Journal of Orthopaedic & Sports Physical Therapy
Official Publication of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association
Effect of Hamstring Stretching on Hamstring
Muscle Performance
Teddy W. Worrell, EdD, PT, SCS, ATC, FACSM1
Troy I. Smith, MS, PT, ATCZ
lason Winegardner, MS, PT3
ncreasing athletic perforni-
ance is a common goal for
athletes, coaches, and sports
medicine clinicians. Most ef-
forts to improve sprint per-
f o ~ m ~ a n chave
e focused 011sprint
training and increasing muscle per-
forniance. Sprinting places maxi-
muni demands on the niusculotendi-
nous structures of the lower extrem-
ity. Specifically, the hamstring
riiuscles become riiore active than
any other lower extremity niuscle
during sprinting (6). In addition,
Mann and Sprague (7) reported that
sprinters who were faster generated
the greatest hamstring niuscle mo-
ment (torque) during ground con-
tact. Moreover, they reported that
the faster sprinters had riiore ham-
string injuries than the slower
sprinters.
In the past, much of the litera-
ture has focused on the relationship
between hamstring flexibility and in-
jury (2 1) and the most effective ham-
string stretching method (1 5). Sulli-
van et al (1 5) reported that no signif-
icant difference existed between
static and proprioceptive neuromus-
cular facilitation (PNF) hamstring
stretching. This conflicts with ~iiost
studies that report the superiority of
PNF stretching conipared with static
stretching (5,8- 10.12.13).
Very little literature has focused
on the relationship between niuscle
flexibility and force production ( 1 8).
During an eccentric contraction, me-
chanical work is absorbed bv the se-
The relationship between hamstring flexibility and hamstring muscle performance has not
been reported. The purposes of this study were I) to determine the most effective stretching method
for increasing hamstring flexibility and 2) to determine the effects of increasing hamstring flexibility
on isokinetic peak torque. Nineteen subjects participated in this study. A two-way analysis of
variance was used to compare two stretching techniques: proprioceptive neuromuscular facilitation
stretch and static stretch. A one-way repeated measures analysis of variance was used to compare
hamstring isokinetic values pre- and poststretching. No significant increase occurred (p > .05) in
hamstring flexibility even though increases occurred with each technique: static stretch (+2 1.3%)
and proprioceptive neuromuscular facilitation (+25.7%). Significant increases occurred in peak
+
torque eccentrically at 6O0/sec (p < .05, +8.S0/o) and 12O0/sec(p < .05, 13.5%) and concentri-
+
cally at 12O0/sec(p < .05, 11.2%). No significant increase occurred at 6O0/sec (p > .05, +2.5%).
We concluded that increasing hamstring flexibility was an effective method for increasing hamstring
muscle performance at selective isokinetic conditions. Further study is needed to determine if
increasing hamstring flexibility will increase performance in closed kinetic chain activities.
Key Words: hamstring flexibility, active knee extension test, stretching
' Assistant Professor and Director of Research, Krannerf School of Physical Therapy, University of Indianapolis,
1400 E. Hanna Ave., Indianapolis, IN 46227-3697
Staff Physical Therapist, Aboite Physical Therapy, Inc., Fort Wayne, IN
'Staff Physical Thera~ist,Wishard Memorial Hosoital, Indiana~olis,IN
ries elastic component of the muscle sorbed during the eccentric contrac-
as potential energy, which is used tion and more forces will be gener-
during the immediate concentric ated during the concentric
contraction (3,4). This condition of contraction. Theoretically, patients
eccentric contraction followed by with lower extremity overuse inju-
concentric contraction occurs during ries would benefit by muscle stretch-
gait and running. For example, the ing because greater force will be ab-
quadriceps femoris undergoes an ec- sorbed, lessening the overload on
centric contraction during heelstrike weakened and inflamed tissues. In
and concentric contraction at push- addition, theoretically, muscle per-
off. T h e same is true for the gastroc- formance will be increased for activi-
nemius and soleus nluscles during ties of daily living o r sports by in-
niidstance and push-off. Factors that creasing the potential energy avail-
determine the amount of energy ab- able for concentric contractions.
