ariellerosadeoliveira@gmail.com

proffernandof@gmail.com

laysla.rodel@gmail.com

laisgattino@hotmail.com

patricia.klahr@gmail.com

bmbaroni@ufcspa.edu.br

luisr@gmail.com

*Graduada em Fisioterapia pelo Centro Universitário Metodista do Sul- IPA

Especialista em Fisioterapia Dermatofuncional - Concurso COFFITO/ABRAFIDEF

Mestre pelo Programa em Ciências da Reabilitação

pela Universidade Federal de Ciências da Saúde (UFCSPA)

Pós-graduada em Fisioterapia Dermatofuncional pelo FISEPE-RS

Atualmente é professora universitária da disciplina de fisioterapia dermatofuncional

das Faculdades Integradas de Taquara (FACCAT)

**Concluiu, em 2022, doutorado

pelo programa de pós graduação em Ciências da Reabilitação

pela Universidade Federal de Ciências da Saúde de Porto Alegre (PPG-CR/UFCSPA), 

onde concluiu também o mestrado

Professor dos cursos de saúde da escola Grau Técnico, sendo docente

das disciplina de anatomia, fisiologia, epidemiologia, geriatria e traumatologia

Graduado em Educação física pela Faculdade Cenecista de Osório

Membro fundador do Grupo de Estudos em Reabilitação (GEReab) da UFCSPA

***Fisioterapeuta pelo Centro Universitário Metodista - IPA

Mestra em Ciências da Reabilitação:

Fundamentos da Reabilitação Musculoesquelética pela UFCSPA

Atualmente atua como fisioterapeuta em Florianópolis

+Graduada em Fisioterapia pela UFCSPA

Pós-graduada no programa de Residência Multiprofissinal

com ênfase em Atenção a Terapia Intensiva da UFCSPA

++Doutora pelo PPG Ciências da Reabilitação da UFCSPA,

linha de pesquisa em reabilitação musculoesquelética

Mestre em Ciências da Reabilitação, com ênfase

na área Cardiopulmonar e Metabólica, pela UFCSPA

Realizou Pós-Graduação em Cinesioterapia e Terapia Manual

com ênfase em Atendimento Clínico pela Celer

Graduação em Fisioterapia pela UNIJUÍ

Pró-Reitora Acadêmica do Centro Universitário Newton Paiva

+++ Graduado em Fisioterapia pela Universidade de Caxias do Sul (UCS)

Especialização em Cinesiologia pela UFRGS

Mestrado e Doutorado em Ciências do Movimento Humano pela UFRGS

Realizou período de aperfeiçoamento

junto ao Muscle Physiology and Biophysics Laboratory

na McGill University (Montreal, Canadá)

Pós-Doutorado junto ao Laboratório de Pesquisa do Exercício, na UFRGS

Atualmente é professor do Departamento de Fisioterapia da UFCSPA

Coordenador e orientador de Mestrado e Doutorado

do Programa de Pós-Graduação em Ciências da Reabilitação

Líder do Grupo de Ciência no Esporte e Exercício

Bolsista de Produtividade em Pesquisa do CNPq

++++Graduado em Educação Física pela Universidade de Cruz Alta

Graduado em Fisioterapia pela Universidade Federal de Santa Maria

Mestrado em Salud Publica - Universidad Nacional de Rosario

Doutorado em Gerontologia Biomédica pela PUCRGS

Atualmente é docente pela UFCSPA

Professor associado do departamento de fisioterapia

Professor permanente do Programa de Pós-graduação

em Ciências da Reabilitação e do Programa de Pós-graduação em Hepatologia

(Brasil)

Reception: 06/11/2020 - Acceptance: 11/23/2022

1st Review: 10/31/2022 - 2nd Review: 11/21/2022

Accessible document. Law N° 26.653. WCAG 2.0

Suggested reference: Oliveira, A.R. de, Ribeiro, L.R., Ferreira, L.F., Gattino, L.A.F., Klahr, P. da S., Baroni, B.M., & Rosa, L.H.T. da (2023). Effect of Thermotherapies Associated with Hamstring Stretching in Peak Torque: Randomized Clinical Trial. Lecturas: Educación Física y Deportes, 27(296), 70-79. https://doi.org/10.46642/efd.v27i296.1990

