O treino da flexibilidade muscular e o aumento da amplitude de movimento: uma revisão crítica da literatura

 

Luís Filipe dos Santos Coelho

 

Fisioterapeuta e Professor de Pilates do Consultório e Clínica de Reabilitação, Lda. – Lisboa

 

 

RESUMO

O treino da flexibilidade muscular põe em evidência uma série de princípios neurofisiológicos e um conjunto intrincado de propriedades musculares e visco-elásticas. São diversos os métodos de estiramento realizados nos contextos clínico e desportivo. Apesar da sua utilização ser comum, não é usual os profissionais de saúde e educação reflectirem sobre as componentes e eficácia dos diversos métodos de estiramento. Neste artigo, realizamos uma revisão crítica dos diversos métodos utilizados no treino de flexibilidade, assim como dos princípios e parâmetros que com eles se relacionam. Daremos especial ênfase aos princípios em que se baseia a facilitação neuromuscular proprioceptiva e os diversos métodos de relaxamento local, como o aquecimento. Para além disso, teremos em conta os dados reveladores relativos ao paradoxo do Coeficiente de elasticidade, os quais podem ajudar a conceber uma filosofia de intervenção do treino de flexibilidade divergente relativamente ao que classicamente tem sido defendido e efectivado.

Palavras-Chave: Estiramento passivo, Estiramento activo, Facilitação Neuromuscular Proprioceptiva, Aquecimento, Coeficiente de elasticidade.

 

 

The muscular flexibility training and the range of movement improvement: a critical literature review

ABSTRACT

The muscular flexibility training put in evidence a train of neurophysiological principals and an intricate amount of muscular and viscous-elastic properties. There are a lot of stretching methods, used on the clinical and sport contexts. Despite its common utilization, it isn’t usual the health and educational professionals reflect about the compounds and efficacy of the diverse stretching methods. In this article, we realize a critical review about the diverse methods used on the flexibility training, as the principles and parameters related with that. We will done special emphasis to the principles of the proprioceptive neuromuscular facilitation and the diverse local relaxation methods, like warming. We will also have in count the revealing data relating to the Elasticity Coefficient paradox, witch can help to conceive an intervention philosophy of the flexibility training different from what it have being defended and practiced.

Key-words: Passive stretching, Active stretching, Proprioceptive Neuromuscular Facilitation, Warming, Elasticity Coefficient.  

 

 

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REFERÊNCIAS

1. Kisner C, Colby L (1998). Exercícios terapêuticos: fundamentos e técnicas (3ª edição). São Paulo: Editora Manole Ltda.         [ Links ]

2. Flitney FW, Hirst, DG (1978). Cross bridge detachment and sarcomere “give” during stretch of active frog’s muscle. J Physiol 276:449-465.

3. Tardieu C, Tabary JC, Tabary C, Tardieu G (1982). Adaptation of connective tissue length to immobilization in the lengthened and shortened position in cat soleus muscle. J Physiol (Paris) 78:214-220.

4. Threlkeld AJ (1992). The effects of manual therapy on connective tissue. Phys Ther 72:893-902.

5. Tillman LJ, Cxummings GS (1992). Biologic mechanisms of connective tissue mutability. In: Currier DP, Nelson RM (Eds.). Dynamics of human biologic tissues. Philadelphia: FA Davis.

6. Etnyre BR, Abraham LD (1986). Gains in range of ankle dorsiflexion using three popular stretching techniques. Am J Phys Med 65:189-196.

7. Madding SW, et al. (1987). Effect of duration of passive stretch on hip abduction range of motion. J Orthop Sports Phys Ther 8:409.

8. Bandy WD, Irion JM (1994). The effect of time on static stretch on the flexibility of the hamstrings muscles. Phys Ther 74(9):845-850.

9. Bandy WD, Irion JM, Briggler, M (1998). The effect of time and frequency of static stretching on flexibility of the hamstrings muscles. Phys Ther 77(10):1090-1096.