sorbed by muscles are the speed of Recently, Wilson et al (18) dem-
the eccentric contraction and the onstrated that increases in pectoralis
length of the niuscle (3). Thus, if the and deltoid flexibility resulted in sig-
length of the muscle can be in- nificant increases ( p < 0.05) in initial
creased, more forces will be ab- concentric bench-press work if the
Volume 20 Number 3 September 1994 JOSPT

concentric contraction was preceded
immediately by an eccentric contrac-
tion. During sprinting, concentric
hamstring contractions are preceded
by eccentric contractions (6.20). No
reports a r e available that describe
the relationship between increasing
hamstring flexibility and increasing
hamstring muscle performance,
which has important implications for
enhancing athletic performance.
Therefore, the purposes of this
study were 1 ) t o determine the most
effective method for increasing ham-
string flexibility and 2) t o determine
the effects of increasing hamstring
flexibility on isokinetic hamstring
peak torque.
METHODS
Subjects
Nineteen university students
without a history of knee o r ham-
string muscle injury participated in
this study (Table 1). In addition, sub-
jects lacked a t least 20" (range 22-
52") of active knee extension with
the hip in 90" of flexion during the
active knee extension test. Prior t o
participation, each subject read and
signed a consent form approved by
o u r university human subjects com-
mittee.
, contraction mode for several repeti-
Flexibility Assessment
Hamstring muscle flexibility was
assessed with the active knee exten-
sion test (15,22). Subjects were
placed in a supine position with the
anterior thigh touching the crossbar
of a testing apparatus. T h e hip and
knee angles were visually estimated
at 90". In this position, a inclinome-
ter was placed 1 inch below and par-
allel t o the fibular head. During the
warm-up procedure, the subjects ac-
tively extended a leg four times
while maintaining anterior thigh
contact against the crossbar (1 6).
Then, subjects actively extended the
knee two additional times during
which knee extension was recorded
(1 5,22).
JOSPT* Volume 20 * Number 3 * September 1994
lsokinetic Testing
A Biodex isokinetic dynamome-
ter (Biodex, Shirley. New York, NY)
was used to measure hamstring peak
torque values. Calibration was per-
formed prior to testing. Subjects
were tested in the seated position
with their arms crossed over their
chest and straps for stabilization
placed over their waist and distal
thigh. T h e tibia1 pad was placed and
secured approximately two finger-
widths proximal t o the medial mal-
leolus. Axis of the dynamometer was
aligned with the knee axis. T h e test-
ing protocol consisted of an eccen-
Theoretically, patients
with lower extremity
overuse injuries would
benefit by muscle
stretching because
greater force will be
absorbed, lessening
the overload on
weakened and
inflamed tissues.
tric loading of the hamstring muscle
group, followed by an immediate
concentric hamstring muscle con-
traction. In order to accomplish this,
the Biodex was set u p in the passive
mode for flexion and extension. Ec-
centric muscle contraction occurred
during passive knee extension mode,
and the concentric phase occurred
during the passive knee flexion
mode. Subjects received standard-
ized verbal cues of "holdn during the
eccentric phase and "pulln during
the concentric phase, with instruc-
tion t o not relax between the two
stages but to maintain hamstring
contraction throughout the arc of
RESEARCH STUDY
movement. Both eccentric and con-
centric peak torque values were re-
corded between 0 and 90" of knee
flexion a t 60°/sec (1.02 radianslsec)
and 120°/sec (2.04 radianslsec).
