Støve Morten Pallisgaard, Hirata Rogerio Pessoto, Palsson Thorvaldur Skuli
Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220 Aalborg East, Denmark, Phone: 004522980862.
SMI® , Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg East, Denmark.
Scand J Pain. 2019 Apr 24;19(2):415-422. doi: 10.1515/sjpain-2018-0334.
Background and aims The effect of stretching on joint range of motion is well documented and is primarily related to changes in the tolerance to stretch, but the mechanisms underlying this change are still largely unknown. The aim of this study was to investigate the influence of a remote, painful stimulus on stretch tolerance. Methods Thirty-four healthy male subjects were recruited and randomly assigned to an experimental pain group (n=17) or a control group (n=17). Passive knee extension range of motion, the activity of hamstring muscles and passive resistive torque were measured with subjects in a seated position. Three consecutive measures were performed with a 5-min interval between. A static stretch protocol was utilized in both groups to examine the effect of stretching and differences in stretch tolerance between groups. Following this, the pain-group performed a cold pressor test which is known to engage the endogenous pain inhibitory system after which measurements were repeated. Results A significant increase in knee extension range of motion was found in the pain group compared with controls (ANCOVA: p<0.05). No difference was found in muscle activity or passive resistive torque between groups (ANCOVA p>0.091). Conclusions Passive knee extension range of motion following stretching increased when following a distant, painful stimulus, potentially engaging the endogenous pain inhibitory systems. Current findings indicate a link between increased tolerance to stretch and endogenous pain inhibition. Implications The current findings may have implications for clinical practice as they indicate that a distant painful stimulus can influence range of motion in healthy individuals. This implies that the modulation of pain has significance for the efficacy of stretching which is important knowledge when prescribing stretching as part of rehabilitation.
背景与目的 拉伸对关节活动范围的影响已有充分记录，且主要与拉伸耐受性的变化有关，但这种变化背后的机制仍 largely 未知。本研究的目的是调查远程疼痛刺激对拉伸耐受性的影响。方法 招募了 34 名健康男性受试者，并将其随机分为实验性疼痛组（n = 17）或对照组（n = 17）。在受试者坐姿时测量被动膝关节伸展活动范围、腘绳肌活动和被动阻力扭矩。连续进行三次测量，每次间隔 5 分钟。两组均采用静态拉伸方案来检查拉伸的效果以及组间拉伸耐受性的差异。在此之后，疼痛组进行了冷加压试验，已知该试验会激活内源性疼痛抑制系统，之后重复测量。结果 与对照组相比，疼痛组膝关节伸展活动范围显著增加（协方差分析：p < 0.05）。两组之间在肌肉活动或被动阻力扭矩方面未发现差异（协方差分析 p > 0.091）。结论 在受到远程疼痛刺激后，拉伸后的被动膝关节伸展活动范围增加，这可能激活了内源性疼痛抑制系统。当前研究结果表明拉伸耐受性增加与内源性疼痛抑制之间存在联系。意义 当前研究结果可能对临床实践有意义，因为它们表明远程疼痛刺激可影响健康个体的活动范围。这意味着疼痛调制对拉伸效果具有重要意义，这是在将拉伸作为康复的一部分进行处方时的重要知识。
