human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY DESIGN R and omized , double-blind pre-test and post-test with repeated measures . OBJECTIVE To determine whether heating with continuous wattage ultrasound ( CWUS ) augmented the effects of stretching on ligament extensibility in nonimpaired human subjects . BACKGROUND Heating with CWUS , combined with static stretching , is often used to treat ligament " tightness , " but " heat and stretch " has not been studied well in vivo . METHODS AND MEASURES Twenty-one nonimpaired women subjects ( aged 31.5 + /- 11.0 years ) underwent serial measurements of knee joint displacement ( valgus and varus ) on a Genucom arthrometer before and after valgus stretch ( 10 ft-lb x 2.5 minutes ) . Subjects received either simultaneous CWUS ( 3 MHz , 1.25 W/cm2 ) or sham CWUS applied over the medial collateral ligament . Five trials ( 2 before , 3 after treatment ) were conducted with the right knee positioned in 20 degrees of flexion . Subjects received the alternate treatment 28 days later . For each subject , all testing was performed by the same investigator . RESULTS Repeated measures ANOVA revealed that stretching , combined with sham CWUS , increased mean valgus displacement from 8.95 degrees ( + /-1.72 degrees ) to 10.00 degrees ( + /-2.10 degrees ) . Stretching , combined with CWUS , increased mean valgus displacement from 9.24 degrees ( + /-2.36 degrees ) to 10.48 degrees ( + /-2.54 degrees ) . This was a 13.4 % change from the control condition . CONCLUSION Heating with CWUS did not augment the effects of stretching . " Heat and stretch " with CWUS may not be more effective than stretching alone for increasing the extensibility of dense connective tissue The purpose of the study was to demonstrate for the first time on human subjects that static stretch and ultrasound ( SS and US ) combined increases triceps surae muscle extensibility more than SS alone . The SS and US combined consisted of seven minutes of continuous US at 1.5 W/cm2 to the muscle with SS during the seventh minute . The SS alone consisted of a 51-lb ( 23.1 kg ) load applied for one minute . We r and omly assigned 10 healthy , female subjects to each of three groups ( N = 30 ) . Each group received each of the three types of treatment ( SS and US , SS , and no treatment ) in a different order . St and ardized goniometric measurements of active dorsiflexion were taken before and after each treatment session . The SS and US treatment increased dorsiflexion an average of 1.2 degrees , or 20 % , more than the SS treatment . The SS treatment increased dorsiflexion an average of 1.3 degrees , or 27 % , more than no treatment . Both increases were statistically significant This study was funded in part by a Minigrant award from California State University , Fresno . The use of thermal modalities to enhance stretching procedures is not well documented clinical ly . This study documented the effectiveness of applying superficial heat and cold in conjunction with a low-load prolonged stretch ( LLPS ) for increasing  shoulder flexibility .  Ninety-two healthy males were r and omly assigned to one of five groups : 1 ) an LLPS alone , 2 ) heat applied in the initial phase of an LLPS , 3 ) cold applied in the final phase of stretch , 4 ) a combination of heat initially followed by cold , and 5 ) no intervention . Subjects received three , 40-minute treatments across a 5-day period . A follow-up measurement was taken 3 days later . Results demonstrated that an LLPS associated with the use of heat , ice , or a combination of both facilitated greater long-term improvements in flexibility compared with controls . However , only subjects receiving heat in the initial phase of an LLPS showed significant gains when compared with those who received stretching alone ( p < /= 0.05 ) . We concluded that applying heat in conjunction with an LLPS to a nonpathologic shoulder is a clinical ly superior method of improving flexibility compared with an LLPS alone . J Orthop Sports Phys Ther 1992;16(5):200 - 207 The purpose of the study was to evaluate the influence of Fluori-Methane spray as a method of affecting passive range of motion measured at the right hip joint . Subjects were 30 normal volunteers r and omly divided into an experimental group and a control group . A special table was constructed to position and stabilize each subject for monitoring the right