Stretching is a general term used to describe • -Myostatic (myogenic) contracture-

any therapeutic maneuvers designed to

increase the extensibility of soft tissues. most common related to tightness can be
addressed through stretching
Flexibility is the ability to move a single joint or
series of joints smoothly and easily through an • Pseudomyostatic (apparent) caused by injury
unrestricted, pain free rom. neuro

Dynamic flexibility- active mobility or active • Arthogenic and Periarticular sa joints

rom
• Fibrotic contracture and irreversible
Passive flexibility- passive mobility or passive contracture
rom pt gumagawa
Indications
Hypomobility- decreased mobility or restricted
motion caused by adaptive shortening of soft • rom is limited because soft tissues have
tissues lost their extensibility
• Restricted motion may lead to
Contracture- irreversible shortening Tightness- structural deformities that are
reversible can be stretched Hypomobility otherwise preventable
• There is muscle weakness and
Factors for restricted motion: shortening of opposing tissues
• May be used as part of a total fitness
• prolonged immobilization of a program designed to prevent
body segment musculoskeletal injuries
• Sedentary lifestyle • May be used prior to or after vigorous
• Postural malalignment and exercise
muscle
Contraindications
• imbalances
• Impaired muscle performance
• A bony blocks limits jt motion
• Tissue trauma resulting in • There was a recent fracture and bony
• inflammation and pain union is incomplete
• Congenital or acquired • There is evidence of an acute
deformities inflammatory or infectious process or
soft tissue healing could be disrupted in
Contracture- adaptive shortening of the the tight tissues and surrounding region
muscle tendon unit and other soft • There is sharp acute pain with jt
tissues that cross or surround a jt that movement or muscle elongation.
results in significant resistance to • A hematoma or other indication of
passive or active stretch and limitation tissue trauma is observed
of rom. Might be reversed by surgery • Hypermobility already exists.
• Shortened soft tissues provide
Self is active stretching Pt is passive necessary jt stability in lieu of normal
stretching structural stability or neuromuscular
control.
Types of contracture
 • Shortened soft tissues enable a patient Selective stretching- process whereby
with paralysis or severe muscle the overall function of a patient may be
weakness to perform specific functional improved by applying stretching
skills otherwise not possible techniques selectively to some muscles
and joints but allowing limitation of
General Precautions motion to develop in other muscles or
joints
• do not passively force a jt beyond its
normal rom. -induce of tightness

Precautions for stretching Overstretch- is a stretch beyond the

normal length of muscle and rom of a jt
• Use extra caution in patients with and the surrounding soft tissues
known or suspected osteoporosis due resulting hypermobility (excessive
to disease prolonged bed rest, age or mobility)
prolonged use of steroids
• Protect newly united fractures Determinants
Alignment- positioning a limb or the
• Avoid vigorous stretching of muscle and body
connective tissues that have been
immobilized for an extended period of Contra sa action ng muscle example
time rectus femoris hip flexion and knee
• Progress the dosage (intensity duration extension
and frequency) of stretching
interventions gradually to minimize soft Stabilization- fixation of one site of
tissue trauma and post exercise muscle attachment of the muscle as the stretch
soreness force is applied to the other bony
• Avoid stretching edematous tissue attachment .
• Avoid over-stretching weak muscles
Passive Stretching proximal ang in stabilize
Intervention to increase mobility of soft tissues tapos distal ang i m move
Self stretching stabilize mo distal move is
• manual or mechanical/passive or proximal
assisted stretching
• Self-stretching Intensity- magnitude of the stretch force
• Neuromuscular facilitation and applied.
inhibition techniques
• Muscle energy techniques -Low intensity stretching ( coupled with a long
• Joint, soft tissue or neural tissue duration of stretch) results in optimal rates of
mobilization/ manipulation improvement in rom.

Kung sino yung tight na muscle suya 15 seconds to 60 second madalas is only 15 or
dapat i contract kasi gutso mo siya yung 30 seconds. Low stretching mas madali 30 secs
mag fatigue so after non pwede na yung
opposing motion Example hamstrings 15 secs hold x 10 reps x 1 set

30 secs hold x 3 reps x 1 set

Duration- length of time the stretch force is Interventions to increase mobility of soft
applied during a stretch cycle. tissues w extra infos
- The shorter the duration of a single stretch Stretching: Manual or Mechanical/ Passive
cycle the greater the number of repetitions or Assisted
applied during a stretching session.
-elongation of shortened muscle tendon
and periarticular soft tissues
Ask the patient kung saan niya na f feel or san
dapat ma feel tapos ask the patient to count
-kapag passive stretching nakarelax
para malaman mo na na stretch na talaga. I -kapag assited stretching patient assists in
clarify din kung saan na stretch. moving the jt

