Types: Static,cycling,ballistic, PNF stretching,manual, mechanical,self ,active and passive stretching

1. Nootan Physiotherapy College,
Visnagar.
Prepared By:
Dr. Nidhi Vedawala

3.  Alignment: positioning a limb or the body such that the stretch force is
directed to the appropriate muscle group
 Stabilization: fixation of one site of attachment of the muscle as the
stretch force is applied to the other bony attachment
 Intensity of stretch: magnitude of the stretch force applied
 Duration of stretch: length of time the stretch force is applied during a
stretch cycle
 Speed of stretch: speed of initial application of the stretch force
 Frequency of stretch: number of stretching sessions per day or per week
 Mode of stretch: form or manner in which the stretch force is applied
(static, ballistic, cyclic); degree of patient participation (passive, assisted,
active); or the source of the stretch force (manual, mechanical, self)
Determinants of Stretching Interventions

4.  Static stretching
 Cyclic/intermittent stretching
 Ballistic stretching
 Proprioceptive neuromuscular facilitation stretching procedures (PNF
stretching)
 Manual stretching
 Mechanical stretching
 Self-stretching
 Passive stretching
 Active stretching
Types of Stretching

7. Alignment and Stabilization
Alignment:-
 Proper alignment or positioning of the patient and the specific muscles and
joints to be stretched is necessary for patient comfort and stability during
stretching.
 E.g.- to stretch the rectus femoris (a muscle that crosses two joints)
effectively, as the knee is flexed and the hip extended, the lumbar spine
and pelvis should be aligned in a neutral position. The pelvis should not
tilt anteriorly nor should the low back hyperextend; the hip should not
abduct or remain flexed.
 When a patient is self-stretching to increase shoulder flexion, the trunk
should be erect, not slumped
Determinants, Types, And Effects Of Stretching
Interventions

10. Stabilization:-
 To achieve an effective stretch of a specific muscle or muscle group and
associated periarticular structures, it is imperative to stabilize (fixate)
either the proximal or distal attachment site of the muscle-tendon unit
being elongated.
 For manual stretching it is common for a therapist to stabilize the
proximal attachment and move the distal segment.
 During self-stretching, it is often the distal attachment that is stabilized
as the proximal segment moves.
 Sources of stabilization include manual contacts, body weight, or a firm
surface such as a table, wall, or floor.
Determinants, Types, And Effects Of Stretching
Interventions (Conti…)

13. Intensity of Stretch

14.  The intensity (magnitude) of a stretch force is determined by the load
placed on soft tissue to elongate it.
 Stretching should be applied at a low intensity by means of a low load.
Low-intensity stretching in comparison to high-intensity stretching makes
the stretching maneuver more comfortable for the patient .
 Low-intensity stretching has also been shown to elongate dense
connective tissue, a significant component of chronic contractures, more
effectively and with less soft tissue damage and post-exercise soreness
than a high-intensity stretch.
Intensity of Stretch

15. Duration of Stretch

16.  The duration of stretch refers to the period of time a stretch force is
applied and shortened tissues are held in a lengthened position.
 Duration most often refers to how long a single cycle of stretch is applied.
If more than one repetition of stretch (stretch cycle)is carried out during a
treatment session, the cumulative time of all the stretch cycles is also
considered an aspect of duration.
 The shorter the duration of a single stretch cycle, the greater the
number of repetitions applied during a stretching session.
 Example : Two repetitions of 30 second hamstring stretches were found to
be equally effective compared to six repetitions of 10 second stretches.
 Terms such as static, sustained, maintained and prolonged are all used to
describe a long duration stretch, whereas terms such as cyclic,
intermittent or ballistic are used to short duration stretch.
Duration of Stretch

17.  Static stretching is a commonly used method of stretching in which soft
tissues are elongated just past the point of tissue resistance and then held
in a lengthened position with a sustained stretch force over a period of
time.
 It also known as sustained, maintained or prolonged stretching.
 In research studies the term “static stretching” has been linked to durations
of a single stretch cycle ranging from as few as 5 seconds to 5 minutes
per repetition when either a manual stretch or self-stretching procedure is
employed.
 If a mechanical device provides the static stretch, the time frame can
range from almost an hour to several days or weeks
Static Stretching

