How Does Contract Relax Help Lead To A Change In Rom

Introduction

Range of motion (ROM), which is the ability to move a joint and ease muscle stiffness, is essential in sports operation and activities of daily living (Mulholland and Wyss, 2001; Hemmerich et al., 2006), and it might influence the adventure of muscle strain injury (Witvrouw et al., 2003). In sports and clinical settings, static stretching (SS) is a common and easy technique to increase ROM, which is involved in changing the viscoelastic properties of the muscle-tendon unit of measurement (i.e., decreasing muscle stiffness) (Morse et al., 2008) and increasing an private'due south capacity to tolerate loading earlier stretch termination (i.e., increased stretch tolerance) (Magnusson et al., 1996).

Previous studies accept shown that ROM significantly increased after acute and chronic interventions using proprioceptive neuromuscular facilitation (PNF) stretching compared with using SS (Funk et al., 2003; Hindle et al., 2012). A mutual method of PNF stretching is the contract-relax (CR) technique (Sharman et al., 2006), which includes an SS phase for a prescribed duration, followed immediately by a maximal isometric contraction in a fully stretched position. Kay et al. (2015) reported that CR stretching was more effective in increasing ROM and decreasing passive muscle-tendon stiffness than SS. Alternatively, Ferber et al. (2002) reported that antagonist CR (ACR) stretching, which is a combination of SS and voluntary contraction of the antagonist musculus group in a stretched position, that is, "active stretching," was more constructive in changing ROM than CR stretching for older participants. Even so, to the all-time of our noesis, no study has investigated the issue of ACR stretching on musculus stiffness and stretch tolerance in younger participants. Furthermore, no study has compared ACR stretching with CR stretching regarding these outcomes.

Recently, the shear elastic modulus was measured as the quantitative issue of muscle stiffness using shear moving ridge elastography (SWE) (Lacourpaille et al., 2012; Inami and Kawakami, 2016). A previous study reported a positive correlation between the subtract in shear elastic modulus of the medial gastrocnemius (MG) and a decrease in muscle stiffness of MG (Nakamura et al., 2014). Additionally, Watsford et al. (2010) measured the hamstring muscle stiffness using a free oscillation technique and showed that excessive hamstring muscle stiffness causes hamstring strain injuries (Watsford et al., 2010). Therefore, it is important to decrease the shear elastic modulus to forbid injury. Studies have shown that the shear elastic modulus acutely and chronically decreased after SS (Ichihashi et al., 2016; Nakamura et al., 2017). Additionally, the shear elastic modulus decreased after both active stretching and SS; however, no significant difference was observed betwixt agile stretching and SS (Nakao et al., 2018). Although previous studies accept investigated the outcome of CR stretching on the shear rubberband modulus (Reiner Chiliad. et al., 2021) or muscle stiffness (Nakamura et al., 2015, 2021), no report has compared the effect of CR and ACR stretching on the shear rubberband modulus. Thus, it is of import to investigate which of CR and ACR stretching is the better method to increase ROM. Additionally, we would similar to analyze the difference in the modify in stretch tolerance and shear elastic modulus, which is likely associated with the increasing ROM between both techniques.

Therefore, this study aimed to examine and compare the effect of CR and ACR stretching on ROM, stretch tolerance, and shear elastic modulus. Hypothetically, ACR stretching is more effective in irresolute ROM, stretch tolerance, and shear elastic modulus than CR stretching because the previous study has shown that changes in ROM were greater after ACR stretching than after CR stretching (Ferber et al., 2002).

Materials and Methods

Experimental Pattern

Participants were randomly assigned to the CR and ACR stretching groups. The characteristics of the participants are shown in Tabular array 1, and no significant differences were found in each feature value between the CR and ACR stretching groups. CR and ACR stretching was performed for 2 min (30 south × iv sets, with no remainder) for plantar flexor muscles. To examine the furnishings of CR and ACR stretching, dorsiflexion (DF) ROM, passive torque at DF ROM, and shear rubberband modulus of the MG muscle in the ascendant leg (preferred to kick a brawl) were measured earlier (PRE) and subsequently (Postal service) stretching.

