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Stretching
By: Sankari Nedunsaliyan
Dip PT (MAL)
Bsc Hons Applied Rehab (UK)
By: Sankari Nedunsaliyan
Dip PT (MAL)
Bsc Hon...
Chapter Outline
Definition
Stretching Protocol
Hypomobility and Flexibility
Anatomic factors affecting flexibility
Ne...
Stretching is a general term used to describe any
therapeutic maneuver designed to increase the
extensibility of soft tiss...
Hypomobility :
refers to decreased mobility or restricted motion. A wide
range of pathological processes can restrict move...
• Prolonged immobilization of a body segment
• Sedentary lifestyle
• Postural malalignment and muscle imbalances
• Impaire...
• Term used for interchangeably with extensibility
• the range of motion that is available to a joint or joints
• Refers t...
Muscles, tendons and their surrounding fascial sheaths
•Stretching attempts to take advantage of highly elastic
properties...
Bony structures
•Restrict end point in the range of motion
•Good for stability
•After fracture excess calcium can develop ...
Skin
•Inelastic scar tissue can develop after surgery or injury
•Incapable of stretching with joint movement
•Overtime can...
Neural tissue
•Tightness develops in neural tissues from acute compression,
chronic repetitive microtrauma, muscle imbalan...
Mechanoreceptors in muscle tell CNS what is happening
within that muscle
•2 of these are important in the stretch reflex
•...
•Muscle spindle initially sends sensory impulse to spinal
cord which then sends a message back to muscle spindle
causing t...
•If stretch last longer than 6 seconds, impulses from GTO
begin to override muscle spindle
•autogenic inhibition, or a ref...
Autogenic Inhibition &
Reciprocal Inhibition
Autogenic Inhibition:
Relaxation in the same muscle that is experiencing
incr...
Reciprocal Inhibition:
Relaxation that occurs in the opposing muscle experiencing
increased tension.
– This is accomplishe...
•Muscle temperature should be increased prior to stretching
•Positive effect of collagen and elastin components to deform
...
muscle spindles & GTO.mp4
• This stage is the first 72 hours after the injury.
• During this stage, there should not be any stretching at all…
compl...
• The second stage is the next 1-2 weeks following the
injury and resting period. Stage 1 might be a bit longer for
some p...
• This stage is the time period from approximately 2-5 weeks
post injury
• This stage is more intense, but will bring the ...
• This really isn’t a stage, it’s a new way of stretching for life
• The long term outlook can be determined by a lifetime...
• Alignment: positioning a limb or the body such that the
stretch force is directed to the appropriate muscle group
• Stab...
• Speed of stretch: speed of initial application of the stretch
force
• Frequency of stretch: number of stretching session...
• Proper alignment or positioning of the patient and the
specific muscles and joints to be stretched is necessary for
pati...
Stretching Protocols
(Stabilization)
• To achieve an effective stretch of a specific muscle or
muscle group and associated...
• The intensity (magnitude) of a stretch force is determined
by the load placed on soft tissue to elongate it.
• There is ...
• Low-intensity stretching (coupled with a long duration of
stretch) results in optimal rates of improvement in ROM
• Low-...
Stretching Protocols
(Duration )
• The duration of stretch refers to the period of time a
stretch force is applied and sho...
Example: Two repetitions daily of a 30-second static stretch
of the hamstrings yield significant gains in hamstring
flexib...
Stretching Protocols
(Speed )
• To ensure optimal muscle relaxation and prevent injury to
tissues, the speed of stretch sh...
Stretching Protocols (Frequency )
• Refers to the number of bouts (sessions) per day or per
week a patient
carries out a s...
Stretching Protocols
(Mode of stretch)
Mode of Stretching
•Manual Stretching
•Self Stretching
•Mechanical Stretching
•PNF ...
Stretching Protocols (Warm Up)
• Prepares your body physically and psychologically
• Increases blood flow to your muscles ...
Stretching Protocols (Cool Down)
• Never skip this step of your workout!
• If you abruptly stop an intense activity, you r...
• Slow the intensity of the activity you are doing
• Gradually slow your pace down to a walk
• End the cool-down by doing ...
