An overview of facilitatedstretching. . . . . . . . . . . . . . . .

Robert E. McAtee

This article offers a brief look at facilitated stretching, an active-assisted form of

stretching based on proprioceptive neuromuscular facilitation. It describes the

method, the rationale for its development and use, and gives detailed instructions for

performing several stretches, both with a facilitator and alone. r 2001 Harcourt

Publishers Ltd

Introduction

Flexibility and coordination make iteasier to accomplish any task thatrequires the use of muscles. They aremajor components of optimumathletic performance and also playan important role in our daily lives.Flexibility and coordination arecritical to preventing injuries,whether on the playing field, in thewarehouse, or in front of thecomputer. Overuse injuries, orrepetitive stress injuries, occur inpart because of soft tissuerestrictions that limit flexibility(Cash 1996, Benjamin & Lamp1996).Over the past 20 years,

proprioceptive neuromuscularfacilitation (PNF) stretching hasgained popularity, especially in theathletic and therapeutic communityand increasingly with the generalpublic. PNF stretching uses anisometric contraction prior to thestretch to achieve greater gains thanare typically achieved from staticstretching alone. PNF stretching isgenerally done passively; that is, afacilitator administers the stretch tothe stretcher.

Facilitated stretching is based onPNF principles and techniques butis an active form of stretching, inwhich the stretcher does most or allof the work. When a facilitator isinvolved, the facilitator’s job is tomonitor and direct the stretcher’sactivity. Facilitated stretching is alsoknown as CRAC stretching, anacronym for contract-relax, agonist-contract (The muscle that moves thebody segment in the desireddirection is the agonist, the musclebeing stretched is the antagonist).

Facilitated stretchingsequence: simpli¢edversion

Facilitated stretching is active-assisted stretching, which uses activemotion and isometric work toimprove flexibility and enhancemotor learning in the process.Simplified, the steps involved infacilitated stretching are:

1. Actively lengthen the targetmuscle to its end-range,

2. Isometrically contract the targetmuscle, and

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Journal of Bodywork and Movement Therapies (2002)

6(1), 000^000r 2002 Harcourt Publishers Ltd

doi: 10.1054/jbmt.2000.0225, available online at

http://www.idealibrary.com on

Robert E. McAtee NCTMB,CSCS

Pro-Active Massage Therapy, 1119 N. Wahsatch

Ave., Suite 1, Colorado Springs, CO 80903, USA

Correspondence to: R.E. McAtee

Tel/fax: +1 719 475 1172;

E-mail: stretchman@stretchman.com

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3. Actively lengthen the targetmuscle again to a new range ofmotion.

Rationale for use

The developers of PNF therapybased some of their work onactivating several physiologicalmechanisms in the body (Voss et al.1985). For facilitated stretching,interest lies in two of them:reciprocal innervation and theinverse stretch reflex. Research intowhether these mechanisms areactually responsible for the effectsattributed to them in PNF hasproduced mixed results (Sapega etal. 1981, Taylor et al. 1990, Moore& Hutton 1980, Condon & Hutton1987, Cornelius 1983, Osternig et al.1987, 1990).Reciprocal innervation (reciprocal

inhibition) is a reflex loop betweenopposing muscles (Alter 1996, Adleret al. 1993). When one musclecontracts, reciprocal innervationsimultaneously inhibits the opposingmuscle on the other side of the joint.This allows movement to occuraround the joint. For instance, whenthe quadriceps muscle contracts, thehamstring is reciprocally inhibited,thereby allowing the knee tostraighten.In facilitated stretching, the

stretcher uses active motion tostimulate the reciprocal innervationresponse thereby maximizing thelengthening of the target muscle.The inverse stretch reflex (also

called autogenic inhibition) causes amuscle under tension, either from astrong stretch or a strongcontraction, to suddenly give way.This reflex was originally thought tobe mediated by the Golgi tendonorgans (GTOs), which are located inthe musculotendinous junction andthe tendon. The developers of PNFused maximal isometric contractionsbased on their belief that doing sowould stimulate the GTOs to fire the

inverse stretch reflex. Altersummarizes a plethora ofsubsequent research on theneurophysiology of PNF. Regardingautogenic inhibition, he says, ‘It[autogenic inhibition] is nowbelieved to be the result of afferentinput from Group II nerve fiberscoming from the muscle spindlesand perhaps from thinly myelinatedfibers subserving pain sensationfrom the joints’ (Alter 1996).It is known that one of the

functions of the GTOs is to monitorthe load on the tendon. GTOs aremore sensitive to tendon loadingfrom muscular contraction thanfrom passive stretch, they have a lowstimulation threshold and have adynamic sensitivity that allows themto report small changes in musclecontractile forces (Alter 1996).These factors may help explain thephenomenon of post isometricrelaxation (PIR).

