Physical Therapy in Sport xxx (2012) 1e7
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Physical Therapy in Sport
journal homepage: www.elsevier.com/ptsp
Original research
Effects of a neurodynamic sliding technique on hamstring flexibility in healthy
male soccer players. A pilot study
Yolanda Castellote-Caballero a, Marie Carmen Valenza b, Lydia Martín-Martín b, Irene Cabrera-Martos b,
Emilio J. Puentedura c, *, César Fernández-de-las-Peñas d
a
Hospital Virgen de las Nieves, Servicio Andaluz de Salud, Spain
Department of Physical Therapy, Universidad de Granada, Granada, Spain
Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
d
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
b
c
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 1 September 2011
Received in revised form
1 July 2012
Accepted 11 July 2012
Purpose: To compare the short-term effects of a neurodynamic sliding technique versus control condition
on hamstring flexibility in healthy, asymptomatic male soccer players.
Subjects: Twenty-eight young male soccer players from Palencia, Spain (mean age 20.7 yrs 1.0, range
19e22) with decreased hamstring muscle flexibility.
Methods: Subjects were randomly assigned to one of two groups: neurodynamic sliding intervention or
no intervention control. Each subject’s dominant leg was measured for straight leg raise (SLR) range of
motion (ROM) pre- and post-intervention. Subjects received interventions as per group allocation over
a 1 week period. Data were analyzed with a 2 (intervention: neurodynamic and control) 2 (time: pre
and post) factorial ANOVA with repeated measures and appropriate post-hoc analyses.
Results: A significant interaction was observed between intervention and time for hamstring extensibility, F(1,26) ¼ 159.187, p < .0005. There was no difference between the groups at the start, p ¼ .743;
however, at the end of the study, the groups were significantly different with more range of motion in
the group that received neurodynamic interventions, p ¼ .001. The group that received neurodynamic
interventions improved significantly over time (p < .001), whereas the control group did not (p ¼ .684).
Conclusion: Findings suggest that a neurodynamic sliding technique can increase hamstring flexibility in
healthy, male soccer players.
Ó 2012 Elsevier Ltd. All rights reserved.
Keywords:
Humans
Muscle
Skeletal/physiology
Neurodynamic
Short hamstring syndrome
Straight leg raise test
Range of motion
1. Introduction
Hamstring injuries are common in physically active people and
athletes participating in competitive sports such as sprinting,
rugby, football, and soccer (Bahr & Holme, 2003; Davis, Ashby,
McCale, McQuain, & Wine, 2005; Decoster, Cleland, Altieri, &
Russell, 2005; Malliaropoulos, Papalexandris, Papalada, &
Papacostas, 2004). Hamstring strains accounted for 11% of injuries
in British professional soccer and for 12.7% in the two highest
soccer divisions in Iceland (Arnason, Sigurdsson, Gudmundsson,
Holme, Engebretsen, & Bahr, 2004; Dadebo, White, & George,
2004). Many predisposing factors for hamstring injury have been
* Corresponding author. University of Nevada Las Vegas, School of Allied Health
Sciences, Department of Physical Therapy, 4505 Maryland Parkway, Box 453029, Las
Vegas, NV 89154-3029, USA.
E-mail address: [email protected] (E.J. Puentedura).
suggested within the literature, including: insufficient warm-up
(Safran, Garrett, Seaber, Glisson, & Ribbeck, 1988); poor flexibility
(Witvrouw, Danneels, Asselman, D’Have, & Cambier, 2003); muscle
imbalance (Croisier, 2004; Croisier, Forthomme, Namurois,
Vanderthommen, & Crielaard, 2002); neural tension (Turl &
George, 1998); and previous injuries (Bennell et al., 1998; Verrall,
Slavotinek, Barnes, Fon, & Spriggins, 2001). Among risk factors for
hamstring injury, inadequate extensibility within the posterior
thigh compartment appears to be one of the more commonly
accepted causes (Davis et al., 2005; Decoster, Scanlon, Horn, &
Cleland, 2004) and it has been suggested that stretching before
physical activity may increase extensibility of the stretched muscle,
fascia and neural tissues, which may in turn decrease the chance for
injury (Halbertsma, Mulder, Goeken, & Eisma, 1999; Hartig &
Henderson, 1999; Ross, 1999).
