Effects of Myofascial Release with and without Quick Icing on Tone, Range of Motion and Balance in Children with Cerebral Palsy: A Randomized Controlled Trial
Abstract
Background: Spastic hemiplegic cerebral palsy is associated with lower-limb hypertonia, restricted ankle range of motion (ROM), and impaired postural control. Myofascial release (MFR) may improve soft-tissue extensibility, while quick icing may provide additional short-term modulation of spasticity. Objective: To compare the effects of MFR with and without quick icing on muscle tone, ankle ROM, and static balance in children with spastic hemiplegic cerebral palsy. Methodology: This randomized controlled trial included 28 children aged 6-12 years with hemiplegic cerebral palsy, recruited using non-probability convenience sampling and allocated equally by a simple coin-flip method. Group A received quick icing to the ankle dorsiflexors followed by 15 minutes of MFR to the ankle plantarflexors, while Group B received MFR alone. Both groups received six sessions per week for four weeks. Muscle tone, ankle ROM, and static balance were assessed before and after treatment using the Modified Ashworth Scale (MAS), goniometry, and the Romberg Test, respectively. Within-group changes were analyzed using the Wilcoxon signed-rank test, and between-group differences using the Mann-Whitney U test via SPSS version 25.0. Results: Both groups demonstrated significant within-group improvements in plantar flexion, dorsiflexion, MAS scores, and Romberg Test performance (p≤0.031). Post-treatment between-group differences favored MFR plus icing for plantar flexion (29.21±1.85° vs. 22.36±2.34°, p<0.001), dorsiflexion (14.71±2.09° vs. 13.25±2.19°, p=0.013), MAS (0.64±0.50 vs. 2.21±0.43, p=0.020), and Romberg Test scores (26.29±3.07 vs. 18.71±1.27, p=0.009). Conclusion: Both interventions improved muscle tone, ankle ROM, and static balance; however, MFR combined with quick icing produced significantly greater post-treatment improvements across all assessed outcomes and may represent a practical adjunct to pediatric neurorehabilitation.