How Does Stretching Induce Positive aspects in Hypertrophy and Energy? • Stronger by Science

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

Key Factors 

  1. This assessment of human and animal information explored the affect of long-duration stretching on hypertrophy and power. In animals, giant and constant will increase in power 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 larger 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 energetic contraction and ends in the addition of sarcomeres (in parallel and in sequence) in animals. It’s potential that stretching may present a stimulus that’s complementary to lifting. 

Once I noticed this assessment (1), I obtained excited. I’ve been fascinated with stretch-induced hypertrophy since MASS first lined the research by Warneke and colleagues demonstrating the strong potential of long-duration, high-frequency static stretching to induce hypertrophy and power beneficial properties in people (2). I’ve been protecting a detailed eye on this analysis group’s work ever since. I’ve reviewed necessary 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 to this point. Consider 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 power pushed by the identical physiological mechanisms as resistance coaching, or are they completely different? In the event that they differ, are they probably complementary? These are open questions, so I used to be excited to see Warneke and colleagues try and sort out a few of them within the current paper, which helps us get nearer to understanding what’s going on with stretch-induced hypertrophy and power beneficial properties.

Objective and Hypotheses


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


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


Overview Kind

Whereas narrative critiques are generally positioned as a decrease type of proof in comparison with systematic critiques and meta-analyses, many narrative critiques merely serve a special objective. Systematic critiques and meta-analyses are finest fitted 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 pointers for inclusion and exclusion standards, database looking, high quality management of research, and, if a meta-analysis is carried out, the statistical method. For instance, a scientific assessment about HMB (with or with out meta evaluation) would talk about all the related research exploring numerous outcomes of curiosity in numerous populations over time. It might seemingly acknowledge the proposed mechanisms resulting in these outcomes, however it must also 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 assessment that would have been a scientific assessment or meta-analysis, however authors extra continuously write narrative critiques to debate a possible mechanism, cowl a broad or multifaceted matter, make clear methodology, or all the above. The current assessment is one such instance. 

Overview Technique

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

“As it is a narrative assessment, the authors tried to replicate the important state of the literature by performing an prolonged research search. Nonetheless, 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 presumably led to some research lacking within the assessment article. To research research addressing our analysis query, we began by screening current systematic assessment articles addressing the subject (4, 5, 6, 7, 8). Subsequently, associated articles and reference lists had been screened to search out articles excluded within the aforementioned systematic critiques. Moreover, solely research investigating the results of stretching on power or strength-related parameters, corresponding to peak torque, maximal voluntary contractions (eccentric, isometric, or concentric), or muscle mass-related parameters, had been thought of on this assessment. For a complete assessment of the literature, systematic critiques are wanted, specializing in the results of stretching on completely different outcomes – flexibility, maximal power and muscle hypertrophy – individually.”

Findings and Interpretation

As this was a story assessment with no 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 foul cause. The nice cause is the actually astounding magnitude of hypertrophy reported. The dangerous cause is that the protocols are excessive (as is commonly 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 following paragraph). In a lot of the animal research the researchers connected a weight or utilized resistance to 1 wing of a hen or a quail by way of a stretching equipment. Most often, 10-35% of the wing’s weight was used and the non-weighted wing was used because the comparator. Intermittent protocols had been utilized in some circumstances (as brief as two rounds of quarter-hour of stretching per day), however most often 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 assessment in a very 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 much 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 hen 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 exhibiting the standardized imply modifications in stretched wings relative to regulate wings. As a reminder, standardized imply variations are the impact measurement generally reported in meta-analysis and characterize proportional will increase in a imply relative to their customary deviation. So, if a complement was related to an impact measurement of 0.3 for 1RM power, the typical 1RM enhance after supplementation was about 30% of the pre-study customary deviation. Additional, 0.2 is the brink that researchers usually use to separate a “small” impact from a trivial one, and an impact measurement of 0.8 or increased is often thought of “giant.” 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 larger than the standard threshold for a “giant” impact measurement. Nonetheless, Dr. Trexler spot-checked a few of the authentic research to confirm the impact measurement calculations. Whereas he solely checked a couple of, all the impact sizes he spot-checked had been calculated utilizing customary error values as a substitute of normal deviations, which dramatically inflates the impact measurement metric. We must always take the calculated values in these tables with a giant grain of salt, however the uncooked values and % change values clearly inform us that the impact sizes had been very substantial nonetheless (certainly, as might be mentioned, the will increase in muscle measurement are roughly 10-fold what’s been noticed in people).