• Static / Dynamic stretching
• Static Progressive Stretching
• Proprioceptive neuromuscular facilitation stretching
proce...
• Stretch the muscle to the point of slight or mild
discomfort (overload)
• Hold each stretch for 10 to 30 seconds
• Repea...
• Static progressive stretching is another term that describes
how static stretch is applied for maximum effectiveness.
• ...
• Most dangerous of the stretching
procedures
• Involves the use of repetitive, bouncing
• Virtually abandoned
• May lead ...
• Isometric contraction
• Contraction and relaxation phases (stretch phase)
• Normally performed with a partner
• Hold the...
Ballistic Stretching
• Involves active muscular effort and uses a bouncing
motion in which the position is not held.
• Hig...
Manual Stretching :
• During manual stretching a therapist or other trained
practitioner applies an external force to move...
Mechanical Stretching :
• Mechanical stretching devices apply a very low intensity
stretch force (low load) over a prolong...
Self Stretching :
• Self-stretching (also referred to as flexibility exercises or
active stretching) is a type of stretchi...
Contraindication
Joint Instability
Joint instability can be the result of a prior dislocation, fracture, or
sprain.
Diseas...
Contraindication
Acute Injury
Scar tissue takes time to mature. Premature stretching can
cause re-injury and the depositio...
Contraindication
Excessive Pain When Stretching
If stretching is excessively painful an underlying medical
condition may p...
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Stretching Exercises

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Fundamental of stretching

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Stretching Exercises

  1. 1. Stretching By: Sankari Nedunsaliyan Dip PT (MAL) Bsc Hons Applied Rehab (UK) By: Sankari Nedunsaliyan Dip PT (MAL) Bsc Hons Applied Rehab (UK)
  2. 2. Chapter Outline Definition Stretching Protocol Hypomobility and Flexibility Anatomic factors affecting flexibility Neurophysiologic basic of stretching Phases of stretching Stretching Protocols Contraindication Types of stretching
  3. 3. Stretching is a general term used to describe any therapeutic maneuver designed to increase the extensibility of soft tissues, thereby improving flexibility by elongating (lengthening) structures that have adaptively shortened and have become hypomobile over time
  4. 4. Hypomobility : refers to decreased mobility or restricted motion. A wide range of pathological processes can restrict movement and impair mobility. There are many factors that may contribute to hypomobility and stiffness of soft tissues, the potential loss of ROM, and the development of contractures.
  5. 5. • Prolonged immobilization of a body segment • Sedentary lifestyle • Postural malalignment and muscle imbalances • Impaired muscle performance (weakness) associated with list of musculoskeletal or neuromuscular disorders • Tissue trauma resulting in inflammation and pain • Congenital or acquired deformities
  6. 6. • Term used for interchangeably with extensibility • the range of motion that is available to a joint or joints • Refers to ability of the muscles to relax and yield to a stretch force • Flexibility exercises are stretching exercises designed to increase range of motion Flexibility
  7. 7. Muscles, tendons and their surrounding fascial sheaths •Stretching attempts to take advantage of highly elastic properties of muscle •Overtime it is possible to increase elasticity , or the length a given muscle can be stretched Connective tissue (ligaments and joint capsule) •Become shortened and stiff during periods of immobilization •People can also be loose jointed from slack or increased laxity in connective tissue •Creates some instability
  8. 8. Bony structures •Restrict end point in the range of motion •Good for stability •After fracture excess calcium can develop which interferes with normal range Fat •Excess fatty tissue can restrict range of motion •For example; excess abdominal fat can restrict trunk movement
  9. 9. Skin •Inelastic scar tissue can develop after surgery or injury •Incapable of stretching with joint movement •Overtime can improve elasticity to varying degrees through stretching
  10. 10. Neural tissue •Tightness develops in neural tissues from acute compression, chronic repetitive microtrauma, muscle imbalances, joint dysfunctions, or poor posture •Can create structural changes in tissue that can cause pain •Pain can cause muscle guarding and spasm •Can eventually lad to neural fibrosis or scarring
  11. 11. Mechanoreceptors in muscle tell CNS what is happening within that muscle •2 of these are important in the stretch reflex •Muscle spindle and the Golgi tendon organ (GTO) •Sensitive to changes in muscle length •GTO also sensitive to change in muscle tension
  12. 12. •Muscle spindle initially sends sensory impulse to spinal cord which then sends a message back to muscle spindle causing the muscle to reflexively contract
  13. 13. •If stretch last longer than 6 seconds, impulses from GTO begin to override muscle spindle •autogenic inhibition, or a reflex relaxation of the antagonist muscle •Protective mechanism to allow stretch to avoid damage to muscle fibers •Reciprocal inhibition •Contraction of agonist causes a reflex relaxation in the antagonist muscle •Allows antagonist to stretch and protects from injury
  14. 14. Autogenic Inhibition & Reciprocal Inhibition Autogenic Inhibition: Relaxation in the same muscle that is experiencing increased tension. – Tension built up during the active contraction stimulates the GTO, causing a reflexive relaxation of the muscle during the subsequent passive stretch.
