• 대한물리치료과학회지
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• 제19권3호
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• pp.39-47
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• 2012

Background : Patients with frozen shoulder have pain and limited range of motion (ROM) at the affected shoulder. Shoulder pain of these patients usually decreases with recovery of range of motion. The aim of this study is to identify effects of static stretching and hold-relax on recovering ROM and reducing pain of patients with frozen shoulder. Methods : In this study, 15 patients with frozen shoulder who were only treated with physical therapy were recruited. Patients who received any surgical procedure or hydrotherapy were excluded. The subjects were divided randomly into 3 groups; control(n=5), static stretching(n=5) and hold-relax(n=5) groups. Patients were treated with stretching and the total number of treatments was 12 times. The ROM was measured at baseline, after fourth, eighth and final treatments. Shoulder pain and disability index(SPADI) scores were assessed before and after doing all treatments. Repeated measures ANOVA was used to analyze ROM change within each group. Changes of ROM between groups was analyzed by one way ANOVA followed by post hot analysis(Tukey's HSD). SPADI score within each group analyzed using Wilcoxon signed ranks test. A p-value<0.05 was considered statistically significant. Study Design : Repeated measures design. Result : There were significant differences of ROM in both treatment groups except internal rotation of static stretching group. ROM was significantly increased in treatment groups compared with control group, but the difference of ROM change between two treatment groups did not differ significantly. SPADI scores for treatment groups significantly decreased compared with pre-SPADI score. Conclusion : The result suggests that hold-relax can be more effective than static stretching to recover range of motion and alleviate shoulder pain on patients with frozen shoulder.

• PNF and Movement
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• 제14권1호
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• pp.59-65
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• 2016

Purpose: The purpose of this study was to review articles in order to establish optimal contraction intensity and duration in the performance of relaxation techniques for maximal increase in range of motion. Methods: The Cochrane, EBSCO, Embase, Medline, ProQuest, PubMed, ScienceDirect, and Scopus databases were used to search articles from 1990 to January 2016. The search terms were "contract relax," "hold relax," "muscle energy technique (MET)," and "proprioceptive neuromuscular facilitation (PNF) stretching." Only experimental human studies (randomized controlled trials) that compared the effects of varying intensity and duration of isometric contraction were included. Non-English language and unpublished studies were excluded. Results: A total of 2,156 articles were initially identified, with only five eventually meeting the inclusion and exclusion criteria. Three studies compared the effects of varying intensity in isometric contraction and two studies compared the effects of varying duration in isometric contraction with regard to range of motion (ROM). Two articles suggested that submaximal voluntary isometric contraction was more effective than maximum voluntary isometric contraction (MVIC) in the improvement of ROM. One article showed that a longer contraction time led to greater increases in ROM. Conclusion: Submaximal voluntary isometric contraction was recommended during contract-relax exercises in healthy people. Lack of evidence makes it difficult to suggest the optimal duration of isometric contraction during relaxation techniques. For future research, high-quality evidence will be needed to establish the optimal contraction intensity for maximum improvement of ROM.

• Physical Therapy Rehabilitation Science
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• 제8권4호
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• pp.210-217
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• 2019

Objective: This study was conducted to compare the immediate effect of hamstring stretching techniques of static stretching, proprioceptive neuromuscular facilitation (PNF) hold-relax and PNF irradiation on the hamstring muscle. Design: Three-group pretest-posttest design. Methods: Fifty-one subjects with shortened hamstrings were randomly assigned to the static stretching group (n=17), PNF hold-relax group (n=17), and the PNF irradiation group (n=17). All subjects performed an active knee extension (AKE) test to assess for the lower extremity with a shortened hamstring. The static stretching group performed stretches by lifting their leg to the maximum extent (3 times, 30 seconds). The PNF hold-relax group performed maximal isometric contraction against the experimenter's resistance (3 times, 10 seconds). The PNF irradiation group performed maximum isometric contraction against the experimenter's resistance toward the direction of the body (5 times, 5 seconds). The pre and post-tests measured range of motion (ROM), pressure pain thresholds (PPT) and muscle tone. Results: There were significant differences in ROM and PPT between pre and post intervention in each group (p<0.05). There was a significant difference only in the ROM among groups (p<0.05). Post-hoc analysis showed that the changes in ROM occurred in the order of the PNF hold-relax group, static stretching group and PNF irradiation group (p<0.05). Conclusions: The findings of this study suggest that the PNF irradiation technique may improve ROM and may be used to improve ROM similar to other stretching techniques. Therefore, the PNF irradiation technique could be included in stretching programs and can be used as a suitable stretching method depending on the situation.

