Dynamic hamstring stretching is preferred for patients with patellofemoral pain – Healio

Lee JH, et al. Sports Health. 2021;doi:10.1177/1941738120932911.
Lee JH, et al. Sports Health. 2021;doi:10.1177/1941738120932911.
Compared with static hamstring stretching, dynamic hamstring stretching with strengthening exercises improved muscle activation and outcomes in patients with inflexible hamstrings and patellofemoral pain, according to published results.
In a prospective, randomized controlled trial, Jin Hyuck Lee, PT, MSc, and colleagues from Korea University analyzed outcomes of 46 patients with patellofemoral pain syndrome (PFP). Researchers assigned 25 patients to a static stretching regimen and 21 patients to a dynamic stretching regimen.
According to the study, primary outcome measures included hamstring flexibility, muscle strength and activation time, VAS for pain and the anterior knee pain scale (AKPS).
Lee and colleagues noted no significant differences in hamstring flexibility and knee muscle strength between the cohorts. However, researchers found the dynamic stretching cohort demonstrated “significantly improved” hamstring and quadriceps activation time, VAS and AKPS compared with the static stretching cohort.
“The most important result of the present study was that compared with the static stretching group, the dynamic stretching group had significantly improved muscle activation time and clinical outcomes but not significantly improved hamstring flexibility or knee muscle strength,” Lee and colleagues wrote in the study. “Clinicians and therapists could implement dynamic hamstring stretching to improve function and reduce pain in patients with PFP who have inflexible hamstrings,” they concluded.
Bohdanna T. Zazulak, DPT, OCS
I was interested to read the manuscript by Lee and colleagues evaluating the effects of static and dynamic stretching in patients with patellofemoral pain who have inflexible hamstrings, as this is a common presentation of patients with knee pain. Although the benefits of dynamic stretching vs. static stretching have been extensively documented, this randomized controlled trial sheds light on the specific benefits of dynamic stretching for improving muscle activation time and clinical outcomes in this patient population. The investigators found that both static and dynamic stretching improved flexibility of the body’s hardware (muscles), but only dynamic stretching trained the body’s software (nervous system). Dynamic stretching trains the nervous system to enhance control of the musculoskeletal system for improved performance and reduced risk of injury.
One limitation of this study is the absence of a healthy control group; thus, a further prospective study is necessary to confirm differences in hamstring flexibility, knee muscle strength and muscle activation time between patients with patellofemoral pain and healthy asymptomatic controls. Furthermore, trunk and hip muscle activation and strength were not evaluated in this study. However, the investigators did include a core muscle-strengthening program and balance exercises to improve proprioception and neuromuscular control. Further investigations should include other stretching methods, such as proprioceptive neuromuscular facilitation and oscillation techniques, and to correlate the interventions with other objective measures of neuromuscular control such as electromyographic and biomechanical analysis. This information will help identify the most effective exercises for optimal muscle activation strategies to minimize pain and risk of injury throughout the kinetic chain.
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