1023 Helms Strength Table1
How Does Stretching Induce Positive aspects in Hypertrophy and Energy? • Stronger by Science 42
1023 Helms Strength Table2
How Does Stretching Induce Positive aspects in Hypertrophy and Energy? • Stronger by Science 43

Whereas these findings are bonkers, the human information are promising however much less excessive in magnitude. It’s because the applicability of animal information to people is all the time restricted. For one, any time you evaluate two completely different species (like people and birds) it’s best to anticipate completely different responses as a result of…properly, they’re completely 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 most often, and it’s additionally more difficult to precisely measure modifications in hypertrophy (animal research may be extra exact, because the precise mass tissue is commonly weighted post-intervention). Within the current instance, each limitations apply: these birds had been doing much more excessive stretching protocols than people would ever (willingly) do. 

To cross the species hole somewhat, we are able to take 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 had been solely noticed when extra frequent stretching occurred. Particularly, two of the 4 research reported important hypertrophy, one doing intermittent every 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 enhance in non-human mammals of +13.4% (9). 

Human Findings

I needed to go over the animal information first, even if we’ve got human information, as a result of the findings are simply so loopy. The straightforward magnitudes of hypertrophy reported within the animal analysis give cause to why this matter is price 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 come back). This part might be transient, as a result of we’ve already lined 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 assessment on the subject of stretching to induce hypertrophy in people was printed in 2020 (4). Notably, the reviewed research’ protocols had 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 assessment concluded that “passive, low-intensity stretch doesn’t seem to confer useful modifications in muscle measurement 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 energetic muscle contractions) might 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 had been printed by the authors of the current assessment, on the identical muscle group (the calves), utilizing the identical protocol of every day stretching with a calf orthosis for an hour per day for as much as six weeks in all however two circumstances, and at an 8/10 stretch ache tolerance. Whereas I wish to concentrate on mechanisms, I summarized these findings in a Quantity 7 video in Situation 2 and a Analysis Transient in Situation 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 information earlier than this level had been unimpressive, these findings are in keeping with the non-human mammal information, fairly spectacular, and truly corresponding to what’s been noticed in resistance coaching trials of an identical size within the calves. The notable variations of the current 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 power and hypertrophy, seemingly 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 much 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 power change (3). Thus, for most individuals, stepping into the weeds on this matter might be not price it. The one cause one would possibly contemplate participating in such an excessive protocol is that if they 1) had an excessive purpose (say, aggressive bodybuilding) and if 2) stretching seems to be a probably complementary stimulus to resistance coaching primarily based on its mechanism(s) of motion.   

Mechanical Pressure as a Mechanism

Now that we’ve gone via the findings, let’s speak in regards to the proposed major mechanism of stretch-induced hypertrophy: mechanical pressure. Studying that mechanical pressure is the proposed major mechanism may need simply taken the wind out of your sails should you had been hoping that resistance coaching and stretching would have completely different major mechanisms. Nonetheless, mechanical pressure isn’t just one factor. Lately, “mechanical pressure” will get thrown round so much in evidence-based circles when discussing hypertrophy mechanisms, however generally I ponder if everybody actually understands what that truly means. So, to start out, let’s get into the weeds a bit on what precisely mechanical pressure is.

Mechanical pressure is normally induced with resistance coaching (however can be induced with stretching) which stimulates the underlying mobile signaling pathways to reinforce protein synthesis, leading to muscle hypertrophy (15). This happens via mechanotransduction, the method of an exterior bodily stimuli (corresponding to pressure) being sensed by mechanosensors (of which there are numerous varieties 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 stability and thus, the corresponding internet protein synthesis price (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 energetic (contractile) forces. It’s not absolutely clear which mechanosensors are most impacted by completely 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 stated, plenty 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 element 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, probably resulting in the activation of anabolic signaling pathways (15, 18). 

1023 Helms Strength Fig1
How Does Stretching Induce Positive aspects in Hypertrophy and Energy? • Stronger by Science 44

Titin, the biggest 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 purposeful position of offering elasticity to muscle on the sarcomere stage, performing 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, probably activating anabolic signaling cascades (15).

