Stretching para reduzir dor muscular pós-exercício

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Stretching to prevent or reduce muscle soreness after
exercise (Protocol)
Herbert R, Gabriel M
This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane
Library 2004, Issue 1
http://www.thecochranelibrary.com
Stretching to prevent or reduce muscle soreness after exercise (Protocol)
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
T A B L E O F C O N T E N T S
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW . . . . . . . . . . . . . . . . . .
2SEARCH METHODS FOR IDENTIFICATION OF STUDIES . . . . . . . . . . . . . . . . . . .
2METHODS OF THE REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3POTENTIAL CONFLICT OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . .
3SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4COVER SHEET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iStretching to prevent or reduce muscle soreness after exercise (Protocol)
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Stretching to prevent or reduce muscle soreness after
exercise (Protocol)
Herbert R, Gabriel M
This record should be cited as:
Herbert R, Gabriel M. Stretching to prevent or reduce muscle soreness after exercise. (Protocol) Cochrane Database of Systematic Reviews
2004, Issue 1. Art. No.: CD004577. DOI: 10.1002/14651858.CD004577.
This version first published online: 26 January 2004 in Issue 1, 2004.
Date of most recent substantive amendment: 29 September 2003
A B S T R A C T
This is the protocol for a review and there is no abstract. The objectives are as follows:
The aim of this review is to determine the effect of stretching before or after exercise on the development of post-exercise muscle
soreness.
B A C K G R O U N D
Many people stretch prior to or after engaging in athletic activity.
Usually the purpose is to reduce the risk of injury, reduce soreness
after exercise, or enhance athletic performance (de Vries 1961;
Gleim 1990; Gleim 1997; Cross 1999). This review focuses on the
effects of muscle stretching on muscle soreness. Another Cochrane
review (Yeung 2003) has examined whether stretching prevents
injury, and a non-Cochrane systematic review (Herbert 2002) has
examined whether stretching prevents muscle soreness or injury.
The muscle soreness that is the focus of this review is sometimes
called delayed-onset muscle soreness to differentiate it from sore-
ness associated with fatigue. Delayed-onset muscle soreness (here-
after referred to simply as muscle soreness) is usually caused by un-
accustomed exercise, particularly exercise that requires primarily
eccentric muscle contraction. Eccentric contractions occur when
the muscle lengthens as it contracts. Typically the soreness arises
within the first day after exercise and peaks in intensity at around
48 hours (Bobbert 1986; Balnave 1993; Wessel 1994). The sore-
ness is usually associated with tenderness and may be associated
with swelling (Bobbert 1986; Wessel 1994).
The series of events that ultimately cause muscle soreness are partly
understood. The initial event is probably mechanical disruption of
sarcomeres (contractile units within muscle fibres; Proske 2001).
This causes swelling of damaged muscle fibres and initiates an in-
flammatory response, which could excite nociceptors (receptors
capable of transmitting information about pain; Lieber 2002).
Muscle soreness is usually only experienced when the muscle con-
tracts or is stretched. This indicates that, while swelling of muscle
fibres and inflammation may be necessary for muscle soreness to
occur, swelling and inflammation are not sufficient to cause sore-
ness on their own. Muscle soreness is exacerbated by vibration over
the belly of the muscle, and pressure thresholds increase when large
diameter afferents are blocked (large diameter afferents are nerve
cells that conduct information about touch and limb position),
indicating that excitation of large diameter muscle afferents, prob-
ably primary spindle afferents from stretch receptors in muscles,
is involved in generating the sensation of soreness (Weerakkody
2001).
The practice of stretching to prevent muscle soreness was encour-
aged by early investigators of muscle soreness who thought that
unaccustomed exercise caused muscle spasm (de Vries 1961). Mus-
cle spasm was believed to impede blood flow to the muscle, caus-
ing ischaemic pain and further spasm. Stretching the muscle was
thought to restore blood flow to the muscle and interrupt the pain-
spasm-pain cycle. The muscle spasm theory of muscle soreness has
since been discredited (Bobbert 1986), but the practice of stretch-
ing persists.
Typically people who stretch to prevent muscle soreness do so
prior to exercise, but some people stretch after exercise. Usually
each at-risk muscle is stretched for between 15 seconds and 2
minutes, once or several times. Some proponents of stretching
recommend applying a sustained stretch to the relaxed muscle (de
1Stretching to prevent or reduce muscle soreness after exercise (Protocol)
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Vries 1961), but other recommend more elaborate techniques such
as the ’contract-relax-agonist contract’ technique (Feland 2001).
O B J E C T I V E S
The aim of this review is to determine the effect of stretching
before or after exercise on the development of post-exercise muscle
soreness.
C R I T E R I A F O R C O N S I D E R I N G
S T U D I E S F O R T H I S R E V I E W
Types of studies
Randomised or quasi-randomised studies.
Types of participants
Trials involving participants of any age group, and of either sex
will be considered for inclusion.
Types of intervention
Any pre-or post-exercise stretching technique designed to prevent
or treat delayed-onset muscle soreness, provided the stretching was
conducted soon before or soon after exercise of any type.
