THE EFFECTS OF PNF STRETCHING ON THE AGILITY OF HIGH SCHOOL ATHLETES A THESIS Submitted to the Faculty of the School of Graduate Studies and Research of California University of Pennsylvania in partial fulfillment of the requirements for the degree of Master of Science By Brett Piper Research Advisor, Dr. Robert Kane California, Pennsylvania 2009 ii iii ACKNOWLEDGEMENTS I’d first like to thank my family for their perpetual love and support. Thanks to my parents for raising into the person I’ve become today. Without you pushing me, believing in me, and encouraging me, I wouldn’t have been able to complete this thesis or finish this final year of school. Also, thanks to my brother, Brad. You’ve been a fantastic brother and a great friend to me my entire life. I know that you’re there for me no matter what I do with my life. I love all of you. Thanks to my undergraduate ACIs: Karyn, Shannon, Jason, Drea, Brad, and Jill. group of instructors like you. I was so fortunate to have a You sharing your knowledge and experience with me have shaped me into the ATC I am today and the ATC I will become. Thanks to my professors here at Cal U especially my committee: Bob, Bruce, and Brian. Also thanks to Dr. Carol Biddington and Dr. Becky Hess for their help with my statistics. You’ve all helped make this thesis possible. Finally I’d like to thank all my classmates in the Athletic Training Education Programs at both BW and Cal U. To Megan, Zach, Jerry, and Emily: It was a pleasure sharing 4 years with you guys. I know you helped keep me sane from iv Module Check-offs to the BOC. Good luck to all of you in your future endeavors. And to my Cal U classmates: Kevin, Dane, Chris, Kristin, Amber, Natalie, Ashley, Will, James, Eric, Brandon, Alex, Danielle, Miz, Maya, and Yohei. year was one heck of an experience with you guys. like I made 16 great new friends here. This I feel Good luck to all of you and I hope we’ll stay in touch throughout our careers. Thanks to all of you. v TABLE OF CONTENTS Page SIGNATURE PAGE . . . . . . . . . . . . . . . ii AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii TABLE OF CONTENTS LIST OF TABLES . . . . . . . . . . . . . . v . . . . . . . . . . . . . . . viii LIST OF FIGURES . . . . . . . . . . . . . . . ix INTRODUCTION METHODS . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . 8 Research Design Subjects . . . . . . . . . . . . . . 8 . . . . . . . . . . . . . . . . . 8 Pilot Research . . . . . . . . . . . . . . . 9 Procedures . . . . . . . . . . . . . . . . 9 Instruments . . . . . . . . . . . . . . . . 14 Hypothesis . . . . . . . . . . . . . . . . 14 Data Analysis RESULTS . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . . . . . . 16 Demographic Information Hypothesis Testing . . . . . . . . . . . 16 . . . . . . . . . . . . . 17 Additional Findings . . . . . . . . . . . . . 18 DISCUSSION . . . . . . . . . . . . . . . . . 22 Discussion of Results Conclusions . . . . . . . . . . . . 22 . . . . . . . . . . . . . . . . 26 vi Recommendations for Future Research . . . . . . . 27 REFERENCES . . . . . . . . . . . . . . . . . 29 APPENDICES . . . . . . . . . . . . . . . . . 32 A: Review of Literature Anatomy/Physiology . . . . . . . . . . . 32 . . . . . . . . . . . . 34 Principles/Techniques of PNF Stretching and ROM . . . . . . . . . 38 . . . . . . . . . . . . . 42 Stretching and Injury Prevention . . . . . . . . 46 Stretching and Strength/Power . . . . . . . . . 47 Stretching and Speed . . . . . . . . . . . 51 Stretching and Agility. . . . . . . . . . . 52 B: The Problem . . . . . . . . . . . . . . . 55 Statement of the Problem . . . . . . . . . . 56 Definition of Terms . . . . . . . . . . . . . 56 Basic Assumptions . . . . . . . . . . . . . 58 Limitations of the Study . . . . . . . . . . 59 Significance of the Study . . . . . . . . . . 59 C: Additional Methods . . . . . . . . . . . . . 62 Informed Consent Form (C1) . . . . . . . . . . 63 Permission From Burgettstown High School (C2) . . 65 IRB: California University of Pennsylvania (C3) . . 68 Demographic Information sheet (C4) . . . . . 74 Individual Data Collection Sheet(C5) Stretching Positions (C6) . . . . 76 . . . . . . . . . 78 vii REFERENCES . . . . . . . . . . . . . . . . 80 ABSTRACT . . . . . . . . . . . . . . . . . . 86 viii List of Tables Table Title Page 1 Repeated Measures ANOVA . . . . . . 18 2 Male T-Test Descriptive Statistics . . 19 3 Female T-Test Descriptive Statistics . 20 4 Between-Subjects Effects . . . . . . 21 ix List of Figures Figure Title Page 1 Autogenic Inhibition . . . . . . . 2 2 Reciprocal Inhibition . . . . . . . 3 3 T-Test Diagram . . . . . . . . . . 12 1 INTRODUCTION In several competitive sports, a key component of a successful athlete is the athlete’s agility; the ability to stop, change direction, and attain full speed again as quickly as possible while sometimes moving laterally. Improving this skill is a priority for coaches and athletes alike. One possible mode of improvement could lie in an activity almost every athlete performs, stretching. There are several stretching techniques that have shown to be beneficial in different settings. Specifically, Proprioceptive Neuromuscular Facilitation (PNF) is a type of stretching where research in certain areas of performance is lacking. In addition, understanding the anatomy of stretching is key to grasping how stretching can be beneficial to different measures of performance. Muscular organelles called Golgi Tendon Organs (GTOs) and muscle spindles are the target of stretching techniques, specifically PNF. GTOs are activated by tension in a muscle. If too much tension is placed on a muscle, the GTOs will send a signal directly to the brain and stimulate relaxation preventing the muscle from being overworked and possibly causing injury 1, 2 . 2 Muscle spindles perform the opposite function. They respond to a muscle being overly stretched and will stimulate a contraction in response. PNF stretching is thought to target these structures specifically; inhibiting muscle spindles and increasing GTO activity allowing a muscle to stretch farther 1,2 . Several Theories exist that attempt to explain the mechanisms by how PNF stretching can increase ROM and therefore improve performance. The main theories are Autogenic Inhibition and Reciprocal Inhibition (see Figures 1 and 2). These theories were recounted by Sharman et al1. Autogenic Inhibition is a reduction in the excitability of a stretched muscle that is being contracted. Figure 1. Autogenic Inhibition 1 . 3 Reciprocal Inhibition is a similar process but results in reduced excitability in a stretched muscle when its opposing muscle is contracted. Figure 2. Reciprocal Inhibition 1. Autogenic inhibition may not be correct however as several researchers have found evidence that supports alternate theories. Moore3 explored these theories and applied them to the professional dance setting. She also proposed that signals from GTOs may reach the cerebral cortex in the brain and autogenic inhibition may be incorrect. Chalmers conducted two separate studies researching the role of GTOs in the muscle. Chalmers 4,5 also found evidence that autogenic inhibition may be decreased in regards to force production at a muscle. He 4 also found evidence that relaxation of a muscle with stretching may be due to inhibition of the muscle spindle only rather than the activation of GTOs as originally thought. It is the actions on these organelles that lead to increased flexibility and ROM. Stretching techniques have also been studied extensively in regards to their effect on flexibility and Range of Motion (ROM) including studies that involved PNF. Marek et al 6 conducted two separate studies that compared PNF and static stretching and their effect on several areas including flexibility of the hamstrings. Among other results, the authors found that both PNF and static stretching significantly increased active range of motion (AROM) and passive range of motion (PROM). Mitchell et al 7 in 2007 looked at the maximal stretch force that could be applied to a person with tight hamstrings. the subjects. Both PNF and static stretching were used on PNF lead to increased stretch that could be applied as compared to static stretching. Stretching’s effect on strength has also been researched extensively. In this case, stretching was found to be more of a detriment than beneficial. Weerapong et al8 compared static, dynamic, and PNF stretching. In addition to measuring ROM, the researchers also measured strength. 