Effects of 12-Week Active and Passive Stretching Programs on Lower-Extremity Range of Motion and Pain in Adults Aged 45 - 60 : A Systematic Literature Review

Abstract

The signs of musculoskeletal disorders include lower-extremity range of motion (ROM) and related pain that are prevalent in middle-aged adults and may severely affect functional capacity and quality of life. Stretching exercises, such as active and passive ones, are commonly prescribed to mitigate these constraints but it is not clear how long, how frequently, and what type of stretching exercise should be used by people of 45 to 60 years. It was a systematic literature review that tested the impact of 12-week or longer stretching programs on lower-extremity ROM and pain in adults age 4560 years. The search of structured electronic collections of peer-reviewed academic articles, books, and reports using PRISMA 2020 principles was carried out. Keywords such as stretching interventions, lower-extremity joints, range of motion, pain outcomes, and target age group were used as search strategies. The inclusion criteria were eligible studies that were randomized controlled trials or quasi-experiments that enrolled adults aged 4560 years and applied stretching interventions of at least 12 weeks and reported lower-extremity ROM and/or pain. The study screening and data extraction were done by two independent reviewers, with the methodological quality evaluated with Cochran Risk of Bias tool. Out of 230 original records, 87 unique studies were left after the removal of duplicates. After the screening of abstracts (n = 24) and the evaluation of the full-text, seven studies were selected as meeting all the inclusion criteria indicating an inclusion rate of 8.0%. The studies included reviewed various modalities of stretching such as contraceptive intramuscular facilitation (PNF), dynamic stretching, static passive stretching, and static active stretching, as well as muscle-directed stretching and nerve directed stretching with sample sizes of 10 to 76 individuals. Five studies found a significant enhancement of ROM with a range of 7.3 to 9.9 degrees increase of ankle reflexion, and three studies that assessed pain outcome results showed significant decrease of pain levels after the interventions of stretching. The assessment of risk-of-bias revealed that there were a number of methodological limitations, most notably concerning the procedure of blinding and allocation concealment. In general, the results indicate that stretching programs of 12 weeks or more can be actively used to increase lower-extremity ROM and decrease pain in middle-aged adults. Passive stretching and PNF methods seem especially useful in the reduction of pain, though, both muscle-specific and nerve-specific stretching methods also lead to the increase of ROM. However, the paucity of the eligible studies, the differences in the intervention regimes and the methodological shortcomings necessitate a careful interpretation of the findings. Randomized controlled trials with rigorously designed and standardized stretching protocols, sufficient blinding and detailed reporting should be used in future research to enhance the body of evidence and guide clinical practice recommendations.