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STRETCHING WHY STRETCH Stretching, because it relaxes your mind and tunes up your body, should be part of your daily life. You will find that regular stretching will do the following things: • Reduce muscle tension and make the body feel more relaxed. • Help coordination by allowing for freer and easier movement. • Increase range of motion (ROM) • Prevents injuries such as muscle strains. (A strong pre-stretched muscle resists stress better than a strong, unstretched muscle.) • Makes strenuous sporting activities easier because it prepares you for activity; its a way of signalling the muscles that they are about to be used. • Develop body awareness. As you stretch various parts of the body, you focus on them and get in touch with them. You get to know yourself. • Help loosen the mind's control of the body so the body moves for "its own sake" rather than for competition or ego. • Promotes circulation. • It feels good. HOW TO STRETCH The Easy Stretch When you begin a stretch, spend 10-30 seconds in the easy stretch. No bouncing! Go to the point where you feel a mild tension (pathological motion barrier) and relax as you hold the stretch. The feeling of tension should subside as you hold the position. If it does not, ease off slightly and find a degree of tension that is comfortable. The easy stretch eases muscular tension and readies the connective tissue for the developmental stretch. The Developmental Stretch After the easy stretch move slowly into the developmental stretch. Again, no bouncing. Move very slightly further into the stretch to a new pathological motion barrier and hold for 10 - 30 seconds. Be in control. Again the tension should diminish; if not, ease off slightly. Repeat several times to gradually increase flexibility. ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 1 Breathing Your breathing should be slow, rhythmical and under control. If you are bending forward to do a stretch, exhale as you bend forward and then breathe slowly as you hold the stretch. Do not hold your breath while stretching. If a stretch position inhibits your natural breathing pattern then you are obviously not relaxed. Just ease up on the stretch so you can breathe naturally. Counting At first silently count the seconds for each stretch. This will ensure that you hold the proper tension for a long enough time. After a while you will stretch by the way it feels without the distraction of counting. The Stretch Reflex Your muscles are protected by a mechanism called the stretch reflex. When you overstretch or do ballistic type stretching a nerve impulse from the muscle spindle and/or golgi tendon organs initiates muscle contraction in an attempt to prevent muscle injury. Therefore, when you stretch too far, you tighten the very muscles you are trying to stretch. Holding a stretch as far as you can go or bouncing up and down strains the muscles and activates the stretch reflex. These harmful methods cause pain, as well as physical damage due to microscopic tearing of muscle fibres. This tearing leads to the formation of scar tissue in the muscles with a gradual loss of elasticity. The muscles become tight and sore which is counter-productive to what you are trying to achieve. TYPES OF STRETCHES • • • • Static Self Stretch (Slow Held Stretch = Easy > Developmental Stretch) Ballistic Stretch Static Assisted (Passive) - done by therapist/partner Assisted (Active) - Proprioceptive Neuromuscular Facilitation (PNF) ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 2 THRESHOLD OF TRAINING Type Frequency Intensity Duration STATIC 3 days per week Stretch as far as you can go without pain with slow movement. Hold at the end ROM Hold the stretch for a minimum of 10 sees. BALLISTIC 3 days per week 3 sets of 5 reps with a 10 second rest between sets. PNF 3 days per week Stretch muscle beyond normal length with gentle bounce or swing. Do not exceed 10% of antagonist-static ROM Same as static but use an isometric contraction of the muscle prior to stretch. Hold isometric contraction for 6 secs. Hold stretch 10 secs. Repeat 3 times. TARGET ZONES Type STATIC Frequency 3 to 7 days per week Intensity When antagonist stretch is used the muscle should be stretched as far as possible but only through contraction of the antagonist muscles. Duration Hold 20 - 60 secs 5 sets of 5 - 10 reps BALLISTIC 3 to 7 days per week When assisted stretch is used the muscle should not be stretched more than 10% beyond its normal ROM and it should not reach the point of pain. Care should be taken to avoid overstretch. Hold isometric contraction 6 secs for 1 - 3 sets PNF 3 to 7 days per week When assisted stretch is used the muscle should not be stretched more than 10% beyond its normal ROM and it should not reach the point of pain. Care should be taken to avoid overstretch. ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 Hold stretch 20 - 60 secs for 1 - 3 sets. 3 For each of the following muscles/muscle groups we will try to develop 3 stretches (where appropriate), i.e. • a static stretch (slow held stretch) the client can practise at home. • a passive stretch done by the therapist • a PNF stretch done using an immovable object (usually a partner) STRETCHING OF THE MUSCLES & CONNECTIVE TISSUE OF THE UPPER BODY Region/Action Main Muscles Involved Cervical - anterior posterior Sternocleidomastoid Trapezius Splenius Capitis Levator Scapulae Rotators - lateral Scalenes (Anterior, Medius, Posterior) Thoracic - anterior posterior Pectorals (Major & Minor) Trapezius Rhomboids Serratus Anterior Levator Scapulae Spinal Extensors Spinal Rotators lateral Spinal Lateral Flexors Abdominals (esp. Rectus Abdominis) Abdominals (esp. External Obliques) ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 4 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Cervical Flexors Cervical Extensors Cervical Side-Benders Cervical Rotators ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 5 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Thoracic Side-Benders Thoracic Extensors Bi-lateral Thoracic Extensors Uni-lateral Thoracic Flexors ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 6 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Thoracic Rotators Scapular Elevators Upper Trapezius ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 7 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Levator Scapulae ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 8 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Shoulder Abductors: Deltoid & Supraspinatus Shoulder Adductors: Latissimus Dorsi & Teres Major Shoulder Flexor Shoulder Extensors Lats, Teres Major & Long Head of Triceps Shoulder Medial Rotators Subscapularis, Pec Major & Coracobrachialis ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 9 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Shoulder Lateral Rotators Infraspinatus & Teres Minor Elbow Flexors: Biceps Brachii, Brachialis & Brachioradialis Elbow Extensors: Triceps & Anconeus Forearm Pronators Forearm Supinators ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 10 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Wrist/Hand Flexors Wrist/Hand Extensors Wrist Abductors Wrist Adductors ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 11 STRETCHING OF THE MUSCLES & CONNECTIVE TISSUE OF THE LOWER BODY Lumbar Region/Action Main Muscles Involved anterior Rectus Abdominis Obliques (External & Internal) Erector Spinae Group (Spinalis, Longissimus, Ilio-Costalis), Multifidus Quadratus Lumborum Intertransversarii & Rotatores Ilio Psoas Gluteals (Maximus, Medius, Minimus) Hamstrings Tensor Fascia Latae External Rotators (esp. Piriformis) Pectineus Adductors (Brevis, Longus, Magnus) Tensor Fascia Latae Ilio-Tibial Band Gluteals (Medius & Minimis) Adductors (Brevis, Longus, Magnus) Pectineus Gracilis Ilio Psoas Rectus Femoris Sartorius Hamstrings Gluteus Maximus Gluteus Minimis Gracilis Piriformis Gemelli (Superior & Inferior), Obturators (Intemus & Extemus) Quadratus Femoris Pectineus Sartorius Tibialis Anterior Gastrocnemius Soleus Tibialis Posterior Peroneals (Longus and Brevis) posterior lateral Hip & Pelvis anterior posterior lateral medial Thigh abductors adductors flexors extensors medial rotators lateral rotators Lower Leg anterior posterior lateral ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 12 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Lumbar Flexors Rectus Abdominus External Oblique Internal Oblique Lumbar Extensors Erector Spinae Group Bi-lateral Low Back Extensor Stretch Uni-lateral Hip & Low Back Stretch ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 13 Muscle/Muscle Group Lumbar Sidebenders Quadratus Lumborum STATIC PASSIVE ASSISTED Standing PNF Prone Quadratus Lumborum Stretch Side (Down) Side (Up) Hip Flexors Iliopsoas "Iliopsoas Stretch” “hurdler’s position” supine "kneel-lunge" prone side-lying Upper Iliopsoas Stretch ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 14 Muscle/Muscle Group STATIC PASSIVE ASSISTED Rectus Femoris standing supine "kneel-lunge" prone PNF Quadriceps Stretch Hip Flexing Abductors Tensor Fascia Latae Abductor Stretch - Side View Abductor Stretch - Back Hip Flexing Adductors Adductors Brevis & Longus Sitting Adductor Stretch Others Sartorius Gracilis ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 15 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Hip Extensors Gluteus Maximus Hip Extensors Stretch Upper Hamstrings Hamstring Stretch Hamstring Stretch Hip Extending Abductors Gluteus Medius Gluteus Medius & Minimus Stretch Hip Extending Adductors Adductor Magnus Standing Adductor Stretch Hip Medial Rotators Gluteus Medius Medial Rotators Stretch Minimus Stretch ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 16 Muscle/Muscle Group STATIC Hip Lateral Rotators Piriformis Group Supine PASSIVE ASSISTED PNF Lateral Rotators Stretch Standing Knee Extensors Quadriceps Group 1 2 3 Knee Flexors Lower Hamstrings Standing ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 17 Muscle/Muscle Group STATIC Lower Hamstrings Long Sitting PASSIVE ASSISTED PNF Supine Ankle Plantar Flexors Gastrocnemius Gastrocnemius Stretch Soleus Soleus Stretch Tibialis Posterior Posterior Compartment Stretch Ankle Dorsi Flexors Tibialis Anterior Anterior Compartment Stretch ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 18 Muscle/Muscle Group STATIC PASSIVE ASSISTED PNF Foot Everters Peroneus Longus Peroneus Brevis Lateral Compartment Stretch Peroneus Tertius Plantar Surface of Foot Plantar Fascia Flexor Digitorum Longus Flexor Hallicus Longus Dorsal Surface of Foot Extensor Digitorum Longus Extensor Hallicus Longus ©2007 MCPT Stretching Techniques – Diploma (HLT50307) Version 1 – 13 Feb 2007 19