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Keyword: stretching

By Ethan Konoza, ATC
Athletic Trainer
MUSC Health Sports Medicine

Flexibility in relation to the human body can be defined as the range of motion (ROM) of a joint that is largely affected by the muscles, tendons, and bones around the joint (Borges, Medeiros, Minotto, Lima, 2017). There are several methods to increase ones flexibility and ROM. Proprioceptive neuromuscular facilitation (PNF) in particular is a stretching technique that has been shown to effectively increase ROM and flexibility (Hindle, Whitcomb, Briggs, Hong, 2012). PNF stretching can be performed to increase passive range of motion (PROM) and active range of motion (AROM). Two of the most common methods discussed in the current literature of PNF stretching include a contract relax (CR) method and a contract relax antagonist contract (CRAC) method. The CR method is performed by lengthening the muscle targeted for stretch and holding it in lengthened position while maximal isometric contracting of the same target muscle is being performed for a set amount of time. This is then followed by relaxation of the target muscle while being passively stretched. (Hindle et al., 2012; Maharjan, Mallikarjunaiah, 2015; Muscolino, 2017). The CRAC method of PNF stretching is performed similarly to CR but with an antagonist contraction instead of passive stretching following relaxation of the targeted muscle. There are four theories as to why PNF stretching is effective in increasing ROM. These include autogenic inhibition, reciprocal inhibition, stress relaxation, and the gate control theory (Hindle et al., 2012; Maharjan, Mallikarjunaiah, 2015).

Muscle spindles and Golgi tendon organs (GTO) are two types of muscle proprioceptors that are protective in nature but also play an important role in how these proposed mechanisms work to increase ROM during PNF stretching. Muscle spindles are located within the belly of a muscle and senses stretch or lengthening of a muscle (Powers & Howley, 2018; Muscolino, 2017). When a muscle becomes stretched (lengthened) to a point the muscle spindle too is stretched. The stretching of the muscle spindle causes an impulse and an afferent neuron is sent to the central nervous system (CNS) through the spinal cord. The CNS receives and interprets this information. If a muscle is lengthened too far the CNS will send an efferent neuron to cause a reflex contraction called a myotatic reflex to contract (shortening of the muscle) to prevent any more lengthening to that muscle to prevent damage or tearing. (Powers & Howley, 2018; Muscolino, 2017). The GTO is another type of muscle proprioceptor that is located near the musculotendinous junction and is attached to muscle fibers. The GTO detects changes in tension within a muscle. When a muscle contracts (shortens) increased tension is placed upon the GTO (Hindle et al., 2012; Powers & Howley, 2018; Maharjan, Mallikarjunaiah, 2015; Muscolino, 2017). The shortening of the muscle causes the GTO to become stretched and in turn creates an impulse that sends an afferent neuron to the CNS by way of the spinal cord. The CNS then interprets this information sent by the GTO detecting a pulling force on a tendon. This pulling force can damage and injure the tendon. This ultimately causes another impulse to be sent to relax the muscle so that no more tension is place upon the tendon (Powers & Howley, 2018; Muscolino, 2017) This is termed the GTO reflex or inverse myotatic reflex as it has the opposite or inverse effect of the myotatic reflex created by the muscle spindle.

It is important to note that both muscle proprioceptors discussed are protective in their design. Due to this protective element, the GTO’s inhibitory type reflex in particular can be utilized in increasing the amount of stretch that can be placed upon a muscle. Isometric contraction of the target muscle causes tension to be placed upon the muscle and its tendon, which in turn activates the GTO reflex. The GTO reflex causes relaxation of the targeted muscle due to its protective nature. This relaxation of the muscle by way of the GTO reflex prevents excessive tension or stretching on the tendon to avoid tearing or damage. This relaxation of the muscle allows for further stretch to be placed upon the targeted muscle and in turn allows for increases in ROM and ultimately flexibility seen from PNF stretching.

While by design the GTO acts as a protective measure by sending an inhibitory reflex to the target muscle, we are essentially using this reflex as means of enhancing the effectiveness of the stretch. That is getting the muscle to relax so that we can further stretch the muscle. By adding tension to the GTO by asking our athletes to isometrically contract during PNF stretching we are triggering their bodies into sending this inverse myotatic reflex to inhibit any further contraction of that targeted muscle. This inhibitory reflex is what allows us to stretch the targeted muscle further. Stretching the soft tissue is just one area of the mobility and ROM puzzle. Optimizing mobility leads to proper execution of functional movements, which in turn reduces the likelihood of injury and ultimately improves performance.


