Ofori J, Freeman J, Logan A, Rapson R, Zajieck J, Hobart J, Marsden J
School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, PL6 8BH, UK.
Stroke Rehabilitation Unit, Camborne/Redruth Community Hospital, Barncoose Terrace, Redruth TR15 3ER, UK.
Clin Biomech (Bristol). 2016 Aug;37:22-26. doi: 10.1016/j.clinbiomech.2016.05.013. Epub 2016 Jun 1.
Stretches are often prescribed to manage increased limb stiffness in people with Multiple Sclerosis. This study determined the ankle plantarflexor torque magnitude that people with Multiple Sclerosis can apply during four commonly prescribed stretches and determined the relationship between the applied torque and functional ability.
People with Multiple Sclerosis (N=27) were compared to healthy control participants (n=15). Four stretches were investigated; stretching in step standing; using a step; pulling the ankle into dorsiflexion and standing in a frame. Joint position and forces were measured using 3D motion analysis and torque transducers. Baseline ankle strength and stiffness was measured using motor driven ankle perturbations.
People with Multiple Sclerosis (N=27) had higher stretch reflex amplitudes and lower strength compared to the control group (n=15). People with Multiple Sclerosis achieved less lengthening of the plantarflexor muscle-tendon complex when stretching but similar ankle torques compared to controls. While stretching people with Multiple Sclerosis showed greater muscle activation in the ankle plantarflexors. Stretches in weight bearing positions produced higher plantarflexor torques. People with Multiple Sclerosis with lower functional ability preferred the more supported stretches (ankle pull and standing frame).
Stretches in weight bearing positions achieve higher ankle torques but this is in part due to increased postural activity in people with Multiple Sclerosis. Functional ability may limit stretch effectiveness.
拉伸疗法常用于缓解多发性硬化症患者肢体僵硬症状。本研究测定了多发性硬化症患者在四种常用拉伸动作中能够施加的踝跖屈扭矩大小，并确定了所施加扭矩与功能能力之间的关系。
将27例多发性硬化症患者与15名健康对照参与者进行比较。研究了四种拉伸动作：单脚站立拉伸；使用台阶拉伸；将脚踝拉至背屈位拉伸以及在框架内站立拉伸。使用三维运动分析和扭矩传感器测量关节位置和受力情况。使用电机驱动的踝部扰动测量基线踝关节力量和刚度。
与对照组（15名）相比，多发性硬化症患者（27例）的牵张反射幅度更高，力量更低。拉伸时，多发性硬化症患者的跖屈肌 - 肌腱复合体延长程度小于对照组，但踝关节扭矩与对照组相似。拉伸时，多发性硬化症患者的踝跖屈肌肌肉激活程度更高。负重位拉伸产生的跖屈扭矩更大。功能能力较低的多发性硬化症患者更喜欢支撑性更好的拉伸动作（脚踝牵拉和站立框架）。
负重位拉伸可产生更大的踝关节扭矩，但这部分归因于多发性硬化症患者姿势活动增加。功能能力可能会限制拉伸效果。
