Functional stretching decreases knee joint loading in male athletes with gastroc--soleus tightness

Background and objective: Tightness of the gastroc--soleus muscle complex is one of the limiting factors of the ankle joint's range of motion (ROM) during daily activities. The aim of this study was to investigate the effectiveness of functional and extra-functional stretching of the gastrocnemius--soleus complex on knee joint loading in athletes with limited ankle dorsiflexion.

Material and methods: In this cross-sectional study, 30 male athletes with gastrocnemius--soleus shortness were recruited and randomly divided into three equal-size groups of functional stretching, extra-functional stretching, and a control group. The extra-functional stretching group performed stretching exercises three times per day for eight weeks. The functional stretching group was instructed to change their gait pattern via increased heel strike during daily activities.

Results: None of the stretching programs reduced the knee flexion angle in heel contact (p > 0.05). The knee flexion angle was significantly increased in the stance phase in the functional group (p ≤ 0.05). Walking speed was increased significantly in the extra-functional group (p ≤ 0.05). The knee adductor moment and external rotation moment decreased significantly in the functional group (p ≤ 0.05).

Conclusion: An eight-week functional stretching program in this study led to a reduction of knee loading in the frontal and horizontal planes in comparison to the extra-functional stretching group, demonstrating the effectiveness of functional stretching in improving knee joint biomechanics during walking.

Functional stretching exercises; Knee; Gastroc--soleus; Bomechanics

[1] Araújo VL, Carvalhais VOC, Souza TR, Ocarino JM, Gonçalves GGP, Fonseca ST. Validity and reliability of clinical tests for assessing passive ankle stiffness. Revista Brasileira de Fisioterapi. 2011; 15: 166–173.

[2] Huguenin LK. Myofascial trigger points: the current evidence. Physical Therapy in Sport. 2004; 5: 2–12.

[3] You J-Y, Lee H-M, Luo H-J, Leu C-C, Cheng P-G, Wu S-K. Gastrocnemius tightness on joint angle and work of lower extremity during gait. Clinical Biomechanics. 2009; 24: 744–750.

[4] Mason-Mackay AR, Whatman C, Reid D. The effect of reduced ankle dorsiflexion on lower extremity mechanics during landing: a systematic review. Journal of Science and Medicine in Sport. 2017; 20: 451–458.

[5] Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: the Janda approach. Human Kinetics. 2010.

[6] Tabrizi P, McIntyre WMJ, Quesnel MB, Howard AW. Limited dorsiflexion predisposes to injuries of the ankle in children. The Journal of Bone and Joint Surgery. 2000; 82: 1103–1106.

[7] Boonchum H, Bovonsunthonchai S, Sinsurin K, Kunanusornchai W. Effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis. Journal of Musculoskeletal & Neuronal Interactions. 2020; 20: 411–420.

[8] Zhang L, Liu G, Han B, Wang Z, Yan Y, Ma J, et al. Knee joint biomechanics in physiological conditions and how pathologies can affect it: a systematic review. Applied Bionics and Biomechanics. 2020; 2020: 1–22.

[9] Piva SR, Goodnite EA, Childs JD. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2005; 35: 793–801.

[10] Moseley AM, Crosbie J, Adams R. High- and low-ankle flexibility and motor task performance. Gait & Posture. 2003; 18: 73–80.

[11] Ota S, Ueda M, Aimoto K, Suzuki Y, Sigward SM. Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait. The Knee. 2014; 21: 669–675.

[12] Macklin K, Healy A, Chockalingam N. The effect of calf muscle stretching exercises on ankle joint dorsiflexion and dynamic foot pressures, force and related temporal parameters. The Foot. 2012; 22: 10–17.

[13] Lederman E. Therapeutic stretching towards a functional approach. 1st ed. London: Elsevier. 2014.

[14] Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Baghban AA, et al. The effect of functional stretching exercises on functional outcomes in spastic stroke patients: a ran-domized controlled clinical trial. Journal of Bodywork and Movement Therapies. 2018; 22: 1004–1012.

[15] Allet L, IJzerman H, Meijer K, Willems P, Savelberg H. The influence of stride-length on plantar foot-pressures and joint moments. Gait & Posture. 2011; 34: 300–306.

[16] Youdas JW, Krause DA, Egan KS, Therneau TM, Laskowski ER. The effect of static stretching of the calf muscle-tendon unit on active ankle dorsiflexion range of motion. Journal of Orthopaedic & Sports Physical Therapy. 2003; 33: 408–417.

[17] Neptune RR, Zajac FE, Kautz SA. Muscle force redistributes segmental power for body progression during walking. Gait and Posture. 2004; 19: 194–205.

[18] Neptune RR, Kautz SA, Zajac FE. Contributions of the individual ankle plantar flexors to support, forward progression and swing initiation during walking. Journal of Biomechanics. 2001; 34: 1387–1398.

[19] Bell-Jenje T, Olivier B, Wood W, Rogers S, Green A, McKinon W. The association between loss of ankle dorsiflexion range of movement, and hip adduction and internal rotation during a step down test. Manual Therapy. 2016; 21: 256–261.

[20] Wu S-K, Lou S-Z, Lee H-M, Chen H-Y, You J-Y. Gastrocnemius inflexibility on foot progression angle and ankle kinetics during walking. Clinical Biomechanics. 2014; 29: 556–563.

[21] Lewis CL, Garibay EJ. Effect of increased pushoff during gait on hip joint forces. Journal of Biomechanics. 2015; 48: 181–185.

[22] Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. 2 nd edition philadelphia: F.A Davis Company. 2003.

[23] Johanson M, Baer J, Hovermale H, Phouthavong P. Subtalar joint position during gastrocnemius stretching and ankle dorsiflexion range of motion. Journal of Athletic Training. 2008; 43: 172–178.

[24] Gajdosik RL, Vander Linden DW, McNair PJ, Williams AK, Riggin TJ. Effects of an eight-week stretching program on the passive-elastic properties and function of the calf muscles of older women. Clinical Biomechanics. 2005; 20: 973–983.

[25] Guissard N, Duchateau J. Effect of static stretch training on neural and mechanical properties of the human plantar-flexor muscles. Muscle & Nerve. 2004; 29: 248–255.

[26] Sahrmann S. Diagnosis and treatment of movement impairments syndromes. 1st ed. Maryland: Mosby. 2002.

[27] Gruber AH, Edwards WB, Hamill J, Derrick TR, Boyer KA. A comparison of the ground reaction force frequency content during rearfoot and non-rearfoot running patterns. Gait & Posture. 2017; 56: 54–59.

[28] Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, et al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. Journal of Biomechanics. 2002; 35: 543–548.

[29] Mercer JA, Horsch S. Heel–toe running: a new look at the influence of foot strike pattern on impact force. Journal of Exercise Science & Fitness. 2015; 13: 29–34.

[30] Gajdosik RL, Allred JD, Gabbert HL, Sonsteng BA. A stretching program increases the dynamic passive length and passive resistive properties of the calf muscle-tendon unit of unconditioned younger women. European Journal of Applied Physiology. 2007; 99: 449–454.

[31] Thorstensson CA, Henriksson M, von Porat A, Sjödahl C, Roos EM. The effect of eight weeks of exercise on knee adduction moment in early knee osteoarthritis—a pilot study. Osteoarthritis and Cartilage. 2007; 15: 1163–1170.

[32] Timothy L N, Joel H, Michael R G, J David B. Knee loading due to varus and external rotation in gait supports medial compartment wear in total knee arthroplasty. Journal of Orthopedics and Rheumatism. 2017; 1: 8–18.