Post isometric relaxation

PIR is another way of describingwhat results from an isometriccontraction. Chaitow, in his text onmuscle energy techniques, describesPIR as follows: ‘Following on froman isometric contraction . . . there isa refractory, or latency, period ofapproximately 15 seconds duringwhich there can be an easier (due toreduced tone) movement towardsthe new position (new resistancebarrier) of a joint or muscle’(Chaitow 1996). In muscle energywork, the patient may be asked touse as little as 10% of his maximumstrength during the isometriccontraction, yet the relaxation effectis still achieved.So, although the developers of

PNF based their work onstimulating the inverse stretch reflexthrough a maximal contraction ofthe target muscles, the resultsobtained in facilitated stretching,which uses less than maximal effortin the isometric phase, may be the

result of PIR, or some othermechanism, or combination ofeffects not yet understood. Furtherresearch in this area would shedwelcome light.

Lewit and PIR technique

Besides being the name of thephysiological result of an isometriccontraction, PIR is also the namegiven to a technique introduced byKarel Lewit for the treatment ofmyofascial pain. The protocol issimilar to facilitated stretching, butthe goal of Lewit’s PIR technique isnormalizing the tone of hypertonicmuscles, not stretching. In Lewit’stechnique, the hypertonic muscle ispassively lengthened to its resistancebarrier, then isometricallycontracted, using only 10–20% of itsstrength, for 5–10 seconds. After thecontraction, the patient completelyrelaxes and the practitioner movesthe limb to the new resistancebarrier, taking up any slack nowavailable, but not stretching themuscle tissue. This process isrepeated several times (Lewit &Simons 1984, Chaitow 1996).

Facilitated stretchingsequence: detailed version

(Editor’s note : the descriptions in the

remainder of the article are written in

instructional style in which second

and third person narrative is used)

As mentioned earlier, facilitatedstretching is frequently done with afacilitator, although many of thestretches can be done alone, assistedby accessories. The detailed stepsinvolved in a facilitator-assistedfacilitated stretch are as follows:

1. The stretcher actively lengthensthe muscle to be stretched (thetarget muscle) to its maximalpain-free end range. This is alsocalled the soft tissue barrier orrestriction barrier (Chaitow

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1996). This active movementincorporates reciprocalinhibition.For example, if you wish tostretch the hamstring, have thestretcher lie on his back andcontract his quadriceps and psoas(hip flexors) to actively lift the legas high as possible, keeping theknee straight. You may need tohold the knee straight as thestretcher lifts his leg. Thisstretches the hamstrings to theirend range. As the hip flexorscontract to lift the leg, thehamstrings are reciprocallyinhibited.

2. As the facilitator, you thenposition yourself to offerresistance for the stretcher toisometrically contract the targetmuscle against. For stretching thehamstring, support the lower legagainst your shoulder or byholding it with both hands.

3. Direct the stretcher to beginslowly and ‘push’ or ‘pull’ toisometrically contract the targetmuscle as you provide matchingresistance. You want thestretcher to work, but not with somuch effort that he overpowersyou. When the stretcher hasachieved the proper level ofisometric contraction, hold it for6 to 10 seconds. The stretcher

breathes normally throughout.This isometric contractioncauses post isometricrelaxation.

4. The stretcher then relaxes theisometric contraction and inhalesdeeply. During this time,maintain the limb in the startingposition.

5. On the exhale, the stretchercontracts the opposingmuscleFin this case the quadsand psoas and pulls the targetmuscle into a deeper stretch, onceagain using reciprocal inhibitionto enhance the stretch. As thefacilitator, don’t push or pull todeepen the stretch. (Facilitatedstretching is an active techniquewhenever possible. If thefacilitator aids in the stretch, itbecomes a passive stretch, andthe stretcher loses theopportunity to improve hismuscular coordination andactivation through activemovement. There is also theadded risk of injury inherentwhen a facilitator is passivelymoving the limb to a new rangeof motion.)

