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(PRINCIPLES OF STRETCHING) - Coggle Diagram
- Positioning a limb or the body such that the stretch force is directed to the appropriate ms group
- Fixation of one site of attachment of the ms as the stretch force is applied to the other bony attachment
- Magnitude of the stretch force applied
- Length of time the stretch force is applied during a stretch cycle
- Speed of initial application of the stretch force
- Number of stretching sessions per day or week.
- 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)
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- 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
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- 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
- The duration of stretch refers to the period of time a stretch force is applied & shortened tissues are held in a lengthened position
- Duration most often refers to how long a single cycle of stretch is applied
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
STATIC STRETCH
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- the intensity (magnitude) of a stretch force is determined by the load placed on soft tissue to elongate it.
- There is a general agreement among clinicians & researchers that stretching should be applied at 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 & 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
- 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
- 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
- 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
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
- 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