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  • Title: Effect of chronic stretching interventions on the mechanical properties of muscles in patients with stroke: A systematic review.
    Author: Lecharte T, Gross R, Nordez A, Le Sant G.
    Journal: Ann Phys Rehabil Med; 2020 May; 63(3):222-229. PubMed ID: 31981838.
    Abstract:
    BACKGROUND: Muscle contractures are common after stroke and their treatment usually involves stretching. However, recent meta-analyses concluded that stretching does not increase passive joint amplitudes in patients with stroke. The effectiveness of treatment is usually evaluated by measuring range of motion alone; however, assessing the effects of stretching on the structural and mechanical properties of muscle by evaluating the torque-angle relationship can help in understanding the effects of stretching. Although several studies have evaluated this, the effects remain unclear. OBJECTIVE: A systematic review of the literature on the effectiveness of stretching procedures for which the outcomes included a measurement of torque associated with range of motion or muscle structure (e.g., fascicle length) in stroke survivors. METHODS: PubMed, ScienceDirect and PEDro databases were searched by 2 independent reviewers for relevant studies on the effects of chronic stretching interventions (>4 weeks) that evaluated joint angle and passive torque or muscle structure or stiffness. The quality of the studies was assessed with the PEDro scale. RESULTS: Eight randomized clinical trials (total of 290 participants) met the inclusion criteria, with highly variable sample characteristics (at risk/existing contractures), program objectives (prevent/treat contractures) and duration (from 4 to 52 weeks) and volume of stretching (1 to 586 hr). All studies were classified as high quality (>6/10 PEDro score). Six studies focused on the upper limb. Many programs were less than 12 weeks (n=7 studies) and did not change mechanical/structural properties. The longest intervention (52 weeks) increased muscle fascicle length and thickness (plantar flexors). CONCLUSION: Long interventions involving high stretching volumes and/or loads may have effects on muscle/joint mechanical properties, for preventing/treating contractures after stroke injury, but need to be further explored before firm conclusions are drawn.
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