Active stretch is necessary for regulating muscle fiber length (ie, the number of series sarcomeres). Elevated cytoplasmic calcium is the proposed component of contractile activity required to activate signaling pathways for sarcomere number regulation. Passive stretch reduces muscle tissue stiffness, most likely by signaling connective tissue remodeling via fibroblasts. Passive stretch may induce sarcomere addition if the muscle fibers are lengthened sufficiently to raise cytoplasmic calcium through stretch-activated calcium channels. The magnitude of stretch in vivo is limited by the physiologic range of movement and stretch pain tolerance. The greatest effect of stretching muscle fibers is expected when the lengthening exceeds the optimum fiber length (Lo).