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Behm DG, Alizadeh S, Daneshjoo A, Anvar SH, Graham A, Zahiri A, Goudini R, Edwards C, Culleton R, Scharf C, Konrad A. Acute Effects of Various Stretching Techniques on Range of Motion: A Systematic Review with Meta-Analysis. SPORTS MEDICINE - OPEN 2023; 9:107. [PMID: 37962709 PMCID: PMC10645614 DOI: 10.1186/s40798-023-00652-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
Background Although stretching can acutely increase joint range of motion (ROM), there are a variety of factors which could influence the extent of stretch-induced flexibility such as participant characteristics, stretching intensities, durations, type (technique), and muscle or joint tested. Objective The objective of this systematic review and meta-analysis was to investigate the acute effects of stretching on ROM including moderating variables such as muscles tested, stretch techniques, intensity, sex, and trained state. Methods A random-effect meta-analysis was performed from 47 eligible studies (110 effect sizes). A mixed-effect meta-analysis subgroup analysis was also performed on the moderating variables. A meta-regression was also performed between age and stretch duration. GRADE analysis was used to assess the quality of evidence obtained from this meta-analysis. Results The meta-analysis revealed a small ROM standard mean difference in favor of an acute bout of stretching compared to non-active control condition (ES = −0.555; Z = −8.939; CI (95%) −0.677 to −0.434; p < 0.001; I2 = 33.32). While there were ROM increases with sit and reach (P = 0.038), hamstrings (P < 0.001), and triceps surae (P = 0.002) tests, there was no change with the hip adductor test (P = 0.403). Further subgroup analyses revealed no significant difference in stretch intensity (P = 0.76), trained state (P = 0.99), stretching techniques (P = 0.72), and sex (P = 0.89). Finally, meta-regression showed no relationship between the ROM standard mean differences to age (R2 = −0.03; P = 0.56) and stretch duration (R 2 = 0.00; P = 0.39), respectively. GRADE analysis indicated that we can be moderately confident in the effect estimates. Conclusion A single bout of stretching can be considered effective for providing acute small magnitude ROM improvements for most ROM tests, which are not significantly affected by stretch intensity, participants’ trained state, stretching techniques, and sex. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-023-00652-x. The meta-analysis on joint range of motion (ROM) increases revealed a small effect size in favor of an acute bout of stretching compared to the control condition. Subgroup analysis revealed a significant increase in ROM with sit and reach, hamstrings, and triceps surae tests, but no improvement with the hip adductor tests. Whereas all moderating variables presented significant increases in ROM, further subgroup analyses revealed no significant difference in ROM gains with the stretch intensity, trained state of the participants, stretching techniques, and sex. A meta-regression showed no relationship between the effect sizes to age and stretch duration, respectively.
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Affiliation(s)
- David George Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Abdolhamid Daneshjoo
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
- Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, Shahid Bahonar University of Kerman, Kerman, 76169-13439, Iran
| | - Saman Hadjizadeh Anvar
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Andrew Graham
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Ali Zahiri
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Reza Goudini
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Chris Edwards
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Robyn Culleton
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada
| | - Carina Scharf
- Institute of Human Movement Science, Sport and Health, Graz University, Mozartgasse 14, 8010, Graz, Austria
| | - Andreas Konrad
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, A1C 5S7, Canada.
- Institute of Human Movement Science, Sport and Health, Graz University, Mozartgasse 14, 8010, Graz, Austria.
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Campanini I, Bò MC, Bassi MC, Damiano B, Scaltriti S, Lusuardi M, Merlo A. Outcome measures for assessing the effectiveness of physiotherapy interventions on equinus foot deformity in post-stroke patients with triceps surae spasticity: A scoping review. PLoS One 2023; 18:e0287220. [PMID: 37824499 PMCID: PMC10569611 DOI: 10.1371/journal.pone.0287220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/01/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Equinus foot deformity (EFD) is the most common deviation after stroke. Several physiotherapy interventions have been suggested to treat it. However, studies evaluating the efficacy of these treatments vary widely in terms of assessment modalities, type of data analysis, and nomenclature. This scoping review aimed to map current available evidence on outcome measures and the modalities employed to assess the effectiveness of physiotherapy programs for the reduction of triceps surae (TS) spasticity and EFD in patients with stroke. METHODS Scoping review methodological frameworks have been used. Three databases were investigated. Primary literature addressing TS spasticity in adult patients with stroke using physiotherapy interventions was included. Findings were systematically summarized in tables according to the intervention used, intervention dosage, control group, clinical, and instrumental outcome measures. RESULTS Of the 642 retrieved studies, 53 papers were included. TS spasticity was assessed by manual maneuvers performed by clinicians (mainly using the Ashworth Scale), functional tests, mechanical evaluation through robotic devices, or instrumental analysis and imaging (such as the torque-angle ratio, the H-reflex, and ultrasound images). A thorough critical appraisal of the construct validity of the scales and of the statistics employed was provided, particularly focusing on the choice of parametric and non-parametric approaches when using ordinal scales. Finally, the complexity surrounding the concept of "spasticity" and the possibility of assessing the several underlying active and passive causes of EFD, with a consequent bespoke treatment for each of them, was discussed. CONCLUSION This scoping review provides a comprehensive description of all outcome measures and assessment modalities used in literature to assess the effectiveness of physiotherapy treatments, when used for the reduction of TS spasticity and EFD in patients with stroke. Clinicians and researchers can find an easy-to-consult summary that can support both their clinical and research activities.
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Affiliation(s)
- Isabella Campanini
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
| | - Maria Chiara Bò
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
- Merlo Bioengineering, Parma, Italy
| | | | - Benedetta Damiano
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
| | - Sara Scaltriti
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
| | - Mirco Lusuardi
- Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Reggio Emilia, Correggio, Italy
| | - Andrea Merlo
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
- Merlo Bioengineering, Parma, Italy
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Boulard C, Gautheron V, Lapole T. Acute passive stretching has no effect on gastrocnemius medialis stiffness in children with unilateral cerebral palsy. Eur J Appl Physiol 2023; 123:467-477. [PMID: 36318307 DOI: 10.1007/s00421-022-05046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The aim of this study was to investigate the effects of an acute high-intensity, long-duration passive stretching session of the plantar flexor muscles, on maximal dorsiflexion (DF) angle and passive stiffness at both ankle joint and gastrocnemius medialis (GM) muscle levels in children with unilateral cerebral palsy (CP). METHODS 13 children [mean age: 10 years 6 months, gross motor function classification system (GMFCS): I] with unilateral CP underwent a 5 min passive stretching session at 80% of maximal DF angle. Changes in maximal DF angle, slack angle, passive ankle joint and GM muscle stiffness from PRE- to POST-intervention were determined during passive ankle mobilization performed on a dynamometer coupled with shear wave elastography measurements (i.e., ultrasound) of the GM muscle. RESULTS Maximal DF angle and maximal passive torque were increased by 6.3° (P < 0.001; + 50.4%; 95% CI 59.9, 49.9) and 4.2 Nm (P < 0.01; + 38.9%; 95% CI 47.7, 30.1), respectively. Passive ankle joint stiffness remained unchanged (P = 0.9; 0%; 95% CI 10.6, - 10.6). GM muscle shear modulus was unchanged at maximal DF angle (P = 0.1; + 34.5%; 95% CI 44.7, 24.7) and at maximal common torque (P = 0.5; - 4%; 95% CI - 3.7, - 4.3), while it was decreased at maximal common angle (P = 0.021; - 35%; 95% CI - 11.4, - 58.5). GM slack angle was shifted in a more dorsiflexed position (P = 0.02; + 20.3%; 95% CI 22.6, 18). CONCLUSION Increased maximal DF angle can be obtained in the paretic leg in children with unilateral CP after an acute bout of stretching using controlled parameters without changes in passive stiffness at joint and GM muscle levels. CLINICAL TRIAL NUMBER NCT03714269.