 

Abstract

    Background: Stretching is an effective strategy used mainly to reduce muscle stiffness, and increase both flexibility and Range of Motion. Aim: To compare the effects of different thermotherapy modalities associated with static stretching on peak torque (PT) of knee flexor muscles. Methods: This study compared a sample of 34 healthy men, aged between 20 and 30 years, with active knee range of motion (ROM) ≤160 degrees. They were subjected to three sessions of static stretching of the hamstrings, either with or without a thermotherapy modality. The order of interventions was randomized for one of the groups: isolated stretching (IS), stretching with heat (SH), and stretching with cold (SC). The concentric and eccentric PTs were assessed pre and post-intervention. Results: In the comparison of PT among different measures, there was a significant decrease in eccentric and concentric PT of knee flexor muscles in IS, in eccentric PT of knee flexor muscles in SH, and in eccentric and concentric PT of knee flexors in SC groups. Conclusion: Regardless of the use of thermotherapy, one single session of static stretching resulted in decreased PT of knee flexor muscles. This is probably due to the effects of stretching, such as the immediate change of the elastic component of the muscle-tendon unit, which leads to a deficit in acute force production.

    Keywords: Cryotherapy. Diathermy. Hamstrings. Muscle stretching exercises. Torque.

 

Resumo

    Introdução: O alongamento é uma estratégia eficaz, utilizada principalmente para reduzir a rigidez muscular e aumentar a flexibilidade e a amplitude de movimento. Objetivo: Comparar os efeitos de diferentes modalidades de termoterapia associadas ao alongamento estático no pico de torque (PT) dos músculos flexores do joelho. Métodos: Este estudo comparou uma amostra de 34 homens saudáveis, com idades entre 20 e 30 anos, com amplitude de movimento (ADM) ativa do joelho ≤160 graus. Eles foram submetidos a três sessões de alongamento estático dos isquiotibiais com ou sem a modalidade de termoterapia. A ordem das intervenções foi randomizada para um dos grupos: alongamento isolado (IS), alongamento com calor (AC) e alongamento com frio (AF). Os PTs concêntricos e excêntricos foram avaliados pré e pós-intervenção. Resultados: Na comparação do PT entre as diferentes modalidades, houve diminuição significativa no PT excêntrico e concêntrico dos músculos flexores do joelho no IS, no PT excêntrico dos músculos flexores do joelho no AC, e no PT excêntrico e concêntrico dos flexores do joelho nos grupos AF. Conclusão: Independentemente do uso da termoterapia, uma única sessão de alongamento estático resultou em diminuição do PT dos músculos flexores do joelho. Isso provavelmente se deve aos efeitos do alongamento, como a alteração imediata do componente elástico da unidade músculo-tendínea, que leva a um déficit na produção aguda de força.

    Unitermos: Crioterapia. Diatermia. Isquiotibiais. Exercícios de alongamento muscular. Torque muscular.

 

Resumen

    Introducción: El estiramiento es una estrategia eficaz, utilizada principalmente para reducir la rigidez muscular y aumentar la flexibilidad y el rango de movimiento. Objetivo: Comparar los efectos de diferentes modalidades de termoterapia asociadas con el estiramiento estático sobre el torque máximo (TM) de los músculos flexores de la rodilla. Métodos: Este estudio comparó una muestra de 34 hombres sanos, con edades entre 20 y 30 años, con rango de movimiento (RDM) activo de la rodilla ≤160 grados. Se sometieron a tres sesiones de estiramiento estático de isquiotibiales con o sin la modalidad de termoterapia. El orden de las intervenciones fue aleatorizado a uno de los grupos: estiramiento aislado (EA), estiramiento en caliente (EC) y estiramiento en frío (EF). Los TM concéntricos y excéntricos se evaluaron antes y después de la intervención. Resultados: Comparando el TM entre las diferentes modalidades, hubo una disminución significativa en el TM excéntrico y concéntrico de los músculos flexores de la rodilla en el EA, en el TM excéntrico de los músculos flexores de la rodilla en el EC y en el TM excéntrico y concéntrico de los flexores de rodilla en los grupos EF. Conclusión: Independientemente del uso de la termoterapia, una sola sesión de estiramiento estático resultó en una disminución del TM de los músculos flexores de la rodilla. Probablemente esto se deba a los efectos del estiramiento, como la alteración inmediata del componente elástico de la unidad musculotendinosa, lo que conduce a un déficit en la producción aguda de fuerza.

