Stretching is an intervention often used in various kinds of rehabilitation protocols and the effects on pain sensitivity has sparsely been investigated, especially when addressing potential effects on pain. The objective is to investigate the immediate effects of an axial and peripheral prolonged stretch on pressure pain sensitivity (PPT) and temporal summation (TS) on local and distal sites in healthy subjects.
Twenty-two healthy volunteers were recruited to participate in this pilot study. Two prolonged stretching protocols were performed: low back and wrist extensors stretches. PPT and pinprick TS were measured pre- and post-intervention at local and remote sites. Repeated measures analysis of variance (ANOVA) was used to examine the effects and significance of the interventions.
The low back stretch induced an increase in PPT for both local and remote sites, and the wrist stretch produced a PPT increase only at the local site. TS did not change.
Low back stretching induced an increase in PPT at both local and remote sites whereas the wrist stretch only increased PPT locally, suggesting hypoalgesia at these sites. Further studies are needed to confirm the effect and mechanisms using randomised, controlled and parallel study design. Considering that pain sensitivity is different than clinical pain, results are difficult to extrapolate to clinical practice. Future studies testing clinical pain are needed to better understand the clinical implication of these results.
Funding source: Quebec Pain Research Network
Funding source: Canadian Musculoskeletal Research Network
Funding source: Quebec Rehabilitation Network (REPAR)
Funding source: Fonds de recherche du Québec – Santé
Award Identifier / Grant number: 281961
We acknowledge the help of Jean Tittley for data collection and Richard Preuss for commenting the first version of the article.
Research funding: This study was funded by a collaborative grant from the Quebec Pain Research Network, Canadian Musculoskeletal Research Network and the Quebec Rehabilitation Network (REPAR). HMA is supported by a research scholar from Fonds de recherche du Québec – Santé (281961). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Conflict of interest: Authors state no conflict of interest.
Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The local ethics committee (CER CIUSSS Capitale Nationale 2019-1547) provides a written ethical consent to undertake the study and the study was conducted in accordance with the Declaration of Helsinki.
1. Lalonde, L, Choiniere, M, Martin, E, Berbiche, D, Perreault, S, Lussier, D. Costs of moderate to severe chronic pain in primary care patients – a study of the ACCORD Program. J Pain Res 2014; 7: 389–403. https://doi.org/10.2147/jpr.s55388.Search in Google Scholar
3. Foster, NE, Anema, JR, Cherkin, D, Chou, R, Cohen, SP, Gross, DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018; 391: 2368–83. https://doi.org/10.1016/s0140-6736(18)30489-6.Search in Google Scholar
5. Naugle, KM, Fillingim, RB. A meta-analytic review of the hypoalgesic effects of exercise. J Pain 2012; 13: 1139–50. https://doi.org/10.1016/j.jpain.2012.09.006.Search in Google Scholar PubMed PubMed Central
6. Voogt, L, de Vries, J, Meeus, M, Struyf, F, Meuffels, D, Nijs, J. Analgesic effects of manual therapy in patients with musculoskeletal pain: a systematic review. Man Ther 2015; 20: 250–6. https://doi.org/10.1016/j.math.2014.09.001.Search in Google Scholar PubMed
