See also figures p 78,79, 83, 84
1. Alignment:
positioning a limb or the body such that the stretch force
is directed to the appropriate muscle group
2. Stabilization:
fixation of one site of attachment of the muscle as
the stretch force is applied to the other bony
attachment
3. Intensity of stretch:
• Magnitude of the stretch force applied
• Stretching should be applied at a Low intensity
Proximal attachment stabilization
Distal attachment stabilization
4. Duration of stretch:
• length of time the stretch force is applied during a
stretch cycle
• 2 types: Long-duration stretch & short- duration
stretch.
• The shorter the duration of a single stretch cycle, the
greater the number of repetitions applied during a
stretching session.
A. Static Stretching
• Soft tissues are elongated just past the point of
tissue resistance and then held in the lengthened
position with a sustained stretch force over a period
of time
• More safe and more effective
B. Static Progressive Stretching
• Continuous displacement of a limb by varying the
stretch force
C. Cyclic (Intermittent) Stretching
• short-duration stretch force that is repeatedly but
gradually applied, released, and then reapplied
• cyclic stretching each cycle of stretch is held between 5
and 10 seconds.
• appropriately applied, end-range cyclic stretching is
effective and more comfortable than static stretch
• particularly if the static stretch is applied continuously
for more than 30 seconds
5. Frequency:
• The number of bouts (sessions) per day or per week.
• Depend on:
Cause of Hypomobility.
the quality and level of healing of tissues.
chronicity and severity of a contracture.
Age of patient.
Previous response to stretching.
• Ranges from two to five sessions per week to promote
tissue healing and to minimize postexercise soreness
Excessive frequency
Progressive loss of
ROM over time
Tissue failure
Tissue breakdown
exceeds repair
Continued low-grade
inflammation
Excessive collagen
formation
6. Mode of Stretch
• The form of stretch or the manner in which stretching
exercises are carried out
• manual and mechanical stretching
• or self-stretching as well as passive, assisted, or active
stretching
• Regardless form of stretching, Low-intensity active
exercise or therapeutic heat should be done before
stretching to warm up the tissues and decrease tissue
resistance.
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Based on the results of your examination.
Is there evidence of pain or inflammation?
How long has the hypomobility existed?
What is the stage of healing of restricted tissues?
What form(s) of stretching have been used previously?
How did the patient respond?
Are there any underlying abnormalities that might affect
the choice of stretching procedures?
Does the patient have the ability to actively participate
Is assistance from a therapist or caregiver necessary to
apply the stretching
what is and strength of the therapist?
A. Manual Stretching:
• Applying an external force by therapist to move the
involved body segment slightly beyond the point of
tissue resistance and available ROM.
Indication:
• Manual stretching may be most appropriate in the
early stages of a stretching program.
• If a patient cannot perform self-stretching due to a lack
of neuromuscular control of the body segment to be
stretched.
• If a patient has control of the body segment to be
stretched, but he needs assistance.
B. Self-Stretching:
• It is a type of stretching procedure a patient carries out
independently after careful instruction and supervised
practice.
• Goal: To enables a patient to maintain or increase the
ROM gained.
• 30sec to 60sec duration per repetition is considered the
safest type of stretching for a self-stretching program
C. Mechanical Stretching:
• It use of equipment as a method for stretching
• It ranged from simple equipment as a cuff weight or
weight-pulley system to sophisticated as some
adjustable orthoses or automated stretching machines.
• Duration ranged from 15 min to 30 or it may be reach
10 hours or n some case it reach few days or weeks.
7. Speed of Stretch
• should be slow.
• applied and released gradually.
Why?????
• To ensure optimal muscle relaxation and prevent injury
to tissues
• to prevent activation of the stretch reflex and increase
tension in the contractile structures of the muscle being
stretched.
• To increase safety of patient and it is much easier to
therapist to control the motion.
• A rapid, forceful intermittent stretch
• Quick, bouncing movements that create momentum to
carry the body segment through the ROM to stretch
shortened structures
Side effect:
• Can cause greater trauma to stretched tissues and greater
residual muscle soreness.
Indication:
• increase ROM safely in young, healthy subjects
participating in a conditioning program.
Contraindication:
• for elderly or sedentary individuals or patients with
musculoskeletal pathology or chronic contractures.
Why?????
• Tissues, weakened by immobilization or disuse, are easily
injured.
• Dense connective tissue found in chronic contractures does
not yield easily with high-intensity, short-duration stretch;
rather, it becomes more brittle and tears more rapidly.
• Highly trained athletes.
• Young active patient in final stage of rehabilitation.
• If high-velocity stretching is employed, rapid, but lowload (low-intensity) stretches are recommended, paying
close attention to effective stabilization.
• There is an inverse relationship between intensity and
duration as well as between intensity and frequency of
stretch.
• The lower the intensity of stretch, the longer the time
the patient will tolerate stretching and the soft tissues
can be held in a lengthened position.
• The higher the intensity, the less frequently the
stretching intervention can be applied to allow time for
tissue healing and resolution of residual muscle
soreness.