    Palabras clave: Crioterapia. Diatermia. Isquiotibiales. Ejercicios de estiramiento muscular. Torque muscular.

 

Lecturas: Educación Física y Deportes, Vol. 27, Núm. 296, Ene. (2023)

---

 

Background 

 

    Flexibility refers to the range of motion (ROM) available within one or more articulations, allowing the execution of physiological movement (Hotta et al., 2018). Thus, the decrease in flexibility may interfere in daily life activities, increase the incidence of injury, and alter sports performance (Thomas, Bianco, Paoli, & Palma, 2018; Wang, Ikeda, & Ikoma, 2021; Xiao et al, 2020). Stretching is an effective strategy used mainly to reduce muscle stiffness, and increase both flexibility and ROM. (Begovic, Can, Yağcioğlu, & Ozturk, 2018; Thomas et al., 2018)

 

    To optimize the effects of stretching, it can be associated with a thermotherapy with either heat or cold modalities (Afonso et al., 2021; Kujawski et al., 2022). Heat can be applied with external sources, profoundly by using short waves, microwaves and continuous ultrasound, or superficially by use of hot water bags, hot immersion bath, and infrared, whereas cold can be applied by the use of cold bags, ice packs, cold immersion baths, and sprays (Bleakley, & Costello, 2013). The prior use of heat reduces the passive resistance and decreases the viscosity of soft tissues, while the cold application results in decrease of nerve conductivity, activation of muscle spindles, and decrease of pain threshold; therefore, both facilitate stretching and the consequent gain of ROM. (Brasileiro, Faria, & Queiroz, 2007; Magalhaes et al., 2015)

 

    Some studies report that stretching acutely reduces force production (Ferrari, & Arroyo, 2013; Kataura et al., 2017; Lima et al., 2016; Xiao et al, 2020). Therefore, due this possibility, alternative therapeutic interventions should be proposed to allow the use of this resource without losses in muscular strength. In this sense, the use of thermotherapy is an interesting approach, since they facilitate the ROM gain. Although different studies have associated stretching with thermotherapy, only flexibility was assessed, whereas muscle strength has not been extensively assessed (Andrade Filho et al., 2016; Magalhaes et al., 2015). Therefore, this study aimed to compare the effects of different thermotherapy modalities concomitantly associated with static stretching of hamstrings on the peak torque (PT) of knee flexor muscles.

 

Methods 

 

Experimental design 

 

    This is a randomized, crossover, single-blind clinical trial, registered at ClinicalTrials.gov under identification number NCT03021850. For sample size calculations, the study by Draper et al. (Draper, Castro, Feland, Schulthies, & Eggett, 2004) was considered, with standard deviation of 2.1 degrees in ROM, and a difference in pre and post-intervention of 4.9 ROM degrees, and 5 ROM degrees between groups. The significance level was 5%, and the statistical power was 80%. A sample of 9 subjects per group was estimated (27 subjects), plus 20% for possible losses, thus obtaining a minimum sample size of 11 subjects per group (33 subjects in total).

 

    The research was conducted at the Physiotherapy Laboratory of Federal University of Health Sciences of Porto Alegre (UFCSPA), from April 2016 to February 2017, and approved by the Human Research Ethics Committee of UCSPA, Porto Alegre, Brazil (CAAE 52107115.7.0000.5345).

