A randomized trial assessing the effects of 4 weeks of daily stretching on ankle mobility in patients with spinal cord injuries

Harvey, L A; Batty, Julia; Crosbie, Jack; Poulter, Simone; Herbert, Robert D.

doi:10.1053/apmr.2000.9168

Cited by 96 publications

(62 citation statements)

References 30 publications

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“…[16][17][18][19][20] Although passive movements confer a slightly different mechanical stimulus to that provided by sustained stretch, the two interventions are similar. The main difference is that passive movements involve the administration of repetitive short-duration stretches.…”

Section: Discussionmentioning

confidence: 99%

Effects of 6 months of regular passive movements on ankle joint mobility in people with spinal cord injury: a randomized controlled trial

et al. 2008

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Study design: Assessor-blinded within-subject randomized controlled trial. Objective: To determine the effects of 6 months of regular passive movements on ankle joint mobility in people with spinal cord injury. Setting: Community, Australia. Methods: A total of 20 people with tetraplegia living in the community had one ankle randomized to a control group and the other to an experimental group. Carers administered passive movements to participants' experimental ankles for 10 min, 10 times a week for 6 months. The control ankles were left untreated. The primary outcome was passive ankle dorsiflexion range of motion. Results: Adherence was high (mean adherence rate of 96%). Ankle dorsiflexion range of motion decreased by a mean (s.d.) of 21 (4) in control ankles and increased by 21 (4) in experimental ankles. The mean (95% confidence interval, CI) effect on ankle dorsiflexion range of motion was 41 (95% CI, 2-61). Conclusion: Regular passive movements have small effects on ankle joint mobility. It is unclear if these effects are clinically worthwhile.

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Section: Discussionmentioning

confidence: 99%

Effects of 6 months of regular passive movements on ankle joint mobility in people with spinal cord injury: a randomized controlled trial

et al. 2008

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“…Most importantly, contractures limit the function and independence of patients with these conditions, and they predispose individuals to other complications such as pressure sores, sleep disturbances, and pain [4,12,15,42]. Consequently, attention has been directed toward preventing and treating contractures in patients with neurologic conditions [10]. Nevertheless, we continue to see patients who have contractures that limit limb function [6].…”

Section: Introductionmentioning

confidence: 99%

“…Stretching (that is, the application of tension to soft tissues) has been advocated as an effective means of preventing and treating contractures in patients with neurologic conditions [9,10,12,15,16]. Additionally, it is believed that contractures can be prevented more readily than treated, and that less stretching is required to maintain rather than to increase the extensibility of soft tissues [12].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, it is believed that contractures can be prevented more readily than treated, and that less stretching is required to maintain rather than to increase the extensibility of soft tissues [12]. Considerable resources [12], including some rigorously designed clinical studies [1,10,11,13], have investigated the efficacy of stretching. However, it remains unclear whether the effects observed in these trials are clinically worthwhile, and the therapeutic effect of stretching on the pathophysiology of contractures has received little attention.…”

Section: Introductionmentioning

confidence: 99%

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Amount of Torque and Duration of Stretching Affects Correction of Knee Contracture in a Rat Model of Spinal Cord Injury

Moriyama¹,

Tobimatsu²,

Ozawa³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions. Questions/purposes Using an established T8 spinal cord injury rat model of knee contracture, we sought to determine what combination of static or intermittent stretching, varied by magnitude (high or low) and duration (long or short), leads to the best (1) improvement in the limitation in ROM; (2) restoration of the muscular and articular factors leading to contractures; and (3) prevention and treatment of contracture-associated histologic alterations of joint capsule and articular cartilage. Methods Using a rat animal model, the spinal cord was transected completely at the level of T8. The rats were randomly assigned to seven treatment groups (n = 4 per group), which were composed of static or intermittent stretching in combination with different amounts of applied torque magnitude and duration. We assessed the effect of stretching by measuring the ROM and evaluating the histologic alteration of the capsule and cartilage. Results Contractures improved in all treated groups except for the low-torque and short-duration static stretching conditions. High-torque stretching was effective against shortening of the synovial membrane and adhesions in the posterosuperior regions. Collagen Type II and VEGF in the cartilage were increased by stretching. Conclusions High-torque and long-duration static stretching led to greater restoration of ROM than the other torque and duration treatment groups. Stretching was more effective in improving articular components of contractures compared with the muscular components. Stretching in this rat model prevented shortening and adhesion of the joint capsule, and affected biochemical composition, but did not change morphologic features of the cartilage. Clinical Relevance This animal study tends to support the ideas that static stretching can influence joint ROM and histologic qualities of joint tissues, and that the way stretching is performed influences its efficacy. However, further studies are warranted to determine if our findings are clinically applicable.

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“…[10][11][12][13][14][15][16][17] Clinical assessment tools have been designed using these principles to measure the extensibility of muscles such as the plantarflexor muscles, [18][19][20] hamstring muscles, 21,22 and extrinsic finger flexor muscles. 23 However, no equivalent device to measure the extensibility of the FPL muscle has been described.…”

Section: Introductionmentioning

confidence: 99%

Quantifying the passive extensibility of the flexor pollicis longus muscle in people with tetraplegia

et al. 2005

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Study design: Repeat measures design. Objective: The purpose of this study was firstly, to describe a simple clinical tool that can be used to measure the extensibility of the flexor pollicis longus (FPL) muscle; secondly, to test its reliability; and thirdly, to attain some 'normative' data of the extensibility of the FPL muscle in a representative sample of people with tetraplegia. Setting: A spinal cord injury unit in Sydney. Subjects: A total of 37 people (62 hands) with C4-C7 tetraplegia. Main outcome measures: Angle of the carpometacarpal (CMC) joint of the thumb was measured in all subjects with the application of a series of thumb extensor torques. A device specifically designed for this purpose was used to standardize the torque and objectively quantify the CMC joint angle. In addition, repeat measurements were taken 3-5 days later in one subgroup of 13 subjects (one hand per subject) and 3 months later in another subgroup of 13 subjects (one hand per subject). Analysis: Intraclass correlation coefficients and percent close agreement scores were derived to quantify the 3-5 days and 3-month reliability between repeat measurements. Results: The median CMC angle of the thumb with the application of a 0.044 Nm torque was 63 degrees (range, 20-93 degrees). The intraclass correlation coefficients with the application of a 0.044 Nm torque were 0.88 (95% CI, 0.65-0.96) for measurements taken 3-5 days apart, and 0.90 (95% CI, 0.67-0.97) for measurements taken 3 months apart. Conclusion: This study describes a simple and reliable way of measuring the extensibility of the FPL muscle in people with tetraplegia. This assessment tool and the 'normative' data provided in this study can be used to further investigate the contribution of the passive mechanical properties of the FPL muscle to hand function of people with C6 and C7 tetraplegia.Spinal Cord (2005) 43, 620-624.

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A randomized trial assessing the effects of 4 weeks of daily stretching on ankle mobility in patients with spinal cord injuries

Cited by 96 publications

References 30 publications

Effects of 6 months of regular passive movements on ankle joint mobility in people with spinal cord injury: a randomized controlled trial

Effects of 6 months of regular passive movements on ankle joint mobility in people with spinal cord injury: a randomized controlled trial

Amount of Torque and Duration of Stretching Affects Correction of Knee Contracture in a Rat Model of Spinal Cord Injury

Quantifying the passive extensibility of the flexor pollicis longus muscle in people with tetraplegia

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