While the results showed a significant increase from both types of stretching, they found the PNF/MET stretching provided an better increase in range of motion (ROM).  The static stretch resulted in an average of 7.53 degree increase in ROM, while the single bout of 6-second PNF stretching resulted in an increase of 11.80 degrees.

One thing to note is they did not specify how much effort was used by the participants during the PNF technique.  There is a wide-range of thought on the effort of PNF stretching, from 10% of maximum contraction, up to a full 100% effort.

Take this study into account as you are working with athletes.  I have found similar results in my practice, and utilize PNF/MET stretching often to release muscles before and/or after any hands-on massage techniques.

O’Hora, J, Cartwright, A, Wade, CD, Hough, AD, and Shum, GLK.  Efficacy of static stretching and proprioceptive neuromuscular facilitation stretch on hamstrings length after a single session.  J Strength Cond Res 25(6): 1586-1591, 2011

Levator Scapula

They attached cadavers and skeletons to machines that would take the arms through an overhand throwing motion, allowing them to look at the stresses on the shoulder joint when different movement dysfunctions were introduced.

So, when presented with a shoulder impingement, check the scapular motion!

Subjects were reassessed after 1, 24, 48, 72, and 96 hours of the initial plyometric exercise for:  perceived soreness, creatine kinase activity, isokinetic muscle strength, and jump performance.

The results of the study showed that the compression group and the combined group both reduced the loss of strength after the plyometric exercise, when compared to the control group.  The addition of sports massage to compression did not improve recovery compared to the compression group, but the combined massage and compression group did show significant improvement in perceived muscle soreness.

Jakeman, JR, Byrne, C, and Eston, RG.  Efficacy of lower limb compression and combined treatment of manual massage and lower limb compression on symptoms of exercise-induced muscle damage in women.  Journal of Strength and Conditioning Research 24(11): 3157-3165, 2010

Huang, SY, Di Santo, M, Wadden, KP, Cappa, DF, Alkanani, T, and Behm, DG, Short duration massage at the hamstrings musculotendinous junction induces greater range of motion. J Strength Cond Res 24(7): 1917-1924, 2010.

The massage technique performed was slow, circular friction at a pace of 1 repetition per second.  The subjects were supine, with their knee straight, and massage was performed to the distal hamstrings with the fingertips wrapped around the thigh.

Before and after the massage, they measured the EMG activity of the hamstrings as well as the passive muscle tension.  Tension was measured as the torque force produced at the posterior knee at the point of discomfort during stretching.

There were a few interesting results from this study.  First, the massage was performed only to the musculotendinous junction, targeting the golgi tendon organs, and not the muscle belly and attachments.

Next, the increased range of motion did not create an increase in either muscle tension or EMG muscle activity.  The investigators suggest the massage increased the range of motion through a modified stretch perception or increased compliance of the hamstrings.

The suggested practical application of this research is to use slow, circular friction massage to the musculotendinous junction of a muscle either before stretching or after activity to improve range of motion.  This work can be applied to a sports massage therapist’s toolbox, or to teach an athlete for self-care of a chronically tight muscle.

Streepey, JW, Mock, MJ, Riskowski, JL, VanWye, WR, Vitvitskiy, BM, and Mikesky, AE.  Effects of Quadriceps and Hamstrings Proprioceptive Neuromuscular Facilitation Stretching on Knee Movement Sensation.  J Strenth Cond Res 24(4): 1037-1042, 2010.

I found this to be a very interesting study, as most previous studies on the effects of stretching focused on its effect on the muscle’s ability to contract or generate power.  As this study shows a decrease in the proprioception of the knee position, it shows a potentially dangerous effect of static stretching before sports involving rapid start and stop or lateral movements, as the muscles must be able to sense and control the joint position to prevent damage to the joint structures.

However, the authors of the study do note that the proprioception was tested with the subject’s leg hanging in a non-weight bearing position, where in a weight-bearing situation, the quadriceps and hamstrings would be actively contracting and not completely relaxed.

So, further testing needs to be performed to identify a true risk, but the study did show a slowed response of the body to identify a change in position of the joint angle following a contract-relax PNF stretch, and shows another reason to avoid holding a stretch for long periods before athletic activity.

Arroyo-Morales M, Olea N, Martínez MM, Hidalgo-Lozano A, Ruiz-Rodríguez C, Díaz-Rodríguez L. Psychophysiological effects of massage-myofascial release after exercise: a randomized sham-control study. J Altern Complement Med 2008; 14 (10): 1223-9.

This study suggests a few things to me:

First, it shows the potential effectiveness of post-event sports massage to aid in the recovery of an athlete.  The quicker we can calm down the muscles after intense activity, the faster the body’s natural healing processes can get into action.

Second, I believe it shows the potential error of using deep tissue work in a pre-event or inter-event massage.  In these situations, we do not want to calm the muscles, but rather keep them at a semi-excited state to allow them to contract with maximum power in the upcoming competition.