  15. 15. Reciprocal Inhibition: Relaxation that occurs in the opposing muscle experiencing increased tension. – This is accomplished by simultaneously contracting the muscle opposing the muscle being passively stretched. – The tension in the contracting muscle stimulates the GTO and causes simultaneous reflexive relaxation of the stretched muscle Autogenic Inhibition & Reciprocal Inhibition
  16. 16. •Muscle temperature should be increased prior to stretching •Positive effect of collagen and elastin components to deform •Capability of GTO to reflexively relax is enhanced •Can be achieved through low intensity warm up or through various therapeutic modalities •However exercise is recommended over modalities •If muscle guarding occurs cold therapy can also be used prior to stretching
  17. 17. muscle spindles & GTO.mp4
  18. 18. • This stage is the first 72 hours after the injury. • During this stage, there should not be any stretching at all… completely avoid it. • Instead, focus on what is called the R.I.C.E.R. treatment. This is the acronym for rest, ice, compression, elevation, referral • Stage one, no stretching at all to avoid further injury.
  19. 19. • The second stage is the next 1-2 weeks following the injury and resting period. Stage 1 might be a bit longer for some people • Relatively light static and passive stretches, following heat or massage treatments, will aid in speeding up the healing process. • Stretching not necessarily supposed to cause pain. If that occurs, ease up on the amount of tension you are applying to the muscles. Discomfort is expected, but not pain.
  20. 20. • This stage is the time period from approximately 2-5 weeks post injury • This stage is more intense, but will bring the greatest amount of recovery • Regain most, if not all of your strength, flexibility, and endurance, as well as coordination and balance • PNF can be introduced along with static and passive stretch depending on clients perfomance
  21. 21. • This really isn’t a stage, it’s a new way of stretching for life • The long term outlook can be determined by a lifetime practice of appropriate stretching • Two areas of stretching should now be considering are dynamic and active stretching.
  22. 22. • Alignment: positioning a limb or the body such that the stretch force is directed to the appropriate muscle group • Stabilization: fixation of one site of attachment of the muscle as the stretch force is applied to the other bony attachment • Intensity of stretch: magnitude of the stretch force applied • Duration of stretch: length of time the stretch force is applied during a stretch cycle Stretching Protocols
  23. 23. • Speed of stretch: speed of initial application of the stretch force • Frequency of stretch: number of stretching sessions per day or per week • Mode of stretch: form or manner in which the stretch force is applied (static, ballistic, cyclic); degree of patient participation (passive, assisted, active); or the source of the stretchforce (manual, mechanical, self) Stretching Protocols
  24. 24. • Proper alignment or positioning of the patient and the specific muscles and joints to be stretched is necessary for patient comfort and stability during stretching. • Alignment influences the amount of tension present in soft tissue and consequently affects the ROM available in joints. • For eg: to stretch the rectus femoris (a muscle that crosses two joints) effectively, as the knee is flexed and the hip extended, the lumbar spine and pelvis should be aligned in a neutral position. The pelvis should not tilt anteriorly nor should the low back hyperextend Stretching Protocols (Alignment)
  25. 25. Stretching Protocols (Stabilization) • To achieve an effective stretch of a specific muscle or muscle group and associated periarticular structures, it is imperative to stabilize (fixate) either the proximal or distal attachment site of the muscle-tendon unit being elongated. • Example: when stretching the iliopsoas, the pelvis and lumbar spine must maintain a neutral position as the hip is extended to avoid stress to the low back region. Sources of stabilization include manual contacts, body weight, or a firm surface such as a table, wall
  26. 26. • The intensity (magnitude) of a stretch force is determined by the load placed on soft tissue to elongate it. • There is general agreement among clinicians and researchers that stretching should be applied at a low intensity by means of a low load. • Low-intensity stretching in comparison to highintensity stretching makes the stretching maneuver more comfortable for the patient and minimizes voluntary or involuntary muscle guarding so a patient can either remain relaxed or assist with the stretching maneuver. Stretching Protocols (Intensity )