lower extremity 's resistance to side-lying straight leg raising . Specific right hip flexion goniometric measurements were compared and analyzed before and after application of Fluori-Methane spray to the soft tissue overlying the posterior part of the right thigh . The results of the study showed that the experimental group , which received application of Fluori-Methane spray and static passive stretch , did significantly ( p less than .02 ) increase the range of passive hip flexion over that of the control group , which received only static passive stretch STUDY DESIGN Prospect i ve , research er-blinded , repeated- measures , r and omized complete block design . OBJECTIVES To compare the effects of a single treatment of Pneumatherm , moist heat pack , and a control treatment on  hamstring muscle length .  BACKGROUND Traditionally , heating modalities have been used to facilitate increases in tissue length . The Pneumatherm has been developed over the past 20 years for use in the clinical treatment of a variety of musculoskeletal pathologies . However , there is no published evidence supporting the use of Pneumatherm for improving muscle length .  SUBJECTS Participants consisted of 30 healthy , college-age males taken from a convenience sampling from the University of Indianapolis student population . METHODS AND MEASURES Participants received a 3-treatment sequence on consecutive days . Treatments involved applying the determined modality to the posterior thigh using st and ard treatment protocol s. A h and -held dynamometer was used to establish a consistent passive measurement force to measure hamstring muscle length . RESULTS A mixed-model analysis of variance with pretest-posttest ( 3 pretest and 3 posttest measures ) and treatment sequence of the modalities ( 6 sequences of Pneumatherm , moist heat , and control ) was completed . The only significant effect was for pretest-posttest measures . Post hoc comparisons revealed that the  Pneumatherm posttest value was significantly different from all other measures . There were no differences found between pretest scores and the moist heat and control posttest scores . CONCLUSIONS Our results demonstrate that the Pneumatherm modality is an effective agent for increasing hamstring muscle length following a single 20-minute treatment . In this study , a significant gain in hamstring muscle length was not found following a 1-time treatment with moist heat . The Pneumatherm may be a good option when heat is used to assist in gaining flexibility of the hamstring musculature Background : The influence of superficial precooling on range of motion ( ROM ) as part of a stretching program has not been extensively studied . It is not clear if the analgesic effect can benefit a stretching program . Hypotheses : Superficial precooling will result in greater gains in ROM as part of a stretching program , compared with stretching without a precooling intervention . Superficial precooling will also result in greater retention in ROM gains following cessation of stretching , compared with stretching without a precooling intervention . Study Design : Prospect i ve r and omized single-blind test-retest design . Methods : Twenty-nine participants were r and omly assigned to 1 of 2 static stretching protocol  s : a st and ard protocol ( n , 14 ; age , 24.6 ± 5.4 years ) or a precool protocol ( n , 15 ; age , 25.1 ± 7.3 years ) . These sample s allowed for 80 % power for statistical significance testing . Both groups performed static hamstring stretching daily for 4 weeks . The precool group applied ice to the hamstring for 10 minutes before stretching . Both groups stretched for 4 weeks and then stopped stretching for the last 4 weeks . Hip ROM measures were obtained each week for 8 weeks . Results : For the st and ard group , mean hip ROM increased from 71.4 ° ± 18.5 ° to 90.6 ° ± 20.5 ° and for the precool group , 71.5 ° ± 22.3 ° to 91.8 ° ± 20.9 ° . For the st and ard group , mean hip ROM decreased from 90.6 ° ± 20.5 ° to 83.9 ° ± 20.3 ° and for the precool group , 91.8 ° ± 20.9 to 85.0 ° ± 19.4 ° . There were no differences between groups at any time in the study ( P > .05 ) . Conclusions : Precooling had no beneficial effects on ROM or on retention of ROM . Clinical Relevance : Cold application , before stretching , does not provide any benefit to a stretching program Objective This study aim ed at comparing