Melayna Sager and Sylvain Grenier*
Human Kinetics, Laurentian University, Sudbury Ontario, Canada
Received Date: April 02, 2014; Accepted Date: June 17, 2014; Published Date: June 20, 2014
Citation: Sager M, Grenier S (2014) Comparison of Yoga Versus Static Stretching for Increasing Hip and Shoulder Range of Motion. Int J Phys Med Rehabil 2:208. doi: 10.4172/2329-9096.1000208
Copyright: © 2014 Sager M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Background/Purpose: Currently the most common method to increase flexibility is through static stretching, however yoga is rising in popularity. The purpose of the study was to compare yoga and static stretching to determine which is most effective for improving hip and shoulder range of motion. Methods: Subjects participated in one of three groups, yoga, stretching and control. Range of motion was assessed on entry and 1 month later. An analysis of variance was conducted for comparison between each group. A p value of 0.05 was used to determine if the data is significantly different. Results: Compared to the control group, those who participated in the one-month class, both yoga and static stretching showed significant improvements in range of motion. The yoga group showed a greater range of motion improvement that the static stretching group with a mean difference of 1.08902 degrees (p<0.001, 95% confidence interval, η2=0.224). Conclusions: Yoga is shown to have a greater effect on range of motion at the shoulder and hip than static stretching in a healthy population. With further positive results, yoga may prove to have an important therapeutic role with joint restrictions.
Yoga; Static stretching; Range of motion; Flexibility
ROM: Range of Motion; ANOVA: Analysis of
With increasing age people will often lose range of motion diminishing their ability to do activities of daily living [1,2]. To maintain flexibility the most common method is through static stretching, however yoga is becoming increasingly more popular  with the added benefits of deep breathing and relaxation. This study explores the value of yoga in comparison to static stretching when related to increasing range of motion in the hip and shoulder joints.
It is important to have an understanding of the difference between range of motion and flexibility, to properly decipher the issues. Range of motion has been defined as the obtainable movement at any specific joint [1,4,5]. Flexibility on the other hand refers to the muscles surrounding the joint and is defined as the mobility of the muscles and the length to which they extend . Range of motion within a joint is dependent on the bony structure of the joint, the surrounding connective tissues, as well as the length of the muscles spanning the particular joint [1,4,5]. Therefore if a muscle is lacking in flexibility it may cause a reduced range of motion [1,4,6].
Throughout activities of daily living, repetitive stress or overuse injuries are very common and are in part caused by restrictions in soft tissues and limitations in joint flexibility [4,7]. Stretching is a popular method used in order to promote improvements in mobility and range of motion [4,8]. With regular stretching muscle tension is reduced, movements become easier helping to improve coordination. Range of motion is improved, flexibility is maintained or improved, and the likelihood of strain injuries is decreased [6,9]. In general stretching helps to create a general feeling of well-being [6,9].
Yoga uses asanas (static postures) to help improve muscular strength and flexibility.
Specifically, hatha yoga combines a focus on asanas, pranayamas (breath control) and chanda (meditation), throughout the class to quiet the mind and to increase concentration [3,10–13]. Graves, Krepcho and Mayo, did a study in which they determined that of 3000 patients treated with yoga for various chronic health problems, 98% of those surveyed proclaimed it to be useful in preventing and managing the effects of their chronic health problems [11,12]. Looking specifically at flexibility it was shown to increase range of motion, which is most likely attributed to the asanas [10,14].
In general, more research needs to be done on yoga as it is an ever-growing method of treatment for increasing flexibility, which in turn is thought to help increase range of motion [1,4]. Using goniometry as an accepted method for evaluating range of motion, the effects of yoga and static stretching on flexibility will be compared for hip and shoulder range of motion. To date no comparison studies have been conducted on these types of treatments. Based on previous research it is hypothesized that though both will have a positive effect when it comes to increasing flexibility, yoga will be better suited to increase range of motion do to its focus on asanas (static postures), pranayamas (breath control), and chanda (meditation). The aim of the study is to compare yoga and static stretching to determine which is most effective for improving hip and shoulder range of motion.
First, contact was made with multiple YMCA yoga instructors in order to find a certified instructor who would be willing to teach a yoga class two nights a week with a focus on hips and shoulders. Two yoga instructors, certified yearly by the YMCA, volunteered each to teach one night a week for an hour. The next step was to book the facility. The multipurpose room was booked at the YMCA four nights a week for an hour each night.
