MUSCLE flexibility training may offer a targeted non-pharmacologic option to ease chronic pain in older adults. In this exploratory systematic review, investigators evaluated whether isolated flexibility exercise can meaningfully reduce chronic pain in people aged 65 years and older.
Chronic Pain and Muscle Flexibility Training in Older Adults
Following a predefined protocol based on PICOS criteria and PRISMA 2020 guidelines, the authors searched multiple databases for randomized controlled trials in which flexibility training was delivered as a standalone intervention. Eligible studies included adults aged at least 65 years with chronic pain outcomes, and excluded multimodal programs that combined flexibility with strength, aerobic training or other modalities. From 1,390 records identified, only three trials met all inclusion criteria, underscoring how little direct evidence currently informs muscle flexibility training in chronic pain in older adults.
Muscle Flexibility Training in Knee Osteoarthritis
The three randomized trials were conducted in China and the United States and showed moderate methodological quality on the PEDro scale. Two studies focused on participants with knee osteoarthritis and used Proprioceptive Neuromuscular Facilitation stretching protocols, while the third compared a flexibility-based program with combined strength and aerobic training in a healthy elderly population. Across all three trials, muscle flexibility training was associated with significant reductions in chronic pain symptoms, including joint stiffness, movement discomfort and pain intensity, particularly in osteoarthritis settings.
Clinical Role Of Muscle Flexibility Training In Rheumatology
For clinicians, these findings suggest that structured flexibility exercise may have a specific role within osteoarthritis pain management, especially where mobility is limited by stiffness and discomfort. While muscle flexibility training is already familiar to many teams delivering exercise therapy, this review highlights its potential as a distinct therapeutic strategy rather than only a warmup component of broader programs.
Evidence Gaps And Future Research Needs
However, the authors emphasize that current evidence remains preliminary. The very small number of trials, heterogeneity in training protocols and variability in pain assessment tools limit firm conclusions and prevent clear recommendations on optimal dosage or technique. Larger, high quality randomized studies are needed to clarify which older adults with chronic pain benefit most from muscle flexibility training, how best to integrate PNF stretching into multimodal care pathways and whether gains in pain relief are sustained over time.
Reference: Melenas R et al. The Influence of Muscle Flexibility Training on Chronic Pain in Older Adults: An Exploratory Systematic Review. Sports. 2025;13(11):393.