18.  Static progressive stretching is another term that describes how static
stretch is applied for maximum effectiveness.
 The shortened soft tissues are held in a comfortably lengthened position
until a degree of relaxation is felt by the patient or therapist. Then the
shortened tissues are incrementally lengthened even further and again
held in the new end-range position for an additional duration of time.
This approach involves continuous displacement of a limb by varying the
stretch force (stretch load).
 Most studies that have explored the merits of static progressive stretching
have examined the effectiveness of a dynamic orthosis, which allows the
patient to control the degree of displacement of the limb.
Static Progressive Stretching

19.  A relatively short-duration stretch force that is repeatedly but
gradually applied, released, and then reapplied is described as a cyclic
(intermittent) stretch. Cyclic stretching, by its very nature, is applied for
multiple repetitions (stretch cycles) during a single treatment session.
 With cyclic stretching the end-range stretch force is applied at a slow
velocity, in a controlled manner, and at relatively low intensity. For these
reasons, cyclic stretching is not synonymous with ballistic stretching,
which is characterized by high-velocity movement.
 According to some authors, for cyclic stretching each cycle of stretch is
held between 5 and 10 seconds. However, investigators in other studies
refer to stretching that involves 5- and 10- second stretch cycles as static
stretching.
 End-range cyclic stretching is as effective and more comfortable
for a patient than a static stretch .
Cyclic (Intermittent) Stretching

20. Speed of Stretch

21. Importance of a Slowly Applied Stretch
 To ensure optimal muscle relaxation and prevent injury to tissues, the
speed of stretch should be slow.
 The stretch force should be applied and released gradually. A slowly
applied stretch is less likely to increase tensile stresses on connective
tissues or to activate the stretch reflex and increase tension in the
contractile structures of the muscle being stretched.
 Remember, the Ia fibers of the muscle spindle are sensitive to the velocity
of muscle lengthening. A stretch force applied at a low velocity is also
easier for the therapist or patient to control and is therefore safer than a
high-velocity stretch.
Speed of Stretch

22. Ballistic Stretching
 A rapid, forceful intermittent stretch that is, a high-speed and high-
intensity stretch is commonly called ballistic stretching.
 It is characterized by the use of quick, bouncing movements that create
momentum to carry the body segment through the ROM to stretch
shortened structures.
 Although both static stretching and ballistic stretching have been shown
to improve flexibility equally, ballistic stretching is thought to cause
greater trauma to stretched tissues and greater residual muscle soreness
than static stretching.
Speed of Stretch (conti…)

23. High-Velocity Stretching in Conditioning Programs and Advanced-Phase
Rehabilitation
 There are situations when high-velocity stretching is appropriate for carefully
selected individuals. For example, a highly trained athlete involved in a sport such
as gymnastics that requires significant dynamic flexibility may need to
incorporate high-velocity stretching in a conditioning program.
 Also, a young, active patient in the final phase of rehabilitation who wishes to
return to high-demand, recreational activities after a musculoskeletal injury may
need to perform carefully progressed, high velocity stretching activities prior to
beginning plyometric training or simulated, sport-specific exercises or drills.
 The following self-stretching sequence, referred to as a Progressive Velocity
Flexibility Program, has been suggested for a safe transition and progression from
static stretching to ballistic stretching to improve dynamic flexibility.
 Static stretching → Slow, short end-range stretching → Slow, full-range
stretching → Fast, short end-range stretching → Fast, full-range stretching.
Speed of Stretch (conti…)

