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The efficacy of two modified proprioceptive neuromuscular facilitation stretching techniques in subjects with reduced hamstring muscle length
Youdas JW, Haeflinger KM, Kreun MK, Holloway AM, Kramer CM, Hollman JH
Physiotherapy Theory and Practice 2010;26(4):240-250
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

Difference scores in knee extension angle and electromyographic (EMG) activity were quantified before and after modified proprioceptive neuromuscular facilitation (PNF) hold-relax (HR) and hold-relax-antagonist contraction (HR-AC) stretching procedures in 35 healthy individuals with reduced hamstring muscle length bilaterally (knee extension angle < 160 degrees). Participants were randomly assigned each PNF procedure to opposite lower extremities. Knee extension values were measured by using a goniometer. EMG data were collected for 10 seconds before and immediately after each PNF stretching technique and normalized to maximum voluntary isometric contraction (% MVIC). A significant time by stretch-type interaction was detected (F[1,34] = 21.1; p < 0.001). Angles of knee extension for HR and HR-AC were not different prior to stretching (p = 0.45). Poststretch knee extension angle was greater in the HR-AC condition than the HR condition (p < 0.007). The proportion of subjects who exceeded the minimal detectable change (MDC95) with the HR-AC stretch (97%) did not differ (p = 0.07) from the proportion who exceeded the MDC95 with the HR stretch (80%). Because EMG activation increased (p < 0.013) after the HR-AC procedure, it is doubtful a relationship exists between range of motion improvement after stretching and inhibition of the hamstrings. On average the 10-second modified HR procedure produced an 11 degrees gain in knee extension angle within a single stretch session.

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