6. Now the facilitator moves intothe new position to once againoffer resistance.

7. Repeat the process two to threetimes.

Facilitated stretches should always bepain free. If the stretcher experiencespain or discomfort, try repositioningthe limb or use less force during theisometric contraction of the targetmuscle. If pain persists, don’t stretchthat particular muscle until you’vedetermined why it’s causing pain.You can use this sequence to

construct a stretch for any muscleyou would like to stretch that cancontract isometrically.

Use of language

In general, your instruction to thestretcher will be to either ‘push’ or‘pull’ during the isometric phase.This communicates more clearlywhat you wish to have happen. Ifyou ask the stretcher to ‘resist’, youare communicating that you will bedoing something to her that sheneeds to act against. In fact, youwant her to contract the muscle, theforce of which you, as the facilitator,will resist. This also helps toencourage the stretcher to take anactive, rather than passive, role inthe process.

Breathing

Muscles need oxygen to work. Evenso, many of us are in the habit ofholding our breath during strongmuscular effort. During facilitatedstretching, it’s important to breathe,especially because we are not askingfor maximal effort on the part of thestretcher during any part of thesequence. Another reason fornormal breathing is that holding thebreath during the isometric phase isoften accompanied bycompensatory recruitment of othermuscles. And third, there is somerisk that holding the breath duringmuscular contraction may raise theblood pressure due to the Valsalvamaneuver (Cornelius 1983,Cornelius et al. 1995).It is easy to monitor the

stretcher’s breathing (and your own)

Fig. 1 Starting position of the hamstringsstretch (right leg). Support the stretcher’s leg

using excellent biomechanics.

Fig. 2 The stretcher actively deepens thestretch.

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Overview of facilitated stretching

throughout the process. Two cyclesof normal breathing (in and out)takes about 10 seconds, which isabout the length of time we want forthe isometric contraction.

Safety issues

Stretching safely is of utmostconcern for both the stretcher andthe facilitator. Body mechanics areextremely important during allphases of stretching, but especiallyduring the isometric phase. Plancarefully and communicate freelywith each other. The facilitatorproviding the resistance may beexpending unnecessary energy(because of poor ergonomics), or thestretcher may be working too hard.Not only can you become acutelyinjured by using these techniquescarelessly, but you can developoveruse syndromes unnecessarily.As with any flexibility training

program, facilitated stretchingshould only be undertaken aftercarefully considering whether anycontraindications to stretching arepresent. These would include, butare not limited to, recent injuryaccompanied by swelling and/orinflammation, recent surgery to thearea to be stretched, jointhypermobility that would beaggravated by stretching, and painduring any phase of the stretch.

Importance of positioning

To achieve the most benefit fromstretching, our goal is to position thestretcher to isolate the target muscleas much as possible. This isolationensures that the target muscle is theprimary one contracting during theisometric phase and being stretchedduring the lengthening phase.Although it is impossible tocompletely isolate and activate onlyone muscle, careless positioningallows inappropriate, compensatorymuscle recruitment and interferes

with achieving optimum resultsfrom facilitated stretching.For instance, when doing a

hamstrings stretch, it is common forthe stretcher to lift the ipsilateral hipoff the table during the isometriccontraction of the hamstrings. Thisunconscious shift engages thegluteus maximus more and is usuallybecause the hamstrings are weak.Directing the stretcher to keep thehip in contact with the treatmenttable will ensure that the hamstringsare more fully engaged during theisometric phase and more able tostretch in the lengthening phase.

Reducing fatigue

Because facilitated stretching is anactive form of work, it can befatiguing for both the stretcher andthe facilitator. Reducing fatigue canreduce the chance of injury.For the stretcher, it is important

to remember that maximal effort isnot necessary. We need only amoderate contraction of the targetmuscle during the isometric phase.This can be especially important forstretchers who don’t participate in aregular exercise program becausethey may experience delayed onsetmuscle soreness the day after astretching session if they work toohard.For you, the facilitator, reducing

fatigue becomes an issue if you areworking with several peoplethroughout the day. Injuries aremore likely if you are fatigued. Oneof the benefits of facilitatedstretching is that the stretcher doesmost of the work. As the facilitator,your main task is to assist thestretcher, not do the work for him.The stretcher moves the limb intoposition; you don’t have to lift it orsupport it for him except for briefperiods during the sequence. Relaxwhenever possible during the sessionand expend only the effortnecessary.

