Original researchEffects of a neurodynamic sliding technique on hamstring flexibility in healthy male soccer players. A pilot study
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.
References (45)
- et al.
Immediate effects of the suboccipital muscle inhibition technique in subjects with short hamstring syndrome
Journal of Manipulative and Physiological Therapeutics
(2009) Measurement properties of a hand-held inclinometer during straight leg raise neurodynamic testing
Physiotherapy
(2012)- et al.
Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application
Manual Therapy
(2008) - et al.
Repeated passive stretching: acute effect on the passive muscle moment and extensibility of short hamstrings
Archives of Physical Medicine and Rehabilitation
(1999) - et al.
Neurodynamic interventions and physiological effects: clinical neurodynamics in neck and upper extremity pain
- et al.
Management of peripheral neuropathic pain: integrating neurobiology, neurodynamics, and clinical evidence
Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine
(2006) - et al.
Immediate effects of quantified hamstring stretching: hold-relax proprioceptive neuromuscular facilitation versus static stretching
Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine
(2011) Improving application of neurodynamic (neural tension) testing and treatments: a message to researchers and clinicians
Manual Therapy
(2005)- et al.
Agreement and correlation between the straight leg raise and slump tests in subjects with leg pain
Journal of Manipulative and Physiological Therapeutics
(2009) - et al.
Risk factors for injuries in football
American Journal of Sports Medicine
(2004)
Risk factors for sports injuries – a methodological approach
British Journal of Sports Medicine
Isokinetic strength testing does not predict hamstring injury in Australian rules footballers
British Journal of Sports Medicine
The sensitive nervous system
Factors associated with recurrent hamstring injuries
Sports in Medicine
Hamstring muscle strain recurrence and strength performance disorders
American Journal of Sports Medicine
A survey of flexibility training protocols and hamstring strains in professional football clubs in England
British Journal of Sports Medicine
The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters
Journal of Strength and Conditioning Research
The effects of hamstring stretching on range of motion: a systematic literature review
Journal of Orthopaedic and Sports Physical Therapy
Standing and supine hamstring stretching are equally effective
Journal of Athletic Training
Effect of submaximal contraction intensity in contract-relax proprioceptive neuromuscular facilitation stretching
British Journal of Sports Medicine
Repercusiones de la cortedad isquiosural sobre la pelvis y el raquis lumbar
Comparacion de dos tests (E.P.R. y Popliteo) para el diagnostico del sindrome de isquiosurales cortos
Archivos de Medicina del Deporte [Archives of Sports Medicine]
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2019, Journal of Bodywork and Movement TherapiesCitation Excerpt :In this sense, several stretching techniques have been used aiming to improve flexibility, although the protocols used are diverse, both regarding intervention duration and follow-up (Rogan et al., 2013). In recent years, alternative techniques have been proposed, such as techniques acting remotely like ischemic compression (Espejo-Antúnez et al., 2016a,b), neurodynamic sliding (Castellote-Caballero et al., 2013) or Electric Muscle Elongation (EME) (Espejo-Antúnez et al., 2012). The EME technique constitutes an electrotherapy procedure based on increasing muscle tension of the shortened muscle through the application of electrical current (interferential current or biphasic symmetrical pulsed current) combined with simultaneous stretching and contraction of the antagonist muscle group.
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2017, Musculoskeletal Science and PracticeCitation Excerpt :Five studies showed a significant medium effect size (k = 5; g = 0.73; 95% CI = 0.49–0.98; z = 5.71 p < 0.001) favoring the use of NM to increase flexibility. The largest effect size (g = 1.38) was found in the trial conducted by Castellote-Caballero et al. (2013) that compared three sessions of active neural siding, in a slump position, with no intervention. Participants who performed NM had a significant increase in flexibility (i.e. 16%).