Once ethics approval was obtained, flyers were put up throughout the YMCA advertising for participants who would be interested in volunteering to be participants in this study. Through e-mail further contact was made with participants in order to provide them with further details. A total of 44 subjects, (control group: n=21, yoga group: n=11, and static stretching group: n=12), gave their full consent and participated in data collection. Subjects were between the ages of 18- 65 years old with no recent musculoskeletal injuries.
Following pre-testing, each subject participated in 1 of 3 groups. The first group participated as a control in the study and did not do any stretching for 4 weeks in between pre- test and post-test measures . The second group participated in 4 weeks of hatha yoga and the third group participated in 4 weeks of static stretching.
Participants in the hatha yoga group attended one-hour classes two nights a week for the duration of 4 weeks . The classes took place Tuesday nights from 6:30 to 7:30pm and Thursday nights form 7:30 to 8:30pm. Attendance was taken at each class . See APPENDIX I, for a breakdown of the yoga class provided.
Finally the participants in the static stretching group also attended classes two nights a week for four weeks. These classes took place Monday and Wednesday nights from 7:30pm to 8:30pm. Attendance was taken at each class . See APPENDIX II for a breakdown of the stretching classes provided to the participants.
Once the 4 weeks were completed all participants attended post-testing sessions two days following their last class. The same procedures were followed as that of the pre-test measures.
Range of motion at the hip and shoulder was measured using a goniometer. The goniometer1 was made of metal, had two arms and a 180-degree protractor in the center on each side. The protractor was marked off in one-degree increments and the arms of the goniometer were 12 inches long. The instrument was validated using known angles of 0, 45, 90, 135, and 180 degrees .
Prior to any data collection participants were required to complete a PAR-Q questionnaire, a general lifestyle questionnaire, and a consent form. If they met all the required criteria they volunteered to take part in one of the three groups and were asked to attend an initial measurement session two days prior to class participation. No warm up was performed at the testing sessions .
Standard goniometer measurements were made for shoulder flexion, extension, abduction, adduction, horizontal abduction and horizontal adduction on both the left and right side. The same examiner made two goniometer measurements for each motion [4,19-21]. The terminal position of range of motion was determined when the participant felt tension . The examiner did have prior knowledge about subject participation in each of the three groups.
When measuring shoulder flexion the subject was supine with knees and hips bent and back flat on the floor. The arm was at their side with the palm of the hand facing in and thumb pointing up [1,4,22]. The axis of rotation was placed just bellow the acromion process on the lateral head of the humerus. The stationary arm was in line with the greater trochanter and along the mid-axillary line of the trunk. The moving arm was placed along the lateral midline of the humerus and in line with the lateral epicondyle [1,23]. Shoulder extension followed the same goniometer placement as that of shoulder flexion however the patient was in a prone position [1,4,22].
For shoulder adduction and shoulder abduction the same protocol was used. The subject was placed in a supine position with their knees and hips bent and back flat on the floor. Their arm at their side with the palm facing up [1,22]. The axis of the goniometer was placed and the anterior portion of the acromion process through the center of the humerus head. The stationary arm was placed at the lateral and anterior surface of the chest, running parallel to the midline of the sternum. The moving arm was placed along the anterior surface of the arm and runs parallel to the midline of the humerus and in line with the medial epicondyle [1,23].
Like adduction and abduction, measuring the range of motion during horizontal shoulder adduction and abduction the protocol remains the same for both the anterior and posterior movements. The subject was positioned in an upright kneeling position their elbow at a 90 degree angle and their arm was be raised out to the side until level with the shoulder . The axis of the goniometer was then placed on the superior portion of the acromion. The stationary arm was along the midline of the shoulder leading towards the neck and the moving arm was placed along the midline of the humerus in line with the lateral epicondyle .
Standard goniometer measurements were then performed on the hip, which included hip flexion, extension, adduction and abduction on both sides of the body. Once again the same examiner made two goniometer measurements for each motion [4,19-21] and the terminal position of range of motion was determined when the participant felt tension .
During hip flexion and extension the axis of the goniometer was placed slightly anterior and superior to the greater trochanter. The stationary arm was placed parallel to the long axis of the trunk and the moving arm was placed along the midline of the femur on the lateral side [1,23]. The subject was in a supine position during hip flexion and in a prone position during hip extension [1,22].
For hip adduction and hip abduction the subjects were lying in a supine position [1,22]. The axis of rotation was placed at the hip joint in line with the greater trochanter. The stationary arm was placed bellow and parallel to level of the anterior supra iliac spine and the moving arm was placed in line with the midline of the patella on the anterior surface of the thigh [1,23].