24. Frequency of Stretch

25.  Frequency of stretching refers to the number of bouts (sessions) per day
or per week a patient carries out a stretching regimen.
 The recommended frequency of stretching is often based on the
underlying cause of impaired mobility, the quality and level of healing of
tissues, the chronicity and severity of a contracture, as well as a patient’s
age, use of corticosteroids, and previous response to stretching.
 Frequency on a weekly basis ranges from two to five sessions, allowing
time for rest between sessions for tissue healing and to minimize post
exercise soreness. Ultimately, the decision is based on the clinical
discretion of the therapist and the response and needs of the patient.
Frequency of Stretch

26.  The mode of stretch refers to the form of stretch or the manner in which
stretching exercises are carried out. Mode of stretch can be defined by
who or what is applying the stretch force or whether the patient is actively
participating in the stretching maneuver.
 Categories include but are not limited to manual and mechanical
stretching or self stretching as well as passive, assisted, or active
stretching.
 Some questions a therapist needs to answer to determine which forms of
stretching are most appropriate and most effective for each patient at
different stages of a rehabilitation program.
Mode of Stretch

27. Considerations for Selecting Methods of Stretching
 Based on the results of your examination, what tissues are involved and impairing
mobility?
 Is there evidence of pain or inflammation?
 How long has the hypo-mobility existed?
 What is the stage of healing of restricted tissues?
 What form(s) of stretching have been implemented previously? How did the
patient respond?
 Are there any underlying diseases, disorders, or deformities that might affect the
choice of stretching procedures?
 Does the patient have the ability to actively participate in, assist with, or
independently perform the exercises? Consider the patient’s physical capabilities,
age, ability to cooperate, or ability to follow and remember instructions.
 Is assistance from a therapist or caregiver necessary to execute the stretching
procedures and appropriate stabilization? If so, what is the size and strength of the
therapist or the caregiver who is assisting the patient with a stretching program?

28. Manual Stretching
 During manual stretching a therapist or other trained practitioner or
caregiver applies an external force to move the involved body segment
slightly beyond the point of tissue resistance and available ROM.
 Manual stretching usually employs a controlled, end range, static,
progressive stretch applied at an intensity consistent with the patient’s
comfort level, held for 15 to 60 seconds and repeated for at least
several repetitions.
 Manual stretching may be most appropriate in the early stages of a
stretching program when a therapist wants to determine how a patient
responds to varying intensities or durations of stretch and when optimal
stabilization is most critical.
 Manual stretching performed passively is an appropriate choice for a
therapist or caregiver if a patient cannot perform self-stretching owing
to a lack of neuromuscular control of the body segment to be stretched.
Mode of Stretch (conti…)

29. Self-Stretching
 Self-stretching (also referred to as flexibility exercises or active
stretching) is a type of stretching procedure a patient carries out
independently after careful instruction and supervised practice.
 This form of stretching is often an integral component of a home
exercise program and is necessary for long-term self-management of
many musculoskeletal and neuromuscular disorders.
 Static stretching with a 30- to 60-second duration per repetition is
considered the safest type of stretching for a self-stretching program.
Mode of Stretch (conti…)

32. Mechanical Stretching
 There are many ways to use equipment to stretch shortened tissues and
increase ROM. The equipment can be as simple as a cuff weight or
weight-pulley system or as sophisticated as some adjustable orthoses or
automated stretching machines.
 Mechanical stretching devices apply a very low intensity stretch force
(low load) over a prolonged period of time.
 An effective stretch load applied with a cuff weight can be as low as a
few pounds.
 Some devices, such as the Joint Active System adjustable orthosis,
allow a patient to control and adjust the load (stretch force) during a
stretching session.
 With other devices the load is pre-set prior to the application of the splint,
and the load remains constant while the splint is in place.
Mode of Stretch (conti…)

33. Duration of Mechanical Stretch
 Mechanical stretching involves a substantially longer overall duration of
stretch than is practical with manual stretching or self-stretching exercises.
 The duration of mechanical stretch reported in the literature ranges from
15 to 30 minutes to as long as 8 to 10 hours at a time or continuous
throughout the day except for time out of the device for hygiene and
exercise.
 Serial casts are worn for days or weeks at a time before being removed
and then reapplied..
Mode of Stretch (conti…)