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Changes in Lower Extremity Passive Range of Motion and Muscle Strength After Selective Percutaneous Myofascial
Vasileios C Skoutelis1,2,3, Zacharias Dimitriadis4, Anastasios Kanellopoulos5
1Department of Physiotherapy, ATTIKON University General Hospital, Chaidari, GRC.
Insights
Selective percutaneous myofascial lengthening (SPML) combined with physiotherapy significantly improved range of motion and muscle strength in children with cerebral palsy (CP). This approach effectively addresses contractures, enhancing lower extremity function.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Neuromuscular Disorders
Background:
- Children with cerebral palsy (CP) frequently exhibit motor impairments, including spasticity and muscle-tendon contractures.
- Traditional surgical interventions for contractures can exacerbate muscle weakness.
- Limited research exists on combined interventions for improving range of motion and strength in pediatric CP.
Purpose of the Study:
- To evaluate the effectiveness of selective percutaneous myofascial lengthening (SPML) plus functional physiotherapy.
- To assess the impact on passive joint range of motion (ROM) and isometric muscle strength.
- To investigate outcomes in the lower extremities of children with spastic CP.
Main Methods:
- A single-group pre- and post-test design was employed.
- Twenty-six children (5-7 years) with spastic CP (GMFCS levels II-IV) participated.
- Intervention included SPML followed by 9 months of functional strength training physiotherapy.
Main Results:
- Significant improvements were noted in passive ROM for hip abduction, straight leg raise, popliteal angle, and ankle dorsiflexion (p < 0.05).
- Substantial gains in isometric muscle strength were observed in hip flexors, extensors, abductors, adductors, knee extensors, and ankle dorsiflexors.
- The combined approach demonstrated statistically significant positive outcomes.
Conclusions:
- SPML combined with postoperative functional physiotherapy is an effective strategy for managing fixed contractures in children with CP.
- This intervention significantly increases passive joint ROM and enhances muscle strength.
- Further long-term studies are recommended to validate and extend these findings.
Abstract:
Background Children with cerebral palsy (CP) often experience motor and postural disorders, along with spasticity, muscle weakness, muscle-tendon contractures, and decreased joint range of motion (ROM). Muscle-tendon contractures are typically addressed through orthopaedic surgery to improve joint ROM, which can result in further muscle weakness. This study aimed to investigate the impact of selective percutaneous myofascial lengthening (SPML) combined with functional physiotherapy on joint passive ROM and isometric muscle strength in the lower extremities of children with spastic CP. Methods A single-group pre- and post-test design was utilised in this study. Twenty-six children aged five to seven years with spastic CP and Gross Motor Function Classification System levels II-IV underwent the SPML procedure and received nine months of postoperative functional strength training physiotherapy. Joint passive ROM and isometric muscle strength were measured using a universal goniometer and a digital hand-held dynamometer, respectively. Paired-sample t-tests were conducted to compare baseline and follow-up measurements. Results Significant improvements (p < 0.05) were observed in passive ROM of hip abduction, straight leg raise, popliteal angle, and ankle dorsiflexion, as well as in isometric strength of hip flexors, extensors, abductors and adductors, knee extensors, and ankle dorsiflexors. Conclusions The SPML procedure supported by postoperative functional physiotherapy can effectively address fixed contractures by significantly increasing passive joint ROM and muscle strength. Further research with longer-term follow-up measurements is necessary to confirm and expand upon these findings.