All statistical analysis was conducted in SPSS v21 . Means and standard deviations for pretest and post-test measures were calculated as well as for the gain scores (the mean differences between pretest and posttest measures). A post-hoc Tukey test was used to compare between between yoga participants, static stretching participants and the control group, in a one- way analysis of variance (ANOVA). Independent variables included the joint, the side of the body and the motion and the dependent variable was range of motion. The changes between the pre-test and post-test values were used to examine the affects of the three groups on hip and shoulder range of motion (ROM). A p value of 0.05 was used to determine if the data is significantly different.
Overall both yoga and static stretching showed a significant improvement in ROM in comparison to the control group (p<0.001, 95% confidence interval, η2=0.224). Yoga showed the greatest improvement in ROM with a mean difference of 1.08902 degrees (p<0.001, 95% confidence interval, η2=0.224) in relation to static stretching. The above results are summarized in Figure 1.
The results were later broken down by joint and compared between the three groups. For the hip yoga was shown to have a significant increase in hip ROM compared to both the control (p<0.001, 95% confidence interval, η2=0.280) and static stretching groups (p=0.003, 95% confidence interval, η2=0.280), with a mean difference of 1.4232995 degrees greater than that of static stretching. Results also showed that overall both static stretching and yoga showed the change in ROM to be significantly greater than that of the control group for the shoulder (p<0.001, 95% confidence interval, η2=0.195), however neither yoga nor static stretching were significantly different from each other (p=0.07, 95% confidence interval, η2=0.195).
Finally results for the joints were further broken down into the individual motions. Of the six shoulder motions analyzed, two were found to be significant between the two treatment groups. Yoga had a significant increase in shoulder abduction (p<0.001, 95% confidence interval, η2=0.376) while static stretching had a significant increase of horizontal adduction (p=0.016, 95% confidence interval, η2=0.199). See Table 1 for a summary of the mean difference and significance for the six shoulder motions.
|Flexion||Yoga 1.45265 degrees > than Static Stretching||Yoga 4.80087*degrees>than Control||Static Stretching 3.34821*degrees>than Control|
|Extension||Yoga 0.35606 degrees > than Static Stretching||Yoga 7.37987 *degrees>than Control||Static Stretching 7.02381*degrees>than Control|
|Adduction||Yoga 1.43561 degrees > than Static Stretching||Yoga 4.34632*degrees>than Control||Static Stretching 2.91071*degrees>than Control|
|Abduction||Yoga 5.07955*degrees > than Static Stretching||Yoga 8.34740*degrees>than Control||Static Stretching 3.26786*degrees>than Control|
|Horizontal Adduction||Yoga 2.83144*degrees< than Static Stretching||Yoga 2.80844*degrees>than Control||Static Stretching 5.63988*degrees>than Control|
|Horizontal Abduction||Yoga 0.29545 degrees < than Static Stretching||Yoga 2.38312*degrees>than Control||Static Stretching 2.67857*degrees>than Control|
*Theme an differenceis significant at the 0.05 level
Table 1: Mean difference and significance determined for the shoulder joint.
Upon completion of the hip analysis only one motion was found to show any increased improvement in ROM with respect to a comparison between treatment groups. Hip adduction had a positive mean increase for yoga (p=0.023, 95% confidence interval, η2=0.252). The mean differences and the significance of the hip motions are summarized in Table 2.
|Flexion||Yoga 1.60038 degrees > than Static Stretching||Yoga 7.44264*degrees > than Control||Static Stretching 5.84226*degrees > than Control|
|Extension||Yoga 1.09280 degrees > than Static Stretching||Yoga 5.16126*degrees > than Control||Static Stretching 4.06845*degrees > than Control|
|Adduction||Yoga 2.14394*degrees > than Static Stretching||Yoga 5.28680*degrees > than Control||Static Stretching 3.14286*degrees > than Control|
|Abduction||Yoga 0.85606*degrees > than Static Stretching||Yoga5.09416*degrees > than Control||Static Stretching 4.23810*degrees > than Control|
*Theme an differenceis significant at the 0.05level
Table 2: Mean difference and significance determined for the hip joint.
The results of this study confirm, in agreement with our hypothesis, that both yoga and static stretching interventions significantly increase range of motion as compared to a control group. Further results indicate that overall there was a significant difference between the two treatment groups (yoga and static stretching). Participants in the yoga group had an overall mean increase in ROM greater than that of the other participants. These findings are in agreement with the original hypothesis.