7. Rice, D, Nijs, J, Kosek, E, Wideman, T, Hasenbring, MI, Koltyn, K, et al. Exercise-induced hypoalgesia in pain-free and chronic pain populations: state of the art and future directions. J Pain 2019; 20: 1249–66. https://doi.org/10.1016/j.jpain.2019.03.005.Search in Google Scholar PubMed
8. Da Silva Santos, R, Galdino, G. Endogenous systems involved in exercise-induced analgesia. J Physiol Pharmacol 2018; 69: 3–13. https://doi.org/10.26402/jpp.2018.1.01.Search in Google Scholar PubMed
9. Bartholdy, C, Zangger, G, Hansen, L, Ginnerup-Nielsen, E, Bliddal, H, Henriksen, M. Local and systemic changes in pain sensitivity after 4 Weeks of calf muscle stretching in a nonpainful population: a randomized trial. Pain Pract 2016; 16: 696–703. https://doi.org/10.1111/papr.12322.Search in Google Scholar PubMed
10. Guissard, N, Duchateau, JJM. Effect of static stretch training on neural and mechanical properties of the human plantar-flexor muscles. Muscle Nerve 2004; 29: 248–55. https://doi.org/10.1002/mus.10549.Search in Google Scholar PubMed
11. Park, KN, Kwon, OY, Yi, CH, Cynn, HS, Weon, JH, Kim, TH, et al. Effects of motor control exercise vs muscle stretching exercise on reducing compensatory lumbopelvic motions and low back pain: a randomized trial. J Manip Physiol Ther 2016; 39: 576–85. https://doi.org/10.1016/j.jmpt.2016.07.006.Search in Google Scholar PubMed
12. Klingler, W, Velders, M, Hoppe, K, Pedro, M. Clinical relevance of fascial tissue and dysfunctions. Curr Pain Headache Rep 2014; 18: 439. https://doi.org/10.1007/s11916-014-0439-y.Search in Google Scholar PubMed
13. Blazevich, AJ, Cannavan, D, Waugh, CM, Miller, SC, Thorlund, JB, Aagaard, P, et al. Range of motion, neuromechanical, and architectural adaptations to plantar flexor stretch training in humans. J Appl Physiol 2014; 117: 452–62. https://doi.org/10.1152/japplphysiol.00204.2014.Search in Google Scholar PubMed
14. Bishop, MD, George, SZ. Pain sensitivity and torque used during measurement predicts change in range of motion at the knee. J Pain Res 2017; 10: 2711–6. https://doi.org/10.2147/jpr.s150775.Search in Google Scholar PubMed PubMed Central
15. Stove, MP, Hirata, RP, Palsson, TS. Muscle stretching – the potential role of endogenous pain inhibitory modulation on stretch tolerance. Scand J Pain 2019; 19: 415–22. https://doi.org/10.1515/sjpain-2018-0334.10.1515/sjpain-2018-0334Search in Google Scholar PubMed
16. Lee, JH, Gak, HB. Effects of self stretching on pain and musculoskeletal symptom of bus drivers. J Phys Ther Sci 2014; 26: 1911–4. https://doi.org/10.1589/jpts.26.1911.Search in Google Scholar PubMed PubMed Central
17. Ylinen, J, Kautiainen, H, Wiren, K, Hakkinen, A. Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial. J Rehabil Med 2007; 39: 126–32. https://doi.org/10.2340/16501977-0015.Search in Google Scholar PubMed
18. Franca, FR, Burke, TN, Caffaro, RR, Ramos, LA, Marques, AP. Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized, controlled trial. J Manip Physiol Ther 2012; 35: 279–85. https://doi.org/10.1016/j.jmpt.2012.04.012.Search in Google Scholar PubMed
19. Kim, G, Kim, H, Kim, WK, Kim, J. Effect of stretching-based rehabilitation on pain, flexibility and muscle strength in dancers with hamstring injury: a single-blind, prospective, randomized clinical trial. J Sports Med Phys Fit 2018; 58: 1287–95. https://doi.org/10.23736/s0022-4707.17.07554-5.Search in Google Scholar