5 Their results showed no significant changes in their subjects’ strength. A study done by Marek 6 et al on PNF also examined stretching’s effect on strength. In both studies, the PNF interventions caused significant decreases in the subjects peak torque, mean power output, and EMG amplitude. Two measures of performance where stretching research is lacking are its effects on speed and agility. Fletcher and Anness9 studied the effects of several stretching protocols and their effects on fifty meter sprint times. Only one protocol showed a significant change. A static, passive stretch combined with an active, dynamic stretch produced significantly slower sprint times. Nelson et al10 examined the effects of three different static stretches compared to no stretching in twenty yard sprint times of sixteen division one college track athletes. Once a week a different stretch was given and measure were taken. With each of the three stretches, results showed a significant increase in sprint times compared to no stretching revealing a decrease in performance. Finally, research on stretching’s effect on agility has received very little research. This gave the researcher the motivation to perform this study. Oakley11 6 explored static and dynamic stretching and its effect on Ttest times, a measure of agility that requires sprinting, shuffling, and backpedaling. Both stretching interventions showed significantly lower T-test times compared to control with the dynamic stretching group showing significantly lower times than the static stretching group. Faigenbaum12 also conducted a study with children. This study also examined different warm-up protocols’ effect on several measures including agility. The protocols included five minutes of walking followed by five minutes of static stretching, ten minutes of dynamic exercise, or ten minutes of dynamic exercise plus three drop jumps from a fifteen centimeter box. Results revealed a significant decrease in agility measures with five minutes of walking with five minutes of static stretching compared to the ten minutes of exercise with three drop jumps measures. The effects of stretching have been researched in nearly every measure of performance. Stretching’s effect on Range of Motion has been researched extensively with results consistently showing a significant increase in subjects’ ROM after every stretching protocol. Stretching also appears to be detrimental to strength measures. However, there are still areas where research is lacking. Specifically, PNF techniques need more research in the area 7 of agility. These techniques need to be examined to determine if they can be beneficial to an athlete’s agility. 8 METHODS The Methods Section explains how the research was conducted as well as information about the subjects and instruments used. The following sections are included: Research Design, Subjects, Pilot Research, Procedures, Instruments, Hypotheses, and Data Analysis. Research Design A repeated measures, within subject design was used in this study. Subjects served as their own control. The independent variable was stretching (which contained three levels: “No Stretching”, “PNF Hold-Relax,” and “PNF Contract-Relax”) and gender. The dependent variable was the subjects’ agility test times. Times were taken to the hundredth of a second. Each subject completed agility tests after both stretching protocols as well as a control trial. The order in which subjects received the stretching protocols or control was randomized. 9 Subjects Subjects used in this study (N=30) were male and female high school athletes attending Burgettstown High School. No subjects with any lower extremity injuries in the prior 3 months were included. As most subjects were minors, both the subjects and their parent/guardian completed Informed Consent Forms (Appendix C1). Consent was also obtained from the Burgettstown Athletic Director and Principal (Appendix C2). To control for possible injury and/or fatigue, none of the subjects used were in season of their respective sports. Pilot Research Prior to conducting the research on the intended subjects, a short pilot study was completed on three California University Graduate Assistant Athletic Trainers. This was to familiarize the researcher with the testing procedures and equipment used in this study. Pilot research was also done to determine any problems that may have been present in the procedures. Subjects in the pilot also completed informed consent forms (Appendix C1). After the 10 pilot research was conducted, the researcher decided no changes were needed to the testing procedures. Procedures This study was approved by the Institutional Review Board (IRB) at California University of Pennsylvania (Appendix C3). The researcher was granted permission to perform this study at Burgettstown High School and ask its students for participation by the Burgettstown High School Athletic Director and Principal (Appendix C2). Athletes who were not currently in season at Burgettstown High School were asked to participate in this study by the researcher. Each subject signed an informed consent/assent form and/or their parent/guardian signed informed consent/assent forms if they were a minor. Each subject and parents/guardians were also informed of the procedures and potential risks of the study and was given the option to drop out at any time. To begin the study, each subject was asked to select one of six cards placed face down on a table. The cards contained each potential order of receiving interventions and a control trial. This was to randomize the order of interventions as well as potentially minimize learning 11 effects. Subjects also completed Demographic Information Sheets (Appendix C4) and the researcher recorded each completed trial on an Individual Data Collection Sheet (Appendix C5). Each trial was performed in the Burgettstown High School gymnasium. To measure subjects’ agility, the T-Test for agility was used13. According to standard T-Test protocols (Figure 3), four cones were placed in a “T” formation on the floor labeled A-D. Cones A and B were placed ten yards apart. Cones C and D were placed five yards apart to the left and right of Cone B. Subjects were then informed of the proper procedure for running a T Test for agility. Subjects start at Cone A and sprint forward to Cone B and touch it with their favored hand. Upon completing this, subjects were to then shuffle, without crossing their legs to Cone C and touch it with their favored hand. Cone D and touched it. Next, subjects shuffled from C to Next, subjects shuffled from Cone D back to Cone B and executed a final touch at this cone. Upon completion of the final touch at Cone B, subjects backpedaled to their original starting point of Cone A to finish the test. 12 Figure 3. T-Test Diagram 13 . The three recorded trials were performed over the course of 3 days with one trial being performed each day. The control trials were performed without warm-up of any kind. Due to their key involvement in the actions of sprinting and quickly changing direction, the quadriceps and hamstring muscles of both legs were stretched for both PNF stretching trials. For the Contract-Relax trials, the hamstring muscles were stretched with the subjects lying supine. The knee of the leg being stretched was kept in full extension. The degree of hip flexion needed to gently stretch the hamstrings varied from subject to subject but was always near ninety degrees (Appendix C6). leg was also kept flat by the researcher’s leg. The opposite The 13 hamstring was stretched for thirty seconds. After ten seconds the patient was asked to concentrically contract the quadriceps with a “Push” command from the researcher. The contraction was held for four seconds after which the subject was told to “Relax” and release the contraction. For Hold-Relax stretching of the hamstrings, the procedure was the same except for one difference. Instead of a concentric contraction, the subject would be asked to contract isometrically and the command “Hold” was used to start contractions. For the quadriceps muscles, the subjects were asked to lay prone. The knee was flexed to 120 degrees or until the foot contacted the gluteus muscles. An additional stretch was provided by the researcher grabbing the foot with one hand and the knee with the other. The researcher then lifted the knee off the ground until a comfortable stretch was felt (Appendix C6). seconds. The stretch was then held for ten For Contract-Relax stretching, the subject was asked to extend the knee and push the knee back toward the ground for a concentric contraction for four seconds. For Hold-Relax, the stretching protocol was the same except the muscles were contracted isometrically and the command “Hold” was used by the researcher. In the case of both muscles, each stretching protocol was performed three times 14 on each muscle bilaterally. After being stretched, each subject performed a T Test measured to the hundredth of a second. Times were taken by the researcher. For consistent timing procedures, the researcher stood at the start/finish line, out of the way of the subjects. Instruments Several instruments were used to assist the researcher in completing this study. Four orange cones provided by Burgettstown High School were used to mark the distances needed to perform the T Test. To measure those distances, a Stanley 30’ tape measure was used. Johnson & Johnson athletic tape was used to mark the floor of the gymnasium where the cones had been after they had been removed after a day of testing. To time the subjects’ T Test times, a Speed Trap II Timer was used. This device a touch pad to start a timer and two infrared “eyes” to stop the timer making if more reliable than a stopwatch as it eliminates human error. 