Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Clinical Relevance
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.
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References
Ben M, Harvey L, Denis S, Glinsky J, Goehl G, Chee S, Herbert RD. Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries? Aust J Physiother. 2005;51:251–256.
Bramono DS, Richmond JC, Weitzel PP, Kaplan DL, Altman GH. Matrix metalloproteinases and their clinical applications in orthopaedics. Clin Orthop Relat Res. 2004;428:272–285.
Coutinho EL, DeLuca C, Salvini TF, Vidal BC. Bouts of passive stretching after immobilization of the rat soleus muscle increase collagen macromolecular organization and muscle fiber area. Connect Tissue Res. 2006;47:278–286.
Dalyan M, Sherman A, Cardenas DD. Factors associated with contractures in acute spinal cord injury. Spinal Cord. 1998;36:405–408.
Enneking WF, Horowitz M. The intra-articular effects of immobilization on the human knee. J Bone Joint Surg Am. 1972;54:973–985.
Farmer SE, James M. Contractures in orthopaedic and neurological conditions: a review of causes and treatment. Disabil Rehabil. 2001;23:549–558.
Fergusson D, Hutton B, Drodge A. The epidemiology of major joint contractures: a systematic review of the literature. Clin Orthop Relat Res. 2007;456:22–29.
Gomes AR, Cornachione A, Salvini TF, Mattiello-Sverzut AC. Morphological effects of two protocols of passive stretch over the immobilized rat soleus muscle. J Anat. 2007;210:328–335.
Harvey L, Herbert R, Crosbie J. Does stretching induce lasting increases in joint ROM? A systematic review. Physiother Res Int. 2002;7:1–13.
Harvey LA, Batty J, Crosbie J, Poulter S, Herbert RD. A randomized trial assessing the effects of 4 weeks of daily stretching on ankle mobility in patients with spinal cord injuries. Arch Phys Med Rehabil. 2000;81:1340–1347.
Harvey LA, Byak AJ, Ostrovskaya M, Glinsky J, Katte L, Herbert RD. Randomised trial of the effects of four weeks of daily stretch on extensibility of hamstring muscles in people with spinal cord injuries. Aust J Physiother. 2003;49:176–181.
Harvey LA, Herbert RD. Muscle stretching for treatment and prevention of contracture in people with spinal cord injury. Spinal Cord. 2002;40:1–9.
Harvey LA, Herbert RD, Glinsky J, Moseley AM, Bowden J. Effects of 6 months of regular passive movements on ankle joint mobility in people with spinal cord injury: a randomized controlled trial. Spinal Cord. 2009;47:62–66.
Haywood L, McWilliams DF, Pearson CI, Gill SE, Ganesan A, Wilson D, Walsh DA. Inflammation and angiogenesis in osteoarthritis. Arthritis Rheum. 2003;48:2173–2177.
Katalinic OM, Harvey LA, Herbert RD. Effectiveness of stretch for the treatment and prevention of contractures in people with neurological conditions: a systematic review. Phys Ther. 2011;91:11–24.
Katalinic OM, Harvey LA, Herbert RD, Moseley AM, Lannin NA, Schurr K. Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev. 2010;9:CD007455.
Kawamoto T. Use of a new adhesive film for the preparation of multi-purpose fresh-frozen sections from hard tissues, whole-animals, insects and plants. Arch Histol Cytol. 2003;66:123–143.
Lee S, Sakurai T, Ohsako M, Saura R, Hatta H, Atomi Y. Tissue stiffness induced by prolonged immobilization of the rat knee joint and relevance of AGEs (pentosidine). Connect Tissue Res. 2010;51:467–477.
Lieber RL, Steinman S, Barash IA, Chambers H. Structural and functional changes in spastic skeletal muscle. Muscle Nerve. 2004;29:615–627.
Lowenthal M, Tobis JS. Contractures in chronic neurologic diseases. Arch Phys Med Rehabil. 1957;38:640–645.
Moriyama H, Kanemura N, Brouns I, Pintelon I, Adriaensen D, Timmermans JP, Ozawa J, Kito N, Gomi T, Deie M. Effects of aging and exercise training on the histological and mechanical properties of articular structures in knee joints of male rat. Biogerontology. 2012;13:369–381.
Moriyama H, Nishihara K, Hosoda M, Saka Y, Kanemura N, Takayanagi K, Yoshimura O, Tobimatsu Y. Contrasting alteration patterns of different cartilage plates in knee articular cartilage after spinal cord injury in rats. Spinal Cord. 2009;47:218–224.
Moriyama H, Yoshimura O, Kawamata S, Takayanagi K, Kurose T, Kubota A, Hosoda M, Tobimatsu Y. Alteration in articular cartilage of rat knee joints after spinal cord injury. Osteoarthritis Cartilage. 2008;16:392–398.
