How Does Stretching Induce Gains in Hypertrophy and Strength? • Stronger by Science

Word: This text was the MASS Analysis Evaluation cowl story for October 2023 and is a overview of a latest paper by Warneke et al. If you need extra content material like this, subscribe to MASS.

Key Factors 

  1. This overview of human and animal information explored the influence of long-duration stretching on hypertrophy and energy. In animals, massive and constant will increase in energy and hypertrophy happen throughout species with excessive (usually steady) stretching protocols.
  2. There are fewer human research for moral and logistical causes, and so they use much less excessive protocols. Whereas increased intensities, frequencies, and durations of stretching seem to trigger higher beneficial properties in people, mechanisms have solely been studied in animals. 
  3. Mechanical pressure is the principle proposed mechanism, however pressure is multifaceted and different mechanisms could also be concerned. Stretch-induced hypertrophy can happen with out lively contraction and leads to the addition of sarcomeres (in parallel and in collection) in animals. It’s attainable that stretching might present a stimulus that’s complementary to lifting. 

After I noticed this overview (1), I received excited. I’ve been taken with stretch-induced hypertrophy since MASS first coated the research by Warneke and colleagues demonstrating the sturdy potential of long-duration, high-frequency static stretching to induce hypertrophy and energy beneficial properties in people (2). I’ve been conserving an in depth eye on this analysis group’s work ever since. I’ve reviewed essential publications like their comparability of calf stretching to calf resistance coaching (3), and I made a video on all of the analysis this group printed up to now. Imagine it or not, I’ve even gone so far as getting an identical ankle orthosis that this group used and tried it on myself for 12 weeks (we’re at present writing a case research about it). 

As an enormous nerd and aggressive bodybuilder (and one who has struggled to make calf beneficial properties), I discover this space fascinating. The massive query in my thoughts is, how does this work? Extra particularly, are stretch-induced beneficial properties in hypertrophy and energy pushed by the identical physiological mechanisms as resistance coaching, or are they totally different? In the event that they differ, are they doubtlessly complementary? These are open questions, so I used to be excited to see Warneke and colleagues try to deal with a few of them within the current paper, which helps us get nearer to understanding what’s going on with stretch-induced hypertrophy and energy beneficial properties.

Objective and Hypotheses

Objective

The aim of this narrative overview was “to debate the influence of stretch-induced mechanical pressure as an underlying mechanism on muscle hypertrophy and energy enhancements.” 

Speculation

The authors didn’t explicitly state any hypotheses, which is widespread for narrative overview papers.

Strategies

Evaluation Kind

Whereas narrative evaluations are typically positioned as a decrease type of proof in comparison with systematic evaluations and meta-analyses, many narrative evaluations merely serve a unique goal. Systematic evaluations and meta-analyses are finest suited to matters which have a strong physique of literature reporting end result information that may be systematically gathered and summarized successfully. For that reason, they’ve particular tips for inclusion and exclusion standards, database looking, high quality management of research, and, if a meta-analysis is carried out, the statistical strategy. For instance, a scientific overview about HMB (with or with out meta evaluation) would talk about the entire related research exploring numerous outcomes of curiosity in numerous populations over time. It could probably acknowledge the proposed mechanisms resulting in these outcomes, but it surely also needs to embody a qualitative or quantitative comparability of particular outcomes in response to consuming HMB versus placebos or controls.

You’ll sometimes come throughout a story overview that would have been a scientific overview or meta-analysis, however authors extra often write narrative evaluations to debate a possible mechanism, cowl a broad or multifaceted matter, make clear methodology, or the entire above. The current overview is one such instance. 

Evaluation Technique

When writing a story overview, researchers have an excessive amount of latitude when figuring out their search technique and inclusion standards. The authors described their strategy as follows: 

“As this can be a narrative overview, the authors tried to replicate the important state of the literature by performing an prolonged research search. Nevertheless, as a result of there’s a huge variety of research, particularly relating to the results of stretching on flexibility in people and on hypertrophy in animals, it was essential to focus the literature search, which probably led to some research lacking within the overview article. To research research addressing our analysis query, we began by screening latest systematic overview articles addressing the subject (4, 5, 6, 7, 8). Subsequently, associated articles and reference lists have been screened to seek out articles excluded within the aforementioned systematic evaluations. Moreover, solely research investigating the results of stretching on energy or strength-related parameters, reminiscent of peak torque, maximal voluntary contractions (eccentric, isometric, or concentric), or muscle mass-related parameters, have been thought of on this overview. For a complete overview of the literature, systematic evaluations are wanted, specializing in the results of stretching on totally different outcomes – flexibility, maximal energy and muscle hypertrophy – individually.”