15 Hypothesis One hypothesis was tested on the data from this research. 1. PNF stretching will cause significantly lower agility test times compared to a control trial. Data Analysis The level of significance for all statistical tests used in this study was set at ά=0.05. To test the hypothesis, a Repeated Measures Analysis of Variance (ANOVA) was performed using the SPSS 16.0 computer software. The Tukey statistical test was used post-hoc to determine where differences occurred if applicable. 16 RESULTS The purpose of this study was to examine the effects of the PNF stretching techniques “Hold-Relax” and “Contract-Relax” on the agility of high school athletes as measured by the T-Test for agility. three trials of the T-Test. Subjects performed One trial was performed with no stretching and served as the control. The other two trials were performed with each of the PNF stretching techniques listed above. This results section is divided into three sections: Demographic Information, Hypothesis Testing, and Additional Findings. Demographic Information Subjects used in this study (N=30) were volunteers from Burgettstown High School in Burgettstown, Pennsylvania. Each subject was a participant in at least one sport and remained physically active in the off-season. The subjects age ranged from 14-18 (15.77 ± 1.38). Fifteen subjects were male while the remaining fifteen were female. The subjects’ “Primary Sports” (the sport they listed as being the one they spent the most time in preparation both 17 in-season and off-season) listed were football (n=14), baseball (n=1), softball (n=8), track and field (n=2), and volleyball (n=5). Hypothesis Testing Hypothesis Testing was performed on the data using SPSS software. All subjects were tested for agility following both stretching interventions as well as a control trial. All three trials were compared with an alpha level of 0.05. Hypothesis 1: PNF stretching will cause significantly lower agility test times compared to a control trial. Conclusion: To test the Hypothesis, mean scores of the Control trials, Hold-relax and Contract-relax trials were calculated for both the male and female participants. A Repeated Measures ANOVA was performed to compare the trial times for the subjects under three conditions: Control, Contract-Relax, and Hold-Relax. results of the ANOVA. (F 2,56 =.046 Table 1 illustrates the No significant difference was found p > .05) The test revealed no significant differences among Control (11.63 ± 1.41), Hold-Relax (11.59 18 ± 1.31), and Contract-Relax (11.64 ± 1.36) agility test times. Therefore, the hypothesis was not supported. Table 1. Repeated Measures ANOVA. Source Type II DF Mean Sum of Square Squares 2 .022 Outcomes – .045 F P .250 .780 .046 .955 Sphericity Assumed Outcomes * .008 2 .004 4.997 56 .089 Gender – Sphericity Assumed Error (Outcomes)– Sphericity Assumed Additional Findings In addition to testing the above hypotheses, the researcher also examined if significant differences existed between male and female T-test times under any conditions. Additional testing was done by the researcher to examine this possibility. 19 Mean times in the T-Test for males and females under all three conditions can be seen in Table 1. The Repeated measures ANOVA used to test the above hypotheses was done to also test the differences in all T-Test trials according to gender. Males had significantly faster T-test times (10.58 ± 0.69) compared to the female T-test times (12.66 ± 1.00). Table 2 shows the descriptive statistics of the male subjects. Table 3 shows the descriptive statistics of the female subjects. Table 2. Male T-Test Descriptive Statistics. Protcol Mean, in Std. seconds Deviation N Range, in seconds Control 10.594 .706 15 2.38 Contract- 10.615 .732 15 2.48 Hold-Relax 10.544 .664 15 2.45 Total 10.580 .686 45 2.69 Relax 20 Table 3. Female T-Test Descriptive Statistics. Protocol Mean, in Std. seconds Deviation N Range, in seconds Control 12.675 1.139 15 4.62 Contract- 12.661 1.032 15 2.62 Hold-Relax 12.634 .890 15 3.47 Total 12.657 1.002 45 4.62 Relax The results of the Repeated Measures ANOVA comparing gender are shown below in Table 4. In each of the three conditions, Control, Contract-Relax, and Hold-Relax, significant differences were found with the males having significantly lower times. 21 Table 4. Between-Subjects Effects. Source Type III DF Sum of Mean F P Square Squares Intercept 12153.126 1 12153.126 5686.626 Gender 96.638 1 96.638 Error 59.840 28 2.137 45.218 .000 .000 22 DISCUSSION To discuss the results found in this study, the following sections will be included: Discussion of Results, Conclusions, and Recommendations for Future Research. Discussion of Results The purpose of this study was to determine if the PNF stretching techniques Contract-relax and Hold-relax caused significant changes in the agility of high school aged athletes. Past studies have shown that stretching can be beneficial to an athlete’s agility 11 . The researcher wanted to see if PNF techniques could also improve agility as well as see if one technique was more effective than the other. Research into this possibility showed that no significant changes were made in agility test times in response to the two PNF stretching techniques using the selected stretching protocols. The research also showed that PNF stretching does not affect males and females differently as neither stretching protocols showed 23 improvements in the males vs. the females. The research did not support the hypothesis presented by the researcher. As stated before, there have been studies that examined different stretching protocols and their effect on agility performance tests. However, PNF stretching techniques had not been examined. Although the techniques have been around for some time, PNF stretching has never been examined in the context of agility although other areas of performance have been measured in response to PNF stretching 6, 7, 14-16 . Previous research showed that stretching techniques can lead to improvements in dynamic levels of performance. Oakley found that stretching will significantly decrease subjects’ times in the T-test, the same performance measure used in this study 9 . This implies that stretching techniques can be used to improve agility. However, the best protocol to do this has yet to be uncovered. Fletcher and Anness showed that stretching can also significantly improve sprint speed 11 . This suggests that increasing a person’s ROM in the lower extremity is beneficial to that person’s lower extremity performance in dynamic physical activity. However, these studies did not incorporate PNF stretching although PNF stretching has also shown to increase ROM measures 6, 7, 14-16 . The researcher 24 believed that PNF stretching could also lead to increased performance levels. significant results. However, this study did not yield any The reason for these results could come from several different areas. For this study, a relatively short stretching protocol in regards to time compared to previous studies was used. Other studies where significant increases in performance were noted utilized thirty second, static stretch periods with five second contraction periods 6, 7, 14-16 . The researcher incorporated a protocol that used a ten second static stretch period followed by four second contraction periods. This was done for the sake of keeping the protocol short in regards to time. Brevity was important as subjects were high school students. Many were involved in other extra-curricular activities and/or had problems with transportation to and from testing. Subjects simply did not have time to complete a longer stretching protocol. This shortened protocol may have affected the subjects’ results. Also, the processes that PNF stretching takes advantage of, Autogenic Inhibition and Reciprocal Inhibition reduces muscular excitability. While these processes can facilitate additional gains in ROM, it may 25 have made the muscles less efficient in the T-test, blocking any possible improvements. This theory may coincide with a previous study done by Faigenbaum et al. in 2006. This study also looked at teenage athletes but rather different warm-up protocols’ effect on sprint speed. Several different stretching protocols were used but it was found that a static, passive stretch combined with an active, dynamic stretch produced significantly slower sprint times 17 . If this holds true, under different PNF protocols, T-test test may have shown a significant increase indicating a detriment to performance. Subjects were also asked to come in three days in a row to complete their agility tests. Looking at individual data collection sheets showed that a great percentage of subjects exhibited a “Practice” or “Learning” Effect, meaning that regardless of the order of their stretching interventions, their first trial was their worst while their last trial was their best. The timing of the trials in conjunction with the shortened stretching protocols may have lead to the results found in the research. 