If you are using good bodymechanics, you will usually have amechanical advantage whenresisting the isometric contraction ofthe stretcher. This leverage allowsyou to accomplish your work withminimal physical effort.

Passive stretching

When using facilitated stretching,we normally ask the stretcher toactively stretch the target muscle bycontracting the opposing muscle. Incertain muscles, it is moreproductive and safer to stretch thetarget muscle passively. Forinstance, due to active insufficiency(Lowe 1996) and the fleshy mass ofthe calf, the hamstrings are usuallyunable to contract fully enough toadequately stretch the quadriceps.When the hamstrings are fullyshortened actively, further attemptsto contract the muscles usually leadto painful cramping. In thissituation, the protocol is modified sothe facilitator passively stretches thequadriceps by flexing the knee.Similarly, in some stretchers, thepectoralis major is so hypertrophiedthat active horizontal adduction ofthe humerus is limited. Thislimitation prevents the activelengthening of the rhomboids andmiddle trapezius, so passivestretching of these muscles becomesnecessary.

Single plane facilitatedstretches

Here are a few examples of singleplane stretches:

Iliopsoas stretch-prone, witha facilitator

This stretch is used to improve hipextension.

1. The stretcher lies prone. If thestretcher has any low backdiscomfort in this position, place

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a pillow under his hips to takesome of the stress off the lowback. Or you may want thestretcher to contract hisabdominal muscles to stabilizeand flatten his low back toeliminate low back discomfort.

2. The stretcher uses his hipextensors (gluteals andhamstrings) to lift his leg off thetable as high as possible, with theknee bent. This lengthens theiliopsoas to its end of range. Thestretcher must keep his hips flaton the table (or on the pillow)throughout this stretch. Therewill be a strong tendency for himto lift his hip as he lifts his leg.You may need to work with thestretcher on body awareness untilhe is able to stabilize his hipsproperly before performing thisstretch.

3. Support the leg just above theknee to provide resistance to theisometric contraction of theiliopsoas. Use your hand or yourleg to support the stretcher.

4. Direct the stretcher to beginslowly to try to pull his thigh

toward the table, isometricallycontracting the iliopsoas. He isnot trying to straighten his lowerleg. During the isometriccontraction of the psoas, makesure the gluteal muscles relax. Itis very common for the stretcherto keep the gluteal musclescontracted while simultaneouslytrying to engage the psoas.

5. After the isometric push, thestretcher relaxes and inhalesdeeply. During this time,maintain the leg in the startingposition.

6. On the exhale, the stretchercontracts the hip extensors to lifthis thigh higher, deepening thepsoas stretch. Be sure thestretcher keeps his hips flat on thetable. (This helps preventhyperextension in the lumbarspine and enhances the stretchingof the iliopsoas. You can alsodirect the stretcher to performand hold a pelvic tilt, using theabdominal muscles, to maintainthe lumbars in a neutral position.Whenever possible, have thestretcher self-stabilize, ratherthan you doing it for himpassively. In this way, thestretcher can carryover into dailyactivities what he learns on thetreatment table.)

7. Repeat two to three times.8. If you use your leg to provideresistance, move it closer to thehip with each round of stretching.

Iliopsoas self-stretch

Because the stretcher is weight-bearing, this standing stretchincorporates passive movement tomake it less awkward to stretch theiliopsoas.

1. Stand in a lunge position, withyour left leg forward and right legback, keeping your torso uprightand your low back flat.

2. Keeping your right foot flat onthe floor, push forward with your

right hip to lengthen the rightiliopsoas. Allow your left knee tobend as you push forward. Youshould feel the stretch high on thefront of the right thigh.

3. Isometrically contract the rightiliopsoas by attempting to pullyour right leg forward butkeeping the foot anchored on thefloor. Be sure your glutealmuscles are relaxed! Maintain theisometric contraction for 6 to 10seconds, then relax.