10. Roberts JM, Wilson K (1999). Effect of stretching duration on active and passive range of motion in the lower extremity. Br J Sports Med 33(4):259-263.

11. Feland JB, Myrer JW, Schulthies SS, Fellingham GW, Measom GW (2001). The effect of duration of stretching of the hamstrings muscle group for increasing range of motion in people aged 65 years or older. Phys Ther 81(5):1110-1117.

12. Loannis T, Christos G, Nikolaos Z, Aikaterini V, Efstratios V (2005). The effect of stretching duration on the flexibility of lower extremities in junior soccer players. Physical Training September.

13. Bertherat T (1976). Le corps a ses raisons. Auto-Guerison et anti-gymnastique. Paris: Seuil.

14. Souchard Ph-E (2004). Stretching global activo: de la perfección muscular al éxito deportivo II (3ª ed.). Barcelona: Paidotribo.

15. Busquet L (1998). Les chaînes musculaires (3ème éd. revue et complétée) (v. 2: Lordoses, cyphoses, scolioses et déformations thoraciques). Paris: Frison-Roche.

16. Souchard Ph-E (2003). As escolioses. Seu tratamento fisioterapêutico e ortopédico. São Paulo: É Realizações.

17. Cummings GS, Tillman LJ (1992). Remodelling of dense connective tissue in normal adult tissues. In: Currier DP, Nelson RM (Eds.). Dynamics of human biologic tissues. Philadelphia: FA Davis.

18. Walker SM (1961). Delay of twitch relaxation induced by stress and stress relaxation. J Appl Physiol 16:801.

19. Smith LL, Brunetz MH, Chenier TC, McCammon MR, Houmard JA, Franklin ME, Israel RG (1993). The effects of static and ballistic stretching on delayed onset muscle soreness and creatine kinase. Res Q Exerc Sport 64(1):103-107.

20. Nelson AG, Kokkonen J (2001). Acute ballistic muscle stretching inhibits maximal strength performance. Res Q Exerc Sport 72(4):415-419.

21. Unick J, Kieffer HS, Cheesman W, Feeney A (2005). The acute effects of static and ballistic stretching on vertical jump performance in trained women. J Strenght Cond Res 19(1):206-212.

22. Bohannon RW (1984). Effect of repeated eight minute muscle loading on the angle of straight leg raising. Phys Ther 64:491.

23. Kottke F (1971). Therapeutic exercise. In: Krusen F, Kottke F, Ellwood M (Eds.). Handbook of physical medicine and rehabilitation, 2^nd edition. Philadelphia: Saunders.

24. Sapega A, et al. (1981). Biophysical factors in range of motion exercises. The Physician and Sportsmedicine 9:57.

25. Godges JJ, et al. (1989). The effects of two stretching procedures on hip range of motion and gait economy. J Ortho Sport Phys Ther 10(9):350-356.

26. Bohannon RW, Larkin PA (1985). Passive ankle dorsiflexion increases in patients after a regimen of tilt table: wedge board standing. Phys Ther 65:1676.

27. Hepburn G, Crivelli K (1984). Use of elbow Dynasplint for reduction of elbow flexion contracture: a case study. J Orthop Sports Phys Ther 5:269.

28. Cottarola J, Gautheron V, Metton G, Charmet E, Chavier Y (2000). Toe walking in children younger than six years with cerebral palsy – The contribution of serial corrective casts. J Bone joint Surg 82:541-544.

29. Booth B, Doyle M, Montgomery J (1983). Serial casting for the management of spasticity in the head injured adult. Phys Ther 63:1960-1966.

30. Cusick B (1990). Serial casts - an approach to management of static soft tissue contracture. In: Progressive casting and splinting for lower extremity deformities in Children with neuromotor dysfunction. Arizona: Arizona Therapy Skill Builders, p. 265-311.

31. Ada L, Canning (1990). Key Issues in neurological physiotherapy. Oxford: Butterworth Heinemann.

32. Cottarola J, Gautheron V, Metton G, Charmet E, Chavier Y (2000). Toe walking in children younger than six years with cerebral palsy – The contribution of serial corrective casts. J Bone joint Surg 82:541-544.

