ProviderPulse

Home Use of Mechanical Stretching Devices

From Pinnacol's Medical Director

December 2011
Contributed by Pinnacol Assurance Medical Director Edward Leary, M.D., and Pinnacol Assurance Physician Advisor Jon Erickson, M.D.

This article addresses home usage of dynamic and customized devices to provide mechanically and anatomically focused serial stretching for specific joints. The devices are designed to improve range of motion (ROM) of shoulder, elbow, knee and ankle joints. Clinical situations in which dynamic serial ROM equipment might be utilized include the acute post-operative period for patients with prior documented post surgical stiffness or stiffness in sub-acute injury period.

There are a number of manufacturers and product names in the field of mechanical stretching devices. The basic mechanism is to provide serial stretching using a patient controlled device, which can deliver variable force to the ROM of the affected joint. Typically, the joint is flexed or extended for a number of minutes and then allowed to relax for an equal time period. Usually, the treatment regime will call for five to eight sessions per day.

Review of the literature fails to locate any controlled, peer-reviewed studies that demonstrate enhanced clinical effectiveness of shoulder flexionator, elbow extensionator, knee extensionator or knee/ankle flexionator. In addition, there is no published data to demonstrate that using these devices in a home setting will reduce the need for future surgery.

All requests for home usages of mechanical stretching devices for contracture or joint stiffness require prior authorization and review by a physician advisor. If future peer-reviewed literature regarding home usage of dynamic and customized ROM devices becomes available, a reconsideration of this prior authorization could be considered.