Static progressive stretch orthosis-consensus modality to treat knee stiffness-rationale and literature review

Anil Bhave, Nipun Sodhi, Hiba K Anis, Joseph O Ehiorobo, Michael A Mont, Anil Bhave, Nipun Sodhi, Hiba K Anis, Joseph O Ehiorobo, Michael A Mont

Abstract

The current literature supports static progressive stretch (SPS) orthoses as the consensus modality to treat joint stiffness as an adjunct to manual therapy. Over 50 published studies prove the efficacy and safety of this modality as an adjunct to therapy to improve range of motion (ROM) as well as decrease stiffness and pain. Data from a large prospective study on SPS effectiveness identified a 90% improvement in ROM, 84% reduction in stiffness and swelling, 70% reduction in pain, and no reports of complications or injury. Another 13 studies evaluating patients with knee stiffness have shown excellent results with SPS, and a reduced need for manipulation under anesthesia or additional surgeries. The bidirectional SPS device allows for ROM therapy in both flexion and extension, uses short, 5-minute incremental stretches for up to a 30-minute session applied 1 to 3 times per day for 8 weeks, though treatment might be needed for longer durations (8 to 12 weeks) in cases with chronic stiffness/contracture, to improve motion and significantly reduces need for manipulation or surgery for treatment of knee fibrosis. Earlier application of SPS therapy, even immediately postoperative following corrective surgery for motion loss, can greatly improve the results for patients who have limitations in knee motion.

Keywords: Bracing; knee arthroplasty; knee fibrosis; physical therapy; static progressive stretching.

Conflict of interest statement

Conflicts of Interest: MA Mont: AAOS, Cymedica, DJ Orthopaedics, Johnson & Johnson, Journal of Arthroplasty, Journal of Knee Surgery, Microport, National Institutes of Health (NIAMS & NICHD), Ongoing Care Solutions, Orthopedics, Orthosensor, Pacira, Peerwell, Performance Dynamics Inc., Sage, Stryker: IP royalties, Surgical Technologies International, Kolon TissueGene. The other authors have no conflicts of interest to declare.

2019 Annals of Translational Medicine. All rights reserved.

Figures

Figure 1
Figure 1
SPS brace with knee in extension. SPS, static progressive stretch.
Figure 2
Figure 2
SPS brace with knee in flexion. SPS, static progressive stretch.
Figure 3
Figure 3
Treatment algorithm for management of post-operative fibrosis following TKA. TKA, total knee arthroplasty; ROM, range of motion.
Figure 4
Figure 4
PRISMA diagram for study selection.

