Stretching Therapy Workshop Introduction
1. Introduction
2. Physiology of stretching
3. Neurophysiology of stretching
4. Definitions of stretching
5. Research on stretching
6. Comparison of stretching methods in healthy subjects
7. Conclusions of stretching research
8. Proprioceptive neuromuscular facilitation
9. Muscle energy technique
10. Strain and counter-strain
11. Functional stretching
12. Stretching in physiotherapy
13. Measuring stretch force
14. Subjective and objective muscle tension
15. Motivation
16. Complications due to stretching therapy
17. Introduction to stretching techniques
Introduction
Flexibility is considered to be an important factor affecting physical health. Range of
movement (ROM) is a fundamental part of normal function of the musculoskeletal
system .A certain amount of flexibility is necessary for the success of all physical
movements. Individual differences in physical condition and range of
joint movement can largely be due to innate, hereditary factors. Flexibility can, however,
be significantly increased with intensive training of the elastic connective tissues,
even in 'naturally stiff' persons. The general understanding of the importance of
flexibility is in regard to the prevention of injury. A decrease in mobility may cause
changes in function, which puts abnormal loading on the muscle-tendon
system and joint structure. Thus, stretching is commonly included in the warm-up
process in both training and competition situations. Furthermore, stretching is
important in recovery following intense training and competition.
The purpose of stretching is usually to increase joint mobility, muscle length and
flexibility, as well as to relax muscles in general. Metabolism is less efficient in stiff
muscles because of increased intramuscular pressure and decreased circulation of fluid s.
Stretching, therefore, is also used to improve metabolism. Increased flexibility
achieved by stretching will help to prevent injury to muscles, tendons and joints as well
as improving performance capability.
PHYSIOTHERAPY TREATMENTS
PRIOR TO STRETCHING
Prior to static stretching methods, many different
physiotherapy methods have been used to induce maximum
relaxation. It has been suggested that stretching of
tense muscles requires more effort and increases the risk
of trauma. Thus, adequate relaxation has been considered
to be important to the success of stretching and in the
prevention of possible complications. If motor neuron
activity is abundant, relaxation during stretching will be
more difficult. Pain, in particular, can present a problem
by stimulating motor neuron activity, causing muscle
contraction and, in the worst case, preventing any
stretching at all.
1.Heat treatment: Superficial treatments may also raise temperatures of
the deeper tissues, as a result of the increased circulation
and direct conduction in tissues. There is a natural
response within the body to actively balance the local rise
of tissue temperature by transferring heat to other areas
of the body with circulation.
Heat treatments are not recommended as routine
with all stretching. Inflammation or damage of nerves
when combined with heat treatments only irritates
nerves further, increasing pain and muscle tension. Based
on clinical research, it is often impossible to determine
whether pain is purely of nerve or muscular origin.
Heat and stretching prior to exercise is not advisable
because, according to previous studies, it may increase
injury risk. The increase in compliance of warmed muscles
is associated with a reduction in their energy-absorbing
capabilities. Thus a protective effect may be decreased
with increased elasticity
2.Cold Treatments
Cold decreases the speed of neuron conductivity, but
increases muscle activity.
Stretching combined with applications of cold can be
used to speed recovery from acute trauma.
Cold therapy decreases tissue temperature and increases
stiffness. Thus, combining stretch with applications of
cold may seem paradoxical. However cold can be used
effectively in cases where stretching has become impossible
due to intense pain. Cold is often used in the stretching
treatment of fibrous adhesions and scar tissue to
improve mobility. Furthermore, it has been shown that
applications of cold, combined with stretching, to areas
of pain and tension fo llowing intense workout can be useful.
Application of cold to deeper layers will reduce the
sensitivity of the Golgi tendon receptors and other
mechanoreceptors, as well as pain receptors, by directly
affecting the nerves and nerve endings. Applications of
cold are noticeably better than heat in cases where pain
results from stretching.
3.massage: Massage has been shown to affect the muscle-tendon reflex
system, as well as mechanical receptors via pressure and
stretching.
PHYSIOLOGY OF STRETCHING
Changes will occur in all tissue during stretching. The
effects depend on the amount of force plus the time
duration of the stretching teclmiques used. Blood vessels
will stretch with the surrounding connective tissue and
withstand stretching well in the healthy individual. Skin
and subcutaneous tissue do not normally give any
significant resistance in stretching; however, when using
manual stretching the skin may be the structure that is
stretched most if the grip gives away. After trauma, scald
combustion radiation therapy or surgery, excessive scar
tissue may develop in the skin or subcutaneous connective
tissue, which may restrict movement and stretching.
1.
EFFECTS ON FASCIAE
Connective tissue acts to support and stabilize
muscles, blood vessels, and nerves. Tissue sheets direct
muscle force to the whole muscle and reduce friction
between musclesr fasciculus and fibres. Connective tissue
sheets (CTS) accounts for 30% of the total muscle mass.
Fasciae are also an important part of the structure in
tendons.
Without regular stretching, CTS will gradually lose
their flexibility. There can be both structural changes and
dehydration. CTS, under abnormal mechanical and
chemical influence, may be damaged, thicken, shorten
and calcify. Tight CTS, when stretched, often induce paincausing
limitations in movement. Although stretching
and exercise may be avoided due to such pain, exercise is
important in order to restore normal mobility. When a
muscle is not tight, but relaxed during passive
movement, CTS will only slightly resist movement, while
joint capsules and ligaments tend to give more resistance
and limit the movement.
2.
EFFECTS ON TENDONS
Tendon fibres at rest are in a wavelike formation and
will straighten out during stretch. Tendons stretched
beyond capacity will suffer micro trauma and are unable
to return to their original length. Tendons are susceptible
to tearing and rupture even when stretched less than 1 %
of their length, despite laboratory research showing that
tendons can stretch under constant pull up to 20% of
their resting length. The elastic characteristics of tendons
allow for only about 2% lengthening while still preserving
their full stretching capability.
3.
4.
EFFECTS ON JOINT LIGAMENTS
EFFECTS ON NERVES
NEUROPHYSIOLOGY
OF STRETCHING