the effect of linear polarized near-infrared light irradiation ( PL irradiation ) and bicycle exercise with 50%HRreserve on the flexibility of the shoulder joint . Design Placebo-controlled trial . Setting Twenty-four healthy young adults ( 10 males : mean±SD , age 20.9±3.1 y , height 171.0±3.9 cm , body mass 63.4±3.5 kg and 14 females : age 21.2±1.7 y , height 162.0±7.8 cm , body mass 56.2±7.2 kg ) . Interventions PL-irradiation ( 100 % , 1800 mW ) , placebo-irradiation ( 10%,180 mW ) , and light exercise ( 50%HRreserve ) for 10 minutes . Outcome Measurements and Results The shoulder joint angles were measured twice-before and after each intervention . We measured the angles when the right shoulder joint extended forward and flexed backward maximally without support , and analyzed these shoulder joints and range of motion . Trial-to-trial reliability ( intraclass correlations ) of each joint angle was very high , over 0.98 . All joint angles showed significant changes , and values in post-PL-irradiation and postlight exercise were significantly greater than that in postplacebo-irradiation . Shoulder forward flexion and backward extension angles had significantly greater change rates in PL-irradiation and light exercise than placebo-irradiation , and their range of motion angle was in the order of PL-irradiation , light exercise , and placebo-irradiation . Conclusions It is suggested that PL-irradiation produces almost the same effect on shoulder joint range of motion  as light exercise OBJECTIVE : To compare the effects of low-load , short- duration stretching with or without high-intensity , pulsed short-wave diathermy on  hamstring flexibility .  DESIGN AND SETTING : We used a single-blind , repeated- measures design ( pretest and posttest for all treatments ) that included a placebo . The 3 independent variables were treatment mode , pretest and posttest measurements , and day . Treatment mode had 3 levels : diathermy and stretching , stretching alone , and control . The dependent variable was range of motion . Subjects were r and omly assigned to the diathermy and stretching , stretching-only , or control group . Subjects were treated and tested each day ( at approximately the same time ) for 5 days , with a follow-up test administered 72 hours later . Hamstring flexibility was tested using a sit- and -reach box before and after each treatment . Diathermy and stretching subjects received a 15-minute diathermy treatment on the right hamstring at a setting of 7000 pulses per second , with an average pulse width of 95 μsec . Stretching-only subjects received a 15-minute sham diathermy treatment . Both diathermy and stretching and stretching-only subjects then performed three 30-second stretches ( short duration ) before being retested . Control subjects lay prone for 15 minutes before being retested . SUBJECTS : Thirty-seven healthy college students ( 11 men , 26 women , age = 20.46 + /- 1.74 years ) volunteered . MEASUREMENTS : Hamstring flexibility was measured using a sit- and -reach box before and after each treatment . RESULTS : The average increases in hamstring flexibility over the 5 treatment days for the diathermy and stretching , stretching-only , and control groups were 6.06 cm ( 19.6 % ) , 5.27 cm ( 19.7 % ) , and 3.38 cm ( 10.4 % ) , respectively . Three days later ( after no treatment ) , the values for the diathermy and stretching , stretching-only , and control groups were 8.27 cm ( 26.7 % ) , 6.83 cm ( 25.3 % ) , and 4.15 cm ( 14.2 % ) , respectively . No significant differences in hamstring flexibility were noted among the groups . CONCLUSIONS : Diathermy and short- duration stretching were no more effective than short- duration stretching alone at increasing hamstring flexibility . The effects of diathermy with longer stretching times need to be research ed The purpose of this study was to determine whether the application of a moist heat pack ( MHP ) could increase hamstring flexibility . Both legs for each subject were used for this study . Each leg was r and omly assigned to either an MHP leg or a control leg condition . Twenty-seven male subjects ( height = 178.5 ± 8.6 cm ; weight = 84.4 ± 18.7 kg ; age = 21.9 ± 6.3 years ) volunteered for this study . For the MHP leg condition , baseline hamstring flexibility was measured using an active knee extension test . A 23-ga indwelling thermistor was inserted to a depth of  
