ACUTE EFFECTS OF TWO HIP FLEXOR STRETCHING TECHNIQUES ON KNEE JOINT POSITION SENSE AND BALANCE

Hussain Aslan, Harsh H Buddhadev, David N Suprak, Jun G San Juan, Hussain Aslan, Harsh H Buddhadev, David N Suprak, Jun G San Juan

Abstract

Background: Tightness of hip flexor muscles has been recognized as a risk factor for various musculoskeletal injuries in the lower extremities.

Purpose: The purpose of this study was to examine the acute effects of two hip flexor stretching techniques (dynamic and hold-relax proprioceptive neuromuscular facilitation, HR-PNF) on hip extension (ROM), knee joint position sense (JPS) and balance in healthy college age students who exhibit tightness in hip flexor muscles.

Study design: Pretest-posttest randomized experimental groups.

Methods: Thirty-six healthy college age students (mean = 22.37 years) with tight hip flexors participated in this study. Hip extension ROM, knee joint position sense and dynamic balance were tested pre- and post-stretching using a digital inclinometer, an iPod touch and the Y-Balance test, respectively. Subjects were randomly divided into dynamic and HR-PNF stretching groups. Three-way mixed analysis of variance was utilized to explore if an interaction existed between the groups in tested variables.

Results: There was a significant effect of time on hip extension ROM in both groups (p < 0.001). There was also a significant effect of stretch type on hip extension ROM (p = 0.004) favoring hold-relax over dynamic stretching group. There was a non-significant effect of time on mean knee joint position replication error in both groups. There was a significant main effect of time on the Y-Balance test's mean distance of reach to posteromedial and posterolateral directions (p < 0.001). There was also a significant main effect of directions of reach on distances achieved (p < 0.001) favoring posterolateral over posteromedial, and the latter over anterior direction.

Conclusions: The results of this study demonstrated the effectiveness of both HR-PNF and dynamic stretching techniques which resulted in a significant acute improvement in hip extension ROM and dynamic balance measures, with HR-PNF being more effective than dynamic stretch. However, there were no significant improvements in knee joint position replication over time in either stretching group.

Level of evidence: 2b.

Keywords: Dynamic balance; dynamic stretching; hold-relax proprioceptive neuromuscular facilitation; knee joint position sense; tight hip flexor.

Figures

Figure 1.
Figure 1.
Dynamic stretching technique used for stretching hip flexor muscles.
Figure 2.
Figure 2.
Hold-relax proprioceptive neuromuscular facilitation (HR-PNF) stretching technique used for stretching hip flexor muscles.
Figure 3.
Figure 3.
Hip extension range of motion (ROM) measurement test using a digital inclinometer (Jewell Construction LLC, Manchester, NH, USA).
Figure 4.
Figure 4.
Knee joint position sense (JPS) measurement using iPod touch device (Apple Inc., Cupertino, CA, USA) integrated with custom-made application software.
Figure 5.
Figure 5.
The Y-Balance Test.
Figure 6.
Figure 6.
A graphical comparison of hip extension ROM (°) of right and left hips between dynamic and HR-PNF stretching groups during pre-test, immediately post-stretch, and 5-minute post-stretch time points.
Figure 7.
Figure 7.
A graphical comparison of knee joint position sense (JPS) replication error (°) between dynamic and HR-PNF stretching groups during pre-test, post-test time points.
Figure 8.
Figure 8.
A graphical comparison of the Y-Balance test's directions of reach (%) between dynamic and HR-PNF stretching groups during pre-test, post-test time points.

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