Chapter 5- Stretching

8/11/2019 Chapter 5- Stretching

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STRETCHING



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LEARNING OBJECTIVE:

At the end of the lesson, students will be able :

1. To have a knowledge on history of stretching.

2. To Define stretching and flexibility.

3. To Describe the tissue response towards elongation and

immobilization.

4. To Explain the determinants of stretching exercise and the

effects of stretching.

5. To have a knowledge about precautions and

contraindications of stretching.

6. To Explain and demonstrate the techniques of stretching.



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LEARNING OUTCOME:

At the end of the lesson, students will be able to:

1. Define stretching.

2. Describe the tissue response towards elongation and

immobilization.

3. Explain the determinants of stretching exercise.

4. Explain the effects of stretching.

5. Explain the precautions and contraindications of

stretching.

6. Explain and demonstrate the techniques of stretching.



HISTORY OF STRETCHING

500-700 B. C.: originof gymnast ics --as itwas believed that thiswould facilitate unityof mind and body.

5000 B.C.: The

primitive origins ofmartial arts

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HISTORY OF STRETCHING

Yoga: sanskrit to unite

A series of spiritualpractices arising > 5,000

years ago.Hatha yoga: developed in

the 15th century; utilizedasanas (body postures) to

seek self-enlightenment16.5 million Americans nowpractice yoga



ATHLETIC CULTURE

“

Stretching has

become

embedded in

sport folklore asthe universal

strategy for

injury

prevention” -

Thacker S., et al Med

Sci Sports

Exerc. 2004.


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DEFINITIONS

Flexibility

Flexibility is the ability to move a single joint or series of

joints smoothly and easily through an unrestricted, pain-

free ROM.

Dynamic Flexibility refers to the active range of motion of a

joint.

Passive Flexibility is the degree to which a joint can bepassively moved through the available ROM



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DEFINITIONS

Hypomobility

Hypomobility refers to decreased mobility or restricted

motion.

ContractureContracture is defined as the adaptive shortening of the

muscle-tendon unit and other soft tissues that cross or

surround a joint that results in significant resistance to

passive or active stretch and limitation of ROM, and itmay compromise functional abilities.



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TYPES OF STRETCHING

Static Stretch A static stretch is slow and constant, with the end position held for 30

seconds.

Ballistic Stretch A ballistic stretch typically involves active muscular effort and uses a

bouncing-type movement in which the end position is not held.

Dynamic Stretch

A dynamic stretch is a type of functionally based stretching exercise thatuses sport-specific move-ments to prepare the body for activity.



STRETCHING: SHORT AND

LONG-TERM CHANGES

Short term:

Redistribution of liquid

and polysaccaharides

within the collagen

matrixes of the tendon -

McNair et al. Med Sci Sports Exerc 2001

Duration of increased

flexibility 60-90 minutes –

DePino et al J. Athletic Training 1982;Moller et al Arch of Phys Med Rehab

1985



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MECHANICAL PROPERTIES OF

CONTRACTILE TISSUE:

1. Stretching of Soft Tissue causes two responses

A. Elastic change: the ability of soft tissue to return to its

resting length after passive stretch

B. Plastic change: the tendency of soft tissue to assume new

and greater length after the stretch force has been removed.Remodeling of plastic changes take 6 weeks - 6 months and

this is why consistent stretching is important.

2. Both contractile (muscle and tendon) and non-

contractile (bursae, ligament, joint capsule) tissues have

elastic and plastic qualities.

3. Tendons: resist greatest tensile loads because the collagen

fibers are parallel 14



STRESS-STRAIN CURVE



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STRESS-STRAIN CURVE

1. Elastic Range: the tissue returns to its original size andshape when an appropriate load is administered and then

released.

2. Elastic Limit: the point beyond which the tissue will not

return to it

s original shape and size.

3. Plastic range: the range beyond the elastic limit

extending to the point of rupture. Tissue strained within

this range will have permanent deformation.

4. Yield strength

5. Necking: region where considerable weakening of thetissue- less force is needed for deformation, and failure

rapidly approaches

6. Failure: rupture of the tissue



DECREASE OUR RISK

OF INJURY?

Agree

0r

Disagree



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MYOFILA

MENT

SLIDING

18



STRETCHING IMAGES

19



NEUROPHYSIOLOGIC PROPERTIES OF CONTRACTILE

TISSUE

1.MUSCLE SPINDLE: Major sensory organ which is composed of microscopic

intrafusal fibers that lie in parallel to the extrafusal fibers.

Monitors velocity and duration of stretch.

2.GOLGI TENDON ORGAN (GTO):

wraps around the ends of the extrafusal fibers

Sensitive to tension in a muscle which may be caused by

either passive stretch or active muscle contraction. In this way it

works to protect the muscle from overstretching which could

cause injury.

20

THE NEUROPYSIOLOGIC RESPONSE



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THE NEUROPYSIOLOGIC RESPONSE

OF MUSCLE TO STRETCH

MONOSYNAPTIC STRETCH REFLEX:

• Placing a quick stretch on a muscle causes the spindle to contract.

• stimulates the primary afferent (sensory) fibers which are located in the

nuclear bag.

• Sensing too much stretch they give feedback to the extrafusal efferent(motor) fibers which fire and cause tension to increase in the muscle.

• Stretching procedures that are performed at too high velocity may

actually increase the tension in a muscle that is attempting to be

lengthened.

