Original research
Effects of a neurodynamic sliding technique on hamstring flexibility in healthy male soccer players. A pilot study

https://doi.org/10.1016/j.ptsp.2012.07.004Get rights and content

Abstract

Purpose

To compare the short-term effects of a neurodynamic sliding technique versus control condition on hamstring flexibility in healthy, asymptomatic male soccer players.

Subjects

Twenty-eight young male soccer players from Palencia, Spain (mean age 20.7 yrs ± 1.0, range 19–22) with decreased hamstring muscle flexibility.

Methods

Subjects were randomly assigned to one of two groups: neurodynamic sliding intervention or no intervention control. Each subject’s dominant leg was measured for straight leg raise (SLR) range of motion (ROM) pre- and post-intervention. Subjects received interventions as per group allocation over a 1 week period. Data were analyzed with a 2 (intervention: neurodynamic and control) × 2 (time: pre and post) factorial ANOVA with repeated measures and appropriate post-hoc analyses.

Results

A significant interaction was observed between intervention and time for hamstring extensibility, F(1,26) = 159.187, p < .0005. There was no difference between the groups at the start, p = .743; however, at the end of the study, the groups were significantly different with more range of motion in the group that received neurodynamic interventions, p = .001. The group that received neurodynamic interventions improved significantly over time (p < .001), whereas the control group did not (p = .684).

Conclusion

Findings suggest that a neurodynamic sliding technique can increase hamstring flexibility in healthy, male soccer players.

Introduction

Hamstring injuries are common in physically active people and athletes participating in competitive sports such as sprinting, rugby, football, and soccer (Bahr and Holme, 2003, Davis et al., 2005, Decoster et al., 2005, Malliaropoulos et al., 2004). Hamstring strains accounted for 11% of injuries in British professional soccer and for 12.7% in the two highest soccer divisions in Iceland (Arnason et al., 2004, Dadebo et al., 2004). Many predisposing factors for hamstring injury have been suggested within the literature, including: insufficient warm-up (Safran, Garrett, Seaber, Glisson, & Ribbeck, 1988); poor flexibility (Witvrouw, Danneels, Asselman, D’Have, & Cambier, 2003); muscle imbalance (Croisier, 2004, Croisier et al., 2002); neural tension (Turl & George, 1998); and previous injuries (Bennell et al., 1998, Verrall et al., 2001). Among risk factors for hamstring injury, inadequate extensibility within the posterior thigh compartment appears to be one of the more commonly accepted causes (Davis et al., 2005, Decoster et al., 2004) and it has been suggested that stretching before physical activity may increase extensibility of the stretched muscle, fascia and neural tissues, which may in turn decrease the chance for injury (Halbertsma et al., 1999, Hartig and Henderson, 1999, Ross, 1999).

Hamstring stretching is considered an appropriate intervention in both the prevention and treatment of hamstring injury. Although stretching for the prevention of injury is common practice in many sports (Witvrouw, Mahieu, Danneels, & McNair, 2004), evidence for decreased hamstring flexibility as a risk factor for hamstring injury remains equivocal (Hennessey and Watson, 1993, Witvrouw et al., 2003) and a recent Cochrane review found no evidence for stretching as a sole intervention for prevention of hamstring injury (Goldman & Jones, 2010). Accordingly, flexibility has been suggested as but one factor in the multi-factorial etiology of hamstring strain injury (Worrell & Perrin, 1992). In a review on risk factors for recurrent hamstring strains, Croisier (2004) noted only limited evidence for stretching but suggested at least normalizing hamstring length. In a Cochrane review, Mason, Dickens, and Vail (2007) reported evidence for a higher frequency of daily stretching in the rehabilitation of hamstring injuries, and in another study, Witvrouw et al. (2004) suggested that stretching might be most relevant for sports that predominantly include plyometric activities.

Although there are various theories, evidence is lacking for any credible explanation for the observed increases in muscle extensibility following intermittent stretching. In a recent review article, Weppler and Magnusson (2010) suggested that increases in tissue extensibility come not from affecting the mechanical properties of the muscle being stretched but result from changes in the individual’s perception of stretch or pain. In other words, the point of limitation in hamstring range is increased not because of changes within the muscle structure but rather, because the individual receiving the stretching interventions has adopted a ‘new stop point’ for limitation in hamstring range based on altered perceptions of stretch or pain. This is known as the ‘sensory theory’ and it proposes that increases in muscle extensibility after stretching are due to modified sensation (Weppler & Magnusson, 2010). Changes in neurodynamics (movement of the nervous system) could modify such sensations. Neurodynamics is the term used to describe the integration of the morphology, biomechanics and physiology of the nervous system (Butler, 2000, Shacklock, 2005).

An individual with decreased hamstring extensibility may demonstrate limited range in the passive straight leg raise test (SLR) because of altered neurodynamics affecting the sciatic, tibial and common fibular nerves (Kornberg & Lew, 1989). Abnormal posterior lower extremity neurodynamics may influence resting muscle length and lead to changes in the perception of stretch or pain (Marshall, Cashman, & Cheema, 2011). It follows that providing a movement/stretching intervention could alter the neurodynamics and lead to modification of the sensation and ultimately, increased extensibility.

The purpose of the current paper, therefore, is to explore the effect of a specific neurodynamic intervention on passive SLR in healthy soccer players, and specifically investigate the hypothesis that neurodynamic mobilizations (sliders) would produce a greater ipsilateral increase in SLR than control treatment.

Section snippets

Subjects

We recruited a convenience sample of 28 subjects (all male; mean age 20.8 ± 1.0, range 19–22) who were active in the Palencia non-professional soccer leagues. Subjects had to be aged between 18 and 25 years, and actively participating in soccer (training and competitive matches) for at least 5 h/week and at least 3 days/week. Exclusion criteria were as follows: a) any hamstring injury within the past year; b) presence of any history of neurological or orthopedic disorder affecting the lower

Results

Characteristics of the study sample are summarized in Table 1, and demonstrate that there were no significant differences between the groups at the start of the study. Standard deviations for SLR measurements ranged from 5.9 to 7.0°. This allowed us to calculate a range of SEM from 1.8 to 2.1° and subsequently a range for the MDC95 of 5.0–5.8°. The neurodynamic intervention group had a pre-test mean range of 58.1° (95% CI: 54.3–61.8) and post-test mean range of 67.4° (95% CI: 64.2–70.7). The

Discussion

The results from this study showed a significant between-group difference favoring the neurodynamic intervention with regard to increasing post-intervention hamstring flexibility. Furthermore, a within-group difference was observed for the intervention group over time (p < .001) whereas no within-group difference was observed for the control group over time (p = .684). Pre-test-to-post-test differences in average SLR values for the intervention group exceeded the MDC95 suggesting the changes

Conclusion

The findings of this study suggest that a neurodynamic sliding technique can increase hamstring flexibility in male soccer players. Future research should compare neurodynamic techniques with other interventions. Such studies should address additional muscle groups and examine the duration of lengthening in repeated measure designs.

Conflict of interest

None declared.

Ethical approval

This clinical trial received ethical from the Universidad de Granada, Spain and was also approved by Hospital Virgen de las Nieves, Servicio Andaluz de Salud, Spain.

Funding

None declared.

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