Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe, Hyogo, 654-0142, Japan,
Clin Orthop Relat Res. 2013 Nov;471(11):3626-36. doi: 10.1007/s11999-013-3196-z. Epub 2013 Jul 27.
Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions.
QUESTIONS/PURPOSES: Using an established T8 spinal cord injury rat model of knee contracture, we sought to determine what combination of static or intermittent stretching, varied by magnitude (high or low) and duration (long or short), leads to the best (1) improvement in the limitation in ROM; (2) restoration of the muscular and articular factors leading to contractures; and (3) prevention and treatment of contracture-associated histologic alterations of joint capsule and articular cartilage.
Using a rat animal model, the spinal cord was transected completely at the level of T8. The rats were randomly assigned to seven treatment groups (n = 4 per group), which were composed of static or intermittent stretching in combination with different amounts of applied torque magnitude and duration. We assessed the effect of stretching by measuring the ROM and evaluating the histologic alteration of the capsule and cartilage.
Contractures improved in all treated groups except for the low-torque and short-duration static stretching conditions. High-torque stretching was effective against shortening of the synovial membrane and adhesions in the posterosuperior regions. Collagen Type II and VEGF in the cartilage were increased by stretching.
High-torque and long-duration static stretching led to greater restoration of ROM than the other torque and duration treatment groups. Stretching was more effective in improving articular components of contractures compared with the muscular components. Stretching in this rat model prevented shortening and adhesion of the joint capsule, and affected biochemical composition, but did not change morphologic features of the cartilage.
This animal study tends to support the ideas that static stretching can influence joint ROM and histologic qualities of joint tissues, and that the way stretching is performed influences its efficacy. However, further studies are warranted to determine if our findings are clinically applicable.
关节挛缩是许多神经疾病的常见并发症，常主张通过拉伸来预防和治疗这些挛缩。然而，实际中所进行的拉伸幅度和时长通常是基于主观的临床印象来指导的。
问题/目的：我们使用 T8 脊髓损伤大鼠膝关节挛缩模型，旨在确定何种组合的静态或间歇性拉伸，通过幅度（高或低）和时长（长或短）的变化，可以达到以下最佳效果：（1）最大限度地改善关节活动度受限；（2）恢复导致挛缩的肌肉和关节因素；（3）预防和治疗关节囊和关节软骨挛缩相关的组织学改变。
使用大鼠动物模型，在 T8 水平完全横断脊髓。大鼠被随机分为 7 个治疗组（每组 4 只），由静态或间歇性拉伸与不同的施加扭矩幅度和时长相结合组成。我们通过测量关节活动度和评估关节囊和软骨的组织学改变来评估拉伸的效果。
除了低扭矩和短时间的静态拉伸条件外，所有治疗组的挛缩都有改善。高扭矩拉伸可有效防止后上区域滑膜缩短和粘连。软骨中的胶原 II 型和 VEGF 增加。
高扭矩和长时间的静态拉伸比其他扭矩和时长治疗组更能恢复关节活动度。拉伸在改善挛缩的关节成分方面比改善肌肉成分更有效。在该大鼠模型中，拉伸可预防关节囊缩短和粘连，并影响生化成分，但不会改变软骨的形态特征。
这项动物研究倾向于支持以下观点，即静态拉伸可以影响关节活动度和关节组织的组织学特性，并且拉伸的方式会影响其效果。然而，需要进一步的研究来确定我们的发现是否具有临床应用价值。
