…
Creep is the continued deformation with the application of a fixed load.11 For tissue, the deformation and elongation are continuous but slow (requiring hours to days to obtain plastic deformation), and the material is kept under a constant state of stress. Treatment methods such as traction therapy and dynamic splinting are based on the properties of creep.Stress relaxation is the reduction of forces, over time, in a material that is stretched and held at a constant length.11 Relaxation occurs because of the realignment of fibers and elongation of the material when the tissue is held at a fixed position over time. Treatment methods that use stress relaxation are serial casting and static splinting.
Elastic deformation is the elongation produced by loading that is recovered after the load is removed. 5,9 If a force is applied to tissue and then released, the tissue returns to its original length. No long-term elongation or stretch occurs with elastic deformation, Plastic deformation, however, is the elongation produced under loading that will remain after the removal of a load.5,9 A tissue undergoing plastic deformation will remain stretched, yielding a permanent increase in length.
Since a permanent increase in ROM is the goal of most treatments, therapy should be aimed at producing plastic deformation of the tissue. It has been shown that a low force accompanied with a slow, progressively increased stretch will produce plastic deformation at low peak loads.6,9,12 This can be obtained with either creep or stress relaxation. Creep, however, requires prolonged treatment times ranging from hours to days, and places the tissue under a state of constant stress. Faster stretching also supplies a greater chance for tissue tearing rather than stretching. 6,9,11 Therapy, therefore must be designed to achieve a slow, progressive stretch, with plastic deformation at low loads, while minimizing the chance for soft tissue injury. The optimal method to obtain plastic deformation appears to be SPS.
Static progressive stretch appears to be an ideal method for reestablishing range of motion. The orthosis described here embodies the principles of static progressive stretch, and allows the patient to work on therapy in a home-based program. The overall average increase in motion was 31° (69%), with excellent compliance and no cases of significant pain with the use of the orthosis. No patient discontinued the use of the orthosis on their own; thus, compliance was excellent.
Short, 30-minute treatment sessions allow for increased patient compliance and improvement in functional outcome over conventional therapy or splinting systems.2,3,5 The SPS approach was so successful that two patients originally scheduled for surgical contracture release were satisfied with their improvements and believed that no further intervention was necessary. Nineteen of 20 patients were satisfied with this rehabilitation approach. The one dissatisfied patient used an earlier prototype and experienced some discomfort with the orthosis use; however, the patient was satisfied with the functional outcome. The authors realize that this is a small series with a short follow-up time of one-year; however, the initial results of this new approach are encouraging.
Based on the results of this study, it is concluded that (1) SPS is a successful method for the reestablishment of ROM. Treatments based on stress relaxation (static progressive stretching) appear beneficial and require less time (one or two 30-minute sessions/day for one to three months) than those treatments based on creep. (2) A low-force, patient-directed stretching can produce plastic deformation with permanent elongation of soft tissue, which does not deteriorate over time. (3) No complications or side effects occurred with the SPS or the JAS orthosis. There was 100% patient compliance, with no complaint of increased pain. (4) Significant gains were noted in this short-term study, with an average increase in ROM of 31° (69%). In patients observed more than one year, there was no decrease in ROM, suggesting that once plastic deformation occurs, the tissue will maintain the elongation over time.