Bakgrund: Fotleden används dagligen och en nedsatt fotledsrörlighet kan orsaka många problem för personer i vardagen. Knäböj är en rörelse som används både i vardagen samt i träningssammanhang och kräver en god dorsalflexion i fotleden. Det är därför värdefullt att som fysioterapeut veta vilken metod som ökar dorsalflexion inför ett rehabiliteringsprogram där knäböj ingår. Syfte: Sammanställa litteraturen gällande akuta effekter av dynamisk och statisk stretching samt posterior talocrural glide på dorsalflexion i talocruralleden hos friska individer, definierat som personer utan fysiologisk sjukdom eller trauma med eventuell påverkan på fotleden. Studien syftar även till att värdera graden av evidens för behandlingarna. Metod: Litteratursökning utfördes i databasen PubMed. Slutligen inkluderades åtta studier med sammanlagt 141 deltagare. Samtliga studier kvalitetsgranskades enligt PEDro scale, därefter användes SBU:s GRADE för evidensbedömning. Resultat: Statistisk signifikant ökning på dorsalflexion för samtliga metoder med liknande utslag på rörlighet, med liten fördel för statisk stretch. Kvalitetsgranskning enligt PEDro scale visar på att fem studier anses vara av måttlig till hög kvalitet och tre anses vara av låg kvalitet. Otillräckligt vetenskapligt underlag för posterior talocrural glide, statisk och dynamisk stretch på dorsalflexion. Konklusion: Statisk stretch, dynamisk stretch och posterior talocrural glide ökar dorsalflexionen efter minst två minuters behandling. Evidensen talar för att samtliga metoder ger liknande utfall på dorsalflexionen med en liten fördel för statisk stretch, men fler studier behövs för att bekräfta resultatet. / Background: Demands are put on the ankle daily. Limited ankle range of motion can present problems during daily activities. The squat is a movement performed both in everyday life as well as in the context of training and requires ample dorsiflexion of the ankle. Therefore, it is of value to physiotherapists to know which method should be used to increase dorsiflexion in a rehabilitation protocol where the squat is included. Objective: To provide an overview of the acute effects of static and dynamic stretching as well as posterior talocrural glide in healthy individuals without physiological diseases or trauma relating to the ankle. The study will also assess the level of evidence surrounding each of these methods. Method: The database PubMed was used to search for the included studies. A total of eight studies was included in this review, with a total of 141 participants. Study quality was judged using PEDro scale, after which SBU’s GRADE was used to determine the level of evidence for each method. Result: A statistically significant increases present for each of the methods, with similar outcomes on the dorsiflexion. Assessing the quality of the included studies with PEDro scale resulted in five studies of moderate to high quality and three of low quality. Evidence supporting posterior talocrural glide, static and dynamic stretching is deemed insufficient according to SBU’s GRADE. Conclusion: Dorsiflexion is increased after two minutes of static and dynamic stretching as well as posterior talocrural glide. The evidence suggests that similar increases are present with each method, with static stretch showing a slightly higher result. However further research is required to confirm the result.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18200号 / 人健博第17号 / 新制||人健||2(附属図書館) / 31058 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 三谷 章, 教授 杉本 直三 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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Abstrakt  Bakgrund: En allmän uppfattning är att stretching kan påskynda musklernas förmåga till återhämtning, underlätta inlärning av rätt teknik samt minska risken för överbelastningsskador i vissa idrotter (1). Det har presenterats motstridiga resultat om hur statisk stretch påverkar senor samt på de muskulära komponenterna i muscle-tendon unit (MTU). En del studier har visat att statisk stretching (SS) minskar styvheten i MTU och/eller ökar senans slakhet (4,5), vilket i sin tur leder till sämre kraft produktion och en långsammare muskelaktivering (6). Syfte: Syftet med studien var att systematiskt granska vetenskapliga artiklar gällande effekten av hur statisk stretch kombinerat med uppvärmning påverkar höjden i ett vertikalhopp hos friska unga vuxna, mätt i centimeter med hjälp av hoppmatta. Metod: Litteratursökningen genomfördes via databasen PubMed och nio artiklar inkluderades enligt kriterierna för PICO (Population, Intervention, Control & Outcome). Artiklarna