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The Effect of Time on Static Stretch on the Flexibility of the Hamstring

Muscles

Article  in  Physical Therapy · October 1994

DOI: 10.1093/ptj/74.9.845 · Source: PubMed

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Research Report

The Effect of Time on Static Stretch on the

Flexibility of the Hamstring Muscles

Background and Purpose. To date, there are no reports comparing dura- Wllliam D Bandy
tion of static stretch in humans on joint range of motion (ROM) and ham- Jean M lrlon
string muscle flexibility. The purpose of this study was to examine the length of
time the hamstring muscles should be placed in a sustained stretched position
to maximally increase ROM. Subjects. Fifty-seven subjects (40 men, 17 wom-
en), ranging in age from 21 to 37 years and with limited hamstring muscle
flexibility (ie, 30" loss of knee extension measured with femur held at 90" of
hip flexion), were randomly assigned to one of four groups. Three groups
stretched 5 days per week for 15, 30, and 60 seconds, respectively. The fourth
group, which served as a control group, did not stretch. Metbods. Before and
after 6 weeks of stretching, flexibility of the hamstring muscles was determined
by measuring knee extension ROM with the femur maintained in 90 degrees of
hip flexion. Data were analyzed with a 4 X2 analysis of variance group X test)
for repeated measures o n one variable. Results. The data analysis revealed a
signi$cant group X test interaction, indicating that the change in flexibility was
dependent o n the duration of stretching. Further post hoc analysis revealed
that 30 and 60 seconds of stretching were more effective at increasing flexibil-
ity of the hamstring muscles (as determined by increased ROM of knee exten-
sion) than stretching for 15 seconds or no stretching. In addition, n o sign@-
cant difference existed between stretching for 3 0 seconds and for 1 minute,
indicating that 30 seconds of stretching the hamstring muscles was as effective
as the longer duration of 1 minute. Conclus#onand Discuss#on. The re-
sults of this study suggest that a duration of 3 0 seconds is an effective time of
stretching for enhancing the flexibility of the hamstring muscles. Given the
information that no increase in flexibility of the hamstring muscles occurred
by increasing the duration of stretching from 3 0 to 60 seconds, the use of the
longer duration of stretching for an acute effect must be questioned. [Bandy
WD, It-ion JM. The effect of time on static stretch on the flexibility of the ham-
string muscles. Phys Ther. 1994;74:845-852.]

Key Words: Kinesiologvlbiomechanics, lower extremity;Muscle; Muscle pdor-

mance, l o w extremity.

Anderson and Burke defined

flexibility as "the range of motion
available in a joint or a group of joints
WD Bandy, PhD, PT, SCS, ATC, is Associate Professor, Depanrnent of Physical Therapy, Health Sci-
ences Center, University of Central Arkansas, 201 Donaghey Ave, Ste 200, Conway, AR 72035-0001 that is influenced by muscles, ten-
(USA). Address all correspondence to Dr Bandy. dons, ligaments, and bones."l(p63)
JM Irion, PT, SCS, ATC, is Instructor, Department of Physical Therapy, Health Sciences Center, Uni-
Flexibility of muscle has long been a
versity of Central Arkansas. concern of physical therapists and
rehabilitation specialists, as well as
This study was approved by the University of Central Arkansas Human Subjects Review Committee.
physical educators and coaches.
This research was supported, in pan, by a grant awarded by the University of Central Arkansas Claims have been made that increased
Research Council.

This article was submilred Augusl 25, 1993, and was accepted March 22, 1994.

