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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. Application of Passive Stretch
and Its Implications for Muscle Fibers. Physical
Therapy. 2001. 81: 819-827.
5.
Cross, Kevin M., Musculotendinous-Unit Anatomy and
Pathophysiology. Athletic Therapy Today. 2000. 5: 613.
6.
Martini, Frederic H., Fundamentals of Anatomy &
Physiology. 6th ed. San Francisco, CA: Pearson
Education Inc.; 2004.
7.
Voss, Dorothy E., Ionta, Marjorie K., & Myers, Beverly
J., Proprioceptive Neuromuscular Facilitation Patterns
and Techniques. 3rd ed. Philadelphia, PA: Harper and
Row Publishers; 1985.
8.
Prentice, William E. Rehabilitation Techniques. 4th ed.
New York, NY. McGraw-Hill Companies Inc.; 2004.
9.
Baechle, Thomas R., Earle, Roger W. Essentials of
Strength Training and Conditioning. 2nd ed. Champaign,
IL. Human Kinetics; 2000.
10.
Sharman, Melanie J., Cresswell, Andrew G., & Riek,
Stephan. Proprioceptive Neuromuscular Facilitation
Mechanisms and Clinical Implications. Sports Med.
2006. 36: 929-939.
81
11.
Swanson, John R. A Functional Approach to Warm-up and
Flexibility. Strength and Conditioning Journal. 2006.
28: 30-36.
12.
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.
13.
Ogura, Yugi, Miyahara, Yutetsu, Naito, Hisashi,
Katamoto, Shizuo, & Aoki, Junichiro. Duration of
Static Stretching Influences Muscle Force Production
in Hamstring Muscles. Journal of Strength and
Conditioning Research. 2007. 21: 788-892.
14.
Nelson, Russell T. & Bandy, William D. Eccentric
Training and Static Stretching Improve Hamstring
Flexibility of High School Males. Journal of Athletic
Training. 2004. 39: 254-258.
15.
Stipcak, Deanne. The Effects of Stretching Shoulder
Musculature on Throwing Velocity. Submitted to the
Faculty of the School of Graduate Studies and Research
of California University of Pennsylvania. 2006. 1-86.
16.
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.
17.
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.
18.
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.
19.
Wen, John N. The Effects of Proprioceptive
Neuromuscular Facilitation vs. Static Stretching vs.
82
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.
20.
Ford, Phillip & McChesney, John. Duration of
Maintained Hamstring ROM Following Termination of
Three Stretching Protocols. Journal of Sport
Rehabilitation. 2007. 16: 18-27.
21.
Pollard H, Ward G. A Study of Two Stretching
Techinques for Improving Hip Flexion Range of Motion.
Journal of Manipulative & Physiological Therapeutics.
1997. 20.
22.
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.
23.
Rees, Sven S., Murphy, Aron J., Watsford, Mark L.,
McLachlan, Ken A., & Coutts, Aaron J. Effects of
Proprioceptive Neuromuscular Facilitation on Stiffness
and Force Production Characteristics of the Ankle in
Active Women. Journal of Strength and Conditioning
Research. 2007. 21: 572-577.
24.
Carter, Allyson M., Kinzey, Stephen J., Chitwood,
Linda F., & Cole, Judith L., Proprioceptive
Neuromuscular Facilitation Decreases Muscle Activity
During the Stretch Reflex in Selected Posterior Thigh
Muscles. Journal of Sport Rehabilitation. 2000. 9:
269-278.
25.
Bjorklund, Martin, Djupsjobacka, Mats, & Crenshaw,
Albert G. Acute Muscle Stretching and Shoulder
Position Sense. Journal of Athletic Training. 2006.
41: 270-274.
26.
Rubini, Ercole C., Costa, Andre LL., & Gomes, Paulo
SC. The Effects of Stretching on Strength Performance.
Sports Med. 2007. 37: 213-224.
83
27.
Bradley, Paul S., Olsen, Peter D., & Portas, Matthew
D. The Effect of Static, Ballistic, and Proprioceptive
Neuromuscular Facilitation Stretching on Vertical Jump
Performance. Journal of Strength and Conditioning
Research. 2007. 21(1): 223-226.
28.
Papadapolous, Christos, Kalapotharakos, Vasilios I.,
Noussios, Georgios, Meliggas, Konstantinos, &
Gantiraga, Evangelia. The Effect of Static Stretching
on Maximal Voluntary Contraction and Force-Time Curve
Characteristics. Journal of Sport Rehabilitation.
2006. 15: 185-194.
29.
Behm, David G., Button, Duane C., & Butt, Jeremy C.
Factors Affecting Force Loss with Prolonged
Stretching. Canadian Journal of Applied Physiology.
2001. 26: 262-272.
30.
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.
31.
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.
32.
Fletcher, Iain & Jones, Bethan. The Effect of
Different Warm-up Stretch Protolcols on 20 Meter
Sprint Performance in Trained Rugby Union Players.
National Strength and Conditioning Association. 2004.
18(4): 885-888.
33.
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.
34.
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.
84
35.
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.
36.
McMillian, Danny J., Moore, Josef H., Hatler, Brian
S., & Taylor, Dean C. Dynamic vs. Static-Stretching
Warm-up: The Effect on Power and Agility Performance.
Journal of Strength and Conditioning Research. 2006.
20(3): 492-499.
37.
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.
38.
Powers, Scott K. & Howley, Edward T. Exercise
Physiology: Theory and Application to Fitness and
Performance. 6th ed. New York, NY. McGraw-Hill
Companies Inc.; 2007.
39.
Houglum, Peggy A. Therapeutic Exercise for
Musculoskeletal Injuries. 2th ed. Champaign, IL. 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
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. Application of Passive Stretch
and Its Implications for Muscle Fibers. Physical
Therapy. 2001. 81: 819-827.