Prior to the three maximum test
repetitions, the subjects underwent a
series of warm-up sets. T h e initial set
consisted of five repetitions of the
eccentric phase only, then five repe-
titions of the concentric phase only
at approximately 50% maximum ef-
fort. Three repetitions at 50% maxi-
mum effort of the eccentric/concen-
tric cycle were then performed. T h e
next two warm-up sets consisted of
three and two repetitions at 7 5 and
100% effort, respectively. Each
warm-up set was separated by 30 sec-
onds. T h e testing trials were sepa-
rated from the warm-up sets by a 1-
minute rest period. Subjects were
tested bilaterally. Gravity effect
torque was measured with the leg in
full knee extension in the seated po-
sition. Testing order alternated be-
tween right and left legs.
All subjects participated in a fa-
miliarization session prior t o the ac-
tual pretest session. During the fa-
miliarization session, subjects prac-
ticed the eccentric and concentric
components separately and then
practiced the eccentric/concentric
tions. Adequate practice was allowed
until subjects were comfortable with
the testing procedure.
Stretching Protocol
During the familiarization ses-
sion, subjects were instructed on
how to perform an anterior pelvic
tilt while standing (1 5). All subjects
demonstrated the ability to obtain an
anterior pelvic tilt in the standing
position prior t o the experimental
study. Subjects were told t o face a
table o r chair and place the heel of
the leg t o be stretched on the table
o r chair seat (this was determined by
subject's comfort and his/her ability
to maintain an anterior pelvic tilt),
keep their hands on their hips, hold
their head in a neutral position look-
RESEARCH STUDY
Gender Age
Males ( N = 10) 25.7 f 2.4
Females ( N = 9) 26.7 f4.8
TABLE 1. Description of subjects (rfSD).
ing forward, keep the stretched leg
fully extended, extend their cervical
and thoracic spine, and retract their
scapulae while maintaining an ante-
rior pelvic tilt. Then they were asked
to move their trunks forward at the
pelvis until they perceived a ham-
string stretching sensation without
pain (Figure 1). Each subject
stretched both legs, one leg using
static stretch and the other leg using
contract-relax-contract (PNF)
stretch. Both stretching methods
were performed in an anterior pelvic
tilt position. Assignment of stretch-
ing technique was randomly deter-
mined. T h e static stretch leg was
stretched four repetitions of 15-20
seconds. Each repetition was sepa-
rated by 15 seconds. T h e PNF
stretch leg was then stretched during
four bouts of 20 seconds. Each repe-
tition consisted of 5 seconds of maxi-
mal isometric hamstring contraction,
5 seconds of rest, 5 seconds of maxi-
mal isometric quadriceps contrac-
tion, and 5 seconds of rest (contract-
relax-contract). Subjects performed
four repetitions of each stretching
method 5 days a week (Monday-Fri-
day) at approximately the same time
each day for 3 weeks (15 stretching
sessions). Subjects were monitored
during each stretching session to en-
sure proper performance of the
stretching methods.
Statistical Analyses
For the reliability study, intra-
class correlations (ICC 2.1) (14) and
standard errors of measurement
(SEM) (2) were calculated for the iso-
kinetic and flexibility data. For de-
termining active knee extension test
reliability, the mean of two test trials
was used for data analysis. For isoki-
netic reliability, the largest single
peak torque value was used for data
Height (c& Weight (kg)
+
180.2 5.7 80.1 f 13.7
166.7 f4.1 +
59.8 6.1
analysis. A two-way analysis of vari-
ance (stretching method and time)
was used to compare stretching tech-
niques. A one-way analysis of vari-
ance was used to compare hamstring
isokinetic values pre- and post-
stretching. Probability was set at p <
.05. Daily attendance was kept. Sub-
jects participated in a total of 570
individual stretching sessions (38 ex-
tremities for 15 days).
Reliability Study
Prior to the experimental study,
10 subjects were tested bilaterally 7
days apart to determine intrarater
Stretching of a
musculotendinous
unit may affect
neuromuscular
transmission.
intersession reliability of the active
knee extension test and isokinetic dy-
namometry. T h e testers were
blinded from the prior test results
for both the active knee extension
test and the isokinetic dynamometer.
