Definition of Stretching
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.
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systematic examination, evaluation, and diagnosis of
a patient's presenting problems determine what
structures are restricting motion and when and what
types of stretching procedures are indicated.
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After gaining desired ROM, Stretching must be
supported by an appropriate level of strength and
endurance to become permanent.
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stretching interventions are designed to elongate the
contractile and non-contractile components of
muscle-tendon units and periarticular structures.
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Mobility.
Hypomobility.
Flexibility.
Contracture.
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• the ability of structures or segments of the
body to move to allow range of motion for
functional activities (functional ROM).
• OR
• the ability of an individual to initiate, control,
or sustain active movements of the body to
perform simple to complex motor skills
(functional mobility)
• ROM needed for the performance of functional
activities does not necessarily mean full or
“normal” ROM.
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Sufficient mobility must be supported by:
muscle strength and endurance
neuromuscular control
All are important factors in the prevention of injury or
reinjury of the musculoskeletal system.
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Decreased mobility or restricted motion
Caused by adaptive shortening of soft tissues can occur
as the result of many disorders or situations.
Factors affect mobility:
◦ Prolonged immobilization of a body segment
Extrinsic: cast, splint or skeletal traction.
Intrinsic: pain, inflammation, effusion, Ms
disorders, skin disorder, bony block, or vascular
disorders
◦ Sedentary lifestyle
◦ Postural malalignment: congenital or acquired
deformities.
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◦ Paralysis, tonal abnormality, Muscle imbalance. ther 246
the ability to move a single joint or series of joints
smoothly and easily through an unrestricted, pain-free
ROM
 related to :
◦ The extensibility of musculotendinous units
◦ Arthrokinematics of the moving joint. (the ability of the
joint surfaces to roll and slide)
◦ Deformation of periarticular connective tissues.
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• Dynamic flexibility. (active mobility/active ROM)
– the degree to which an active muscle contraction
moves a body segment through the available ROM
of a joint.
– dependent on the degree to which a joint can be
moved by a muscle contraction and the amount of
tissue resistance met during the active movement.
• Passive flexibility. (passive mobility/passive ROM)
– the degree to which a joint can be passively moved
through the available ROM
– dependent on the extensibility of muscles and
connective tissues that cross and surround a joint.
Passive flexibility is a prerequisite for but does not
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ensure dynamic flexibility.ther 246
• The adaptive shortening of the muscle-tendon unit and
other soft tissues that cross or surround a joint
• That results in
– significant resistance to passive or active stretch
– limitation of ROM
– compromise functional abilities
• Contracture is defined as an almost complete loss of
motion, whereas the term shortness is used to denote
partial loss of motion.
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• Designation of Contractures by Location
• Contractures are described by identifying the
action of the shortened muscle.
• Example If a patient has shortened elbow
flexors and cannot fully extend the elbow, he
or she is said to have an elbow flexion
contracture.
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Contracture Versus Contraction
• Contraction: the process of tension developing in a
muscle during shortening or lengthening
– The terms contracture and contraction are not
synonymous and should not be used
interchangeably.
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Precautions for Stretching
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Do not passively force a joint beyond its normal ROM
Patients with known or suspected osteoporosis
Protect newly united fractures
Avoid vigorous stretching of tissues that have been
immobilized for an extended period of time
• Progress gradually
• Avoid stretching edematous tissue
• Avoid overstretching weak muscles
Indications for Stretching
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Limited ROM .
Structural deformities .
Muscle weakness.
Muscle shortening.
Part of a total fitness program designed to prevent
musculoskeletal injuries.
Prior to and after vigorous exercise potentially to
minimize post-exercise muscle soreness.
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Contraindications to Stretching
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A bony block limits joint motion.
Recent fracture, and incomplete bony union
acute inflammatory or infectious process
sharp, acute pain with joint movement or muscle
elongation.
A hematoma or other indication of tissue trauma.
Hypermobility already exists.
Shortened soft tissues provide necessary joint stability in
lieu of normal structural stability or neuromuscular
control.
Shortened soft tissues enable a patient with paralysis or
severe muscle weakness to perform specific functional
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skills otherwise not possible.
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Guidelines for Application of Stretching
• Perform appropriate Examination and Evaluation
for joint that you will apply stretching for its
surrounding soft structures.
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Explain the procedure to the patient
Review the goals and desired outcomes & obtain consent
Select effective and efficient stretching techniques
Warm up the soft tissues to be stretched
The direction of stretch is exactly opposite the direction
of the joint or muscle restriction.
Remove any restrictive clothing, bandages, or splints.
Explain to the patient that it is important to be as relaxed
as possible or assist when requested.
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After Stretching
• Apply Cold packs in the lengthened position.
• Perform active ROM for shorted group of muscles
and strengthening exercises for antagonist muscle
group through the gained range immediately after
stretching.
Follow with functional movement patterns
B. Heat
• Warming up prior to stretching is a common
practice in rehabilitation program.
• Superficial heat (hot packs, paraffin) or deepheating modalities (ultrasound, shortwave
diathermy) .
C. Massage
• Local muscle relaxation can be enhanced by massage.
D. Soft Tissue Mobilization Techniques
• the primary purpose of these techniques is not
relaxation but, rather, increasing the mobility of
adherent or shortened connective tissues including
fascia, tendons, and ligaments.
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E. Biofeedback
• Biofeedback is another tool to help a patient
learn and practice the process of relaxation. A
patient, if properly trained, can electronically
monitor and learn to reduce the amount of
tension in muscles, as well as heart rate and
blood
pressure,
through
biofeedback
instrumentation.
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