54 / 845 Physical Therapy /Volume 74, Number S/September 1994

flexibility resulting from stretching bility of the muscle is the static position to maximally increase flexi-
activities may decrease the incidence ~tretch.1-3.~,~ bility. More specifically, this study
of musculotendinous injuries, mini- compared the effects of daily stretches
mize and alleviate muscle soreness, Only limited studies exist concerning of the hamstring muscles of 15, 30,
and improve athletic perf~rmance.l-~ the optimal time the stretch should and 60 seconds in duration on knee
be sustained, and no comparative joint ROM.
Three types of stretching exercises studies evaluating the optimal time of
are used in an attempt to gain an stretch have been performed. Investi- Method
increase in flexibility: static stretching, g a t o r ~ 3 ~ ~demonstrating
~l~l3 that static
ballistic stretching, and proprioceptive stretching is an effective means of Subjects
neuromuscular facilitation (PNF) tech- increasing flexibility have used stretch
n i q u e ~ . ' , The
~ ballistic stretch uses durations ranging from 15 to 60 sec- Seventy-five subjects (44 men, 31
bouncing o r jerking movements onds, but no justification was given women) between the ages of 20 and
imposed on the muscles to be for the stretch duration used. In addi- 40 years @=26.53, SD=5.33) and
stretched.lB8 The quick, jerking motion tion, studies comparing the effective- without any significant history of pa-
that occurs during the ballistic stretch ness of static stretch and PNF have thology of the hip, knee, thigh, o r low
can theoretically exceed the extensi- used varying lengths of static stretch back were recruited for this study.
bility limlts of the muscle in an un- (10,3710,1130,14and 6015 seconds), as Subjects were volunteers and signed
controlled manner and cause injury. have investigations evaluating the an institutionally approved informed
The use of this technique, therefore, effectiveness of combining various consent statement.
has not been widely supported in the modalities (eg, massage, heat, cold)
literature.1~3The static stretch is a with static stretch (3,13 10,1691730,18 To participate in the study, subjects
method in which the muscle is slowly and 4519 seconds). No rationale was must have exhibited "tight" hamstring
elongated to tolerance (comfortable given for the duration of stretch in muscles, operationally defined as
stretch, short of pain) and the posi- any of these studies. having greater than 30 degrees' loss
tion held with the muscle in this of knee extension measured with the
greatest tolerated length. Static In only one study were changes in femur held at 90 degrees of hip flex-
stretching offers advantages over the flexibility in humans as a result of ion (refer to "Procedure" section for
ballistic stretching method. Exceeding different durations of static stretch details). In addition, subjects who
the extensibility limits of the tissue investigated. Comparing the effects of were not involved in any exercise
involved is unlikely, and the tech- one session of 15, 45, and 120 sec- activity at the start of the study had to
nique requires less energy to perform onds of stretching on hip abduction agree to avoid lower-extremity exer-
and alleviates muscle The passive range of motion (ROM), Mad- cise and activities other than those
PNF techniques of contract-relax and ding et a120 reported that sustaining a prescribed by the research protocol.
hold-relax involve the use of a brief stretch for 15 seconds was as effective Subjects who were involved in exer-
isometric contraction of the muscle as sustaining a stretch for 120 sec- cise activity at the start of the study
to be stretched prior to a static onds. These results reflect only one agreed not to increase the intensity o r
stretch.9--!IThe PNF techniques pre- session of stretching, and the effect of frequency of the activity during the 6
sumably not only require the most these vatying durations of stretch over weeks of training.
expertise of the three techniques time are not known.
described, but an experienced thera- Fourteen (2 men, 12 women) of the
pist is required to administer the PNF In summary, the literature supports original 75 volunteers were excluded
techniques.9-11 the fact that static stretch will increase from the study because their ham-
the flexibility of muscle. A great deal string muscles were considered too
Each of these three types of stretching of variability exists, however, concern- flexible by the established criteria,
techniques (static, ballistic, and PNF) ing the length of time a static stretch and 4 subjects (2 men, 2 women)
appears I:O increase the flexibility of a should be sustained. To date, no were eliminated from the study as a
muscle immediately after the stretch- multiple-day study with the specific result of noncompliance with the
ing.1.2.6,8,10,11Given that the ballistic purpose of comparing duration of training program. Therefore, 57 sub-
stretch may pose the greatest poten- static stretch and the effect on muscle jects (40 men, 17 women), with a
tial for trauma and that PNF requires length in humans has been reported. mean age of 26.11 years (SD=5.26,
the assisl.ance of an experienced prac- range=21-37), met the established
titioner, the most common method of The purpose of our study was to criteria and completed the study.
stretching used to increase the flexi- examine the length of time a muscle
should be sustained in a stretched Equipment

Flexibility of the hamstring muscles

was measured with a goniometer*
*CleoInc, 3957 Mayfield Rd, Cleveland, OH 44121. that was a double-armed, full-circle

Physical Therapy /Volume 74, Number 9/September 1994

 Figure 2. Stretching procedure, for
hamstring muscles.

