DOI QR코드

DOI QR Code

Effects of Hold-Relax and Active Range of Motion on Thoracic Spine Mobility

  • Received : 2012.08.21
  • Accepted : 2012.09.28
  • Published : 2012.10.31

Abstract

Few studies address the use of manual muscle stretching to improve spinal active range of motion(AROM). There is evidence that' Hold-Relax'(HR) is effective for increasing ROM in the extremities, which leads the researchers to anticipate similar benefits in the spine. The purpose of this study is to investigate the effects of HR(trunk flexors) and active thoracic flexion and extension on thoracic mobility, specifically flexion and extension in healthy individuals. A convenience sample of 30 physical therapy students(22-38 years) were randomly assigned to intervention sequence 'A-B' or 'B-A', with at least 7 days between interventions. Intervention' A' consisted of HR of the ventral trunk musculature while 'B' consisted of thoracic flexion-extension AROM. Thoracic flexion and extension AROM were measured before and after each intervention using the double inclinometer method. Paired t-tests were used to compare AROM pre and post-intervention for both groups, and to test for carry-over and learning effects. There was a statistically significant increase(mean=$3^{\circ}$ ; p=0.006) in thoracic extension following HR of the trunk flexors. There were no significant changes in thoracic flexion following HR, or in flexion or extension following the AROM intervention. No carryover or learning effects were identified. HR may be an effective tool for improving AROM in the thoracic spine in pain free individuals. Further investigation is warranted with symptomatic populations and to define the minimal clinical difference(MCD) for thoracic spine mobility.

