18 Ways Physical Therapy Can Make a Difference

If you are reading this post, chances are that you have heard of physical therapy (PT). Perhaps you have attended PT as a patient or know a friend who has had PT in the past. But if asked, you might not be able to define physical therapy or describe all the ways it can benefit a person. That’s no surprise; physical therapy is such a large profession with so many practice settings that it can be tough to describe what PT truly is!

Physical Therapists are movement experts who combine their extensive education, clinical experience, and the latest medical research to assess and treat people of all ages and abilities, from highly athletic to extremely physically debilitated. PT is a dynamic profession with established theoretical and scientific bases for therapeutic interventions, with an end-goal being to maximize and optimize each person’s capacity for movement. With use of patient education, corrective exercises and manual therapy, PTs can help relieve pain and normalize imbalances to ensure patients are as independent as possible.

Physical Therapy is a high-benefit, low-risk solution to treat many conditions. PT is considered a conservative intervention, meaning that it is less taxing on the body than harsh medications and surgeries, which should be considered last resort options. PT can truly make a difference in the following ways:

1. Avoid surgery. Physical Therapy can often help avoid unnecessary and costly invasive surgery altogether. Research has shown that PT can be more effective than surgery in the long-term for injuries such as rotator cuff tears, spinal stenosis, and disc herniation. If it is necessary to perform surgery, physical therapy will expedite your recovery by increasing your strength pre-operatively and preparing your body for the rigors of an operation.

2. Assess your Injury risk. In the same way you visit your primary care physician for an annual check-up, you can visit a PT for a full movement screen and orthopedic examination every year. PTs are trained to recognize postural habits and biomechanical shortcomings of each individual’s unique body. Movement screens can bring your attention to areas of weaknesses that may predispose you to future injury.

While everyone has different muscle imbalances, range of motion and alignment, a PT can pinpoint your specific limitations. After recognizing your individual impairments, your physical therapist can then give you the tools to overcome these subtle postural habits or limitations to prevent future injury.

3. Reduce or eliminate pain. Chronic pain, pain that lasts several months, is a common problem and can be very frustrating, especially if the underlying cause is unknown.

People can suffer from chronic pain in a number of areas in the body, including headaches or neck pain caused by postural syndromes, hip and knee pain as a result of osteoarthritis, or low back pain due to work-related activities. Patients who are experiencing chronic pain often fear performing daily activities and experience tightness, stiffness or increased used of pain medications.

If you are experiencing pain, PTs can provide hands on treatment to mobilize your joints, release soft tissue and restore muscle function, thereby reducing aches and pain. Patient education is important in understanding that chronic pain is complex involving more than damaged muscles, tendons, ligaments and joint tissues. Emotions, depression, anxiety and nervous system hypersensitivity are important components of chronic pain that will be addressed by your PT. Finally, understanding how to properly lift, sit, bend, reach and perform specific daily activities will help facilitate healing and decrease repetitive trauma to your body. Physical therapy can give you the tools and guidance you need to live pain free and improve your quality of life.

4. Avoid Prescription Medications. The ongoing opioid crisis in the United States reflects the unintended consequences of a nationwide effort to help individuals control their pain. The health care system has, since the mid-1990s, employed an approach to pain management that focuses on the pharmacological masking of pain, rather than treating the actual cause of pain. This strategy has resulted in a dramatic increase in opioid prescriptions, causing widespread misuse and addiction. In recent years, it has also led to a growing realization that current strategies for managing pain have to change, as opioid-centered solutions for dealing with pain at best mask patients’ physical problems and delay or impede recovery and at worst may prove to be dangerous and even deadly.

Ensuring that patients are aware of and have access to various options for care is a significant step in addressing this complex issue. PT interventions are an essential component of the multidisciplinary undertaking that is required to improve patient outcomes and alter the trajectory of this public health crisis.

The CDC released opioid prescription guidelines in March 2016, which recognized that properly-dosed opioids are appropriate for pain management in cancer treatment, palliative care, certain acute care cases, and end-of-life care. For other conditions, the CDC recommends non-opioid approaches, such as physical therapy. The CDC’s recommendations reference high-quality evidence that treatments provided by PTs are especially effective at reducing pain and improving function in cases of low back pain, fibromyalgia and hip and knee osteoarthritis.

