One of our common goals in the rehabilitation of a multitude of conditions is to increase range of motion. In this months’ Research Refresh we looked at a systematic review of human research that compares strength training with stretching to improve range of motion.
According to the review, both strength training and stretching resulted in improvements in range of motion, in both short-term and long-term interventions. The decision with regard to which programme to pursue for an individual patient may hinge on the additional benefits, goals and requirements of that patient.
Do you know how strengthening and stretching programmes differ, yet can affect the same outcome measure?
A reduced range of motion
A reduction in range of motion can occur as a result of many conditions or pathologies, and can be divided into the following categories:
Muscle injury or pathology
Ligament/tendon injury or pathology
Loss of proprioception
Nerve injury or dysfunction
Muscle weakness or atrophy
Range of motion can be reduced actively, referring to a reduced range of motion in the active movement of the patient. A restriction in active movement can be as a result of muscle weakness or restriction, pain, a physical inability to complete the full range of motion, or instability of the region.
Passive range can be restricted as a result of pain, contracture of the muscle or joint capsule, or restrictions within the joint. When we test range of motion in our patients, we are testing the passive range.
An understanding of the cause of the reduced range of motion can guide us in our choice of whether to opt for stretching or strengthening as a treatment intervention.
Stretching to increase range of motion
We will commonly use stretching in our patients to increase range of motion, both during treatment and as part of the home programme.
Static stretching is performed by the therapist or owner stretching out the limb or muscle group and holding it for a period of time. Dynamic stretching requires the patient to move into and hold a stretched position. This can be specific to the sport or function that the patient needs to perform. An example of a dynamic stretch would be placing the forelimbs on a raised surface such as a peanut ball and doing cookie stretches to increase the extension of the back and hips.
Dynamic stretching will impact the whole body, increasing full body circulation and cardiovascular rates, and improving neuromuscular control and proprioception. It can help us to achieve specific goals in addition to increasing range of motion.
Stretching will improve range of motion in a number of ways, increasing stretch tolerance through neuromodulation, and through histological changes at the level of the musculotendinous unit.
Strengthening to increase range of motion
Strengthening is primarily used to address muscle weakness or asymmetry, or to improve function. There are many ways to incorporate strength training into our patients’ routines. All that is required is the addition of resistance to an exercise, which can include increasing the load on a limb through lifting another limb/s, the use of the theraband, or hydrotherapy.
Strength training has been shown to increase fascicle length, improve muscle coordination, improve reciprocal inhibition, and improve stretch-shortening cycles, as well as to increase range of motion, but studies comparing strengthening to stretching have shown conflicting results.
Strengthening VS Stretching
In Strength Training versus Stretching for Improving Range of Motion: A Systematic Review and Meta-Analysis, 194 peer reviewed journal articles were evaluated, and 11 were finally eligible for inclusion in the review. In this review, no statistical difference could be shown between the use of strengthening or stretching to promote range of motion, and one protocol could not be favoured or recommended above another.
The articles reviewed were all human-based, and this certainly does add some complications as we try to extrapolate these findings to our animal patients. For one, there are limitations in both stretching and strengthening protocols in animals, with many of the techniques used in humans not relevant to our equine or small animal practices simply because they are impractical to perform.
Considering other factors
As we make decisions clinically to guide our treatment interventions, we must consider the preferences of the patient, the concurrent treatment goals, the cause of reduced range of motion, and the ability and compliance of the owner. In some cases, static stretching may be simple, easy and enjoyable for both owner and patient, and can be incorporated into a leisurely massage and cuddle session.
For other owners and patients, a more active approach will be more enjoyable, and incorporating active stretches into a training routine or exercise routine may be far more beneficial.
Strengthening exercises can have the additional advantages of improving neurological deficits, improving muscle symmetry, strengthening specific muscle groups, improving joint health, and addressing functional or competition goals.
Both strengthening protocols and stretching protocols can improve range of motion in our patients. It is up to us to use sound clinical reasoning to establish the cause of the dysfunction and the goals of the patient when deciding which intervention to prioritise.
If you would like to learn more about clinical reasoning or exercise protocols, there are some phenomenal webinars in our members platforms for you to learn from:
- Understanding Exercise Physiology, a four-part series with Lesie Eide
- Therapeutic Exercise for Every Dog, with Debbie Gross Torraca
- Force-Free Exercise in the Canine, with Robert J Porter
- Biomechanics of Tissue Healing and its Relationship to Therapeutic Exercise, with Carrie Adrian