RESULTS
For the reliability study, intrates-
ter ICC and SEM for the active knee
extension test measures were .93 and
2.9 1" , respectively. For the isoki-
netic dynamometer, intratester ICC
and SEM ranged from .95 to .97 and
8.2 to 13.2 Nm, respectively (Table
2). For the experimental study, no
significant increase occurred in ham-
FIGURE 1. Hamstrrng stretchrng rn an dntenor pelvrc
tr11 pootion. (From Sullrvan MK, Delulia /I, Worrell
TW: Eifect of pelvic position and stretching method
on hamstring muscle flexibility. Med Sci Sports Exerc
24:1383-1389,O The American College of Sports
Medicine, 1992. with permission).
string flexibility for either stretching
method ( p > .05). T h e hamstring
flexibility of the statically stretched
leg increased 8.0" and the flexibility
of the PNF stretched leg increased
9.5" (Table 3). Since no significant
increase occurred for either stretch-
ing method, stretching groups were
collapsed to compare pre- and post-
test isokinetic measures. Significant
increases occurred eccentrically at
60°/sec ( p < .05) and 120°/sec ( p <
.05) and concentrically at 120"/set
( p < .05). No significant increase oc-
curred concentrically at 60°/sec ( p
> .05) (Table 4). Daily attendance
was 99.3% (5661570).
DISCUSSION
Stretching Techniques
Results indicated no significant
increase in motion occurred in either
stretching group. However, ham-
string flexibility increases (static
stretch = 8.0°, +21.3%; PNF =
9.5". +25.7%) approached signifi-
cance ( p = 0.082) (Table 3). Large
intersubject variation occurred as re-
vealed by the 24.6% coefficient of
variation. Consequently, statistical
power was low (0.40), increasing the
probability of a type I1 error, ie., the
Volume 20 Number 3 September 1994 JOSPT
 -
RESEARCH S T U D Y

Measure ICC SEM p* inability to detect actual differences (larger pretest active knee extension
that existed because of large subject test) tended to gain more hamstring
Activekneeextension 0.93 2.91' 0.224
test variation and small sample size. As flexibility. However, this variability
60°/sec concentric 0.95 12.7 Nm 0.883 demonstrated in Table 5, four ex- in stretching response cannot be
60a/sececcentric 0.95 10.9 Nm 0.450 tremities lost flexibility and a large completely explained by initial active
12O0/secconcentric 0.95 13.2 Nm 0.928 range of responses to stretching ex- knee extension test because the cor-
120°/sec eccentric 0.97 8.2 Nm 0.278 isted (from a loss of 2.5" to a gain of relation between initial active knee
* Cornparrson oi test and retest rneature5. 3 1.5"). We are unable to explain extension test and changes in active
TABLE 2. Reliability data for the active knee such a large variation in response to knee extension test was low (r =
extension test and isokinetic measures for the pilot the stretching protocol. Generally, 0.428, p = 0.068).
studv. subjects who were less flexible Increases in flexibility in this
study are in general agreement with
Sullivan et al (15). who reported a 9
Group Pretest Posttest Change and 1 1" increase for static stretching
SS 37.5 f 8.8' 29.5 f 8.6' 8.0" (21.3%) and PNF stretching, respectively,
PNF 36.7 f 8.7' 27.3 f 5.9" 9.5' (25.7%) after 10 stretching sessions, which
were statistically significant ( P <
SS = Static stretch.
PNF = Proprioceptive neurornuscular facilitation stretch. .05). We did not find a significant
TABLE 3. Changes in hamstring flexibility as measured by the active knee extension test. Smaller numbers on
difference between static stretching
the posttest indicate more knee extension, ie., increased hamstring flexiblity. and PNF stretching, which is in
agreement with Sullivan et al and in
disagreement with others (12.1 7).
