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Does long-term passive stretching alter muscle-tendon unit mechanics in children with spastic cerebral palsy?
Nicola Theis1, Thomas Korff2, Amir A Mohagheghi3
1School of Sport, Health and Applied Science, St Mary's University, Strawberry Hill, Middlesex TW1 4SX, UK.
Insights
Passive ankle stretching in children with cerebral palsy reduced muscle stiffness by altering fascicle strain. This intervention shows potential for improving motor function in pediatric cerebral palsy patients.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a developmental disorder causing motor impairments, often associated with excessive muscle stiffness impacting function.
- Passive stretching is a common intervention for reducing stiffness in CP, but evidence supporting its efficacy is limited.
- Understanding the effects of stretching on muscle-tendon unit parameters is crucial for optimizing CP management.
Purpose of the Study:
- To investigate the impact of a six-week passive ankle stretching program on muscle-tendon unit properties in children with spastic cerebral palsy.
- To determine if passive stretching influences muscle stiffness, tendon stiffness, and fascicle length in pediatric CP.
- To provide evidence regarding the effectiveness of passive stretching as a therapeutic strategy for managing muscle stiffness in CP.
Main Methods:
- A randomized controlled trial involving thirteen children (8-14 years) with spastic cerebral palsy (quadriplegic/diplegic).
- Participants were assigned to an experimental group (passive ankle dorsiflexion stretching, 15 min/leg/day, 4 days/week for 6 weeks) or a control group (normal routine).
- Muscle and tendon stiffness, strain, and resting length were measured before and after the 6-week intervention.
Main Results:
- The experimental group showed a 3° increase in maximum ankle dorsiflexion.
- A significant 13% reduction in triceps surae muscle stiffness was observed, with no change in tendon stiffness.
- Fascicle strain increased, while resting fascicle length remained unchanged, indicating stiffness reduction is linked to connective tissue changes.
Conclusions:
- Six weeks of passive ankle stretching effectively reduces muscle stiffness in children with spastic cerebral palsy.
- The mechanism of stiffness reduction involves alterations in fascicle strain, not changes in resting fascicle length.
- These findings support the use of passive stretching as a targeted intervention for improving muscle properties in pediatric CP.
Background:
Cerebral palsy causes motor impairments during development and many children may experience excessive neural and mechanical muscle stiffness. The clinical assumption is that excessive stiffness is thought to be one of the main reasons for functional impairments in cerebral palsy. As such, passive stretching is widely used to reduce stiffness, with a view to improving function. However, current research evidence on passive stretching in cerebral palsy is not adequate to support or refute the effectiveness of stretching as a management strategy to reduce stiffness and/or improve function. The purpose was to identify the effect of six weeks passive ankle stretching on muscle-tendon unit parameters in children with spastic cerebral palsy.
Methods:
Thirteen children (8-14 y) with quadriplegic/diplegic cerebral palsy were randomly assigned to either an experimental group (n=7) or a control group (n=6). The experimental group underwent an additional six weeks of passive ankle dorsiflexion stretching for 15 min (per leg), four days per week, whilst the control group continued with their normal routine, which was similar for the two groups. Measures of muscle and tendon stiffness, strain and resting length were acquired pre- and post-intervention.
Findings:
The experimental group demonstrated a 3° increase in maximum ankle dorsiflexion. This was accompanied by a 13% reduction in triceps surae muscle stiffness, with no change in tendon stiffness. Additionally, there was an increase in fascicle strain with no changes in resting length, suggesting muscle stiffness reductions were a result of alterations in intra/extra-muscular connective tissue.
Interpretation:
The results demonstrate that stretching can reduce muscle stiffness by altering fascicle strain but not resting fascicle length.
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