3. • When moving the patient’s extremities or
spine, pay close attention to the patient’s
reaction to movements to determine the
probable dosage (such as intensity and
duration) of stretch that stays within the
patient’s comfort range.
• Assess the underlying strength of muscles
in which there is limitation of motion.
• Be sure to determine what outcome goals
(i.e., functional improvements) the patient is
seeking.
• Analyze the impact of any factors that could
adversely affect the projected outcomes of
the stretching program.
5. Application of Manual
Stretching
Procedures
• Do not attempt to gain the full
range in one or two treatment
sessions. Resolving mobility
impairment is a slow, gradual
process. It may take several
weeks of stretching to see
significant results. Between
stretching sessions, it is important
to use the newly increased range
to maintain what has been gained.
6. After Stretching
• Apply cold to the soft tissues that have
been stretched and allow these
structures to cool in a lengthened
position.
• Regardless of the type of stretching
intervention used, have the patient
perform active ROM and strengthening
exercises through the gained range
immediately after stretching.
• Develop a balance in strength in the
antagonistic muscles in the new range,
so there is adequate neuromuscular
control and stability as flexibility
increases.
7. Precautions for
Stretching
• Do not passively force a joint beyond
its normal ROM.
• Use extra caution in patients with
known or suspected osteoporosis due
to disease, prolonged bed rest, age, or
prolonged use of steroids.
• Protect newly united fractures.
• Avoid stretching edematous tissue.
• Avoid overstretching weak muscles.
• Progress the dosage (intensity,
duration, and frequency) of stretching
interventions gradually to minimize soft
tissue trauma and post exercise
muscle soreness
8. Common Errors and
Potential Problems
• Nonselective or poorly balanced
stretching activities.
• Insufficient warm-up.
• Ineffective stabilization.
• Use of ballistic stretching.
• Excessive intensity.
• Abnormal biomechanics: “hurdler’s”
stretch.
9. Adjuncts to Stretching
Interventions
1.Relaxation Training.
Common Elements of Relaxation Training:
• Relaxation training involves a reduction in
muscle tension in the entire body or the
region that is painful or restricted by using
conscious effort and thought.
• Training occurs in a quiet environment
with low lighting and soothing music or an
auditory cue on which the patient may
focus.
• The patient performs deep breathing
exercises or visualizes a peaceful scene.
• When giving instructions, the therapist
uses a soft tone of voice.
10. Examples of Approaches to
Relaxation Training
• Autogenic training.
• Progressive relaxation.
• Awareness through
movement.
11. 2.Pilates
• Components of a Pilates
exercise session typically
include deep breathing and
core stabilization exercises,
focus on activation and
relaxation of specific muscle
groups, posture control and
awareness training, strength
training (primarily using body
weight as resistance), balance
exercises, and flexibility
exercises.
12.
13. 3.Heat
• Methods of Warm-Up
• Superficial heat (hot packs, paraffin) or
deep-heating modalities (ultrasound,
shortwave diathermy) provide different
mechanisms to heat tissues.
• These thermal agents are used primarily to
heat small areas such as individual joints,
muscle groups, or tendons and may be
applied prior to or during the stretching
procedure.
• Low-intensity, active exercises, which
generally increase circulation and core
body temperature, also have been used as
a mechanism to warm up large muscle
groups.
14. • Some common warm-up
exercises are a brief walk, non
fatiguing cycling on a stationary
bicycle, use of a stair-stepping
machine, active heel raises, or
a few minutes of active arm
exercises.
15. 4.Cold
• Cooling soft tissues in a
lengthened position after
stretching has been shown to
promote more lasting increases
in soft tissue length and
minimize post stretch muscle
soreness.
19. 7.Joint Traction or
Oscillation
• Slight manual distraction of joint
surfaces prior to or in
conjunction with joint
mobilization/manipulation
techniques or stretching a
muscle-tendon unit can be used
to inhibit joint pain and spasm
of muscles around a joint.
20.
21. Activity no.1
• Identify a recreational/sport
activity that your partner
enjoys (i.e., tennis, golf,
cycling, jogging, etc.) and
design and demonstrate a
program of self-stretching
exercises to prepare your
partner for the activity and
reduce the risk of injury.
22. Activity no.2
• Design an effective and
efficient series of self-
stretching exercises that a
person who works at a desk
most of the day could
incorporate into a daily
home fitness routine.
• Demonstrate and teach
each self-stretching
exercise to your laboratory
partner.
