Static stretching for calves

[Bill Hartman]

This is from the newest Journal of Orthopedic and Sports Physical Therapy...

6 weeks of static stretching the calf muscle-tendon unit for 2 minutes per day DID NOT increase active dorsiflexion range of motion. The interesting thing is that the same protocol has demonstrated improvements in hamstring extensibility in other studies.

Hmmmm...?

Bill Hartman

[bryanc]

I'm too lazy to trek over to the library to check the article out, and JOSPT is one of the few journals we don't have electronic subscription to, but I did read the abstract (which sadly, doesn't comment much on their methods or statistics and oftentimes, _that's_ where the explanation for odd results are). I think the thing that struck me most as odd is that the investigators were looking at _active_ ankle dorsiflexion range of motion, which is both a product of strength (of the dorsiflexors) and flexibility (of the achilles unit). It's interesting that in their abstract, they mention, "Static stretching of the calf MTU is often prescribed to increase flexibility in patients with shortened connective tissues or to maintain ADFROM in healthy individuals." I'm not aware that static stretching of the calf MTU get prescribed that often in isolation of other modalities, and really, how large does your ADFROM have to BE in healthy individuals. It would have been interesting to see the passive ROM to tease out whether or not the lack of change was a result of lack of concommittant strength improvements or whether the MTU actually didn't change at all.

[Bill Hartman]

Exactly!

This plays into our discussion of flexibility development on another post.

Often times active range of motion will not change with "stretching" simply because of a lack of strength at a specific point in the range of motion.

It would be interesting to see how just strengthening the dorsiflexors would alter AROM.

FYI...active DF was measured in prone. Static stretch was the typical wall stretch for gastroc with no attempt to maintain subtalar neutral. 4 groups: control, 30 sec/day, 1 min/day, 2 min/day with one stretch per day at 5 days/week x 6 weeks.

There was also a comment that stuck out...
a minimum of 10 degrees of ankle DF is required for normal gait...according to baseline data, the average subject had impaired active DF (less than 10 degrees) but none ambulated with an observable locomotor disorder.

Bill

[bryanc]

Yeah, their sample mean for dorsiflexion ROM seems a bit dicey. What was the standard deviation on that?

You'd think that if they made the statement that 10 degrees is required for normal gait that they would comment on their sample having less than 10 degrees ROM, and yet no "observable" gait dysfunction.

Just another reason why I don't read JOSPT.

[Bill Hartman]

Which reminds me bryanc...where are you finding the best info these days?

Back to the study

Original baseline for the 2 min stretch group. Mean DF = 9.4 with SD = 5.2, range -2 to 18.

...(I just read the last paragraph)...this is pissing me off.

They tested some folks who fit the test criteria but were not in the actual study.

When the subject maintained activation of the dorsiflexors AND the examiner forcefully dorsiflexed the ankle (active assisted ROM - could we examine one variable at a time please ), mean active (actually active assistive) DF increased to 15.3 degrees.

Why measure AAROM when the study called for active ROM?

Me thinks this study sucks...who reviews these anyway?

Bill Hartman, not a reviewer of JOSPT

[bryanc]

I don't know who reviews the articles. JOSPT does not have a great reputation for publishing high-quality articles. The Clinical Journal of Sport Medicine is a good source of clinically relevant material (though, I have to admit, I'm a bit slanted seeing as the editor in chief is one of the doc/profs here), but knowing the editor's standards, it holds its papers to a pretty high standard. I would say that out of all the sport medicine journals it's probably the best. Medicine and Science in Sport and Exercise (MSSE) is a bit of rag, with the occasional good study. The Physician and Sport Medicine only recently went peer-reviewed, but gets the nickname "The Physician and Sports Illustrated" because it's not that great. The British Journal of Sport Medicine has the occasional gem, and the American Journal of Sports Medicine is considered as the journal you publish in if you can't get in anywhere else but want to still be in a semi-reputable journal. The journal Sports Medicine (published out of New Zealand) usually has very good review articles (I'm not sure that they publish anything else), and would be my first choice for interesting reviews (though sometimes the reviews piss me off too). Anyhoo, those are the main ones I tend to read for interest. I obviously source from everywhere, and my research often takes me into the orthopaedic journals. I browse JAMA and NEJM and occasionally BMJ, but those are more medically oriented than 'sport/fitness' oriented.

Anyhoo, back to the study. How does one get a range of -2 degrees in a population of people who have no visual gait abnormalities? They can't have been looking very hard. I generally make it a rule never to read the "discussion" section of any paper--unless it's for pure interest. I rarely even read the introductions anymore. Methods and then Results. The rest is just fluff.

The scary part is that SO much research falls into this category: published, but sucks and therefore useless.

Bryan (who hopes Bill doesn't have a subscription to JOSPT, and if he does, offers his condolences)

[Bill Hartman]

Actually I steal most of my journals cause I'm not an APTA member anymore ($275/year for nothin')

I'm lucky (lucky?) that my facility has access to quite a few journals. PT on one side of the clinic docs on the other.

That's hilarious about the Phys. and SM...I'm always shocked when folks would reference it in their work. I'm curious to see how it changes with peer review.

Bill (who does not subscribe to JOSPT)