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Affiliation(s)
- Clément Boulard
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, 42023, Saint-Etienne, France. .,Department of Pediatrics Physical Medicine and Rehabilitation, Faculty of Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Vincent Gautheron
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, 42023, Saint-Etienne, France
| | - Thomas Lapole
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, 42023, Saint-Etienne, France
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Campanini I, Bò MC, Salsi F, Bassi MC, Damiano B, Scaltriti S, Lusuardi M, Merlo A. Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review. Front Neurol 2022; 13:1026850. [DOI: 10.3389/fneur.2022.1026850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveEquinus foot deformity (EFD) is the most common deformity following a stroke. Several approaches have been suggested for its correction, including pharmacological, surgical, and physical therapy (PT) interventions. This scoping review aims to map and synthesize the available evidence focusing on physical therapy treatments for EFD caused by triceps surae (TS) spasticity.MethodsScoping review methodological frameworks have been used. Pubmed, Cinahl, and Cochrane databases were searched for primary literature. Studies focusing on the treatment of EFD in adult stroke patients were included only when the intervention involved PT treatments and presented at least one outcome measure for the functional and/or structural condition of the TS. Data were systematically collected and reported in tables inclusive of type of intervention, sample characteristics, dosage, comparators, outcomes, follow-up timeline, and treatment efficacy. A narrative synthesis was also added.ResultsOf the 642 experimental or observational screened studies, 53 were included, focusing on stretching exercises, shock waves, electrical stimulation, dry needling, TENS, vibration therapy, ultrasounds, cryotherapy, and active physiotherapy. Patients with EFD benefited from specific physical therapy treatments. These usually resulted in Modified Ashworth Scale reduction, typically by 1 point, and an increase in ROM. Interventions consisting of shock waves, dry needling, and electrostimulation showed the best results in reducing EFD. Heterogeneous dosage and delivery mode generally limited conclusions.ConclusionsThis scoping review summarized available primary literature based on PT treatments for the correction of EFD. By highlighting the remaining gaps in knowledge, it provides a reference for future studies on this pathology. Further investigations are necessary to pinpoint the best dosage and delivery methods. Future studies should investigate whether early rehabilitation programs started during the acute phase might help prevent or limit the development of secondary deformities.
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Mita M, Suzumori K, Kudo D, Saito K, Chida S, Hatakeyama K, Shimada Y, Miyakoshi N. Utility of a wearable robot for the fingers that uses pneumatic artificial muscles for patients with post-stroke spasticity. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2022; 13:12-16. [PMID: 37859849 PMCID: PMC10545049 DOI: 10.11336/jjcrs.13.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 10/21/2023]
Abstract
Mita M, Suzumori K, Kudo D, Saito K, Chida S, Hatakeyama K, Shimada Y, Miyakoshi N. Utility of a wearable robot for the fingers that uses pneumatic artificial muscles for patients with post-stroke spasticity. Jpn J Compr Rehabil Sci 2022; 13: 12-16. Objective We investigated the utility of a wearable robot for the fingers that we developed using pneumatic artificial muscles for rehabilitation of patients with post-stroke spasticity. Methods Three patients with post-stroke finger spasticity underwent rehabilitation for 20 minutes a day, 5 days a week, for 3 weeks. Passive range of motion, Modified Ashworth Scale (MAS), and circumference of each finger were measured before and after training and compared. Results The range of motion and finger circumference increased when using a wearable robot. The MAS improved partially, and no exacerbation was observed. Conclusions The wearable robot we developed is useful for rehabilitation of post-stroke spasticity and may improve venous return.
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Affiliation(s)
- Motoki Mita
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Department of Orthopedic Surgery, Yuri Kumiai General Hospital, Yurihonjo, Akita, Japan
| | - Koichi Suzumori
- Department of Mechanical Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kimio Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Department of Rehabilitation Unit, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoaki Chida
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Department of Rehabilitation Unit, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazutoshi Hatakeyama
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Department of Rehabilitation Unit, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Akita Prefectural Center on Development and Disability, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Fukaya T, Sato S, Yahata K, Yoshida R, Takeuchi K, Nakamura M. Effects of stretching intensity on range of motion and muscle stiffness: A narrative review. J Bodyw Mov Ther 2022; 32:68-76. [DOI: 10.1016/j.jbmt.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/15/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
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Emara HA, Al-Johani AH, Khaled OA, Ragab WM, Al-Shenqiti AM. Effect of extracorporeal shock wave therapy on spastic equinus foot in children with unilateral cerebral palsy. J Taibah Univ Med Sci 2022; 17:794-804. [PMID: 36050947 PMCID: PMC9396049 DOI: 10.1016/j.jtumed.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives This study aims to investigate the effects of radial extracorporeal shock wave therapy on selective motor control, spasticity, gross motor function, and balance in children with unilateral cerebral palsy. Methods This randomised controlled study recruited 34 children aged 7–9 with spastic unilateral cerebral palsy. They were randomly allocated to either the control or study group. Both groups undertook traditional exercises for 12 weeks. The study group received shock waves (one session/week) on the calf muscle (1500 shocks, frequency of 4 Hz, energy of 0.030 mJ/mm2). All children were evaluated at baseline and after 12 weeks using the Modified Ashworth Scale, a Biodex System 4 isokinetic dynamometer, dimensions D (standing) and E (walking) of the Gross Motor Function Measure – 88, the Trost Selective Motor Control test, and the single leg standing test. Results Mixed analysis of variance and Mann–Whitney results showed significant improvement in eccentric peak torque, torque threshold angles, gross motor function, selective motor control, and balance in the study group compared with the control group (p < 0.05). Conclusions Shock wave therapy may be a valuable instrument for reducing spasticity, improving the ability to isolate and control movement, and consequently, improving balance and gross motor function in children with unilateral cerebral palsy.
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Zhai X, Wu Q, Li X, Xu Q, Zhang Y, Fan S, Zhang LQ, Pan Y. Effects of Robot-Aided Rehabilitation on the Ankle Joint Properties and Balance Function in Stroke Survivors: A Randomized Controlled Trial. Front Neurol 2021; 12:719305. [PMID: 34721259 PMCID: PMC8549728 DOI: 10.3389/fneur.2021.719305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Stroke survivors with impaired control of the ankle due to stiff plantarflexors often experience abnormal posture control, which affects balance and locomotion. Forceful stretching may decrease ankle stiffness and improve balance. Recently, a robot-aided stretching device was developed to decrease ankle stiffness of patient post-stroke, however, their benefits compared to manual stretching exercises have not been done in a randomized controlled trial, and the correlations between the ankle joint biomechanical properties and balance are unclear. Objective: To compare the effects of robot-aided to manual ankle stretching training in stroke survivors with the spastic ankle on the ankle joint properties and balance function post-stroke, and further explore the correlations between the ankle stiffness and balance. Methods: Twenty inpatients post-stroke with ankle spasticity received 20 minutes of stretching training daily over two weeks. The experimental group used a robot-aided stretching device, and the control group received manual stretching. Outcome measures were evaluated before and after training. The primary outcome measure was ankle stiffness. The secondary outcome measures were passive dorsiflexion ranges of motion, dorsiflexor muscle strength, Modified Ashworth Scale (MAS), Fugl-Meyer Motor Assessment of Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and the Pro-Kin balance test. Results: After training, two groups showed significantly within-group improvements in dorsiflexor muscle strength, FMA-LE, BBS, MBI (P < 0.05). The between-group comparison showed no significant differences in all outcome measures (P > 0.0025). The experimental group significantly improved in the stiffness and passive range of motion of dorsiflexion, MAS. In the Pro-Kin test, the experimental group improved significantly with eyes closed and open (P < 0.05), but significant improvements were found in the control group only with eyes open (P < 0.05). Dorsiflexion stiffness was positively correlated with the Pro-Kin test results with eyes open and the MAS (P < 0.05). Conclusions: The robot-aided and manual ankle stretching training provided similar significant improvements in the ankle properties and balance post-stroke. However, only the robot-aided stretching training improved spasticity and stiffness of dorsiflexion significantly. Ankle dorsiflexion stiffness was correlated with balance function. Clinical Trial Registration:www.chictr.org.cn ChiCTR2000030108.