Borges, M. O., Medeiros, D. M., Minotto, B. B., Lima, C. S. (2017). Comparison between static stretching and proprioceptive neuromuscular facilitation on hamstring flexibility: systematic review and meta-analysis. European Journal of Physiotherapy, 20. 12-19.

Hindle, K., Whitcomb, T., Briggs, W., & Hong, J. (2012). Proprioceptive Neuromuscular Facilitation (PNF): Its Mechanisms and Effects on Range of Motion and Muscular Function. Journal of Human Kinetics, 31: 105-113.

Maharjan, J., Mallikarjunaiah, H. S. (2015). Proprioceptive neuromuscular facilitation stretching versus static stretching on sprinting performance among collegiate sprinters. International Journal of Physiotherapy, 2, 619-626.

Muscolino, J. E. (2017). Kinesiology: The Skeletal System and Muscle Function. MO, St. Louis. Elsevier

Powers, S. K., & Howley, E. T. (2018). Exercise physiology: Theory and application to fitness and performance. New York, NY: McGraw-Hill Education.

Guest post by:

Kathleen Choate, ATC, CSCS, CEAS
Athletic Trainer
MUSC Health Sports Medicine

No one likes being injured.  It's painful, expensive, takes time away from the sports we love, affects our daily life, and can even lead to pain and disability later in life.  Wouldn't it be nice if we could enjoy the sports we love without this risk?  While it isn't possible to completely eliminate the risk, there are ways to prevent them.


            Before participating in physical activity, a good warm-up should be in order.  Both static and dynamic stretches are acceptable prior to participation, but you may choose one or the other depending what your goal is. Stratching on track

            Static stretches involve holding a muscle in a lengthened position for an extended period of time.  For example, a static stretch could include sitting on the ground in a pike position with legs fully extended, reach for your toes, and hold it for 30 seconds.  If you choose to primarily use static stretching prior to physical activity, try to incorporate things like jogging, jumping jacks, or squats to increase your body temperature.

            Dynamic stretches involve bringing a muscle through a full range of motion; it comes with an active movement that should be slow and controlled.  One benefit of using dynamic stretching over static stretching is that it also increases your body temperature, which helps to increase elasticity of the muscles right before physical activity.  An example of a dynamic stretch would include slow and controlled lunges with a straight instead of bent back knee. 

            Ballistic stretches involves a bouncing motion at the end range of a stretch and should not be used as a way to warm-up since it is likely to lead to a muscle strain.  Regardless of your warm-up, remember that it should never be painful.


            Proper equipment should be a no-brainer with any sport.  Runners need shoes, football players need helmets, pads, and mouth guards, and wrestlers need headgear.  Not only are these pieces of equipment necessary to be worn, but they should also be fitted correctly.

            Shoes are especially important for sports with a high volume of running including cross country, track and field, soccer, field hockey, and basketball.  While quality shoes are pricey, they are the only piece of equipment a runner needs.  Running is a fairly straightforward movement compared to other sports.  It involves a series of repetitive movements over the course of several miles.  If your feet hit the pavement 1,000 times in one mile, then a faulty running gait or a worn out pair of shoes can cause injuries anywhere from your feet to your back.  It can be difficult to spend our hard earned money on a pair of running shoes; however this investment can prevent you from having to spend hundreds or thousands of dollars at the doctor’s office.  Since shoe needs are going to vary from person to person, consult with your Athletic Trainer for guidance prior to making this purchase.  Also, plan to replace your shoes every 300-500 miles.


            Have your coaches ever sounded like a broken record?  Maybe they told you ten times in one practice to follow through, keep your head up, or to bend your knees more.  Good technique doesn't just make you a throw a ball better, score more points, or run faster; it prevents injury.  The more obvious injuries are the ones that happen when a movement is performed incorrectly one time and sudden pain is felt.  The injuries that creep up on you are ones that arise from consistently flawed technique.  Next time your coach tells you to correct a motion, do everything in your power to fix it the first time!