• 한국전문물리치료학회지
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• 제17권2호
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• pp.67-74
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• 2010

The purpose of this study was to examine the acute effects of nerve mobilization, static stretching, and hold-relax on the flexibility of hamstring muscles and their surface electromyographic (EMG) responses to passive stretches in poststroke hemiparesis. This study was a randomized cross-over trial. Fourteen subjects received three treatment sessions in random order with each consisting of ten repetitions. The treatment sessions included nerve mobilization, static stretching, and hold-relax. The treatment sessions were held at least 24 hours apart to minimize any carryover effect. The outcome was measured by the distance between the greater trochanter and lateral malleolus and hamstring EMG activity during passive knee extension stretching. Repeated-measures analysis of variance showed significant changes in hamstring flexibility and EMG activity in main effect of time pre, post and followup (p<.05). However, no significant differences occurred among the three stretching techniques. No technique was consistently found to be superior. The three stretching techniques in this study make it difficult to determine the most effective technique. Therefore, clinicians use nerve mobilization of effective stretching techniques with other stretching techniques.

• 한국전문물리치료학회지
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• 제21권1호
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• pp.47-54
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• 2014

The aim of this study was to compare the duration of hamstring flexibility improvement after 3 stretching interventions in people with limited hamstring flexibility. Twenty-two subjects (12 men, 10 women) with limited hamstring flexibility of the dominant leg received 3 stretching interventions- modified dynamic stretching (MDS), hold-relax (HR), and static stretching (SS)-in a random order. All the subjects received all 3 interventions at intervals of at least 24 hours to minimize any carry-over effect. Modified dynamic stretching was applied as a closed kinetic chain exercise in the supine position by using the sling suspension system (Redcord Trainer(R)). The SS and HR interventions were individually performed in the straight leg raising (SLR) position, and all 3 interventions were performed for 3 minutes. Outcome measures included passive knee extension (PKE) measurements. Five post-test measurements were recorded for all subjects at 3, 6, 9, 15, and 30 minutes after the interventions. MDS was associated with a significant increase in knee extension range of motion even at 30 minutes post-treatment. In contrast, the HR and SS stretching methods showed increased hamstring flexibility for only 6 minutes post-treatment. Improvements in the range of motion of knee extension (indicating enhancement in hamstring flexibility) with MDS were maintained longer than those with the HR and SS interventions. Therefore, MDS may be more effective than the other interventions for maintaining hamstring flexibility.

• Physical Therapy Rehabilitation Science
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• 제9권2호
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• pp.90-97
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• 2020

Objective: This study investigated the effects of combining both mobilization and hold-relax (HR) technique on the function of post-surgical patients with shoulder adhesive capsulitis. Design: Randomized controlled trial. Methods: Forty-five surgical patients with shoulder adhesive capsulitis participated in this study and were randomly divided into three groups; both mobilization with movement (MWM) and HR technique (HR-MWM) group (n=15), the MWM group (n=15), and control group (n=15). All participants received three different interventions; 1) MWM combined with HR technique in PNF stretching on the shoulder, 2) MWM on the shoulder, 3) general physical therapy and intervention with neither MWM or HR stretching. Pre- and post-intervention, each subject was randomly evaluated for shoulder flexion range of motion (ROM), shoulder flexor muscle strength, Visual Analogue Scale (VAS), and the Korean version of the Shoulder Pain And Disability Index (SPADI). Results: The MWM combined with HR technique group had significant effects on shoulder flexion ROM, shoulder flexor muscle strength, VAS and SPADI compared to the MWM and control group (p<0.05). The MWM group showed a significantly greater increase in shoulder flexion ROM compared to the control group (p<0.05). Conclusions: These findings suggest that combining both the MWM and HR technique on the shoulder may more effectively improve shoulder function than MWM alone or without MWM&HR technique. Therefore, combining both the MWM and HR technique is a suggested intervention for increasing function due to shoulder adhesive capsulitis after surgery.

• PNF and Movement
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• 제13권3호
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• pp.135-143
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• 2015

