Effects of stretching and heat treatment on hamstring extensibility in children with severe mental retardation and hypertonia

Abstract

Objectives: To examine the effect of heat and duration of stretching on the extensibility of hamstring muscles and their electromyographic responses to passive stretch in children with hypertonia and severe mental retardation.

Design: Randomized cross-over trial.

Setting: Developmental disability unit in a local hospital.

Participants: Twenty-nine subjects (9 females) with ages ranged from 4 to 13 years with spastic and/or dystonic hypertonia and hamstring tightness.

Interventions: Subjects received four treatment sessions in random order with each consisting of five repetitions of stretching: (A) 10-second stretching, (B) 30-second stretching, (C) hot pack followed by 10-second stretching, and (D) hot pack followed by 30-second stretching. Each treatment session comprised five repetitions of stretch and successive treatments were separated by at least 24 hours.

Main outcome measures: The distance between greater trochanter and lateral malleolus and hamstring electromyographic (EMG) activity during passive knee extension stretching.

Results: Two-way ANOVA showed a larger increase in hamstring extensibility in conditions C and D (1.3 ± 1.1 cm) than conditions A and B (0.7 ± 0.9 cm) (P<0.001). For the EMG recordings, conditions B and D (-25.1 ± 58.4μV) had greater decrease than conditions A and C (-3.5 ± 36.6 μV) (P= 0.039).

Conclusions: Heat application to the hamstrings before stretching could result in greater increase in extensibility than stretching alone in children with hypertonia and severe mental retardation. Stretching could promote relaxation of the hamstring muscles regardless of prior heat treatment. Stretching sustained for 30 seconds led to greater relaxation than that for 10 seconds.

References

O'Dwyer NJ , Ada L. Reflex hyperexcitability and muscle contracture in relation to spastic hypertonia . Curr Opin Neurol 1996; 9: 451-55.

Sheean G. The pathophysiology of spasticity . Eur J Neurol 2002; 9(supp1): 3-9.

Gracies J-M. Pathophysiology of spastic paresis. I: Paresis and soft tissue changes . Muscle Nerve 2005 ; 31: 535-51.

Gracies J-M. Pathophysiology of spastic paresis. II: Emergence of muscle over activity . Muscle Nerve 2005 ; 31: 552-71.

Tardieu C. , Huet de la Tour E. , Bret MD , Tardieu G. Muscle hypoextensibility in children with cerebral palsy: I. clinical and experimental observations . Arch Phys Med Rehabil 1982; 63: 97-107.

Goldspink G. , Williams PE Muscle fibre and connective tissue changes associated with use and disuse . In Ada A, Canning C eds. Foundations for practice. Topics in neurological physiotherapy . Heinemann , 1990.

Booth CM , Cortina-Borja MJF , Theologis TN Collagen accumulation in muscles of children with cerebral palsy and correlation with severity of spasticity . Dev Med Child Neurol 2001; 43: 314-20.

Chung SG , van Rey E. , Bai Z. , Roth EJ , Zhang LQ Biomechanic changes in passive properties of hemiplegic ankles with spastic hypertonia . Arch Phys Med Rehabil 2004; 85: 1638-46.

McPherson JJ , Arends TG , Michaels M. , Trettin K. The range of motion of long term knee contractures of four spastic cerebral palsied children: a pilot study . Phys Occup Ther Pediatr 1984 ; 4: 17-34.

10.

Damiano DL , Quinlivan J. , Owen BF , Shaffrey M. , Abel MF Spasticity versus strength in cerebral palsy: relationships among involuntary resistance, voluntary torque, and motor function . Eur J Neurol 2001; 8(suppl 5): 40-49.

11.

Gracies J-M. Physical modalities other than stretch in spastic hypertonia . Phys Med Rehabil Clin N Am 2001 ; 12: 769-92.

12.

Richardson D. Physical therapy in spasticity . Eur J Neurol 2002; 9(suppl 1): 17-22.

13.

Watanabe T. The role of therapy in spasticity management . Am J Phys Med Rehabil 2004; 83(suppl): S45-S49.

14.

Fragala MA , Goodgold S. , Dumas HM Effects of lower extremity passive stretching: pilot study of children and youth with severe limitations in self-mobility . Pediatr Phys Ther 2003; 15: 167-75.

15.

Miedaner JA , Renander J. The effectiveness of classroom passive stretching programs for increasing or maintaining passive range of motion in non-ambulatory children: an evaluation of frequency . Phys Occup Ther Pediatr 1987; 7: 35-43.

16.

Rabkin JM , Hunt TK Local heat increases blood flow and oxygen tension in wounds . Arch Surg 1987; 122: 221-25.