Findings and Interpretation

As this was a story overview and not using a particular qualitative or quantitative comparability, I’ll talk about their findings and my interpretations on this mixed part. 

Animal Findings 

First, the animal information are eye-opening, for each a superb and a nasty purpose. The nice purpose is the really astounding magnitude of hypertrophy reported. The unhealthy purpose is that the protocols are excessive (as is usually the case with animal analysis); I’m certain none of those animals loved them (to skip studying in regards to the protocols, go to the subsequent paragraph). In a lot of the animal research the researchers hooked up a weight or utilized resistance to 1 wing of a rooster or a quail by way of a stretching equipment. Usually, 10-35% of the wing’s weight was used and the non-weighted wing was used because the comparator. Intermittent protocols have been utilized in some instances (as quick as two rounds of quarter-hour of stretching per day), however usually the wing was weighted repeatedly (24 hours a day) for so long as 5 weeks straight. 

The authors reported the findings of all of the animal stretching research within the current narrative overview in a extremely large, three-page desk. However, additionally they printed a meta-analysis on hypertrophy final yr (6) on simply the 16 highest high quality animal research which met their inclusion standards, which is way simpler to summarize. In that meta-analysis they reported will increase in muscle fiber cross-sectional space as excessive as +141.6%, will increase in fiber variety of as much as +82.2% (indicating hyperplasia), and will increase in fiber size as excessive as +50% in rooster and quails, following interventions lasting not than 5 weeks! 

To place this in perspective, Tables 1 and a couple of show the forest plots from that meta-analysis for each the muscle- and fiber-level hypertrophy information displaying the standardized imply modifications in stretched wings relative to regulate wings. As a reminder, standardized imply variations are the impact dimension generally reported in meta-analysis and symbolize proportional will increase in a imply relative to their customary deviation. So, if a complement was related to an impact dimension of 0.3 for 1RM energy, the common 1RM improve after supplementation was about 30% of the pre-study customary deviation. Additional, 0.2 is the edge that researchers usually use to separate a “small” impact from a trivial one, and an impact dimension of 0.8 or increased is often thought of “massive.” You’ll see standardized imply distinction values starting from 4.62 to eight.55 in Tables 1 and a couple of. At first look, it seems that stretching protocols routinely produced impact sizes 5-10x higher than the standard threshold for a “massive” impact dimension. Nevertheless, Dr. Trexler spot-checked a few of the unique research to confirm the impact dimension calculations. Whereas he solely checked a number of, the entire impact sizes he spot-checked have been calculated utilizing customary error values as an alternative of ordinary deviations, which dramatically inflates the impact dimension metric. We should always take the calculated values in these tables with a giant grain of salt, however the uncooked values and p.c change values clearly inform us that the impact sizes have been very substantial nonetheless (certainly, as might be mentioned, the will increase in muscle dimension are roughly 10-fold what’s been noticed in people).

How Does Stretching Induce Gains in Hypertrophy and Strength? • Stronger by Science 11
1023 Helms Strength Table2
How Does Stretching Induce Gains in Hypertrophy and Strength? • Stronger by Science 12

Whereas these findings are bonkers, the human information are promising however much less excessive in magnitude. It is because the applicability of animal information to people is at all times restricted. For one, any time you examine two totally different species (like people and birds) you must count on totally different responses as a result of…nicely, they’re totally different species. Secondly, the moral constraints for stretching protocols allowed in animal research are rather more liberal than the moral constraints governing human research. Thus, human trials merely can’t replicate the intervention or the identical stimulus usually, and it’s additionally more difficult to precisely measure modifications in hypertrophy (animal research will be extra exact, because the precise mass tissue is usually weighted post-intervention). Within the current instance, each limitations apply: these birds have been doing much more excessive stretching protocols than people would ever (willingly) do. 

To cross the species hole somewhat, we will have a look at the findings in non-human mammals. This space consists of simply 4 stretching research in rabbits and rats (9, 10, 11, 12), the place just like the human information, the protocols consisted of intermittent stretching. Maybe unsurprisingly, the findings are extra just like the human information, with smaller magnitudes of change which have been solely noticed when extra frequent stretching occurred. Particularly, two of the 4 research reported vital hypertrophy, one doing intermittent each day stretches in rats for 3 weeks (12) and the opposite stretching rabbits 3 times per week for 4 weeks reporting the best muscle mass improve in non-human mammals of +13.4% (9). 