References

    1. Abdul N, Dixon D, Walker A, et al. Fibrosis is a common outcome following total knee arthroplasty. Sci Rep 2015;5:16469. 10.1038/srep16469
    1. Huleatt J, Gottschalk M, Fraser K, et al. Risk Factors for Manipulation Under Anesthesia and/or Lysis of Adhesions After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2018;6:2325967118794490. 10.1177/2325967118794490
    1. Schiavone Panni A, Cerciello S, Vasso M, et al. Stiffness in total knee arthroplasty. J Orthop Traumatol 2009;10:111-8. 10.1007/s10195-009-0054-6
    1. Fitzsimmons SE, Vazquez EA, Bronson MJ. How to treat the stiff total knee arthroplasty?: a systematic review. Clin Orthop Relat Res 2010;468:1096-106. 10.1007/s11999-010-1230-y
    1. Deyle GD, Allison SC, Matekel RL, et al. Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program. Phys Ther 2005;85:1301-17.
    1. Coke T, Alday R, Biala K, et al. The new role of physical therapy in home care. Home Healthc Nurse 2005;23:594-9. 10.1097/00004045-200509000-00012
    1. Tao X, Chow SKY, Wong FK. The effects of a nurse-supervised home exercise programme on improving patients’ perceptions of the benefits and barriers to exercise: A randomised controlled trial. J Clin Nurs 2017;26:2765-75. 10.1111/jocn.13798
    1. Song YD, Jain N, Kang YG, et al. Active Flexion in Weight Bearing Better Correlates with Functional Outcomes of Total Knee Arthroplasty than Passive Flexion. Knee Surg Relat Res 2016;28:118-29. 10.5792/ksrr.2016.28.2.118
    1. Kalson NS, Borthwick LA, Mann DA, et al. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J 2016;98-B:1479-88. 10.1302/0301-620X.98B10.37957
    1. Flowers KR, LaStayo P. Effect of total end range time on improving passive range of motion. J Hand Ther 1994;7:150-7. 10.1016/S0894-1130(12)80056-1
    1. Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. J Orthop Sports Phys Ther 2009;39:135-48. 10.2519/jospt.2009.2916
    1. Jacobs CA, Sciascia AD. Factors that influence the efficacy of stretching programs for patients with hypomobility. Sports Health 2011;3:520-3. 10.1177/1941738111415233
    1. Bonutti PM, Windau JE, Ables BA, et al. Static progressive stretch to reestablish elbow range of motion. Clin Orthop Relat Res 1994;(303):128-34.
    1. McHugh MP, Magnusson SP, Gleim GW, et al. Viscoelastic stress relaxation in human skeletal muscle. Med Sci Sports Exerc 1992;24:1375-82. 10.1249/00005768-199212000-00011
    1. Cyr LM, Ross RG. How controlled stress affects healing tissues. J Hand Ther 1998;11:125-30. 10.1016/S0894-1130(98)80009-4
    1. Frost HM. Skeletal structural adaptations to mechanical usage (SATMU): 1. Redefining Wolff’s law: the bone modeling problem. Anat Rec 1990;226:403-13. 10.1002/ar.1092260402
    1. Sodhi N, Yao B, Anis HK, et al. Patient satisfaction and outcomes of static progressive stretch bracing: a 10-year prospective analysis. Ann Transl Med 2019;7:67. 10.21037/atm.2018.08.31
    1. Sodhi N, Yao B, Khlopas A, et al. A Case for the Brace: A Critical, Comprehensive, and Up-To-Date Review of Static Progressive Stretch, Dynamic, and Turnbuckle Braces for the Management of Elbow, Knee, and Shoulder Pathology. Surg Technol Int 2017;31:303-18.
    1. Sodhi N, Khlopas A, Vaughn MD, et al. Manufactured Brace Modalities for Elbow Stiffness. Orthopedics 2018;41:e127-35. 10.3928/01477447-20171102-02
    1. Veltman ES, Doornberg JN, Eygendaal D, et al. Static progressive versus dynamic splinting for posttraumatic elbow stiffness: a systematic review of 232 patients. Arch Orthop Trauma Surg 2015;135:613-7. 10.1007/s00402-015-2199-5
    1. Müller AM, Sadoghi P, Lucas R, et al. Effectiveness of bracing in the treatment of nonosseous restriction of elbow mobility: a systematic review and meta-analysis of 13 studies. J Shoulder Elbow Surg 2013;22:1146-52. 10.1016/j.jse.2013.04.003
