Study Two: Stretch Intensity vs. Inflammation: Is There a Dose-Dependent Association?

  • Nikos C. Apostolopoulos


After observing that high-intensity passive static stretching causes an inflammatory response, as suggested by the previous study, the next step was to determine the existence of a stretching threshold in relation to inflammation. In other words, is there a fixed or a range of intensity, from which stretching (a mechanical force), above or below this threshold, is associated with an inflammatory response. Eleven recreationally active males were involved in a randomised crossover trial. Each participant was exposed to three different stretching intensities, 30 (low), 60 (moderate), and 90 (high) corresponding to 30, 60, and 90% of the maximum range of motion of each participant’s right hamstring muscle. During the stretching sessions, the duration of the stretch was for 60 s, repeated for five times. To determine the occurrence of an inflammatory response, hsCRP was measured. It was observed that both a low- and moderate-intensity passive static stretch was not associated with an inflammatory response. However, similar to study one, inflammation was associated with a high-intensity passive static stretch. The current data revealed that an increase in passive static stretching intensity was associated with progressive increase in hsCRP. In practical terms, this suggests that low- and moderate-passive static stretching may be of greater benefit for both performance and recovery of musculoskeletal tissue.


Passive static stretching Stretching intensity (low, moderate, high) Inflammation hsCRP Mechanical force ROM Sensation magnitudes Qualitative Quantitative Pain 