range=22-36) was assigned to partici-

Figure 1. Measurement of hamstring muscle flexibility. pate in passive, static stretching activi-
ties sustained for 15 seconds; group 2
protractor made of transparent plastic. knee extension was reached, the (10 men, 4 women; X age=24.64
The arms of the goniometer were second examiner measured the years, SD=2.31, range=22-28) was
30.48 cm (12 in) long and marked off amount of knee extension with the assigned to participate in static
in 1-degree increments. goniometer using methods described stretching sustained for 30 seconds;
by Norkin and White.21 Zero degrees and group 3 (9 men, 5 women;
Procedure of knee extension was considered full X age=26.36 years, SD=6.66,
hamstring muscle flexibility. No range =2 1-37) was assigned to receive
All subjects who met the criteria for warm-up period was allowed prior to static stretching for a 60-second dura-
inclusion in the study were measured data collection. tion. Group 4 (11 men, 4 women;
for flexibility of the right (arbitrarily r? age=26.87 years, SD=6.42,
chosen) hamstring muscles prior to The same examiners made all gonio- range=22-36) served as a control
assignment to groups. Each subject metric measurements throughout the group. No stretching was performed
was positioned supine with the right study. In addition, the second exam- by the control group.
hip and knee flexed to 90 degrees. iner (measuring the amount of knee
The lateral malleolus, lateral epi- extension) was not informed which Subjects in groups 1 through 3
condyle of the femur, and greater subjects were doing stretching. stretched five times a week for 6
trochanter of the right lower extrem- weeks. The subjects performed
ity were then marked with a felt- Prior to data collection, intratester stretching of the hamstring muscles
tipped pen for later goniometric mea- reliability of the measurement of by standing erect with the left foot
surement. Ninety degrees of hip hamstring muscle flexibility using the planted on the floor and placed di-
flexion was maintained by one re- procedure described was evaluated in rectly forward without hip medial
searcher (MB), while the tibia of the these researchers using a test-retest (internal) or lateral (external) rota-
knee was passively moved to the (I-week apart) design on 10 different tion. The posterior calcaneal aspect of
terminal position of knee extension subjects. The intraclass correlation the contralateral (right) foot was
by the second researcher (JMI) (Fig. coefficient (ICC[1,1])22was .98, which placed on a plinth or chair with the
1). The terminal position of knee was considered appropriate for pro- toes of the foot directed toward the
extension was defined as the point at ceeding with this study. ceiling, again without hip medial o r
which the subject complained of a lateral rotation (Fig. 2). The knee
feeling of discomfort o r tightness in Following pretesting, the subjects remained fully extended. The arms
the hamstring muscles o r the experi- were randomly assigned to four were flexed to shoulder height with
menter perceived resistance to groups. Group 1 (10 men, 4 women; the elbows fully extended. The sub-
stretch. Once the terminal position of age=26.50 years, SD=4.69, ject then flexed forward from the hip,

56 / 847 Physical Therapy /Volume 74, Number 9/September 1994

maintaining the spine in a neutral tions for the pretest and posttest mea- subjects in both groups 2 and 3, who
position, while reaching the arms surements were calculated for each stretched for 30 and 60 seconds, re-
forward. The subject moved forward group, as well as the mean differences spectively, were much greater than
in this position until a gentle stretch between the pretest and posttest data for the subjects in both groups 1 and
was felt in the posterior thigh. Once (gain scores), for the dependent vari- 4, who stretched for 15 and 0 (con-
the subject achieved this position, the able, knee extension ROM (in trol) seconds, respectively. The differ-
stretch was sustained the assigned degrees). ences observed between groups 2
amount of time. This stretching tech- and 3 and between groups 1 and 4
nique was used to approximate the To determine whether significant were minimal (Fig. 3).
type of static stretch procedure com- differences existed between the
monly taught in a clinical setting.3.6 values of the four groups, a 4 x 2 Discussion
(group x test) two-way analysis of
Performance of each stretching ses- variance (ANOVA) for repeated mea- To ensure that appropriate reliability
sion by each subject was supelvised sures on one variable (test) was per- occurred in the study, we used ICC
and recorded by one researcher (MB) formed. Significance for all statistical (formula 1,1), which Shrout and
on an attendance sheet to document tests was accepted at the .05 level of FleisszZsuggest is the most conserva-
compliance with the program. If a probability. tive form of ICC and almost always
subject missed a scheduled session, underestimates the reliability. The
he or she made up the session on Results conservative estimate of .91 for the
another day during the same week or reliability of the pretest-posttest mea-
during the next week (requiring an The mean values for the pooled pre- surements of knee extension ROM for
exercise frequency of six times per test measurements and the pooled the 15 control group subjects, there-
week during the week following the posttest measurements of the control fore, appears quite acceptable for the
missed session). Any subject missing group for degrees of knee extension purposes of this study.
more than 4 days without performing were 45.47 degrees (SD=7.29) and
the stretching was eliminated from 45.20 degrees (SD=6.68), respec- Based on the results of the two-way
the study. tively. The ICC value calculated for ANOVA (Tab. 2), the null hypothesis
the pretest-posttest knee extension that no difference would be obtained
After the 6 weeks of training, all sub- data of the control group was .91. in knee extension ROM if the ham-
jects were retested using the same string muscles were stretched at dura-
procedures described for the pretest. The means for pretest and posttest tions of 15, 30, and 60 seconds for 6
Two days of rest was provided prior measurements and gain scores for weeks must be rejected. Stretching
to the posttest. each group are presented in Table 1. the hamstring muscles for 30 and 60
The two-way ANOVA indicated a sig- seconds showed greater gains in ROM
Data Analysis nificant interaction between the than stretching for 15 seconds or no