Static stretching- method of stretching in which Self-stretching

soft tissues are elongated just past the point of -ginagawa sa bahay
tissue resistance and then held in lengthened
position with a sustained stretch force over a Neuromuscular Facilitation and Inhibition
period of time. 15 secs or 60 secs Techniques
-to relax tension in shortened muscles prior
Subdivision static progressive stretching to muscle elongation
Cyclic stretching- gradually short duration
-proprioceptive neuromuscular facilitation
stretch force that is repeatedly applied,
released and then reapplied
Muscle Energy Techniques
Speed- speed of initial application of the stretch -to lengthen muscle and fascia to mobilize
force joints
-postisometric relaxation
-gradual apply tapos pagbaba initial application Joint mobilization
of stretch force -to modulate pain and treat joint
impairments
Balistic- a rapid, forceful intermittent stretch Soft Tissue mobilization
that is high speed and high intensity stretch. -to improve muscle extensibility
e.g techniques
-for athletes -myofascial release
-acupressure
Frequency – number of stretching sessions per
-triggerpoint theraphy
day or per week.

Mode- form of manner in which the force is Nueral Soft tissue Mobilization
applied (static, ballistic, cyclic) (neuromeningeal mobilization)
-after trauma, surgical procedures,
- degree of patient participation (passive, adhesions and scar tissues.
assisted, active)
- the source of stretch force (manual,
mechanical, self)
SKILLS forearm supination and pronation
shoulder flexion to increase supination pronation
to increase shoulder flexion -stretch force to radius- rotating on ulna
stretch the extensors supinator and pronator quadratus
-stabilize scapula: to stretch teres major
-stabilize pelvis: to stretch latissimus dorsi wrist flexion
to increase wrist flexion
shoulder hyperextension stretch wrist extensors
-to increase shoulder hyperextension extensor digitorum
stretch shoulder flexors deltoid
wrist extension
shoulder abduction to increas wrist extension
-to increase shoulder abduction stretch wrist flexors
stretch shoulder adductors pecs major
radial deviation
shoulder adduction to increase radial deviation
rare lang stretch ulnar deviators flexor carpi ulnaris
kasi kapag upright naeelongate na rin yung
abductors so naaaduct na rin in neutral ulnar deviation
position to increase ulnar deviation
deltoid supraspinatus stretch radial deviators

shoulder external rotation cmc joint of thumb

-to increase shoulder extension to increase flexion: extensor pollicis brevis
stretch internal rotators: teres major to increase extension: flexor pollicis brevis
subscap to increase abduction: adductor pollicis
to increase adduction: abductor pollicis
shoulder internal rotation
to increase internal rotation mcp joint
stretch external rotation: infraspinatus to increase flexion: extensor indicis
teres minor to increase extension: lumbricals
to increase abduction: palmar
to increase adduction: dorsal na
shoulder horizontal abduction
to increase horizontal abduction
hip flexion
stretch adductor: pectoralis major
to increase hip flexion
stretch hip extensor gluteus max
elbow flexion (w shoulder flexed)
to increase elbow flexion
hip flexion with knee extension
stretch elbow extensors: long head of
to increase hip flexion with knee extension
triceps brachii
stretch leg flexor: hamstrings
hip extension ankle plantarflexion
to increase hip extension
stretch hip flexor ankle inversion eversion
iliopsoas
to stretch tibialis anterior
hip abduction -plantarflex and abduct
to increase hip abduction
stretch hip adductors: adductor longus To stretch tibialis posterior
brevis magnus -dorsiflex and abduct

hip adduction To stretch the peroneals

to increase hip adduction -invert the foot
stretch hip abductors: tensor fascia latae
and iliotibial band

hip external rotation

to increase hip external rotation
stretch internal rotators semiten semimem

hip internal rotation

to increase hip internal rotation
stretch external rotatos poosiq muscles

knee flexion
to increase knee flexion
stretch knee extensors
quads

knee extension
to increase knee extension
stretch knee flexors
biceps fem hamstrings

end range knee extension

ankle dorsiflexion w knee extended

to increase ankle dorsiflexion
stretch plantarflexor gastroc

ankle dorsiflexion w knee flexed

to increase ankle dorsiflexion
stretch plantarflexor soleus