Stretching Exercises
Mazyad Alotaibi
1
Mobility and Flexibility of soft tissues (muscles, tendons, fascia, joint
capsule, and skins) surrounding the joint along with adequate joint
mobility, are necessary for normal ROM.
 Mobility: is the ability of segments of the body to move through
range of motion for functional activities.
 Flexibility: is the ability to move a single joint or series of joints
smoothly and easily through an unrestricted, pain –free ROM.
2
Types of Flexibility
1. Dynamic flexibility (active mobility or active ROM )
It is the degree to which an active muscle contraction
moves the a body segment through the available ROM
of the joint.
It depends on:
 The degree to which joint can be moved by a muscle
contraction
 The amount of soft tissue resistance met during the
active movement.
3
2. Passive flexibility (passive mobility or passive ROM )
It is the degree to which a joint can be passively moved
through the available ROM.
It depends on:
- extensibility of muscles and connective tissues (soft tissues )
that crosses and surrounding a joint.
Types of Mobility
1- Hypo-mobility: Refers to decreased mobility or restricted motion.
2- Hyper-mobility: Refers to increased mobility
4
Factors that influence flexibility
1- Joint structure
 The type of joint determine the degree of
ROM. For example; a ball-and-socket joint,
like shoulder has greater ROM than a hinge
joint like wrist.
2- Age
 With age, muscles go through a shortening
process due to lack of physical activities and a
loss of elasticity in the connective tissues
surrounding the muscles. As a result, there
tends to be a decrease in flexibility with age.
5
Factors that influence flexibility
3- The Elasticity
 The elasticity of the skin, tendons and
ligaments, (ligaments do not stretch
much and tendons should not stretch
at all).
4-Gender
 Females tend to be more flexible than
males of similar age throughout life,
generally due to anatomical variations
in joint structures.
6
Factors that influence flexibility
5-Exercise
 Participation in regular exercise involving full
ROM generally enhances flexibility, while a
sedentary lifestyle often results in diminished
flexibility.
6-Muscle mass
 muscle mass can be a factor when the muscle is so
7
heavily developed that it interferes with the
ability to take the adjacent joints through their
complete range of motion (for example, large
hamstrings limits the ability to fully bend the
knees). Excess fatty tissue imposes a similar
restriction.
Factors that influence flexibility
7-Temperature
 An increase in either body temperature as a
result of exercise or external temperature
increases ROM.
8-Pregnancy
 During pregnancy, the pelvic joints and
ligaments are relaxed and capable of a greater
ROM.
8
Causes of soft tissue Shortening
1- Prolonged Immobilization due to:
A. Extrinsic factors
* casts and splint
* skeletal traction
B. Intrinsic factors
* pain
* joint inflammation &stiffness
* skin &muscle disorders
* bony block
* vascular disorders
9
Causes of soft tissue shortening
2- Sedentary lifestyle due to bed rest, work environment
3- Muscle imbalance, paralysis or tone abnormality
4- Postural malalignment which may be
* congenital
* acquired
e.g. Scoliosis, Kyphosis
10
# Contracture it is not equal to Contraction
Contracture
 Is the adaptive shortening of the muscle-tendon unit
and other soft tissues that crosses or surround a joint
that results in significant resistance to passive or active
stretch and limitation of ROM
Contraction
 The process of tension developing in a muscle during
shortening or lengthening
11
Types of Stretching
1- Passive stretching
2- Active (Neuromuscular) Inhibition stretching.
3- Self stretching
4- Ballistic stretching.
12
1- Passive Stretching
 A sustained external force applied at the end –range manually or
mechanically to elongates a shortened muscle-tendon unit, while the
patient is relaxed.This type can be classified into:
 The tension created in a muscle during ballistic stretch is nearly twice that
created with low- intensity static (sustained) stretch.
 When a gentle passive stretch position is held for at least 30 to 60 second,
the facilitatory effect of stretch reflex on muscle appear to be minimal as
the inhibitory action of the GTO may override the facilitatory effect of
stretch reflex, so that there is no increase in muscle tension.
13
a- Manual Passive Stretch
 The therapist applies an external force and controls the direction,
speed, intensity and duration of stretch to shorten soft tissues beyond
their resting length.
 This technique should not be confused with passive range of motion
exercises. Passive stretching takes the structures beyond the free
range of motion. Passive range of motion is applied only within the
unrestricted available range.
14
 The patient must be as relaxed as possible during passive stretching.
 The stretch force is usually applied for at least 15 to 30 seconds and
repeated several times in an exercise session.
 The intensity and duration of the stretch are dependent on the
patient’s tolerance and the therapist’s strength and endurance. A
low-intensity manual stretch applied for as long a duration as
possible will be more comfortable and more readily tolerated by the
patient.
15
b- Prolonged Mechanical Passive Stretch
 2- Prolonged mechanical passive stretching
 A low intensity external force is applied over a prolonged period of time with
mechanical equipment.
 The stretch force is applied with the patient as relaxed as possible.
 The stretch may be maintained for 15-30 minutes or as long as several days or weeks,
depending on the type of apparatus used.
 The stretch can be applied through positioning of the patient, with weighted traction
and pulley systems, or with serial splints or casts.
16
C-Cyclic (Intermittent) stretch
*A short duration stretch force, repeatedly but gradually
applied, released, and then reapplied using mechanical
device.
*Each cycle of stretch is held between 5-10 seconds at
the end-range, which is applied gradually at a controlled
manner and at a relatively low intensity. These cyclic
stretching is applied for many repetitions in each single
treatment session.
*This type of stretching showed that it is more effective
and comfortable than a prolonged static stretch.
17
2- Active (Neuromuscular) Inhibition stretching
 These procedures reflexively relax the tension in shortened muscles




18
prior to or during stretching maneuver.
