Randomised trial of the effects of four weeks of daily stretch on extensibility of hamstring muscles in people with spinal cord injuries

Abstract

The aim of this assessor-blind randomised controlled trial was to determine the effect of four weeks of 30 minute stretches each weekday on extensibility of the hamstring muscles in people with recent spinal cord injuries. A consecutive sample of 16 spinal cord-injured patients with no or minimal voluntary motor power in the lower limbs and insufficient hamstring muscle extensibility to enable optimal long sitting were recruited. Subjects' legs were randomly allocated to experimental and control conditions. The hamstring muscles of the experimental leg of each subject were stretched with a 30 Nm torque at the hip for 30 minutes each weekday for four weeks. The hamstring muscles of the contralateral leg were not stretched during this period. Extensibility of the hamstring muscles (hip flexion range of motion with knee extended, measured with a 48 Nm torque at the hip) of both legs was measured by a blinded assessor at the commencement of the study and one day after the completion of the four-week stretch period. Changes in hamstring muscle extensibility from initial to final measurements were calculated. The effect of stretching was expressed as the mean difference in these changes between stretched and non-stretched legs. The mean effect of stretching was 1 degree (95% CI -2 to 5 degrees). Four weeks of 30 minute stretches each weekday does not affect the extensibility of the hamstring muscle in people with spinal cord injuries.

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

“…Our results showed that stretch interventions may prevent degeneration of the joint capsule leading to contractures and may affect biochemical composition rather than the morphologic features of the cartilage, although we cannot conclude from this study whether stretching is harmful to the cartilage. Several clinical studies in patients with spinal cord injuries suggest a substantial positive effect on soft tissues in stretched positions for prolonged periods [10,11,13]. The treatments evaluated in our study, using this particular animal model, should be considered to be geared toward treatment of contractures that might form very early after spinal cord injury, not chronic contractures of long duration.…”

“…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.…”

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

“…[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.…”

The effectiveness of physical interventions for people with spinal cord injuries: a systematic review

“…The median (interquartile range) PEDro score for trials was 4 (3-5; see Table 1). Only 12 trials blinded assessors 8,10,23,29,[31][32][33][35][36][37]40,43 and only six trials concealed allocation 10,[30][31][32][33]35 and performed intention-to-treat analyses. 23,[31][32][33]35,37 Dropouts were also a common problem, with only 18 trials reporting outcome data on at least 85% of subjects.…”