Similar to how PT can help avoid costly surgeries, it can replace the need to purchase and consume expensive drugs. PT will address the underlying cause of your injury or condition, rather than prescription drugs which mask pain, and is a safer alternative for long-term pain. During an initial evaluation, your physical therapist will focus on your symptoms and the movement patterns that may be contributing to pain.

5. Prevent falls. A fall can result in joint dislocations, fractures, reduced self-confidence, permanent disability or other health, psychosocial and economic consequences. There are many reasons that a person may be at risk for falls. Potential causes for imbalance include reduced joint position awareness, visual impairments or problems of vestibular origin.

During your initial evaluation, your physical therapist will perform a screen to evaluate your fall risk. After isolating the cause behind your imbalance, your PT will prescribe treatment to address deficits that are contributing to your fall risk.

PT intervention will improve your balance, increase your neuromuscular control and coordination, and decrease your fear of falls. Fall prevention is important to avoid further injury and ensure that you can carry out your day safely and independently.

6. Refer you to specialists. Although it may seem like physical therapists can do it all, we recognize that, at times, your health condition may be out of our scope of practice. PTs identify problems that may require consultation with or referral to other professionals when appropriate.

Sometimes a person might require simultaneous multidisciplinary care from a team of health care practitioners. In such cases, your PT will work hand in hand with your primary care physician or specialty provider to ensure your wellness goals are met.

7. Increase your functional independence. Functional independence is the ability to carry out activities of daily living safely and autonomously. Whether you are experiencing a physical disability or not, participation in daily living activities is essential to your health and well-being.

If you are having difficulty standing, walking, standing from a chair or other daily activities, physical therapy can help. The treatment approach chosen by your PT depends on your specific goals, the degree of functional limitation experienced and the type and severity of the skill impairments noted.

8. Recover from a stroke, neurological injury or chronic disease. PT is essential following a traumatic injury or diagnosis of chronic disease. Adults and children who experience a stroke, Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), Cerebral Palsy and many other conditions have shown to benefit significantly from physical therapy.

After an unexpected injury, it can be difficult for patients to return to daily activities such as writing, eating, or climbing stairs. If you have been diagnosed with a chronic disease, PT can help manage symptoms or delay progression of the disease by maintenance of strength and mobility, incorporation of nutritional education, and improvement of gait and balance. It is current knowledge that nutrition, the intestinal microbiota, the gut mucosal immune system, and autoimmune pathology are deeply intertwined. Nutritional intervention can be very effective in managing autoimmune diseases, such as diabetes and hypothyroidism, which share the underlying pathology of chronic systemic inflammation.

At Agility PT, Dr. Marci has obtained her functional medicine certification. Dr. Marci’s training has equipped her with the scientific knowledge and experience to recommend individualized diet and lifestyle modifications to decrease your symptoms, restore hormone balance, and support the gut and immune system. Studies have shown that nutritional intervention is effective in controlling the progression of MS, Systemic Lupus Erythematosus (SLE), and Diabetes by modulating the autoimmune response and systemic inflammation. For example, symptoms of disease, such as fatigue in MS, pain and diarrhea in inflammatory bowel disease, or the need for acute medication in type 2 diabetes are considerably affected by food intake.

9. Recover from sports injury. While we try to prevent injuries, sometimes accidents occur. The fact that athletes place higher demands on muscles and joints increases their risk for injury. However, an injury on the field does not mean that you have to sit on the sideline indefinitely.

PTs have experience rehabilitating athletes with rotator cuff injuries, ligament sprains, muscle strains, tendinitis, overhead sports injuries, and pains that occur with running and cycling.

After a thorough evaluation of your condition, your PT will develop a custom rehabilitation program of hands-on techniques for pain and inflammation control. Your PT will also help you build up strength in your muscles, restore normal joint and soft tissue mobility, and recover neuromuscular control, speed, power and agility. It is important for an athlete to practice and feel confident in sport-specific drills before returning to play, such as deceleration, jumping and cutting. Studies have shown that instability activities which challenge the athlete’s balance after an injury make a successful return to sport 5x more likely.

If surgery is required, the physical therapists at Agility PT are trained to help athletes recover from operation of the knee, shoulder, ankle, hip and spine. Your PT is trained to monitor for signs of infection or complications that can occur in the operated joint or joints above and below as a result of injury or post-surgery. We will work with you to optimize your performance and help you reach your fullest potential following a sports injury.

