Study Design: Experimental pretest-posttest control design. Objectives: The purpose of the study was twofold: (1) to determine the lasting effect of static stretch on hamstring length for up to 24 hours and (2) to compare the efficacy of static stretch with and without warm-up exercise on hamstring length. Background: Research is limited on the lasting effects of static stretching and is controversial on the combined effects of warm-up activities and static stretching on muscle lengthening. Methods and Measures: Fifty-six volunteer subjects (ages 18-42 years) with limited bilateral hamstring length were assigned to 1 of 4 groups: (1) warm-up and static stretch, (2) static stretch only, (3) warm-up only, and (4) control. The warm-up was 10 minutes of stair climbing at 70% of maximum heart rate. Static stretch consisted of a single session of three 30-second passive stretches of the hamstring. Hamstring length was measured preintervention and at several intervals postintervention (immediately and then at 15 minutes, 60 minutes, 4 hours, and 24 hours) using the active knee extension (AKE) test. Data were analyzed using a mixed-model analysis of variance. Results:The warm-up-and-static-stretch group and the static-stretch-only group showed a significant increase in hamstring length between preintervention and all postintervention measurements. At 24 hours poststretch, the warm-up-and-static-stretch group had a mean increase of 10.3°( 95% confidence interval, 7.7-12.9) and the static-stretch-only group had a mean increase of 7.7°( 95% confidence interval, 4.7-10.7) in AKE range of motion (ROM). Both of these groups did show a significant decrease (2.9°and 4.0°, respectively) in hamstring muscle length (AKE ROM) at 15 minutes poststretch when compared to immediate poststretch values. The static-stretch-only and the warm-up-and-static-stretch groups did not differ significantly from each other. Control and warm-up-only groups showed no significant increase in hamstring length between preintervention and any of the postintervention measurements. Conclusions: A significant increase in hamstring length can be maintained for up to 24 hours when using static stretching. Muscle length gains are greatest immediately after stretching and decline within 15 minutes. The addition of a warm-up exercise prior to stretching does not appear to significantly increase the effectiveness of static hamstring stretching. J Orthop Sports Phys Ther 2003;33:727-733.

Study Design: Clinical trial. Objective: To determine the effect of 2 conservative intervention approaches for functional hallux limitus. Background: Metatarsophalangeal joint (MPJ) sprains are common and can result in long-term sequelae such as persistent pain and loss of range of motion (ROM) secondary to bony proliferation and articular degeneration. It is important to determine the most effective intervention for functional hallux limitus to decrease pain and restore function. Methods and Measures: Twenty individuals with first MPJ pain, loss of motion, and weakness participated in the study. All patients received whirlpool, ultrasound, first MPJ mobilizations, calf and hamstring stretching, marble pick-up exercise, cold packs, and electrical stimulation. Ten of the 20 patients (experimental group) also received sesamoid mobilizations, flexor hallucis strengthening exercises, and gait training. Treatment was provided 3 times a week for 4 weeks. Measurements of first MPJ extension ROM, flexor hallucis strength, and subjective pain level were performed on the first and last visits. Results: Following the 12 therapy sessions, the experimental group achieved significantly greater MPJ extension ROM and flexor hallucis strength and had significantly lower pain levels as compared to the control group (PϽ.001). Conclusions: These results suggest that sesamoid mobilization, flexor hallucis strengthening, and gait training should be included in the plan of care when treating an individual with functional hallux limitus.

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