Yoga uses asanas (static postures) to help improved muscular strength and flexibility. Specifically, hatha yoga combines a focus on asanas, pranayamas (breath control) and chanda (meditation), throughout the class to quiet the mind and to increase concentration [3,10-13]. Further benefits include relaxation, deep breathing, monitored stretching and increased body awareness [3,10,17] As a result, the combined factors are a leading reason for the increased range of motion when compared to static stretching.
There have been many studies over the years that focus on range of motion and flexibility. A number of these articles have used the same definition as that provided above which is that range of motion is the obtainable movement at any specific joint [1,4,5], while flexibility refers to the muscles surrounding the joint and is defined as the mobility of the muscles and the length to which they extend . Other articles have used the two terms interchangeably or defined the terms in a different manner all together. This becomes an issue when comparing studies, therefore a universal definition of both flexibility and range of motion needs to be determined.
Another issue that presents itself and that has remained controversial over the years is whether or not flexibility is a benefit or detriment to health. Several articles have found that flexibility and increased ROM have little to no effect at preventing sport injuries [24-26] however in opposition, many articles termed flexibility and increased ROM to be a leading treatment in rehabilitation and for maintenance of overall health [6-8,27,28]. In general of the various studies that have been performed, there have been mixed findings, varying in quality, suggesting a need for further investigation in this area of research.
Though there is still debate about joint flexibility in athletes, increasing ROM and flexibility is an important component with people suffering from various musculoskeletal
injuries. Properly designed therapeutic exercise programs will put emphasis on regaining range of motion first . The significant increase in ROM from yoga participants proves that even a 4- week program twice a week would be beneficial for those suffering from restricted ROM and decreased flexibility.
Most recent claims in the media have been that yoga is actually the cause of multiple repetitive strain injuries mainly related to the hip when performed repeatedly over a long period of time . To date no definitive research has been done on this topic. Proper care needs to be taken in order to ensure that postures are adjusted to evenly distribute that body weight throughout the joint and muscles to reduce the risk of injury . Once again the opportunity presents itself for future research that is needed in this area.
Breathing is also a very important component of yoga. An environment that is created to emphasized quiet, relaxation and trust has been found to be associated with dramatic increases in flexibility and athletic performance . As a result of the focus on breath control, yoga has been shown to have increasing value when it comes to therapy and rehabilitation . There is a need for yoga to become more widely recognized as a health care treatment along side exercise and the more traditional practices .
With this study there were a few limitations due to the pool of participants who volunteered. The first limitation is age. An average age of 34 was achieved within the age range that was recruited however a greater range including older adults and children would also be beneficial. A second limitation is gender balance. Of the 44 participants 11 were male and 33 were female. Though this is an accurate representation of yoga practitioners, a more balanced gender ratio would allow for further comparisons between male and female participants and the effect that gender has on ROM. Gender balance within the groups also creating a possible limitation. Studies have found that there are joint dependent differences created between male and female participants  which could create a variation in results. Finally the sample size was another constraint put the results of the research. By increasing the number of participants the experiment would have increased power.
Human error also poses a potential limitation as it does in many experimental designs. The goniometer itself is reliable tool therefore all issues with reliability come from the protocol . Studies such as those done by Brosseau et al. Kolber and Hanney and Mullaney et al. conclude that throughout a study it is best to use the same examiner to limit error and that the various devices that can be used for measurement should not be used interchangeably, as was the case here [21,33,34].
Other limitations included time constraints. A four-week program only allowed for 8 classes yet still produced significant results. Further research of long-term results is an important next step for this study.
In conclusion, after 4 weeks of participation results showed participants taking part in yoga and static stretching classes had significant overall improvements in ROM in the hip and shoulder. Through past research it is evident that various styles of flexibility training will create improvements in ROM, however in a comparison of yoga to static stretching, yoga had a greater overall effect. For clientele suffering from musculoskeletal injuries a four-week yoga program would be a beneficial treatment. It is hoped that with this study yoga may start to have an increased therapeutic role with joint restrictions as well as promote future research in this field.
I would like to thank my supervisor Sylvain Grenier for his help in making this research possible. With his support, encouragement and advice, he inspired me to continue research in this field and to concentrate my research on rehabilitation.
I also offer my gratitude to my certified yoga instructors, Shirle Landriault, and Laurissa Laframboise, who volunteered their time and expertise to this project.
As well I would like to thank Laurentian University who supplied me the tools and support necessary to complete the research.