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Effect of Superficial Heat, Deep Heat, and Active Exercise Warm-up on the Extensibility of the Plantar Flexors

CA Knight, PT, MPT, is Staff Physical Therapist, Albuquerque VA Medical Center and Lovelace Medical Center, Albuquerque, NM. She was a Master of Physical Therapy student at the University of Texas at El Paso, El Paso, Tex, at the time of this study
CR Rutledge, PT, MPT, is Director of Rehabilitation Services, Harris Medical Group, Irving, Tex. She was a Master of Physical Therapy student at the University of Texas at El Paso at the time of this study
ME Cox, PT, MPT, is Lead Physical Therapist, Center of Rehabilitative Excellence, Lewisville, Tex. He was a Master of Physical Therapy student at the University of Texas at El Paso at the time of this study
M Acosta, PT, MS, GCS, is Assistant Professor of Physical Therapy, Department of Physical Therapy, University of Texas at El Paso, 1101 N Campbell St, El Paso, TX 79902 (USA) (maracost{at}utep.edu).
SJ Hall, PhD, was Director, Kinesiology Program, University of Texas at El Paso at the time of this study

Address all correspondence to Ms Acosta

Background and Purpose. Warm-up prior to static stretching enhances muscle extensibility. The relative effectiveness of different modes of warm-up, however, is unknown. The purpose of this study was to evaluate the effectiveness of superficial heat, deep heat, and active exercise warm-up prior to stretching compared with stretching alone on the extensibility of the plantar-flexor muscles. Subjects. Ninety-seven subjects (59 women, 38 men) with limited dorsiflexion range of motion (ROM) were randomly assigned to 1 of 5 groups. Female subjects had a mean age of 27.6 years (SD=7.68, range=17–50), and male subjects had a mean age of 26.8 years (SD=6.87, range=18–48). Methods. The first group (group 1) was a control group and did not perform the stretching protocol. The 4 experimental groups (groups 2–5) performed a stretching protocol 3 days per week for 6 weeks. Group 2 performed the static stretching protocol only; group 3 performed active heel raises before stretching; group 4 received 15 minutes of superficial, moist heat to the plantar-flexor muscles before stretching; and group 5 received continuous ultrasound for 7 minutes before stretching. Dorsiflexion ROM measurements were taken initially and after 2, 4, and 6 weeks. Results. All experimental groups increased active and passive range of motion (AROM and PROM). The mean AROM/PROM differences at 6 weeks were 1.11/1.39 degrees for group 1, 4.10/6.11 degrees for group 2, 4.16/4.21 degrees for group 3, 4.38/4.90 degrees for group 4, and 6.20/7.35 degrees for group 5. The group receiving ultrasound before performing the stretching protocol (group 5) displayed the greatest increase in both AROM (6.20°) and PROM (7.35°). Discussion and Conclusion. Among the modalities tested, the use of ultrasound for 7 minutes prior to stretching may be the most effective for increasing ankle dorsiflexion ROM.

Key Words: Exercise • Plantar flexors • Range of motion • Stretching • Thermal modalities

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