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Affiliation(s)
- Xiaoxue Zhai
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qiong Wu
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Xin Li
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Quan Xu
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yanlin Zhang
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Senchao Fan
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States.,Department of Orthopaedics, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
| | - Yu Pan
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
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Oba K, Samukawa M, Nakamura K, Mikami K, Suzumori Y, Ishida Y, Keeler N, Saitoh H, Yamanaka M, Tohyama H. Influence of Constant Torque Stretching at Different Stretching Intensities on Flexibility and Mechanical Properties of Plantar Flexors. J Strength Cond Res 2021; 35:709-714. [DOI: 10.1519/jsc.0000000000002767] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vialleron T, Delafontaine A, Ditcharles S, Fourcade P, Yiou E. Effects of stretching exercises on human gait: a systematic review and meta-analysis. F1000Res 2020; 9:984. [PMID: 33728043 PMCID: PMC7919610 DOI: 10.12688/f1000research.25570.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.
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Affiliation(s)
- Thomas Vialleron
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Arnaud Delafontaine
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Sebastien Ditcharles
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
- ENKRE, Saint Maurice, Ile de France, 94410, France
| | - Paul Fourcade
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Eric Yiou
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
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Vialleron T, Delafontaine A, Ditcharles S, Fourcade P, Yiou E. Effects of stretching exercises on human gait: a systematic review and meta-analysis. F1000Res 2020; 9:984. [PMID: 33728043 PMCID: PMC7919610 DOI: 10.12688/f1000research.25570.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 04/01/2024] Open
Abstract
Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.
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Affiliation(s)
- Thomas Vialleron
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Arnaud Delafontaine
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Sebastien Ditcharles
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
- ENKRE, Saint Maurice, Ile de France, 94410, France
| | - Paul Fourcade
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Eric Yiou
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
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Effect of chronic stretching interventions on the mechanical properties of muscles in patients with stroke: A systematic review. Ann Phys Rehabil Med 2020; 63:222-229. [DOI: 10.1016/j.rehab.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 12/02/2019] [Accepted: 12/14/2019] [Indexed: 01/01/2023]
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Comparing the acute effect of myofascial release techniques and passive stretching on hind foot dynamic loading in patients with multiple sclerosis: A cohort-blinded study. BIOMEDICAL HUMAN KINETICS 2020. [DOI: 10.2478/bhk-2020-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Summary
Study aim: It is important for therapists to incorporate new practical methods into therapy programs when they have demonstrable efficacy in the treatment of multiple sclerosis. Investigating the acute effects of myofascial release techniques (MFR) and passive stretching (PS) on hind foot loading and the severity of spasticity in individuals with multiple sclerosis (MS) was the aim of the study.
Material and methods: Following the initial evaluation, 10 participants with MS (n = 20 feet) were given MFR for the plantar flexor muscle group. After the day following the first visit, participants were asked to come again and PS was applied to the plantar flexor muscle groups after the evaluation. The severity of spasticity was assessed with the Modified Ashworth Scale (MAS). Dynamic loading parameters of the hind foot – medial and lateral maximum pressure (N/cm2), active contact areas (cm2), contact percentiles (%) – were evaluated with dynamic pedobarography. Participants of the study were evaluated four times: (1) at the initial evaluation, (2) after MFR application, (3) 24 hours after the initial evaluation (pre-PS), (4) after PS.
Results: There were no differences in MAS (p > 0.05) according to time-dependent analyses (p > 0.05). After MFR, the maximum pressure of the medial heel and active contact area were increased (p < 0.05) and there was a carryover effect on the maximum pressure of the right foot.
Conclusions: This study showed that MFR was an effective method for management of plantar flexor spasticity in patients with multiple sclerosis in the short term and there was a carryover effect in favor of MFR. There was no additional effect of PS.
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Immediate Effects of Intermittent Bilateral Ankle Plantar Flexors Static Stretching on Balance and Plantar Pressures. J Manipulative Physiol Ther 2020; 43:24-31. [PMID: 32061419 DOI: 10.1016/j.jmpt.2019.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the immediate effects of an intermittent plantar flexion static-stretching protocol on balance and plantar pressures. METHODS The study included a sample size of 24 healthy participants (21 female and 3 male). Participants were 32.20 ± 8.08 years, 166.20 ± 8.43 cm, and 62.77 ± 9.52 kg. All participants performed an intermittent plantar flexion static-stretching protocol. Five sets (60 seconds intermittent stretch; 15 seconds for the rest time) of a passive plantar flexor stretching (70% to 90% of the point of discomfort) were performed. Static footprint analysis and a stabilometry analysis were performed before and after stretching. A P value < .05 with a CI of 95% was considered statistically significant for all tests. RESULTS Intermittent ankle plantar static stretching resulted in a significantly greater forefoot surface contact area and lower rear foot medium and maximum plantar pressures. In addition, static stretching caused a lower displacement of the center of pressure for both eyes open and eyes closed conditions. CONCLUSION An intermittent plantar flexor static-stretching protocol improved balance and reduced rear foot plantar pressures (maximum and medium pressures).
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Martínez-Jiménez EM, Losa-Iglesias ME, Díaz-Velázquez JI, Becerro-De-Bengoa-Vallejo R, Palomo-López P, Calvo-Lobo C, López-López D, Rodríguez-Sanz D. Acute Effects of Intermittent Versus Continuous Bilateral Ankle Plantar Flexor Static Stretching on Postural Sway and Plantar Pressures: A Randomized Clinical Trial. J Clin Med 2019; 8:jcm8010052. [PMID: 30621009 PMCID: PMC6352023 DOI: 10.3390/jcm8010052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Postural balance and fall efficacy (self-perceived confidence in performing daily physical activities) have been found to be risk factors associated with falls in older adults. Stretching is one intervention that has been investigated to improve balance and therefore reduce fall risk. Various forms of stretching have been evaluated with different outcomes, but there is a lack of knowledge about the effect of stretching (continuous and intermittent) on plantar pressures and balance. Therefore, the aim of the present study was to analyze the effects of stretching (continuous and intermittent) of the bilateral ankle plantar flexors on plantar pressures and static balance. METHODS A randomized clinical trial was carried out. Forty-eight healthy subjects (42 females and 6 males) were recruited in an outpatient clinic. Subjects were randomly assigned to an intermittent stretching group (five sets of 1 min; 15 s of rest) or a continuous stretching group (2 min of continuous stretching) of the plantar flexors. Plantar pressures and balance using stabilometry were measured before and after stretching. RESULTS There were significant differences between intermittent and continuous stretching in rearfoot maximum pressure, forefoot surface area, and center of pressure surface area with eyes open. CONCLUSIONS Bilateral intermittent stretching of the ankle plantar flexors was found to be more effective than continuous stretching for the reduction of rearfoot maximum pressure and improved balance.
