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Stretching: - Coggle Diagram

- - - - 1-A bony block limits jnt motion
        2- Recent fracture, & bony union is incomplete.
        3- There is evidence of an acute inflammatory or
        infectious process (heat & swelling) , or soft tissue healing could be disrupted in the restricted tissues & surrounding region.
        4- There is sharp acute pain with jnt movement or ms elongation.
        5- A hematoma or any other indication of tissue trauma is observed.
        6-Hypermobility already exists.
        7- Shortened soft tissues provide necessary jnt stability in lieu of normal structural stability or neuromuscular control
        8- Shortened soft tissues enable a patient with paralysis or severe ms weakness to perform specific functional skills otherwise not possible
- - - - • Proper alignment or positioning of the patient & the specific muscles & jnts to be stretched is necessary for the patient comfort & stability during stretching. Alignment influences the amnt of tension present in soft tissue & consequently affects the ROM available in jnts.
        
        • For eg: To stretch rectus femoris ( a ms that crosses 2 jnts) effectively, as the knee is flexed & hip extended, the lumbar spine & pelvis should be aligned in a neutral position. The pelvis should not tilt anteriorly nor should the low back hyperextend.
    - - Fixation of one site of attachment of the ms as the stretch force is applied to the other bony attachment.
        
        o To achieve an effective stretch of a specific muscle or ms group & associated periarticular structures, it is imperative to stabilize (fixate) either the proximal or distal attachment site of the muscle-tendon unit being elongated.
        
        o Eg: When stretching the iliopsoas, the pelvis & lumbar spine must maintain a neutral position as the hip is extended to avoid stress to the low back region. Sources of stabilization include manual contacts, body weight, or a firm surface such as a table, wall.
      -  INTENSITY OF STRETCH
        
        Magnitude of the stretch force applied.
        
        o The intensity (magnitude) of a stretch force is determined by the load placed on soft tissue to elongate it.
        
        o There is a general agreement among clinicians & researchers that stretching should be applied at low intensity by means of a low load.
        o Low intensity stretching in comparison to high-intensity stretching makes the stretching maneuver more comfortable for the patient & minimizes voluntary or involuntary muscle guarding so a patient can either remain relaxed or involuntary ms guarding so a patient can either remain relaxed or assist with the stretching maneuver.
        
        o Low-intensity stretching (coupled with a long duration of stretch) results in optimal rates of improvement in ROM without exposing tissues, possibly weakened by immobilization, to excessive loads & potential injury.
        
        o Low-intensity stretching has also been shown to elongate dense connective tissue, a significant component of chronic contractures more effectively & with less soft tissue damage & post-exercise soreness than a high intensity stretch.
        
         DURATION OF STRETCH:
        
        Length of time the stretch force is applied during a stretch cycle
        
        o The duration of stretch refers to the period of time a stretch force is applied & shortened tissues are held in a lengthened position.
        
        o Duration most often refers to how long a single cycle of stretch is applied.
        
        o Classification of stretching according to duration of stretch cycle i.e. long duration stretch & short duration stretch:
         Static stretch
         Static progressive stretch
         Cyclic intermittent stretch
        
        2.STATIC PROGRESSIVE STRETCH
        
        Progressive stretching is another term that describes how static stretch is applied for maximum effectiveness. The shortened soft tissues are comfortably held in a lengthened position until a degree of relaxation is felt by the patient or therapist.
        
        Then the shortened tissues are incrementally lengthened even further & 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).
        
        1.STATIC STRETCH:
        
        A commonly used method of stretching in which soft tissues are elongated just past the point of tissue resistance & then held in the lengthened position with a sustained stretch force over a period of time.
        
        Other terms used interchangeably are sustained, maintained, 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.
        
        In research studies the term “static stretching “has been linked to durations of a single stretch cycle ranging from as few as 5s to 5mins per repetition when either a manual stretch or self stretching procedure is employed.
        
        During static stretching it is thought that the GTO which monitors tension created by stretch of a muscle-tenon unit, may contribute to ms elongation by overriding any facilitative impulses from the primary afferents of the ms spindle ( Ia afferent fibers) and may contribute to ms relaxation by inhibiting tension in the contractile units of the ms being stretched.
        
        3.CYCLIC (INTERMITTENT) STRETCHING:
        
        Short duration stretch cycle. A relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied is describe 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 movements.
        
         SPEED OF STRETCH:
        
        Speed of initial application of the stretch force
        
        To ensure optimal ms relaxation & prevent injury to tissues, the speed of stretch should be slow. The stretch force should be applied & released gradually.
        
        Slowly applied stretch is less likely to increase tensile stresses on connective tissues or to activate the stretch reflex & increase tension in the contractile structures of the ms being stretched.
        
        Stretch force applied at a low velocity is also easier for the therapist or patient to control & is therefore safer than a high-velocity stretch.
        
         FREQUENCY OF STRETCH:
        
        Number of stretching sessions per day or week.
        
        Refers to the number of bout (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 & level of healing of tissues, the chronicity & severity of a contracture as well as a patient’s age.
        
        3 to 5 repetitions per session & done 3 times a week is considered as an adequate for gaining improvements in the flexibility of soft tissues
        
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        Further the decision relies upon the therapist according to the clinical scenario.
        
         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)
        
        Manual stretching
        Self-stretching
        Mechanical stretching
        PNF stretching
        
        manual stretching
        
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