Hamstring stretching is considered an appropriate intervention
in both the prevention and treatment of hamstring injury. Although
stretching for the prevention of injury is common practice in many
1466-853X/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ptsp.2012.07.004
Please cite this article in press as: Castellote-Caballero, Y., et al., Effects of a neurodynamic sliding technique on hamstring flexibility in healthy
male soccer players. A pilot study, Physical Therapy in Sport (2012), http://dx.doi.org/10.1016/j.ptsp.2012.07.004
2
Y. Castellote-Caballero et al. / Physical Therapy in Sport xxx (2012) 1e7
sports (Witvrouw, Mahieu, Danneels, & McNair, 2004), evidence for
decreased hamstring flexibility as a risk factor for hamstring injury
remains equivocal (Hennessey & Watson, 1993; Witvrouw et al.,
2003) and a recent Cochrane review found no evidence for
stretching as a sole intervention for prevention of hamstring injury
(Goldman & Jones, 2010). Accordingly, flexibility has been suggested as but one factor in the multi-factorial etiology of hamstring
strain injury (Worrell & Perrin, 1992). In a review on risk factors for
recurrent hamstring strains, Croisier (2004) noted only limited
evidence for stretching but suggested at least normalizing
hamstring length. In a Cochrane review, Mason, Dickens, and Vail
(2007) reported evidence for a higher frequency of daily stretching in the rehabilitation of hamstring injuries, and in another study,
Witvrouw et al. (2004) suggested that stretching might be most
relevant for sports that predominantly include plyometric
activities.
Although there are various theories, evidence is lacking for any
credible explanation for the observed increases in muscle extensibility following intermittent stretching. In a recent review article,
Weppler and Magnusson (2010) suggested that increases in tissue
extensibility come not from affecting the mechanical properties of
the muscle being stretched but result from changes in the individual’s perception of stretch or pain. In other words, the point of
limitation in hamstring range is increased not because of changes
within the muscle structure but rather, because the individual
receiving the stretching interventions has adopted a ‘new stop
point’ for limitation in hamstring range based on altered perceptions of stretch or pain. This is known as the ‘sensory theory’ and it
proposes that increases in muscle extensibility after stretching are
due to modified sensation (Weppler & Magnusson, 2010). Changes
in neurodynamics (movement of the nervous system) could modify
such sensations. Neurodynamics is the term used to describe the
integration of the morphology, biomechanics and physiology of the
nervous system (Butler, 2000; Shacklock, 2005).
An individual with decreased hamstring extensibility may
demonstrate limited range in the passive straight leg raise test
(SLR) because of altered neurodynamics affecting the sciatic, tibial
and common fibular nerves (Kornberg & Lew, 1989). Abnormal
posterior lower extremity neurodynamics may influence resting
muscle length and lead to changes in the perception of stretch or
pain (Marshall, Cashman, & Cheema, 2011). It follows that
providing a movement/stretching intervention could alter the
neurodynamics and lead to modification of the sensation and
ultimately, increased extensibility.
The purpose of the current paper, therefore, is to explore the
effect of a specific neurodynamic intervention on passive SLR in
healthy soccer players, and specifically investigate the hypothesis
that neurodynamic mobilizations (sliders) would produce a greater
ipsilateral increase in SLR than control treatment.
separated by one week. Recruitment occurred between April and
July 2010. This study received ethical approval from the Ethical
Committee of the University of Granada, Spain.
2.2. Measurement of hamstring flexibility
All physical measurements were obtained by the same pair of
trained evaluators who were blinded to each subject’s group allocation and included height and weight to determine body mass
index (BMI ¼ kg/m2). The passive SLR test was used to determine
changes in hamstring muscle extensibility. With the subject in the
supine position, the lateral condyle of the femur was pinpointed
with a marker, as were the head of the fibula and the fibular malleolus. The axis of a goniometer was placed on the projection of the
greater trochanter of the femur. One of the arms of the goniometer
was placed parallel to the table (checking with a level). The knee
and ankle were kept in the extension position. Holding the talus
and without rotating the hip, flexion of the hip was gradually
increased, lifting the subjects’ lower limb until they first complained of pain in the region of the posterior thigh. The point of first
onset of pain has traditionally been referred to as P1 (Maitland,
Hengeveld, Banks, & English, 2005). Care was taken to ensure
that they did not bend their knee, or begin to swing the pelvis in
retroversion. At that moment, the other arm of the goniometer was
placed in the direction of the line between the head of the fibula
and the fibular malleolus, and the degree of elevation of the straight
leg was noted. One evaluator was tasked with performing the
passive SLR to P1, while the other was tasked with taking the
goniometric measurement (Fig. 1). This measurement has been
shown to have high reliability and validity in various studies. Boyd
(2012) reported intra-rater reliability ICCs to be 0.95e0.98; the
standard error of measurement (SEM) was between 0.54 and
1.22 ; and minimal detectable change was between 1.50 and 3.41.