Types of outcome measures
Measures of muscle soreness (pain) or tenderness (pain on palpa-
tion of the muscle).
S E A R C H M E T H O D S F O R
I D E N T I F I C A T I O N O F S T U D I E S
See: methods used in reviews.
We will search the Cochrane Musculoskeletal Injuries Group
specialised register, the Cochrane Central Register of Controlled
Trials (The Cochrane Library, current issue), MEDLINE
(OVID WEB; 1966 to present), EMBASE (OVID WEB;
1988 to present), CINAHL (OVID WEB; 1982 to present),
SPORTDiscus (OVID WEB; 1949 to present), PEDro
(http://ptwww.cchs.usyd.edu.au/pedro/) and reference lists of
articles.
In MEDLINE (OVID WEB) the following subject-specific
search will be used. As it is anticipated that only a small number
of references will be identified, the results will not be combined
with a trial search strategy. This strategy will be modified for use
in other databases.
1. stretch$.tw.
2. flexib$.tw.
3. Pliability/
4. (range adj3 motion).tw.
5. Range of Motion, Articular/
6. (warmup or warm-up or warm up or cooldown or cool-down
or cool down).tw.
7. or/1-6
8. (sore$ adj3 musc$).tw.
9. DOMS.tw.
10. exp Muscle Contraction/
11. Muscle, Skeletal/
12. or/10-11
13. Pain/
14. and/12-13
15. or/8-9,14
16. and/7,15
In The Cochrane Library (CD version) the following search
strategy will be used:
#1. stretch*
#2. flexib*
#3. PLIABILITY single term (MeSH)
#4. (range near motion)
#5.(((((warmup or warm-up) or (warm next down)) or cooldown)
or cool-down) or (cool next down))
#6. ((((#1 or #2) or #3) or #4) or #5)
#7. (sore*near musc*)
#8. doms
#9. MUSCLE CONTRACTION explode all trees (MeSH)
#10. MUSCLE SKELETAL single term (MeSH)
#11. (#9 or #10)
#12. PAIN single term (MeSH)
#13. (#11 and #12)
#14. (#7 or #8 or #13)
#15. (#6 and #14)
In PEDro, two searches will be conducted:
The first search will combine the following terms with “OR”:
[in the Title/abstract field] stretch* sore* DOMS
The second search will combine the following terms with
“AND”:
[in the Therapy field] stretching, mobilisation, manipulation,
massage
[in the Subdiscipline field] sports
[in the Problem field] pain
M E T H O D S O F T H E R E V I E W
Selection of trials: Two people will screen search results for
potentially eligible studies. When titles and abstracts suggest a
study is potentially eligible for inclusion a paper copy of the
report will be obtained. Disagreements between the two people
regarding a study’s eligibility will be resolved by discussion or,
where necessary, by a third person.
2Stretching to prevent or reduce muscle soreness after exercise (Protocol)
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Assessment of methodological quality: The methodological
quality of the studies will be assessed using the Cochrane
Collaboration Musculoskeletal Injuries Group methodological
quality assessment tool. Two people will independently assess
study quality in this way. Disagreements will be resolved by a
third person. It is anticipated that several of the included studies
will be laboratory-based studies which are unlikely to describe
elements thought important in clinical trials (such as concealment
of allocation). These studies may appear methodologically weak
when assessed with a tool designed for clinical trials. Nonetheless
it may be useful to document the degree to which they conform
with best practice clinical trial design.
Data extraction: Soreness or tenderness data from stretch and
comparison groups will be extracted from study reports using a
proforma. This will be done by the author and a colleague; again,
disagreements will be resolved by discussion or a third person. It
is expected that some studies will report soreness data and some
will report tenderness data. Some studies may report raw scores,
whereas others may report change scores or covariance-adjusted
scores. It is expected that outcomes will usually be measured at
a series of times following exercise. Where available, data will be
extracted for each of a series of 12-hour intervals following exercise
(6-17 hours, 18-29 hours, 30-41 hours, etc). Only one outcome
will be recorded from each study for each time. Where multiple
outcomes are available, soreness data will be preferred to tenderness
data. Covariate-adjusted data will be most preferred, then change
scores, then raw scores. Where cross-over studies do not provide
estimates of the variance of differences between conditions or of
the correlations between outcomes under the two conditions being
compared (Elbourne 2002) the variance of the difference between
conditions will be estimated by assuming correlations of 0.5.
Analysis: Pain and tenderness data are typically reported on
100mm visual analogue scales or 10 point scales. To facilitate
pooling, data will be scaled to a common 100-point metric. The
effect of stretching will be estimated from each study using the
difference between mean pain levels in stretch and comparison
groups. Where there is apparent qualitative homogeneity in
subjects, interventions and outcome measures, meta-analysis
will be considered. Meta-analysis will be conducted using the
RevMan Analysis program in Review Manager (RevMan 2003).
