Medial gastrocnemius muscle stiffness cannot explain the increased ankle joint range of motion following passive stretching in children with cerebral palsy.

Abstract

What is the central question of this study? Can the increased range of motion seen acutely after stretching in children with cerebral palsy be explained by changes in the stiffness of the medial gastrocnemius fascicles? What is the main finding and its importance? We show, for the first time, that passive muscle and tendon properties are not changed acutely after a single bout of stretching in children with cerebral palsy and, therefore, do not contribute to the increase in range of motion. This contradicts common belief and what happens in healthy adults. Stretching is often used to increase or maintain the joint range of motion (ROM) in children with cerebral palsy (CP), but the effectiveness of these interventions is limited. Therefore, our aim was to determine the acute changes in muscle-tendon lengthening properties that contribute to increased ROM after a bout of stretching in children with CP. Eleven children with spastic CP [age 12.1(3SD)years, 5/6 hemiplegia/diplegia, 7/4 gross motor function classification system level I/II] participated. Each child received three sets of five×20s passive, manual static dorsiflexion stretches separated by 30s rest, with 60s rest between sets. Before and immediately after stretching, ultrasound was used to measure medial gastrocnemius fascicle lengthening continuously over the full ROM and an individual common ROM pre- to post-stretching. Simultaneously, three-dimensional motion of two marker clusters on the shank and the foot was captured to calculate ankle angle, and ankle joint torque was calculated from manually applied torques and forces on a six degrees-of-freedom load cell. After stretching, the ROM was increased [by 9.9(12.0)deg, P=0.005]. Over a ROM common to both pre- and post-measurements, there were no changes in fascicle lengthening or torque. The maximal ankle joint torque tolerated by the participants increased [by 2.9(2.4) Nm, P=0.003], and at this highest passive torque the maximal fascicle length was 2.8(2.4) mm greater (P=0.009) when compared with before stretching. These results indicate that the stiffness of the muscle fascicles in children with CP remains unaltered by an acute bout of stretching.