Bronte Joyce

10/22/2014
BIOL1615
Stretch exercises Increase Tolerance to Stretch in Patients with Chronic Musculoskeletal Pain: A
Randomized Controlled Trial.
Chronic Musculoskeletal Pain is caused by muscle tissue being damaged with the wear
and tear of daily activities. Other causes of pain include postural strain, repetitive movements,
overuse, and prolonged immobilization. Stretch is the most common prescribed activity during
physical rehabilitation. Research says that good extensibility enhances patients ability to
perform normal functional activities. But controversy arises whether or not stretch has lasting
effects. In recent studies on animals the supports the effectiveness on stretch, but studies with
humans has been less consistent. The goal of this study is to see if a 3-week stretch program
helped a patients extensibility and stretch tolerance.
This was a randomized controlled trial with 30 adults who were recruited from a hospital
in Sydney, Australia. To be eligible for the trail, patients had to have musculoskeletal pain for at
least 3 months, be able to participate in hamstring stretch, and be over 18 years old. 3 days
before the intervention started the participants had to test for initial measurements and final
measurements were taken 24 hours after the last stretch. Hamstrings of the experimental leg were
stretched daily for 1 minute over a 3 week period, and the controlled leg received no specific
stretch treatment during this time, 14/18 sessions were supervised by a register physical therapist
while the other 4 were unsupervised. 12 out of 540 stretches were missed for all participants. A
device specifically designed to measure passive hip flexion and hip flexor torque was used to

measure muscle extensibility and stretch tolerance. The blind assessors used a standardized
torque during muscle extensibility stretch and a nonstandardized torque during the stretch
tolerance portion of the intervention.
The intervention did not increase muscle extensibility, but it improved stretch tolerance.
The between- group mean difference in hip flexion with a standardized (muscle extensibility)
torque was 1 degree (95% CI=-2 to 4; P=.39 (P<.05)).The between-group mean difference in hip
flexion with a nonstandardized (stretch tolerance) torque was 8 degree (95% CI=5 to 10;
P<.001). The results indicated that stretching did not increase hamstring extensibility, but the
intervention improved the participants willingness to tolerate more stretch for the same level of
pain. The possible reason for increase muscle extensibility failure was because stretching for 1
minute a day for 3 weeks isnt a long enough duration. Although the intervention increased
patient stretch tolerance, there were no changes in their pre and post intervention pain intensity
scores on the Multidimensional Pain Inventory test. I find that very interesting those patients
have a larger torque, but no change in pain intensity.
The intervention had a variety of patients between the ages of 19-38 with
musculoskeletal pain originating from different sources; legs, neck, back and arm. The study was
limited for a couple of reasons. The participants were not blinded, so there was a possibility that
they had strong expectations that the intervention would improve muscle extensibility therefore
tolerated larger torques, leading to an increase in ROM (range of motion). Also, participants with
pain in the leg are likely to have reacted to the intervention differently than those with pain
elsewhere.