Tabular array 1. Physical characteristics of the subjects.

Participants

Forty healthy immature adults (24 men and sixteen women) took part in the study (mean age, 21.7 ± ii.3 years; mean peak, 166.2 ± 8.one cm; mean body mass, threescore.0 ± ix.4 kg). Previous studies take not investigated separately the event of SS on men and women (Ryan et al., 2009; Kay et al., 2015). Therefore, this study did not split up men and women. Those who had a history of surgery on their back or lower body, lower-extremity contracture, and neurological disorders and those who took hormone- or musculus-affecting drugs were excluded from the study.

Written informed consent was obtained from all participants. Additionally, this study was approved by the ethics committee of our institution (approval no. 17677).

After computing the sample size required for a separate-plot analysis of variance (ANOVA) (effect size = 0.40 [large], α error = 0.05, and power = 0.fourscore) using 1000* ability 3.1 software (Heinrich Heine Academy, Düsseldorf, Germany) based on a previous study (Ferber et al., 2002), the minimum required number of participants in each group was 14.

Measurement of Dorsiflexion Range of Move and Passive Torque at Dorsiflexion Range of Motility

The participants were seated in an isokinetic dynamometer (System 3.0; Biodex Medical Systems, Inc., Shirley, NY, United States) chair at 0° articulatio genus bending (i.eastward., anatomical position) and lxx° hip flexion to prevent tension at the back of the knee joint, with adaptable belts over the trunk and pelvis and ankle stock-still to a footplate (Figure ane; Nakamura et al., 2020). And so, they moved the footplate of the dynamometer at a speed of 5° per s, starting from the talocrural joint at 0° to the maximum DF angle without feeling pain until stopping the dynamometer by activating a safe trigger (Morse et al., 2008). DF ROM and passive torque were calculated from the torque–angle curve using the dynamometer (Nakamura et al., 2020; Sato et al., 2020). DF ROM (°) was divers as the maximum DF angle at the torque–angle curve. Passive torque at DF ROM (Nm) was calculated from the passive torque at the betoken of the DF bending at the torque–angle curve and was defined as the stretch tolerance (Mizuno et al., 2013). Two trials were conducted. The largest DF bending and the passive torque at the largest DF angle were used for farther analysis (Blazevich et al., 2014).

Figure one. Experimental set-up for measuring the dorsiflexion range of motion and passive torque.

Measurement of Shear Elastic Modulus of the Medial Gastrocnemius Muscle

Ultrasonic SWE (Aplio 500, Toshiba Medical Systems, Tochigi, Nihon) was used with a 5–14 MHz linear probe to measure the shear elastic modulus of the MG. Participants were positioned similar to the position during DF ROM measurement. The shear elastic modulus of the MG at x° DF was measured at 30% of the lower leg length from the popliteal crease to the lateral malleolus almost the betoken at which the maximal cross-exclusive area in the lower leg is located (Nakamura et al., 2014, 2019). Ultrasound image measurements were conducted twice using long-centrality images of the MG. The assay of the shear wave speed in ultrasound images was conducted using an MSI Analyzer (version five.0; Rehabilitation Scientific discipline Enquiry Found, Japan). The measurement of the shear moving ridge speed (Vs) was set as the region of interest in the area equally big every bit possible in the MG, and the average value of the shear wave speed inside this region was obtained. The shear elastic modulus was calculated as μ (kPa) = ρVs^two, where ρ is the muscle mass density (ane,000 kg/grand³). The average value of the shear elastic modulus obtained from ii ultrasound images was used for analysis.