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Affiliation(s)
- Eva María Martínez-Jiménez
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid 28040, Spain.
| | | | | | | | - Patricia Palomo-López
- Department of Nursing, University Center of Plasencia, University of Extremadura, Plasencia 10600, Spain.
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Faculty of Health Sciences, Universidad de León, Ponferrada 24401, León, Spain.
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences. Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol 15403, Spain.
| | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid 28040, Spain.
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid 28670, Spain.
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Bani-Ahmed A. The evidence for prolonged muscle stretching in ankle joint management in upper motor neuron lesions: considerations for rehabilitation - a systematic review. Top Stroke Rehabil 2018; 26:153-161. [PMID: 30477408 DOI: 10.1080/10749357.2018.1550958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND As clinicians, muscles stretching approaches are one of the most commonly used interventions in rehabilitation. However, there is a need for an in-depth evaluation of research on prolonged stretching in terms of the features of the stretching approaches, such as duration and frequency, as well as the compatible measures of a successful stretching approach. OBJECTIVE This review is an effort to synthesize findings from studies on "prolonged" stretching approaches in patients with UMNs including stroke, spinal cord injuries, and traumatic brain injuries. We investigated the compatible features of successful stretching regimens in terms of reducing spasticity, improving the Active Range of Motion (AROM), Passive Range of Motion (PROM), and gait training of spastic patient with upper motor neuron lesions. METHODS Studies evaluating the effectiveness of "prolonged" stretching on spastic ankle planterflexor muscles and its complications were critically reviewed, and the level of evidence was analyzed. RESULTS There is a sufficient level of evidence to support the use of stretching as and effective techniques in rehabilitation. However, more research is yet to be done to objectively examine the ideal parameters of a successful stretching approach using functional assessments, such as walking, speed, walking capacity, and balance. CONCLUSION The review adds stronger understanding with regard to stretching considerations in rehabilitation following UMNs. The ideal approach, as well as the functional implications on motor performance are yet to be further studied.
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Affiliation(s)
- Ali Bani-Ahmed
- a Department of Physical Therapy , University of Tabuk (UT) , Tabuk , Kingdom of Saudi Arabia (KSA)
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Ochi A, Fukumoto M, Takami R, Ohko H, Hayashi T, Yamada K. Effect of ankle stretching combined with arm cycling on the improvement of calf muscle stiffness in patients with stroke: a pilot study. J Phys Ther Sci 2018; 30:1305-1309. [PMID: 30349169 PMCID: PMC6181649 DOI: 10.1589/jpts.30.1305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to ascertain whether ankle stretching combined with arm cycling compared with that without arm cycling results in greater improvement in maximum dorsiflexion range of motion (ROM), calf muscle stiffness, and gait velocity in the affected limb of patients with stroke. [Participants and Methods] Random ABAB reversal design was used in this study involving nine patients with stroke. Participants performed 10 min of ankle plantar flexor stretching through weight bearing using the tilt table under the following 2 conditions: with or without arm cycling at 60 revolutions per minute. Pre- and post-stretching maximum ROM and passive plantar flexion torque were measured using a custom-made passive torque indicator. Stiffness was calculated based on passive torque-angle relationships. [Results] Maximum ROM and stiffness significantly improved after stretching in both conditions, whereas no changes in gait velocity were found. The difference in pre- and post-stretching stiffness was significantly greater in the stretching with arm cycling group. Change in maximum ROM showed no difference between both stretching conditions. [Conclusion] This study indicates that ankle plantar flexor stretching combined with arm cycling was more effective than that without cycling in improving calf muscle stiffness in the affected limb of patients with stroke.
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Affiliation(s)
- Akira Ochi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University: 2-172 Fukinodai, Toukai-City, Aichi 476-8588, Japan.,Department of Rehabilitation, Yamada Hospital, Japan
| | | | - Ryosuke Takami
- Department of Rehabilitation, Geriatric Health Services Facility, Terada Garden, Japan
| | - Hiroshi Ohko
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University: 2-172 Fukinodai, Toukai-City, Aichi 476-8588, Japan
| | - Takahiro Hayashi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University: 2-172 Fukinodai, Toukai-City, Aichi 476-8588, Japan
| | - Kazumasa Yamada
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University: 2-172 Fukinodai, Toukai-City, Aichi 476-8588, Japan.,Department of Rehabilitation, Yamada Hospital, Japan
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Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Akbarzadeh Baghban A, Ghasemi M. The Effect of Functional Stretching Exercises on Neural and Mechanical Properties of the Spastic Medial Gastrocnemius Muscle in Patients with Chronic Stroke: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2018; 27:1733-1742. [PMID: 29706442 DOI: 10.1016/j.jstrokecerebrovasdis.2018.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/08/2018] [Accepted: 01/23/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Following spasticity, neural and mechanical changes of the paretic muscle often occur, which affect the muscle function. The aim of this study was to investigate the effect of functional stretching exercises on neural and mechanical properties of the spastic muscle in patients with stroke. MATERIALS AND METHODS This study was a single-blinded, randomized control trial. Forty five patients with stroke (experimental group: n = 30; control group: n = 15) participated in this study. Subjects in the experimental group participated in a functional stretching program 3 times a week for 4 weeks. Subjects in both groups were evaluated before the training, at the end of training, and then during a 2-month follow-up. Neural properties, including H-reflex latency and Hmax/Mmax ratio, were acquired. Mechanical properties, including fascicle length, pennation angle, and muscle thickness in the spastic medial gastrocnemius muscle, were evaluated. Repeated measure analysis of variance was used in the analysis. RESULTS Time by group interaction in the pennation angle (P = .006), and in muscle thickness (P = .030) was significant. The results indicated that the H-reflex latency (P = .006), pennation angle (P < .001), and muscle thickness (P = .001) were altered after stretching training program and these changes were at significant level after 2-month follow-up. CONCLUSION The results indicated that the use of functional stretching exercises can cause significant differences in neural and mechanical properties of spastic medial gastrocnemius muscle in patients with chronic stroke.
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Affiliation(s)
- Ehsan Ghasemi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi-Kalantari
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Minoo Khalkhali-Zavieh
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Rezasoltani
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Ghasemi
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ghasemi
- Department of Neurology & Isfahan Neurosciences Research Center, Faculty of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Baghban AA, Ghasemi M. The effect of functional stretching exercises on functional outcomes in spastic stroke patients: A randomized controlled clinical trial. J Bodyw Mov Ther 2017; 22:1004-1012. [PMID: 30368324 DOI: 10.1016/j.jbmt.2017.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/04/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stroke is the biggest cause of disability in adults. Spasticity is a primary impairment of stroke with a highly variable prevalence. In the present research, we aimed to determine the impact of functional stretching exercises on functional outcomes in stroke patients. METHODS Thirty stroke patients were randomized into two groups-Experimental group and control group for the purposes of the study. The subjects in the experimental group participated in a functional stretching training program at the rehabilitation center thrice a week for four weeks. The subjects in both groups were evaluated in 3 intervals, once at baseline, once at the end of the program, and once at 2 months following the program. Clinical assessments, such as measuring spasticity, were conducted using the Modified Modified Ashworth Scale (MMAS). Functional outcomes were also evaluated, using the Timed Up and Go (TUG) test, as well as the Timed 10-Meter Walk Test (WTT). Friedman test in SPSS version 22.0 was used to analysis the response variables with respect to each stage of evaluation. Spearman rank correlation was also used to measure correlation among clinical assessments and functional outcomes. RESULTS The comparison between two groups showed significant differences only in the Modified Modified Ashworth Scale and Visual Analogue Scale (VAS) post treatment. The experimental group showed significant differences in the MMAS (p = 0.002), WTT (p < 0.001), and TUG (p < 0.001) scores. Nevertheless, the scores of the control group were not significantly different in different stages of evaluation. CONCLUSION The findings of the study suggest that using functional stretching exercises can improve functional outcomes in chronic spastic stroke patients.