Keywords

References

  1. Lewis C, Erhard R, Drysdale G. Kyphoscoliosis improvement while treating a patient for adhesive capsulitis using the active therapeutic movement. J Manipulative Physiol Ther 2008; 31(9):715-722. https://doi.org/10.1016/j.jmpt.2008.10.003
  2. Fernandez-de-las-Penas C, Fernandez-Carnero J, Fernandez A, Lomas-Vega R, Miangolarra-Page J. Dorsal manipulation in whiplash injury treatment: a randomized controlled trial. J Whiplash Related Disorders 2004; 3: 55-72.
  3. Cleland J, Childs J, McRea M, Palmer J, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther 2005; 10: 127-135. https://doi.org/10.1016/j.math.2004.08.005
  4. Cleland J, Whitman G, Eberhart S, Macdonald C, Childs J. Short-term effects of thrust vs nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther 2007; 87: 431-440. https://doi.org/10.2522/ptj.20060217
  5. Krauss J, Creighton D, Ely J, Podlewska-Ely J. The immediate effects of upper thoracic translatoric spinal manipulation on cervical pain and range of motion: a randomized clinical trial. JMMT 2008; 16(2): 93-99. https://doi.org/10.1179/106698108790818530
  6. Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland J, Gutierrez-Vega M. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2009; 39(1): 20-27. https://doi.org/10.2519/jospt.2009.2914
  7. Gavin D. The effect of joint manipulation techniques on active range of motion in the mid-thoracic spine of asymptomatic subjects. J Man Manip 1999; 7(3): 114-122. https://doi.org/10.1179/106698199790811672
  8. Schiller L. Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: a pilot randomized clinical trial. J Manipulative Physiol Ther 2001; 24: 394-401. https://doi.org/10.1067/mmt.2001.116420
  9. Adams G, Sim J. A survey of UK manual therpaists' practice of and attitudes towards manipulation and its complications. Phyisother Res Int 1998; 3(3): 206-227. https://doi.org/10.1002/pri.141
  10. Evjenth O, Hamberg J. Muscle Stretching in Manual Therapy, A Clinical Manual: The Spinal Column and the TM-Joint. Vol II. Alfta, Sweden: Alfta Rehab; 1997.
  11. Kisner C, Colby L. Therapeutic Exercise: Foundations and Techniques 5th Ed. F.A. Davis Company; 2007.
  12. Kabat H. Studies on neuromuscular dysfunction: XV role of central facilitation in restoration of motor function in paralysis. Arch Phys Med Rehabil 1952; 33: 521-533.
  13. Knott M, Voss D. Proprioceptive Neuromuscular Facilitation: Patterns & Techniques. New York: Harper & Row; 1968.
  14. Tanigawa MC. Comparison of the hold-relax procedure and passive mobilization on increasing muscle length. Phys Ther 1972; 52(7): 725-735.
  15. Holt LE, Travis TM, Okita T. Comparative study of three stretching techniques. Percept Mot Skills 1970; 31(2): 611-616. https://doi.org/10.2466/pms.1970.31.2.611
  16. Sady SP, Wortman M, Blanke D. Flexibility training: ballistic, static or proprioceptive neuromuscular facilitation? Arch Phys Med Rehabil 1982; 63(6): 261-263.
  17. Kisner C CL. Therapeutic Exercise: Foundations and Techniques 5th Ed. F.A. Davis Company;2007.
  18. Williford H, Smith J. A comparison of proprioceptive neuromuscular facilitation and static stretching techniques. Amer Corr Ther J 1985:30-33.
  19. Sullivan MK, Dejulia JJ, Worrell TW. Effect of pelvic position and stretching method on hamstring muscle flexibility. Med Sci Sports Exerc 1992; 24(12): 1383-1389.
  20. Davis DS, Ashby PE, McCale KL, McQuain JA, Wine JM. The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. J Strength Cond Res 2005; 19(1): 27-32.
  21. Bonnar BP, Deivert RG, Gould TE. The relationship between isometric contraction durations during hold-relax stretching and improvement of hamstring flexibility. J Sports Med Phys Fitness. 2004; 44(3): 258-261.
  22. Carter AM, Kinzey SJ, Chitwood LF, Cole JL. Proprioceptive nuromuscular facilitation decreases muscle activity during the stretch reflex in selected posterior thigh muscles. J Sport Rehabil 2000; 9: 269-278.
  23. Feland JB, Myrer JW, Merrill RM. Acute changes in hamstring flexibility: PNF versus static stretch in senior athletes. Physical Therapy in Sport 2001; 2: 186-193. https://doi.org/10.1054/ptsp.2001.0076
  24. Gribble P GK, Prentice W, Shields E. Effects of static and hold-relax stretching of hamstring range of motion using the FlexAbility LE1000. J Sport Rehab 1999; 8: 195-208.
  25. Spernoga SG, Uhl TL, Arnold BL, Gansneder BM. Duration of maintained hamstring flexibility after a one-time, modified hold-relax stretching protocol. J Athl Train 2001; 36(1): 44-48.
  26. Puentedura EJ, Huijbregts PA, Celeste S, Edwards D, In A, Landers MR, Fernandez-de-Las-Penas C. Immediate effects of quantified hamstring stretching: hold-relax proprioceptive neuromuscular facilitation versus static stretching. Phys Ther Sport 2011; 12(3): 122-126. https://doi.org/10.1016/j.ptsp.2011.02.006