26 Conclusions According to data collected, PNF stretching seems to have no effect on the agility of high school aged athletes as measured by the T-test. PNF stretching also seems to have no significant effect on either gender group. However, previous research shows that stretching can be beneficial to agility so PNF techniques should not be discarded altogether. PNF stretching techniques have been utilized for many years and the processes of Autogenic and Reciprocal Inhibition which they utilize are accepted theories in the medical community. Additional stretching may be needed in order for these processes to show an observable effect on performance. In studies where PNF stretching caused significant improvements in performance, thirty second static stretches with five second contractions were used. This study verified that this protocol is necessary to show improvements as the ten second stretch with a four second contraction protocol used by the researcher was not effective. If athletic trainers, physical therapists, coaches, personal trainers, and others working with athletes want to incorporate PNF stretching into their 27 routines, a longer protocol needs to be used for it to be effective. Also, male subjects outperformed female subjects in the T-test under any of the three conditions. likely due to basic human anatomy. This is most Males in the study were taller (mean height of 70.8 in. compared to a mean height of 64.8 in. in females) which would lead to an increased stride length and males traditionally have increased lower extremity musculature. This allowed them to perform faster times in the T-test. Recommendations for Future Research For future studies, it is recommended that researchers incorporate a stretching protocol that utilizes static stretch periods of at least thirty seconds and contraction periods of at least five seconds. This protocol has been effective in previous studies that looked at other measures of performance and may be effective in regards to agility. It is also recommended that future researchers look at how the stretching may affect agility after a lengthy stretching program. In this study, agility tests were done only after an acute bout of stretching. A previous study done by Winters et al., showed that significant gains in 28 ROM can be made after a six week stretching program 18 . A PNF stretching program that lasts a similar length of time should be performed to see if the program could affect agility or other measures of performance. It is also recommended that future researchers focus on individual sports. five different sports. This study utilized athletes from It is recommended that researchers use samples from one sport at a time such as a study that utilizes only football or softball players. This may determine if PNF is effective for only certain sports. Finally, the researcher recommends that future studies examine athletes of different age groups and/or ability levels. This study only looked at athletes of the adolescent age group. Future research should be done on college and professional athletes. Future researchers could also perform studies at the Division I, II, and/or III college level. Future subjects should also have some familiarity with the T-test. If subjects have consistently performed T-tests prior to data collection, it is less likely they will experience the “Learning Effect” as their bodies will have already adapted to the demands imposed by this agility test. 29 REFERENCES 1. Sharman, Melanie J., Cresswell, Andrew G., & Riek, Stephan. Proprioceptive Neuromuscular Facilitation Mechanisms and Clinical Implications. Sports Med. 2006. 36: 929-939. 2. De Deyne, Patrick G. Application of Passive Stretch and Its Implications for Muscle Fibers. Physical Therapy. 2001. 81: 819-827. 3. Moore, Marjorie. Golgi Tendon Organs: Neuroscience Update with Relevance to Stretching and Proprioception in Dancers. Journal of Dance Medicine and Science. 2007. 11: 85-92. 4. Chalmers, Gordon. Re-examination of the Possible Role of Golgi Tendon Organs and Muscle Spindle Reflexes in Proprioceptive Neuromuscular Facilitation Stretching. Sports Biomechanics. 2005.3:159-183. 5. Chalmers, Gordon. Do Golgi Tendon Organs Really Inhibit Muscle Activity and High Force Levels to Save Muscles from Injury, and Adapt with Strength Training. Sports Biomechanics. 2003. 1: 239-249. 6. Marek, Sarah M., Cramer, Joel T., Fincher, A. Louise, Massey, Laurie L., Dangelmaier, Suzanne M., Purkayastha, Sushmita, Fitz, Kristi A., & Culbertson, Julie Y. Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Power Output. Journal of Athletic Training. 2005. 40: 94-103. 7. Mitchell, Ulrike H., Myrer, J. William., Hopkins, Ty, Hunter, Iain, Feland J. Brent, & Hilton, Sterling C. Acute Stretch Perception Alteration Contributes to the Success of PNF “Stretch-Relax” Stretch. Journal of Sport Rehabilitation. 2007. 16: 85-92. 8. Weerapong, Pornratshanee, Hume, Patria A., & Kolt, Gregory S. Stretching: Mechanisms and Benefits of Sport Performance and Injury Prevention. Physical Therapy Reviews. 2004. 9: 189-206. 30 9. Fletcher, Iain M., & Anness Ruth. The Acute Effects of Combined Static and Dynamic Stretch Protocols on Fifty-Meter Sprint Performance in Track and Field Athletes. Journal of Strength and Conditioning Research. 2007. 21: 784-787. 10. Nelson, Arnold G., Driscoll, Nicole M., Landin, Dennis K., Young, Michael A., & Schexnayder, Irving C. Acute Effects of Passive Muscle Stretching on Sprint Performance. Journal of Sports Sciences. 2005. 23(5): 449-454. 11. Oakley, Jaclyn C. The Effect of Dynamic and Static Stretching on Performance. Submitted to the Faculty of the School of Graduate Studies and Research of California University of Pennsylvania. 2007. 1-89. 12. Faigenbaum, Avery D., Belluci, Mario, Bernieri, Angelo, Bakker, Bart, and Hoorens, Karlyn. Acute Effects of Different Warm-up Protocols on Fitness Performance in Children. Journal of Strength and Conditioning Research. 2005. 19(2): 376-381. 13. Pauole, Kainoa, Madole, Kent, Garhammer, John, Lacourse, Michael, & Rozenek, Ralph. Reliability and Validity of the T-Test as a Measure of Agility, Leg Power, and Leg Speed in College-Aged Men and Women. Journal of Strength and Conditioning Research. 2000. 14(4): 443-450. 14. Davis, D. Scott, Ashby, Paul E., McCale, Kristi L., McQuain, Jerry A., & Wine, Jamie M., The Effectiveness of Three Stretching Techniques on Hamstring Flexibility Using Consistent Stretching Parameters. Journal of Strength and Conditioning Research. 2005. 19: 27-32. 15. Wen, John N. The Effects of Proprioceptive Neuromuscular Facilitation vs. Static Stretching vs. Control on the Hamstring Muscle Group for Flexibility, Peak Torque, and Power. Submitted to the Faculty of the School of Graduate Studies and Research of California University of Pennsylvania. 2005. 1-84. 16. Pollard H, Ward G. A Study of Two Stretching Techniques for Improving Hip Flexion Range of Motion. Journal of Manipulative & Physiological Therapeutics. 31 1997. 20. 17. Faigenbaum, Avery D., Kang, Jie, McFarland, James et al., Acute Effects of Different Warm-up Protocols on Anaerobic Performance in Teenage Athletes. Pediatric Exercise Science. 2006. 17: 64-75. 17. Winters, Michael V., Blake, Charles G., Trost, Jennifer S., Marcello-Brinker, Toni B., Lowe, Lynn, Garber, Matthew B., & Wainner, Robert S. Passive Versus Active Stretching of Hip Flexor Muscles in Subjects with Limited Hip Extension: A Randomized Clinical Trial. Physical Therapy. 2004. 84: 800-807. 32 APPENDIX A REVIEW OF THE LITERATURE 33 REVIEW OF THE LITERATURE This review of the literature will discuss the effects of different stretching protocols on different measures of performance. A focus will be put on the effects proprioceptive neuromuscular facilitation (PNF) on those different measures of performance. A great deal of research has been done measuring various stretching protocols effect on strength, speed, peak torque, muscle activation, and other areas. Very little research has been done on these stretching protocols effects on agility and even less has been done with PNF. PNF is an alternative to traditional static and dynamic stretching protocols because of its various techniques and its effect on muscle spindles and the golgi tendon organs. The review of the literature will be divided into seven sections: Anatomy and Physiology, Principles/Techniques of PNF, Stretching and Flexibility/ROM, Stretching and Injury Risk Stretching and Strength/Power, Stretching and Speed, and Stretching and Agility. included. A summary of this information will also be 34 Anatomy and Physiology First, to understand how stretching can be beneficial to different levels of performance and reduce injury risk, a review of the anatomy of physiology of muscles is necessary. Stretching causes several physiological changes in the muscles. To understand how stretching can be beneficial to performance and prevent injury, an understanding of these changes is necessary. A microscopic look must be taken to discover the details of this process. Muscular organelles called Golgi Tendon Organs (GTOs) and muscle spindles are the target of stretching techniques, specifically