    1. Lindenhovius AL, Doornberg JN, Brouwer KM, et al. A prospective randomized controlled trial of dynamic versus static progressive elbow splinting for posttraumatic elbow stiffness. J Bone Joint Surg Am 2012;94:694-700. 10.2106/JBJS.J.01761
    1. Schwartz DA. Static progressive orthoses for the upper extremity: a comprehensive literature review. Hand (N Y) 2012;7:10-7. 10.1007/s11552-011-9380-2
    1. Bhat AK, Bhaskaranand K, Nair SG. Static progressive stretching using a turnbuckle orthosis for elbow stiffness: a prospective study. J Orthop Surg (Hong Kong) 2010;18:76-9. 10.1177/230949901001800117
    1. Ulrich SD, Bonutti PM, Seyler TM, et al. Restoring range of motion via stress relaxation and static progressive stretch in posttraumatic elbow contractures. J Shoulder Elbow Surg 2010;19:196-201. 10.1016/j.jse.2009.08.007
    1. Doornberg JN, Ring D, Jupiter JB. Static progressive splinting for posttraumatic elbow stiffness. J Orthop Trauma 2006;20:400-4. 10.1097/00005131-200607000-00006
    1. Gelinas JJ, Faber KJ, Patterson SD, et al. The effectiveness of turnbuckle splinting for elbow contractures. J Bone Joint Surg Br 2000;82:74-8. 10.1302/0301-620X.82B1.0820074
    1. Green DP, McCoy H. Turnbuckle orthotic correction of elbow-flexion contractures after acute injuries. J Bone Joint Surg Am 1979;61:1092-5. 10.2106/00004623-197961070-00021
    1. Nandi S, Maschke S, Evans PJ, et al. The stiff elbow. Hand (N Y) 2009;4:368-79. 10.1007/s11552-009-9181-z
    1. Issack PS, Egol KA. Posttraumatic contracture of the elbow: current management issues. Bull Hosp Jt Dis 2006;63:129-36.
    1. Charalambous CP, Morrey BF. Posttraumatic elbow stiffness. J Bone Joint Surg Am 2012;94:1428-37. 10.2106/JBJS.K.00711
    1. Evans PJ, Nandi S, Maschke S, et al. Prevention and Treatment of Elbow Stiffness. J Hand Surg Am 2009;34:769-78. 10.1016/j.jhsa.2009.02.020
    1. Kim PD, Grafe MW, Rosenwasser MP. Elbow Stiffness: Etiology, Treatment, and Results. J Am Soc Surg Hand 2005;5:209-16. 10.1016/j.jassh.2005.08.003
    1. Mansat P, Morrey BF. The column procedure: a limited lateral approach for extrinsic contracture of the elbow. J Bone Joint Surg Am 1998;80:1603-15. 10.2106/00004623-199811000-00006
    1. Phillips BB, Strasburger S. Arthroscopic treatment of arthrofibrosis of the elbow joint. Arthroscopy 1998;14:38-44. 10.1016/S0749-8063(98)70118-5
    1. Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am 1998;80:566-80. 10.2106/00004623-199804000-00014
    1. Morrey BF. Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 1990;72:601-18. 10.2106/00004623-199072040-00019
    1. McGrath MS, Ulrich SD, Bonutti PM, et al. Static progressive splinting for restoration of rotational motion of the forearm. J Hand Ther 2009;22:3-8; quiz 9. 10.1197/j.jht.2008.06.005
    1. Lucado AM, Li Z. Static progressive splinting to improve wrist stiffness after distal radius fracture: a prospective, case series study. Physiother Theory Pract 2009;25:297-309. 10.1080/09593980902782389
    1. Foran J, Stevens-Lapsley J, Bade M. Multimodal conservative management of stiffness after total knee arthroplasty: A pilot study with retrospective historical cohort comparison. In: Combined Sections Meeting of the APTA, 2019.
    1. McGinn T, Chughtai M, Bhave A, et al. Innovative Multi-Modal Physical Therapy Reduces Incidence of Manipulation Under Anesthesia (MUA) in Non-Obese Primary Total Knee Arthroplasty. Surg Technol Int 2016;29:328-33.
    1. Chughtai M, McGinn T, Bhave A, et al. Innovative Multimodal Physical Therapy Reduces Incidence of Repeat Manipulation under Anesthesia in Post-Total Knee Arthroplasty Patients Who Had an Initial Manipulation under Anesthesia. J Knee Surg 2016;29:639-44. 10.1055/s-0036-1592339
    1. Bonutti PM, Marulanda GA, McGrath MS, et al. Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010;18:194-9. 10.1007/s00167-009-0947-1
    1. Suksathien R, Suksathien Y. A new static progressive splint for treatment of knee and elbow flexion contractures. J Med Assoc Thai 2010;93:799-804.