granskades sedan via granskningsmallen PEDro-scale i syfte att skatta studiekvaliteten. Därefter betygsattes evidensstyrkan via SBU:s metod GRADE. Resultat: Tre av studierna konkluderar en minskning av vertikalhöjden efter stretching medan resterande sex studier fann ingen signifikant skillnad. Den sammanlagda evidensgraden av vilken effekt statisk stretchs har på vertikalhopp bedöms som begränsad. Konklusion: Efter granskning av de nio inkluderande artiklarna går det ej att säkerställa att statisk stretching påverkar utfallet av ett vertikalhopp. Hur durationen av statisk stretch kombinerat med uppvärmning påverkar höjden i vertikalhopp är ett område där det behöver bedrivas ytterligare forskning. / Abstractz Background: The general perception is that stretching can accelerate the muscles ability to recover, facilitate the learning of correct technique and reduce the risk of overuse injuries in certain sports (1). Conflicting results have been presented on the effects of static stretching on the tendons as well as on the muscular components on the muscle-tendon unit (MTU). Some studies have shown that static stretching (SS) reduces the stiffness of the MTU and/or increases the tendon slackness (4,5), which in turn results in poorer force production and slower muscle activation (6). Purpose: The purpose of this study was to systematically review scientific articles regarding the effect of how static stretching combined with a warm-up effects the height in a vertical jump in healthy young adults, measured in centimeters using a jumping mat.  Method: The literature search was performed on the database PubMed and nine articles were included according to the criteria for PICO (Population, Intervention, Control & Outcome). The articles were reviewed by PEDro-scale in order to assess the study quality. Thereafter the strength of evidence was assessed by SBU's method GRADE. Results: Three of the included studies conclude a reduction in vertical height after static stretching while the remaining six studies found no significant difference in jump height. The total evidence grading on the effect of static stretch on vertical jumps I assessed as a limited basis. Conclusion: After a review of the nine included articles it is not possible to come to a definitive conclusion that static stretching affects the outcome of a vertical jump. How duration of static stretching combined with warm-up affects the height in vertical jumps is an area where further research needs to be conducted.

Background: Mechanical ventilation (MV) inflicts stress on the lungs, initiating or increasing lung inflammation, so-called ventilator-induced lung injury (VILI). Besides overdistention, cyclic opening-and-closing of alveoli (atelectrauma) is recognized as a potential mechanism of VILI. The dynamic stretch may be reduced by positive endexpiratory pressure (PEEP), which in turn increases the static stretch. We investigated whether static stretch modulates the inflammatory response of rat type 2 alveolar epithelial cells (AECs) at different levels of dynamic stretch and hypothesized that static stretch increases pro-inflammatory response of AECs at given dynamic stretch. - Methods: AECs, stimulated and not stimulated with lipopolysaccharide (LPS), were subjected to combinations of static (10, 20, and 30%) and dynamic stretch (15, 20, and 30%), for 1 and 4 h. Non-stretched AECs served as control. The gene expression and secreted protein levels of interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and macrophage inflammatory protein 2 (MIP-2) were studied by real-time polymerase chain reaction (RTqPCR) and enzyme-linked immunosorbent assay (ELISA), respectively. The effects of static and dynamic stretch were assessed by two-factorial ANOVA with planned effects post-hoc comparison according to Šidák. Statistical significance was considered for p < 0.05. - Results: In LPS-stimulated, but not in non-stimulated rat type 2 AECs, compared to nonstretched cells: 1) dynamic stretch increased the expression of amphiregulin (AREG) (p < 0.05), MCP-1 (p < 0.001), and MIP-2 (<0.05), respectively, as well as the protein secretion of IL-6 (p < 0.001) and MCP-1 (p < 0.05); 2) static stretch increased the gene expression of MCP-1 (p < 0.001) and MIP-2, but not AREG, and resulted in higher secretion of IL-6 (p < 0.001), but not MCP-1, while MIP-2 was not detectable in the medium. - Conclusion: In rat type 2 AECs stimulated with LPS, static stretch increased the proinflammatory response to dynamic stretch, suggesting a potential pro-inflammatory effect of PEEP during mechanical ventilation at the cellular level.