4. You can now stretch the iliopsoasby pushing the right hip forwardagain, being sure to maintain anupright posture with your lowback flat.

Pectoralis major stretch-prone,with a facilitator

Stretching the pectoralis major canimprove range of motion inhorizontal abduction, flexion,extension, and external rotation ofthe humerus, depending on which

Fig. 3 Initiation of the left iliopsoas stretch.Be sure the stretcher relaxes his gluteals when

isometrically contracting the iliopsoas.

Fig. 4 You may use your leg to provideresistance to the stretcher’s isometric

contraction, as long as it doesn’t cause the

stretcher’s ASIS to lift off the table.

Overview of facilitated stretching

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fibers of the muscle are emphasizedduring the stretch.

1. The stretcher is prone, with hisface resting in the face cradle, orhis head turned to one side if noface cradle is available. His rightarm is abducted to 90 degreesand externally rotated, with theelbow bent to 90 degrees. Hisupper arm rests on the table.Stand at the right side of the tableand ask the stretcher to lift hisright arm toward the ceiling(horizontal abduction of thehumerus) as high as possible,keeping the forearm horizontal.As he lifts, make sure he does notlift his sternum off the table,which would indicate that he isrotating his trunk. This startingposition lengthens the rightpectoralis major to its pain-freeend range.

By changing the angle of abductionof the arm, you can emphasizedifferent fibers of the pectoralismajor. Less abduction (45 degrees)focuses on the clavicular head; more

abduction (135 degrees) focusesmore on the lower fibers of thesterno-costal head.

2. Support the stretcher’s right armfrom the elbow to the hand usingyour right forearm and hand.Ask the stretcher to begin slowlyto attempt to bring his arm downand across his chest, leading withthe elbow, isometricallycontracting the pectoralis major.

3. After the isometric push, thestretcher relaxes and breathes in.During this time, maintain thearm in the starting position.

4 On the exhale, ask the stretcher tolift his arm higher, keeping theforearm horizontal and hissternum to the table.

5. Repeat two to three times.

Pectoralis major self-stretch

Self-stretching of the pectoralis canbe done using a doorway (or anyother vertical column) to provide

resistance during the isometricphase.

1. Stand in a doorway and placeyour forearm against thedoorjamb. Be aware of yourposture, and use a wide front-to-back stance, keeping your backlengthened and not arched. Usingyour upper back muscles, pullyour arm backwards, away fromthe doorjamb as far as you can,then take a step or two forward,until your forearm is once againplaced against the doorjamb.This is your starting position.

2. Start slowly and push withmoderate effort against thedoorjamb, isometricallycontracting the pectoralis major.Your arm is not moving, justpushing. Breathe normally. Holdthe push for 6–10 seconds, thenrelax.

3. Take another breath and on theexhale, use your upper backmuscles to pull your armbackwards, away from the doorjamb, as far as you can. Thisfurther stretches the pec major.

4. Repeat two to three times.

Fig. 5 Iliopsoas self-stretch (right leg). Keepyour low back flat and focus on feeling the

stretch high on the front of your right thigh.

Fig. 6 Starting position for the pectoralismajor stretch (right). Be sure the stretcher

keeps his sternum in contact with the table.

During the isometric phase, the rhomboids and

middle traps should be relaxed.

Fig. 7 Pectoralis major self-stretch using adoorway. Keep your back lengthened, not

arched.

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Raise your arm higher or lower tostretch different parts of thepectoralis. Raising your arm higheragainst the doorjamb will emphasizethe pectoralis fibers that attach tothe sternum. Having your arm loweron the doorjamb will emphasize thefibers that attach to the collarbone.

Spiral diagonal patterns

Kabat, Knott and Voss noticed thatnormal movements found in sportsand physical activities are spiral-diagonal in nature. They definedthese ‘mass movement patterns’ as‘various combinations of motion . . .(that) require shortening andlengthening reactions of manymuscles in varying degrees’ (Voss etal. 1985). They developed PNFtechniques to mimic these naturalspiral-diagonal movements, as a wayto restore and increase strength,coordination, and flexibility throughentire ranges of motion. Theynamed the patterns Diagonal One(D1) and Diagonal Two (D2).