-
groups (control and 15-, 30-, and stretching (control).
Reliability of the knee extension mea- 60-second stretches) and test (pretest
surements were determined using an and posttest) in degrees of knee ex- Because 15 seconds of stretching was
ICC (formula 1,l) on the pretest and tension (Tab. 2). Further evaluation of no more effective than no stretching,
posttest measurements of the control the data indicated that the change in we must question the use of stretch-
Means and standard devia- degrees of knee extension for the ing of 15 seconds or less. Based on
our results, individuals performing
15-second stretches may be wasting
their time, as only a minimal increase
Table 1. Mean (fStandard Deviation) Valuesfor Pretest, Posttest, and Gain Scores in flexibility is likely to occur.
(in Degrees) of Knee Flexion for Each Level of Group
Our study is the first to investigate the
effect of static stretching on ROM over
Groupa
a period of time (eg, 6 weeks). In the
1 (n=14) 2 (n=14) 3 (n=14) Control (n= 15) only other investigation of the effect
of time on stretching, only one ses-
Pretest 50.14 (6.09) 51.64 (9.74) 50.07 (4.92) 45.47 (7.29) sion of stretching was used. Although
Posttest 46.36 (7.92) 39.14 (9.54) 39.21 (9.59) 45.20 (6.68)
previous research on humans using
Gain (difference
one session of stretching exercise
between pretest indicated that 15 seconds' duration
and posttest) 3.78 12.50 10.86 was as effective as 2 minutes,2O the
results of our study contradict these
"Group 1 stretched for 15 seconds, group 2 stretched for 30 seconds, and group 3 stretched for 1 findings and indicate that longer peri-
minute; the control group did not stretch. ods of time (eg, 30 and 60 seconds)

Physical Therapy/Volume 74, Number 9/September 1994

-
Table 2. Two-Way (Four Groupsx Two Tests) Analysis-opVariance Results

Source

Groupa
df

3
SS

215.71
MS

0.68
F

0.68
research could evaluate whether dura-
tions of 90 to 120 seconds or longer
will provide increased muscle flexibil-
ity. We believe, however, that compli-
ance may be decreased if durations of
stretching are too long, particularly in
people with muscle tightness. In fu-
ture research, durations of stretching
Testb 1 1337.03 1337.03 72.2gc
that are clinically appropriate and
Groupx test 3 726.27 242.09 13.09" acceptable need to be studied and the
effect of multiple stretches per day
"Control (no stretching) and 15-, 30-, and 60-second static stretching groups. need to be investigated. Future re-
'~est-retest. search would also be appropriate to
'P<.05. evaluate the effect of duration of
stretching on other muscles. Although
are more effective for increasing effective duration of stretching is 30 30 seconds of stretching the ham-
muscle flexibility. We believe evalu- seconds. string muscles was found to be as
ating one session of stretching22 did effective as 60 seconds of stretching in
not provide a true indication of Our study was limited to the effects of increasing ROM at the knee, similar
what actually occurs. Measuring the one session of static stretching per- studies are needed to evaluate the
change in ROM across 6 weeks, as formed once a day. Future research is effects of various durations of stretch-
was performed in our research, we needed to evaluate the effects of dif- ing on other muscles such as the
believe is a more clinically relevant ferent durations of stretching per- gastrocnemius, soleus, and quadriceps
investigation. formed at various times throughout femoris muscles.
the day and to determine how long
Only a minimal increase in flexibility lasting are increases in flexibility. Conclusion
of the hamstring muscles (as indi- Instructions for individuals who lack
cated by increased ROM) occurred by appropriate flexibility include stretch- Our study demonstrated that 30 and
increasing the duration of stretching ing frequently during the day, such as 60 seconds of static stretching of the
from 30 to 60 seconds. The use of the three to five times in 1 day, irrespec- hamstring muscles for 5 days per
longer duration of stretching, there- tive of the duration of the stretch. week for 6 weeks was more effective
fore, must be questioned. The results for increasing muscle flexibility (as
of our study suggest that the most We examined the time of stretch of determined by increased knee exten-
up to 1 minute in duration. Future sion ROM) than stretching for 15
seconds or no stretching. In addition,
no significant difference existed be-
tween 30 and 60 seconds of stretch-
ing. Enhanced understanding of the
effect of duration of stretching on the
hamstring muscles as a result of the
14 findings of our study will hopefully
enable clinicians to provide more
12
effective and scientifically based treat-
0
C
.- ment when incorporating stretching
;10 activities into rehabilitation programs.
s
W
a,
a,
8
Acknowledgment
5
.G 6
w
CD
C We thank Michelle Baltz, who served
g 4 as a research assistant in this study.
c
0
P References
0
Control 15 Seconds 30 Seconds 60 Seconds 1 Anderson B, Burke ER. Scientific, medical,
Stretch Stretch Stretch and practical aspects of stretching. Clin Sports
Group Med 1991;10:63-86.
2 Zachazewski JE, Reischl SR. Flexibility for
the runner: specific program considerations.
Figure 3. Mean change (dijerence between pretest and posnest measurements, in Topics in Acute Care Trautna Rebabi[itation,
degrees) in knee extension bv group. 1986;1:9-27.