Human Findings

I wished to go over the animal information first, even supposing we have now human information, as a result of the findings are simply so loopy. The straightforward magnitudes of hypertrophy reported within the animal analysis give purpose to why this matter is value exploring in people. Additional, as we’ll talk about in a bit, the findings additionally push again towards a few of the reductionist statements about stretch-induced hypertrophy mechanisms I’ve seen (extra on that to return). This part might be transient, as a result of we’ve already coated these information in MASS (Analysis Transient; video). 

Whereas the primary human stretching analysis was carried out a long time in the past, the primary systematic overview on the subject of stretching to induce hypertrophy in people was printed in 2020 (4). Notably, the reviewed research’ protocols have been largely short-term, low-intensity, and short-duration in nature, with the longest particular person stretching bouts lasting 4.5 minutes, and the best quantity being 36 minutes of stretching per week. The authors of this systematic overview concluded that “passive, low-intensity stretch doesn’t seem to confer helpful modifications in muscle dimension and structure; alternatively, albeit restricted proof means that when stretching is finished with a sure diploma of tensile pressure (significantly when loaded, or added between lively muscle contractions) could elicit muscle hypertrophy.” 

In 2022 and 2023, the primary human research utilizing longer-duration, higher-frequency, higher-intensity protocols resembling a few of the much less excessive (however nonetheless efficient) animal protocols have been printed by the authors of the current overview, on the identical muscle group (the calves), utilizing the identical protocol of each day stretching with a calf orthosis for an hour per day for as much as six weeks in all however two instances, and at an 8/10 stretch ache tolerance. Whereas I need to give attention to mechanisms, I summarized these findings in a Quantity 7 video in Concern 2 and a Analysis Transient in Concern 5. For comfort, I’ll restate the principle findings right here:

  • Energy: +6.2-14.2% following 1hr/day orthosis stretching and +22.3% within the one 2hr/day research, and +10.5% within the one research utilizing a calf board 10min/day, in six weeks. 
  • Muscle thickness: +4.5-15.2% following 1hr/day orthosis stretching for six weeks, with bigger will increase amongst males and within the medial versus lateral gastrocnemius. 

Whereas the info earlier than this level have been unimpressive, these findings are in step with the non-human mammal information, fairly spectacular, and really akin to what’s been noticed in resistance coaching trials of an identical size within the calves. The notable variations of the latest stretching information in comparison with resistance coaching, are for one, that not like in resistance coaching trials (13), in response to stretching ladies appear to reply proportionally much less in magnitude for each energy and hypertrophy, probably as a result of at baseline ladies are extra versatile on common, so the mechanical pressure from stretching is decrease (14). Moreover, as I mentioned, 7 hours of steady, painful stretching per week is way much less logistically possible than doing 45 minutes of whole calf coaching per week (three days of 5 units of 10-12 reps to failure) to get a comparable magnitude of hypertrophy or energy change (3). Thus, for most individuals, stepping into the weeds on this matter might be not value it. The one purpose one would possibly take into account partaking in such an excessive protocol is that if they 1) had an excessive objective (say, aggressive bodybuilding) and if 2) stretching seems to be a doubtlessly complementary stimulus to resistance coaching primarily based on its mechanism(s) of motion.   

Mechanical Pressure as a Mechanism

Now that we’ve gone by means of the findings, let’s speak in regards to the proposed main mechanism of stretch-induced hypertrophy: mechanical pressure. Studying that mechanical pressure is the proposed main mechanism may need simply taken the wind out of your sails in case you have been hoping that resistance coaching and stretching would have totally different main mechanisms. Nevertheless, mechanical pressure is not only one factor. Lately, “mechanical pressure” will get thrown round loads in evidence-based circles when discussing hypertrophy mechanisms, however typically I’m wondering if everybody actually understands what that really means. So, to begin, let’s get into the weeds a bit on what precisely mechanical pressure is.

Mechanical pressure is often induced with resistance coaching (however may also be induced with stretching) which stimulates the underlying mobile signaling pathways to reinforce protein synthesis, leading to muscle hypertrophy (15). This happens by means of mechanotransduction, the method of an exterior bodily stimuli (reminiscent of pressure) being sensed by mechanosensors (of which there are a lot of sorts within the physique which sense numerous exterior stimuli) in a (muscle) cell that are then translated into biochemical indicators – on this case anabolic and anti-catabolic indicators which management muscle protein steadiness and thus, the corresponding internet protein synthesis fee (16). The related mechanosensors to muscular adaptation are diversified and situated at a number of websites in skeletal muscle. Particular sensors are higher positioned and suited to sensing passive (stretch) and lively (contractile) forces. It’s not totally clear which mechanosensors are most impacted by totally different coaching modalities (stretching versus resistance coaching, concentric versus eccentric muscle actions, and many others.), how every mechanosensor influences mobile signaling in response to power sensing, and the diploma to which every impacts downstream adaptation. With that mentioned, quite a lot of potential mechanosensors which may be concerned in stimulating muscular adaptation in response to mechanical pressure have been recognized and proposed. 