Using the patternsfor stretching

The full spiral-diagonal patterns usemovement through three planes ofmotion: extension or flexion,adduction or abduction, andexternal or internal rotation. Whena physical therapist uses these PNFpatterns with a patient, the goal is torestore or increase strength andcoordination, as well as to increaserange of motion.In facilitated stretching, our

primary goal is to increase range ofmotion. We stretch groups of relatedmuscles simultaneously when we usethese three-dimensional patterns,thereby gaining greater benefit in ashorter amount of time.

Working at the end of range

For stretching, we employ only thelengthened position of the pattern,

preventing the limb from goingthrough its range of motion. Thestretcher assumes the startingposition of the pattern (lengthenedrange), but her attempts to move thelimb through the pattern areisometric; that is, she pushes or pullsin all three planes of motion, but weallow no movement to occur. Thestretch to a new range of motionoccurs when the stretcher activelymoves farther into the lengtheningdirections of the pattern.

Stretching using diagonalpattern one

This stretch is for increasing rangeof motion in flexion, adduction, andexternal rotation of the lowerextremity.

1. The stretcher is supine, with hisright leg in as much flexion,adduction, and external rotationas possible. His foot is dorsiflexedand inverted, and the toes areextended. This is the startingposition for the D1 pattern andlengthens the target muscles totheir end range. These includehamstrings (especially bicepsfemoris), gluteals, TFL,gastrocnemius (especially lateralhead), soleus, and peroneals.

2. Support and stabilize the leg.Remember, your hand contactsgive the stretcher proprioceptivecues about which way to push orpull. Your hand positions shouldmatch your verbal commands.

3. Direct the stretcher to beginslowly to try to initiate the D1extension pattern, beginning withinternal rotation, then abduction,then extension. (‘Begin byrotating, then pull down andout.’) Be sure the stretcher keepsboth hips flat on the table.Passive rehearsal of the patternwith the stretcher makes it easierfor him to understand what todo. During the actual sequence,remember that you resist the

stretcher’s effort so no movementoccurs.

4. After the isometric push, thestretcher relaxes and inhalesdeeply. As he relaxes, maintainthe leg in the starting position.

5. On the exhale, the stretchermoves the hip farther intoflexion, adduction, and externalrotation. Remember, we want ablend of all three directions tokeep moving in a diagonal line.He increases dorsiflexion andinversion of the foot andextension of the toes. Support theleg but do not push to deepen thestretch.

6. Repeat two to three times.

Spiral patterns or singleplane stretches

PNF techniques were developed aspatterns of spiral movement toincrease strength, coordination, andflexibility through entire ranges ofmotion. Facilitated stretching isbased on PNF principles but focusesprimarily on increased flexibility.

Fig. 8 Starting position for a stretch usingthe flexion end of Diagonal Pattern One (D1).

The stretcher’s right leg is flexed, adducted

and externally rotated.

Overview of facilitated stretching

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When should you use patterns,and when should you use singleplane stretches? The spiral-diagonalpatterns are an excellent way toincrease the flexibility andcoordination of groups of musclesthat act together.We can also use the patterns as an

assessment tool to determine whichmuscles in a synergistic group arelimiting motion, exhibitingweakness, or not firing in the propersequence. Once these deficiencies areidentified, we can modify thepatterns to focus on improving themuscular function that is deficient(Adler et al. 1993).The single plane stretches are

more appropriate when we want todevelop flexibility or awareness in aspecific muscle or muscle group.Single plane stretches can also beused as an adjunct to soft tissuetherapy. For instance, you can usethese stretches for relaxinghypertonic muscles to reduce thediscomfort of deep massage ortrigger-point work or in conjunctionwith deep friction work to releaseadhesions within or betweenmuscles.

Stretching, some closingthoughts

Even though we all have ourfavorite styles of stretching, there isample evidence that all of themwork. I believe that flexibilitytraining needs to be based upon theactivity we wish to enhance.Therefore, stretching styles shouldbe chosen which will improve thestretcher’s functional capacity. Adistance runner has differentfunctional needs than a baseballplayer, who is different than aweight lifter. Pre-activity stretchingmay need to be different than post-activity stretching.