Contract-Relax and Adversary Contract-Relax Stretching Interventions and Measurement of the Stretching Bending

CR and ACR stretching were performed for the plantar flexor muscles in a position similar to that during DF ROM measurement. CR and ACR stretching were performed based on a previous study (Nakamura et al., 2015). Initially, the ankle was passively dorsiflexed at a speed of 5° per 2d from 0° angle to the maximal angle and was held for xv s without feeling hurting. In the CR stretching groups, participants were instructed to perform a maximal voluntary isometric contraction of the plantar flexors for 5 s in the stretching position. In the ACR stretching groups, participants performed a maximal voluntary isometric contraction of the dorsiflexors for five s in the stretching position. Afterward this wrinkle, the ankle was held at the angle for an boosted 10 s. After 30 due south of CR and ACR stretching, the ankle was returned to 0° angle and was immediately moved to a new bending without rest to perform the adjacent stretching. CR or ACR stretching was repeated four times for a full time of 2 min. The angle during stretching among sets of stretching was measured past using the isokinetic dynamometer.

Measurement Reliability

The test-retest reliabilities of the DF ROM, passive torque at the DF ROM, and shear elastic modulus of the MG in seven healthy young adults (3 men and four women) were investigated on different days. The calculated intraclass correlation coefficients (one,1) for the DF ROM, passive torque at DF ROM, and shear elastic modulus were 0.91 (95% confidence interval (CI) 0.63–0.98), 0.85 (95% CI 0.42–0.97), and 0.82 (95% CI 0.32–0.97), respectively, which indicates loftier reliability for all outcome measures (Landis and Koch, 1977).

Statistical Analysis

Differences in all variables at PRE stretching between CR and ACR stretching were investigated using an unpaired t-examination. To analyze the interaction effect of the DF ROM, passive torque at DF ROM, and shear elastic modulus of the MG, we conducted a dissever-plot ANOVA [time (PRE vs. POST) and weather (CR vs. ACR stretching)]. Furthermore, if the interaction event or principal effect was significant, we determined the significant differences between PRE and Postal service using a paired t-test in each protocol as a postal service hoc test. Additionally, the Isle of man–Whitney U-exam was used to evaluate the relative changes from PRE to POST to compare CR and ACR stretching because the relative changes were not normally distributed in the Shapiro–Wilk test. To evaluate the stretching intensity between CR and ACR stretching, we conducted a split-plot ANOVA [sets (1 vs. 2 vs. 3 vs. 4 sets) and weather (CR vs. ACR stretching)] for the angle during CR and ACR stretching. Furthermore, if the interaction effect or main effect was significant, we conducted a Bonferroni exam as a post hoc test. The effect size (ES) was calculated when the consequence was applied to the parametric tests using the F ratio and sample size. By contrast, using z-value and sample size, ES was calculated when the outcome was practical to not-parametric tests. The ES classification (Cohen's d) was equally follows: r < 0.ane, trivial; 0.1–0.3, small-scale; 0.3–0.5, moderate; and > 0.five, large (Cohen, 1988). All statistical analyses were conducted using R (version 2.8.ane; The R Foundation, Vienna, Austria), and significance was set at p < 0.05. All data were presented as mean ± standard deviation.

Results

Dorsiflexion Range of Motion

No meaning difference was institute between CR and ACR stretching for DF ROM at PRE stretching (p = 0.52). The dissever-plot ANOVA did not indicate a significant interaction for DF ROM (F = 0.15, ES = 0.06; p = 0.71); however, a pregnant main effect for time was establish (F = 45.52, ES = 0.74; p < 0.05). The post hoc exam revealed a significant increase in DF ROM after both CR and ACR stretching similarly (Table ii). The relative change in DF ROM was no significant difference between CR and ACR stretching (Figure 2A).

Table 2. Acute effects of contract-relax (CR) stretching and antagonist contract-relax (ACR) stretching on dorsiflexion (DF) range of motility (ROM), passive torque at DF ROM, and shear elastic modulus at before (PRE), and subsequently (Mail service) stretching intervention.