  1. Ablij, H. C., & Meinders, A. E. (2002). C-reactive protein: History and revival. European Journal of Internal Medicine, 13, 412–422.CrossRefGoogle Scholar
  2. Apostolopoulos, N., Metsios, G. S., Flouris, A. D., Koutedakis, Y., & Wyon, M. (2015). The relevance of stretch intensity and position - a systematic review. Frontiers in Psychology, 6, 1128.CrossRefGoogle Scholar
  3. Baliki, M. N., Geha, P. Y., & Apkarian, A. V. (2009). Parsing pain perception between nociceptive representation and magnitude estimation. Journal of Neurophysiology, 101, 875–887.CrossRefGoogle Scholar
  4. Behm, D. G., & Kibele, A. (2007). Effects of differing intensities of static stretching on jump performance. European Journal of Applied Physiology, 101, 587–594.CrossRefGoogle Scholar
  5. Boone, D. C., & Azen, S. P. (1979). Normal range of motion of joints in male subjects. Journal of Bone and Joint Surgery (American Volume), 61, 756–759.CrossRefGoogle Scholar
  6. Frey, W., Wassmer, P., Frey-Rinddova, P., Braun, D., Schwarz, F., Arnold, M., et al. (1994). Muscle aches and biochemical changes following a ultra-marathon in the cold-modification by diclofenac. Schweizerische Zeitschrift für Medizin und Traumatologie, 2, 30–36.Google Scholar
  7. Gabay, C. (2006). Interleukin-6 and chronic inflammation. Arthritis Research & Therapy, 8, S3–S8.CrossRefGoogle Scholar
  8. Gresnigt, M. S., Joosten, L. A. B., Verschueren, I., Van Der Meer, J. W. M., Netea, M. G., Dinaello, C. A., et al. (2012). Neutrophil inhibition of proinflammatory cytokine responses. Journal of Immunology, 189, 4806–4815.CrossRefGoogle Scholar
  9. Jacobs, C. A., & Sciacia, A. D. (2011). Factors that influence the efficacy of stretching programs for patients with hypomobility. Sports Health, 3, 520–523.CrossRefGoogle Scholar
  10. Kilicarslan, A., Uysal, A., & Roach, E. C. (2013). Acute phase reactants. Acta Medica, 2, 2–7.Google Scholar
  11. Mackay, D. M. (1963). Psychophysics perceived intensity: A theoretical basis for Fechner's and Steven's laws. Science, 139, 1213–1216.CrossRefGoogle Scholar
  12. Marino, A., & Giotta, N. (2008). Cinacalcet, fetuin-A and interleukin-6. Nephrology, Dialysis, Transplantation, 23, 1461.Google Scholar
  13. Marschall, F. (1999). Wie beinflussen unterschiedliche dehnintensitaten kurzfristig die veranderung der bewegungsreichweite? (Effects of different stretch-intensity on the acute change of range of motion). Deutsche Zeitschrift fur Sportmedizin, 50, 5–9.Google Scholar
  14. Melzack, R., & Katz, J. (Eds.). (1999). Pain measurements in persons with pain. London, UK: Chruchill Livingstone.Google Scholar
  15. Mueller, M. J., & Maluf, K. (2002). Tissue adaptation to physical stress: A proposed “physical stress theory” to quide physical therapist practice, education, and research. Physical Therapy, 82, 383–403.PubMedGoogle Scholar
  16. Mujika, I., Chatard, J.-C., Busso, T., Geyssant, A., Barale, F., & Lacoste, L. (1995). The effects of training on performance in competitive swimming. Canadian Journal of Applied Physiology, 20, 395–406.CrossRefGoogle Scholar
  17. Nanri, A., Moore, M. A., & Kono, S. (2007). Impact of C-reactive protein on disease risk and its relation to dietary factors: Literature review. Asian Pacific Journal of Cancer Prevention, 8, 167–177.PubMedGoogle Scholar
  18. Noakes, T. D. (1987). Effect of exercise on serum enzyme activities in humans. Sports Medicine, 4, 245–267.CrossRefGoogle Scholar
  19. Pearle, A. D., Scanzello, C. R., George, S., Mandl, L. A., Dicarlo, E., Peterson, M., et al. (2007). Elevated high-sensitivity C-reactive protein levels are associated with lack inflammatory findings in patients with osteoarthritis. Osteoarthritis and Cartilage, 15, 516–523.CrossRefGoogle Scholar
  20. Pepys, M. B., & Hirschfield, G. M. (2003). C-reactive protein: A critical update. The Journal of Clinical Investigation, 111, 1805–1812.CrossRefGoogle Scholar
  21. Pizza, F. X., Koh, T. J., Mcgregor, S. J., & Brooks, S. V. (2002). Muscle inflammatory cells after passive stretches, isometric contractions, and lengthening contractions. Journal of Applied Physiology, 92, 1873–1878.CrossRefGoogle Scholar
  22. Pradhan, A. D., Manson, J. E., Rifai, N., Buring, J. E., & Ridker, P. M. (2001). C-reactive protein, interleukin 6, and risk of developing type 2 diabetus mellitus. JAMA, 286, 327–334.CrossRefGoogle Scholar
  23. Ridker, P. M. (2001). High-sensitivity C-reactive protein, potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation, 103, 1813–1818.CrossRefGoogle Scholar
  24. Roberts, W. L., Moulton, L., Law, T. C., Farrow, G., Cooper-Anderson, M., Savory, J., et al. (2001). Evaluation of nine-automated high sensitivity C-reactive protein methods: Implications for clinical and epidemiological applications. Part 2. Clinical Chemistry, 47, 418–425.PubMedGoogle Scholar
  25. Seiler, S. (2010). What is best practice for training intensity and duration distribution in endurance athletes? International Journal of Sports Physiology and Performance, 5, 276–291.CrossRefGoogle Scholar
  26. Soucie, J. M., Wang, C., Forsyth, A., Funk, S., Denny, M., Roach, K. E., et al. (2011). Range of motion measurements: Reference values and a database for comparison studies. Haemophilia, 17, 500–507.CrossRefGoogle Scholar
  27. Stevens, J. C., & Mack, J. D. (1959). Scales of apparent force. Journal of Experimental Psychology, 58, 405–413.CrossRefGoogle Scholar
  28. Tiidus, P., & Ianuzzo, C. (1983). Effects of intensity and duration of muscular exercise on delayed onset muscle soreness and serum enzymes activities. Medicine and Science in Sports and Exercise, 15, 461–465.CrossRefGoogle Scholar
  29. Toumi, H., F’guyer, S., & Best, T. M. (2006). The role of neutrophils in injury and repair following muscle stretch. Journal of Anatomy, 208, 459–470.CrossRefGoogle Scholar
  30. Vigushin, D. M., Pepys, M. B., & Hawkins, P. N. (1993). Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. The Journal of Clinical Investigation, 91, 1351–1357.CrossRefGoogle Scholar
  31. Zwislocki, J. J. (2009). Sensory neuroscience: Four laws of psychophysics. New York: Springer.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Nikos C. Apostolopoulos
    • 1
  1. 1.University of TorontoTorontoCanada

Personalised recommendations