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Affiliation(s)
- Ehsan Ghasemi
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi-Kalantari
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Minoo Khalkhali-Zavieh
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Rezasoltani
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Ghasemi
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ghasemi
- Department of Neurology& Isfahan Neurosciences Research Center, Faculty of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Takeuchi N, Takezako N, Shimonishi Y, Usuda S. Effects of high-intensity pulse irradiation with linear polarized near-infrared rays and stretching on muscle tone in patients with cerebrovascular disease: a randomized controlled trial. J Phys Ther Sci 2017; 29:1449-1453. [PMID: 28878481 PMCID: PMC5574354 DOI: 10.1589/jpts.29.1449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/29/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to clarify the influence of high-intensity pulse
irradiation with linear polarized near-infrared rays (HI-LPNR) and stretching on
hypertonia in cerebrovascular disease patients. [Subjects and Methods] The subjects were
40 cerebrovascular disease patients with hypertonia of the ankle joint plantar flexor
muscle. The subjects were randomly allocated to groups undergoing treatment with HI-LPNR
irradiation (HI-LPNR group), stretching (stretching group), HI-LPNR irradiation followed
by stretching (combination group), and control group (10 subjects each). In all groups,
the passive range of motion of ankle dorsiflexion and passive resistive joint torque of
ankle dorsiflexion were measured before and after the specified intervention. [Results]
The changes in passive range of motion, significant increase in the stretching and
combination groups compared with that in the control group. The changes in passive
resistive joint torque, significant decrease in HI-LPNR, stretching, and combination
groups compared with that in the control group. [Conclusion] HI-LPNR irradiation and
stretching has effect of decrease muscle tone. However, combination of HI-LPNR irradiation
and stretching has no multiplier effect.
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Affiliation(s)
- Nobuyuki Takeuchi
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Japan.,Department of Rehabilitation, Honjo General Hospital, Japan
| | - Nobuhiro Takezako
- Department of Rehabilitation, Takasaki University of Health and Welfare Attached Clinic, Japan
| | | | - Shigeru Usuda
- Gunma University Graduate School of Health Sciences, Japan
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KUNG PINCHENG, LIN CHOUCHINGK, CHEN SHUMIN, JU MINGSHAUNG. CONTROL OF FOREARM MODULE IN UPPER-LIMB REHABILITATION ROBOT FOR REDUCTION AND BIOMECHANICAL ASSESSMENT OF PRONATOR HYPERTONIA OF STROKE PATIENTS. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spastic hypertonia causes loss of range of motion (ROM) and contractures in patients with post-stroke hemiparesis. The pronation/supination of the forearm is an essential functional movement in daily activities. We developed a special module for a shoulder-elbow rehabilitation robot for the reduction and biomechanical assessment of pronator/supinator hypertonia of the forearm. The module consisted of a rotational drum driven by an AC servo motor and equipped with an encoder and a custom-made torque sensor. By properly switching the control algorithm between position control and torque control, a hybrid controller able to mimic a therapist’s manual stretching movements was designed. Nine stroke patients were recruited to validate the functions of the module. The results showed that the affected forearms had significant increases in the ROM after five cycles of stretching. Both the passive ROM and the average stiffness were highly correlated to the spasticity of the forearm flexor muscles as measured using the Modified Ashworth Scale (MAS). With the custom-made module and controller, this upper-limb rehabilitation robot may be able to aid physical therapists to reduce hypertonia and quantify biomechanical properties of the muscles for forearm rotation in stroke patients.
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Affiliation(s)
- PIN-CHENG KUNG
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
| | - CHOU-CHING K. LIN
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
- Department of Neurology, University Hospital, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
| | - SHU-MIN CHEN
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
- Department of Physical Medicine and Rehabilitation, University Hospital, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
| | - MING-SHAUNG JU
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
- Department of Mechanical Engineering, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
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Rhee MH, Kim LJ. Muscle tone changes in the lower limbs of stroke patients induced by trunk stabilization exercises. J Phys Ther Sci 2015; 27:2663-4. [PMID: 26357455 PMCID: PMC4563339 DOI: 10.1589/jpts.27.2663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/15/2015] [Indexed: 11/28/2022] Open
Abstract
bstract. [Purpose] The purpose of this study was to identify the effects of
trunk stabilization exercises on the spasticity of the lower limbs in stroke patients.
[Subject] The subject of this study was a 38-year-old male patient who experienced a
spontaneous intracranial hemorrhage, and had motor paralysis symptoms and spasticity on
the left side. [Methods] The Hmax/Mmax ratio was measured before and after the trunk
stabilization exercises, by using proprioceptive neuromuscular facilitation techniques.
[Results] The Hmax/Mmax ratio changed from 37% to 20%. [Conclusion] Trunk stabilization
exercises help control the muscle tone in stroke patients.
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Affiliation(s)
- Min-Hyung Rhee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Republic of Korea
| | - Laurentius Jongsoon Kim
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
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Thibaut A, Deltombe T, Wannez S, Gosseries O, Ziegler E, Dieni C, Deroy M, Laureys S. Impact of soft splints on upper limb spasticity in chronic patients with disorders of consciousness: A randomized, single-blind, controlled trial. Brain Inj 2015; 29:830-6. [DOI: 10.3109/02699052.2015.1005132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Are rest intervals between stretching repetitions effective to acutely increase range of motion? Int J Sports Physiol Perform 2014; 10:191-7. [PMID: 25010018 DOI: 10.1123/ijspp.2014-0192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Static stretching with rest between repetitions is often performed to acutely increase joint flexibility. PURPOSE To test the effects of the lack of resting between stretching repetitions and the minimal number of stretching repetitions required to change the maximal range of motion (ROM), maximal tolerated joint passive torque (MPT), and submaximal passive torque at a given angle (PT). METHODS Five static stretching repetitions with a 30-s rest-interval (RI) and a no-rest-interval (NRI) stretching protocol were compared. Participants (N=47) were encouraged to perform the maximal ROM without pain in all the repetitions. Each repetition lasted 90 s. Maximal ROM, MPT, PT, and muscle activity were compared between protocols for the same number of stretching repetitions. RESULTS The NRI produced a higher increase in maximal ROM and MPT during and after stretching (P<.05). PT decreased in both protocols, although the NRI tended to have a lower decrement across different submaximal angles (.05<P<.08) in the initial range of the torque-angle curve. Significant changes in maximal ROM (P<.01) and PT (P<.01) were obtained at the 3rd and 2nd repetitions of RI, respectively. The RI did not significantly increase the MPT (P=.12) after stretching; only the NRI did (P<.01). CONCLUSIONS Lack of rest between repetitions more efficiently increased the maximal ROM and capacity to tolerate PT during and after stretching. The use of 30 s rest between repetitions potentiates the decrease in PT. Rest intervals should not be used if the aim is to acutely increase maximal ROM and peak passive torque.