Costameres, for instance (17), are protein assemblies situated beneath the sarcolemma which hyperlink the extracellular matrix to the contractile part of muscle fibers (Determine 1). Costameres transmit contractile power laterally throughout muscle fibers to the extracellular matrix and are additionally proposed to sense compression forces, like muscle swelling, in addition to modifications within the stiffness of the extracellular matrix in response to coaching, doubtlessly resulting in the activation of anabolic signaling pathways (15, 18). 

1023 Helms Strength Fig1
How Does Stretching Induce Gains in Hypertrophy and Strength? • Stronger by Science 13

Titin, the most important protein within the human physique, is one other proposed mechanosensor with elastic properties (Determine 2). It connects the z-disk (the anchoring plate for actin filaments within the sarcomere) to the central m-line (the attachment level for myosin) and serves the practical position of offering elasticity to muscle on the sarcomere stage, appearing as a “molecular spring,” producing passive power when stretched (20). Titin truly goes slack throughout concentric contractions, however at lengthy muscle lengths it stretches and unfolds, doubtlessly activating anabolic signaling cascades (15).

1023 Helms Strength Fig2
How Does Stretching Induce Gains in Hypertrophy and Strength? • Stronger by Science 14

Filamins are one other class of proteins that act as mechanosensors, with filamin-c particularly situated on the z-disk. This v-shaped, hinge-like protein cross hyperlinks actin filaments and deforms throughout contraction (22). Such deformation is assumed to provoke signaling that would result in hypertrophy (15). One other intriguing discovering is that myonuclei themselves could act as mechanosensors (23). As myonuclei flatten and deform in response to muscle stretch, the protein desmin situated beneath the sarcolemma acts as a mechanosensor detecting nuclear deformation (24), which can result in downstream anabolic signaling (18). Lastly, stretch-activated ion channels are one other mechanosensor situated within the membrane of muscle cells. These gate-like buildings reply to stretch, which may happen as a result of eccentric contraction or muscle stretching, permitting ions to go into the cell, doubtlessly leading to signaling cascades associated to muscle injury and hypertrophy (18, 25). Thus, as proven in Determine 3, a number of mechanosensors might be able to sense and reply to muscle stretching (a few of them might also sense and reply to dynamic contraction) doubtlessly resulting in hypertrophic signaling.   

1023 Helms Strength Fig3
How Does Stretching Induce Gains in Hypertrophy and Strength? • Stronger by Science 15

As soon as pressure is sensed, hypertrophic signaling pathways are activated, a number of of which have been recognized (e.g., mTOR/p70s6K/PI3K) and all of that are extremely advanced, contain anabolic and/or anti-catabolic cascades, and are probably not totally elucidated. Additional, there could also be different pathways (and mechanosensors) not but recognized (15, 26).

Thus, at the same time as a main mechanism, it’s essential to know that mechanical pressure just isn’t a singular idea. Completely different types of mechanical pressure will be sensed by totally different mechanosensors and will result in totally different variations. Certainly, one scorching take I’ve seen on the web is that stretching will solely improve the variety of sarcomeres in collection, however not in parallel. The declare posits that growing sarcomeres in collection is unlikely to meaningfully influence muscle thickness or cross-sectional space, thus having a minimal or negligible influence on the looks of bigger muscular tissues. Earlier than refuting this declare, it’s essential to notice that molecular-level modifications (e.g., measuring sarcomere modifications in parallel or collection) are not often measured in human research and haven’t been particularly measured in people in response to high-intensity, long-duration, and high-frequency stretching protocols. So, any definitive assertion on this matter is arguably untimely, because it’s essentially primarily based on animal information or oblique human information. 