Physical Therapy /Volume 74, Number 9/September 1994

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thopaedic Surgeons; 1991. Soderberg GL. The influences of isometric ex- flexion. Phys Ther. 1981;61:185-189.
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romuscular facilitation?Arch Phys Med Rehabil. active range of hip flexion. Res Q. 1980;51: Joint Motion: A Guide to Goniometty. Philadel-
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Invited Commentary

The authors are to be commended though it is often stated that this Reproducibility of the study is im-
for investigating the effect of time, stretch should he of "long duration," peded by the authors' lack of a clear
stretching over a 6-week period, on the ideal duration has not been definition of what exactly was done.
the flexibility of the hamstring mus- established. They state that subjects stretched "five
cles. Both amateur and professional times a week for 6 weeks" and that
sport persons, as well as many ordi- The authors state that subjects had a subjects had "one session of static
nary people who daily walk, jog, or loss of greater than 30 degrees of knee stretching performed once a day."
run, do flexibility exercises as part of extension when in a position of 90 I am unclear on what a "session" is,
their warm-up routine. As the authors degrees of hip flexion. Subjects used, whether subjects stretched once, 3, 5,
note, there have been a number of however, were healthy, and no evi- or 10 times per session.
investigat.ions into different combina- dence was given to support a "loss" of
tions of heat and cold with stretching, ROM; rather, this was their normal Acceptable intersession reliability was
but no lc~ngitudinalstudies have been ROM in that position. The measure of reported, but to reproduce the study
reporred that have examined static muscle flexibility used, ROM, is a vari- it is necessary to also know how the
stretches on flexibility. able that appears to be a graded trait, length of the stretch was controlled.
with a normal distribution in the pop- Was a stopwatch used? Additionally,
Although many, including the authors, ulation, so that some veer toward the end-of-range limit of a "gentle
tend to relate flexibility solely to a hypermobility (double-jointed), others stretch sensation" is likely to be inter-
muscle group, it is, in healthy sub- to hypomobility, as their "normal" preted differently dependent on an
jects, more likely that biochemical ROM. It would be useful to know individual's perception of stretch. Was
alterations in collagen and elastin whether subjects were screened for this defined in a standardized manner
structure account for variation among symptomless abnormalities such as to all subjects? Individuals who regu-
individuals in laxity . . . flexibility, and sacralization of lumbar vertebra, which larly stretch as part of a warm-up
for interethnic differences. The unit of is a factor in reduced ROM in the routine may have a higher threshold
concern is the muscle-tendon unit position tested. It would be useful to than inactive individuals. Although the
and specifically the passive elements repeat the study using a clinical sam- sample consisted of individuals who
of that unit, connective tissues pre- ple in whom a real loss of ROM due regularly exercise and some who did
dominantly composed of collagen. to muscle pathology has occurred to not, the authors did not report
Maintenance of stretch after the limit determine whether similar results in whether the randomized placement
of joint range of motion (ROM) has terms of time are obtained. into groups gave about equal num-
been achieved influences the creep bers of exercisers and nonexercisers
response of connective tissues.' Al- in each group, or whether the change

Physical 'Therapy /Volume 74, Number 9/September 1994

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