  27. 27. • Low-intensity stretching (coupled with a long duration of stretch) results in optimal rates of improvement in ROM • Low-intensity stretching has also been shown to elongate dense connective tissue, a significant component of chronic contractures, more effectively and with less soft tissue damage and post-exercise soreness than a high-intensity stretch Stretching Protocols (Intensity )
  28. 28. Stretching Protocols (Duration ) • The duration of stretch refers to the period of time a stretch force is applied and shortened tissues are held in a lengthened position. • Duration most often refers to how long a single cycle of stretch is applied. • If more than one repetition of stretch (stretch cycle) is carried out during a treatment session, the cumulative time of all the stretch cycles is also considered an aspect of duration • Ideal duration for a stretch cycle: 20-30 seconds
  29. 29. Example: Two repetitions daily of a 30-second static stretch of the hamstrings yield significant gains in hamstring flexibility similar to those seen with six repetitions of 10- secondstatic stretches daily Stretching Protocols (Duration )
  30. 30. Stretching Protocols (Speed ) • To ensure optimal muscle relaxation and prevent injury to tissues, the speed of stretch should be slow. • The stretch force should be applied and released gradually. • Slowly applied stretch is less likely to increase tensile stresses on connective tissues or to activate the stretch reflex and increase tension in the contractile structures of the muscle being stretched • Stretch force applied at a low velocity is also easier for the therapist or patient to control and is therefore safer than a high-velocity stretch.
  31. 31. Stretching Protocols (Frequency ) • Refers to the number of bouts (sessions) per day or per week a patient carries out a stretching regimen. • The recommended frequency of stretching is often based on the underlying cause of impaired mobility, the quality and level of healing of tissues, the chronicity and severity of a contracture, as well as a patient’s age. • 3 to 5 repetitions per session and done 3 times a week is considered as adequate for gaining improvements in the flexibility of soft tissues. • Frequencies are also determined by clinicians according to the impairments
  32. 32. Stretching Protocols (Mode of stretch) Mode of Stretching •Manual Stretching •Self Stretching •Mechanical Stretching •PNF stretching techniques
  33. 33. Stretching Protocols (Warm Up) • Prepares your body physically and psychologically • Increases blood flow to your muscles and increases your body temperature • The warm-up should last about five minutes • Slow walking is a good warm-up for a moderate-paced walk. Brisk walking is a good warm-up for more vigorous activity. • Make sure your warm-up does the following: Increases heart rate ,Increases breathing rate Elevates body temperature, Utilizes muscles you will use in the upcoming activity , Takes your joints through a full rage of motion needed for the upcoming activity
  34. 34. Stretching Protocols (Cool Down) • Never skip this step of your workout! • If you abruptly stop an intense activity, you risk:  Increasing your chance of experiencing heart arrhythmias,  Hindering the removal of cellular waste from your muscles,  Increasing the likelihood of muscle soreness,  Blood pooling  Becoming light-headed
  35. 35. • Slow the intensity of the activity you are doing • Gradually slow your pace down to a walk • End the cool-down by doing some deep stretching. • Focus on the muscles that you were using during your workout, this will help reduce the incidence of stiffness or soreness later. • After the entire workout, stretch the whole body, focus on the muscles that were used during the workout. • Each stretch should last 20-30 seconds and be repeated. Stretching Protocols (Cool Down)
  36. 36. • Static / Dynamic stretching • Static Progressive Stretching • Proprioceptive neuromuscular facilitation stretching procedures • Ballistic stretching • Cyclic/intermittent stretching • Manual stretching • Mechanical stretching • Self-stretching • Passive stretching • Active stretching Types of Stretching
