Most of us suffering with Charcot Marie Tooth (CMT) develop contractures. Contractures are defined as a stiffening of joints resulting in loss of movement of the joint and musculoskeletal deformities (most commonly of the feet and hands). They occur because as muscles weaken around a joint due to the effects of CMT, they cause the tendons, ligaments and other tissues around the joints to shorten/stiffen.
The most frequent initial presentation of CMT (according to the NIH) is distal weakness and atrophy, manifesting with foot drop and pes cavus (high arched feet).
Foot drop (also known as plantar flexion contracture) is due to shortening of the Achilles tendon. As the Achilles tendon shortens, the foot is pulled down. This, coupled with weaking of muscles involved in lifting the front part of the foot (due to CMT), causes the foot to remain in plantar flexion. This results in a decrease in range of motion (ROM), and an increase in tripping and falls.
Stretching has often been recommended as a method of managing limb contractures for those suffering from neuromuscular diseases. Passive and static stretching techniques have most commonly been suggested for use in maintaining and improving range of motion and decreasing muscle stiffness in those suffering from neuromuscular diseases. According to the American Sport and Fitness Association (ASFA), in passive stretching, an external force or assistance is used to move a muscle into a stretched position. The individual receiving the stretch remains relaxed, and the force—applied by a partner, stretching strap, or gravity—gradually elongates the muscle. Static stretching (the one most of us are familiar with) is where you hold a stretch in a stationary position for a prolonged period.”
Research on Stretching
Prevention and Management of Limb Contractures in Neuromuscular Diseases published in 2012 in the Physical Medicine and Rehabilitation Clinics of North America states that “Limb contractures are a common impairment in neuromuscular diseases (NMD). They contribute to increased disability due to decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living (ADL), and increased pain.”
The 2012 article continues by telling readers that for the prevention and management of limb contractures “A program of passive stretching should be started as early as possible in the course of neuromuscular disease and become part of a regular morning and evening routine.”
A more recent study, entitled Acute and Chronic effects of Static Stretching on Neuromuscular Properties: a Meta-Analytical Review published in 2023 in Applied Sciences, sought to provide an overview of the recent findings on the acute (a single session of intervention) effects and chronic (multiple sessions of intervention over several weeks) effects of static stretching on joint behaviors (ex; ROM, joint torque [rotation]) and neuromuscular responses (ex; reflex responses, muscle stiffness, tendon stiffness). The authors believe that understanding the effects of static stretching on the neuromuscular system could provide clinicians with information to develop more effective protocols to improve functional outcomes for neuromuscular patients. The results of the study demonstrated that both acute and chronic static stretching increased range of motion, improved joint torque, and decreased muscle and tendon stiffness.
Other studies suggest both passive and static stretching be used to combat contracture formation and progression. In all cases, researchers stress the importance of seeking patient-specific instruction from a qualified physical therapist.
Many CMT organizations also encourage doing stretching exercises as a daily routine to help prevent joint pain and loss of ROM. Some recommend stretching through yoga, Pilates and other low-impact exercise regimes, or just as a general activity throughout your day. In speaking with fellow CMT sufferers the general consensus is that stretching indeed helps with mobility, pain and range of motion. As always, consult your doctor, but the key is to keep moving, moving, moving!
Author: Teresa M. Carroll PhD (Therapies for Inherited Neuropathies; TIN)