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Types of stretching technique
The document provides a comprehensive overview of various stretching techniques, emphasizing key factors such as alignment, stabilization, intensity, duration, speed, frequency, and mode of stretch. It distinguishes between static, cyclic, ballistic, and proprioceptive neuromuscular facilitation (PNF) stretching methods while discussing their applications, effectiveness, and considerations for different patient needs. Clear guidelines on the execution and monitoring of stretching interventions are provided to optimize therapeutic outcomes.
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Types of stretching technique
- 1. Nootan Physiotherapy College, Visnagar. PreparedBy: Dr. Nidhi Vedawala
- 3. Alignment: positioninga 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 achievean 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…)
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- 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
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- 16. The durationof 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 stretchingis 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 progressivestretching 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 relativelyshort-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.
- 21. Importance of aSlowly 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 Arapid, 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 inConditioning 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.
- 25. Frequency ofstretching 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 modeof 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 SelectingMethods 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 Duringmanual 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 (alsoreferred 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 Thereare 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 MechanicalStretch 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…)
Editor's Notes
- #3 Introduction
- #4 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #5 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #6 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #7 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #8 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #9 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #10 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #11 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #12 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #13 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #14 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #15 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #16 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #17 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #18 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #19 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #20 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #21 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #22 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #23 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #24 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #25 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #26 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #27 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #28 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #29 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #30 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #31 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #32 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #33 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #34 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #35 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.
- #36 Figure 4.1 illustrates the structure of skeletal muscle. Figure 4.3 illustrates a model of myofilament sliding. Elongation and shortening of the sarcomere, the contractile unit of muscle.