Walsh and Hall (2009) found substantial agreement between SLR
and slump test interpretation (kappa ¼ 0.69) and good correlation
in ROM between the two tests (r ¼ 0.64). Measurements were taken
before the intervention and re-evaluated after the intervention
(moving to end of ROM). Between-session intra-rater reliability
was established on the first 10 subjects as sufficient for clinical
measurement (ICC ¼ .91).
2.3. Procedures
All subjects began with a single measure of the passive SLR on
their dominant (kicking) leg. As long as range of motion was 75 ,
2. Methods and materials
2.1. Subjects
We recruited a convenience sample of 28 subjects (all male;
mean age 20.8 1.0, range 19e22) who were active in the Palencia
non-professional soccer leagues. Subjects had to be aged between
18 and 25 years, and actively participating in soccer (training and
competitive matches) for at least 5 h/week and at least 3 days/
week. Exclusion criteria were as follows: a) any hamstring injury
within the past year; b) presence of any history of neurological or
orthopedic disorder affecting the lower extremities (e.g. peripheral
neuropathy, femoral fracture, meniscal injury, low back pain, etc.);
and/or c) exceeding 75 in the initial passive SLR. Subjects signed
a consent form and agreed to participate in two testing sessions
Fig. 1. Measurement of hamstring flexibility pre- and post-intervention using the
passive straight leg raise (SLR) test with universal goniometer.
Please cite this article in press as: Castellote-Caballero, Y., et al., Effects of a neurodynamic sliding technique on hamstring flexibility in healthy
male soccer players. A pilot study, Physical Therapy in Sport (2012), http://dx.doi.org/10.1016/j.ptsp.2012.07.004
Y. Castellote-Caballero et al. / Physical Therapy in Sport xxx (2012) 1e7
they were accepted into the study. We chose to limit passive SLR
range of motion to ensure we would have subjects with bilateral
short hamstring syndrome as described by Ferrer (Ferrer, 1998;
Ferrer, Santonja, Carrion, & Martinez, 1994; Verrall, Slavotinek, &
Barnes, 2005). Using a random numbers table, subjects were
randomly assigned to either an intervention group or a control
group. Subjects in both groups were measured for passive SLR as
described above and the average of 3 measurements was obtained
for each subject. Subjects in the intervention group were then
treated with neurodynamic sliding techniques on 3 different days
over 1 week, and instructed to continue their routine soccer
training sessions and matches as scheduled during the study.
Subjects in the control group were given no specific treatment and
instructed to continue their routine soccer training and matches as
per usual. Both groups were allowed to continue their hamstring
stretching and warm-up procedures before soccer training sessions
3
and matches during the study. After 1 week, subjects in both groups
had their passive SLR re-measured, with an average of 3
measurements once more. The study design is shown in Fig. 2.
The neurodynamic sliding techniques administered to the
intervention group consisted of ‘seated straight leg sliders’, and
were provided by a researcher blinded to SLR measurements. These
neurodynamic sliders are maneuvers performed in order to
produce a sliding movement of neural structures relative to their
adjacent tissues (Butler, 2000; Mintken, Puentedura, & Louw, 2011).
Sliders involve application of movement/stress to the nervous
system proximally while releasing movement/stress distally, and
then reversing the sequence. Research has shown that sliders
actually result in greater excursion than simply stretching the nerve
(Coppieters & Butler, 2008). Each subject sat with their trunk in
thoracic flexion (slump) and while maintaining that posture, they
performed alternating movements of knee extension/ankle
Fig. 2. Flow chart of the study design.
Please cite this article in press as: Castellote-Caballero, Y., et al., Effects of a neurodynamic sliding technique on hamstring flexibility in healthy
male soccer players. A pilot study, Physical Therapy in Sport (2012), http://dx.doi.org/10.1016/j.ptsp.2012.07.004
4
Y. Castellote-Caballero et al. / Physical Therapy in Sport xxx (2012) 1e7
dorsiflexion with cervical extension, and knee flexion/ankle plantarflexion with cervical flexion (Fig. 3). Subjects performed these
active movements for approximately 60 s and repeated them 5
times. At present, there is no research evidence on the appropriate
dosage for active neurodynamic sliders; however, we chose 60 s
and 5 repetitions based on clinical experience and suggestions from
authors (Butler, 2000; Nee & Butler, 2006). Each of the subjects in
the intervention group was treated with the neurodynamic sliders
for 3 sessions on alternate days over 1 week. All interventions were
provided by the same researcher in the training rooms at the soccer
club.