20. Bretischwerdt, C, Rivas-Cano, L, Palomeque-del-Cerro, L, Fernandez-de-las-Penas, C, Alburquerque-Sendin, F. Immediate effects of hamstring muscle stretching on pressure pain sensitivity and active mouth opening in healthy subjects. J Manip Physiol Ther 2010; 33: 42–7. https://doi.org/10.1016/j.jmpt.2009.11.009.Search in Google Scholar PubMed
21. Vaegter, HB, Handberg, G, Graven-Nielsen, T. Isometric exercises reduce temporal summation of pressure pain in humans. Eur J Pain 2015; 19: 973–83. https://doi.org/10.1002/ejp.623.Search in Google Scholar PubMed
22. Falla, D, Gizzi, L, Tschapek, M, Erlenwein, J, Petzke, F. Reduced task-induced variations in the distribution of activity across back muscle regions in individuals with low back pain. Pain 2014; 155: 944–53. https://doi.org/10.1016/j.pain.2014.01.027.Search in Google Scholar PubMed
23. Kuithan, P, Heneghan, NR, Rushton, A, Sanderson, A, Falla, D. Lack of exercise-induced hypoalgesia to repetitive back movement in people with chronic low back pain. Pain Pract 2019; 19: 740–50. https://doi.org/10.1111/papr.12804.10.1111/papr.12804Search in Google Scholar PubMed
24. Gajsar, H, Titze, C, Hasenbring, MI, Vaegter, HB. Isometric back exercise has different effect on pressure pain thresholds in healthy men and women. Pain Med 2017; 18: 917–23.10.1093/pm/pnw176Search in Google Scholar PubMed
25. Naugle, KM, Fillingim, RB, Riley, JL3rd. A meta-analytic review of the hypoalgesic effects of exercise. J Pain 2012; 13: 1139–50. https://doi.org/10.1016/j.jpain.2012.09.006.Search in Google Scholar PubMed PubMed Central
26. Gierthmuhlen, J, Enax-Krumova, EK, Attal, N, Bouhassira, D, Cruccu, G, Finnerup, NB, et al. Who is healthy? Aspects to consider when including healthy volunteers in QST–based studies-a consensus statement by the EUROPAIN and NEUROPAIN consortia. Pain 2015; 156: 2203–11. https://doi.org/10.1097/j.pain.0000000000000227.Search in Google Scholar PubMed
27. Naugle, KM, Naugle, KE, Riley, JL3rd. Reduced modulation of pain in older adults after isometric and aerobic exercise. J Pain 2016; 17: 719–28. https://doi.org/10.1016/j.jpain.2016.02.013.Search in Google Scholar PubMed PubMed Central
28. Hackett, J, Naugle, KE, Naugle, KM. The decline of endogenous pain modulation with aging: a meta-analysis of temporal summation and conditioned pain modulation. J Pain 2019. https://doi.org/10.1016/j.jpain.2019.09.005.Search in Google Scholar PubMed
29. Burrows, NJ, Booth, J, Sturnieks, DL, Barry, BK. Acute resistance exercise and pressure pain sensitivity in knee osteoarthritis: a randomised crossover trial. Osteoarthr Cartilage 2014; 22: 407–14. https://doi.org/10.1016/j.joca.2013.12.023.Search in Google Scholar PubMed
30. Vaegter, HB, Handberg, G, Emmeluth, C, Graven-Nielsen, T. Preoperative hypoalgesia after cold pressor test and aerobic exercise is associated with pain relief 6 Months after total knee replacement. Clin J Pain 2017; 33: 475–84. https://doi.org/10.1097/ajp.0000000000000428.Search in Google Scholar
31. Bandy, WD, Irion, JM. The effect of time on static stretch on the flexibility of the hamstring muscles. Phys Ther 1994; 74: 845–50. https://doi.org/10.1093/ptj/74.9.845. discussion 50–2.Search in Google Scholar PubMed
32. Ozcan, A, Tulum, Z, Pinar, L, Baskurt, F. Comparison of pressure pain threshold, grip strength,dexterity and touch pressure of dominant and non-dominant hands within and between right-and left-handed subjects. J Kor Med Sci 2004; 19: 874–8. https://doi.org/10.3346/jkms.2004.19.6.874.Search in Google Scholar PubMed PubMed Central
