The Efficacy of Different Types of Stretching on Range of Motion, Pain and Function in Elbow Limitation

Study Overview
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Brief Summary
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The aim of the study is to compare the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) stretching and static stretching on range of motion (ROM), pain and function in elbow limitation.

Detailed Description
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To compare the efficacy of PNF stretching and static stretching on ROM, pain and function in elbow limitation, forty voluntary patients with elbow limitation, aged between 18-55 years will be randomly divided into two groups: PNF Stretching group and Static Stretching group. PNF stretching will be combined with exercise and cold application in PNF Stretching group, static stretching will be combined with exercise and cold application in Static Stretching group, will be applied for 12 sessions. The patients will be assessed before and after six-week treatment. The pain on activity, at rest and at night will be assessed with Visual Analog Scale (VAS). ROM will be assesed with universal goniometer. The functional status will be evaluated by Disabilities Arm, Shoulder and Hand (DASH). Kinesiophobia and quality of life will be assessed with Tampa Scale for Kinesiophobia and Short Form-12, respectively. The Global Rating of Change will be used to evaluate patient satisfaction.

Official Title
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The Efficacy of Proprioceptive Neuromuscular Facilitation Stretching and Static Stretching on Range of Motion, Pain and Function in Elbow Limitation

Conditions
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Postoperative Pain, Elbow Fracture, Stiffness of Elbow, Not Elsewhere Classified

Intervention / Treatment
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* Other: PNF stretching
* Other: Static Stretching
* Other: Exercise
* Other: Cold Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjectswill be included with Aged between 18 and 65 years Elbow fracture in the six months before the study Elbow limitation in flexion or extension Being volunteer to participate Fractures should be managed with conservatively or surgically Exclusion Criteria: Malunion or Nonunion Fracture Occurrence of complex regional pain syndrome, peripheric nerve injury, heterotopic ossification, myositis ossification or post-traumatic ankylosing Non-healing wound or infection Previously received physiotherapy for elbow limitation Having any cardiovascular diseases, neurological disorders, rheumatic diseases or psychiatric diseases Could not adjust to treatment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PNF Stretching group<br>Each subject in PNF Stretching group will receive a treatment protocol consisting of PNF stretching, cold therapy and exercise. | Other: PNF stretching<br>* For hold-relax stretching, each subject in PNF Stretching group will be comfortably positioned in a supine lying position, and patient will move the joint to the end of the passive or pain-free ROM. The therapist will ask for an isometric contraction of the restricting muscle or pattern (antagonists) with emphasis on rotation. The patients will be asked to perform submaximal isometric contractions of the target muscle for 10 seconds. After the contraction, the patients will be instructed to relax for 5 seconds. The joint will be repositioned actively to the new limit of range, and then therapist will passively control the new ROM. The procedure will be repeated 10 times with 10 seconds of rest between two successive trials. Patients will be treated 2 times per week for 6 weeks.<br>Other: Exercise<br>* Shoulder, elbow and wrist AROM exercises. Elbow flexion and extansion self-stretching exercises Elbow and wrist strengthening exercises Proprioception exercises for elbow. Grip strengthening exercises.<br>Other: Cold Therapy<br>* Cold therapy will be applied over the elbow for 15 minutes in the form of cold pack after stretching and exercise protocol.<br>|
| Experimental: Static Stretching group<br>Each subject in Static Stretching group will receive a treatment protocol consisting of static stretching, cold therapy and exercise. | Other: Static Stretching<br>* For static stretching, each subject in Static Stretching group will be comfortably positioned in a supine lying position, and the stretching of target muscle will be maintained for 20 seconds followed by 10 seconds of rest. The procedure will be repeated 10 times with 10 seconds of rest between two successive trials. Patients will be treated 2 times per week for 6 weeks.<br>Other: Exercise<br>* Shoulder, elbow and wrist AROM exercises. Elbow flexion and extansion self-stretching exercises Elbow and wrist strengthening exercises Proprioception exercises for elbow. Grip strengthening exercises.<br>Other: Cold Therapy<br>* Cold therapy will be applied over the elbow for 15 minutes in the form of cold pack after stretching and exercise protocol.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional Status | The functional status of the patients will be evaluated by The Disabilities of the Arm, Shoulder and Hand (DASH). | After the six-week intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Active Range of Motion (AROM) Assessment | The elbow's and forearm's AROM, including flexion, extansion, supination, pronation will be measured described by the American Academy of Orthopaedic Surgeons (AAOS) using a universal goniometer. The process will be repeated three times in each direction, with the the average value recorded. | Baseline | 
| Active Range of Motion (AROM) Assessment | The elbow's and forearm's AROM, including flexion, extansion, supination, pronation will be measured described by the American Academy of Orthopaedic Surgeons (AAOS) using a universal goniometer. The process will be repeated three times in each direction, with the the average value recorded. | After the six-week intervention | 
| Active Range of Motion (AROM) Assessment | The elbow's and forearm's AROM, including flexion, extansion, supination, pronation will be measured described by the American Academy of Orthopaedic Surgeons (AAOS) using a universal goniometer. The process will be repeated three times in each direction, with the the average value recorded. | 1-month follow up | 
| Functional Status | The functional status of the patients will be evaluated by The Disabilities of the Arm, Shoulder and Hand (DASH). | Baseline | 
| Functional Status | The functional status of the patients will be evaluated by The Disabilities of the Arm, Shoulder and Hand (DASH). | 1-month follow up | 
| Pain Intensity | Pain intensity of the patients at rest, during activity, and at night will be assessed by Visual Analog Scale. | Baseline | 
| Pain Intensity | Pain intensity of the patients at rest, during activity, and at night will be assessed by Visual Analog Scale. | After the six-week intervention | 
| Pain Intensity | Pain intensity of the patients at rest, during activity, and at night will be assessed by Visual Analog Scale. | 1-month follow up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pain, exercise, proprioceptive neuromuscular facilitation stretching, static stretching