fujita, K., . . . Ichihashi, N. (2016). Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: A randomized controlled trial. Journal of Shoulder and Elbow Surgery.
http://www.ncbi.nlm.nih.gov/pubmed/27475455 

Zaremski, J.L., Wasser, J.G., Vincent, H.K. (2017). Mechanisms and Treatments for Shoulder Injuries in Overhead Throwing Athletes. Curr Sports Med Rep.
https://www.ncbi.nlm.nih.gov/pubmed/28498227