Table 1
Sample characteristics
2.4. Statistical analysis
test mean range of 59.1 (95% CI: 55.9e62.4). The pre-test-topost-test differences in average SLR values exceeded the upper
limit of this MDC95 range for the neurodynamic intervention (9.4 )
but not for the control group (0.2 ).
A
statistically
significant
interaction was
observed,
F(1,26) ¼ 159.187, p < .0005 (h2p ¼ :860) (Fig. 4). There was no
difference between the groups at the start, p ¼ .743; however, at the
end of the study, the groups were significantly different with more
range of motion in the group that received neurodynamic interventions (p ¼ .001). The group that received neurodynamic interventions improved significantly over time (p < .001), whereas the
control group did not (p ¼ .684).
Descriptive statistics (mean, standard deviation, 95% CI) were
calculated for pre-test and post-test SLR averaged values for the 2
groups. SLR responsiveness data were calculated using the
between-session ICC established in this study (ICC ¼ .91) and the
formulae SEM ¼ SD O(1 ICC) (Weir, 2005) and
MDC95 ¼ 1.96 O2 SEM (Stratford, 2004). To analyze the
difference between groups over time on hamstring extensibility
(SLR), one 2 (group: intervention and control) 2 (time: pre and
post) mixed factorial ANOVA with repeated measures on both
factors was conducted, with appropriate post-hoc analysis. Significance level was set at .05. A Bonferroni corrected alpha of .0125
(four t-tests) would be utilized for simple main effects (SME)
analyses.
3. Results
Characteristics of the study sample are summarized in Table 1,
and demonstrate that there were no significant differences
between the groups at the start of the study. Standard deviations
for SLR measurements ranged from 5.9 to 7.0 . This allowed us to
calculate a range of SEM from 1.8 to 2.1 and subsequently a range
for the MDC95 of 5.0e5.8 . The neurodynamic intervention group
had a pre-test mean range of 58.1 (95% CI: 54.3e61.8) and posttest mean range of 67.4 (95% CI: 64.2e70.7). The control group
had a pre-test mean range of 58.9 (95% CI: 55.2e62.7) and post-
Intervention
group
n ¼ 14
Age (years) e mean SD
Training hours/week e mean SD
Weight (kg) e mean SD
Height (cm) e mean SD
BMI (kg/cm2) e mean SD
a
20.79
5.23
77.29
176.50
24.7
1.05
1.20
5.25
4.70
1.35
Control group
n ¼ 14
20.71
5.47
78.93
176.21
24.5
0.99
0.84
4.60
3.53
1.04
p Valuesa
0.792
0.607
0.300
0.908
0.451
t-Test.
4. Discussion
The results from this study showed a significant between-group
difference favoring the neurodynamic intervention with regard to
increasing post-intervention hamstring flexibility. Furthermore,
a within-group difference was observed for the intervention group
over time (p < .001) whereas no within-group difference was
observed for the control group over time (p ¼ .684). Pre-test-topost-test differences in average SLR values for the intervention
group exceeded the MDC95 suggesting the changes observed were
not a result of measurement error and represent a true change in
hamstring flexibility following the neurodynamic sliders.
Increasing hamstring flexibility may play an important role in
preventing lower extremity overuse injuries. In fact, a study on 298
Fig. 3. The neurodynamic sliding technique used in this study. The subject sat with their trunk in thoracic flexion (slump) and while maintaining this posture, they started with
cervical flexion and knee flexion with ankle plantarflexion (A), and then moved into cervical extension while performing knee extension and ankle dorsiflexion (B). These alternating active movements were performed for approximately 60 s and repeated 5 times.
Please cite this article in press as: Castellote-Caballero, Y., et al., Effects of a neurodynamic sliding technique on hamstring flexibility in healthy
male soccer players. A pilot study, Physical Therapy in Sport (2012), http://dx.doi.org/10.1016/j.ptsp.2012.07.004
Y. Castellote-Caballero et al. / Physical Therapy in Sport xxx (2012) 1e7
5
70
68
67.4 °
66
64
p=.001
62
60
58
p=.743
59.1 °
58.9 °
58.1°
56
54
Pre
Neurodynamic
Post
Control
Fig. 4. Mean SLR values ( ) with 95% confidence intervals of hamstring extensibility before and after intervention and control.
military basic trainees found that the numbers of lower extremity
injuries were reduced after introduction of a hamstring stretching
regimen that significantly increased hamstring flexibility (Hartig &
Henderson, 1999). Another study by Malliaropoulos et al. (2004)
followed 80 Greek athletes who were diagnosed as having
second-degree hamstring strains. Subjects were divided into 2
groups and both groups performed the same stretches, although
with a different frequency each day. Researchers found that the
group who stretched more frequently regained normal knee
extension range of motion (ROM) in an average of 5.6 days
compared to 7.3 days for the control group (p < .001). The intervention group also returned to normal, unrestricted activities in an
average of 13.3 days compared to 15.0 days for the control group
(p < .001).