Purpose: The purpose of this study was to assess the effect of the proprioceptive neuromuscular facilitation (PNF) relaxation technique (hold relax; HR, contract relax; CR) and static stretch (SS) on hamstring flexibility and vertical jump performance in healthy adults over a four-week period. Methods: Twenty-four healthy adults volunteered to participate in PNF and static stretch sessions. The subjects were divided into three groups as follows: 8 subjects in the SS group, 8 subjects in the HR group, and 8 subjects in the CR group. In the HR and CR groups, contractions lasted 15 seconds per trial and consisted of 5 sets of 15 seconds of hamstring contraction immediately followed by 15 seconds of passive static hamstring stretching. For the static group, the participants were asked to stretch by hanging a leg over a table for 30 seconds. Subjects in all groups performed the exercises three days per week for 4 weeks. The active straight leg raising (ASLR) test, active knee extension (AKE) test, and vertical jump test were performed before the intervention and after 1, 2, and 4 weeks. Results: The SS, HR, and CR techniques effected positive improvement in hamstring flexibility and vertical jump performances but neither of the stretching methods had any statistically significant different effects according to group, although there were interactions (between group and time) in the ALSR group from 1 week to 2 week and in the AKE test from pretest to 1 week. Conclusion: Based on the results of the current study, SS, HR, and CR were shown to affect hamstring flexibility and vertical jump performance in healthy adults. In particular, it was determined that within a short period, hamstring flexibility could be attributed more to CR than to SS.

• 한국전문물리치료학회지
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• 제14권4호
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• pp.1-6
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• 2007

This study examined the effects of hold-relax with agonist contraction (HR-AC) on the symptoms of delayed onset muscle soreness (DOMS) induced by intensive eccentric exercise of the non-dominant biceps brachii. Ten men (mean age=26.7 yrs, mean height=172.1 cm, mean weight=66.2 kg) and ten women (mean age=27.4 yrs, mean height=165.9 cm, mean weight=60.7 kg) who had not participated in a regular exercise program for the upper extremities in the previous six months were randomly assigned to one of two experimental groups: the HR-AC group, or the control group. We measured joint range of motion (ROM), maximal voluntary isometric contraction (MVIC), and muscle soreness before eccentric exercise, and 24, 48, and 72 hours after eccentric exercise. The subjects in the HR-AC group received the HR-AC technique in the non-dominant biceps brachii. The HR-AC technique was applied 24 and 48 hours after eccentric exercise. There was no significant difference between the HR-AC and the control group. However, the HR-AC group, compared to the control group, had a significant difference between the time points of the various parameters. Increased ROM (p<.05), decreased muscle soreness (p<.05), and reduced MVIC (p<.05) were found in the HR-AC group after 72 hours. Decreased ROM (p<.05) and MVIC (p<.05), and increased muscle soreness (p<.05) were observed in the control group. These findings suggest that the HR-AC technique effectively reduces muscle soreness and increases ROM 72 hours after eccentric exercise.

• 대한통합의학회지
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• 제3권4호
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• pp.29-35
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• 2015

Purpose: The purpose of this study was to effect of application methods of stretching exercise on angular variation and muscle activation changes in the hallux valgus. Method : This study was performed on twenty subjects. Twenty subjects were divided into two groups; Agonist Contraction(AC)(n=10), Hold-relax with Agonist Contraction(HR-AC)(n=10). Both of the group performed the exercise 5 times a week for 6 weeks. The data was analyzed by the paired t-test for comparing before and after changes of factors in each group and the independent t-test for comparing the between groups. Result : In the within group comparisons, HR-AC group abductor hallucis muscle activity showed significant difference between before and after the intervention(p<0.01). And all the two groups, there were significant decreased in hallux valgus angle(p<0.01). In the comparison of the two groups, there were significant difference among the two groups in abductor hallucis muscle activity(p<0.01). Conclusion : The findings of this study, we found that the HR-AC technique were more effective than AC technique in increase in abductor hallucis muscle activity.

• 국제물리치료학회지
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• 제3권2호
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• pp.413-421
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• 2012

Few studies address the use of manual muscle stretching to improve spinal active range of motion(AROM). There is evidence that' Hold-Relax'(HR) is effective for increasing ROM in the extremities, which leads the researchers to anticipate similar benefits in the spine. The purpose of this study is to investigate the effects of HR(trunk flexors) and active thoracic flexion and extension on thoracic mobility, specifically flexion and extension in healthy individuals. A convenience sample of 30 physical therapy students(22-38 years) were randomly assigned to intervention sequence 'A-B' or 'B-A', with at least 7 days between interventions. Intervention' A' consisted of HR of the ventral trunk musculature while 'B' consisted of thoracic flexion-extension AROM. Thoracic flexion and extension AROM were measured before and after each intervention using the double inclinometer method. Paired t-tests were used to compare AROM pre and post-intervention for both groups, and to test for carry-over and learning effects. There was a statistically significant increase(mean=$3^{\circ}$ ; p=0.006) in thoracic extension following HR of the trunk flexors. There were no significant changes in thoracic flexion following HR, or in flexion or extension following the AROM intervention. No carryover or learning effects were identified. HR may be an effective tool for improving AROM in the thoracic spine in pain free individuals. Further investigation is warranted with symptomatic populations and to define the minimal clinical difference(MCD) for thoracic spine mobility.