10. Reduce or eliminate vertigo. Vertigo is a sense of rotation or rocking, even when a person is perfectly still. Movement of the head or body can worsen symptoms, and may lead to lightheadedness, nausea or vomiting. If untreated, this imbalance will likely lead to a fall or accident and cause further complications.

There are various reasons that dizziness and vertigo may occur. Some causes of vertigo include nervous system abnormalities, cervical spine conditions, vascular impairment, Meniere’s disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), or inner ear infections.

PTs will perform an evaluation to determine the cause behind your symptoms. For example, if you have BPPV, our vestibular therapy experts can perform a series of simple movements, such as the Epley maneuver, which can facilitate the return of the crystals in the inner ear to their normal position. With this specific condition, symptoms can typically be completely resolved within one or two visits.

Dr. Marci at Agility PT has completed continuing education to receive Advanced Vestibular and Vestibular Rehab Certifications. With her specialization in vestibular rehab, Dr. Marci has helped numerous patients eliminate their symptoms.

11. Prevent an injury. PTs understand how different sports can increase your risk for specific types of injuries. For example, stress fractures and patella tendinitis are common in runners, while ACL tears often occur in female soccer players. PTs can design an appropriate injury prevention program individually tailored to you to keep you healthy all year long.

At Agility PT, Dr. Jessica has earned her certification as a Strength and Conditioning Specialist (CSCS). Her experience has prepared her with in-depth knowledge pertaining to biochemistry of energy systems and nutrition, exercise modalities, training strategies for performance adaptations, and most importantly, injury prevention. Her experience has prepared her to apply scientific knowledge in the design of safe and effective strength and conditioning programs with the primary goal of improving athletic performance and preventing injuries.

12. Find the best workout for you. PTs gather information from prior surgeries, diet, lifestyle, body mechanics, and personal preferences to determine what physical activities will best fit you.

Proper programming and prehab before starting a new type of exercise or increasing the intensity of a current exercise routine will help you address muscle imbalances, guarantee that you are progressing adequately and prevent injury in the long run.

Whether your goal is to manage weight, increase strength after an injury, improve athletic performance, or combat the effects of chronic conditions such as type 2 diabetes, PTs can develop a safe, individualized exercise plan.

With guidance on the fundamental principles of strength training and training cycles and individualized exercise prescription, you can avoid new and recurring injuries. Additionally, a model of progression needs to be implemented and followed, or results will be slow or non-existent.

13. Nutritional education. PTs are educated in nutrition, fitness and exercise. It is well known in the literature that nutrition plays a key role in both prevention and treatment of injuries.

When muscles are exercised, the result is tears at the microfiber level. This is a normal process that results in local inflammation in the specific muscle to repair the fibers and increase resilience against future damage. This is the process by which muscles grow, or hypertrophy. In a similar manner, when a person is injured, an inflammatory response is initiated.

The success of this repair and build process depend on the person’s body composition and is influenced by nutrition. If a person does not meet adequate dietary intakes when the body requires extra energy for recovery with exercise, repetitive stress injuries may result, such as tendinitis or ligamentous tears. Furthermore, nutrient deficiencies during recovery will delay the repair process and prolong healing. Therefore, nutritional status and energy requirements should be assessed throughout recovery and nutrient intake adjusted accordingly for optimal prevention and recovery from injury.

Often patients come in the clinic with a musculoskeletal condition, but sometimes working on mobility, control and strength aren’t enough to relieve their pain. These patients will truly benefit from lifestyle changes in addition to physical treatment. Nutrition is often the missing link to comprehensive care in managing and relieving musculoskeletal pain.

At Agility PT, Dr. Marci has completed training to become a functional medicine practitioner. Often there are multiple factors contributing to an individual’s clinical presentation and finding the root cause is the heart of functional medicine. Nutritional intervention is an effective and useful tool to improve overall health outcomes, optimize performance and help patients achieve goals.

14. Order Imaging. Incorporating greater purposes for imaging by PTs systematically improves patient management and cost containment.

The role of PTs in ordering diagnostic imaging has been in existence for several decades. The most notable example is in the U.S. military, where since 1972, PTs have practiced as direct access providers with imaging privileges. Imaging instructional content is foundational in PT education programs, allowing for competencies in imaging use and decision making in physical therapy practice.