33. Brouwer B, Wheeldon R, Stradiotto-Parker N, Album J (1998). Reflex excitability and isometric force production in cerebral palsy: the effect of serial casting. Dev Med Child Neurol 40:168-175.

34. Carr J, Shepherd R, Ada L (1995). Spasticity: Research findings and implications for intervention. Physiot 81(8):421-429.

35. Boyd R, Ada L (2001). Physiotherapy management of spasticity. In: Barnes M, Johnson G (Eds.). Upper motor neurone syndrome and spasticity: Clinical management and neurophysiology. Cambridge: Cambridge University Press, p. 142.

36. Richardson D (2002). Physical Therapy in spasticity. Eur J Neur 9 suppl:17-22.

37. Farmer S, James M (2001). Contractures in orthopaedic and neurological conditions: a review of causes and treatment. Disab Rehab 23(13):549-558.

38. Bonutti P, Windau J, Ables B, Miller B (1994). Static progressive stretch to reestablish elbow range of motion. Clin Orthop Rel Res 303:128-134.

39. Steffen T, Mollinger L (1995). Low-load, prolonged stretch in the treatment of knee flexion contractures in nursing home residents. Phys Ther 75:303-305.

40. James M, Farmer S, Hunt K, Stallard J (1997). Contracture correction using mechanically applied torques: A report to the NHS management executive by Orthotic Research and Locomotor Assessment unit, Oswestry, Shropshire and The Centre for Health Planning and Management. Staffordshire: Keele University.

41. Gelinas J, Faber K, Patterson S, King G (2000). The effectiveness of turnbuckle splinting for elbow contracture. J Bone Joint Surg 82:74-78.

42. Warren CG, Lehmann JF, Koblanski JN (1970). Elongation of rat tail tendon: Effect of load and temperature. Arch Phys Med Rehabil 51:481.

43. Wessling KC, Derane DA, Hylton CR (1987). Effect of static stretch vs. static stretch and ultrasound combined on triceps surae muscle extensibility in healthy women. Phys Ther 67:674. 

44. Starring DT, Gossman MR, Nicholson GG Jr, Lemons J (1998). Comparison of cyclic and sustained passive stretching using a mechanical device to increase resting length of hamstring muscles. Phys Ther 68(3):314-320.

45. Van Hatten B (2005). Passive versus active stretching. Phys Ther 85(1) :80.

46. Winters MV, Blake CG, Trost JS, Marcello-Brinker TB, Lowe LM, Garber MB, Wainner RS (2005). Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: a randomized clinical trial. Phys Ther 85(1):80.

47. Voss DE, Ionla MK, Myers BJ (1985). Proprioceptive neuromuscular facilitation, 3^rd edition. Philadelphia: Harper & Row.

48. Chalmers G (2004). Re-examination of the possible role of Golgi tendon organ and muscle spindle reflexes in proprioceptive neuromuscular facilitation muscle stretching. Sports Biomech 3(1):159-183.

49. Sady SP, Wortman M, Blanke D (1982). Flexibility training: ballistic, static or proprioceptive neuromuscular facilitation? Arch Phys Med Rehabil 63(6):261-3.

50. Lucas RC, Koslow R (1984). Comparative study of static, dynamic, and proprioceptive neuromuscular facilitation stretching techniques on flexibility. Percept Mot Skills 58(2):615-618.

51. Wallin D, Ekblom B, Grahn R, Nordenbord T (1985). Improvement of muscle flexibility. A comparison between two techniques. Am J Sports Med 13(4):263-268.

52. Cornelius WL, Ebrahim K, Watson J, Hill DW (1992). The effects of cold application and modified PNF stretching techniques on hip joint flexibility in college males. Res Q Exerc Sport 63(3):311-314.

53. Spernoga SG, Uhl TL, Arnold BL, Gansneder BM (2001). Duration of maintained hamstring flexibility after a one-time, modified hold-relax stretching protocol. J Athl Train 36(1):44-48.