Most of the existing research on hamstring flexibility has
focused on different modes of stretching, such as Proprioceptive
Neuromuscular Facilitation (PNF) (Puentedura et al., 2011;
Wallmann, Gillis, & Martinez, 2008); static stretching (Puentedura
et al., 2011; Wallmann et al., 2008; Wallmann, Mercer, &
McWhorter, 2005); plyometric stretching and ballistic stretching
(Samuel, Holcomb, Guadagnoli, Rubley, & Wallmann, 2008). They
have also compared different stretching intensities (Marshall et al.,
2011) and frequencies (Feland & Marin, 2004). We could only find
one older study (Kornberg & Lew, 1989) which examined the effect
of neurodynamic ‘stretching’ on Australian Rules football players
with grade one hamstring injuries. That particular study involved
28 subjects with grade one hamstring injuries, who also demonstrated positive responses to the slump test (neurodynamic test).
The researchers randomized 16 subjects to receive traditional
physical therapy management, and 12 to receive traditional
management plus slump stretching. The results indicated that
adding the slump stretch technique to traditional care was more
effective (p < .001) in returning players to full function than the
traditional management alone (Kornberg & Lew, 1989). In that
particular study, researchers used a neurodynamic ‘stretch’ or what
is now referred to as a ‘tensioner’ (Butler, 2000; Mintken et al.,
2011) instead of the ‘slider’. We believe that this present study is
the only one in the current literature to apply a neurodynamic
slider technique to healthy subjects with shortened hamstrings. We
chose to use a neurodynamic slider technique rather than
a ‘tensioner’ because we wanted to assess for the effect of movement rather than stretch (which is a part of the ‘tensioner’) in
altering perceptions of stretch or pain associated with the SLR.
Mendez-Sanchez et al. (2010) completed a randomized
controlled pilot study on 8 healthy male soccer players to assess the
immediate effects of a sciatic nerve slider technique added to
sustained hamstring stretching on lumbar and lower quadrant
flexibility. Lower quadrant flexibility was assessed by the passive
straight leg raise test performed in exactly the same manner as for
our study. One group of 4 players were assigned to receive bilateral
hamstring stretching while supine for 5 min while the other group
of 4 received the same stretching plus a sciatic slider neural
mobilization technique on both sides. The slider technique in their
study consisted of placing each soccer player in supine with the
neck supported in a flexed forward position and then applying hip
and knee flexion concurrently, then alternating this with hip and
knee extension and repeated the motions for 60 s. Both groups
demonstrated improved flexibility over time; however, straight leg
raise of the left leg showed a significantly greater improvement in
the experimental group (Mendez-Sanchez et al., 2010). The
experimental group also had greater improvements in lumbar and
lower quadrant flexibility as measured by the modified Schöber test
and slump test. The authors postulated that the observed changes
may have been secondary to decreasing neuromeningeal sensitivity; however, an alternative explanation may be that the neurodynamic sliders led to a modification of sensation such that the
soccer players’ perceptions of stretch or pain were altered (Weppler
& Magnusson, 2010).
Such a proposal is further supported by a recent study conducted by Aparicio, Quirante, Blanco, and Sendin (2009). The
authors examined the immediate effect of a suboccipital muscle
inhibition (SMI) technique on hamstring flexibility (measured by
the forward flexion distance test; straight leg raise test; and
popliteal angle test) and pressure pain threshold (PPT) over myofascial trigger points (MTrPs) in the hamstring musculature.
