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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☆,☆☆,★,★★

https://doi.org/10.1053/apmr.2000.9168Get rights and content

Abstract

Harvey LA, Batty J, Crosbie J, Poulter S, Herbert RD. A randomized trial assessing the effects of 4 weeks of daily stretching on ankle mobility in patients with spinal cord injuries. Arch Phys Med Rehabil 2000;81:1340-7. Objective: To determine the effect of 4 weeks of 30 minutes of daily stretching on ankle mobility in patients with recent spinal cord injuries (SCIs). Design: Assessor-blinded randomized controlled trial. Setting: Two spinal injury units in Sydney, Australia. Patients: Consecutive sample of 14 recently injured patients with paraplegia and quadriplegia. Intervention: Treated ankles were stretched continuously into dorsiflexion with a torque of 7.5N·m for 30 minutes each weekday for 4 weeks. Contralateral ankles received no stretches. Main Outcome Measures: Passive torque-angle curves for both ankles were obtained at study commencement, then at weeks 2, 4, and 5 (ie, during, at the end of, and 1 week after the stretching program). Torque-angle measurements were obtained with the knee extended and flexed. Mean values for parameters (baseline angle, angle at 10N·m, slope) describing the characteristics of the torque-angle curves were derived for each knee position. Changes from pretest to each subsequent test were calculated, as well as 95% confidence intervals (CIs) for differences in these changes between stretched and controlled ankles. Results: The stretching intervention did not significantly change any of the 3 parameters describing the torque-angle curves of the ankle in either knee position. At the beginning of the study, the mean (±SD) angles obtained with the application of a standardized torque with the knee extended for the control and stretch ankles were 105° (± 10.4°) and 106° (± 9.8°), respectively. After 4 weeks, these values were 106° (± 10.6°) and 107° (± 10.6°) (mean difference in change of angle = 0°; 95% CI, − 3.3° to 3.3°). Conclusion: Thirty minutes of daily stretching for 4 weeks does not significantly change ankle mobility in recently injured patients with SCIs. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Patients

Patients from 2 SCI units in Sydney were asked to participate in the study. To be included, patients had to be participating in a rehabilitation program, have sustained an SCI within the preceding year, have no more than flickers of activity in muscles around both ankles (ie, not more than grade 1 of 5 motor strength), and be willing to cease assisted-standing and all passive exercises and stretches to their ankles for the duration of the study. Patients were not considered if they had pressure

Results

No patient withdrew from the study and all patients' ankles were treated according to their initial allocation. Outcome measures were obtained from all patients except in 1 patient in whom knee flexion data were not collected at week 2 because of an acute medical complication. At the commencement of the study, differences between stretched and controlled ankles for all 3 parameters were small and insignificant (table 1).

Table 1: Initial values of parameters of stretched and nonstretched ankles

Discussion

The aim of this study was to determine the effectiveness of stretching that is routinely provided to patients with SCIs for the treatment and prevention of ankle contractures. To ensure that sufficient stretching was applied, stretches were conducted for 30 minutes each day, which is a session that is considerably longer than those frequently applied in many clinical settings. In addition, stretching was administered with a mechanical device capable of providing more intense stretches than a

Conclusion

The results of this study indicate that patients with recent SCIs do not benefit from 4 weeks of 30-minute daily stretches. Those with poor initial ankle mobility did not respond more readily to regular stretching than others. Although our results do not suggest that patient subgroups will benefit from stretching interventions of this kind (fig 5), further studies are needed to clarify this issue. For example, it may be interesting to determine if the degree of spasticity influences the effect

Acknowledgements

The authors thank Dr. Anne Moseley for use of her instrumented footplate, and for advice on analyzing the data. We also thank the Motor Accident Authority of New South Wales for financial support, and the staff and patients from the Moorong Spinal Injuries Unit and the Spinal Injuries Unit at The Prince Henry Hospital, Sydney, Australia. The stretching devices were made by Ian Gothard and Darren Dawson.

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    ☆

    Supported by the Motor Accident Authority of New South Wales.

    ☆☆

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

    ★

    Reprint requests to Lisa Harvey, School of Physiotherapy, University of Sydney, P.O. Box 170, Lidcombe, New South Wales, 1825, Australia.

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    Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.