The effects of stretching interventions in people with multiple sclerosis: a systematic review

Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system marked by heterogeneous symptoms including spasticity and flexibility limitations. This systematic review investigates the effects of stretching (ST) interventions on physical function and health-related outcomes in people with MS (PwMS). Scopus, NLM PubMed, and Web of Science (Core Collection) were searched through December 2025. Studies evaluating ST in PwMS were included. Methodological quality was assessed using a modified Downs and Black checklist, and certainty of evidence using the GRADE framework. Seven studies involving 144 participants (44.5 ± 9.6 years) were included. Across acute and longitudinal studies, descriptively favorable changes following ST were observed, with several outcomes meeting/exceeding previously published minimal important/detectable change thresholds for Timed Up and Go, flexibility, spasticity, pain, and fatigue. Downs and Black assessment indicated moderate methodological quality. GRADE suggested very low certainty of evidence. ST appears well tolerated and may improve flexibility while also being potentially associated with clinically meaningful improvements in mobility, spasticity, pain, and fatigue in PwMS. However, current evidence remains limited, with ST frequently serving as an active comparator or control rather than the primary intervention, precluding definitive clinical recommendations and underscoring the need for well-designed randomized controlled trials. Stretching interventions may potentially improve flexibility and may also be associated with clinically meaningful improvements in mobility, spasticity, pain, and fatigue in people with multiple sclerosis.Stretching appears to be a well-tolerated, low-impact, home-based intervention that may serve as a promising adjunct to comprehensive rehabilitation for people with multiple sclerosis.Rehabilitation professionals may consider incorporating individualized stretching programs as part of a comprehensive rehabilitation strategy for people with multiple sclerosis. Stretching interventions may potentially improve flexibility and may also be associated with clinically meaningful improvements in mobility, spasticity, pain, and fatigue in people with multiple sclerosis. Stretching appears to be a well-tolerated, low-impact, home-based intervention that may serve as a promising adjunct to comprehensive rehabilitation for people with multiple sclerosis. Rehabilitation professionals may consider incorporating individualized stretching programs as part of a comprehensive rehabilitation strategy for people with multiple sclerosis.