21



CONT..

•If a slow stretch is applied to muscle,

the GTO

s fire and inhibit the tension

in the muscle allowing the parallel

elastic component (the sarcomere) to

lengthen.

•With static stretching GTO

s are able

to override impulses from muscle

spindle following initial reflex

resistance

•Allows muscle to remain stretchedwithout injury

22



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DETERMINANTS OF STRETCHING EXERCISE

Al ignment : positioning a limb or the body such that the stretch force is directed tothe appropriate muscle group.

Stabil ization : fixation of one site of attachment of the muscle as the stretch force isapplied to the other bony attachment.

Intensi ty o f stretch : magnitude of the stretch force applied.

Durat ion of stretch : length of time the stretch force is applied during a stretchcycle.(15- 60 sec)

Speed o f stretch : speed of initial application of the stretch force Frequency of stretch:

number of stretching sessions per day or per week.(3-4 times each session)

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 thestretch force (manual, mechanical, self).



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EFFECTS OF STRETCHING

Stretching exercise may

Increase and maintain the joint range of motion.

Prevent contracture of joint.

Reduce the muscle tone in case of hyper tonicity if given

prolonged stretch.

Mobilize the scar tissue.

Reduce pain and joint lubrication.



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INDICATIONS

• ROM is limited because soft tissues have lost their extensibility

as the result of adhesions, contractures, and scar tissueformation, causing functional limitations or disabilities.

• Restricted motion may lead to structural deformities that are

otherwise preventable.

• muscle weakness and shortening of opposing tissue.

• fitness program

• to prevent musculoskeletal injuries.

• prior to and after vigorous exercise potentially to minimize post

exercise muscle soreness.



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CONTRAINDICATIONS

•Bony block

• Acute infection

• Beyond normal ROM of a joint

• Prolonged immobilization

• Severe tissue damage

• Acute inflammation

• Acute pain

• Prolonged increased pain or soreness after treatment



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PRECAUTIONS

Use extra caution in patients with known or suspectedosteoporosis due to disease, prolonged bed rest, age, orprolonged use of steroids.

Protect newly united fractures; be certain there is

appropriate stabilization between the fracture site andthe joint in which the motion takes place.

Avoid vigorous stretching of muscles and connectivetissues that have been immobilized for an extended

period of time.

Progress the dosage (intensity, duration, and frequency)of stretching interventions gradually to minimize softtissue trauma and post exercise muscle soreness.



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CONT ..

Avoid stretching edematous tissue, as it is more

susceptible to injury than normal tissue. Continued

irritation of edematous tissue usually causes increased

pain and edema.

Avoid overstretching weak muscles, particularly those

that support body structures in relation to gravity.



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STRETCHING PROCEDURES

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.

Self-Stretching

Self-stretching (also referred to as flexibility exercises

or active stretching) is a type of stretching procedure apatient carries out independently after careful

instruction and supervised practice.



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CONT …

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.

PNF Stretching techniques

PNF stretching), also referred to as active stretching or facilitative

stretching, integrate active muscle contractions into stretching

manoeuvre's purportedly to facilitate or inhibit muscle activation

and to increase the likelihood that the muscle to be lengthenedremains as relaxed as possible as it is stretched.



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Types of PNF Stretching

There are several types of PNF stretching procedures. They

include:

1. Hold –relax (HR) or contract –relax (CR)

2. Agonist contraction (AC)

3. Hold –relax with agonist contraction (HR-AC).



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Hold –Relax and Contract –Relax

With the hold –relax (HR) procedure, the range limiting

muscle is first lengthened to the point of limitation or to

the extent that is comfortable for the patient.

The patient then performs a pre-stretch, end-range,

isometric contraction (for 5 to 10 seconds) followed by

voluntary relaxation of the tight muscle.

The limb is then passively moved into the new range as

the range-limiting muscle is elongated.



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Hold –relax (HR) procedure to stretch the pectoralis major muscles bilaterally.

Fig- a Fig- b



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Agonist Contraction

To perform the AC procedure the patient concentrically

contracts (shortens) the muscle opposite the range

limiting muscle and then holds the end-range position

for at least several seconds.

The movement of the limb is independently controlled by

the patient and is deliberate and slow, not ballistic.



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Hold –Relax with Agonist Contraction

The HR-AC stretching technique combines the HR and

AC procedures. To perform the HR-AC procedure, move

the limb to the point that tissue resistance is felt in the

tight (range-limiting) muscle; then have the patientperform a resisted, pre-stretch isometric contraction of

the range-limiting muscle followed by relaxation of that

muscle and an immediate concentric contraction of the

muscle opposite the tight muscle.



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ANSWER ?



GROUP FORUM DISCUSSION IN



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GROUP FORUM DISCUSSION IN

BLACK BOARD

1. Describe flexibility exercises that take advantage of proprioceptiveneuromuscular facilitation.

2. Explain the mechanisms that cause the muscular inhibition that

improves the stretch.

3. Select and apply appropriate static and dynamic stretching methods for

upper and lower limb.



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REFERENCES

Carolyn Kisner(2007). Therapeutic Exercise.

Foundations and Techniques (5th Ed). F. A.

Davis Company

Greene W.B (1999). Practical Exercise

Therapy. (4th Ed). Blackwell Science Ltd.



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THANK YOU

Chapter 5- Stretching

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