Comparison of PNF Stretching vs. Sustained Stretching for Hamstring Spasticity in Diplegic CP

Abstract

Background: Hamstring spasticity and the associated loss of muscle extensibility restrict knee extension, promote crouched postures, and limit gross motor function in children with spastic diplegic cerebral palsy (CP). Stretching is a routine component of physiotherapy, yet the choice between sustained (static) stretching and proprioceptive neuromuscular facilitation (PNF) stretching is largely guided by clinical preference rather than comparative evidence.
Objective: To synthesise the neurophysiological and clinical literature relevant to both techniques and to present a fully specified protocol for a randomised, assessor-blinded, parallel-group comparison of PNF (hold-relax) stretching and sustained stretching for hamstring spasticity and extensibility in children with spastic diplegic CP.
Methods: The proposed trial will recruit 62 children aged 6–15 years (GMFCS levels I–III), allocate them equally to either technique in addition to conventional physiotherapy, and deliver the intervention five days per week for eight weeks with follow-up at week twelve. The primary outcome is the active knee extension angle; secondary outcomes are the modified Tardieu angles, the Modified Ashworth Scale, the Gross Motor Function Measure-66, and gait speed.
Anticipated Findings: Both techniques are expected to improve hamstring extensibility, with PNF hypothesised to yield a larger gain in active knee extension and sustained stretching a more feasible home-based profile. This paper reports no trial data; the hypotheses are stated explicitly so that they can be confirmed or refuted.
Conclusion: The protocol provides a transparent framework for generating comparative evidence to guide stretching prescription in diplegic CP