PNF. activated by tension in a muscle. GTOs are If too much tension is placed on a muscle, the GTOs will send a signal directly to the brain and stimulate relaxation preventing the muscle from being overworked possibly causing injury 1-3 . Muscle spindles perform the opposite function. They respond to a muscle being overly stretched and will stimulate a contraction in response. PNF stretching is thought to target these structures specifically; inhibiting muscle spindles and increasing GTO activity allowing a muscle to stretch farther. This process is called autogenic inhibition which will be discussed later in this 35 section. Autogenic inhibition may not be correct however as several researchers have found evidence that supports alternate theories. It is also proposed that signals from GTOs may reach the cerebral cortex in the brain and autogenic inhibition may be incorrect 1 . There is also evidence that autogenic inhibition may have decreased effects in regards to force production in muscle. This evidence states that relaxation of a muscle with stretching may be due to inhibition of muscle spindle only rather than the activation of GTOs as originally thought. It is the actions on these organelles that lead to increased flexibility and ROM 2-3 . The GTOs and Muscle Spindles interact with neurons to allow stretching to passively lengthen a muscle. This process is known as the Stretch Reflex and is the basis for every stretching technique. Muscle Spindles are proprioceptors that connect directly to the Central Nervous System (CNS). Muscle spindles contain two types of sensory nerve endings which innervate its fibers called intrafusal fibers. Skeletal muscle fibers are called extrafusal fibers. One type responds to dynamic changes in muscle length while the others continuously feed the CNS information about static muscle length. The latter will synapse in the anterior horn of the spinal cord. If the 36 muscle is stretched, the sensory neurons in the spindle and the surrounding extrafusal muscles will also be stimulated causing contraction. This will lead to increased muscle tone. This increased muscle tone will provide resistance to overstretching. In addition to the increased muscle tone, if a muscle is stretched, Ia nerve fibers will relay the stimulation to the spinal cord. The Ia fibers synapse with Alpha motor neurons in the spinal cord which travel back to the muscle and cause a reflexive muscle action to relieve the stretch 4-5 . Muscle spindles are also simulated when they are compressed such as when a muscle is being shortened. When compressed, a muscle spindle will decrease muscle tone and reduce resistance to the movement being performed. 6 Martini gives the following example that illustrates this function. “If your elbow is flexed and you let gravity extend it, the triceps brachii muscle, which is compressed by this movement, relaxes.” Muscle spindles are innervated gamma motor neurons which control the sensitivity of the spindle. the neurons are called gamma efferents. The axons of They decrease the sensitivity of the spindles whenever a voluntary muscle contraction takes place. Without this regulation, whenever a muscle is contracted, the muscle spindle would be 37 compressed decreasing the muscle tone, hindering the contraction. The gamma efferents stimulate myofibrils in the intrafusal fibers causing it to stay at its normal resting length. This prevents compression from occurring during voluntary contraction and allowing the movement to take place and also keeping the spindle sensitive to other 6 changes in muscle length . The process by which GTOs are activated is very similar to muscle. GTOs are innervated by Ib neurons which can become compressed when a muscle is activated eliciting a sensory nerve signal to the CNS. The Ib nerve enters the dorsal horn where it will synapse with interneurons and then alpha motor neurons. These processes in regards to stretching will be elaborated on the section entitled PNF Principles/Techniques 1,6 . Golgi tendon organs and muscle spindles are the key components that make stretching beneficial. It is stretching’s influence on these organelles that allow a muscle to be more flexible. It is along with that increased flexibility that a person is able to also increase their Range of Motion (ROM). 38 Principles/Techniques of PNF Proprioceptive Neuromuscular Facilitation stretches are a group of stretching techniques originally explored in the 1940s. The techniques were tested and collected by Voss et al. 7 They discussed the guiding principles of PNF. PNF stretching not only utilizes passive static stretching, but also tactile contact, vocal commands from the clinician, and muscular contractions. Tactile stimulation is used to facilitate contraction of target muscles. If tactile pressure is applied to an agonist muscle, the muscle’s antagonist will be inhibited. This will allow the agonist to contract more efficiently and with more strength. Vocal commands are a key component to successful PNF stretching. They signal the beginning of muscular contraction and should describe the desired muscular contraction as well as let the athlete know when to relax. Simple commands should be used such as “Push” or “Pull” to signal an isotonic contraction, “Hold” to signal an isometric contraction, or “Relax” to tell the athlete to relax their contractions 7 . Two other concepts important to PNF are Timing and Maximal Resistance. Maximal Resistance is the amount of 39 force an athlete exerts against the resistance provided by the clinician. To achieve the maximum amount of facilitation, an athlete must provide the maximum resistance against the clinician. Timing is also an important concept discussed. is the sequence is which muscles contract. Timing Naturally, our muscles develop movements moving proximal to distal. The same is true into our adult lives and is evident in PNF. Initially, rotational movements will be initiated in the extremities followed by other movements such as flexion/extension and abduction/adduction. Depending on the goal of the treatment, one of these movements will be needed to be inhibited by the clinician to focus on other movements 7 . Prentice 8 identified three PNF stretching techniques: Contract-relax, Hold-relax, and Slow-reversal-hold-relax. Prentice also identified a stretching protocol of a ten second static stretch followed by four second contraction would be effective. All three can be used to increase range of motion, muscle relaxation, and encourage inhibition. Contract-relax involves first moving the target muscle passively into a stretched position. The subject is asked to contract the agonist (the muscle that will be stretched) concentrically against the resistance of the clinician. 40 This technique is useful when range of motion is limited by muscle tightness 8. Hold-relax is the second PNF technique identified. This technique is very similar to contract-relax. The procedure is the same as contract-relax except when the contraction occurs, it is isometric. This technique can be used with either the agonist or antagonist muscle. It is useful when there is muscle tension on one side of a joint 8-9 . The final PNF stretching technique is called Slow- reversal-hold-relax. After the initial stretch of the antagonist, a concentric contraction of the agonist occurs followed by an isometric contraction of the antagonist. Like contract-relax, this technique is effective when the antagonist muscles are tight, limiting ROM at the given joint 8. As stated in the previous section, GTOs and muscle spindles are muscular organelles that are the target of PNF and all other stretching techniques. There are several theories that potentially explain the mechanism for how these organelles are inhibited. These theories include Autogenic Inhibition, Reciprocal Inhibition, and Passive Properties of the Musculotendinous Unit (MTU) 2,3 ,6, 10 . 