Eight weeks of proprioceptive neuromuscular facilitation stretching and static stretching do not affect muscle-tendon properties, muscle strength, and joint function in children with spastic cerebral palsy

Annika Kruse; Andreas Habersack; Guido Weide; Richard T Jaspers; Martin Svehlik; Markus Tilp

doi:10.1016/j.clinbiomech.2023.106011

Eight weeks of proprioceptive neuromuscular facilitation stretching and static stretching do not affect muscle-tendon properties, muscle strength, and joint function in children with spastic cerebral palsy

Clin Biomech (Bristol, Avon). 2023 Jul:107:106011. doi: 10.1016/j.clinbiomech.2023.106011. Epub 2023 Jun 7.

Authors

Annika Kruse¹, Andreas Habersack², Guido Weide³, Richard T Jaspers³, Martin Svehlik⁴, Markus Tilp⁵

Affiliations

¹ Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria. Electronic address: annika.kruse@uni-graz.at.
² Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria; Department of Othopaedics and Trauma, Medical University of Graz, Graz, Austria.
³ Department of Human Movement Science, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
⁴ Department of Othopaedics and Trauma, Medical University of Graz, Graz, Austria.
⁵ Department of Biomechanics, Training and Movement Science, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.

PMID: 37329655
DOI: 10.1016/j.clinbiomech.2023.106011

Abstract

Background: While the effect of static stretching for individuals with cerebral palsy is questionable, recent results suggest that the combination with activation seems promising to improve muscle-tendon properties and function. Therefore, this study analyzed the effects of 8-week proprioceptive neuromuscular facilitation stretching on the gastrocnemius medialis muscle-tendon properties, muscle strength, and the ankle joint in children with spastic cerebral palsy in comparison to static stretching.

Methods: Initially, 24 children with spastic cerebral palsy were randomly assigned to a static stretching (10.7 ± 1.8 years) or proprioceptive neuromuscular facilitation stretching group (10.9 ± 2.6 years). Plantar flexors were manually stretched at home for 300 s and ∼ 250-270 s per day four times a week for eight weeks, respectively. Assessments of ankle joint function (e.g., range of motion), muscle-tendon properties, and isometric muscle strength were conducted using 3D motion capture, 2D ultrasound, dynamometry, and electromyography. A mixed analysis of variance was used for the statistical analysis.

Findings: Stretching adherence was high in the proprioceptive neuromuscular facilitation stretching (93.1%) and static stretching group (94.4%). No significant changes (p > 0.05) were observed in ankle joint function, muscle-tendon properties, and isometric muscle strength after both interventions. Moreover, no differences (p > 0.05) were found between the stretching techniques.

Interpretation: The findings support the idea that manual stretching (neither proprioceptive neuromuscular facilitation stretching nor static stretching) performed in isolation for eight weeks may not be appropriate to evoke significant changes in muscle-tendon properties, voluntary muscle strength, or joint function in children with spastic cerebral palsy.

Clinical trial registration number: NCT04570358.

Keywords: Achilles tendon; Autogenic inhibition; Children; Plantar flexors; Spasticity; Stretching.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cerebral Palsy*
Child
Humans
Muscle Strength
Muscle Stretching Exercises*
Muscle, Skeletal / physiology
Range of Motion, Articular / physiology
Tendons

Associated data

ClinicalTrials.gov/NCT04570358

Grants and funding

T 1017/FWF_/Austrian Science Fund FWF/Austria