Stretching for Pain Relief

A review of

Sameeha S. MANSOORI, PT1, Ibrahim M. MOUSTAFA, PT, PhD1, Amal AHBOUCH, PT1 and Deed E. HARRISON, DC2

From the 1Department of Physiotherapy, College of Health Sciences, University of Sharjah, UAE, and 2Private Practice and CBP NonProfit, Inc. (A Spine Research Foundation), Eagle, ID, USA

A Summarized Review of the Conclusion

The study found that stretching the cervical muscles for 30 seconds provides the best balance between gaining stretching benefits and avoiding negative effects on nerve and central nervous system function. Longer stretches can harm nerve activity, so 30 seconds is recommended to optimize results while preventing neural issues.

Quotes from the Article

“Based on these results, stretching for 15 s or 30 s was safer with respect to the neural function measured with evoked potentials. Considering the minimal change in pain intensity and algometric pressure after 15 s, the results of this study suggest that the most effective duration of stretching is 30 s. To our knowledge, this study is the first of its kind to present objective evidence that relates different stretching times to these

specific neurophysiological parameters.”

“It has been proven that continuous stress on the spinal cord will directly affect blood flow to the meningeal complex and may decelerate or impair the neural transport processes (31, 32). The biomechanics of the nervous system may explain the significant decrease in the amplitude after 60 s of flexion stretching in the current study. This idea of relating the dynamic forces applied on the neural tissue to the impairment seen in the neural function is in agreement with the concept described by Brieg (33), who proposed that the cross-sectional area of the spinal cord decreases with spinal flexion, while the spinal cord and nerve roots fold and relax in extension.”

“The results show that stretching for 30 s was the optimal time, for achieving stretching benefits and minimizing the negative effects on the neural function of the involved nerve roots and central nervous system. Stretching for a longer time negatively affected the neural function, but decreased the pain level, while stretching for a shorter time did not achieve the optimal muscle length after stretching.”

Introduction to The Research

Chronic myofascial pain syndrome (CMPS) is a musculoskeletal condition associated with myofascial trigger points, commonly affecting postural muscles such as the upper trapezius and levator scapulae. These muscles often become shortened, leading to limited neck mobility and pain. Management of CMPS includes both pharmacological and non-pharmacological treatments, with stretching exercises widely recognized as beneficial. However, there is no clear consensus on the optimal stretching parameters, particularly duration. Most research has focused on mechanical outcomes like flexibility, overlooking potential adverse neural effects caused by prolonged stretching and increased neural tension. Since excessive spinal or nerve strain may impair neural function, this study aimed to determine whether continuous stretching could negatively affect nerve and central nervous system performance, hypothesizing that there exists a duration threshold beyond which neural function deteriorates.

Research Methodology

This study was a prospective, blinded, parallel-group, randomized clinical trial conducted at Cairo University’s Physiotherapy Research Lab (Egypt) and registered with ClinicalTrials.gov (NCT04190784). Ethical approval and informed consent were obtained before participation.

Individuals with chronic myofascial pain syndrome (CMPS) involving active myofascial trigger points (MTrPs) in the upper trapezius (with or without levator scapulae involvement) and neck/shoulder pain lasting at least 8 weeks were included. Diagnosis followed Simon’s criteria (five major and one or more minor criteria).Exclusion criteria included serious medical conditions (e.g., tumor, fracture, rheumatoid arthritis), neurological or vascular disorders, prior spinal surgery, or any physical therapy or injections within the previous 3 months.

Study Design and Randomization

Participants were randomly assigned to four groups using sealed opaque envelopes:

15-second stretch

30-second stretch

60-second stretch

Control (no stretch)

The assessor was blinded to group allocation; the treating therapist was not.

Intervention Procedure

Each participant received passive stretching of the upper trapezius and levator scapulae in a supine position, using standard positioning for each muscle.

A 100 N force (measured with a pressure dynamometer) was applied to depress the shoulder.

Stretch was held for 15, 30, or 60 seconds depending on group, repeated three times with 20-second rest intervals.

The control group followed the same positioning but without applied stretching force.

All treatments were performed by a single experienced physiotherapist to ensure consistency.

Outcome Measures

Measurements were taken before, immediately after, and 2 hours after treatment.

Primary outcome: Dermatomal Somatosensory Evoked Potentials (DSSEPs) at C6, C7, and C8 dermatomes to assess neural function.

Secondary outcomes: N13–N20 latency (central conduction time), Pain intensity using the Numerical Pain Rating Scale (NPRS), Pressure Pain Threshold (PPT) using an algometer at the most tender point. All measurements were performed by the same blinded assessor with 12 years of experience.

Sample Size and Data Analysis

Sample size was calculated from a pilot study, requiring at least 20 participants per group, increased by 25% for possible dropouts. Data normality and homogeneity were verified.

A two-way repeated-measures ANOVA was used to compare group and time effects, with Bonferroni post hoc tests for significant interactions (p < 0.05). All analyses were conducted using SPSS v20 under an intention-to-treat framework.

Research Findings

Post hoc analysis indicated that stretching for 60 s significantly decreased the dermatomal

amplitude for C6, C7 and C8 (p<0.001) and significantly increased the central conduction time, indicating negative effect (p<0.001). Stretching for 30 and 60 s resulted in greater improvement in pain intensity and algometric pressure than stretching for 15 s or no stretch (control) p<0.001.

Research References

As always with these reviews, these are my takeaways from the article and I encourage you to read the article in its entirety. The references used in this article by the authors of this article are listed here.

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