17.

Low J. , Reed A. Electrotherapy explained: principles and practice, second edition . Butterworth-Heinemann, 1995.

18.

Warren CG , Lehmann JF , Koblanski JN Elongation of rat tail tendon: effect of load and temperature . Arch Phys Med Rehabil 1971; 52: 465-74.

19.

Warren CG , Lehmann JF , Koblanski JN Heat and stretch procedures: an evaluation using rat tail tendon . Arch Phys Med Rehabil 1976; 57: 122-26.

20.

Lentell G. , Hetherington T. , Eagan J. , Morgan M. The use of thermal agents to influence the effectiveness of a low-load prolonged stretch . J Orthop Sports Phys Ther 1992; 16: 200-207.

21.

Henricson AS , Fredriksson K. , Persson I. , Pereira R. , Rostedt Y. , Westlin NE The effect of heat and stretching on the range of hip motion . J Orthop Sports Phys Ther 1984 ; 6: 110-15.

22.

Taylor BF , Waring CA , Brashear TA The effects of therapeutic application of heat or cold followed by static stretch on hamstring muscle length . J Orthop Sports Phys Ther 1995; 21: 283-86.

23.

Brodowicz GR , Welsh R. , Wallis J. Comparison of stretching with ice, stretching with heat, or stretching alone on hamstring flexibility . J Athl Train 1996; 31: 324-27.

24.

Worley G. , Houlihan CM , Herman-Giddens ME et al. Secondary sexual characteristics in children with cerebral palsy and moderate to severe motor impairment: a cross-sectional survey . Pediatrics 2002; 110: 897-902.

25.

Portney LC , Watkins MP Foundations of clinical research. Applications and practice. Prentice Hall Health , 2000.

26.

Abramson DI , Mitchell RE , Tuck S. , Bell Y. , Zayas AM Changes in blood flow, oxygen uptake and tissue temperatures produced by the topical application of wet heat . Arch Phys Med Rehabil 1961; 42: 305-18.

27.

Ottoson D. The effects of temperature on the isolated muscle spindle . J Physiol 1965; 180: 636-48.

28.

Taylor DC , Dalton JD , Seaber AV , Garrett WE Viscoelastic properties of muscle-tendon units: the biomechanical effects of stretching . Am J Sports Med 1990 ; 18: 300-309.

29.

Holt S. , Baagøe S. , Lillelund F. , Magunsson P.

Passive resistance of hamstring muscles in children with severe multiple disabilities?

Dev Med Child Neurol 2000; 42: 541-44.

30.

Henderson RC , Lin PP , Greene WB Bone-mineral density in children and adolescents who have spastic cerebral palsy . J Bone Joint Surg 1995; 77-A: 1671-81.

31.

Lee JJK , Lyne ED Pathologic fractures in severely handicapped children and young adults . J Pediatr Orthop 1990; 10: 497-500.

32.

Lingam S. , Joester J. Lesson of the week: spontaneous fractures in children and adolescents with cerebral palsy . BMJ 1994; 309: 265-66.

33.

Sturm PF , Alman BA , Christie BL Femur fractures in institutionalized patients after hip spica immobilization . J Pediatr Orthop 1993; 13: 246-48.

34.

Gajdosik RL , Rieck MA , Sullivan DK , Wightman SE Comparison of four clinical tests for assessing hamstring muscle length . J Orthop Sports Phys Ther 1993; 18: 614-18.

35.

Bandy WD , Irion JM , Briggler M. The effect of time and frequency of static stretching on flexibility of hamstring muscles . Phys Ther 1997; 77: 1090-96.

36.

Ashton BB , Pickles B. , Roll JW Reliability of goniometric measurements of hip motion in spastic cerebral palsy . Dev Med Child Neurol 1978; 20: 87-94.

37.

Harris SR , Smith LH , Krukowski L. Goniometric reliability for a child with spastic quadriplegia . J Pediatr Orthop 1985; 5: 348-51.

38.

Kilgour G. , McNair P. , Stott NS Intrarater reliability of lower limb sagittal range-of-motion measures in children with spastic diplegia . Dev Med Child Neurol 2003; 45: 391-99.

39.

Stuberg WA , Fuchs RH , Miedaner JA Reliability of goniometric measurements of children with cerebral palsy . Dev Med Child Neurol 1988; 30: 657-66.

40.

McDowell BC , Hewitt V. , Nurse A. , Weston T. , Baker R. The variability of goniometric measurements in ambulatory children with spastic cerebral palsy . Gait Posture 2000; 12: 114-21.