The 53 United States jurisdictions define the regulatory scope of PT practice differently. The ability to perform certain skilled tasks, including imaging, may be granted overtly through explicit regulatory authority or denied by that same authority. The Colorado State Physical Therapy Board states that PTs may order diagnostic imaging.

How does this affect you? The ability for PTs to order imaging will reduce the delay in treatment that occurs with referral to another provider for imaging. Additionally, the combined advantage of direct access for PTs and their authority to order imaging will decrease costs for yourself and the healthcare system in terms of less visits to multiple providers.

15. Diagnose your movement pathology. PTs are recognized as practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for and prevention of impairments, functional limitations, and disabilities related to movement, function and health.

In Colorado, you can go directly to a PT under a law that grants “direct access.” This means that you can simply walk into a clinic and a PT can diagnose your ailment. This is an advantage that is not legal in all states. Going straight to your PT, rather than visiting your primary care physician who will then likely refer you to a PT, can save you a trip and get you better faster!

When people experience an injury, one of the first things they do is look up their symptoms on the web. Another common tendency is to follow the same treatment that a friend had for their injury. While we want you to be self-sufficient, diagnosing and treating yourself can be dangerous, costly and will likely lead to delayed recovery.

Physical therapists can distinguish a particular disease or condition from others that present with similar symptoms. For example, a PT can differentiate between kidney or liver condition and symptoms that mimic low back pain.

16. Save you money. Depending on your insurance, physical therapy treatment can be free or include copay. Although a copay may seem to be a burden initially, seeking treatment early on before your condition worsens will save future expenses.

Research shows that the longer you wait to treat a condition, the further delayed the recovery and the greater likelihood of developing compensations in surrounding joints. Additionally, the total costs of other treatments, such as surgery and expensive medications, can exceed the cost of seeing a physical therapist.

The scope of PT practice with direct access has demonstrated enhanced quality of patient care and reduced costs. The advantage of direct access to a PT will save you time and money as you can skip the steps of obtaining a prescription for PT from your physician.

17. Orthotics. Each step we take involves a remarkably intricate network of bones, muscles, tendons and ligaments functioning together as pulleys and levers to meet the demands placed on them with walking, running, jumping, and more. The complexity of this system, combined with the weight feet carry, account for why feet can be prone to many orthopedic injuries.

Some of the injuries PTs treat include bone fractures, arthritis, plantar fasciitis, bunions, and tendinitis, among many other conditions.

If you have had a foot injury, you know that it can cause a big restraint in your daily life. If left untreated, foot problems typically lead to more injuries up the chain, including the knees, hips and back. You can take a proactive approach by having a full evaluation by a physical therapist BEFORE symptoms occur in your feet.

The PTs at Agility Physical Therapy can make orthotics customized to fit your feet and promote proper alignment of your body from the ground up. While orthotics are appropriate for some patients, others don’t need them at all. For hypomobile or rigid feet, orthotics can cushion and support those stiff segments of the foot. For hypermobile conditions, as in pronated feet, orthotics can stabilize the foot. Orthotics can also help the foot redistribute forces during weight bearing activities to alleviate pain and prevent injuries.

18. Achieve Developmental milestones. At certain ages, children should reach specific gross and fine motor skill milestones. These skills are required to control muscles of the body for walking, running, sitting, crawling and other activities. While some children may develop faster than others, there are some milestones that should be achieved by a specific age.

Early identification of delayed developmental milestones allows communities to provide more effective and affordable treatment during preschools years. Proactive intervention can also lessen the need for expensive special-education services later in childhood or worsening conditions in the future. Physical therapists can provide early intervention services for children with developmental delay to achieve their age-appropriate milestones.

Core Strength Reduces Low Back Pain and Prevents Injuries in Sport

Core strength is the number one therapy to reduce low back pain and prevent injuries in sport. Low back pain is a prevalent disorder in modern society, with 80% of the population suffering from this condition at least once in their lifetime. This condition is increasingly seen in patients due to the economic development of society and changing work environment. The causes of low back pain are complex and multifactorial. One major cause of low back pain is typically weakness along with decreased motor control of the core muscles.

The core is an anatomical bridge between our hips and shoulders. The core muscles, which are the primary active stabilizers of the spine, can be divided into two groups according to their functions and attributes.