5.
Cross, Kevin M., Musculotendinous-Unit Anatomy and
Pathophysiology. Athletic Therapy Today. 2000. 5: 613.
6.
Martini, Frederic H., Fundamentals of Anatomy &
Physiology. 6th ed. San Francisco, CA: Pearson
Education Inc.; 2004.
7.
Voss, Dorothy E., Ionta, Marjorie K., & Myers, Beverly
J., Proprioceptive Neuromuscular Facilitation Patterns
and Techniques. 3rd ed. Philadelphia, PA: Harper and
Row Publishers; 1985.
8.
Prentice, William E. Rehabilitation Techniques. 4th ed.
New York, NY. McGraw-Hill Companies Inc.; 2004.
9.
Baechle, Thomas R., Earle, Roger W. Essentials of
Strength Training and Conditioning. 2nd ed. Champaign,
IL. Human Kinetics; 2000.
10.
Sharman, Melanie J., Cresswell, Andrew G., & Riek,
Stephan. Proprioceptive Neuromuscular Facilitation
Mechanisms and Clinical Implications. Sports Med.
2006. 36: 929-939.
81
11.
Swanson, John R. A Functional Approach to Warm-up and
Flexibility. Strength and Conditioning Journal. 2006.
28: 30-36.
12.
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.
13.
Ogura, Yugi, Miyahara, Yutetsu, Naito, Hisashi,
Katamoto, Shizuo, & Aoki, Junichiro. Duration of
Static Stretching Influences Muscle Force Production
in Hamstring Muscles. Journal of Strength and
Conditioning Research. 2007. 21: 788-892.
14.
Nelson, Russell T. & Bandy, William D. Eccentric
Training and Static Stretching Improve Hamstring
Flexibility of High School Males. Journal of Athletic
Training. 2004. 39: 254-258.
15.
Stipcak, Deanne. The Effects of Stretching Shoulder
Musculature on Throwing Velocity. Submitted to the
Faculty of the School of Graduate Studies and Research
of California University of Pennsylvania. 2006. 1-86.
16.
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.
17.
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.
18.
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.
19.
Wen, John N. The Effects of Proprioceptive
Neuromuscular Facilitation vs. Static Stretching vs.
82
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.
20.
Ford, Phillip & McChesney, John. Duration of
Maintained Hamstring ROM Following Termination of
Three Stretching Protocols. Journal of Sport
Rehabilitation. 2007. 16: 18-27.
21.
Pollard H, Ward G. A Study of Two Stretching
Techinques for Improving Hip Flexion Range of Motion.
Journal of Manipulative & Physiological Therapeutics.
1997. 20.
22.
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.
23.
Rees, Sven S., Murphy, Aron J., Watsford, Mark L.,
McLachlan, Ken A., & Coutts, Aaron J. Effects of
Proprioceptive Neuromuscular Facilitation on Stiffness
and Force Production Characteristics of the Ankle in
Active Women. Journal of Strength and Conditioning
Research. 2007. 21: 572-577.
24.
Carter, Allyson M., Kinzey, Stephen J., Chitwood,
Linda F., & Cole, Judith L., Proprioceptive
Neuromuscular Facilitation Decreases Muscle Activity
During the Stretch Reflex in Selected Posterior Thigh
Muscles. Journal of Sport Rehabilitation. 2000. 9:
269-278.
25.
Bjorklund, Martin, Djupsjobacka, Mats, & Crenshaw,
Albert G. Acute Muscle Stretching and Shoulder
Position Sense. Journal of Athletic Training. 2006.
41: 270-274.
26.
Rubini, Ercole C., Costa, Andre LL., & Gomes, Paulo
SC. The Effects of Stretching on Strength Performance.
Sports Med. 2007. 37: 213-224.
83
27.
Bradley, Paul S., Olsen, Peter D., & Portas, Matthew
D. The Effect of Static, Ballistic, and Proprioceptive
Neuromuscular Facilitation Stretching on Vertical Jump
Performance. Journal of Strength and Conditioning
Research. 2007. 21(1): 223-226.
28.
Papadapolous, Christos, Kalapotharakos, Vasilios I.,
Noussios, Georgios, Meliggas, Konstantinos, &
Gantiraga, Evangelia. The Effect of Static Stretching
on Maximal Voluntary Contraction and Force-Time Curve
Characteristics. Journal of Sport Rehabilitation.
2006. 15: 185-194.
29.
Behm, David G., Button, Duane C., & Butt, Jeremy C.
Factors Affecting Force Loss with Prolonged
Stretching. Canadian Journal of Applied Physiology.
2001. 26: 262-272.
30.
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.
31.
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.
32.
Fletcher, Iain & Jones, Bethan. The Effect of
Different Warm-up Stretch Protolcols on 20 Meter
Sprint Performance in Trained Rugby Union Players.
National Strength and Conditioning Association. 2004.
18(4): 885-888.
33.
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.
34.
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.
84
35.
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.
36.
McMillian, Danny J., Moore, Josef H., Hatler, Brian
S., & Taylor, Dean C. Dynamic vs. Static-Stretching
Warm-up: The Effect on Power and Agility Performance.
Journal of Strength and Conditioning Research. 2006.
20(3): 492-499.
37.
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.
38.
Powers, Scott K. & Howley, Edward T. Exercise
Physiology: Theory and Application to Fitness and
Performance. 6th ed. New York, NY. McGraw-Hill
Companies Inc.; 2007.
39.
Houglum, Peggy A. Therapeutic Exercise for
Musculoskeletal Injuries. 2th ed. Champaign, IL. 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.
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