Warneke Konstantin, Lohmann Lars Hubertus, Wilke Jan
Institute of Sport Science, Department of Movement Sciences, Alpen-Adrian-University Klagenfurt, Klagenfurt, Austria.
Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University, Jena, Germany.
Sports Med Open. 2024 Jun 5;10(1):65. doi: 10.1186/s40798-024-00733-5.
Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach.
A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied.
A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05).
Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.
异常姿势（如腰椎前凸消失）与肌肉骨骼疼痛的发生有关。拉伸紧张的肌肉同时加强拮抗肌是治疗假定的肌肉失衡最常用的方法。然而，尽管其广受欢迎，但尚无对现有证据进行定量综合分析以检验拉伸与强化方法有效性的研究。
进行了一项系统评价和荟萃分析，检索了PubMed、科学网和谷歌学术。我们纳入了研究拉伸或强化对健康个体脊柱和腰骶部姿势（如骨盆倾斜、腰椎前凸、胸椎后凸、头部倾斜）影响的对照临床试验。使用稳健方差估计汇总效应量。采用GRADE方法对证据的确定性进行评级。
共纳入23项研究，969名参与者。急性拉伸（d = 0.01，p = 0.97）和慢性拉伸（d = -0.19，p = 0.16）均对姿势无影响。慢性强化与显著改善相关（d = -0.83，p = 0.01），但无研究考察急性效应。强化优于拉伸（d = 0.81，p = 0.004）。亚组分析发现强化对胸椎和颈椎有效（d = -1.04，p = 0.005），但对腰椎和腰骶部无效（d = -0.23，p = 0.25）。拉伸在所有部位均无效（p > 0.05）。
中等确定性证据不支持将拉伸作为治疗肌肉失衡的方法。相反，治疗师应专注于针对虚弱肌肉的强化训练计划。