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Triandafilou KM, Kamper DG. Carryover effects of cyclical stretching of the digits on hand function in stroke survivors. Arch Phys Med Rehabil 2014; 95:1571-6. [PMID: 24794423 DOI: 10.1016/j.apmr.2014.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/10/2014] [Accepted: 04/19/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the longevity and cumulative impact of multiple sessions of passive, cyclical stretching of the digits on hand function in subacute stroke survivors. DESIGN Before-after trial with intervention repeated on 3 consecutive days. SETTING Research laboratory. PARTICIPANTS Individuals (N=27) with moderate to severe hand impairment, 2 to 6 months (subacute, n=12) and >7 months (chronic, n=15) poststroke. INTERVENTIONS Subjects wore an actuated glove orthosis that cyclically moved their fingers and thumb from a relaxed/flexed posture into neutral extension for 30 minutes on 3 consecutive days. MAIN OUTCOME MEASURES Three hand-specific tasks from the Graded Wolf Motor Function Test, Box and Block Test (BBT), grip strength, and lateral pinch strength. Recordings were taken before stretching and at 3 time points, each separated by 30 minutes after completion of stretching on each day. RESULTS Significant improvement was observed immediately after the stretching for both groups. Improvements in the subacute group were largely maintained up to 1 hour poststretching, with significant carryover from day to day for some outcomes measures such as the BBT (P=.006) and grip strength (P=.012). In contrast, improvements after stretching for the chronic group were transient, with the changes largely dissipating over time and no significant cumulative effect across days. CONCLUSIONS Cyclical stretching of the digits had a lasting and reinforcing effect on improving hand motor control for subacute stroke survivors. Incorporation of cyclical stretching before active hand therapy may prove to be a beneficial treatment for stroke survivors, especially during the subacute phase of recovery.
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Affiliation(s)
| | - Derek G Kamper
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL; Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL
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Cabido CET, Bergamini JC, Andrade AGP, Lima FV, Menzel HJ, Chagas MH. Acute Effect of Constant Torque and Angle Stretching on Range of Motion, Muscle Passive Properties, and Stretch Discomfort Perception. J Strength Cond Res 2014; 28:1050-7. [DOI: 10.1519/jsc.0000000000000241] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mohammed Meeran RA, Durairaj V, Sekaran P, Farmer SE, Pandyan AD. Assistive technology, including orthotic devices, for the management of contractures in adult stroke patients. Hippokratia 2013. [DOI: 10.1002/14651858.cd010779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Venugopal Durairaj
- South Staffordshire and Stoke-on-Trent Partnership Trust; Provider Services; Edwin House, Centrum 100 2nd Avenue Burton-on-Trent UK DE14 2WF
| | - Padmanaban Sekaran
- Keele University; School of Health and Rehabilitation; MacKay BUilding Keele UK
| | - Sybil E Farmer
- Keele University; Research Institute for Life Course Studies; MacKay Building Keele UK ST5 5BG
| | - Anand D Pandyan
- Keele University; School of Health and Rehabilitation; MacKay BUilding Keele UK
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Rao S, Riskowski JL, Hannan MT. Musculoskeletal conditions of the foot and ankle: assessments and treatment options. Best Pract Res Clin Rheumatol 2013; 26:345-68. [PMID: 22867931 DOI: 10.1016/j.berh.2012.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Musculoskeletal conditions of the foot and ankle are an important public health challenge due to their increasing incidence combined with their substantial negative impact on patients' quality of life. Non-pharmacological treatments serve as the first line of treatment and are frequently used for patients with musculoskeletal conditions of the foot and ankle. This review provides a summary of the assessments and non-invasive treatment options based upon available evidence. Recent studies show that individuals with foot and ankle pain have multiple co-existing impairments in alignment, motion, load distribution and muscle performance that may be evident in static and/or dynamic tasks. In addition, both clinical and epidemiological studies support the inter-dependence between the foot and proximal joints. For instance, aberrant foot structure has been linked to foot osteoarthritis (OA), as well as OA and pain at the knee and hip. Most recently, advances in motion capture technology and plantar load distribution measurement offer opportunities for precise dynamic assessments of the foot and ankle. In individuals with musculoskeletal conditions of the foot and ankle, the chief objectives of treatment are to afford pain relief, restore mechanics (alignment, motion and/or load distribution) and return the patient to their desired level of activity participation. Given that most patients present with multiple impairments, combinational therapies that target foot-specific as well as global impairments have shown promising results. In particular, in individuals with rheumatoid arthritis and other rheumatic diseases, comprehensive rehabilitation strategies including early detection, foot-based interventions (such as orthoses) and wellness-based approaches for physical activity and self-management have been successful. While significant improvements have been made in the last decade to the assessment and treatment of foot and ankle conditions, few randomised clinical trials specifically have investigated patients with foot or ankle conditions to provide global insights into this area. Consequently, current recommendations vary based upon the scope of studies presented in this review as well as the strength of studies. This review indicates a need for more in-depth investigations into the components of assessment and treatment options for foot and ankle musculoskeletal conditions.
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Affiliation(s)
- Smita Rao
- Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, USA
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Haubruck P, Mannava S, Plate JF, Callahan MF, Wiggins WF, Schmidmaier G, Tuohy CJ, Saul KR, Smith TL. Botulinum Neurotoxin A injections influence stretching of the gastrocnemius muscle-tendon unit in an animal model. Toxins (Basel) 2012; 4:605-19. [PMID: 23012650 PMCID: PMC3446746 DOI: 10.3390/toxins4080605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/09/2012] [Accepted: 08/10/2012] [Indexed: 12/13/2022] Open
Abstract
Botulinum Neurotoxin A (BoNT-A) injections have been used for the treatment of muscle contractures and spasticity. This study assessed the influence of (BoNT-A) injections on passive biomechanical properties of the muscle-tendon unit. Mousegastrocnemius muscle (GC) was injected with BoNT-A (n = 18) or normal saline (n = 18) and passive, non-destructive, in vivo load relaxation experimentation was performed to examine how the muscle-tendon unit behaves after chemical denervation with BoNT-A. Injection of BoNT-A impaired passive muscle recovery (15% vs. 35% recovery to pre-stretching baseline, p < 0.05) and decreased GC stiffness (0.531 ± 0.061 N/mm vs. 0.780 ± 0.037 N/mm, p < 0.05) compared to saline controls. The successful use of BoNT-A injections as an adjunct to physical therapy may be in part attributed to the disruption of the stretch reflex; thereby modulating in vivo passive muscle properties. However, it is also possible that BoNT-A injection may alter the structure of skeletal muscle; thus modulating the in vivo passive biomechanical properties of the muscle-tendon unit.
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Affiliation(s)
- Patrick Haubruck
- UniversitätsKlinikum Heidelberg, Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany;
- Authors to whom correspondence should be addressed; (P.H.); (J.F.P.); Tel.: +1-336-713-4025; Fax: +1-336-713-7310
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Johannes F. Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
- Authors to whom correspondence should be addressed; (P.H.); (J.F.P.); Tel.: +1-336-713-4025; Fax: +1-336-713-7310
| | - Michael F. Callahan
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
| | - Walter F. Wiggins
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
- The Neuroscience Program, Wake Forest University Graduate School of Arts and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Gerhard Schmidmaier
- UniversitätsKlinikum Heidelberg, Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany;
| | - Christopher J. Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
| | - Katherine R. Saul
- Department of Biomedical Engineering, Wake Forest School of Medicine and VT-WFU School of Biomedical Engineering and Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA;
| | - Thomas L. Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; (S.M.); (M.F.C.); (W.F.W.); (C.J.T.); (T.L.S.)