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY DESIGN R and omized , double-blind pre-test and post-test with repeated measures . OBJECTIVE To determine whether heating with continuous wattage ultrasound ( CWUS ) augmented the effects of stretching on ligament extensibility in nonimpaired human subjects . BACKGROUND Heating with CWUS , combined with static stretching , is often used to treat ligament " tightness , " but " heat and stretch " has not been studied well in vivo . METHODS AND MEASURES Twenty-one nonimpaired women subjects ( aged 31.5 + /- 11.0 years ) underwent serial measurements of knee joint displacement ( valgus and varus ) on a Genucom arthrometer before and after valgus stretch ( 10 ft-lb x 2.5 minutes ) . Subjects received either simultaneous CWUS ( 3 MHz , 1.25 W/cm2 ) or sham CWUS applied over the medial collateral ligament . Five trials ( 2 before , 3 after treatment ) were conducted with the right knee positioned in 20 degrees of flexion . Subjects received the alternate treatment 28 days later . For each subject , all testing was performed by the same investigator . RESULTS Repeated measures ANOVA revealed that stretching , combined with sham CWUS , increased mean valgus displacement from 8.95 degrees ( + /-1.72 degrees ) to 10.00 degrees ( + /-2.10 degrees ) . Stretching , combined with CWUS , increased mean valgus displacement from 9.24 degrees ( + /-2.36 degrees ) to 10.48 degrees ( + /-2.54 degrees ) . This was a 13.4 % change from the control condition . CONCLUSION Heating with CWUS did not augment the effects of stretching . " Heat and stretch " with CWUS may not be more effective than stretching alone for increasing the extensibility of dense connective tissue The purpose of the study was to demonstrate for the first time on human subjects that static stretch and ultrasound ( SS and US ) combined increases triceps surae muscle extensibility more than SS alone . The SS and US combined consisted of seven minutes of continuous US at 1.5 W/cm2 to the muscle with SS during the seventh minute . The SS alone consisted of a 51-lb ( 23.1 kg ) load applied for one minute . We r and omly assigned 10 healthy , female subjects to each of three groups ( N = 30 ) . Each group received each of the three types of treatment ( SS and US , SS , and no treatment ) in a different order . St and ardized goniometric measurements of active dorsiflexion were taken before and after each treatment session . The SS and US treatment increased dorsiflexion an average of 1.2 degrees , or 20 % , more than the SS treatment . The SS treatment increased dorsiflexion an average of 1.3 degrees , or 27 % , more than no treatment . Both increases were statistically significant This study was funded in part by a Minigrant award from California State University , Fresno . The use of thermal modalities to enhance stretching procedures is not well documented clinical ly . This study documented the effectiveness of applying superficial heat and cold in conjunction with a low-load prolonged stretch ( LLPS ) for increasing  shoulder flexibility .  Ninety-two healthy males were r and omly assigned to one of five groups : 1 ) an LLPS alone , 2 ) heat applied in the initial phase of an LLPS , 3 ) cold applied in the final phase of stretch , 4 ) a combination of heat initially followed by cold , and 5 ) no intervention . Subjects received three , 40-minute treatments across a 5-day period . A follow-up measurement was taken 3 days later . Results demonstrated that an LLPS associated with the use of heat , ice , or a combination of both facilitated greater long-term improvements in flexibility compared with controls . However , only subjects receiving heat in the initial phase of an LLPS showed significant gains when compared with those who received stretching alone ( p < /= 0.05 ) . We concluded that applying heat in conjunction with an LLPS to a nonpathologic shoulder is a clinical ly superior method of improving flexibility compared with an LLPS alone . J Orthop Sports Phys Ther 1992;16(5):200 - 207 The purpose of the study was to evaluate the influence of Fluori-Methane spray as a method of affecting passive range of motion measured at the right hip joint . Subjects were 30 normal volunteers r and omly divided into an experimental group and a control group . A special table was constructed to position and stabilize each subject for monitoring the right lower