Effects of stretching exercises on human gait: a systematic review and meta-analysis

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.

Association of Moderate-to-Vigorous Physical Activity, Sedentary Time, Fat Percentage, and Physical Fitness with Gait Parameters in Women with Fibromyalgia: The Al-Ándalus Project

“…It has been hypothesized that strength improvements can improve gait speed through biomechanical factors, with the strength of the hip extensors and ankle plantar flexors acting as the best predictors of gait speed improvement [56]. However, there is no clear evidence of the effect of stretching on gait performance in older adults [57]. Also, in the current study, an unexpected relationship between upper-body strength and flexibility with multiple gait parameters was found.…”

Effects of Manual Therapy on Parkinson’s Gait: A Systematic Review

“…Thus, MT can be considered a complementary approach to maintain or improve ROM. However, a recent systematic review showed that no strong level of evidence supports the beneficial effect of using stretching alone to improve gait outcomes despite some scattered results [ 68 ]. These findings are in line with the current research, suggesting that MT alone may not be sufficient to increase ROM during gait as only isolated improvements were identified.…”

In Patients With Parkinson’s Disease in an OFF-Medication State, Does Bilateral Electrostimulation of Tibialis Anterior Improve Anticipatory Postural Adjustments During Gait Initiation?

“…The present study adds to the growing efforts made by researchers to improve APA associated with GI in PD patients by the means of non-pharmacological/non-invasive devices such as powered ankle orthosis ( Petrucci et al, 2019 ), self-triggered stimulus lowering stance side support surface, vibrations applied beneath the stance-side support surface ( Creath et al, 2013 ), whole-body vibration ( Fischer et al, 2019 ), lateral pull applied to the pelvis by motor-driven robotic system ( Mille et al, 2007 ) or rhythmic auditory stimulus ( Ghai et al, 2018 ). Study from our laboratory (not published) further suggests that acute ankle stretching may also be efficient to reduce ankle stiffness and improve APA in this population (see Vialleron et al, 2020 for a review on the effect of stretching on gait). Because gait and balance problems often respond poorly to treatment with anti-parkinsonian medications, and to other interventions such as deep brain stimulation ( Bonnet et al, 1987 ; Krack et al, 2003 ), it is admitted that physical therapy interventions are an important clinical treatment for individuals with PD.…”