1. “Effect of Sit-to-Stand activity on
flexibility of lower back,
hamstring and tendoachilles
muscle groups”
Project Guide: Dr. Rashmi Bhoyar.
Date: 10.10.12
Presented by:
1.Miss. Aparna Shirbavikar .
2.Miss. Apeksha Besekar.

2. INTRODUCTION
 Flexibility is defined as “the absolute range of movement in a
joint or series of joints that is influenced by muscles, tendons,
ligaments, bone and bony structures.”
 Hypo mobility caused by adaptive shortening of soft tissues
can occur as a result of many disorders or situations.
 Factors include:
1. Prolonged immobilization of a body segment,
2. Sedentary lifestyle,
3. Postural malallignment and muscle imbalances,
4. Impaired muscle performance(weakness) associated with an array of
musculoskeletal or neuromuscular disorders,
5. Tissue trauma resulting in inflammation and pain,
6. Congenital or acquired deformities.

3.  Stretching, is a general term used to describe any therapeutic
maneuver designed to increase the extensibility of soft tissues,
thereby improving flexibility by elongating structures that
have adaptively shortened and have become hypomobile
overtime.
 It is used as an integral part of physical fitness and
rehabilitation programme because it positively influences
performance.

4. AIM
 To determine the effectiveness of sit-to-stand activity
as a pre stretching tool on the flexibility of the lower
back, hamstring and tendoachilles muscles.

5. NEED FOR STUDY
 With a view to prevent injury to the muscles during stretching an
adequate rise in temperature and blood circulation is a pre requisite.
 This can be achieved by proper muscle contraction preceding the
stretching exercises.
 Satoh et al (2000) has used quadriceps muscle contraction as a pre
stretching activity prior to hamstring muscle stretching exercises.
 Sit-to-stand is a frequently performed dynamic activity which
recruits large group of lower limb muscles.
 Hence this study was undertaken to obtain a long term clinical
implication showing effectiveness of sit-to-stand activity on
flexibility of lower back and lower limb muscles.

6. REVIEW OF LITERATURE
 Dipti B. Geete and Amita Mehta (2003) in their prospective study
studied the “Effect of sit-to-stand exercise on forward bending test.”
The results showed significant improvement in flexibility of back,
hamstring and tendoachilles muscles.
 Kazunori Morozumi et al (2002) tested the “Effect of previous
standing-up exercise on forward bending test in the long sitting
position in elderly subjects.” The results indicated forward bending
distance significantly decreased after the standing-up exercise.
 In a study on similar grounds again by Kazunori Morozumi et al
(2003) reported “Effect of single-leg half squat exercise on forward
bending test in normal adults.” The results suggested forward
bending distance in long sitting was decreased significantly in squat
group when compared with controlled group.”

7.  J.S. Munton et al (1984) studied the leg muscle activity by
using electromyography in patients with arthritis and in
normal subjects during rising from the chair.
 Miroslav Janura et al (1980) reported the “evaluation of
stability of sit-to-stand” and showed how stable is sit-to-stand
performance in repeated trials and are there any differences in
the sit-to-stand movement on the right and left side of the
body.

8. METHODOLOGY
 Study design: Experimental.
 Sample size: 50 females ageing between 17-25 years.
 Study setting: V.S.P.M’s College of Physiotherapy
OPD setup.
 Duration: 3 months.

9. Inclusion criterion
 Females at present not
undergoing any stretching
programme between ages of
17 to 25years were selected.
Exclusion criterion
 Acute neuromuscular or
musculoskeletal pathology.
For e.g. Prolapsed
Intervertebral Disc, Ankle
sprain, Hamstring Strain.
 Subjects having any limb
length discrepancy due to
structural deformity in the
lower limb.
 Males.

10. MATERIAL
Chair without arm support Half circle metal goniometer

11. Measuring tape Velcro-strap

12. Stop-watch

13. PROCEDURE
 Subjects were distributed in two groups:
Group A: Sit-to-stand activity-10 repetitions. (25 subjects)
Group B: Sit-to-stand activity-20 repetitions. (25 subjects)
 The flexibility of lower back, hamstrings and tendoachilles
muscles was measured before and after performing sit-to-
stand activity by using:
a) Forward bending test in long sitting position,
b) Hamstring muscle tightness and
c) Tendoachilles muscle tightness.

14. Measurement of forward bending in sit and reach
test
 Each subject was seated in
long sitting position with
ankle joints fixed in neutral
position and the knee joints
in extended position. The
subject bent her trunk with
arms extending straight
ahead. The sole of foot was
calibrated ‘0’ position and
the distance from the
‘0’position to the tip of the
third finger at which each
subject could hold 3 seconds
and was measured 3 times to
score the maximal value.

15. Assessment of hamstring muscle tightness
 It was done in supine position with
the help of goniometer.
 The lower extremity was fixed at
hip at 90 degrees. Tightness was
measured as the angle between
vertical and that obtained by
passively extending the knee at a
point at which the therapist
perceived resistance to passive
extension. Lack of knee extension
was considered the criterion for
measurement of hamstring muscle
tightness.

16. Assessment of tendoachilles muscle tightness
 It was done in supine lying
with the help of goniometer.
 Alignment of ankle joint
was maintained in neutral
position and with passive
dorsiflexion angle was
measured.

17. Sit-to-stand activity
 It was given on a chair without arm support. The
chair height was such that the subject could stand up
from sitting position with knee joint at the angle of 90
degrees. The load was adjusted by timing the stand up
exercise (Once per 4 seconds) with the help of
stopwatch.

