Background: Physical deconditioning is often associated with chronic pain and is believed to be a result of gradual movement inhibition and reduction of physical activities. It is common for chronic pain sufferers to present with limited muscle extensibility and poor tolerance to physical movement. Exercises are therefore prescribed to assist in regaining muscle extensibility, strength, fitness and endurance. Of particular interest is stretch, a type of exercise aimed at increasing muscle extensibility. Stretch is commonly prescribed as part of physical rehabilitation in pain management programs, yet little is known of its effectiveness in the chronic pain population.
Aim: The aim of this randomised controlled trial was to investigate the effects of a three-week stretch program on muscle extensibility and stretch tolerance in patients with chronic musculoskeletal pain.
Methods: Thirty adults with pain persisting for at least three months and limited hamstring muscle extensibility were recruited from patients enrolled in a multidisciplinary pain management program at a Sydney Hospital. A within-subject design was used, with one leg of each participant randomly allocated to an experimental (stretch) condition and the other to a control (no stretch) condition. The hamstring muscles of the experimental leg were stretched for one minute a day over a three-week period, whilst the hamstring muscles of the control leg were not stretched during this time. This intervention was embedded within a pain management program and supervised by physiotherapists. Primary outcome measures were muscle extensibility and stretch tolerance, reflected by passive hip flexion angles produced with standardised and non-standardised torques, respectively. Initial measures were taken prior to the first stretch on day one and final measures were taken one to two days after the last stretch. A blinded assessor was used for all testing.
Results: After three weeks of intervention, stretch did not increase muscle extensibility (mean between-group difference in hip flexion was 1 degree; 95% CI -2 to 4 degrees) but did improve stretch tolerance (mean between-group difference in hip flexion was 8 degrees; 95% CI 5 to 10 degrees).
Conclusion: Three weeks of stretch increases tolerance to the discomfort associated with stretch but does not change muscle extensibility in patients with chronic musculoskeletal pain. This study provides support for the ongoing incorporation of stretch in pain management programs, where stretch may be conceptualised as a graded exposure to movement and assisting in the restoration of normal activity and function.