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Herda TJ, Costa PB, Walter AA, Ryan ED, Cramer JT. The time course of the effects of constant-angle and constant-torque stretching on the muscle-tendon unit. Scand J Med Sci Sports 2012; 24:62-7. [PMID: 22738303 DOI: 10.1111/j.1600-0838.2012.01492.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2012] [Indexed: 11/30/2022]
Abstract
The purpose of the present study was to examine the time course of passive range of motion (PROM), passive torque (PASTQ), and musculo-tendinous stiffness (MTS) responses during constant-angle (CA) and constant-torque (CT) stretching of the leg flexors. Eleven healthy men [mean ± standard deviation (SD): age = 21.5 ± 2.3 years] performed 16 30-s bouts of CA and CT stretching of the leg flexors. PROM, PASTQ , and MTS were measured during stretches 1, 2, 4, 8, and 16. For PROM and PASTQ , there were no differences between CA and CT stretching treatments (P > 0.05); however, there were stretch-related differences (P < 0.001). PROM increased following one 30-s bout of stretching (collapsed across CA and CT stretching) with additional increases up to 8 min of stretching. PASTQ decreased following one 30-s bout of stretching (collapsed across CA and CT stretching) and continued to decrease up to 4 min of stretching. In contrast, only the CT stretching treatment resulted in changes to MTS (P < 0.001). MTS decreased after one 30-s bout of CT stretching, with subsequent decreases in MTS up to 6 min of stretching. These results suggested that CT stretching may be more appropriate than a stretch held at a constant muscle length for decreasing MTS.
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Affiliation(s)
- T J Herda
- Biomechanics Laboratory, Department of Health, Sport and Exercise Sciences, University of Kansas, Lawrence, Kansas, USA
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31
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Lorentzen J, Nielsen D, Holm K, Baagøe S, Grey MJ, Nielsen JB. Neural tension technique is no different from random passive movements in reducing spasticity in patients with traumatic brain injury. Disabil Rehabil 2012; 34:1978-85. [PMID: 22423894 DOI: 10.3109/09638288.2012.665132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Neural tension technique (NTT) is a therapy believed to reduce spasticity and to increase range of motion (ROM). This study compared the ability of NTT and random passive movements (RPMs) to reduce spasticity in the knee flexors in 10 spastic patients with brain injury. METHODS An RCT study with crossover design evaluated muscle tone measured by: 1) hand-held dynamometer; 2) Modified Ashworth Scale (MAS); 3) and ROM by; 4) angles of resistance onset "catch" (R1) compensatory movement (R2); and 5) 'subjectively perceived reduction in muscle tone'. Outcome measures were recorded by three raters before and after a single treatment session. RESULTS Objective stiffness measured with the hand-held device showed no significant changes for the NTT or RPM (p ≥ 0.09-0.79). The subjective measures showed significant changes after the NTT for the non-blinded rater (MAS: p < 0.05: R1: p < 0.05; R2: p < 0.05), but for the blinded rater a significant reduction was found only for R1 (p < 0.05) and R2 (p < 0.05). For the non-blinded rater intervention effects were found for R1 (p < 0.01), R2 (p < 0.01) and subjectively perceived tone reduction (p < 0.01). For the blinded rater no intervention effect was found. CONCLUSIONS An objective evaluation of NTT demonstrates that it does not reduce spasticity. However, it does increase ROM with the same effect as RPM. IMPLICATIONS FOR REHABILITATION • Neural tension techniques does not reduce spasticity in patients with traumatic brain injury when evaluated with objective biomechanical evaluation methods. • Neural tension techniques may improve range of motion with the same effect as random passive movements.
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Affiliation(s)
- Jakob Lorentzen
- Department of Physiotherapy, Hvidovre Hospital/Department of Neurorehabilitation TBI Unit, Copenhagen University Hospital, Glostrup, Denmark.
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Macklin K, Healy A, Chockalingam N. The effect of calf muscle stretching exercises on ankle joint dorsiflexion and dynamic foot pressures, force and related temporal parameters. Foot (Edinb) 2012; 22:10-7. [PMID: 21944945 DOI: 10.1016/j.foot.2011.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 08/31/2011] [Accepted: 09/02/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous research has found that ankle joint equinus can lead to foot pathologies. Calf stretching exercises are a common treatment prescription; however, no dynamic quantitative data on its effectiveness is available. OBJECTIVE To investigate the effect of calf muscle stretching on ankle joint dorsiflexion and subsequent changes within dynamic forefoot peak plantar pressures (PPP), force and temporal parameters. METHOD Thirteen runners with ankle joint equinus were required to perform calf muscle stretching twice a day (morning and evening) on a Flexeramp. Measurements were collected on day 1, week 4 and week 8. A repeated measures ANOVA with Bonferroni-adjusted post hoc comparisons was used to assess differences across the three data collection sessions. RESULTS Findings indicated that the calf stretching program increased ankle joint dorsiflexion significantly (from 5° to 16°, p≤0.05). The adaptive kinetics brought about by the increased ankle joint range of motion included significantly increased forefoot PPP and maximum force during stance phase but decreased time between heel contact and heel lift and total stance phase time. CONCLUSION The calf stretching programme used in this study was found to increase ankle joint dorsiflexion and hence can be used for first line conservative management of ankle equinus.
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Affiliation(s)
- K Macklin
- Centre for Sport, Health and Exercise Research, Staffordshire University, ST4 2DF, UK
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33
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HERDA TRENTJ, COSTA PABLOB, WALTER ASHLEYA, RYAN ERICD, HOGE KATHERINEM, KERKSICK CHADM, STOUT JEFFREYR, CRAMER JOELT. Effects of Two Modes of Static Stretching on Muscle Strength and Stiffness. Med Sci Sports Exerc 2011; 43:1777-84. [DOI: 10.1249/mss.0b013e318215cda9] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ryan ED, Herda TJ, Costa PB, Walter AA, Cramer JT. Dynamics of viscoelastic creep during repeated stretches. Scand J Med Sci Sports 2011; 22:179-84. [PMID: 21362058 DOI: 10.1111/j.1600-0838.2010.01285.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study examined the viscoelastic creep responses in vivo during repeated constant-torque stretches in human skeletal muscle. Twelve healthy participants completed four consecutive 30-s constant-torque passive stretches of the right plantar flexor muscles. Position and surface electromyographic (EMG) amplitude values were quantified at every 5-s period and the percent change in position was quantified for each 5-s epoch relative to the total increase in ankle joint position for each stretch. In addition, the absolute changes in position were plotted on a logarithmic time scale and fit with a linear regression line to examine both the rate of increase (slope) and the overall increase in position over the entire stretch (y-intercept). The percent change and slope were similar (P>0.05) over all four stretches, with the majority of increases in position occurring within the initial 15-20 s of each stretch (84%). Absolute ankle joint position and the y-intercept increased (P<0.05) following both the first and second stretch but plateaued (P>0.05) after the third stretch. In addition, EMG amplitude values did not change (P>0.05) during or between each 30-s stretch. These data indicate that the amount and rate of viscoelastic creep were similar during practical durations of constant-torque stretching despite no change in ankle joint position following three 30-s stretches.
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Affiliation(s)
- E D Ryan
- Applied Musculoskeletal and Human Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, Stillwater, Oklahoma, USA.
