Search tips
Search criteria 


Logo of jathtrainLink to Publisher's site
J Athl Train. 1998 Apr-Jun; 33(2): 141–144.
PMCID: PMC1320401

Immediate and Residual Changes in Dorsiflexion Range of Motion Using an Ultrasound Heat and Stretch Routine

David O. Draper, EdD, ATC, Chad Anderson, MS, ATC, Shane S. Schulthies, PhD, PT, ATC, and Mark D. Ricard, PhD



With respect to increasing ankle dorsiflexion range of motion, our objective was to examine the influence, if any, of preheating the triceps surae with ultrasound before stretching.

Design and Setting:

Subjects were assigned to either group A (ultrasound and stretch) or group B (stretch alone). Group A received 3-MHz ultrasound (1.5 W/cm2, 4 times effective radiating area) for 7 minutes to the musculotendinous junction of the triceps surae before stretching. Group B rested for 7 minutes before stretching. Both groups then performed identical calf stretches for 4 minutes. Treatment for both groups was conducted at the Brigham Young University Sports Injury Research Laboratory twice daily for 5 days with at least 3 hours between procedures. We analyzed the data with a 2 × 3 × 10 factorial analysis of variance with repeated measures. A Tukey post hoc test was used to identify significant differences in range of motion.


Forty college students (male = 18, female = 22, age = 20.4 ± 2.5 years) volunteered for the study.


Maximal ankle dorsiflexion range of motion was measured using an inclinometer before and after each treatment.


Immediate effects were that ultrasound and stretch increased mean dorsiflexion range of motion in all sessions significantly more than stretch alone in three treatment sessions. Residual effects were that dorsiflexion range of motion increased 3° in both groups after nine treatment sessions; however, neither group significantly outperformed the other.


As studied, an ultrasound and stretch routine may increase immediate range of motion more than stretch alone, possibly enhancing performance in practice and competition. This increased range of motion, however, is not maintained over the long term and is not more than the range of motion gained from stretching alone. A similar study using subjects with decreased range of motion after immobilization or injury should be conducted to see if the ultrasound and stretch regimen would produce lasting range-of-motion increases.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (778K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kottke FJ, Pauley DL, Ptak RA. The rationale for prolonged stretching for correction of shortening of connective tissue. Arch Phys Med Rehabil. 1966 Jun;47(6):345–352. [PubMed]
  • Worrell TW, McCullough M, Pfeiffer A. Effect of foot position on gastrocnemius/soleus stretching in subjects with normal flexibility. J Orthop Sports Phys Ther. 1994 Jun;19(6):352–356. [PubMed]
  • Taylor BF, Waring CA, Brashear TA. The effects of therapeutic application of heat or cold followed by static stretch on hamstring muscle length. J Orthop Sports Phys Ther. 1995 May;21(5):283–286. [PubMed]
  • Wessling KC, DeVane DA, Hylton CR. Effects of static stretch versus static stretch and ultrasound combined on triceps surae muscle extensibility in healthy women. Phys Ther. 1987 May;67(5):674–679. [PubMed]
  • Draper DO, Castel JC, Castel D. Rate of temperature increase in human muscle during 1 MHz and 3 MHz continuous ultrasound. J Orthop Sports Phys Ther. 1995 Oct;22(4):142–150. [PubMed]
  • Reed B, Ashikaga T. The effects of heating with ultrasound on knee joint displacement. J Orthop Sports Phys Ther. 1997 Sep;26(3):131–137. [PubMed]
  • Lehmann JF, Masock AJ, Warren CG, Koblanski JN. Effect of therapeutic temperatures on tendon extensibility. Arch Phys Med Rehabil. 1970 Aug;51(8):481–487. [PubMed]
  • Warren CG, Lehmann JF, Koblanski JN. Heat and stretch procedures: an evaluation using rat tail tendon. Arch Phys Med Rehabil. 1976 Mar;57(3):122–126. [PubMed]
  • GERSTEN JW. Effect of ultrasound on tendon extensibility. Am J Phys Med. 1955 Apr;34(2):362–369. [PubMed]
  • Chan AK, Myrer JW, Measom GJ, Draper DO. Temperature changes in human patellar tendon in response to therapeutic ultrasound. J Athl Train. 1998 Apr;33(2):130–135. [PMC free article] [PubMed]
  • Draper DO, Ricard MD. Rate of Temperature Decay in Human Muscle Following 3 MHz Ultrasound: The Stretching Window Revealed. J Athl Train. 1995 Oct;30(4):304–307. [PMC free article] [PubMed]
  • Rose S, Draper DO, Schulthies SS, Durrant E. The Stretching Window Part Two: Rate of Thermal Decay in Deep Muscle Following 1-MHz Ultrasound. J Athl Train. 1996 Apr;31(2):139–143. [PMC free article] [PubMed]
  • Zito M, Driver D, Parker C, Bohannon R. Lasting effects of one bout of two 15-second passive stretches on ankle dorsiflexion range of motion. J Orthop Sports Phys Ther. 1997 Oct;26(4):214–221. [PubMed]

Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association