However, let me take a step again to make sure I didn’t lose anybody. Sarcomeres are the practical, molecular-level items of muscle fibers. Sarcomeres are the place actin-myosin cross bridging happens and power is produced. A muscle fiber is made up of hundreds of sarcomeres. When a muscle fiber grows it’s largely as a result of addition of extra sarcomeres. Sarcomeres will be added subsequent to 1 one other, in parallel, or finish to finish, in collection. Hypertrophy by way of the addition of sarcomeres in collection is highest in response to stretch overload (as has been reported within the aforementioned animal research) in addition to eccentric coaching (offering overload whereas a muscle elongates). Importantly, muscular tissues produce extra power when extra actin-myosin cross bridges can type, and thus, including sarcomeres in collection permits extra cross bridges to type at longer muscle lengths (27). Subsequently, the addition of sarcomeres in collection is a logical, practical adaptation in response to eccentric coaching or stretching, because it permits the muscle to raised resist elongation and produce power when in a stretched place. Nevertheless, this doesn’t imply that hypertrophy in response to stretching solely consists of will increase within the variety of sarcomeres in collection. Certainly, whereas the muscle fiber size will increase in Desk 2 are big, so are the entire muscle and particular person muscle fiber cross-sectional will increase in Desk 1 and a couple of, respectively, indicating the sturdy addition of sarcomeres in parallel as nicely. Additional, going all the way in which again to the 1970’s, there are information displaying that stretching can produce hypertrophy by way of will increase within the variety of sarcomeres in collection and in parallel. Intriguingly, this was documented in an animal mannequin the place the muscle was denervated (reduce off from the nerve) to stop lively contraction from doubtlessly inflicting the addition of sarcomeres in parallel (28).

As a last notice, adaptation within the human physique is usually the consequence of a number of, advanced, typically redundant, usually complementary processes borne out of thousands and thousands of years of evolution. Whereas it’s psychologically satisfying to seek out the mechanism, as a rule there are a number of mechanisms, with one mechanism at finest being main. Certainly, along with the first mechanism of mechanical pressure, the authors of the current overview famous that hypoxia could play a job in stretch-induced hypertrophy. In a single animal research, researchers assessed microvasculature modifications in rat soleus muscle in response to a stretching protocol (29). The researchers famous that stretching induced increased levels of hypoxia and elevated the variety of microvascular connections and microvascular quantity of the rat soleus, as a result of each the extended deformation of blood vessels throughout stretch, in addition to ischemia (albeit to a lesser diploma). The authors of the current article concluded their overview by stating: “Given the totally different parameters influencing muscle morphology, additional components reminiscent of hypoxia, fascial tissue in addition to neuronal mechanisms needs to be included in additional analysis to maximise potential indicated results.”

Subsequent Steps

I’ve mentioned the subsequent steps relating to the functions of stretch-induced hypertrophy beforehand. Take a look at the final paragraph right here. In the end, we’d like utilized analysis to see if stretching is additive or redundant to resistance coaching. Nevertheless, there are totally different subsequent steps if we need to uncover the underlying mechanisms as to how stretch-induced hypertrophy happens, which might inform us if it operates in another way to resistance coaching induced hypertrophy. Future work must be executed particularly wanting on the fiber- and molecular-level variations to stretching in comparison with resistance coaching. Does stretching end in conversion to slower muscle phenotypes than resistance coaching in people? Does stretching improve muscle fascicle size by way of longer resting sarcomere lengths, or do precise will increase in sarcomeres in collection happen in people? How a lot ischemia happens within the stretching protocols which might be possible in people, and the way does this examine to resistance coaching? Additional, how does it examine to BFR and may we assess how a lot it contributes to the noticed hypertrophy? These are all open questions {that a} lowly utilized researcher like myself can’t reply, however would like to see answered.

Utility and Takeaways

If information in birds are thought to have any relevance to people, huge hypertrophy potential is feasible with long-duration, high-intensity, and high-frequency stretching. Certainly, in people, there’s a dose-response relationship between hypertrophy and energy beneficial properties and the time and depth devoted to stretching. The first mechanism for these variations might be mechanical pressure, however not essentially the identical kind of mechanical pressure that happens throughout resistance coaching. Notably, these outcomes are all reported by the identical lab that has completely studied the calf musculature. The beneficial properties are akin to resistance coaching, however could require a painful and impractical hour of each day stretching with an orthosis to attain. For some, that could be value it, however earlier than you dedicate your self to doing so, I’d advise ready till we perceive what’s happening mechanistically.

This text was the duvet story for the October 2023 problem of MASS Analysis Evaluation. If you happen to’d wish to learn the complete, 106-page October problem (and dive into the MASS archives), you’ll be able to subscribe to MASS right here.

Subscribers get a brand new version of MASS every month. Every problem consists of analysis overview articles, video shows, and audio summaries. PDF points are often round 100 pages lengthy.

References

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  3. Warneke Ok, Wirth Ok, Keiner M, Lohmann LH, Hillebrecht M, Brinkmann A, et al. Comparability of the results of long-lasting static stretching and hypertrophy coaching on maximal energy, muscle thickness and adaptability within the plantar flexors. Eur J Appl Physiol. 2023 Aug;123(8):1773-1787.
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