Effect of ankle stretching combined with arm cycling on the improvement of calf muscle stiffness in patients with stroke: a pilot study

[Purpose] This study aimed to ascertain whether ankle stretching combined with arm cycling compared with that without arm cycling results in greater improvement in maximum dorsiflexion range of motion (ROM), calf muscle stiffness, and gait velocity in the affected limb of patients with stroke. [Participants and Methods] Random ABAB reversal design was used in this study involving nine patients with stroke. Participants performed 10 min of ankle plantar flexor stretching through weight bearing using the tilt table under the following 2 conditions: with or without arm cycling at 60 revolutions per minute. Pre- and post-stretching maximum ROM and passive plantar flexion torque were measured using a custom-made passive torque indicator. Stiffness was calculated based on passive torque-angle relationships. [Results] Maximum ROM and stiffness significantly improved after stretching in both conditions, whereas no changes in gait velocity were found. The difference in pre- and post-stretching stiffness was significantly greater in the stretching with arm cycling group. Change in maximum ROM showed no difference between both stretching conditions. [Conclusion] This study indicates that ankle plantar flexor stretching combined with arm cycling was more effective than that without cycling in improving calf muscle stiffness in the affected limb of patients with stroke.