• See also from pages 94 to 104, therapeutic exercise ,
CAROLYN KISNER
MANUAL STRETCHING TECHNIQUES IN ANATOMICAL
PLANES OF MOTION
Note during practical exam you must say 3 thing:
1. Position of patient.
2. Position of therapist.
3. Grasp:
4. A. Stabilizing hand.
5. B. Moving hand.
• Stabilize the scapula
• ROM is limited to only 120° .
teres major
latissimus dorsi
• Adduction of the Shoulder
• Rare thing to do
• Perform bilateral Stretching as needed
• Techniques should be performed with the forearm
pronated as well as supinated
• Hand Placement and Procedure
• Grasp the distal forearm just proximal to the wrist.
• With the arm at the patient's side supported on the table,
stabilize the proximal humerus.
• Flex the patient's elbow just past the point of tissue resistance
to lengthen the elbow extensors.
• To increase elbow flexion with the shoulder flexed
• heterotopic ossification !!
• the appearance of ectopic bone in the soft tissues around a
joint due to vigorous, forcible passive stretching of the elbow
flexors
• Hand Placement and Procedure
• humerus supported - elbow flexed 90°
• grasp the distal forearm.
• Stabilize the humerus.
• Supinate or pronate the forearm just beyond the point of
tissue resistance.
• Do not twist the hand, thereby avoiding stress to the
wrist articulations.
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•
•
•
Wrist Flexion
Wrist Extension
Radial Deviation
Ulnar Deviation
• CMC Joint of the Thumb
• MCP Joints of the Digits
• PIP and DIP Joints
• to increase flexion of the hip with the knee flexed
(stretch the gluteus maximus).
• Hand Placement and Procedure
• Flex the hip and knee simultaneously.
• Stabilize the opposite femur in extension to prevent posterior
tilt of the pelvis.
• Move the patient's hip and knee into full flexion to lengthen
the one-joint hip extensor.
• Externally rotate the hip prior to
hip flexion to isolate the stretch
force to the medial hamstrings
internally rotate the hip to
isolate the stretch force to
the lateral hamstrings.
• Patient Position
• Use either of the positions previously described for increasing
hip extension in the supine or prone positions
• Hand Placement and Procedure
• With the hip held in full extension on the side to be stretched,
move your hand to the distal tibia and gently flex the knee of
that extremity as far as possible.
• Do not allow the hip to abduct or rotate.
• To increase adduction of the hip [stretch the tensor
fasciae latae and iliotibial (IT) band]
• Alternate Position and
Procedure
• Sitting at the edge of a table
with hips and knees flexed to
90°.
• Stabilize the pelvis by applying
pressure to the iliac crest with
one hand.
• Apply the stretch force to the
lateral malleolus or lateral
aspect of the lower leg, and
externally rotate the hip.
• Alternate Position and
Procedure
• sitting with the thigh supported
on the treatment table and leg
flexed over the edge
• Stabilize the anterior aspect of
the proximal femur with one
hand.
• Apply the stretch force to the
anterior aspect of the distal
tibia and flex the patient's knee
as far as possible.
useful in the 0° to 100° range of knee flexion
useful in the 90° to 135° range of knee
flexion
with the knee extended  stretch the gastrocnemius
with the knee flexed  stretch the soleus
Avoid placing too much pressure against the
heads of the metatarsals
• Hand Placement and Procedure
• Support the posterior aspect of the distal tibia with one hand.
• Grasp the foot along the tarsal and metatarsal areas.
• Apply the stretch force to the anterior aspect of the foot, and
plantarflex the foot as far as possible.
• Hand Placement and Procedure
• Stabilize the talus by grasping just distal to the malleoli with
one hand.
• Grasp the calcaneus with your other hand, and move it
medially and laterally at the subtalar joint.
• Hand Placement and Procedure
• Stabilize the distal tibia with your proximal hand.
• Grasp around the foot with your other hand and align the
motion and force opposite the line of pull of the tendons.
• Apply the stretch force against the bone to which the muscle
attaches distally.
tibialis anterior  Grasp the dorsal aspect of the foot across the
tarsals and metatarsals and plantarflex and abduct the foot.
tibialis posterior  Grasp the plantar surface of the foot around the tarsals and
metatarsals and dorsiflex and abduct the foot.
Peroneals  Grasp the lateral aspect of the foot at the tarsals and metatarsals
and invert the foot.
• It is best to stretch any musculature that limits motion in
the toes individually.
• One hand, stabilize the bone proximal to the restricted joint,
and with the other hand move the phalanx in the desired dire