41 Autogenic Inhibition is a process that results from decreased GTO activity. Most stretching techniques take advantage of this but PNF is thought to lead to increased Autogenic Inhibition. The process begins because of increased tension placed on a muscle via a stretch. Muscular contraction of the agonist places even more tension on the muscle leading to an increased Autogenic Inhibition response. The stretch combined with the contraction will cause a high activation of GTO activity. The increased GTO activity will cause increased inhibition arising from the Ib interneurons, the neurons that connect in the dorsal horn to alpha motor neurons (Figure 1). This causes a reduced excitability in the target muscle, facilitating an additional stretch 6, 10 . Reciprocal Inhibition is a very similar process (Figure 2). Again, the target muscle will be stretched but the difference occurs when the opposing muscle is contracted. The activation of the motor neurons that contract the agonist will also stimulate Ia interneurons. These interneurons will inhibit the alpha motor neurons of the muscle being stretched. The deactivation of these motor neurons will allow for greater stretches 6, 10 . Finally, PNF is thought to be effective because of reasons related to the Passive Properties of the MTU. A 42 muscle and its tendon have both viscous and elastic characteristics. The viscous components will elongate in response to a slow, sustained force but resist a rapid force. With a sustained stretch, the muscle will gradually allow itself to be lengthened. referred to as creep This property is commonly 10 . Stretching and Flexibility/ROM The effect of stretching on ROM and Flexibility is a very common topic of research. Several relevant studies have been published in the last ten years on the topic. Most of these studies were done to determine the best possible protocols for increasing ROM at a given joint. In 2006 Swanson examined the effects of different stretching protocols on ROM measurements. He explored static stretching techniques, stretching the muscle in a set position and holding the stretch for a specific time, vs. dynamic, functional stretching, stretching the muscle using specific types of continuous movement. The author concluded that the functional, dynamic exercises were more effective in increasing ROM 11 . Static and active stretching techniques and their effects were also studied in regards to hip extension ROM. 43 Researchers placed their subjects on a six week program and measured results at the program’s completion. Results showed that although a significant gain was made in both groups compared to pre-test measures, there were no 12 significant differences between the groups . Other researchers examined static stretching but also looked at different durations of stretching. Subjects in this study were stretched for either thirty or sixty seconds after which a sit and reach test was performed as well as testing the subjects’ maximal voluntary contraction. No significant differences were noted between the measures at thirty and sixty seconds 13 . Nelson and Bandy took a slightly different approach and compared static stretching to eccentric exercises and their effect on ROM measurements. They compared knee extension measurements taken from the 90-90 position. Both interventions significantly increased the ROM measurements but no difference was noted between the interventions 14 . Stretching has also been explored on the muscles of the upper extremity. The researcher stretched the shoulders of baseball pitchers and measured their throwing velocity and range of motion. no significant results 15 . This study however, yielded 44 Several studies have compared PNF stretching techniques to other techniques. In one such study, the researches looked at the maximal stretch force that could be applied to person with tight hamstrings. Both PNF and static stretching were used on the subjects. PNF lead to increased stretch that could be applied as compared to static stretching 16 . Davis et al compared PNF, static, and selfadministered stretching. The researchers measured knee extension in the 90-90 position. All three protocols significantly increased knee ROM but only static stretching was found to be significantly greater than the other two 17 PNF, static, and dynamic stretching techniques’ have also been compared in regards to their affect on ROM, strength, and other measures. found in these cases. No significant results were The researchers concluded that additional research was needed to determine the exact effects of the different stretching techniques 18 . Wen also looked at static stretching vs. PNF and measured hamstring flexibility in addition to peak torque and power. The results showed no significant difference between the two groups in these measures 19 . PNF was also compared to static and active stretching techniques. The three techniques were administered to . 45 different subjects and knee extension ROM measurements were taken several times after to determine if the stretching effects lasted long after the stretch was administered. Although significant gains were made in ROM, none of the techniques were found to be more beneficial than the other 20 . Pollard compared PNF to static stretching of the spine to determine if either was more effective in increasing hip flexion ROM. Pollard found that static stretching of the spine was more effective than PNF. He hypothesized that stretching the spine could decrease the likelihood of injury by assisting in increasing lower extremity ROM 21 . Marek et al conducted a study that compared PNF and static stretching and their effect on several areas including flexibility of the hamstrings. Among other results, the authors found that both PNF and static stretching significantly increased active range of motion (AROM) and passive range of motion (PROM) 5. PNF and its effects have also been studied on their own on many occasions. articles concerning PNF. Sharman et al reviewed several The researchers explored the theories as to why PNF is supposedly more beneficial than other techniques as well as determining the best possible protocol to maximize performance. This investigation 46 hypothesized that the best possible protocol for PNF is a shortening contraction of the antagonist followed by a static contraction of the agonist, held for at least 3 seconds and at least 20% of maximal intensity 10 . A final study looked at PNF and its effect on athletes who had stiff ankles. taken. ROM as well as other measures were Results showed that PNF stretching would significantly increase ankle ROM as compared to a control group 23 . Stretching and Injury Prevention Because of the potential benefit of increased ROM, stretching is also thought to reduce the risk of injury. Research has been done in this area to confirm if this is true. Carter et al studied the effects of stretching on injury risk in 2000. The researchers performed both PNF stretching and ballistic stretching on the hamstrings then measured the muscular activity with electrodes. Results showed decreased activity in the biceps femoris muscle. The authors hypothesized the decreased activity was due to desensitization of the muscle spindles which could lead to injury 24 . 47 Others took a different approach, determining if stretching had an effect on the subjects’ joint position sense. After being stretched, subjects were asked to re- create either 30 or 15 degrees of shoulder adduction from a starting position of 45 degrees. Results showed no significant differences between stretching groups and a control group. They concluded shoulder position sense is not influenced by stretching 25 . Weerapong et al’s research also looked at how stretching can be used to prevent injury. In addition to strength and ROM, they also measured subjects’ soreness. The static, dynamic, and PNF stretching groups all reported less soreness compared to a control group although none of the groups was significantly different than the others. This provides evidence that stretching can prevent injuries and soreness in the active population 18 . Stretching and Strength/Power In addition to stretching’s effect on ROM and injury, another commonly researched topic is stretching’s effect on measures of strength. Several studies already mentioned also used strength as a dependent variable in their research. Reviewing literature in this area revealed a 48 common theme. In nearly every case, stretching was a detriment to measures of strength performance or no significant changes were noted. The effects of different stretching protocols on isometric, eccentric, and concentric muscular performance as well as vertical jump have been explored in the past. The different stretching protocols significantly decreased performance in all these areas. The authors concluded that a stretching protocol to avoid these problems has not been determined or simply stretching may be detrimental to strength performance 26 . Vertical jump is often used to measure power and has been used several times in different studies. Another study compared three stretching interventions: static stretching, ballistic stretching, and PNF. With PNF and static stretching, a significant decrease in jump performance was noted while no differences were noted with ballistic stretching. The study took jump measurements at 5, 15, 30, 45, and 60 minutes after stretching. With each intervention, jump performance had recovered 15 after stretching 27 . Stipcak used a slightly different measure of strength in her study. The author used throwing velocity in baseball and softball players to measure strength. Static 49 stretching was performed on the subjects after which, their throwing velocity was measured. As noted earlier, no significant changes in throwing velocity were noted 15 . As stated earlier, Weerapong et al compared static, dynamic, and PNF stretching. In addition to measuring ROM, the researchers also measured strength. Their results showed no significant changes in their subjects’ strength 18 . Rees et al also measured strength in their study on PNF performed on the ankle. Their results were the anomaly in the research found. A significant increase in the strength of the plantarflexors was noted 23 . Other studies reviewed performed a more in-depth test to determine