Moriyama H, Yoshimura O, Kawamata S, Takemoto H, Saka Y, Tobimatsu Y. Alteration of knee joint connective tissues during contracture formation in spastic rats after an experimentally induced spinal cord injury. Connect Tissue Res. 2007;48:180–187.
Moriyama H, Yoshimura O, Sunahori H, Nitta H, Imakita H, Saka Y, Maejima H, Tobimatsu Y. Progression and direction of contractures of knee joints following spinal cord injury in the rat. Tohoku J Exp Med. 2004;204:37–44.
Moriyama H, Yoshimura O, Sunahori H, Tobimatsu Y. Comparison of muscular and articular factors in the progression of contractures after spinal cord injury in rats. Spinal Cord. 2006;44:174–181.
Poole AR. An introduction to the pathophysiology of osteoarthritis. Front Biosci. 1999;4:D662–670.
Prockop DJ, Kivirikko KI, Tuderman L, Guzman NA. The biosynthesis of collagen and its disorders (first of two parts). N Engl J Med. 1979;301:13–23.
Pufe T, Lemke A, Kurz B, Petersen W, Tillmann B, Grodzinsky AJ, Mentlein R. Mechanical overload induces VEGF in cartilage discs via hypoxia-inducible factor. Am J Pathol. 2004;164:185–192.
Renner AF, Carvalho E, Soares E, Mattiello-Rosa S. The effect of a passive muscle stretching protocol on the articular cartilage. Osteoarthritis Cartilage. 2006;14:196–202.
Sakamoto J, Origuchi T, Okita M, Nakano J, Kato K, Yoshimura T, Izumi S, Komori T, Nakamura H, Ida H, Kawakami A, Eguchi K. Immobilization-induced cartilage degeneration mediated through expression of hypoxia-inducible factor-1alpha, vascular endothelial growth factor, and chondromodulin-I. Connect Tissue Res. 2009;50:37–45.
Tabary JC, Tabary C, Tardieu C, Tardieu G, Goldspink G. Physiological and structural changes in the cat’s soleus muscle due to immobilization at different lengths by plaster casts. J Physiol. 1972;224:231–244.
Trudel G, Jabi M, Uhthoff HK. Intraarticular tissue proliferation after immobility: methods of assessment and preliminary results in rat knee joints. J Rheumatol. 1998;25:945–950.
Trudel G, Jabi M, Uhthoff HK. Localized and adaptive synoviocyte proliferation characteristics in rat knee joint contractures secondary to immobility. Arch Phys Med Rehabil. 2003;84:1350–1356.
Trudel G, O’Neill PA, Goudreau LA. A mechanical arthrometer to measure knee joint contracture in rats. IEEE Trans Rehabil Eng. 2000;8:149–155.
Trudel G, Seki M, Uhthoff HK. Synovial adhesions are more important than pannus proliferation in the pathogenesis of knee joint contracture after immobilization: an experimental investigation in the rat. J Rheumatol. 2000;27:351–357.
Trudel G, Uhthoff HK. Contractures secondary to immobility: is the restriction articular or muscular? An experimental longitudinal study in the rat knee. Arch Phys Med Rehabil. 2000;81:6–13.
Trudel G, Uhthoff HK, Brown M. Extent and direction of joint motion limitation after prolonged immobility: an experimental study in the rat. Arch Phys Med Rehabil. 1999;80:1542–1547.
Usuba M, Akai M, Shirasaki Y, Miyakawa S. Experimental joint contracture correction with low torque—long duration repeated stretching. Clin Orthop Relat Res. 2007;456:70–78.
Vasilceac FA, Renner AF, Teodoro WR, Mattiello-Rosa SM. The remodeling of collagen fibers in rats ankles submitted to immobilization and muscle stretch protocol. Rheumatol Int. 2011;31:737–742.
Walsh DA, Bonnet CS, Turner EL, Wilson D, Situ M, McWilliams DF. Angiogenesis in the synovium and at the osteochondral junction in osteoarthritis. Osteoarthritis Cartilage. 2007;15:743–751.
Yarkony GM, Bass LM, Keenan V 3rd, Meyer PR Jr. Contractures complicating spinal cord injury: incidence and comparison between spinal cord centre and general hospital acute care. Paraplegia. 1985;23:265–271.
Acknowledgments
We thank Chika Otsuka BSc, Tatsuya Marumo BSc, and Ryohei Watanabe BSc for their skilled technical assistance.
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One of the authors (HM) has received funding from a research grant for the Grant-in-Aid for Young Scientists (21700545) from the Japanese Ministry of Education, Culture, Sports, Science, and Technology.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at Hiroshima University, Hiroshima, Japan.
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Moriyama, H., Tobimatsu, Y., Ozawa, J. et al. Amount of Torque and Duration of Stretching Affects Correction of Knee Contracture in a Rat Model of Spinal Cord Injury. Clin Orthop Relat Res 471, 3626–3636 (2013). https://doi.org/10.1007/s11999-013-3196-z
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DOI: https://doi.org/10.1007/s11999-013-3196-z