extremity 's resistance to side-lying straight leg raising . Specific right hip flexion goniometric measurements were compared and analyzed before and after application of Fluori-Methane spray to the soft tissue overlying the posterior part of the right thigh . The results of the study showed that the experimental group , which received application of Fluori-Methane spray and static passive stretch , did significantly ( p less than .02 ) increase the range of passive hip flexion over that of the control group , which received only static passive stretch STUDY DESIGN Prospect i ve , research er-blinded , repeated- measures , r and omized complete block design . OBJECTIVES To compare the effects of a single treatment of Pneumatherm , moist heat pack , and a control treatment on  hamstring muscle length .  BACKGROUND Traditionally , heating modalities have been used to facilitate increases in tissue length . The Pneumatherm has been developed over the past 20 years for use in the clinical treatment of a variety of musculoskeletal pathologies . However , there is no published evidence supporting the use of Pneumatherm for improving muscle length .  SUBJECTS Participants consisted of 30 healthy , college-age males taken from a convenience sampling from the University of Indianapolis student population . METHODS AND MEASURES Participants received a 3-treatment sequence on consecutive days . Treatments involved applying the determined modality to the posterior thigh using st and ard treatment protocol s. A h and -held dynamometer was used to establish a consistent passive measurement force to measure hamstring muscle length . RESULTS A mixed-model analysis of variance with pretest-posttest ( 3 pretest and 3 posttest measures ) and treatment sequence of the modalities ( 6 sequences of Pneumatherm , moist heat , and control ) was completed . The only significant effect was for pretest-posttest measures . Post hoc comparisons revealed that the  Pneumatherm posttest value was significantly different from all other measures . There were no differences found between pretest scores and the moist heat and control posttest scores . CONCLUSIONS Our results demonstrate that the Pneumatherm modality is an effective agent for increasing hamstring muscle length following a single 20-minute treatment . In this study , a significant gain in hamstring muscle length was not found following a 1-time treatment with moist heat . The Pneumatherm may be a good option when heat is used to assist in gaining flexibility of the hamstring musculature Background : The influence of superficial precooling on range of motion ( ROM ) as part of a stretching program has not been extensively studied . It is not clear if the analgesic effect can benefit a stretching program . Hypotheses : Superficial precooling will result in greater gains in ROM as part of a stretching program , compared with stretching without a precooling intervention . Superficial precooling will also result in greater retention in ROM gains following cessation of stretching , compared with stretching without a precooling intervention . Study Design : Prospect i ve r and omized single-blind test-retest design . Methods : Twenty-nine participants were r and omly assigned to 1 of 2 static stretching protocol  s : a st and ard protocol ( n , 14 ; age , 24.6 ± 5.4 years ) or a precool protocol ( n , 15 ; age , 25.1 ± 7.3 years ) . These sample s allowed for 80 % power for statistical significance testing . Both groups performed static hamstring stretching daily for 4 weeks . The precool group applied ice to the hamstring for 10 minutes before stretching . Both groups stretched for 4 weeks and then stopped stretching for the last 4 weeks . Hip ROM measures were obtained each week for 8 weeks . Results : For the st and ard group , mean hip ROM increased from 71.4 ° ± 18.5 ° to 90.6 ° ± 20.5 ° and for the precool group , 71.5 ° ± 22.3 ° to 91.8 ° ± 20.9 ° . For the st and ard group , mean hip ROM decreased from 90.6 ° ± 20.5 ° to 83.9 ° ± 20.3 ° and for the precool group , 91.8 ° ± 20.9 to 85.0 ° ± 19.4 ° . There were no differences between groups at any time in the study ( P > .05 ) . Conclusions : Precooling had no beneficial effects on ROM or on retention of ROM . Clinical Relevance : Cold application , before stretching , does not provide any benefit to a stretching program Objective This study aim ed at comparing the effect