strength; attaching electrodes to determine maximal voluntary contraction, peak torque, and various EMG measurements. such study. The study done by Marek et al on PNF was one In the study, the PNF interventions caused significant decreases in the subjects peak torque, mean power output, and EMG amplitude despite the previous mentioned increases in ROM 22 . Papadopolous et al also did measurements on maximum voluntary contraction and EMG measurements as well as time taken to achieve maximum voluntary contraction, and other measures. These were taken after a short jog and seven 50 different stretches as a warm-up. EMG measurements were the only variable to show a significant change 28 . Other work that studied only maximum voluntary contraction and EMG measurements has been researched. The researchers measured these variables in both the quadriceps and hamstring muscles. Results showed a decrease in maximum voluntary contraction but an increase in EMG measurements. The authors concluded that the detriments seen post-stretching are due to inactivity rather than the increased elasticity 29 . Wen looked at only mean power output and peak torque of the hamstrings in his study comparing PNF to static stretching. Results showed no significant results between the two stretching groups. The author concluded that while stretching is beneficial, one technique is not more beneficial than the other 19 . Ogura et al also looked at just maximum voluntary contraction in addition to hamstring flexibility with thirty and sixty second bouts of stretching. As with ROM measurements, results showed no significant differences in the maximum voluntary contraction measures 13 . 51 Stretching and Speed Another common measure of athletic performance is an athlete’s speed. Curiously, the effects of stretching on sprint performance have received little research attention. One area that has received attention is the effects of several stretching protocols on fifty meter sprint times. Only one protocol showed a significant change. A static, passive stretch combined with an active, dynamic stretch produced significantly slower sprint times 30 . Nelson et al examined the effects of three different static stretches compared to no stretching in twenty yard sprint times of sixteen division one college track athletes. Once a week a different stretch was given and measure were taken. With each of the three stretches, results showed a significant increase in sprint times compared to no stretching revealing a decrease in performance 31 . Stretching’s effect on sprint performance has also been examined in rugby players. Four different warm-up protocols were included in this study: passive static stretch, active dynamic stretch, active static stretch, and static dynamic stretch. Results showed a significant increase in the sprint times of the passive static stretch 52 and active static stretch groups. A significant decrease in sprint times of the active dynamic stretch group was also noted 32 . Stretching and Agility A final area that has been explored that must be discussed is the effect of stretching on agility. This area has also received very little attention from researchers. Oakley explored static and dynamic stretching and its effect on T-test times, a measure of agility. Both stretching interventions showed significantly lower T-test times compared to control with the dynamic stretching group showing significantly lower times than the static stretching group 33 . Faigenbaum et al included agility measures in their studies on teenage athlete. The researchers measured shuttle run times along with vertical jump, medicine ball toss, and ten yard sprint; all measures of anaerobic performance. These measures were taken once after a static stretching warm-up and another time after a dynamic warmup. A control trial was also measured. In regards to agility, no significant difference was noted in any of the groups 34 . 53 Faigenbaum’s other study with different colleagues focused on children. This study also examined different warm-up protocols’ effect on several measures including agility. The protocols included five minutes of walking followed by five minutes of static stretching, ten minutes of dynamic exercise, or ten minutes of dynamic exercise plus three drop jumps from a fifteen centimeter box. Results revealed a significant decrease in agility measures with five minutes of walking and five minutes of static stretching compared to the ten minutes of exercise with three drop jumps measures 35 . McMillian et al. also examined static vs dynamic stretching warm-ups on agility. thirty military cadets. This study was done on The two protocols each lasted thirty minutes and the subjects were asked to perform Ttests for agility. In this case, no significant differences were present between the two groups 36 . Stretching seems to have many diverse effects on different measures of performance. Stretching affects the Golgi tendon organs and muscle spindles, two microscopic organelles inside muscles that respond to excess tension or stretch. Stretching seems to have a beneficial effect on ROM and injury prevention but a detriment to strengthening. 54 Research into other areas is lacking or has been inconclusive specifically in the area of agility. 55 APPENDIX B THE PROBLEM 56 Statement of the Problem Research into the area of Stretching’s effect on agility is lacking. The little research that is available shows that stretching may improve an athlete’s performance in agility tests. One stretching technique that has not been explored in regards to agility is proprioceptive neuromuscular facilitation (PNF). Also, the different styles of PNF have not been compared in measures of performance in any study found. Therefore this study was performed to determine if PNF stretching is beneficial to agility and if two PNF techniques had a significant difference between them in the same agility tests. Definition of Terms The definition of the following terms was used in this study. 1. PNF Stretching – several stretching techniques that involve a passive, static stretch followed by a contraction of the agonist and/or antagonist muscle and finally another passive, static stretch 7 . 2. Hold-Relax Stretching – A technique of PNF stretching involving a 10 second passive, static stretch of the 57 target muscle followed by a 4 second isometric contraction of the agonist 8 . 3. Contract-Relax Stretching – A technique of PNF stretching involving a 10 second passive, static stretch of the target muscle followed by a 4 second concentric contraction of the agonist 8 . 4. High School Athlete – subject who is a participant in at least one of the sports Burgettstown High School competes in. 5. Physically Active Subject – one who participates in at least 30 minutes of exercise (cardio, resistance training, etc.) for at least 3 days a week 37 . 6. Isometric – action in which a muscle develops tension, but does not shorten; also called a static contraction. No movement occurs 38 . 7. Concentric – occurs when a muscle is activated and shortens 38 . 8. Eccentric – occurs when a muscle is activated and force is produced but the muscle lengthens 38 . 9. Agility – The ability to control the direction of a body or its parts during rapid movement 39 . In regards to this study, a person’s agility will be measured by their performance in the T-Test. 58 10.Range of Motion (ROM) – Amount of movement within a joint. Range of motion is affected by soft-tissue mobility and can be influenced by strength when performed actively 39 . 11.Flexibility –Mobility of a body segment, dependent on soft-tissue tolerance and the ability of soft tissue to move with forces applied to it. Flexibility can involve soft-tissue mobility alone or in combination with joint motion 39 . Basic Assumptions The following assumptions were made when conducting the research: 1. The PNF techniques Contract-Relax and Hold-Relax are performed correctly. 2. The T-test for agility was set-up correctly and the times collected from the subjects’ tests are accurate. 3. The subjects will perform no other flexibility exercises when participating in this study. 4. The “T” agility test is valid and reliable. 5. The Speed Trap II Timer is a valid and reliable timing device. 6. 59 Limitations of Study The following limitations were noted in this study: 1. Subjects were gathered only from volunteers from Burgettstown High School. 2. Every PNF stretching technique was not utilized. Only the techniques Contract-Relax and Hold-Relax were utilized. 