Effigy 2. The relative changes in dorsiflexion (DF) range of movement (ROM) (A), passive torque at DF ROM (B), and shear elastic modulus (C) later on contract-relax (CR) stretching and antagonist contract-relax (ACR) stretching. The relative changes in DF ROM and passive torque at DF ROM were no pregnant differences between CR and ACR stretching. The relative change in shear elastic modulus after CR stretching was significantly higher than ACR stretching (p < 0.01). *p < 0.05 compared with CR stretching.

Passive Torque at Dorsiflexion Range of Motion (Stretch Tolerance)

No significant deviation was noted between CR and ACR stretching for the passive torque at DF ROM at PRE stretching (p = 0.51). The separate-plot ANOVA did not indicate a pregnant interaction for the passive torque at DF ROM (F = 0.11, ES = 0.05; p = 0.74); however, a meaning main effect for fourth dimension was found (F = 11.22, ES = 0.48; p < 0.05). The post hoc exam revealed a significant increase in the passive torque at DF ROM subsequently both CR and ACR stretching (Table 2). The relative change in passive torque at DF ROM was no significant difference between CR and ACR stretching (Figure 2B).

Shear Elastic Modulus of the Medial Gastrocnemius Muscle

No pregnant deviation was found betwixt CR and ACR stretching for the shear rubberband modulus at PRE stretching (p = 0.29). The split up-plot ANOVA indicated a significant interaction for the shear elastic modulus of the MG (F = vii.94, ES = 0.42; p < 0.05). The postal service hoc test revealed a significant decrease in the shear rubberband modulus afterwards both CR and ACR stretching (p < 0.05) (Table 2). Furthermore, the relative alter in the shear elastic modulus later on CR stretching (–41.9 ± 19.6%) was significantly higher than that afterward ACR stretching (–12.50 ± 61.6%, p < 0.01, ES = 0.48) (Figure 2C).

Stretching Angle

The stretching angle data in both CR and ACR stretching are shown in Tabular array 3. The split up-plot ANOVA did non indicate a meaning interaction for the stretching angle (F = 0.72, ES = 0.14; p = 0.46); however, a pregnant main effect for fourth dimension was found (F = 73.67, ES = 0.81; p < 0.05). The stretching bending increased over sessions in both CR and ACR stretching, and the stretching angle increased significantly from the commencement set to the second, third, and quaternary sets (p < 0.05). Also, the stretching bending increased significantly from the 2d set to the third and 4th sets in both CR and ACR stretching conditions.

Table 3. Stretching bending during contract-relax (CR) stretching and antagonist contract-relax (ACR) stretching.

Give-and-take

This study examined and compared the effect of CR and ACR stretching on ROM, stretch tolerance, and shear elastic modulus. Our results revealed that DF ROM and stretch tolerance were significantly increased after stretching; however, no significant divergence was observed between CR and ACR stretching. Alternatively, the shear elastic modulus of the MG has significantly decreased after both CR and ACR stretching. The relative decrease change in the shear rubberband modulus later CR stretching was college than that after ACR stretching. To our knowledge, this is the first to testify that the effects of CR and ACR stretching on ROM and stretch tolerance accept no significant difference. Still, CR stretching was more effective in changing the shear elastic modulus than ACR stretching.

This study showed that DF ROM significantly increased after CR and ACR stretching. The increase in DF ROM after CR stretching was 21.seven ± 21.6%, which was like to the results of a previous study (17.ii ± 4.4%) performing CR stretching for 2 min (Nakamura et al., 2015). Furthermore, a study reported that ROM increased after ACR stretching for 80 s (Ferber et al., 2002), which was slightly shorter than that in the present study. A study has suggested that longer-duration stretching is more effective in increasing ROM (Matsuo et al., 2013). Therefore, we suggest that 120 southward of ACR stretching is sufficient to increase DF ROM. However, contrary to our hypothesis based on a previous study (Ferber et al., 2002), the increase in DF ROM was non significantly different between CR and ACR stretching. Studies have reported that the increment in ROM subsequently stretching depends on the intensity of stretching (Freitas et al., 2015a; Kataura et al., 2017; Takeuchi and Nakamura, 2020). In the present study, the angle during stretching was measured as the index of stretching intensity. The results showed that the stretching angle was not significantly dissimilar betwixt CR and ACR stretching; equally a result, no differences were establish in the change in DF ROM between the CR and ACR stretching groups. Moreover, Ferber performed the stretching manually (Ferber et al., 2002), while in the present study, stretching was performed past using an isokinetic dynamometer. Therefore, the result was different when compared with those of the previous study considering the stretching methods were different.