Other studies (12,17) have not con-
Velocity Pretest Posttest Change (%) P
trolled for pelvic position when per-
60"sec concentric 115.8 f 37.0 118.7 f 37.7 2.9 Nm (2.5%) 0.322 forming hamstring stretching, which
6O0/sec eccentric 110.1 f 37.0 119.5 f 43.4 9.4 Nm (8.5%) 0.016
120e/secconcentric 112.3 f 35.3 124.9 f 40.3 12.6 Nm (1 1.2%) 0.002
we believe is a confounding factor in
120°/sec eccentric 111.7 f 39.1 126.7 f 41.3 15.1 Nm (13.5%) 0.000 hamstring stretching (15). There-
fore, the use of either of these
TABLE 4. lsokinetic peak torque measures. stretching techniques will serve the
purpose of increasing flexibility. In
our experience, static stretching is
Static Stretch PNFG e t % ~
much easier to teach and to perform
Gender
Pretest Posttest Change Pretest Posttest Change than PNF stretching. Therefore, we
recommend static stretching for in-
Females
1 26.5 23.5 3.0 30.5 23.0 7.5 creasing hamstring flexibility.
2 28.5 20.0 8.5 41.5 25.5 16.0
3 31.0 25.0 6.0 26.5 23.0 3.5
4 43.5 34.0 9.5 36.5 39.0 -2.5 Hamstring Peak Torque
5 22.0 22.0 0.0 23.5 20.5 3.0
6 40.0 30.5 9.5 34.0 31.5 2.5 Significant increases in ham-
7 38.5 40.5 -2.5 37.0 26.5 10.5 string peak torque occurred eccen-
8 45.0 36.5 8.5 47.0 35.0 12.0 trically at 60 and 120°/sec and con-
9 25.0 25.5 -0.5 24.5 25.0 -0.5 centrically at 120°/sec (Figure 2,
Males Table 4). No significant increase oc-
1 33.0 30.0 3.0 28.5 25.5 3.0
2 50.0 45.0 5.0 49.5 32.5 17.0 curred in concentric peak torque at
3 29.0 15.0 14.0 26.5 17.0 9.5 60°/sec. Increases in eccentric force
4 44.0 36.5 7.5 45.5 35.0 10.5 production at 60 and 120°/sec are
5 52.0 38.0 14.0 51.0 29.0 22.0 attributed to increases in hamstring
6 42.5 34.5 8.0 45.0 32.0 13.0 muscle flexibility and increases in
7 45.5 35.0 10.5 43.5 30.0 13.5
8 38.0 30.5 7.5 33.5 26.0 7.5 compliance of the series elastic com-
9 44.0 12.5 31.5 40.5 18.5 22.0 ponent that results in a greater abil-
10 33.5 25.5 8.0 33.5 24.0 9.5 ity to store potential energy
PNF = Propnoceptrve neurornuscular tac~lrtatronstretch (1,3,4,18,19). Improvement in con-
centric peak torque production at
TABLE 5. Individual changes in hamstring stretching by gender and stretching method (active knee extension
test degrees from complete knee extension). Negative numbers indicate loss of hamstring flexibility; other 120°/sec resulted from the in-
numbers indicate increases in hamstring flexibility. creased storage of potential energy

JOSPT Volume 20 Number 3 September 1994

RESEARCH S T U D Y
Peak Torquo
Nm
100
50
-
n
6O0/s Con
FIGURE 2. Pretest and posttest strength values. Con = Concentric, Ecc = Eccentric
during eccentric loading, which is
used in the immediate concentric
contraction (1,3,4,18,19). This
added potential energy must be used
instantaneously following the eccen-
tric contraction (1 1). Wilson et al
(1 8) demonstrated that by increasing
pectoralis and deltoid flexibility, se-
ries elastic component stiffness was
significantly reduced during a 70%
maximal bench press repetition.
Moreover, Wilson et al (18) reported
that initial concentric work of the
bench press was significantly in-
creased ( p < 0.05) after stretching.
In addition, the bench load in-
creased 5.4%. which was not signifi-
cant.
No significant increase in ham-
string force occurred concentrically
a t 6 0 "/set after eccentric loading.
We are unable t o explain this phe-
nomenon. Perhaps at a slower veloc-
ity (60 vs. 120°/sec) the instanta-
neous moment is lost (1 1). Further
study is needed t o support o r refute
this finding.