of linear polarized near-infrared light irradiation ( PL irradiation ) and bicycle exercise with 50%HRreserve on the flexibility of the shoulder joint . Design Placebo-controlled trial . Setting Twenty-four healthy young adults ( 10 males : mean±SD , age 20.9±3.1 y , height 171.0±3.9 cm , body mass 63.4±3.5 kg and 14 females : age 21.2±1.7 y , height 162.0±7.8 cm , body mass 56.2±7.2 kg ) . Interventions PL-irradiation ( 100 % , 1800 mW ) , placebo-irradiation ( 10%,180 mW ) , and light exercise ( 50%HRreserve ) for 10 minutes . Outcome Measurements and Results The shoulder joint angles were measured twice-before and after each intervention . We measured the angles when the right shoulder joint extended forward and flexed backward maximally without support , and analyzed these shoulder joints and range of motion . Trial-to-trial reliability ( intraclass correlations ) of each joint angle was very high , over 0.98 . All joint angles showed significant changes , and values in post-PL-irradiation and postlight exercise were significantly greater than that in postplacebo-irradiation . Shoulder forward flexion and backward extension angles had significantly greater change rates in PL-irradiation and light exercise than placebo-irradiation , and their range of motion angle was in the order of PL-irradiation , light exercise , and placebo-irradiation . Conclusions It is suggested that PL-irradiation produces almost the same effect on shoulder joint range of motion  as light exercise OBJECTIVE : To compare the effects of low-load , short- duration stretching with or without high-intensity , pulsed short-wave diathermy on  hamstring flexibility .  DESIGN AND SETTING : We used a single-blind , repeated- measures design ( pretest and posttest for all treatments ) that included a placebo . The 3 independent variables were treatment mode , pretest and posttest measurements , and day . Treatment mode had 3 levels : diathermy and stretching , stretching alone , and control . The dependent variable was range of motion . Subjects were r and omly assigned to the diathermy and stretching , stretching-only , or control group . Subjects were treated and tested each day ( at approximately the same time ) for 5 days , with a follow-up test administered 72 hours later . Hamstring flexibility was tested using a sit- and -reach box before and after each treatment . Diathermy and stretching subjects received a 15-minute diathermy treatment on the right hamstring at a setting of 7000 pulses per second , with an average pulse width of 95 μsec . Stretching-only subjects received a 15-minute sham diathermy treatment . Both diathermy and stretching and stretching-only subjects then performed three 30-second stretches ( short duration ) before being retested . Control subjects lay prone for 15 minutes before being retested . SUBJECTS : Thirty-seven healthy college students ( 11 men , 26 women , age = 20.46 + /- 1.74 years ) volunteered . MEASUREMENTS : Hamstring flexibility was measured using a sit- and -reach box before and after each treatment . RESULTS : The average increases in hamstring flexibility over the 5 treatment days for the diathermy and stretching , stretching-only , and control groups were 6.06 cm ( 19.6 % ) , 5.27 cm ( 19.7 % ) , and 3.38 cm ( 10.4 % ) , respectively . Three days later ( after no treatment ) , the values for the diathermy and stretching , stretching-only , and control groups were 8.27 cm ( 26.7 % ) , 6.83 cm ( 25.3 % ) , and 4.15 cm ( 14.2 % ) , respectively . No significant differences in hamstring flexibility were noted among the groups . CONCLUSIONS : Diathermy and short- duration stretching were no more effective than short- duration stretching alone at increasing hamstring flexibility . The effects of diathermy with longer stretching times need to be research ed The purpose of this study was to determine whether the application of a moist heat pack ( MHP ) could increase hamstring flexibility . Both legs for each subject were used for this study . Each leg was r and omly assigned to either an MHP leg or a control leg condition . Twenty-seven male subjects ( height = 178.5 ± 8.6 cm ; weight = 84.4 ± 18.7 kg ; age = 21.9 ± 6.3 years ) volunteered for this study . For the MHP leg condition , baseline hamstring flexibility was measured using an active knee extension test . A 23-ga indwelling thermistor was inserted to a depth of  
    Output:
    