Our results showed that the passive torque at DF ROM significantly increased after both CR and ACR stretching. The passive torque at DF ROM was measured equally an index of stretch tolerance, which is the capacity to tolerate loading earlier stretch termination (Halbertsma and Goeken, 1994; Nakamura et al., 2015). In this study, the relative increment change in the passive torque at DF ROM afterward CR stretching was xi.vii%. Nakamura et al. (2015) reported that the relative increment alter in stretch tolerance after concord–relax stretching was xiv.5%, similar to the results of the present study. Moreover, the relative increase modify in stretch tolerance after ACR stretching was xv.iii%, and no pregnant difference was found between CR and ACR stretching. Nakamura et al. (2015) reported that the relative increase modify in the passive torque at DF ROM after SS was four.vii%, which was lower than that after CR and ACR stretching in the nowadays report. However, the mechanism of increasing stretch tolerance after stretching or contraction is even so unclear. Studies have suggested that increases in stretch tolerance are caused by reduced perceptions of hurting and discomfort, accompanied by a change in neural and psychological factors after stretching (Folpp et al., 2006; Police force et al., 2009). In a future written report, examining the effects of a target or adversary musculus contraction at the stretching position on stretch tolerance is warranted.

This study found that the shear elastic modulus of the MG significantly decreased after both CR and ACR stretching. A study reported that the shear elastic modulus significantly decreased after 120 due south of SS (Nakamura et al., 2014). The same duration was used in the present study. However, no study has compared the effect of CR and ACR stretching on the shear elastic modulus. The relative subtract modify in the shear elastic modulus of the MG afterward ACR stretching was significantly lower than that after CR stretching. Nakao et al. (2018) reported that when comparing the effects of active stretching with those of passive stretching on the shear rubberband modulus of the hamstrings, no significant difference was institute between agile stretching and SS intervention. ACR stretching is a combination of passive and active stretching, but ACR stretching could not obtain the combination furnishings on the shear rubberband modulus. Furthermore, Nakamura et al. (2014) reported that the relative decrease modify in the shear elastic modulus of the MG later on SS intervention for 2 min was approximately –18% at 30° DF or –10% at 0° DF. The nowadays study showed that the relative decrease change in the shear elastic modulus afterward ACR stretching was –19%, and this result was similar to that in the previous report (Nakamura et al., 2014), which was smaller than that later CR stretching (–41.nine%). Kay et al. (2015) reported that passive joint stiffness afterward CR stretching greatly decreased compared with that after SS intervention. Chino and Takahashi (2015) reported that a college positive correlation (r = 0.80) was establish between the shear elastic modulus of the MG by SWE and passive joint stiffness. Therefore, when we considered the results of previous and present studies, we suggested that CR stretching was more than effective in decreasing muscle stiffness than ACR stretching. Withal, the detailed mechanism of decreasing the shear elastic modulus after CR and ACR stretching is unknown. A previous report revealed that active stretching has a neurophysiological effect that causes reciprocal suppression (i.e., Ia suppression) by the wrinkle of adversary muscles (Herda et al., 2013). Thus, ACR stretching could generate muscle tone relaxation due to reciprocal suppression. Past contrast, a previous study reported that the stretching outcome generated by CR stretching was a result of autogenic inhibition (Hindle et al., 2012). Regarding autogenic inhibition, neuromuscular inhibition was idea to occur as the tendon loading during the contraction stage of CR stimulated blazon Ib muscle afferent output from the Golgi tendon organs, stimulating spinal inhibitory synapses and hyperpolarizing the dendritic ends of spinal α-motoneurons of the stretched muscle (Hindle et al., 2012). Therefore, autogenic inhibition (CR stretching) may exist more effective in decreasing the shear elastic modulus than reciprocal suppression (ACR stretching). Yet, electromyography was non measured in this study, and future studies should investigate the consequence of neurological properties later on CR and ACR stretching.