When a muscle is reflexively inhibited, there is less resistance to
elongation by the contractile unites of the muscle.
Inhibition techniques increase muscle length by relaxing and elongating
the contractile components of muscle.
This type of stretching is only done with normally innervated muscle
and under voluntary control.
It can not be used in patient with severe muscle weakness, spasticity, or
paralysis from neuromuscular dysfunction.
 For example; where you assume a position and then hold it there with
no assistance other than using the strength of agonist muscles. E.g.,
bringing your leg up and then holding it there without anything, other
than your leg muscles itself, to keep the leg in that extended position.
The tension of the agonists in an active stretch helps to relax the muscles
being stretched (antagonists) by reciprocal inhibition. Active stretches
are hold and maintained for 10 to 15 seconds.
 These techniques have been adapted from Proprioceptive neuromuscular
facilitation (PNF) techniques.
 There are three variations of neuromuscular inhibition techniques:
1- Contract-relax (Hold- relax).
2- Contract-relax- contract (Hold- relax with agonist contraction).
3- Agonist contraction.
19
3- Self Stretching
 Also known as flexibility exercises or active stretching.
 Self stretching is a type of flexibility exercise that a patient can carry
out himself as an integral component of a home exercise program.
 It may involve relaxation of muscle and a passive stretch applied
through the weight of the body.
 Self stretching can also be carried out actively by the patient first
inhibiting and then lengthening the tight muscle.
20
4- Ballistic stretching
 A rapid, forceful intermittent, high-speed and high-intensity
stretch.
 Vigorous bouncing movement to force the body segment
beyond its range of motion to stretch shortened structures.
 It is not advised because the high-velocity and high-intensity
movements are difficult to control and can lead to injury in
weakened tissues.
21
Goals of Stretching
1- Regain normal range of motion of joints and mobility of soft tissue
that surrounding that joint.
2- Prevent irreversible contractures.
3- Increase the general flexibility of muscle and soft tissues before
vigorous strengthening exercises.
4- Minimize and prevent the risk of musculo-tendinous injuries
related to specific physical activities and sports.
22
Indications of Stretching
1- Limited range of motion due to contractures, adhesions and scar tissue
formation leading to shortening of muscles, ligaments, connective tissue
and skin.
2-When there are structural (skeletal) deformities as a result of limitation.
3-Whenever contracture interfere with activities of daily living (ADL).
4-When there is muscle imbalance (muscle weakness and opposing tissue
tightness). Tight muscle must be stretched first before strength of weak
muscle.
5- As part o a total fitness program.
6- Prior to and after vigorous exercise to minimize postexercise muscle
soreness.
23
Contra-indications of Stretching
1- Presence of bony block that limits joint motion.
2- Recent fracture.
3- Cases of acute inflammation or infection (presence of
heat swelling around the joint).
4- Presence of acute sharp pain with joint movement or
muscle elongation.
5- in case of hematoma and hypermobility.
24
TECHNIQUES
25
STRETCH OF PECTORALIS MUSCLE
 TEST PECTORALIS FLEXIBILITY
26
PECTORALIS FLEXIBILITY
27
SHOULDER ROTATOR CUFF
The Rotator Cuff: the Teres Minor, the
Infraspinatus, the Supraspinatus and the
Subscapularis.
28
PECTORALIS TARGET STRETCH
place your palm flat
on the wall, keep
your weight in your
heels, and lean the
whole body forward.
Use the hand on the
wall as your anchor,
and feel the stretch
along the front of
the chest and
armpit.
29
PECTORALIS TARGET STRETCH
• Lower your hand to about
shoulder height, palm facing
the wall, stretching the hand
behind you. Then turn the
whole body away from the
wall, pointing the feet,
knees, and hips away from
the hand. Feel the stretch
across the front of the chest
and inner arm.
30
STRETCH OF PECTORALIS
MUSCLE
• 1- FROM STANDING POSITION
31
32
33
34
35
36
37
38
39
40
Stretching of Lower Limb
 Test of hip flexors shortening (Thomas test)
41
Iliopsoas Stretching
42
Passive Stretch of The Hip Flexors
43
44
OBER’S TEST FOR ILIOTIBIAL BAND
FLEXIBILITY
 Ober’s test is the test for tightness of the ITB.
 The subject is placed on their side, healthy side down. The
knee is flexed 90 degrees and the hip extended to neutral (no
flexion).
45
OBER’S TEST FOR ILIOTIBIAL BAND
FLEXIBILITY
 The PHYSIOTHERAPIST holds the leg up by the foot.
Normally, the knee falls down to the exam table. If the
ITB is very tight, the leg hangs up in the air (very
impressive). If it’s moderately tight, the knee falls
halfway to the table.
46
MODIFIED OBER’S TEST
47
Iliotibial Band Flexibility
48
STRETCHING OF HIP ADDUCTORS
49
STRETCHING OF HIP ADDUCTORS AND
HAMSTRING
50
TEST OF HAMSTRING FLEXIBILITY
51
52
HAMSTRING FLEXIBILITY
53
FLEXIBILITY OF HAMSTRING AND CALF
MUSCLES
54
FLEXIBILITY OF HAMSTRING AND CALF
MUSCLES
55
STRETCHING OF CALF MUSCLE
56
Calf Stretching
57
SELF STRETCHING
58
Stretch of Upper Trunk
59
Lower back flexibility
60
Gluteus flexibility
61
Iliopsoas Flexibility
62
Iliopsoas Flexibility
63
Iliotibial Band flexibility
64
Iliotibial Band flexibility
65
Hamstring Stretching
66
Hip Adductors Stretching
67
Calf stretching
68