  37. 37. • Stretch the muscle to the point of slight or mild discomfort (overload) • Hold each stretch for 10 to 30 seconds • Repeat the stretch 4 times • Flexibility exercise sessions should occur • 3 to 5 times per week Static Stretching:
  38. 38. • Static progressive stretching is another term that describes how static stretch is applied for maximum effectiveness. • The shortened soft tissues are comfortably held in a lengthened position until a degree of relaxation is felt by the patient or therapist. • Then the shortened tissues are incrementally lengthened even further and again held in the new end-range position for an additional duration of time. Static Progressive Stretching:
  39. 39. • Most dangerous of the stretching procedures • Involves the use of repetitive, bouncing • Virtually abandoned • May lead to soreness and muscle injury Dynamic Stretching:
  40. 40. • Isometric contraction • Contraction and relaxation phases (stretch phase) • Normally performed with a partner • Hold the isometric contraction 6 seconds • Repeat 4 times each session • 3-5 times per week PNF Involves:
  41. 41. Ballistic Stretching • Involves active muscular effort and uses a bouncing motion in which the position is not held. • High speed, high intensity Cyclic / Intermittent Stretching • A relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied is described as a cyclic (intermittent) stretch • With cyclic stretching the end-range stretch force is applied at a slow velocity, in a controlled manner, and at relatively low intensity.
  42. 42. Manual Stretching : • During manual stretching a therapist or other trained practitioner applies an external force to move the involved body segment slightly beyond the point of tissue resistance and available ROM. • The therapist manually controls the site of stabilization as well as the direction, speed, intensity, and duration of stretch. • Remember, stretching and ROM exercises are not synonymous terms. • Stretching takes soft tissue structures beyond their available length to increase ROM.
  43. 43. Mechanical Stretching : • Mechanical stretching devices apply a very low intensity stretch force (low load) over a prolonged period of time • The equipment can be as simple as a cuff weight or weight- pulley system • The duration of mechanical stretch reported in the literature ranges from 15 to 30 minutes • The longer durations of stretch are required for patients with chronic contractures • Devices which are commonly used for mechanical stretching are weight cuffs, mechanical pulley devices with springs, CPM and orthosis such as serial casts or splins
  44. 44. Self Stretching : • Self-stretching (also referred to as flexibility exercises or active stretching) is a type of stretching procedure a patient carries out independently after careful instruction and supervised practice. • This form of stretching is often an integral component of a home exercise program and is necessary for long-term self- management • Teaching a patient to carry out self-stretching procedures correctly and safely is fundamental for preventing re-injury or future dysfunction
  45. 45. Contraindication Joint Instability Joint instability can be the result of a prior dislocation, fracture, or sprain. Diseases Affecting the Tissues Being Stretched Conditions such as rheumatoid arthritis can leave joint structures weakened. Those with connective tissue disorders also have altered connective tissue viscoelastic properties. Stretching can lead to disability, instability or deformity. Infection Consult your family doctor prior to stretcing an area that is infected to avoid tissue damage or spread of the infection.
  46. 46. Contraindication Acute Injury Scar tissue takes time to mature. Premature stretching can cause re-injury and the deposition of more scar tissue prolonging the rehabilitation process. Vascular injury Recovering from a vascular trauma or are on anticoagulants. Premature or excessive stretching can lead to further vascular injury and thromboembolism
  47. 47. Contraindication Excessive Pain When Stretching If stretching is excessively painful an underlying medical condition may present. Inflammation or Joint Effusion Be careful when starting a stretching program around an area of inflammation. Inflammation can change the viscoelastic properties of connective tissues and can cause injury if not undertaken correctly. Aggressively stretching a joint with an effusion can damage capsular structures. See your physical therapist.
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Fundamental of stretching

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