 

Subjects 

 

    Eligibility criteria were healthy men, aged between 20 and 30 years, with maximal active knee ROM ≤160° (evidencing the presence of hamstring tightness). Exclusion criteria were self-reported neuromuscular disease, previous surgery in lower limbs, painful symptoms or edema in lower limbs, hypersensitivity to the application of heat or cold, Raynaud syndrome, local impaired thermal sensations, presence of metal implants, heart pacemaker, malignant tumor, artery disease, deep vein thrombosis or phlebitis, fever or inflammatory processes, hemorrhage, osteomyelitis, epilepsy, pulmonary or bone tuberculosis, urinary tract infection, or cryoglobulinemia.

 

Procedures 

 

    At first, participants received an online questionnaire to assess the inclusion criteria and to characterize the sample, in which they were informed about the objectives and procedures of the study; subjects were instructed to maintain their regular physical activities, but avoid lower limb physical exercise in the 48 hours prior to the experiment. 
Participants were invited to perform three sessions with a pause (washout) of at least seven days between sessions, to avoid the residual effect. Each session was performed at the same time of the day, with a different intervention. The order of interventions was randomized by Microsoft Excel 2007 software for one of the following groups: isolated stretching (IS), stretching with heat (SH), and stretching with cold (SC), as presented in Figure 1. 

Where: n: number of individual; SH: stretching with heat association; SC: stretching with cold association; IS: isolated stretching. Source: Research data

 

    On the first session, the active ROM of knee extension was assessed by goniometry to determine whether the subject met the inclusion criteria, and anthropometric measurements for body mass and stature. The selected subjects signed the informed consent form. The measurement of the active ROM of knee extension was performed with a standard 20 cm goniometer (Carci, São Paulo, Brazil) with the subject in supine position, with hips and knees flexed at 90º, extended contralateral lower limb and pelvis in neutral position, kept stable by Velcro strips. A researcher sustained the lower limb position while another researcher positioned the fixed axis of the goniometer on the lateral condyle of the femur, with the stationary arm towards the greater trochanter of the femur and the moveable arm parallel to the fibula. The subject was instructed to extend the knee as much as possible (Brasileiro et al., 2007). The movement was performed three times, with 30s intervals, and the mean in degrees was recorded (Figure 2).

 

Where: TP: torque peak; N.m: Newton-meter. Source: Research data

 

    The assessed outcome was the concentric and eccentric PT of the flexor muscles of the dominant knee. The researcher assessing the outcome was blinded to the order of interventions performed in the subjects.

 

    The PT of knee flexor muscles was tested by the isokinetic dynamometer Biodex System 4 Pro (Biodex Medical Systems, Shirley, New York, USA), with measurements being performed before the session (AV1) and after the intervention (AV2). Initially, the equipment was calibrated according to the manufacturer’s instructions (System). Afterwards, the subjects were positioned in the equipment in sitting position, with hip flexed at 90º, lateral condyle of the femur aligned in sagittal plane with the rotational axis of the equipment, and the cushion of the knee adaptor positioned 5 centimeters from the lateral malleolus of the fibula. The upper body, the pelvic girdle and the lower limb not assessed were stabilized by Velcro strips. For measurements of concentric torque, the concentric/concentric mode was employed, and for measurements of the eccentric torque, the eccentric/eccentric mode, both with angular velocity of 60º/s, in three maximum consecutive repetitions. There was a 120-seconds break between the two modes (Alvares et al., 2015). The analyzed ROM ranged between 90º and 30º of knee flexion. During the assessment, a standardized verbal command was given for the subject, requesting to perform maximum effort.

 

    Prior to each session, the subjects remained at rest for 10 minutes for acclimatization. The IS group was submitted to static stretching of the hamstrings without previous application of the thermotherapy modality, with 10 repetitions performed, with 30 seconds of duration and a 10 second pause between them (Souza, Greco, & Denadai, 2015). The intensity was determined by the maximal stretching sensation sustained by the subject without reporting pain. During the intervention, the therapist performed passively the hip flexion movement with knee extension and kept the ankle in neutral position, and the subject was positioned on the stretcher in supine position, with both the lower limb not assessed and the pelvic girdle stabilized by Velcro strips. (Lim, Nam, & Jung, 2014)

 

    The SH group received diathermy priorly through the short wave equipment, used in the continuous mode with subjective intensity determined by the subject, dose ranging from 50% to 70%, and 20 minute duration. The electrodes were placed coplanarly in the posterior region of the thigh, stabilized by Velcro strips (Brasileiro et al., 2007). Concomitantly, stretching was performed following the same procedure as the IS group.