  27. Decicco PV, Fisher MM. The effects of proprioceptive neuromuscular facilitation stretching on shoulder range of motion in overhand athletes. J Sports Med Phys Fitness 2005; 45(2): 183-187.
  28. Gribble PA, Guskiewicz KM, Prentice WE, Shields EW. Effects of static and hold-relax stretching on hamstring range of motion using the flexAbility LE1000. J Sport Rehabil 1999; 8: 195-208.
  29. McCarthy P, Olsen J, Smeby I. Effects of contract- relax stretching procedures on active range of motion of the cervical spine in the transverse plane. Clinical Biomechanics 1997; 12(2): 136-138. https://doi.org/10.1016/S0268-0033(96)00060-5
  30. Taylor J, Twomey L. Sagfittal and horizontal plane movement of the human lumbar vertebral column in cadavers and in the living. Rheumatol Rehab 1980; 19: 223-232. https://doi.org/10.1093/rheumatology/19.4.223
  31. Keeley J, Mayer T, Cox R, Gatchel R, Smith J, Mooney V. Quantification of lumbar functionpart 5: reliability of range of motion measures in the sagittal plane and an in vivo torso rotation measurement technique. Spine 1985; 11(1): 31-35.
  32. Marras W, Wongsam P. Flexibility and velocity of the normal and impaired lumbar spine. Arch Phys Med Rehabil 1986; 67: 213-217.
  33. Ensink F, Saur P, Frese K, Seeger D, Hildebrant J. Lumbar range of motion: influence of time of day and individual factors on measurements. Spine 1996; 21(11): 1339-1343. https://doi.org/10.1097/00007632-199606010-00012
  34. Engleberg Z. American Medical Association Guides to the Evaluation of Permanent Impairment. Chicago, IL: American Medical Association; 1990.
  35. Mellin G. Meaurement of thoracolumbar posture and mobilty with a myrin inclinometer. Spine 1986; 11: 759-762. https://doi.org/10.1097/00007632-198609000-00019
  36. Mellin G, Kiiski R, Weckstrom A. Effects of subject position on measurements of flexion, extension, and lateral flexion of the spine. Spine 1991; 16(9): 1108-1110. https://doi.org/10.1097/00007632-199109000-00016
  37. Rajdl E. Intra-rater and inter-rater reliability of assessing thoracic spine mobility using the double inclinometer method: Physical Therapy, Oakland University; 2010.
  38. Sullivan M, Dickinson C, Troup J. The influence of age and gender on lumbar spine sagittal plane range of motion. Spine 1994; 19(6): 682-686. https://doi.org/10.1097/00007632-199403001-00007
  39. Portney LG, Watkins, M.P. Foundations of Clinical Research: Applications to Practice. 3 Ed. Upper Saddle River: Prentice-Hall; 2009.
  40. Cohen J. Statistical power analysis for the behavioral sciences, 2 Ed. Hillsdale, New Jersey: Lawrence Eribaum Associates, Inc.; 1988.
  41. Young P, Young P. Basic Clinical Neuroanatomy. Philadelphia: Williams & Wilkins; 1997.
  42. Liebesman J, Cafarelli E. Physiology of range of motion in human joints: a critical review. Critical reviews in physical and rehabilitation medicine 1994; 6(2): 131-150.
  43. Vitti J, Paris S. Use of multifidus isometric for patients with acute neck pain: a case report. JMMT 2003; 22: 103-109.
  44. McCarthy PW, Olsen JP, Smeby IH. Effects of contract-relax stretching procedures on active range of motion of the cervical spine in the transverse plane. Clin Biomech(Bristol, Avon) 1997; 12(2): 136-138. https://doi.org/10.1016/S0268-0033(96)00060-5
  45. Lundberg G, Gerdle B. Correlations between joint and spinal mobility, spinal sagittal configuration, segmental mobility, segmental pain, symptoms and disabilities in female homecare personnel. Scand J Rehabil Med 2000; 32(3): 124-133. https://doi.org/10.1080/003655000750045479
  46. Odebiyi D KS, Lawal T. Relationship between spinal mobility, physical performance, pain intensity and functional disabiltiy in patients with chronic low back pain. NJMR 2006; 11.
  47. Mellin G. Correlations of spinal mobility with degree of chronic low back pain after correction for age and anthropometric factors. Spine 1976; 12(5): 464-468.
  48. Mellin G. Decreased joint and spinal mobility associated with low back pain in young adults. J Spinal Disord 1990; 3(3): 238-243.
  49. Burton AK, Tillotson KM, Troup JD. Variation in lumbar sagittal mobility with low-back trouble. Spine(Phila Pa 1976) 1989; 14(6): 584-590. https://doi.org/10.1097/00007632-198906000-00007
  50. Cross KM, Kuenze C, Grindstaff TL, Hertel J. Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review. J Orthop Sports Phys Ther 2011; 41(9): 633-642. https://doi.org/10.2519/jospt.2011.3670

Cited by

  1. Effects of Combined Therapeutic Exercise on Improvement of Respiratory Function and Trunk Posture in Elderly Patients with Restrictive Lung Disease vol.13, pp.9, 2015, https://doi.org/10.14400/JDC.2015.13.9.333
  2. The Effect of Inspiratory Muscle Training on Respiratory Function in Stroke Patient vol.6, pp.1, 2015, https://doi.org/10.5854/JIAPTR.2015.03.31.795
  3. Spinal-Exercise Prescription in Sport: Classifying Physical Training and Rehabilitation by Intention and Outcome vol.51, pp.8, 2016, https://doi.org/10.4085/1062-6050-51.10.03