Seventy subjects comprised of 49 students from the Physiotherapy
School of the University of Extremadura (Spain) and 21 soccer
players from the Extremadura Football Club, were randomly
assigned to receive SMI or a placebo intervention. Results demonstrated that the SMI technique modified the flexibility of the
hamstring muscles on all outcome measures, and furthermore,
there was a significant difference in pressure algometry (PPT) for
MTrPs in the right semimembranosus following the SMI (p ¼ .021)
but not the left semimembranosus (p ¼ .079). The fact that such
a distant technique (suboccipital region) can have an immediate
effect on the flexibility and pressure pain thresholds in the
Please cite this article in press as: Castellote-Caballero, Y., et al., Effects of a neurodynamic sliding technique on hamstring flexibility in healthy
male soccer players. A pilot study, Physical Therapy in Sport (2012), http://dx.doi.org/10.1016/j.ptsp.2012.07.004
6
Y. Castellote-Caballero et al. / Physical Therapy in Sport xxx (2012) 1e7
hamstrings may lend support to the ‘sensory theory’ proposed by
Weppler and Magnusson (2010). It appears reasonable to suggest
that the observed increases in hamstring tissue extensibility
following the SMI would have more likely come from changes in
the subjects’ perceptions of stretch or pain associated with the
flexibility and pressure pain testing.
Although our study does not provide information about the
mechanism of action or change, it does suggest that neurodynamic
treatment can significantly increase hamstring flexibility in a young
male athletic population.
4.1. Limitations
The present research was designed as a pilot study, and its
findings should be considered as tentative. Some limitations should
be acknowledged. The sample size was small and included only
young males; thus, results cannot be generalized to other populations. Additionally, we only looked at differences in measurements after a week of intervention and it is not possible to
determine how long the observed increase in hamstring flexibility
might have lasted. Furthermore, we did not conduct any long term
follow-up to determine if the observed changes in flexibility
resulted in any change in incidence of hamstring injuries within the
groups. Future research should involve larger sample sizes, perhaps
include female soccer players to assess for gender differences, and
examine for more long term effects of neurodynamic interventions.
Finally, despite the significant increase in flexibility for the neurodynamic intervention group, none of those players surpassed the
75 mark (upper bound 95% CI ¼ 70.7 ) indicating that they
continued to have short hamstring syndrome (Ferrer, 1998; Hartig
& Henderson, 1999). It is not known whether additional stretching may have enabled these players to improve further and this
would need further research.
5. Conclusion
The findings of this study suggest that a neurodynamic sliding
technique can increase hamstring flexibility in male soccer players.
Future research should compare neurodynamic techniques with
other interventions. Such studies should address additional muscle
groups and examine the duration of lengthening in repeated
measure designs.
Conflict of interest
None declared.
Ethical approval
This clinical trial received ethical from the Universidad de
Granada, Spain and was also approved by Hospital Virgen de las
Nieves, Servicio Andaluz de Salud, Spain.
Funding
None declared.
References
Aparicio, E. Q., Quirante, L. B., Blanco, C. R., & Sendin, F. A. (2009). Immediate effects
of the suboccipital muscle inhibition technique in subjects with short
hamstring syndrome [Randomized controlled trial]. Journal of Manipulative and
Physiological Therapeutics, 32(4), 262e269.
Arnason, A., Sigurdsson, S. B., Gudmundsson, A., Holme, I., Engebretsen, L., & Bahr, R.
(2004). Risk factors for injuries in football. American Journal of Sports Medicine,
32(1 Suppl.), 5Se16S.
Bahr, R., & Holme, I. (2003). Risk factors for sports injuries e a methodological
approach. British Journal of Sports Medicine, 37(5), 384e392.
Bennell, K., Wajswelner, H., Lew, P., Schall-Riaucour, A., Leslie, S., Plant, D., et al.
(1998). Isokinetic strength testing does not predict hamstring injury in
Australian rules footballers. British Journal of Sports Medicine, 32(4),
309e314.
Boyd, B. S. (2012). Measurement properties of a hand-held inclinometer during
straight leg raise neurodynamic testing. Physiotherapy, 98(2), 174e179.
Butler, D. (2000). The sensitive nervous system. Adelaide: Noigroup Publications.
Coppieters, M. W., & Butler, D. S. (2008). Do ‘sliders’ slide and ‘tensioners’ tension?
An analysis of neurodynamic techniques and considerations regarding their
application. Manual Therapy, 13(3), 213e221.
Croisier, J. L. (2004). Factors associated with recurrent hamstring injuries. Sports in
Medicine, 34(10), 681e695.
Croisier, J. L., Forthomme, B., Namurois, M. H., Vanderthommen, M., &
Crielaard, J. M. (2002). Hamstring muscle strain recurrence and strength
performance disorders. American Journal of Sports Medicine, 30(2), 199e203.
Dadebo, B., White, J., & George, K. P. (2004). A survey of flexibility training protocols
and hamstring strains in professional football clubs in England. British Journal of
Sports Medicine, 38(4), 388e394.
