Intramuscular hemorrhage during rehabilitation in a post-stroke patient with vascular Ehlers-Danlos syndrome: a case report and review of spasticity-related muscle injury.

This is a single case report, so it describes one person and cannot show that passive stretching caused the bleeding or that any change in practice prevents it. The diagnosis of vascular Ehlers-Danlos syndrome was confirmed only after the injury, so the rehabilitation team did not know the tissue fragility diagnosis at the time. The patient was also taking clopidogrel and antihypertensive medication, and the paper says antiplatelet medication may have increased bleeding; the contribution of stretching, medication, spasticity, and tissue fragility cannot be separated. No muscle biopsy was performed, so histological changes from chronic spasticity and vascular Ehlers-Danlos syndrome could not be directly distinguished. No needle electromyography or nerve conduction studies were performed, so other neuromuscular abnormalities were not assessed. A detailed timeline from stroke onset to rehabilitation admission was not available, so the sequence of events cannot be precisely reconstructed.

The authors declare that no financial support was received for the research or publication.

Do not conclude that passive hamstring stretching is unsafe for all patients with post-stroke spasticity or vascular Ehlers-Danlos syndrome. This is a single case, and the paper cannot separate the effects of stretching, clopidogrel, antihypertensive treatment, fluctuating muscle tone, and tissue fragility.