The effects of stretching will be described as a weighted mean
difference. Effects of pre- and post-exercise stretching will initially
be estimated separately, although they may be combined in a
secondary analysis if the effects do not appear heterogenous. Data
will be inspected for statistical heterogeneity. Where there is no
evidence of heterogeneity of effect, a fixed effects model will be
used to pool findings across studies. If there is evidence of statistical
heterogeneity (Cochran Q, p < 0.1; Fleiss 1993) a decision will be
made either to employ a random effects model or, if there is marked
heterogeneity, not to proceed with meta-analysis. The causes of
marked heterogeneity will be explored.
P O T E N T I A L C O N F L I C T O F
I N T E R E S T
None known.
S O U R C E S O F S U P P O R T
External sources of support
• No sources of support supplied
Internal sources of support
• No sources of support supplied
R E F E R E N C E S
Additional references
Balnave 1993
Balnave CD, Thomson MW. Effect of training on eccentric exercise-
induced muscle damage. Journal of Applied Physiology 1993;75(4):
1545–51.
Bobbert 1986
Bobbert MF, Hollander AP, Huijing PA. Factors in delayed onset
muscle sorenesss of man. Medicine and Science in Sports and Exercise
1986;18(1):75–81.
Cross 1999
Cross KM, Worrell TW. Effects of a static stretching program on
the incidence of lower extremity musculotendinous strains. Journal
of Athletic Training 1999;34:11–4.
de Vries 1961
de Vries HA. Prevention of muscular distress after exercise. Research
Quarterly 1961;32:177–85.
Elbourne 2002
Elbourne DR, Altman DG, Higgins JPT, Curtin F, Worthington
HV, Vail A. Meta-analyses involving cross-over trials: methodological
issues. International Journal of Epidemiology 2002;31(1):140–9.
Feland 2001
Feland JB, Myrer JW, Merrill RM. Acute changes in hamstring flex-
ibility: PNF versus static stretch in senior athletes. Physical Therapy
in Sport 2001;2(4):186–93.
Fleiss 1993
Fleiss JL. The statistical basis of meta-analysis. Statistical Methods in
Medical Research 1993;2:121–45.
3Stretching to prevent or reduce muscle soreness after exercise (Protocol)
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Gleim 1990
Gleim GW, Stachenfeld NS, Nicholas JA. The influence of flexibil-
ity on the economy of walking and jogging. Journal of Orthopedic
Research 1990;8:814–23.
Gleim 1997
Gleim GW, McHugh MP. Flexibility and its effects on sports injury
and performance. Sports Medicine 1997;24:289–99.
Lieber 2002
Lieber RL, Friden J. Morphologic and mechanical basis of delayed-
onset muscle soreness. Journal of the American Academy of Orthopaedic
Surgeons 2002;10(1):67–73.
Proske 2001
Proske U, Morgan DL. Muscle damage from eccentric exercise: mech-
anism, mechanical signs, adaptation and clinical applications. Jour-
nal of Physiology 2001;537(2):333–45.
RevMan 2003
The Cochrane Collaboration. Review Manager (RevMan). Version
4.2.2 for Windows. Oxford, England: The Cochrane Collaboration,
2003.
Weerakkody 2001
Weerakkody NS, Whitehead NP, Canny BJ, Gregory JE, Proske U.
Large-fibre mechanoreceptors contribute to muscle soreness after ec-
centric exercise. Journal of Pain 2001;2(4):209–19.
Wessel 1994
Wessel J, Wan A. Effect of stretching on the intensity of delayed-
onset muscle soreness. Clinical Journal of Sport Medicine 1994;4(2):
82–7.
Yeung 2003
Yeung EW, Yeung SS. Interventions for preventing lower limb soft-
tissue injuries in runners (Cochrane Review). The Cochrane Library
2003, Issue 4.Art. No.: CD001256. DOI: .
References to other published versions of this review
Herbert 2002
Herbert RD, Gabriel M. Effects of pre- and post-exercise stretching
on muscle soreness, risk of injury and athletic performance: a sys-
tematic review. BMJ 2002;325(7362):468–72.
C O V E R S H E E T
Title Stretching to prevent or reduce muscle soreness after exercise
Authors Herbert R, Gabriel M
Contribution of author(s) Information not supplied by author
Issue protocol first published 2004/1
Date of most recent amendment 23 August 2005
Date of most recent
SUBSTANTIVE amendment
29 September 2003
What’s New Information not supplied by author
Contact address Dr Rob Herbert
School of Physiotherapy
4Stretchingto prevent or reduce muscle soreness after exercise (Protocol)
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
University of Sydney
PO Box 170
Lidcombe
New South Wales
1825
AUSTRALIA
E-mail: R.Herbert@fhs.usyd.edu.au
Tel: +612 9351 9380
Fax: +612 9351 9278
DOI 10.1002/14651858.CD004577
Cochrane Library number CD004577
Editorial group Cochrane Bone, Joint and Muscle Trauma Group
Editorial group code HM-MUSKINJ
5Stretching to prevent or reduce muscle soreness after exercise (Protocol)
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd