Journal of Exercise Physiology in Special Populations

Investigating the effectiveness of hamstring stretching exercises and methods with a rehabilitation approach: A systematic review

Document Type : Original Article

Authors

1 Department of Sport Science Education, Farhangian University, Farhangian University,, Tehran, Iran.

2 5. Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.

3 Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.

Abstract

Objectives and Study Background:
Hamstring flexibility is vital for knee function and lower limb mobility, impacting athletic performance and daily activities. Reduced flexibility is linked to musculoskeletal issues (e.g., low back pain) and hamstring injuries, contributing to 12–16% of sports-related injuries. Static stretching, proprioceptive neuromuscular facilitation (PNF), and active stretching are used to improve flexibility, range of motion (ROM), and injury prevention. However, debates persist about their mechanisms and optimal protocols.
Review Methods and Data Sources:
This systematic review evaluates the effectiveness of different hamstring stretching methods in rehabilitation and injury prevention. A comprehensive search of literature published from 2010 to 2024 identified 16 studies of moderate to excellent methodological quality which were analyzed for outcomes related to flexibility, ROM, and injury prevention.
Findings:
Static stretching emerged as the most widely used method, providing short-term flexibility improvements but limited long-term effectiveness. PNF stretching demonstrated superior long-term benefits, though it requires therapist assistance. Active stretching showed rapid ROM gains, particularly beneficial for athletes. While the optimal stretching duration remains unclear, both 15-second and 30-second holds showed positive results. Additionally, combining stretching with adjunct therapies like electrical stimulation or myofascial release produced superior outcomes.
Conclusion:
Overall, this review highlights that different stretching techniques offer distinct benefits, with static stretching being practical for general use, PNF ideal for long-term gains, and active stretching suited for quick performance enhancements. Personalizing stretching regimens based on individual needs and goals is recommended for optimal results.

Keywords

  1. Chumanov E.S., Schache A.G., Heiderscheit B.C., Thelen D.G. Hamstrings are most susceptible to injury during the late swing phase of sprinting. Br J Sports Med. 2012; 90–.
  2. Witvrouw E., Danneels L., Asselman P., D’Have T., Cambier D. Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players: a prospective study. Am J Sports Med. 2003; 31(1):41–6.
  3. Ayala F., De Baranda P.S., Croix M.D.S., Santonja F. Comparison of active stretching technique in males with normal and limited hamstring flexibility. Phys Ther Sport. 2013; 14(2):98–104.
  4. Maras G., Arikan H., Citaker S. Comparison of the effects of 4-week instrument-assisted soft tissue mobilization and static stretching on strength, ROM, flexibility, and pain threshold in hamstring muscle shortness. J Bodyw Mov Ther. 2024; 40:575–83.
  5. Page P. Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther. 2012; 7(1):109.
  6. Bade M., Baertlein S., Bouten T. A comparison of lower extremity alignment risk factors between competitive and recreational runners. Orthop Phys Ther Pract. 2016; 28(2):100–8.
  7. Williams D.B. III, Welch L.M. Male and female runners demonstrate different sagittal plane mechanics as a function of static hamstring flexibility. Braz J Phys Ther. 2015; 19(5):421–8.
  8. De La Motte S.J., Lisman P., Gribbin T.C., Murphy K., Deuster P.A. Systematic review of the association between physical fitness and musculoskeletal injury risk: part 3—flexibility, power, speed, balance, and agility. J Strength Cond Res. 2019; 33(6):1723–35.
  9. Schuermans J., Danneels L., Van Tiggelen D., Palmans T., Witvrouw E. Proximal neuromuscular control protects against hamstring injuries in male soccer players: a prospective study with electromyography time-series analysis during maximal sprinting. Am J Sports Med. 2017; 45(6):1315–25.
  10. McHugh M.P., Cosgrave C.H. To stretch or not to stretch: the role of stretching in injury prevention and performance. Scand J Med Sci Sports. 2010; 20(2):169–81.
  11. Ross M.D. Effect of a 15-day pragmatic hamstring stretching program on hamstring flexibility and single hop for distance test performance. Res Sports Med. 2007; 15(4):271–81.
  12. Manoel M.E., Harris-Love M.O., Danoff J.V., Miller T.A. Acute effects of static, dynamic, and proprioceptive neuromuscular facilitation stretching on muscle power in women. J Strength Cond Res. 2008; 22(5):1528–34.
  13. Chan S., Hong Y., Robinson P. Flexibility and passive resistance of the hamstrings of young adults using two different static stretching protocols. Scand J Med Sci Sports. 2001; 11(2):81–6.
  14. Voss D.E. Proprioceptive neuromuscular facilitation. Am J Phys Med Rehabil. 1967; 46(1):838–98.
  15. Konrad A., Stafilidis S., Tilp M. Effects of acute static, ballistic, and PNF stretching exercise on muscle and tendon tissue properties. Scand J Med Sci Sports. 2017; 27(10):1070–80.
  16. Kubo K., Kanehisa H., Fukunaga T. Effect of stretching training on the viscoelastic properties of human tendon structures in vivo. J Appl Physiol. 2002; 92(2):595–601.
  17. Kay A.D., Husbands-Beasley J., Blazevich A.J. Effects of contract–relax, static stretching, and isometric contractions on muscle–tendon mechanics. Med Sci Sports Exerc. 2015; 47(10):2181–90.
  18. Harvey L., Herbert R., Crosbie J. Does stretching induce lasting increases in joint ROM? A systematic review. Physiother Res Int. 2002; 7(1):1–13.
  19. Shrier I. Does stretching improve performance? A systematic and critical review of the literature. Clin J Sport Med. 2004; 14(5):267–73.
  20. Smith M., Fryer G. A comparison of two muscle energy techniques for increasing flexibility of the hamstring muscle group. J Bodyw Mov Ther. 2008; 12(4):312–7.
  21. Ayala F., De Baranda P.S. Efecto del estiramiento activo sobre el rango de movimiento de la flexión de cadera: 15 versus 30 segundos. Motricidad Eur J Hum Mov. 2008; 20:2–14.
  22. Ayala F., De Baranda Andújar P.S. Effect of 3 different active stretch durations on hip flexion range of motion. J Strength Cond Res. 2010; 24(2):430–6.
  23. Heiderscheit B.C., Sherry M.A., Silder A., Chumanov E.S., Thelen D.G. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010; 40(2):67–81.
  24. Foreman T., Addy T., Baker S., Burns J., Hill N., Madden T. Prospective studies into the causation of hamstring injuries in sport: a systematic review. Phys Ther Sport. 2006; 7(2):101–9.
  25. Orchard J.W. Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med. 2001; 29(3):300–3.
  26. Clark R.A. Hamstring injuries: risk assessment and injury prevention. Ann Acad Med Singapore. 2008; 37(4):341.
  27. Hennessey L., Watson A. Flexibility and posture assessment in relation to hamstring injury. Br J Sports Med. 1993; 27(4):243–6.
  28. Kirkland A., Garrison C., Singleton S., Rodrigo J., Boettner F., Stuckey S. Surgical and therapeutic management of a complete proximal hamstring avulsion after a failed conservative approach. J Orthop Sports Phys Ther. 2008; 38(12):754–60.
  29. Sherry M.A., Best T.M. A comparison of two rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther. 2004; 34(3):116–25.
  30. Mason D.L., Dickens V.A., Vail A. Rehabilitation for hamstring injuries. Cochrane Database Syst Rev. 2007;(1).
  31. Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372.
  32. Wells C., Kolt G.S., Marshall P., Hill B., Bialocerkowski A. The effectiveness of Pilates exercise in people with chronic low back pain: a systematic review. PLoS One. 2014; 9(7):e100402.
  33. Zaidi S., Ahamad A., Fatima A., Ahmad I., Malhotra D., Al Muslem W.H., et al. Immediate and long-term effectiveness of proprioceptive neuromuscular facilitation and static stretching on joint range of motion, flexibility, and electromyographic activity of knee muscles in older adults. J Clin Med. 2023; 12(7):2610.
  34. Kong K. The effects of closed kinetic chain exercise on hamstring length and muscle elasticity. J Hum Mov Sports Sci. 2023; 11(3):643–9.
  35. Nuhmani S. Does soft tissue mobilization assist static stretching to improve hamstring flexibility? A randomized controlled trial. J Complement Integr Med. 2020; 17(4).
  36. Piqueras-Rodríguez F., Palazón-Bru A., Gil-Guillén V.F. Effectiveness analysis of active stretching versus active stretching plus low-frequency electrical stimulation in children who play soccer and who have the short hamstring syndrome. Clin J Sport Med. 2016; 26(1):59–68.
  37. Sharma S., Balthillaya G., Rao R., Mani R. Short-term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle in healthy individuals: A randomized controlled trial. Phys Ther Sport. 2016; 17:30–7.
  38. Eftekhari S., Khayambashi K., Marandi S.M., Yosefzadeh M. To compare immediate, 24 and 48 hours effects of static, dynamic and PNF stretching techniques on hamstring flexibility. J Mod Rehabil. 2015; 9(3):64–71. [In Persian].
  39. Lim K.-I., Nam H.-C., Jung K.-S. Effects on hamstring muscle extensibility, muscle activity, and balance of different stretching techniques. J Phys Ther Sci. 2014; 26(2):209–13.
  40. Janse van Rensburg L., Coetzee F.F. Effect of stretching techniques on hamstring flexibility in female adolescents. Afr J Phys Health Educ Recreat Dance. 2014; 20(3):1237–48.
  41. Sairyo K., Kawamura T., Mase Y., Hada Y., Sakai T., Hasebe K., et al. Jack-knife stretching promotes flexibility of tight hamstrings after four weeks: a pilot study. Eur J Orthop Surg Traumatol. 2013; 23:657–63.
  42. Borman N.P., Trudelle-Jackson E., Smith S.S. Effect of stretch positions on hamstring muscle length, lumbar flexion range of motion, and lumbar curvature in healthy adults. Physiother Theory Pract. 2011; 27(2):146–54.
  43. Puentedura E.J., Huijbregts P.A., Celeste S., Edwards D., In A., Landers M.R., et al. Immediate effects of quantified hamstring stretching: hold-relax proprioceptive neuromuscular facilitation versus static stretching. Phys Ther Sport. 2011; 12(3):122–6.
  44. Meroni R., Cerri C.G., Lanzarini C., Barindelli G., Della Morte G., Gessaga V., et al. Comparison of active stretching technique and static stretching technique on hamstring flexibility. Clin J Sport Med. 2010; 20(1):8–14.
  45. Trampas A., Kitsios A., Sykaras E., Symeonidis S., Lazarou L. Clinical massage and modified proprioceptive neuromuscular facilitation stretching in males with latent myofascial trigger points. Phys Ther Sport. 2010; 11(3):91–8.
  46. Youdas J.W., Haeflinger K.M., Kreun M.K., Holloway A.M., Kramer C.M., Hollman J.H. The efficacy of two modified proprioceptive neuromuscular facilitation stretching techniques in subjects with reduced hamstring muscle length. Physiother Theory Pract. 2010; 26(4):240–50.
Journal of Exercise Physiology in Special Populations
Volume 2, Issue 4
March 2026
Pages 1-22