 

    The SC group received cryotherapy priorly, with a bag containing approximately 1.5L of smashed ice positioned in the posterior region of the thigh and fixed by Velcro strips during 20 minutes (Brasileiro et al., 2007). Concomitantly to cryotherapy, the stretching was performed following the same procedure as the IS group.

 

Statistical analysis 

 

    Data normality was verified by Shapiro-Wilk and analysis of frequency histograms. The numerical continuous variables were presented as mean and standard deviation (parametric), and median, minimum and maximum (nonparametric), and qualitative variables were presented as absolute and relative frequencies. For inferential analysis, in the comparison of PT of knee flexors between different moments and modalities, the Friedman test was performed, followed by Wilcoxon signed-rank test. All statistical analyses were performed using SPSS software version 17.0, with a significance level of 5% (α≤0.05).

Results 

 

    In this study, 42 subjects were assessed for eligibility; 6 were excluded for presenting active ROM of knee extension >160º. Out of the 36 eligible subjects, two did not complete the three interventions. A total of 34 volunteers with average age of 24.44±2.7 years, 80.34±12.45 kg of weigh, 178±7 cm height, and physical exercise 2.76±2.2 times per week comprised the final sample. Additional sample characterization is presented in Table 1.

 

Variable	n	%
Body mass index (kg/m²)
Low weight	1	2.9
Normal weight	13	38.2
Overweight	16	47.1
Class I obesity	3	8.8
Class II obesity	1	2.9
Level of education
Incomplete higher education	21	61.8
Complete higher education	6	17.6
Complete lato sensu graduation	1	2.9
Incomplete lato sensu graduation	6	17.6
Race
White	29	85.3
Black	3	8.8
Pardo (mixed-race)	2	5.9
Physical exercise
Yes	24	70.6
No	10	29.4

Where: Values expressed in absolute (n) and relative (%) frequencies. Source: Research data

 

    Figure 3 presents the comparison of PT in groups at different moments (AV1 and AV2), indicating a statistically significant decrease (p <0.001) in the eccentric PT of knee flexors in IS, SH and SC, and in the concentric PT of knee flexors in IS and SC groups (figure 4). However, in the comparison of PT of knee flexors between the different interventions (IS, SH, SC) there were no statistically significant differences.

 

Where: PT: Peak torque; N.m: Newton-meter; *statistically significant differences. Source: Research data

 

Where: PT: Peak torque; N.m: Newton-meter; *statistically significant differences. Source: Research data

 

Discussion 

 

    In this study, the PT was compared between different thermotherapy modalities associated with static stretching of the hamstring muscles. We identified that, regardless of the use of a thermotherapy modality, one single session of stretching resulted in a reduction of PT of the hamstring muscles, which is corroborated by the literature despite few studies regarding this subject (Alves, Nogueira, Santos, & Oliveira, 2015; YT. Wang, Chen, Huang, & Cheng, 2016). The use of thermotherapies is described in the literature as being capable of potentiate the effects of stretching exercises on the ROM (Bleakley, & Costello, 2013; Mahmood, Sawatsky, & Herzog, 2021; Rosario, & Foletto, 2015); however, few references indicate that such treatment, as it was applied in this study, may decrease force production.

 

    According to Marek et al. (2005), flexibility training in young adults, either static or employing proprioceptive neuromuscular facilitation (PNF), reduced the PT in the angular velocities of 60º/s and 300º/s, which was also identified in our study. A hypothesis is that this finding could be due to the fact that stretching produces acute effects that result in an immediate change in the elastic component of the muscle-tendon unit (Hatano et al., 2017; Notarnicola et al., 2017) and the reduction of the muscle and tendon stiffness, which decreases the capacity of the muscle in generating force. Another explanation for the decrease in PT after the intervention may be the duration of stretching, which in this study was 300 seconds. According to Kay, & Blazevich (2012), longer stretching reduces performance mildly to moderately. Similarly, Simic, Sarabon, & Markovic (2013) found that a stretching duration longer than 45 seconds can interfere in performance.

