STRETCHING EXERCISE

INTRODUCTION:

 Stretching is a form of physical exercise in which a specific muscle or

tendon (muscle group) is deliberately flexed or stretched in order to
improve the muscles felt elasticity and achieve comfortable muscle tone.
 The result in a feeling of increased muscle control, flexibility and range of
motion.
 Stretching can be dangerous when performed incorrectly.

CONTRA-INDICATION FOR STRETCHING:

1. Bony block on EOR on passive assessment.

2. Unstable/recent fracture (joint instability).
3. Acute soft tissue injury.
4. Infection/haematoma in tissues.
5. Post surgical repairs e.g. skin grafts, tendon repairs.
6. Client refusal.
7. Vascular injury.
8. Inflammation or joint effusion.

INDICATION FOR STRETCHING:

1. Improve joint ROM.

2. Increase extensibility of muscle tendon unit and particular connective
tissue.
3. Return normal neuromascular balance between muscle groups.
4. Reduce compression on joint surface.
5. Reduce injuries.

APPLICATION METHOD OF STRETCHING EXERCISE:

1. Scalene:
a. Anterior scalene.
b. Middle scalene.
 c. Posterior scalene.

Anterior scalene Middle scalene Posterior scalene

2. Trapezius:
Patient position: sitting position.
Therapist position: walk standing behind the patient.
Hand placement and procedure:
 Stabilize the head with one hand.
 With other hand push the patient shoulder downward till the tissue
resistance.

Fig: Trapezius stretching. Fig: Teres major stretching Fig: Lattisimus dorsi.

3. Lattisimus dorsi:
Teres major:
Patient position: supine position.
Therapist position: walk standing.
Hand placement and procedure:
  Grasp the posterior aspect of distal humerus, just above elbow.
 Stabilize the lateral aspect of the thorax and superior aspect of the
pelvis to stretch the lattisimus dorsi.
 Stabilize the axillary border of the scapula to stretch the teres major.
 Move the patient’s arm into full shoulder flexion to elongate the
shoulder extensor.

Fig: Pectoralis major stretching.

4. Anterior deltoid:
Pectoralis major:
Coracobrachialis:

Patient position: prone position.

Therapist position: walk standing.

Hand placement and procedures:

 Support the forearm and grasp the distal humerus.

 Stabilize the posterior aspect of the scapula.
 Move the patient arm into full hyperextension of the shoulder to
elongate the shoulder flexor.
5. Biceps brachii:
Brachialis:
Brachioradialis:
Patient position: supine position.

Therapist position: walk standing.

Hand placement and procedure:

 Grasp the distal forearm.

 With the upper arm at the patient’s side supported the table, stabilize the
scapula and anterior aspect of the proximal humerus.
 Extend the elbow just past the point of tissue resistance to lengthen the
elbow flexors.

6. Triceps brachii:

Patient position: supine position.

Therapist position: walk standing.

Hand placement and procedure:

 Stabilize the posterior aspect of the scapula.

 Flex the patient’s elbow, grasp the distal forearm and flex the shoulder.
7. Subscapularis:
 Patient position: supine position with elbow flex to 90 ̊
Therapist position: walk standing.
Hand placement and procedure:
 Stabilize the axillary border of the scapula.
 Grasp the distal humerus.
 Move the patient’s shoulder full abduction to lengthen the abductor
muscles.

STRETCHING FOR LOWER LIMB MUSCLES:

1. Iliopsoas:
Patient position: prone position.
Therapist position: walk standing.
Hand placement and procedures:
 Support and grasp the anterior aspect of the patient’s distal femur.
 Stabilize the patient’s buttocks to prevent movement of the pelvic.
 Extend the patient’s hip by lifting the femur of the table.
2. Gluteus maximus:
Patient position: supine position.
Therapist position: walk standing.
Hand placement and procedure:
 Flex the hip and knee simultaneously.
  Stabilize the opposite femur in extension to prevent posterior tilt of
pelvic.
 Move the patient’s hip and knee into full flexion to lengthen the one-
joint hip extensor.

3. Hamstring:
Patient position: supine position.
Therapist position: walk standing.
Hand placement and procedure:
 Flex the hip.
 Stabilize the knee joint.
 Move the patient’s hip full flexion till tissue resistance.
4. Rectus femoris:
Patient position: prone position.
Therapist position: walk standing.
Hand placement and procedure:
 Knee flex.
 With the hip help in full extension on the side to be stretched, move
therapist hand to the distal tibia and gently flex the knee of that extremity
as far as possible.
 Do not allow the hip to abduct or rotate.
5. Adductor brevis:
Adductor longus:
 Adductor magnus:
Patient position: supine position.
Therapist position: walk standing.
Hand placement and procedure:
 Support the distal thigh with arm and forearm.
 Stabilize the pelvic by placing pressure on the opposite anterior iliac
crest or by maintaining the opposite lower extremity in slight
abduction.
 Abduct the hip as far possible to stretch the adductors.
6. Tensor fasciae latae:
Iliotibial:
Patient position: side lying position.
Therapist position: walk standing.
Hand placement and procedure:
 Stabilize the pelvic at the iliac crest with proximal hand.
 Flex the knee and extend the patient’s hip.
 Let the patient’s hip adduct and apply stretch force with other hand
to the lateral aspect of the distal femur.
7. Gastrocnemius:
Patient position: supine position.
Therapist position: walk standing.
Hand placement and procedure:
 Grasp the patient’s heel with one hand, place forearm along the
planter surface of the foot.
 Stabilize the anterior aspect of the tibia with other hand.
 Dorsiflex the talocrual joint of the ankle by pulling the calcaneus in an
inferior direction with thumb and applying pressure in a superior
direction just proximal to the heads of the metatarsal with forearm.

REFERENCES:

1. Therapeutic Exercise (FOUNDATION AND TECHNIQUES), Sixth Edition, by

CAROLYN KINSER AND LYNN ALLEN COLBY.