            Rest is the word athletes never want to hear, but it's vital to preventing injury.  Give yourself at least one day off a week to let your body recover.  This may seem like slacking to some, but it will prevent overuse injuries and burnout. 

            As athletes, it’s tempting to play through pain, especially during a game.  The pain level may feel tolerable, and you don’t want to let your teammates down.  Choosing to continue to participate with a possible injury will most likely make the injury worse and recovery time longer.

Strength and Conditioning

            Condition your body for the sport you are participating in.  A great strength and conditioning program will vary depending on your age, level of training, sport, and time of year.  A strength and conditioning specialist is your best resource to put a conditioning program together with all factors considered.

Athletic Trainers

            Athletic Trainers are often thought of as the person that runs onto the field when a player gets hurt.  That may be when we are viewed most publicly; however we have many other roles with regards to injury management, including (but not limited to) preventing the injury from happening in the first place.  Consult with your Athletic Trainer about injury prevention to identify a plan that is specific to you as an individual.

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Guest Post by:  Brittany Darling, MS, ATC

The squeak of sneakers on the wood floor, a sound that must only mean one thing: basketball season is finally here. As fall sports are coming to an end there is little time for rest and recovery before the long season, and the last thing you want is to start your season off with an injury. Thankfully, there are some injury prevention strategies that can be utilized in hopes of staying healthy through the winter season.

Basketball in hoopThe first step is to ensure your child has all of the essential equipment. Although basketball does not have very many equipment demands when compared to other sports such as football or hockey, there is one important piece: basketball shoes. Basketball shoes are characterized by a higher ankle fit than most athletic shoes, and they also possess a sole specific for the basketball court that will prevent slipping and sliding. The high ankle fit helps to prevent against one of the major basketball injuries, the ankle sprain, which is an injury to the ligaments connecting bone to bone. Very often a child may cut to the side quickly or come down from a rebound and land on another player’s ankle, which results in the inversion or “rolling inward” of their own ankle. This is a frequent injury that can be prevented by wearing ankle braces. The ankle braces that lace up the front and have adjustable straps usually work best and can be purchased at any sporting goods store. They can take some getting used to initially, but are worth it in the long run.

Basketball is a unique sport that requires power, speed and agility. The demands of the sport can sometimes result in an overstretching of the muscle or too strong of a contraction known as a muscle strain. Strains can take place in the muscle itself or in the tendon, which connects the muscle to the bone. The most successful method for preventing strains is an effective warm-up. Especially as the weather is getting colder outside, our bodies need movement combined with proper clothing to get warm before performing quick and explosive activities.  Extra layers such as sweat suits are encouraged! A suggested routine might include 2-3 laps of light jogging around the basketball court, followed by a dynamic warm-up such as walking lunges, walking quadriceps stretches, arm circles, and walking toe touches. With this, the stretch is only felt in the targeted muscle group for a few brief seconds as compared to when you hold a static stretch that lasts 15-20 seconds. A dynamic warm-up combines movement with brief stretches of the selected muscle group. After initial warm-ups are complete, it can be beneficial to stop every few minutes into practice and ask the athletes to pick something that feels tight and give that muscle an extra stretch. It is important to always perform stretches correctly and to understand that everybody is unique in their abilities, so make sure children stay within their flexibility limitations.

Improving flexibility with stretching can help with another common basketball injury known as patellar tendonitis, or “jumper’s knee,” which is characterized by pain beneath the patella (knee cap) usually from repetitive jumping or quadriceps activation. A similar injury seen in teenagers after growth spurts occur is known as Osgood-Schlatter disease, which is diagnosed when there is a small bump formation that is painful underneath the patella. With either of these injuries, applying ice after practices and games can assist with any pain or inflammation as well as NSAIDs such as ibuprofen.

Additionally, since basketball is a physical sport that can involve some contact, a mouth guard is not a bad idea to utilize, especially if your child has braces. Elbows and hands make contact with mouths frequently when scrambling for a rebound and can cause significant damage to a child’s teeth. They may also experience contusions or bruises from this sort of contact. Compression sleeves with built in padding are made for knees and elbows and can provide some comfort and support to children who fall on the court frequently.

Before retiring cleats for sneakers, remember some of these resourceful tricks that can help your child perform to the best of their ability and stay healthy. Unfortunately not every injury can be prevented, so when one does occur be sure to consult your Athletic Trainer or Physician.


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