 

    The decrease in force post-stretching may also be caused by neural inhibition, due to less muscle activation, inhibition of the central nervous system, and decrease in sensitivity of the muscular and articular proprioceptors, or even due to mechanical aspects such as increased complacency, alteration of the length tension relationship, and rate of speed of sarcomere shortening. Such effects can last from 6 to 90 minutes. (Bley, Nardi, & Marchetti, 2012; Busarello et al., 2011)

 

    On the other hand, the study by Su, Chang, Wu, Guo, & Chu (2017) with young college students, divided into three groups, with three moments (foam roller, dynamic stretching and static stretching), demonstrated that the static stretching in three repetitions with 30 seconds each did not alter the peak of hamstrings in the velocity of 60º/s. This divergence in results could be associated with the different duration of application, since in our study we performed 10 repetitions with 30 seconds each; therefore, the acute effects of the stretching were present for a longer period in the knee flexor muscles.

 

    It is noteworthy that thermotherapy modalities were associated with the stretching, thus they could interfere in the behavior of the assessed variables. Dohnert, Oliveira, & Hoffmann (2017) assessed muscular flexibility and strength related with the isolated use of thermotherapy modalities in a sample comprised of 45 young women, divided into three groups: control, cryotherapy and diathermy. The authors concluded that diathermy was more efficient in increasing flexibility of the hamstring muscles and found that, in both thermotherapies, there were no changes in the muscular force produced by the hamstrings, which corroborates with our findings, since we did not find statistically significant changes in the peak torque of the hamstrings in the comparison between stretching associated with either thermotherapy modality and stretching only. 

 

    Similarly, Elnaggar, Elhafez, Elhabashy, Sedhom, & Shokri (2017) concluded that a single session of pulsed diathermy did not influence the maximum peak of quadriceps. In this study, 15 subjects were assessed with an isokinetic dynamometer before and after the application of pulsed diathermy, which was applied for 20 minutes. These results indicate the hypothesis that the decrease in force found in our study was due to the stretching rather than to the use of thermotherapy, since we did not find a statistically significant difference in PT between interventions, but in the intragroup comparison we found a decrease in the PT of the hamstrings.

 

    However, Schleder, Müller, Fernandes, & Capote (2016), in a crossed study with 30 healthy men subjected to cryotherapy with ice packet and diathermy with 48 hour-break between interventions, found an increment in isometric force with cold, whereas the heat caused its decline up to 15 minutes after the application of thermotherapy. Torres, Silva, Pedrosa, Ferreira, & Lopes (2017) demonstrated that 15 minute applications of ice packet on the shoulders of healthy women negatively affected muscular force. Such divergences in results in comparison with our study are due to the fact that we performed the association of muscular stretching with the application of a thermotherapy modality, differently from the studies mentioned above, which performed cryotherapy and diathermy alone.

 

    The limitations of this study were the lack of blinding of both participants and therapists, as well as the absence of room temperature control. The participants are healthy young men, which restricts the generalization of the results.

 

Conclusion 

 

    The results presented in this study suggest that, regardless of the employed thermotherapy modality (cryotherapy or diathermy), a single session of static stretching of the hamstrings in healthy young men can result in a decrease in the PT of the knee flexor muscles. This result is probably due to the effects of stretching, such as the immediate change in the elastic component of the muscle-tendon unit, which leads to an acute decrease in force production. Such results demonstrate that there is no need for the application of thermotherapy associated with stretching to maintain force, since regardless of this treatment the PT was decreased in the stretched muscle group. We propose further studies regarding the use of thermotherapy associated with flexibility training to assess the chronic effects in PT in athletes or populations with musculoskeletal disorders.