3. Agility was the only measure of performance tested in this study. Significance of Study Stretching has traditionally been part of an athlete’s warm-up procedures. Most research into stretching has dealt with how it affects an athlete’s Range of Motion. Other studies have examined stretching’s effect on strength and power, injury risk, speed, and agility. However, the effects on agility have not been researched extensively. Although research is minimal, the effects of stretching on agility have shown to be beneficial in some studies. Proprioceptive neuromuscular facilitation is a stretching strategy composed of several different techniques, which have shown to be beneficial in several 60 areas including Range of Motion. It has shown to allow for greater stretches compared to other techniques thereby allowing for greater improvements in an athlete’s Range of Motion. However, PNF’s effects on performance have not been researched extensively. Also, the several types of PNF stretching have not been compared in any capacity the researcher could find. This study will compare trials of two of these techniques in an agility test along with a control trial. By performing this study, the researcher hoped to uncover another, better stretching technique that may improve an athlete’s performance. The researcher also hoped to discover if the benefits offered by the techniques of PNF are significantly different from one another. PNF encompasses several stretching techniques which not only stretch the muscles but also expose the muscles to contractions. There may be a more beneficial combination of stretching and muscular contraction compared to others. The results of this study may change warm-up procedures in sports where agility is an important component. PNF stretching may become a favorite procedure of coaches and personal trainers everywhere. The researcher hoped that the study would not only identify new, effective warm-up 61 procedures, but generate questions for further study into stretching techniques and warm-up protocols. 62 APPENDIX C ADDITIONAL METHODS 63 APPENDIX C1 Informed Consent Form 64 Informed Consent Form The Effect of PNF Stretching on the Agility of High School Athletes California University of Pennsylvania California, Pennsylvania 15419 Responsible Investigator: Brett Piper ATC I/ My child has been asked to participate in a research study that investigates the effects of two separate stretching techniques on agility as measured by the T-Test. In participation of this study, I/ my child agrees to: perform three (3) agility tests under the supervision of Brett Piper ATC, each test will be performed after receiving one of two stretching protocols plus a control trial where no stretching will be performed. I/ My child will not perform any additional stretching exercises, resistance exercise, or cardiovascular exercise during his/her participation in this study. I/He/she will not share any information related to the results of this study I/he/she may be made aware of during my participation. My/His/Her participation in this study may lead to findings which show that the selected stretching protocols are beneficial to an athlete’s agility as well as any possible differences between the two different protocols. I understand that: A. The possible risks of this procedure include possible injuries as a result of performing the T-Test for agility such as fatigue, muscular strain, ligament sprain, possible asthmatic episode if applicable, or injuries related to the impact from falling such as contusions, fractures, or concussion. All stretching will be performed by the researcher who will also closely monitor all testing procedures. The possible benefit to me of this study is knowing if the selected stretching techniques are beneficial to agility as well as knowing if differences are present between the techniques. B. Any questions I have concerning my participation in this study will be answered by Brett Piper ATC (419-366-0088). C. I understand that I may refuse to participate from this study at any time without any negative consequences. Also, the investigator may stop at any time. I also understand that no information which identifies me/my child will be released without my separate consent and that all identifiable information will be protected to the limits allowed by law. If the study design or the use of the data is to be changed, I will be so informed and my consent re-obtained. I understand that if I have any questions, comments, or concerns about the study or the informed consent process, I may write or call Department of Health Sciences and Sports Studies, California University of Pennsylvania, 250 University Ave., California, PA 15419. Phone: 724-938-4000. D. I have received a copy of this consent form and the Research Participants’ Bill of Rights. I have read the above and understand it and hereby consent to the procedure(s) set forth. SUBJECT___________________________________________________ PARENT/GUARDIAN (if Necessary) _____________________________________ DATE_______________ INVESTIGATOR_____________________________________ 65 APPENDIX C2 Permission from Burgettstown High School 66 67 68 APPENDIX C3 Institutional Review Board California University of Pennsylvania 69 70 71 72 If your project involves a questionnaire interview, ensure that it meets the requirements of Appendix __ in the Policies and Procedures Manual. 73 74 APPENDIX C4 Demographic Information Sheet 75 Demographic Information Sheet Name:__________________________ Subject #:________ Age:__________________ Gender: M / F Height:________________ Weight:___________ In the last 3 months have you sustained any lower extremity (hips, thighs, knees, shins, feet, toes) injury that caused you to seek medical attention? Yes / No Do you exercise at least 3 days a week for at least 30 minutes? Yes / No Please list your primary sport at Burgettstown. (The sport you spend the most time in practice/preparation both in-season and offseason.) 76 APPENDIX C5 Individual Data Collection Sheet 77 Data Collection Sheet Subject #:_______ Intervention/Order Control Order: Hold-Relax Order: Contract-Relax Order: Subject Initials:____________ Time 78 APPENDIX C6 Stretching Positions 79 Hamstring Stretch Quadriceps Stretch 80 REFERENCES 1. Moore, Marjorie. Golgi Tendon Organs: Neuroscience Update with Relevance to Stretching and Proprioception in Dancers. Journal of Dance Medicine and Science. 2007. 11: 85-92. 2. Chalmers, Gordon. Re-examination of the Possible Role of Golgi Tendon Organs and Muscle Spindle Reflexes in Proprioceptive Neuromuscular Facilitation Stretching. Sports Biomechanics. 2005.3:159-183. 3. Chalmers, Gordon. Do Golgi Tendon Organs Really Inhibit Muscle Activity and High Force Levels to Save Muscles from Injury, and Adapt with Strength Training. Sports Biomechanics. 2003. 1: 239-249. 4. De Deyne, Patrick G. 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Human Kinetics; 2005. 85 ABSTRACT Title: THE EFFECTS OF PNF STRETCHING ON THE AGILITY OF HIGH SCHOOL ATHLETES Researcher: Brett Piper, ATC, PES Advisor: Dr. Robert Kane, PT, ATC Date: May 2009 Research Type: Master’s Thesis Context: Past research has shown that stretching prior to participation may have a positive effect on the agility of athletes. PNF stretching techniques have been found to be beneficial to several areas of performance. However, PNF stretching techniques have not been explored in this area nor has research compared two or more PNF techniques to each other. Objective: The purpose of this study was to determine if PNF stretching techniques had a significant effect on the agility test times of high school athletes. Design: Repeated Measures, Within Subjects design. Setting: Controlled laboratory setting. Participants: Fifteen male and fifteen female physically active high school students (age = 15.8 ± 1.4 yrs. Weight = 157.5 ± 35.5 lbs.) from Burgettstown High School in Burgettstown, Pennsylvania who also participate in athletics. Interventions: Each subject was tested on three separate days under three different stretching interventions (No stretching, Hold-relax PNF, and Contract-relax PNF). Stretching was performed on the hamstrings and quadriceps muscles. Each muscle group was stretched three times under each condition with a ten second static stretch period 86 followed by a four second contraction of the muscles’ antagonist. After stretching was completed, each subject performed a T-Test for agility. Main Outcome Measures: Mean times were calculated from all three trials of all thirty subjects and compared using a Repeated Measures Analysis of Variance (ANOVA) with an alpha level of < .05. Results: No significant differences were found between the control trials and the two PNF stretching techniques (F 2,56 =.046 p > .05). Mean times of the control trials were found to be 11.63 ± 1.41. The mean times of the Hold-relax and Contract-relax trials were found to be 11.59 ± 1.31 and 11.64 ± 1.36 respectively. However, additional findings found that no matter the condition, the male subjects exhibited significantly lower times compared to the female subjects. Conclusions: This study revealed that a PNF protocol of a ten second static stretch followed by a four second contraction is not sufficient to gain significant improvements in performance in regards to agility. Previous studies using a thirty second static stretch and a five second contraction have shown significant differences in other areas of performance. Additional testing using similar protocols with a thirty second stretch and a five second contraction should be done to determine if PNF stretching can be beneficial to agility as other techniques have shown to be. Word Count: 395