Podcast: Is stretch effective for treating and preventing joint deformities?

A range of injuries and disabilities can lead to stiffening in the soft tissues or muscles of the patient’s limbs, causing problems with movement, called contractures. One of the widely used treatments is stretch, but does it work? Lisa Harvey from the University of Sydney in Australia and colleagues tried to find out in an updated Cochrane Review in January 2017, and she tells us more in this podcast.

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John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. A range of injuries and disabilities can lead to stiffening in the soft tissues or muscles of the patient’s limbs, causing problems with movement, called contractures. One of the widely used treatments is stretch, but does it work? Lisa Harvey from the University of Sydney in Australia and colleagues tried to find out in an updated Cochrane Review in January 2017, and she tells us more in this podcast.

Lisa: It’s been believed for a long time that the most appropriate treatment for contractures is stretch. It can be applied in many different ways but is most commonly done through the hands of a physiotherapist and it’s clear stretch will cause a transient increase in the extensibility of soft tissues and muscles. However, our updated review casts doubt on whether these effects last more than a few minutes and are effective for the treatment and prevention of contractures.
The first version of our review was published in 2010 and doing this update, we looked again for randomised trials which included people who either had or were likely to develop contractures. This included people with burns, spinal cord injuries, brain injuries and various types of musculoskeletal conditions such as frozen shoulder.
We found 49 studies involving over 2,000 participants. We were interested in both effects observed up to one week after the last stretch, and effects that lasted longer but because most of studies looked at the short-term effects only, I’ll concentrate on that evidence. The trials typically administered stretch for 20 minutes per day, but some tested it for just a few minutes a day and others administered stretch continuously for days on end by putting limbs in casts or splints. Importantly, though, most trials only lasted a few weeks, which is important because stretch is often advocated for people with disabilities as a life-long intervention; and, in fact, the longest of the 49 trials still only tested stretch out to seven months.
Our focus was on joint mobility, quality of life, pain, and measures of people’s abilities to move and participate in normal activities; but the findings are inconclusive for ability to move or participate in normal activities because of a lack of data. However, there is high quality evidence to indicate that stretch does not have a clinically important effect on joint mobility in people with or without a neurological condition, regardless of how long it was applied for each day. We also found moderate to high quality evidence that stretch does not have an effect on either pain or quality of life in people with non-neurological conditions. In people with neurological conditions, the effects of stretch on pain is unclear and no study looked at the effects on quality of life in these patients.
In summary, our systematic review suggests that stretch is not effective for the management of contractures in people with and without neurological conditions. The only caveat is that we don’t know what would happen if stretch was administered daily for many, many months or years, which is the usual recommendation for people with life-long neurological disabilities such as brain and spinal cord injury.

John: If you would like to find out more about the evidence in Lisa’s review, you can read the full version online at Cochrane Library dot com. Just go to the website and type in a search for 'stretch and contractures'.

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