The first group is the deep core muscles, which act to locally stabilize the spine. These include the transversus abdominis, lumbar multifidus, diaphragm and pelvic floor muscles. The transversus abdominis attaches the ribs to the pelvis, while the lumbar multifidus is directly attached to each lumbar vertebral segment. The transversus abdominis and lumbar multifidus activate a co-contraction mechanism to provide spinal segmental stability and precise motor control.

The second group, known as global stabilizing muscles, are more superficial and include the rectus abdominis, internal and external obliques, erector spinae, quadratus lumborum, and hip muscles. These muscles enable additional spinal control by producing high torque to counteract external forces that impact the body. When both groups of core muscles function normally, they can maintain segmental spinal stability, protect the spine, and reduce stress to the lumbar vertebrae and intervertebral discs. Furthermore, increased core stability helps transfer the full force and power of movement from the lower extremities to the upper extremities and vice-versa.

In the large majority of sport-specific movements, such as kicking, throwing and swinging a bat, power is generated in the hips and then transferred through the core to the upper extremities. Likewise, the ability to maintain strong trunk positions during deceleration of momentum and reorientation of the body to run in a new direction on the field are critical for change-of-direction. A weak core will diminish the transfer of power and limit athletic performance.

A sound core exercise program will strengthen spinal muscles, enhance lumbar stability and result in a better foundation for force production in the extremities. Restoring function of weakened muscles in low back pain patients will augment the ability to support and control the spine and pelvis, thereby alleviating mechanical irritation and pain in the low back region.

Additionally, multifaceted injury prevention programs including core stabilization exercises are effective in reducing lower extremity injury rates. Evidence shows core instability training may reduce anterior cruciate ligament (ACL) injuries. Many muscles related to the knee joint originate in the lumbopelvic region and thus the core is an important contributor to knee and ankle stability.

A literature review examined the effects of core strengthening programs which included trunk balance, stabilization, segmental stabilization and motor control, as well as full body resistance training to strengthen the trunk and lower limb muscles. Pre- and post-evaluations were performed to determine the effectiveness of the exercise interventions among the control and experimental groups in the studies. The results showed reduced pain in the core strengthening group according to the Visual Analog Scale and McGill pain questionnaire. The experimental group also had significant improvements in muscle thickness on ultrasound following intervention.

There are a number of ways to build strength and challenge the core. Isolated exercises, such as the standard plank and side plank, can increase muscle activation and improve spinal stability. Dynamic or instability exercises are used to promote postural imbalance and require a greater stabilizing effort of the core muscles. Examples of instability exercises are bird dogs, side plank with rotation and bear crawl.

 

 

Article written by Dr. Jessica Khani, PT, DPT, CSCS

The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.

 

 

References:

Behm, DG, Drinkwater, EJ, Willardson, JM, and Cowley, PM. Canadian Society for Exercise Physiology position stand: The use of instability to train the core in athletic and nonathletic conditioning.

Chang, Wen-Dien. “Core Strength Training for Patients with Chronic Low Back Pain.” Journal of Physical Therapy Science. March 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395677/.

Appl Physiol Nutr Metab 35:109-112, 2010. Behm, DG, Drinkwater, EJ, Willardson, JM, and Cowley, PM. The use of instability to train the core musculature. Appl Physiol Nutr Metab 35:91-108, 2010.

Myer, GD, Ford, KR, and Hewett, TE. New method to identify athletes at high risk of ACL injury using clinic-based measurements and freeware computer analysis. Br J Sports Med 45:238-244, 2011.

Bliven, Kellie. “Core Stability Training for Injury Prevention.” Sports Health. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/.

Cho, Hwi-Young. “Effects of the Core Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain.” Journal of Physical Therapy Science. 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155227/.

The Most Important Part of a Workout

Warm up exercises are crucial to any sport or fitness program and should precede every exercise session. This component of the work out is the most important part and, if done correctly, will reduce risk of injury and improve overall movement quality. A proactive approach should be used in the warm up to improve strength, mobility and flexibility in areas where the athlete is weak. There are major factors influencing the extent of improvement elicited from a warm-up, such as structure and specificity of warm-up to the task.