33. Hoeger Bement, MK, Dicapo, J, Rasiarmos, R, Hunter, SK. Dose response of isometric contractions on pain perception in healthy adults. Med Sci Sports Exerc 2008; 40: 1880–9. https://doi.org/10.1249/mss.0b013e31817eeecc.Search in Google Scholar
34. Lacourt, TE, Houtveen, JH, van Doornen, LJP. Experimental pressure-pain assessments: test-retest reliability, convergence and dimensionality. Scand J Pain 2012; 3: 31–7. https://doi.org/10.1016/j.sjpain.2011.10.003.Search in Google Scholar PubMed
35. Balaguier, R, Madeleine, P, Vuillerme, N. Is one trial sufficient to obtain excellent pressure pain threshold reliability in the low back of asymptomatic individuals?. A test-retest study. PLoS One 2016; 11: e0160866. https://doi.org/10.1371/journal.pone.0160866.Search in Google Scholar PubMed PubMed Central
36. Khamwong, P, Nosaka, K, Pirunsan, U, Paungmali, A. Reliability of muscle function and sensory perception measurements of the wrist extensors. Physiother Theory Pract 2010; 26: 408–15. https://doi.org/10.3109/09593980903300470.Search in Google Scholar PubMed
37. Rolke, R, Baron, R, Maier, C, Tolle, TR, Treede, RD, Beyer, A, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 2006; 123: 231–43. https://doi.org/10.1016/j.pain.2006.01.041.Search in Google Scholar PubMed
38. Coronado, RA, Bialosky, JE, Robinson, ME, George, SZ. Pain sensitivity subgroups in individuals with spine pain: potential relevance to short-term clinical outcome. Phys Ther 2014; 94: 1111–22. https://doi.org/10.2522/ptj.20130372.Search in Google Scholar PubMed PubMed Central
39. Starkweather, AR, Heineman, A, Storey, S, Rubia, G, Lyon, DE, Greenspan, J, et al. Methods to measure peripheral and central sensitization using quantitative sensory testing: a focus on individuals with low back pain. Appl Nurs Res 2016; 29: 237–41. https://doi.org/10.1016/j.apnr.2015.03.013.Search in Google Scholar PubMed
41. Crombie, KM, Brellenthin, AG, Hillard, CJ, Koltyn, KF. Endocannabinoid and opioid system interactions in exercise-induced hypoalgesia. Pain Med 2018; 19: 118–23. https://doi.org/10.1093/pm/pnx058.Search in Google Scholar PubMed PubMed Central
41. Jones, MD, Taylor, JL, Barry, BK. Occlusion of blood flow attenuates exercise-induced hypoalgesia in the occluded limb of healthy adults. J Appl Physiol 2017; 122: 1284–91. https://doi.org/10.1152/japplphysiol.01004.2016.Search in Google Scholar
42. Sluka, KA. Mechanisms and management of pain for the physical therapist. Pennsylvania: Lippincott Williams & Wilkins; 2016. February 2.Search in Google Scholar
43. Arendt-Nielsen, L, Yarnitsky, D. Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. J Pain 2009; 10: 556–72. https://doi.org/10.1016/j.jpain.2009.02.002.Search in Google Scholar
44. Fillingim, RB, Edwards, RR, Powell, T. The relationship of sex and clinical pain to experimental pain responses. Pain 1999; 83: 419–25. https://doi.org/10.1016/s0304-3959(99)00128-1.Search in Google Scholar
45. Kindler, LL, Valencia, C, Fillingim, RB, George, SZ. Sex differences in experimental and clinical pain sensitivity for patients with shoulder pain. Eur J Pain 2011; 15: 118–23. https://doi.org/10.1016/j.ejpain.2010.06.001.Search in Google Scholar PubMed PubMed Central
46. Geisser, ME, Gracely, RH, Giesecke, T, Petzke, FW, Williams, DA, Clauw, DJ. The association between experimental and clinical pain measures among persons with fibromyalgia and chronic fatigue syndrome. Eur J Pain 2007; 11: 202–7. https://doi.org/10.1016/j.ejpain.2006.02.001.Search in Google Scholar PubMed
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