Frederick and Szymanski (2001),in an article about preparingbaseball players to play the game,cite a recent study that tested staticstretching vs. dynamic stretching(defined as the act of quickly movinga joint through its range of motionwith little resistance). The results ofthe study showed that ‘staticstretching produced a significantreduction in eccentric hamstringstrength for a time period lasting upto one hour poststretching’. Theirconclusion, based on this researchand other evidence, is that staticstretching should be used as part ofa post activity cool down, whiledynamic flexibility exercises shouldbe used as part of the warm upbefore playing.In my experience, facilitated

stretching is an efficient, painlessmethod for improving flexibilityquickly. It is ideally suited to thetreatment table, especially whencombined with other soft tissuework. It also translates well from thetable to the client’s home program.In the long run, the best stretchingmethod is the one the client will doconsistently, since it’s only throughconsistent practice that permanentchanges in flexibility can beaccomplished.

REFERENCES

Adler S, Beckers D, Buck M 1993 PNF in

Practice. Springer-Verlag, Berlin

Alter MJ 1996 Science of Flexibility, 2nd ed.

Human Kinetics, Champaign, IL

Benjamin PJ, Lamp SP 1996 Understanding

Sports Massage. Human Kinetics,

Champaign, IL

Burke DG, Culligan CJ, Holt LE,

MacKinnon NC 2000 Equipment

designed to simulate proprioceptive

neuromuscular facilitation flexibility

training. Journal of Strength and

Conditioning Research 14 (2): 135–139

Cash M 1996 Sport and Remedial Massage

Therapy. Ebury Press, London

Chaitow L 1996 Muscle Energy Techniques.

Churchill Livingstone, Edinburgh

Condon SM, Hutton RS 1987 Soleus muscle

electromyographic activity and ankle

dorsiflexion range of motion during four

stretching procedures. Physical Therapy

67: 24–30

Cornelius WL 1983 Stretch evoked EMG

activity by isometric contraction and

submaximal concentric contraction.

Athletic Training 18: 106–109

Cornelius WL, Jensen RL, Odell ME 1995

Effects of PNF stretching phases on acute

arterial blood pressure. Canadian

Journal of Applied Physiology 20:

222–229

Frederick GA, Szymanski DJ 2001 Baseball

(part I): dynamic flexibility. Strength and

Conditioning Journal 23: 21–30

Lewit K, Simons D 1984 Myofascial pain:

relief by postisometric relaxation.

Archives of Physical Medical

Rehabilitation 65: 452–456

Lowe WW 1996 Kinesiology corner: multi-

articulate muscles. Orthopedic and

Sports Massage Reviews 12: 7–8

Moore MA, Hutton RS 1980

Electromyographic investigation of

muscle stretching techniques. Medicine

and Science in Sports and Exercise 12:

322–329

Osternig LR, Robertson R, Troxel R, Hansen

P 1987 Muscle activation during

proprioceptive neuromuscular

facilitation (PNF) stretching techniques.

American Journal of Physical Medicine

66: 298–307

Osternig LR, Robertson RN, Troxel RK,

Hansen P 1990 Differential responses to

proprioceptive neuromuscular

facilitation (PNF) stretch techniques.

Medicine and Science in Sports and

Exercise 22: 106–111

Sapega AA, Quedenfeld TC, Moyer RA,

Butler RA 1981 Biophysical factors in

range-of-motion exercise. Physician and

Sports Medicine 9: 57–65

Taylor DC, Dalton JD, Seaber AV, Garrett

WE 1990 Viscoelastic properties of

muscle-tendon units: The biomechanical

effects of stretching. American Journal of

Sports Medicine 18: 300–309

Voss D, Ionta MK, Myers B 1985

Proprioceptive Neuromuscular

Facilitation 3rd ed, Harper & Row,

Philadelphia, PA

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JOURNAL OF BODYWORK AND MOVEMENT THERAPIES JANUARY 2002

6/11/01 16:26 BWMT: 20010258 7.00a/W (Sep 25 2000) JAYASHREE MANJU/BALA

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CHURCHILLLIVINGSTONE

JOURNAL TITLE: BWMT DATE: 6/11/2001ARTICLE NO. : 20010258

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6/11/01 16:26 BWMT: 20010258 7.00a/W (Sep 25 2000) JAYASHREE MANJU/BALA