1023 Helms Strength Fig2
How Does Stretching Induce Positive aspects in Hypertrophy and Energy? • Stronger by Science 45

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 believed to provoke signaling that would result in hypertrophy (15). One other intriguing discovering is that myonuclei themselves might 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 move into the cell, probably 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 can also sense and reply to dynamic contraction) probably resulting in hypertrophic signaling.   

1023 Helms Strength Fig3
How Does Stretching Induce Positive aspects in Hypertrophy and Energy? • Stronger by Science 46

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 seemingly not absolutely elucidated. Additional, there could also be different pathways (and mechanosensors) not but recognized (15, 26).

Thus, whilst a major mechanism, it’s necessary to grasp that mechanical pressure shouldn’t be a singular idea. Completely different types of mechanical pressure may be sensed by completely different mechanosensors and will result in completely different diversifications. Certainly, one sizzling take I’ve seen on the web is that stretching will solely enhance the variety of sarcomeres in sequence, however not in parallel. The declare posits that rising sarcomeres in sequence is unlikely to meaningfully affect muscle thickness or cross-sectional space, thus having a minimal or negligible affect on the looks of bigger muscular tissues. Earlier than refuting this declare, it’s necessary to notice that molecular-level modifications (e.g., measuring sarcomere modifications in parallel or sequence) 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 purposeful, molecular-level models 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 because of the addition of extra sarcomeres. Sarcomeres may be added subsequent to 1 one other, in parallel, or finish to finish, in sequence. Hypertrophy by way of the addition of sarcomeres in sequence 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 kind, and thus, including sarcomeres in sequence permits extra cross bridges to kind at longer muscle lengths (27). Due to this fact, the addition of sarcomeres in sequence is a logical, purposeful adaptation in response to eccentric coaching or stretching, because it permits the muscle to higher resist elongation and produce power when in a stretched place. Nonetheless, this doesn’t imply that hypertrophy in response to stretching solely consists of will increase within the variety of sarcomeres in sequence. 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 strong addition of sarcomeres in parallel as properly. Additional, going all the best way again to the 1970’s, there are information exhibiting that stretching can produce hypertrophy by way of will increase within the variety of sarcomeres in sequence and in parallel. Intriguingly, this was documented in an animal mannequin the place the muscle was denervated (lower off from the nerve) to stop energetic contraction from probably inflicting the addition of sarcomeres in parallel (28).

As a closing be aware, adaptation within the human physique is commonly the consequence of a number of, advanced, generally redundant, usually complementary processes borne out of hundreds of thousands of years of evolution. Whereas it’s psychologically satisfying to search out the mechanism, most of the time there are a number of mechanisms, with one mechanism at finest being major. Certainly, along with the first mechanism of mechanical pressure, the authors of the current assessment famous that hypoxia might 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 assessment by stating: “Given the completely different parameters influencing muscle morphology, additional components corresponding to 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 following steps relating to the purposes of stretch-induced hypertrophy beforehand. Try the final paragraph right here. In the end, we want utilized analysis to see if stretching is additive or redundant to resistance coaching. Nonetheless, there are completely different subsequent steps if we wish to uncover the underlying mechanisms as to how stretch-induced hypertrophy happens, which might inform us if it operates otherwise to resistance coaching induced hypertrophy. Future work must be achieved particularly wanting on the fiber- and molecular-level diversifications to stretching in comparison with resistance coaching. Does stretching lead to conversion to slower muscle phenotypes than resistance coaching in people? Does stretching enhance muscle fascicle size by way of longer resting sarcomere lengths, or do precise will increase in sarcomeres in sequence happen in people? How a lot ischemia happens within the stretching protocols which are possible in people, and the way does this evaluate to resistance coaching? Additional, how does it evaluate to BFR and might 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.

Software 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 power beneficial properties and the time and depth devoted to stretching. The first mechanism for these diversifications 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 solely studied the calf musculature. The beneficial properties are corresponding to resistance coaching, however might require a painful and impractical hour of every day stretching with an orthosis to attain. For some, that is likely to be price it, however earlier than you dedicate your self to doing so, I’d advise ready till we perceive what’s occurring mechanistically.

This text was the quilt story for the October 2023 situation of MASS Analysis Overview. When you’d prefer to learn the complete, 106-page October situation (and dive into the MASS archives), you may subscribe to MASS right here.

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


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