Warm-ups are beneficial for many reasons. First, it serves to prepare the athlete mentally and physically for exercise or competition. Second, a thorough warm up will result in physiologic responses to improve subsequent performance. Temperature-related responses will increase muscle tissue temperature, enhance neural function, and disrupt transient connective tissue bonds. Non-temperature-related effects are related to a rise in heart rate and respiratory rate and lead to increased blood flow to muscle, elevation of baseline oxygen consumption, and post-activation potentiation. Post-activation potentiation is the phenomenon by which the contractile history of a muscle directly affects its subsequent ability to generate force in a rapid manner. In other words, post-activationpotentiation results in short-term improvement in performance (i.e. jumping) due to use of a conditioning exercise before hand (i.e. back squats).

Among these positive effects of a warm up are faster muscle contraction and relaxation of both agonist and antagonist muscles, improvements in the rate of force development and reaction time, increases in muscle strength and power, lowered viscous resistance in muscle and joints, enhanced metabolic reactions, and increased psychological preparedness for performance. Furthermore, increased muscle tissue temperature has been shown to increase resistance to tears.

There are several key elements to a proper warm up. The warm up should progress gradually and provide sufficient intensity to increase muscle and core temperatures without causing fatigue or reducing energy stores. Warm-ups should last 10-20 min and end no more than 15 minutes before the start of the next activity, as positive effects of warm-up start to dissipate after this time.

There are two main phases of a proper warm up. The first phase, the general warm-up, should consist of five minutes of slow aerobic activity, such as jogging, skipping, cycling, rowing, or jump rope. The goal of the general warm up phase is to increase key physiological parameters—heart rate and respiratory rate—to improve blood flow to muscles, increase deep muscle temperature and decrease viscosity of joint fluids. The second phase, the specific warm up, incorporates movements similar to those to be performed in the upcoming sport or exercise with a goal of activating key muscle groups. This phase is analogous to stretching with addition of movement patterns required for the workout and in the athlete’s overall development by actively moving through the range of motion. For example, a person warming up for squats with a barbell may perform body weight lunges and squats in the specific warm up phase. The athlete will perform specific movements in this phase that progress in intensity until they are performing at the intensity required for the subsequent competition or training session. This phase presents the opportunity to address particular movement issues the athlete demonstrates and also work on other aspects of performance such as speed and agility.

Beneficial warm up effects are best elicited with active movements rather than passive. Dynamic stretching in a warm up is time efficient and will target activation of key muscle groups, maintain the increased temperature of the general warm up phase and incorporate many joints. Examples of dynamic stretching are toy soldiers for the hamstrings and low back muscles, spiderman lunges for the hips, and inchworms for the pectoral muscles and triceps. Static stretching prior to exercise has shown negative effects on performance in force production, power development, running speed, reaction time, and strength endurance. However, studies have shown that static stretching performed after exercise compared to pre-exercise facilitates greater range of motion improvements. The elevated body temperature post-exercise increases the elastic properties of collagen within muscles and tendons, which allows for a greater stretch magnitude.

The range of motion required for the exercise should be considered in a warm up. Those in sports that require greater range of motion, such as golf, volleyball or gymnastics, may need to spend more time with dynamic stretching than those with a lower range of motion required for exercise.

The more power necessary for the sport or activity, the more important the warm-up becomes. A warm up routine for plyometrics, such as box jumps, broad jumps and sprinting, deserves its own discussion. In short, a warm up for plyometric exercises should consist of low-intensity, dynamic movements. For example, butt kicks and straight-leg jogging prepare the body for the impact of plyometrics and emphasize quick take off and landing to mimic plyometric activities.

Article written by Dr. Jessica Khani, PT, DPT, CSCS

 

The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.

 

References:

Fletcher, I.M., and B. Jones. The effect of different warm-up stretch protocols on 20 meter sprint performance in trained rugby union players. J Strength Cond Res 18(4):885-888. 2004.

Knudson, D.V., P. Magnusson, and M. McHugh. Current issues in flexibility fitness. Pres Council Phys Fitness Sports 3:1-6. 2000.

Funk, D.C., A.M. Swank, B.M. Mikla, T.A. Fagan, and B.K. Farr. Impact of prior exercise on hamstring flexibility: A comparison of proprioceptive neuromuscular facilitation and static stretching. J Strength Cond Res 17(3):489-492. 2003.

Haff, Greg. Triplett, Travis. Essentials of Strength and Conditioning. Fourth edition. Champaign, IL: Human Kinetics, 2016. Print.