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35
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Hoge KM, Ryan ED, Costa PB, Herda TJ, Walter AA, Stout JR, Cramer JT. Gender differences in musculotendinous stiffness and range of motion after an acute bout of stretching. J Strength Cond Res 2011; 24:2618-26. [PMID: 20885189 DOI: 10.1519/jsc.0b013e3181e73974] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of the present study was to examine musculotendinous stiffness (MTS) and ankle joint range of motion (ROM) in men and women after an acute bout of passive stretching. Thirteen men (mean ± SD age = 21 ± 2 years; body mass = 79 ± 15 kg; and height = 177 ± 7 cm) and 19 women (21 ± 3 years; 61 ± 9 kg; 165 ± 8 cm) completed stretch tolerance tests to determine MTS and ROM before and after a stretching protocol that consisted of 9 repetitions of passive, constant-torque stretching. The women were all tested during menses. Each repetition was held for 135 seconds. The results indicated that ROM increased after the stretching for the women (means ± SD pre to post: 109.39° ± 10.16° to 116.63° ± 9.63°; p ≤ 0.05) but not for the men (111.79° ± 6.84° to 113.93° ± 8.15°; p > 0.05). There were no stretching-induced changes in MTS (women's pre to postchange in MTS: -0.35 ± 0.38; men's MTS: +0.17 ± 0.40; p > 0.05), but MTS was higher for the men than for the women (MTS: 1.34 ± 0.41 vs. 0.97 ± 0.38; p ≤ 0.05). electromyographic amplitude for the soleus and medial gastrocnemius during the stretching tests was unchanged from pre to poststretching (p > 0.05); however, it increased with joint angle during the passive movements (p ≤ 0.05). Passively stretching the calf muscles increased stretch tolerance in women but not in men. But the stretching may not have affected the viscoelastic properties of the muscles. Practitioners may want to consider the possible gender differences in passive stretching responses and that increases in ROM may not always reflect decreases in MTS.
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Affiliation(s)
- Katherine M Hoge
- Biophysics Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma, USA
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Effect of a Bout of Leg Cycling With Electrical Stimulation on Reduction of Hypertonia in Patients With Stroke. Arch Phys Med Rehabil 2010; 91:1731-6. [DOI: 10.1016/j.apmr.2010.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 07/17/2010] [Accepted: 08/08/2010] [Indexed: 11/17/2022]
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Espasticidad después de la lesión medular: revisión de los mecanismos fisiopatológicos, técnicas de diagnóstico y tratamientos fisioterapéuticos actuales. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ft.2009.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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38
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Nordez A, McNair P, Casari P, Cornu C. Static and cyclic stretching: Their different effects on the passive torque–angle curve. J Sci Med Sport 2010; 13:156-60. [DOI: 10.1016/j.jsams.2009.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 02/03/2009] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
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Ryan ED, Herda TJ, Costa PB, Defreitas JM, Beck TW, Stout J, Cramer JT. Determining the minimum number of passive stretches necessary to alter musculotendinous stiffness. J Sports Sci 2009; 27:957-61. [PMID: 19629845 DOI: 10.1080/02640410902998254] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this study, we examined the minimum number of constant-torque passive stretches necessary to reduce musculotendinous stiffness. Thirteen healthy individuals (mean age 22 years, s = 3; stature 1.67 m, s = 0.1; mass 66 kg, s = 13 kg) volunteered to participate in the investigation and underwent four 30-s constant-torque passive stretches of the plantar flexor muscles. Musculotendinous stiffness was examined from the angle-torque curves generated prior to the passive stretches, at the beginning of each 30-s stretch, and immediately following the four 30-s passive stretches. The results indicated that musculotendinous stiffness of the plantar flexors was reduced following two 30-s constant-torque passive stretches (P < 0.05) compared with the pre- musculotendinous stiffness assessment. Musculotendinous stiffness remained depressed following the third and fourth stretches, but did not decrease further. These findings suggest that two 30-s bouts of constant-torque passive stretching may be necessary to cause a significant decrease in musculotendinous stiffness of the plantar flexor muscles.
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Affiliation(s)
- Eric D Ryan
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma 73019-6081, USA
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40
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The time course of musculotendinous stiffness responses following different durations of passive stretching. J Orthop Sports Phys Ther 2008; 38:632-9. [PMID: 18827325 DOI: 10.2519/jospt.2008.2843] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Repeated-measures experimental design. OBJECTIVE To examine the acute effects of different durations of passive stretching on the time course of musculotendinous stiffness (MTS) responses in the plantar flexor muscles. BACKGROUND Stretching is often implemented prior to exercise or athletic competition, with the intent to reduce the risk of injury via decreases in MTS. METHODS AND MEASURES Twelve subjects (mean +/- SD age, 24 +/- 3 years; stature, 169 +/- 12 cm; mass, 71 +/- 17 kg) participated in 4 randomly-ordered experimental trials: control with no stretching, 2 minutes (2min), 4 minutes (4min), and 8 minutes (8min) of passive stretching. The passive-stretching trials involved progressive repetitions of 30-second passive stretches, while the control trial involved 15 minutes of resting. MTS assessments were conducted before (prestretching), immediately after (poststretching), and at 10, 20, and 30 minutes poststretching on a Biodex System 3 isokinetic dynamometer. RESULTS MTS decreased (P<.05) immediately after all stretching conditions (2min, 4min, and 8min). However, MTS for the 2min condition returned to baseline within 10 minutes, whereas MTS after the 4min and 8min passive-stretching conditions returned to baseline within 20 minutes. CONCLUSIONS Practical durations of passive stretching resulted in significant decreases in MTS; however, these changes return to baseline levels within 10 to 20 minutes.
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41
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Bovend'Eerdt TJ, Newman M, Barker K, Dawes H, Minelli C, Wade DT. The Effects of Stretching in Spasticity: A Systematic Review. Arch Phys Med Rehabil 2008; 89:1395-406. [DOI: 10.1016/j.apmr.2008.02.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 01/31/2008] [Accepted: 02/06/2008] [Indexed: 10/21/2022]
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42
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Yeh CY, Chen JJJ, Tsai KH. Quantifying the effectiveness of the sustained muscle stretching treatments in stroke patients with ankle hypertonia. J Electromyogr Kinesiol 2007; 17:453-61. [PMID: 16934489 DOI: 10.1016/j.jelekin.2006.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Revised: 05/23/2006] [Accepted: 06/12/2006] [Indexed: 10/24/2022] Open
Abstract
Sustained muscle stretch (SMS) is commonly used to reduce hypertonia. The present study evaluates the effectiveness of three different SMS protocols, namely constant-angle, cyclic, and constant-torque stretching, in the immediate reducing of ankle hypertonia. Forty-seven hemiplegic subjects, 53.7+/-10.3 years old and 22.4+/-16.0 months after stroke, with hypertonic ankle joints were recruited to undergo three SMS applied to protocols treatment their hypertonic ankle joints using an integrated treatment/assessment system. The immediate post-treatment effectiveness of each stretching protocol was assessed by reference to the pre-treatment Modified Ashworth Scale (MAS), passive range of motion (ROM), and reactive torque measurement, from which the viscous-elastic components of the ankle joint were derived. All three SMS protocols successfully reduced MAS grade. Additionally, each stretching method yielded an increase in ankle ROM, from 9.7 degrees to 16 degrees , 9.6 degrees to 14.8 degrees , and 9.2 degrees to 18.3 degrees for the constant-angle, cyclic-stretching, constant-torque protocols, respectively, and reduction of the elastic and viscous properties of the ankle joint dorsiflexion (p<0.05). The changes in the ROM, elasticity, and viscosity were most pronounced in the case of the constant-torque stretching protocol. In addition to clinical scales, current biomechanical assessments indicate that three SMS protocols are all effective in reducing the immediate viscoelastic components of hypertonic ankle joints. Our quantitative analysis further shows that of the three treatment protocols, the constant-torque treatment is the most effective.
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Affiliation(s)
- Chun-Yu Yeh
- School of Physical Therapy, College of Medical Technology, Rehabilitation Hospital, Chung Shan Medical University, Taichung, Taiwan, ROC
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