Stretching Exercises .pdf

Mechanical Properties of Noncontractile Soft Tissue Collagen fibers are responsible for the strength and stiffness of tissue and resist tensile deformation. In tendons, parallel and can resist the greatest tensile load. They transmit forces to the bone created by the muscle. In skin, collag...

Mechanical Properties of Noncontractile Soft Tissue Collagen fibers are responsible for the strength and stiffness of tissue and resist tensile deformation. In tendons, parallel and can resist the greatest tensile load. They transmit forces to the bone created by the muscle. In skin, collagen fibers are random and weakest in resisting tension. In ligaments, joint capsules, and fasciae, the collagen fibers vary between the two extremes, and they resist multidirectional forces. Mechanical Principles for Stretching Connective Tissue - Connective tissue deformation (stretch) requires breaking of - collagen bonds and realignment of the fibers for there to be - permanent elongation or increased flexibility. - Healing and adaptive remodeling time allow the tissue to respond to repetitive and sustained loads. Otherwise, a breakdown of tissue (failure) occurs -> inflammation from the micro ruptures is excessive, additional scar tissue, which could become more restrictive. Application of Manual Stretching Procedures Apply a low-intensity stretch in a slow, sustained manner. Remember, the direction of the stretching movement is directly opposite the line of pull of the range-limiting muscle. Take the hypomobile soft tissues to the point of firm tissue resistance and then move just beyond that point. The force must be enough to place tension on soft tissue structures but not so great as to cause pain or injure the structures. The patient should experience a pulling sensation, but not pain, in the structures being stretched. When stretching adhesions of a tendon within its sheath, the patient may experience a “stinging” sensation. Application of Manual Stretching Procedures (Cont’d) Consider incorporating a prestretch, isometric contraction of the range-limiting muscle (the hold-relax procedure) theoretically designed to relax the muscle reflexively prior to stretching it. To avoid joint compression during the stretching procedure, apply gentle (grade I) distraction to the moving joint. Maintain the stretched position for 30 seconds or longer. repeat the sequence several times. Non-Thrust Sustained Joint-Play Techniques Grade I (loosen). Small-amplitude distraction is applied when no stress is placed on the capsule. Grade II (tighten). Enough distraction or glide is applied to tighten the tissues around the joint. Grade III (stretch). A distraction or glide is applied with an amplitude large enough to place stretch on the joint capsule and surrounding periarticular structures.  Speed of Stretch Importance of a Slowly Applied Stretch Muscle spindle A slowly applied stretch is less likely to increase tensile stresses on connective tissues or to activate the stretch reflex. Ia fibers of the muscle spindle are sensitive to the velocity of muscle lengthening. Types of stretching Static stretching Cyclic/Intermittent stretching Ballistic stretching Proprioceptive neuromuscular facilitation stretching (PNF stretching) Manual stretching Mechanical stretching Self-stretching Passive stretching Active stretching  Duration of Stretch Static Stretching a commonly used method of stretching soft tissues are elongated just past the point of tissue resistance and then held in the lengthened position with a sustained stretch force. =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. an effective form of stretching to increase flexibility and ROM a safer form of stretching than ballistic stretching (tension in muscle during static stretching is approximately half)  Duration of Stretch Static Progressive Stretching 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 Again, held in the new end-range position for an additional duration of time.  Duration of Stretch Cyclic (Intermittent) Stretching A relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied. With cyclic stretching, the end-range stretch force is applied at a slow velocity, in a controlled manner, and at relatively low-intensity. (not synonymous with ballistic stretching, hold 5 to 10 sec)  Speed of Stretch Ballistic Stretching A rapid, forceful intermittent stretch—that is, a high-speed and high- intensity stretch quick, bouncing movements that create momentum to carry the body segment through the ROM not recommended for elderly or sedentary individuals or patients with musculoskeletal pathology or chronic contractures  Speed of Stretch High-Velocity Stretching in Conditioning Programs and Advanced-Phase Rehabilitation a highly trained athlete involved in a sport, such as gymnastics, that requires significant dynamic flexibility a young, active patient in the final phase of rehabilitation prior to beginning plyometric training or simulated, sport-specific exercises or drills Proprioceptive Neuromuscular Facilitation Stretching Techniques  PNF Stretching referred to as active stretching or facilitative stretching underlying mechanisms of PNF stretching reflexive relaxation occurs during the stretching maneuvers, as the result of autogenic or reciprocal inhibition. Current idea: more complex mechanisms of sensorimotor processing, viscoelastic adaptation of the muscle-tendon unit and changes in a patient’s tolerance to the stretching maneuver PNF stretching yields greater gains in ROM than static stretching  PNF Stretching Autogenic inhibition  PNF Stretching Reciprocal inhibition  PNF stretching Types of PNF Stretching Hold-relax (HR) or https://www.youtube.com/watch?v=V31lkMrSk5U Contract-relax (CR) https://www.youtube.com/watch?v=gJHxJEd-BWE -Answer which is using isometric and isotonic contraction? -Which neuromuscular inhibition used? Agonist contraction (AC) Hold-relax with agonist contraction (HR-AC) https://www.youtube.com/watch?v=53_EqT678oI&t=3s  PNF stretching Hold-Relax and Contract-Relax to make passive elongation of muscles more comfortable for a patient than manual passive stretching. A commonly held assumption is that neuromuscular relaxation  PNF stretching Hold-relax Putting a muscle in a stretched position (also called a passive stretch) and holding for a few to 10 seconds. Contracting the muscle isometrically, such as pushing gently against the stretch without actually moving. This is when the reflex is triggered and there is a “6- to 10-second window of opportunity for a beyond ‘normal’ stretch,” Relaxing the stretch, then stretching again, 10sec. This second stretch should be deeper than the first  PNF Stretching Contract-relax almost identical to hold-relax, except that instead of contracting the muscle without moving, the muscle is contracted while moving. This is sometimes called isotonic stretching. For example, in a hamstring stretch, this could mean a trainer provides resistance as an athlete contracts the muscle and pushes the leg down to the floor.  PNF stretching Agonist Contraction The “agonist” refers to the muscle opposite the range-limiting target muscle. AC procedure the patient concentrically contracts the muscle opposite the range- limiting muscle and then holds the end-range position for at least several seconds. the shortening contraction is performed without the addition of resistance. After a brief rest period, the patient repeats For example, if the hip flexors are the range-limiting target muscle group, the patient performs end-range, prone leg lifts by contracting the hip extensors concentrically  PNF Stretching AC technique especially effective when: significant muscle guarding restricts muscle lengthening and joint movement and is less effective in reducing chronic contractures. a patient cannot generate a strong, pain-free contraction of the range- limiting muscle, during the HR and CR procedures. for initiating neuromuscular control in the newly gained range to re-establish dynamic flexibility. But least effective if a patient has close to normal flexibility.  PNF stretching Hold-Relax with Agonist Contraction also referred to as the CR-AC procedure or slow reversal hold-relax technique HR-AC procedure: move the limb to the point that tissue resistance is felt in the range-limiting target muscle; then have the patient perform a resisted, prestretch isometric contraction of the range- limiting muscle followed by voluntary relaxation an immediate concentric contraction of the muscle opposite the range-limiting muscle. Any questions?