    1. Bonutti PM, McGrath MS, Ulrich SD, et al. Static progressive stretch for the treatment of knee stiffness. Knee 2008;15:272-6. 10.1016/j.knee.2008.04.002
    1. Seyler TM, Marker DR, Bhave A, et al. Functional problems and arthrofibrosis following total knee arthroplasty. J Bone Joint Surg Am 2007;89 Suppl 3:59-69.
    1. Jansen CM, Windau JE, Bonutti PM, et al. Treatment of a knee contracture using a knee orthosis incorporating stress-relaxation techniques. Phys Ther 1996;76:182-6. 10.1093/ptj/76.2.182
    1. McElroy MJ, Johnson AJ, Zywiel MG, et al. Devices for the prevention and treatment of knee stiffness after total knee arthroplasty. Expert Rev Med Devices 2011;8:57-65. 10.1586/erd.10.71
    1. Millett PJ, Johnson B, Carlson J, et al. Rehabilitation of the arthrofibrotic knee. Am J Orthop (Belle Mead NJ) 2003;32:531-8.
    1. Ibrahim M, Donatelli R, Hellman M, et al. Efficacy of a static progressive stretch device as an adjunct to physical therapy in treating adhesive capsulitis of the shoulder: a prospective, randomised study. Physiotherapy 2014;100:228-34. 10.1016/j.physio.2013.08.006
    1. Lucado AM, Li Z, Russell GB, et al. Changes in impairment and function after static progressive splinting for stiffness after distal radius fracture. J Hand Ther 2008;21:319-25. 10.1197/j.jht.2008.01.002
    1. McGrath MS, Ulrich SD, Bonutti PM, et al. Evaluation of static progressive stretch for the treatment of wrist stiffness. J Hand Surg Am 2008;33:1498-504. 10.1016/j.jhsa.2008.05.018
    1. Parent-Weiss NM, King JC. Static progressive forearm rotation contracture management orthosis design: a study of 28 patients. J Prosthet Orthot 2006;18:63-7. 10.1097/00008526-200607000-00002
    1. Smith DW, Brou KE, Henry MH. Early active rehabilitation for operatively stabilized distal radius fractures. J Hand Ther 2004;17:43-9. 10.1197/j.jht.2003.10.006
    1. Bell SN, Benger D. Management of radioulnar synostosis with mobilization, anconeus interposition, and a forearm rotation assist splint. J Shoulder Elbow Surg 1999;8:621-4. 10.1016/S1058-2746(99)90101-5
    1. Hussein AZ, Ibrahim MI, Hellman MA, et al. Static progressive stretch is effective in treating shoulder adhesive capsulitis: Prospective, randomized, controlled study with a two-year follow-up. Eur J Physiother 2015;17:138-47. 10.3109/21679169.2015.1057863
    1. Ibrahim MI, Johnson AJ, Pivec R, et al. Treatment of adhesive capsulitis of the shoulder with a static progressive stretch device: a prospective, randomized study. J Long Term Eff Med Implants 2012;22:281-91. 10.1615/JLongTermEffMedImplants.2013007061
    1. Johnson AJ, McKenzie SA, Ulrich SD, et al. Assessment of static progressive stretch for the treatment of shoulder stiffness: a prospective case series. J Long Term Eff Med Implants 2012;22:293-303. 10.1615/JLongTermEffMedImplants.2013007133
    1. Donatelli R, Ruivo RM, Thurner M, et al. New concepts in restoring shoulder elevation in a stiff and painful shoulder patient. Phys Ther Sport 2014;15:3-14. 10.1016/j.ptsp.2013.11.001
    1. LaStayo P, Jaffe R. Assessment and management of shoulder stiffness: a biomechanical approach. J Hand Ther 1994;7:122-30. 10.1016/S0894-1130(12)80081-0
    1. Costa CR, McElroy MJ, Johnson AJ, et al. Use of a static progressive stretch orthosis to treat post-traumatic ankle stiffness. BMC Res Notes 2012;5:348. 10.1186/1756-0500-5-348
    1. Sharma NK, Loudon JK. Static progressive stretch brace as a treatment of pain and functional limitations associated with plantar fasciitis: a pilot study. Foot Ankle Spec 2010;3:117-24. 10.1177/1938640010365183
    1. Grissom SP, Blanton S. Treatment of upper motoneuron plantarflexion contractures by using an adjustable ankle-foot orthosis. Arch Phys Med Rehabil 2001;82:270-3. 10.1053/apmr.2001.19018

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