APTA is a sponsor of the Decade, an international, multidisciplinary initiative to improve health-related quality of life for people with musculoskeletal disorders.Background and Purpose. Stretching protocols for elderly people (Ն65 years of age) have not been studied to determine the effectiveness of increasing range of motion (ROM). The purpose of this study was to determine which of 3 durations of stretches would produce and maintain the greatest gains in knee extension ROM with the femur held at 90 degrees of hip flexion in a group of elderly individuals. Subjects. Sixty-two subjects (mean ageϭ84.7 years, SDϭ5.6, rangeϭ 65-97) with tight hamstring muscles (defined as the inability to extend the knee to less than 20°of knee flexion) participated. Subjects were recruited from a retirement housing complex and were independent in activities of daily living. Methods. Subjects were randomly assigned to 1 of 4 groups and completed a physical activity questionnaire. The subjects in group 1 (nϭ13, mean ageϭ85.1 years, SDϭ6.4, rangeϭ 70 -97), a control group, performed no stretching. The randomly selected right or left limb of subjects in group 2 (nϭ17, mean ageϭ85.5 years, SDϭ4.5, rangeϭ80 -93), group 3 (nϭ15, mean ageϭ85.2 years, SDϭ6.5, rangeϭ65-92), and group 4 (nϭ17, mean ageϭ83.2 years, SDϭ4.6, rangeϭ68 -90) was stretched 5 times per week for 6 weeks for 15, 30, and 60 seconds, respectively. Range of motion was measured once a week for 10 weeks to determine the treatment and residual effects. Data were analyzed using a growth curve model. Results. A 60-second stretch produced a greater rate of gains in ROM (60-second stretchϭ2.4°per week, 30-second stretchϭ1.3°per week, 15-second stretchϭ0.6°per week), which persisted longer than the gains in any other group (group 4 still had 5.4°more ROM 4 weeks after treatment than at pretest as compared with 0.7°and 0.8°for groups 2 and 3, respectively). Discussion and Conclusion. Longer hold times during stretching of the hamstring muscles resulted in a greater rate of gains in ROM and a more sustained increase in ROM in elderly subjects. These results may differ from those of studies performed with younger populations because of age-related physiologic changes. [Feland JB, Myrer JW, Schulthies SS, et al. The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Phys Ther. 2001;81:1100 -1117 Key Words: Age, Elderly, Flexibility, Hamstring muscles, Lower extremity. [1][2][3][4][5] Stretching is important because it is believed to provide many physical benefits, including improved flexibility, 3,6,7 improved muscle or athletic performance, 8,9 improved running economy (decreased energy expenditure at a given speed), 10,11 injury prevention, 3,11 promotion of healing, and possibly decreased delayed-onset muscle soreness. 12,13 Although evidence to support these beliefs is limited, stretching appears to us to be in widespread use.Researchers have looked at the effect of different variables associated wit...

Objective:To determine if submaximal contractions used in contract-relax proprioceptive neuromuscular facilitation (CRPNF) stretching of the hamstrings yield comparable gains in hamstring flexibility to maximal voluntary isometric contractions (MVICs).Method:Randomised controlled trial. A convenience sample of 72 male subjects aged 18–27 was used. Subjects qualified by demonstrating tight hamstrings, defined as the inability to reach 70° of hip flexion during a straight leg raise. Sixty subjects were randomly assigned to one of three treatment groups: 1, 20% of MVIC; 2, 60% of MVIC; 3, 100% MVIC. Twelve subjects were randomly assigned to a control group (no stretching). Subjects in groups 1–3 performed three separate six second CRPNF stretches at the respective intensity with a 10 second rest between contractions, once a day for five days. Goniometric measurements of hamstring flexibility using a lying passive knee extension test were made before and after the stretching period to determine flexibility changes.Results:Pairedttests showed a significant change in flexibility for all treatment groups. A comparison of least squares means showed that there was no difference in flexibility gains between the treatment groups, but all treatment groups had significantly greater flexibility than the control group.Conclusion:CRPNF stretching using submaximal contractions is just as beneficial at improving hamstring flexibility as maximal contractions, and may reduce the risk of injury associated with PNF stretching.

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Neurological and Microvascular FunctionNeuropathies are among the most common complications of diabetes mellitus 1 and are the cause of more than 60% of all nontraumatic amputations in the United States.2 Neuropathy is a set of syndromes, each with a wide range of clinical and subclinical manifestations, the most common of which is distal symmetric polyneuropathy (DSPN).1,3 Distal symmetric polyneuropathy occurs in both type I and type II diabetes, and the symptoms range considerably. Some patients experience no symptoms but show deficits during neurological examinations, while others experience negative symptoms such as loss of thermal and tactile sensations, especially in the lower limbs.1,3 Still others may experience dysesthesia, a painful prickling or electric shock-like sensation in the legs and/or feet, especially at night. 4 The etiology of diabetic neuropathy is multifactorial, 3 making it difficult to identify the treatment. However, a common factor in each of the proposed underlying mechanisms of the pathogenesis is reactive oxygen species, which are the products of metabolic dysfunctions that result from hyperglycemia. [5][6][7] Herein lies some insight into addressing the problem of DSPN. Oxidative stress from these free radicals is implicated in vascular dysfunction, 7 including a change in the expression of endothelial nitric oxide (NO) synthase, 8 resulting in reduced bioavailability of NO. Reduced bioavailability of NO is a factor in nerve ischemia 9 ; therefore, therapies to increase NO may result in increased blood flow and a decrease in symptoms of DSPN.Nitric oxide production is induced by laminar shear stress, resulting from the frictional forces between the vascular endothelium and moving blood. 10 An example of this type of shear stress can be found when blood flows in the vessels during moderate exercise.11,12 Externally applied, low-frequency vibration also results in endothelial shear stress sufficient to produce NO and improve blood flow. [13][14][15][16][17][18] AbstractBackground: Vascular dysfunction due to hyperglycemia in individuals with diabetes is a factor contributing to distal symmetric polyneuropathy (DSPN). Reactive oxygen species reduce the bioavailability of nitric oxide (NO), a powerful vasodilator, resulting in reduced circulation and nerve ischemia. Increases in blood NO concentrations and circulation have been attributed to whole body vibration (WBV). The purpose of this study was to the determine the effects of low-frequency, low-amplitude WBV on whole blood NO concentrations and skin blood flow (SBF) in individuals with symptoms of DSPN. Methods:Ten patients with diabetes and impaired sensory perception in the lower limbs participated in this crossover study. Each submitted to 2 treatment conditions, WBV and sham, with a 1-week washout period between. Blood draws for NO analysis and laser Doppler imager scans of SBF were performed before, immediately after, and following a 5-minute recovery of each of the treatments. Conclusions: These findings demonstrate that pa...

To assess test-retest reliability scores on 16 balance tests of 21 individuals with Down syndrome whose ages ranged from 5 to 31 yr., participants performed a standing test on firm and soft surfaces with the eyes open and closed, the balance subset of the Bruininks-Oseretsky test, full turn, timed-up-and-go test, forward reach, and sit-to-stand. Each participant completed all 16 tests twice in one day and then again on a subsequent day for a total of 4 sessions. The interclass reliability correlation coefficients (ICC) value for each measure of balance varied considerably by age and sex. Based on having an ICC > .50, only 3 tests were reliable in young males and young females, whereas 5 tests could reliably be used in adult females and 9 tests could reliably be used in adult males. The results of this study raise suspicions as to the reliability of tests commonly used to assess balance and differences in reliability due to age and sex. Results of balance tests should be interpreted with caution in males and females with Down syndrome across the age span.