DETERMINANTS OF STRETCHINGINTERVENTIONS

Dr. Marina khan (PT)DPT (IPM&R , KMU)

Lecturer/physiotherapist RMI-CRS

There are a number of essential elements that determine the effectiveness of stretching interventions.

It include:

Alignment Stabilization Intensity of stretch Duration of stretch Speed of stretch Frequency of stretch Mode of stretch

Determinants of Stretching Interventions

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.

Alignment influences the amount of tension present in soft tissue and consequently affects the ROM available in joints.

Alignment

To stretch the rectus

femoris 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.

For example

To achieve an effective stretch of a specific muscle or muscle group it is necessary to stabilize (fixate) either the proximal or distal attachment site of the muscle-tendon.

It is common for a therapist to stabilize the proximal attachment and move the distal segment.

Stabilization

During self-stretching, it is often the distal attachment that is stabilized as the proximal segment moves.

For self-stretching procedures, a stationary object, such as a chair or a doorframe, or active muscle contractions by the patient may provide stabilization.

Stabilization in self-stretching

The intensity (magnitude) of a stretch force is determined by the load placed on soft tissue to elongate it.

Low-intensity stretching in comparison to high-intensity stretching makes the stretching maneuver more comfortable for the patient and minimizes voluntary or involuntary muscle guarding so a patient can either remain relaxed or assist with the stretching maneuver.

Intensity of Stretch

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.

The shorter the duration of a single stretch cycle, the greater the number of repetitions applied during a stretching session.

Duration of Stretch

The speed of stretch should be slow to ensure optimal muscle relaxation and prevent injury to tissues.

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

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:• Underlying cause of impaired mobility• Quality and level of healing of tissues• Chronicity and severity of a contracture• patient’s age• Use of corticosteroids• previous response to stretching

Frequency on a weekly basis ranges from 2 to 5 sessions, allowing time for rest between sessions for tissue healing and to minimize postexercise soreness.

Frequency of Stretch

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.

Mode of Stretch

Types of Stretching

Static stretching Cyclic/intermittent stretching Ballistic stretching Proprioceptive neuromuscular facilitation stretching

procedures (PNF stretching) Manual stretching Mechanical stretching Selective Stretching Self-stretching Passive stretching Active stretching

Types of Stretching

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 the lengthened position with a sustained stretch force over a period of time.

Other terms used interchangeably are sustained or prolonged stretching.

The duration of static stretch is predetermined prior to stretching or is based on the patient’s tolerance and response during the stretching procedure.

Static stretching

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 is applied for multiple repetitions 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.

Cyclic/intermittent 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.

Ballistic stretching has been shown to increase ROM safely in young, healthy subjects BUT not recommended for elderly or sedentary individuals or patients with musculoskeletal pathology or chronic contractures.

Ballistic 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.

The therapist manually controls the site of stabilization as well as the direction, speed, intensity, and duration of stretch.

It is 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

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.

It is the responsibility of a therapist to recommend the type of stretching device that is most suitable for patient. A therapist may also be involved in the fabrication of serial casts or splints.

Mechanical stretching

Mechanical stretching devices apply a very low intensity stretch force (low load) over a prolonged period of time to create relatively permanent lengthening of soft tissues.

Selective stretching is a process whereby the overall function of a patient may be improved by applying stretching techniques selectively to some muscles and joints but allowing limitation of motion to develop in other muscles or joints.

the therapist must always keep in mind the functional needs of the patient to determine which muscles to stretch and which to allow to become slightly shortened.

Selective Stretching

In a patient with spinal cord injury, stability of the trunk is necessary for independence in sitting.

With thoracic and cervical lesions, the patient does not have active control of the back extensors.

Hamstrings are routinely stretched to improve or maintain their extensibility and moderate hypomobility is allowed to develop in the extensors of the low back, this enables a patient to lean into the slightly shortened structures and have some trunk stability for long-term sitting.

FOR EXAMPLE

Self-stretching is a type of stretching procedure a patient carries out independently after careful instruction and supervised practice.

Self-stretching enables a patient to maintain or increase the ROM gained as the result of direct intervention by a therapist.

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.

Self-stretching

This form of

stretching is very similar to static stretching; however therapist assistance or devices are used to help further stretch the muscles.

Passive stretching

An active stretch is

one where patient assume a position and then hold it there with no assistance other than using the strength of muscles.

Active stretching

THE END …. !!!!

What are Determinants of Stretching Interventions? Give an example of correct and incorrect alignment

during stretching procedure. How stabilization is done in self stretching

procedures? What is intensity of stretch? Why low intensity stretch is important in stretching

procedures? What is frequency of stretch? The recommended frequency of stretching is often

based on? What is mode of stretch?

What are type of stretching? What is ballistic stretching? At what velocity and intensity ballistic stretch should be

applied? Ballistic stretching not recommended for? What is cyclic stretch? At what velocity and intensity cyclic stretch should be applied? What is static stretch? In mechanical stretching what types of equipments are used for

stretching?