T h e increases in hamstring mus-
cle performance in this study were
not d u e t o a learning effect for the
following reasons: 1)subjects were
familiarized with the active knee ex-
tension test and Biodex prior t o pre-
testing, and 2) reliability data indi-
cated that n o learning effect oc-
curred between testing sessions
w PmT&
El Postt&
p0.05
6O0/s Ecc 120°/s Con 120°/s Ecc
Velocity
separated by 1 week as indicated by
the ICC, SEM, and probability levels
(Table 2). Therefore, we conclude
that the improvements in muscle
performance were the result of the
flexibility increases (2 1.3-25.7%),
even though the increases in flexibil-
ity were not statistically significant.
Stretching of a musculotendi-
nous unit may also affect neuromus-
cular transmission (23). Yamashita et
al (23) reported that stretching a rat
soleus muscle by 10 and 20% in-
creased posttetanic potentiation of
the miniature end-plate potential,
which indicates increased Ca2+con-
ductance in the nerve terminal. This
increase in intracellular free Ca2+ fa-
cilitates neurotransmitter release.
Theoretically, muscle force genera-
tion should increase as a result of in-
creased transmitter release. There-
fore, the possibility exists that in-
creases in muscle force generation
seen in this study may be d u e in part
t o factors other than changes in se-
ries elastic component stiffness and
flexibility. However, this is specula-
tion and further study is needed t o
address the neurological effects of
stretching in vivo.
Hamstring muscle performance
measured in the open kinetic chain
(distal segment off the ground) was
investigated in this study. Caution
must be used when generalizing
these results t o closed kinetic chain
(distal segment on the ground) activi-
ties. Additional studies a r e needed t o
determine the effect of increasing
hamstring flexibility on closed ki-
netic chain activities.
Limitations
Although three of the four isoki-
netic peak torque values were signifi-
cantly increased, the absolute in-
creases were small t o modest (8.5-
13.5% o r 9.87-1 5.08 Nm). We
would expect such small increases
based on only 15 stretching sessions
and high intersubject variation t o
the stretching procedure. Even
though the lCCs of the reliability
study were high (.95-.97), measure-
ment error was present, as revealed
by the SEM. T h e SEM is a range of
measurement error that is plus o r
minus the measurement value of
concern, which means that 34% of
the time the SEM value will be above
the value of concern, and 34% of the
time the SEM will be below the value
of concern. Therefore, the absolute
increases in peak torque si~ouldbe
compared with the SEM at each
speed. Only a t 1 20°/sec eccentrically
did the absolute increase in peak
torque exceed the upper limit of the
SEM. Again, the SEM is a range of
error that can be above o r below the
value of interest.
CONCLUSION
Results of this study reveal that
no significant increase in hamstring
flexibility occurred using static o r
proprioceptive neuromuscular facili-
tation stretching techniques. Because
of the large intersubject variation,
statistical power was low. However,
increases in hamstring flexibility oc-
curred, ranging from 2 1.3% for
static stretch to 25.7% for propri-
oceptive neuromuscular facilitation.
Significant increases did occur, how-
ever, in isokinetic peak torque eccen-
trically a t 60" and 120°/sec and
concentrically at 120°/sec. No sig-
Volume 20 Number 3 September 1994 JOSPT
 - RESEARCH STUDY
nificant increase occurred concentri-
cally at 60°/sec. W e conclude that
increasing hamstring flexibility was
effective i n increasing selective ham-
string isokinetic peak t o r q u e values
i n t h e open kinetic chain. F u r t h e r
study is needed t o determine t h e ef-
fect o f increasing hamstring flexibil-
ity o n functional activities i n t h e
closed kinetic chain. JOSPT
ACKNOWLEDGMENT
T h e authors thank C h r i s Inger-
soll, P h D , A T C , F A C S M , o f Indiana
State University f o r his critical re-
view o f this manuscript.
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