54. Ferber R, Osternig L, Gravelle D (2002). Effect of PNF stretch techniques on knee flexor muscle EMG activity in older adults. J Electromyogr Kinesiol 12(5):391-397.

55. Rowlands AV, Marginson VF, Lee J (2003). Chronic flexibility gains: effect of isometric contraction duration during proprioceptive neuromuscular facilitation stretching techniques. Res Q Exerc Sport 74(1):47-51.

56. Feland JB, Marin HN (2004). Effect of submaximal contraction intensity in contract-relax proprioceptive neuromuscular facilitation stretching. Br J Sports Med 38(4):E18.

57. Davis DS, Ashby PE, McCale KL, McQuain JA, Wine JM (2005). The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. J Strength Cond Res 19(1):27-32.

58. Decicco PV, Fisher MM (2005). The effects of proprioceptive neuromuscular facilitation stretching on shoulder range of motion in overhand athletes. J Sports Med Phys Fitness 45(2):183-187.

59. Fukami Y, Wilkinson RS (1977). Responses of isolated Golgi tendon organs of the cat. J Physiol 265:673-689.

60. Henricson AS (1985). The effect of heat and stretching on range of hip motion. J Orthop Sports Phys Ther 6(2):269.

61. Lentell, G, et al. (1992). The use of thermal agents to influence the effectiveness of a low-load prolonged stretch. J Ortho Sports Phys Ther 16(5):200-207.

62. Zachazewski JE (1989). Improving flexibility. In: Scully RM, Barnes MR (Eds.). Physical Therapy. Philadelphia: JB Lippincott.

63. Zachazewski JE (1990). Flexibility in sports. In: Sanders B (Ed.). Sports Physical Therapy. Norwalk: Appleton & Lange.

64. Gillette TM (1991). Relationship of body core temperature and warm-up to knee range of motion. J Orthop Sports Phys Ther 13(3):126-131.

65. Hollis M (1982). Practical exercise therapy (2^nd edition). Oxford: Blackwell Scientific.

66. Smith CA (1994). The warm-up procedure: To stretch or not to stretch. A brief review. J Orthop Sports Phys Ther 19(1):12-17.

67. Williford HN, East JB, Smith FH, Burry LA (1986). Evaluation of warm-up for improvement in flexibility. Am J Sports Med 14(4):316-319.

68. Cornelius WL, Hands MR (1992). The effects of a warm-up on acute hip joint flexibility using a modified PNF stretching technique. J Athl Train 27(2):112-114.

69. Burke DG, Holt LE, Rasmussen R, MacKinnon NC, Vossen JF, Pelham TW (2001). Effects of hot or cold water immersion and modified proprioceptive neuromuscular facilitation flexibility exercise on hamstring length. J Athl Train, 36(1):16-19.

70. Knight CA, Rutledge CR, Cox ME, Acosta M, Hall SJ (2001). Effect of superficial heat, deep heat, and active exercise warm-up on the extensibility of the plantar flexors. Phys Ther 81(6):1206-1214.

71. de Weijer VC, Gorniak GC, Shamus E (2003). The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours. J Orthop Sports Phys Ther 33(12):727-733.

72. Draper DO, Castro JL, 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.

73. Wenos DL, Konin JG (2004). Controlled warm-up intensity enhances hip range of motion. J Strength Cond Res 18(3):529-533.

74. Zakas A, Grammatikopoulou MG, Zakas N, Zahariadis P, Vamvakoudis E (2006). The effect of active warm-up and stretching on the flexibility of adolescent soccer players. J Sports Med Phys Fitness 46(1):57-61.

 

 

Data de submissão: Julho 2006

Data de Aceite: Maio 2007

 

 

Correspondência:

Luís Filipe dos Santos Coelho

Av. Coronel Eduardo Galhardo, n.º 28, 5º dto,

1170-105 Lisboa - Portugal

Contacto: 963304478

e-mail: coelholewis@gmail.com