If the primary goal of stretch is to elongate the muscle, two potential
reasons exist as to why these techniques could have different effects.
Due to the voluntary nature of the standing self-stretch, it might be
difficult for children with CP to coordinate muscle activity to maintain
the body position required for the muscle to be stretched (Rose and
McGill, 2005), which could negatively impact the effectiveness of the
stretch. Conversely, during the standing self-stretch proprioceptive
inputs from the foot sole and/or altered input from the vestibular
system, which may serve to suppress the H-reflex (Alrowayeh et al.,
2005), could reduce the activation level of the muscle and thereby
increase the muscle's extensibility. From a basic science perspective, an
understanding of the effect stretch technique has on muscle extensibility
is important as it would provide further insights into these conflicting
mechanisms. From an applied perspective, such an understanding
would help to inform clinicians as to which technique is most
effective in terms of achieving the greatest potential stretch of the
muscle. Therefore, the second purpose of this study was to
investigate the effect of stretch technique on muscle extensibility
in children with spastic CP.
2. Methods
2.1. Participants
Eight children with clinically diagnosed spastic diplegic CP (3 males,
5 females; mean age 10.2y SD 3.2y (range=6–14y) mean stature 138.4
SD 18.4 cm; mean mass 37.3 SD 13.2 kg) were recruited through the
British National Health Service (NHS) paediatric physiotherapy services.
Five patients were classified as Level 2, and 3 patients were classified as
Level 1 on the Gross Motor Function Classification System as assessed by
a physiotherapist (Palisano et al., 1997). No children had received any
form of orthopaedic surgery or Botulinum toxin injection prior to
participation in the study. The study was approved by institutional as
well as the relevant local NHS Ethics Committees. The study was
conducted in accordance with the Declaration of Helsinki. Written
parental consent was obtained in addition to written assent from the
children.
2.2. Experimental design
Participants attended the physiotherapy