Active,passive and proprioceptive neuromuscular facilitation stretching are comparable in improving the knee flexion range in people with total knee replacement: a randomized controlled trial

Abstract

Objective: To compare the immediate and medium-term effects of three stretching methods on the knee flexion range in people with a total knee replacement.

Design: Randomized clinical trial.

Setting: Rehabilitation hospital.

Subjects: 117 patients were recruited and 100 (mean age: 68.43 ± 7.95 years) of them completed the study.

Interventions: Patients receiving total knee replacement due to knee osteoarthritis were randomly assigned into 3 groups of: active stretching (group 1, n =32), passive stretching (group 2, n =35) and proprioceptive neuromuscular facilitation stretching (group 3, n =33).

Main measures: The immediate change in both active and passive knee flexion range after the first treatment session and the pattern of change in these ranges throughout the 2-week study period were compared among the three groups.

Results: All groups demonstrated significant improvement in knee ranges with time. The active range of group 1 improved by 19.9°, group 2 by 25.3° and group 3 by 22.5° throughout the 2-week period, whereas the improvements in the passive range were 18.8°, 24.5° and 22.7°, respectively. For between-group comparisons, no significant difference was found in both active (P = 0.647) and passive (P = 0.501) knee range immediately after stretching. For the changes at 2 weeks, there was also no significant difference among the groups in both active (P = 0.716) and passive (P = 0.959) knee ranges.

Conclusion: This study revealed that all three modes of stretching were associated with an increase in the knee flexion range of patients after total knee replacement, with no statistically significant differences between the changes seen.

References

Kolisek FR , Gilmore KJ , Peterson EK Slide and flex, tighten, extend (SAFTE): a safe, convenient, effective, and no-cost approach to rehabilitation after total knee arthroplasty. J Arthroplasty 2000; 15: 1013-1016.

Maloney WJ The stiff total knee arthroplasty: evaluation and management. J Arthroplasty 2002; 17: 71-73.

Chiu KY , Ng TP , Tang WM et al. Review article: knee flexion after total knee arthroplasty. J Orthop Surg (Hong Kong) 2002; 10: 194-202.

Dennis DA , Komistek RD , Stiehl JB et al. Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplasty 1998; 13: 748-752.

Gatha NM , Clarke HD , Fuchs R. et al. Factors affecting postoperative range of motion after total knee arthroplasty. J Knee Surg 2004; 17: 196-202.

Maloney WJ , Schurman DJ The effects of implant design on range of motion after total knee arthroplasty: total condylar versus posterior stabilized total condylar designs. Clin Orthop Relat Res 1992; 278: 147-152.

Menke W. , Schmitz B. , Salm S. Range of motion after total condylar knee arthroplasty. Arch Orthop Trauma Surg 1992; 111: 280-281.

Ritter MA , Harty LD , Davis KE et al. Predicting range of motion after total knee arthroplasty: clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am 2003; 85: 1278-1285.

Stiehl JB , Voorhorst PE , Keblish P. et al. Comparison of range of motion after posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg 1997; 10: 216-220.

10.

Bandy WD , Irion JM , Briggler M. The effect of time and frequency of static stretching on flexibility of the hamstring muscles. Phys Ther 1997; 77: 1090-1096.

11.

Winters MV , Blake CG , Trost JS et al. Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: a randomized clinical trial. Phys Ther 2004; 84: 800-807.

12.

Balady GJ , Berra KA , Golding LA ACSM’s guidelines for exercise tsesting and prescription. Philadelphia: Lippincott Williams & Wilkins, 2000.

13.

McAtee RE , Charland J. Facilitated stretching. Champaign, Human Kinetics,1999.

14.

Bonnar BP , Deivert RG , Gould TE The relationship between isometric contraction durations during hold-relax stretching and improvement of hamstring flexibility. J Sports Med Phys Fitness 2004; 44: 258-261.

15.

Feland JB , Myrer JW , Schulthies SS et al. The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Phys Ther 2001; 81: 1110-1117.

16.

Swank AM , Durham MP Adding weights to stretching exercise increases passive range of motion for healthy elderly. J Strength Cond Res 2003; 17: 374-378.

17.

Ferber R. , Osternig LR , Gravelle DC Effect of PNF stretch techniques on knee flexor muscle EMG activity in older adults. J Electromyogr Kinesiol 2002; 12: 391-397.

18.

Funk DC , Swank AM , Mikla BM et al. Impact of prior exercise on hamstring flexibility: a comparison of proprioceptive neuromuscular facilitation and static stretching. J Strength Cond Res 2003; 17: 489-492.

19.

Marek SM , Cramer JT , Fincher L. et al. Acute effects of static and proprioceptive neuromuscular facilitation stretching on muscle strength and power output. J Athl Train 2005; 40: 94-103.

20.

Beaupre LA , Davies DM , Allyson Jones C. et al. Exercise combined with continuous passive motion or slider board therapy compared with exercise only: a randomized controlled trial of patients following total knee arthroplasty. Phys Ther 2001; 81: 1029-1037.

21.

Frost H. , Lamb SE , Robertson S. A randomized controlled trial of exercise to improve mobility and function after elective knee arthroplasty. Feasibility, results and methodological difficulties. Clin Rehabil 2002; 16: 200-209.

22.

Feland JB , Marin HN Effect of submaximal contraction intensity in contract-relax proprioceptive neuromuscular facilitation stretching. Br J Sports Med 2004; 38: E18.

23.

Davis DS , Ashby PE , McCale KL et al. The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. J Strength Cond Res 2005; 19: 27-32.

24.

Myers J. Perception of chest pain during exercise testing in patients with coronary artery disease. Med Sci Sports Exerc 1994; 26: 1082-1086.

25.

Clarkson HM , Gilewich GB Musculoskeletal assessment. Joint range of motion and manual muscle strength . Baltimore: Williams & Wilkins , 1989.

26.

Magnusson SP Passive properties of human skeletal muscle during stretch maneuvers. Scand J Med Sci Sports 1998; 8: 65-77.

27.

Spernoga SG , Uhl TL , Arnold BL et al. Duration of maintained hamstring flexibility after a one-time, modified hold-relax stretching protocol. J Athl Train 2001; 36: 44-48.