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Stretching
Rattray 78-83 and TS 13
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Prior to stretching, warm up the tissue with ROM or applying heat
Slow, gentle, sustained manner
Should not be painful
Effects:
 lengthens soft tissue
Contraindications:
 Acute stages of healing
 Acute joint inflammation due to trauma, infection or inflammatory arthritides
 Acute pain present with joint motion or stretching
 Joint motion restricted by bony end feel
 Joint hypermobility
 Fascial or muscle contractures that provide joint stability
Stretching Techniques
1. Active Inhibition Techniques
a. hold-relax
b. contract-relax
c. post-isometric relaxation
d. agonist contraction
2. Passive Stretching
3. Self-Stretching
1. Active Inhibition Techniques
Client reflexively inhibits/relaxes the muscle to be lengthened
a. Hold-Relax
 Therapist lengthens the muscle to the barrier
 Client isometrically contracts muscle maximally against therapist resistance 10 sec
 As muscle fatigues, client relaxes muscle
 Therapist passively stretches to new barrier
 Repeat as desired
 Effects: lengthens soft tissue when pain and restricted range is present
b. Contract-Relax
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Therapist lengthens muscle to barrier
Client concentrically contracts muscle maximally against therapist resistance 5-10 sec
Therapist allows only minimal motion
As muscle fatigues, client relaxes muscle
Therapist passively stretches to new barrier
Repeat as desired
(the stretch portion of this causes golgi tendon organs to fire and relax the muscle)
 Effects: lengthens soft tissue when no pain is present
c. Post-Isometric Relaxation
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Therapist lengthens muscle to barrier
Client gently isometrically contracts submaximally against therapist’s minimal
resistance for up to 10 sec, while inhaling slowly and deeply
Client completely relaxes muscle while taking a full breath and slowly exhaling
Therapist passively gently stretches the muscle to new barrier
Repeat 3 to 5 times
Specific eye movements increase the range of PIR – look in the direction that the stretch
is occurring (or look up with inspiration and look down with expiration)
Effects: lengthens soft tissue, decreases muscle tone and symptoms of trigger points,
aligns the direction of individual muscle fibers
d. Agonist Contraction
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Client maximally contracts the muscle (agonist) opposing the tight muscle for 5 to10 sec
The tight muscle is reciprocally inhibited, it relaxes and lengthens
Useful for reducing muscle spasms
Or:
Therapist lengthens muscle to barrier
Client concentrically contracts submaximally the muscle opposing the tight muscle,
against therapist’s resistance for 5 to 10 sec, limb moves in its range
Effects: lengthens soft tissue when tightness, pain and spasm are present
2. Passive Stretching
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Client relaxes the muscle while the therapist stretches the muscle
Therapist controls the direction and duration of the stretch
Stretch is applied slowly
Held for 15-30 seconds
Repeated several times
Effects: lengthens contractile and noncontractile soft tissue
3. Self-stretching
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Client controls the direction and duration of the stretch
Held for 15-30 seconds
Repeated as necessary
Summary
PIR – stretch, submax isometric 10 sec with eyes and breath, stretch
Hold Relax – stretch, max isometric 10 sec, stretch
Contract relax – stretch, max concentric 10 sec, stretch
Agonist Contraction – contract opposite maximally 5-10 sec
Passive Stretching – 15-30 seconds
Self Stretching – 15-30 seconds
TS 13 – Perform a Stretch Technique
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Client’s treatment plan indicates the need for a stretch technique
The soft tissue is lengthened within the client’s pain tolerance
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The stretch is held without bouncing until there is release in the tissue being stretched
It is not used or is modified if a contraindication exists
You don’t stretch an unstable structure or tissue
Stretching
Know the following:
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The best passive stretch for each muscle
The best position
Be aware of draping concerns
How to strengthen the muscle if performing an active inhibition type stretch
The best patient “self-stretch”
While performing a therapist assisted stretch:
 Do you feel a stretch?
 Do you feel any pain?
 Is my hand placement ok?
1. Sternocleidomastoid
2. Upper Trapezius
3. Middle Trapezius
4. Lower Trapezius
5. Levator Scapula
6. Suboccipitals
7. Posterior Cervical muscles/Cervical spine extensors:
Splenius Capitis
Splenius Cervicis
Semispinalis capitis
8. Anterior Scalenes
9. Middle Scalenes
10. Posterior Scalenes
11. Rhomboids
12. Supraspinatus
13. Infraspinatus
14. Teres Minor
15. Subscapularis
16. Deltoid
17. Teres Major
18. Latissimus Dorsi
19. Coracobrachialis
20 Pectoralis Major
21. Pectoralis Minor
22. Serratus Anterior
23. Biceps
24. Triceps
25. Brachialis
26. Extensor Carpi Radialis Longus/ Extensor Carpi Radialis
27. Extensor Carpi Ulnaris
28. Anconeus
29. Extensor Digitorum
30. Extensor Indicis
31. Flexor Carpi Radialis
32. Flexor Carpi Ulnaris
33. Plamaris Longus
34. Flexor Digitorum Superficialis
35. Flexor Digitorum Profundus
36. Pronator Teres and Pronator Quadratus
37. Flexor Pollicis Longus
38. Opponens Pollicis
39. Adductor Pollicis
40. Palmar Interossei
41. Dorsal Interossei
42. Rectus Abdominus
43. External Obliques
44. Internal Obliques
45. Psoas
46. Paraspinal muscles:
Erector Spinae (Superficial Spinal Muscles - longissimus, iliocostalis, spinalis)
Transversospinalis (Deep Spinal Muscles (semispinalis, multifidi, rotatores,
costae)
47. Quadratus Lumborum
48. Gluteus Maximus
49. Gluteus Medius
51. Gluteus Minimus
52. Piriformis
53. Tensor Fascia Latae
54. Sartorius
55. Rectus Femoris
56. Vastus Intermedius
57. Vastus Medialis
58. Vastus Lateralis
59. Pectineus
60. Adductor Longus and Brevis
61. Adductor Magnus
62. Gracilis
63. Biceps Femoris
64. Semitendinosos and Semimembranosus
65. Popliteus
66. Tibialis Anterior
67. Extensor Digitorum Longus
68. Extensor Hallucis Longus
69. Peroneus Longus, Peroneus Brevis, Peroneus Tertius
70. Plantaris
71. Gastrocnemius
72. Soleus
73. Tibialis Posterior
74. Flexor Digitorum Longus
75. Flexor Hallucis Longus
76. Extensor Digitorum Brevis
77. Extensor Hallucis Brevis
78. Abductor Hallucis
79. Abductor Digiti Minimi
80. Flexor Digitorum Brevis
81. Quadratus Plantae
82. Adductor Hallucis
83. Flexor Hallucis
84. Flexor Digiti Minimi Brevis
85. Dorsal Interossei
86. Plantar Interossei
levator