Davis, D. S., Ashby, P. E., McCale, K. L., McQuain, J. A., & Wine, J. M. (2005). The
effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. Journal of Strength and Conditioning Research, 19(1),
27e32.
Decoster, L. C., Cleland, J., Altieri, C., & Russell, P. (2005). The effects of hamstring
stretching on range of motion: a systematic literature review. Journal of
Orthopaedic and Sports Physical Therapy, 35(6), 377e387.
Decoster, L. C., Scanlon, R. L., Horn, K. D., & Cleland, J. (2004). Standing and supine
hamstring stretching are equally effective. Journal of Athletic Training, 39(4),
330e334.
Feland, J. B., & Marin, H. N. (2004). Effect of submaximal contraction intensity in
contract-relax proprioceptive neuromuscular facilitation stretching. British
Journal of Sports Medicine, 38(4), E18.
Ferrer, V. (1998). Repercusiones de la cortedad isquiosural sobre la pelvis y el raquis
lumbar [Repercussions of shortened hamstring muscles on the lumbar spine].
Murcia: Universidad de Murcia [University of Murcia].
Ferrer, V., Santonja, F., Carrion, M., & Martinez, L. (1994). Comparacion de dos tests
(E.P.R. y Popliteo) para el diagnostico del sindrome de isquiosurales cortos
[Comparison between straight leg raise and finger floor distance for the diagnosis of shortened hamstring muscles]. Archivos de Medicina del Deporte
[Archives of Sports Medicine], 11, 247e254.
Goldman, E. F., & Jones, D. E. (2010). Interventions for preventing hamstring injuries.
Cochrane Database of Systematic Reviews (1), CD006782.
Halbertsma, J. P., Mulder, I., Goeken, L. N., & Eisma, W. H. (1999). Repeated passive
stretching: acute effect on the passive muscle moment and extensibility of
short hamstrings. Archives of Physical Medicine and Rehabilitation, 80(4),
407e414.
Hartig, D. E., & Henderson, J. M. (1999). Increasing hamstring flexibility decreases
lower extremity overuse injuries in military basic trainees. The American Journal
of Sports Medicine, 27(2), 173e176.
Hennessey, L., & Watson, A. W. (1993). Flexibility and posture assessment in relation
to hamstring injury. British Journal of Sports Medicine, 27(4), 243e246.
Kornberg, C., & Lew, P. (1989). The effect of stretching neural structures on grade
one hamstring injuries. The Journal of Orthopaedic and Sports Physical Therapy,
10(12), 481e487.
Maitland, G. D., Hengeveld, E., Banks, K., & English, K. (2005). Maitland’s
vertebral manipulation (7th ed.). Philadelphia, PA: Elsevier ButterworthHeinemann.
Malliaropoulos, N., Papalexandris, S., Papalada, A., & Papacostas, E. (2004). The role
of stretching in rehabilitation of hamstring injuries: 80 athletes follow-up.
Medicine and Science in Sports and Exercise, 36(5), 756e759.
Marshall, P. W., Cashman, A., & Cheema, B. S. (2011). A randomized controlled trial
for the effect of passive stretching on measures of hamstring extensibility,
passive stiffness, strength, and stretch tolerance. Journal of Science and Medicine
in Sport/Sports Medicine Australia, .
Mason, D. L., Dickens, V., & Vail, A. (2007). Rehabilitation for hamstring injuries.
Cochrane Database of Systematic Reviews (1), CD004575.
Mendez-Sanchez, R., Alburquerque-Sendin, F., Fernandez-de-las-Penas, C., BarberoIglesias, F. J., Sanchez-Sanchez, C., Calvo-Arenillas, J. I., et al. (2010). Immediate
effects of adding a sciatic nerve slider technique on lumbar and lower quadrant
mobility in soccer players: a pilot study. Journal of Alternative and Complementary Medicine, 16(6), 669e675.
Mintken, P., Puentedura, E., & Louw, A. (2011). Neurodynamic interventions and
physiological effects: clinical neurodynamics in neck and upper extremity pain.
In C. Fernandez-de-las-Penas, J. Cleland, & P. Huijbregts (Eds.), Neck and arm
pain syndromes (pp. 496e515). Churchill Livingstone, Elsevier.
Nee, R. J., & Butler, D. (2006). Management of peripheral neuropathic pain: integrating neurobiology, neurodynamics, and clinical evidence. Physical Therapy in
Sport: Official Journal of the Association of Chartered Physiotherapists in Sports
Medicine, 7(1), 36e49.
Puentedura, E. J., Huijbregts, P. A., Celeste, S., Edwards, D., In, A., Landers, M. R., et al.