A written report reported that compared with controls, the shear modulus in patients with stroke increased in the gastrocnemius muscle when the knee was extended (Le Sant et al., 2019). Additionally, the shear modulus increased afterwards performing eccentric exercises on several muscles (Pournot et al., 2016; Lacourpaille et al., 2017). Therefore, decreasing shear elastic modulus is important in athletic and clinical fields, and CR stretching should be performed more than ACR stretching based on the results of the present written report. In this study, stretching was conducted using an isokinetic dynamometer, which is not a clinical method. However, Kay et al. (2020) reported no significant difference betwixt field-based CR stretching without a dynamometer and CR stretching using a dynamometer in changing ROM and passive joint stiffness. Therefore, the results of this study could exist applied in clinical practice.

This study has some limitations. Starting time, the intraclass correlation coefficients of the CI for the shear rubberband modulus are wide. However, the CIs of previous studies were similar to the results of this report (Nakamura et al., 2014; Fukaya et al., 2020). Therefore, time to come studies should use foils on the skin and previous B-mode images of the participants to meliorate reproduce the U.s.-probe placement and, hence, to optimize the reliability (Reiner M. et al., 2021; Reiner M. 1000. et al., 2021). Second, the stretching intensity was different amidst participants, as DF ROM was defined as the maximum tolerable ROM without pain. Freitas et al. (2015b) examined ROM using verbal and visual analog scales to evaluate the stretching intensity; these scales should be used to define stretching intensity based on ROM. Therefore, we should unify the stretching intensity between participants past using a verbal or visual analog calibration.

Conclusion

The results of this study revealed that DF ROM and stretch tolerance significantly increased after both CR and ACR stretching; however, no difference was plant between the CR and ACR stretching groups. The shear elastic modulus of the MG significantly decreased afterwards both CR and ACR stretching, and the relative decrease change in the shear elastic modulus of the MG subsequently CR stretching was greater than that after ACR stretching. Therefore, either CR or ACR stretching may be performed to increase ROM; however, CR stretching is preferred to decrease musculus stiffness.

Information Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The present written report was canonical by the ethics committee of our institution (approval number: 17677). The patients/participants provided their written informed consent to participate in this report.

Writer Contributions

TF, AK, RK, SS, KaY, KoY, RO, RY, and MN: conceptualization, investigation, and methodology. TF, RK, SS, KaY, KoY, RO, RY, and MN: investigation and methodology. TF and MN: data curation. AK and MN: funding acquisition, writing—review and editing, and supervision. MN: project assistants. TF: visualization, formal analysis, and writing—original draft. All authors have read and agreed to the published version of the manuscript.

Funding

This piece of work was supported by the JSPS KAKENHI with (Grant No. 19K19890) (MN), and the Austrian Science Fund (FWF) projection P 32078-B (AK). The report sponsors had no involvement, in the study pattern, in the drove, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

Conflict of Interest

The authors declare that the enquiry was conducted in the absence of whatsoever commercial or financial relationships that could be construed equally a potential disharmonize of interest.

Publisher's Notation

All claims expressed in this article are solely those of the authors and do non necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this commodity, or claim that may be made by its manufacturer, is non guaranteed or endorsed by the publisher.

Acknowledgments

We would like to thank Enago (http://www.enago.jp/) for editorial assistance with the manuscript.

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Source: https://www.frontiersin.org/articles/10.3389/fphys.2021.764792/full

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