18. Sit-to-stand activity

19. OBSERVATION
 As seen in graph there is statistically significant difference
observed in pre and post forward bending distance in both the
groups, which indicates increase in flexibility of lower back
muscles.
Graph 1

20. Graph 2
 As seen in graph there is statistically significant difference
observed in pre and post Hamstring muscle tightness in both
the groups, which indicates there was increase in flexibility
of hamstring muscle.

21. Graph 3
 As seen in graph there is statistically significant difference
observed in pre and post tendoachilles muscle tightness in
both the groups, which indicates there was increase in
flexibility of tendoachilles muscle.

22. DATA ANALYSIS
 The collected data was analyzed for statistical significance
using paired & unpaired t test. For within the group
comparison, paired t test was used to compare the effect of sit-
to-stand activity on pre and post forward bending test,
hamstring and tendoachilles muscle tightness.
 For between the groups comparison unpaired t test was used to
compare the effect of 10 repetitions with 20 repetitions of sit-
to-stand activity.

23. RESULTS
PARAMETER PRE POST DIFFERENCE SIGNIFICANCE
Forward
bending dist.
13.88+6.52 7.28+6.06 6.6+4.23 t=8.10,p<0.001
Hamstring 14.72+6.94 7.2+6.14 7.52+3.93 t=9.92,p<0.001
Tendoachilles 3.92+1.44 1.76+1.2 2.16+1.31 t=8.55,p<0.001
TABLE 1: Significance of 10 repetitions.
PARAMETER PRE POST DIFFERENCE SIGNIFICANCE
Forward
bending dist.
16.78+6.76 8.68+6.18 8.1+3.59 t=11.65,p<0.001
Hamstring 15.4+7.11 6.8+5.38 8.6+4.62 t=9.63,p<0.001
Tendoachilles 4.96+1.62 2.6+1.44 2.36+1.18 t=10.31,p<0.001
TABLE 2: Significance of 20 repetitions.
As seen in tables 1 & 2, there was a significant difference observed in pre
and post forward bending distance in both the groups, which indicate
increase in flexibility of lower back, hamstring and tendoachilles muscles.

24. TABLE 3: Significance OF 10-Repetitions vs. 20-Repetitions
 In table 3, on comparison between the two groups no
statistically significant difference was seen (p>0.05) which
means that both the techniques were equally effective.
PARAMETER DIFFERENCE SIGNIFICANCE
10-REPETITIONS 20-REPETITIONS
Forward bending
dist.
6.6+4.23 8.1+3.59 t=1.35,p=0.18
Hamstring 7.52+3.93 8.6+4.62 t=0.37,p=0.88
Tendoachilles 2.16+1.31 2.36+1.18 t=0.57,p=0.56

25. Graph 4
Graph 5
Graph 5

26. Graph 6

27. DISCUSSION
 In this study Sit-to-Stand activity was given as a pre stretching
tool to increase the effectiveness of stretching exercise.
 50 females were selected and were randomly divided into two
groups of 25 each for the comparative study between 10 and
20 repetitions of sit to stand activity.
 There was highly significant decrease in forward bending
distance and significant increase in hamstring, tendoachillies
muscle flexibility after 10 and 20 repetitions of sit-to-stand
activity as the p value obtained is less than 0.001. The
statistical results of the two groups when compared with each
other showed no significant difference between the
effectiveness of a particular exercise regime as the p value was
more than 0.05.

28. Analysis of sit-to-stand activity
As per Munton J S et al in “use of EMG to
study leg muscle activity” (1984).

29.  Kazunori Morozumi et al, Munton J S et al and William E
et al in their respective studies have shown that increase in
flexibility observed after sit-to-stand activity can be
hypothesized due to reciprocal inhibition, autogenic
inhibition and warm-up.
RECIPROCAL INHIBITION:
 EMG study done by Capaday & Laveo et al (1990) on
reciprocal inhibition shows reciprocal inhibition of soleus
muscle with tibialis anterior muscle stimulation in various
motor tasks. Applying this principle to our study as discussed
in biomechanics of sit-to-stand activity i.e. erector spinae,
rectus abdominis , gluteus maximus, quadriceps muscle,
tibialis anterior that causes reflex relaxation of opposite group
of muscles. These relaxed muscles give less resistance to
consequent stretching and hence show improvement in
flexibility.

30. AUTOGENIC INHIBITION:
 William E et al (2001) suggested the second neurophysiologic
basis of increased flexibility is the principle of autogenic
inhibition, which is reflex muscular relaxation that occurs in
the same muscle when Golgi tendon organ is stimulated.
 In our study, the muscles that would have undergone this
effect are gluteus maximus, hamstring muscle and
gastrocnemius.
WARM-UP:
 According to Aoki j, Satoh Y, Muraoka I (2001), the sit-to-
stand activity acted as warm up for further stretching. Muscle
contractions increase the muscle and body temperature and
improve physiological functions and are closely related to
muscle performance.

31. CONCLUSION
 There was statistically highly significant (p<0.01) difference
observed in the flexibility after 10 repetition &20 repetition of
sit-to-stand activity.
 No statistically significant difference (p>0.05) difference was
seen on comparison between 10 repetition and 20 repetition of
sit-to -stand activity indicating that 10 repetition is as effective
as 20 repetition to improve flexibility.

32. RECOMMENDATIONS
 The findings of the study enables a therapist to use the activity
of sit-to-stand as a simple and safe pre-stretching tool so that
consequent stretching becomes more effective.
 In geriatric age groups, sit-to-stand activity can be use
effectively and safely, to stretch the bi articular muscles
without any musculoskeletal injury.
 Sit-to-stand activity can promote reduction in joint stiffness
which could be useful in consequent exercise session. This
benefit is more applicable in geriatric age group where joint
stiffness is more common due to inactivity.