(2011). Immediate effects of quantified hamstring stretching: hold-relax
proprioceptive neuromuscular facilitation versus static stretching. Physical
Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in
Sports Medicine, 12(3), 122e126.
Please cite this article in press as: Castellote-Caballero, Y., et al., Effects of a neurodynamic sliding technique on hamstring flexibility in healthy
male soccer players. A pilot study, Physical Therapy in Sport (2012), http://dx.doi.org/10.1016/j.ptsp.2012.07.004
Y. Castellote-Caballero et al. / Physical Therapy in Sport xxx (2012) 1e7
Ross, M. (1999). Effect of lower-extremity position and stretching on hamstring
muscle flexibility. The Journal of Strength & Conditioning Research, 13(2), 124e129.
Safran, M. R., Garrett, W. E., Jr., Seaber, A. V., Glisson, R. R., & Ribbeck, B. M. (1988).
The role of warmup in muscular injury prevention. American Journal of Sports
Medicine, 16(2), 123e129.
Samuel, M. N., Holcomb, W. R., Guadagnoli, M. A., Rubley, M. D., & Wallmann, H.
(2008). Acute effects of static and ballistic stretching on measures of strength
and power. Journal of Strength and Conditioning Research/National Strength &
Conditioning Association, 22(5), 1422e1428.
Shacklock, M. (2005). Improving application of neurodynamic (neural tension)
testing and treatments: a message to researchers and clinicians. Manual
Therapy, 10(3), 175e179.
Stratford, P. W. (2004). Getting more from the literature: estimating the standard
error of measurement from reliability studies. Physiotherapy Canada, 56(1),
27e30.
Turl, S. E., & George, K. P. (1998). Adverse neural tension: a factor in repetitive
hamstring strain? Journal of Orthopaedic & Sports Physical Therapy, 27(1), 16e21.
Verrall, G. M., Slavotinek, J. P., & Barnes, P. G. (2005). The effect of sports specific
training on reducing the incidence of hamstring injuries in professional
Australian rules football players. British Journal of Sports Medicine, 39(6),
363e368.
Verrall, G. M., Slavotinek, J. P., Barnes, P. G., Fon, G. T., & Spriggins, A. J. (2001).
Clinical risk factors for hamstring muscle strain injury: a prospective study with
correlation of injury by magnetic resonance imaging. British Journal of Sports
Medicine, 35(6), 435e439, discussion 440.
7
Wallmann, H. W., Gillis, C. B., & Martinez, N. J. (2008). The effects of different
stretching techniques of the quadriceps muscles on agility performance in
female collegiate soccer athletes: a pilot study. North American Journal of Sports
Physical Therapy: NAJSPT, 3(1), 41e47.
Wallmann, H. W., Mercer, J. A., & McWhorter, J. W. (2005). Surface electromyographic assessment of the effect of static stretching of the gastrocnemius on
vertical jump performance. Journal of Strength and Conditioning Research/
National Strength & Conditioning Association, 19(3), 684e688.
Walsh, J., & Hall, T. (2009). Agreement and correlation between the straight leg raise
and slump tests in subjects with leg pain. Journal of Manipulative and Physiological Therapeutics, 32(3), 184e192.
Weir, J. P. (2005). Quantifying test-retest reliability using the intraclass correlation
coefficient and the SEM. Journal of Strength and Conditioning Research/National
Strength & Conditioning Association, 19(1), 231e240.
Weppler, C. H., & Magnusson, S. P. (2010). Increasing muscle extensibility: a matter
of increasing length or modifying sensation? Physical Therapy, 90(3), 438e449.
Witvrouw, E., Danneels, L., Asselman, P., D’Have, T., & Cambier, D. (2003). Muscle
flexibility as a risk factor for developing muscle injuries in male professional
soccer players. A prospective study. American Journal of Sports Medicine, 31(1),
41e46.
Witvrouw, E., Mahieu, N., Danneels, L., & McNair, P. (2004). Stretching and injury
prevention: an obscure relationship. Sports in Medicine, 34(7), 443e449.
Worrell, T. W., & Perrin, D. H. (1992). Hamstring muscle injury: the influence of
strength, flexibility, warm-up, and fatigue. Journal of Orthopaedic & Sports
Physical Therapy, 16(1), 12e18.
Please cite this article in press as: Castellote-Caballero, Y., et al., Effects of a neurodynamic sliding technique on hamstring flexibility in healthy
male soccer players. A pilot study, Physical Therapy in Sport (2012), http://dx.doi.org/10.1016/j.ptsp.2012.07.004