 

References 

 

Afonso, J., Clemente, FM, Nakamura, FY, Morouço, P., Sarmento, H., Inman, RA, & Ramirez-Campillo, R. (2021). The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Physiol, 12, 677581. https://doi.org/10.3389/fphys.2021.677581

 

Alvares, J., Rodrigues, R., Franke, R., Silva, C., Pinto, R., & Vaz, M. (2015). Intermachine reliability of the Biodex and Cybex isokinetic dynamometers for knee flexor/extensor isometric, concentric and eccentric tests. Phys Ter Sport., 16(1), 59-65. https://doi.org/10.1016/j.ptsp.2014.04.004

 

Alves, M., Nogueira, A., Santos, W., & Oliveira, L. (2015). Efeito agudo do alongamento estático no pico de torque dos músculos isquiotibiais. 2do. Congr. Int. Atividade Física, Nutr. e Saúde, 3, 29-43. https://eventos.set.edu.br/CIAFIS/article/view/3264

 

Andrade Filho, JHC, Santo, TCSE, Facó, SGG, Magalhães, AT, Silva, BAK, Minghini, BV, Silva, CS, & Cardoso, VS (2016). A influência da termoterapia no ganho de flexibilidade dos músculos isquiotibiais. [The influence of thermotherapy in the flexibility gain of the hamstring muscles. La influencia de la termoterapia en la flexibilidad de los músculos isquiotibiales]. Revista Brasileira de Medicina do Esporte, 22(3), 227-230. https://doi.org/10.1590/1517-869220162203136164

 

Begovic, H., Can, F., Yağcioğlu, S., & Ozturk, N. (2018). Passive stretching-induced changes detected during voluntary muscle contractions. Physiother Theory Pract, 36(6), 731-740. https://doi.org/10.1080/09593985.2018.1491660

 

Biodex System 4 Pro. Applications/Operations. Biodex Medical Systems, Inc. https://www.biodex.com/sites/default/files/s2s_apman_90317.pdf

 

Bleakley, C.M., & Costello, J.T. (2013). Do thermal agents affect range of movement and mechanical properties in soft tissues? A systematic review. Arch Phys Med Rehabil, 94(1), 149-163. https://doi.org/10.1016/j.apmr.2012.07.023

 

Bley, A.S., Nardi, P.S., & Marchetti, P.H. (2012). Alongamento passivo agudo não afeta a atividade muscular máxima dos ísquiotibiais. Motricidade, 8(4), 80-86. https://doi.org/10.6063/motricidade.1555

 

Brasileiro, J.S., Faria, A.F., & Queiroz, L.L. (2007). Influência do resfriamento e do aquecimento local na flexibilidade dos músculos isquiotibiais. [Influence of local cooling and warming on the flexibility of the hamstring muscles]. Brazilian Journal of Physical Therapy, 11(1), 57-61. https://doi.org/10.1590/S1413-35552007000100010

 

Busarello, F. de O., Souza, F. T. de, Paula, G. F. de, Vieira, L., Nakayama, G. K., & Bertolini, G.R.F. (2011). Ganho de extensibilidade dos músculos isquiotibiais comparando o alongamento estático associado ou não à crioterapia. Fisioterapia em Movimento, 24, 247-254. https://doi.org/10.1590/S0103-51502011000200006

 

Dohnert, M.B., Oliveira, M. dos S., & Hoffmann, R.F. (2017). Efeito agudo da crioterapia e diatermia na flexibilidade e força muscular de isquiotibiais. Ciência & Saúde, 10(2). https://doi.org/10.15448/1983-652X.2017.2.24474

 

Draper, D.O., Castro, J.L., Feland, B., Schulthies, S., & Eggett, D. (2004). Shortwave diathermy and prolonged stretching increase hamstring flexibility more than prolonged stretching alone. J Orthop Sports Phys Ther, 34(1), 13-20. https://doi.org/10.2519/jospt.2004.34.1.13

 

Elnaggar, M., Elhafez, H., Elhabashy, H., Sedhom, M., & Shokri, D. (2017). Effect of Pulsed Shortwave Diathermy on Average Isometric Peak Torque of Quadriceps Muscle in Normal Subjects. International Journal of Therapies and Rehabilitation Research, 6(2), 53-59. https://buc.edu.eg/directory/wp-content/uploads/2018/07/1.pdf

 

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Lecturas: Educación Física y Deportes, Vol. 27, Núm. 296, Ene. (2023)