Mobility and Flexibility of soft tissues (muscles, tendons, fascia, joint capsule, and skins) surrounding the joint along with adequate joint mobility, are necessary for normal ROM. Mobility: is the ability of segments of the body to move through range of motion for functional activities. Flexibility: is the ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain –free ROM.

1. Stretching Exercises

2. Mobility and Flexibility of soft tissues (muscles, tendons, fascia,
joint capsule, and skins) surrounding the joint along with
adequate joint mobility, are necessary for normal ROM.
 Mobility: is the ability of segments of the body to move
through range of motion for functional activities.
 Flexibility: is the ability to move a single joint or series of
joints smoothly and easily through an unrestricted, pain –free
ROM.

3. Types of Flexibility
1. Dynamic flexibility: (active mobility or active ROM )
It is the degree to which an active muscle contraction
moves the a body segment through the available ROM
of the joint.
It depends on:
 The degree to which joint can be moved by a muscle
contraction
 The amount of soft tissue resistance met during the
active movement.

4. 2. Passive flexibility (passive mobility or passive ROM )
It is the degree to which a joint can be passively moved through the available
ROM.
It depends on:
- extensibility of muscles and connective tissues (soft tissues ) that crosses and
surrounding a joint.
Types of Mobility
1- Hypo-mobility: Refers to decreased mobility or restricted motion.
2- Hyper-mobility: Refers to increased mobility

5. Factors that influence flexibility
1- Joint structure
 The type of joint determine the degree of
ROM. For example; a ball-and-socket
joint, like shoulder has greater ROM than
a hinge joint like wrist.
2- Age
 With age, muscles go through a
shortening process due to lack of physical
activities and a loss of elasticity in the
connective tissues surrounding the
muscles. As a result, there tends to be a
decrease in flexibility with age.

6. Factors that influence flexibility
3- The Elasticity
 The elasticity of the skin, tendons
and ligaments, (ligaments do not
stretch much and tendons should
not stretch at all).
4-Gender
 Females tend to be more flexible
than males of similar age
throughout life, generally due to
anatomical variations in joint
structures.

7. Factors that influence flexibility
5-Exercise
 Participation in regular exercise involving
full ROM generally enhances flexibility,
while a sedentary lifestyle often results in
diminished flexibility.
6-Muscle mass
 muscle mass can be a factor when the
muscle is so heavily developed that it
interferes with the ability to take the
adjacent joints through their complete range
of motion (for example, large hamstrings
limits the ability to fully bend the knees).
Excess fatty tissue imposes a similar
restriction.

8. Factors that influence flexibility
7-Temperature
 An increase in either body temperature as a
result of exercise or external temperature
increases ROM.
8-Pregnancy
 During pregnancy, the pelvic joints and
ligaments are relaxed and capable of a
greater ROM.

9. Causes of soft tissue Shortening
1- Prolonged Immobilization due to:
A. Extrinsic factors
* casts and splint
* skeletal traction
B. Intrinsic factors
* pain
* joint inflammation &stiffness
* skin &muscle disorders
* bony block
* vascular disorders

10. Causes of soft tissue shortening
2- Sedentary lifestyle due to bed rest, work environment
3- Muscle imbalance, paralysis or tone abnormality
4- Postural malalignment which may be
* congenital
* acquired
e.g. Scoliosis, Kyphosis

11. # Contracture it is not equal to Contraction
Contracture
 Is the adaptive shortening of the muscle-tendon unit
and other soft tissues that crosses or surround a joint
that results in significant resistance to passive or active
stretch and limitation of ROM
Contraction
 The process of tension developing in a muscle during
shortening or lengthening

12. Types of Stretching
1- Passive stretching
2- Active (Neuromuscular) Inhibition stretching.
3- Self stretching
4- Ballistic stretching.

13. 1- Passive Stretching
 A sustained external force applied at the end –range manually or
mechanically to elongates a shortened muscle-tendon unit, while
the patient is relaxed. This type can be classified into:
 The tension created in a muscle during ballistic stretch is nearly
twice that created with low- intensity static (sustained) stretch.
 When a gentle passive stretch position is held for at least 30 to 60
second, the facilitatory effect of stretch reflex on muscle appear to
be minimal as the inhibitory action of the GTO may override the
facilitatory effect of stretch reflex, so that there is no increase in
muscle tension.

14. a- Manual Passive Stretch
 The therapist applies an external force and controls the
direction, speed, intensity and duration of stretch to shorten
soft tissues beyond their resting length.
 This technique should not be confused with passive range of
motion exercises. Passive stretching takes the structures
beyond the free range of motion. Passive range of motion is
applied only within the unrestricted available range.

15.  The patient must be as relaxed as possible during passive
stretching.
 The stretch force is usually applied for at least 15 to 30
seconds and repeated several times in an exercise session.
 The intensity and duration of the stretch are dependent on the
patient's tolerance and the therapist's strength and endurance.
A low-intensity manual stretch applied for as long a duration
as possible will be more comfortable and more readily
tolerated by the patient.

16. b- Prolonged Mechanical Passive Stretch
 2- Prolonged mechanical passive stretching
 A low intensity external force is applied over a prolonged period of time with
mechanical equipment.
 The stretch force is applied with the patient as relaxed as possible.
 The stretch may be maintained for 15-30 minutes or as long as several days or
weeks, depending on the type of apparatus used.
 The stretch can be applied through positioning of the patient, with weighted
traction and pulley systems, or with serial splints or casts.

17. C-Cyclic (Intermittent) stretch
*A short duration stretch force, repeatedly but gradually
applied, released, and then reapplied using mechanical
device.
*Each cycle of stretch is held between 5-10 seconds at the
end-range, which is applied gradually at a controlled
manner and at a relatively low intensity. These cyclic
stretching is applied for many repetitions in each single
treatment session.
*This type of stretching showed that it is more effective
and comfortable than a prolonged static stretch.

18. 2- Active (Neuromuscular) Inhibition stretching
 These procedures reflexively relax the tension in shortened
muscles prior to or during stretching maneuver.
 When a muscle is reflexively inhibited, there is less resistance
to elongation by the contractile unites of the muscle.
 Inhibition techniques increase muscle length by relaxing and
elongating the contractile components of muscle.
 This type of stretching is only done with normally innervated
muscle and under voluntary control.
 It can not be used in patient with severe muscle weakness,
spasticity, or paralysis from neuromuscular dysfunction.

20.  For example; where you assume a position and then hold it there
with no assistance other than using the strength of agonist
muscles. E.g., bringing your leg up and then holding it there
without anything, other than your leg muscles itself, to keep the
leg in that extended position. The tension of the agonists in an
active stretch helps to relax the muscles being stretched
(antagonists) by reciprocal inhibition. Active stretches are hold
and maintained for 10 to 15 seconds.
 These techniques have been adapted from Proprioceptive
neuromuscular facilitation (PNF) techniques.
 There are three variations of neuromuscular inhibition
techniques:
1- Contract-relax (Hold- relax).
2- Contract-relax- contract (Hold- relax with agonist contraction).
3- Agonist contraction.

21. 3- Self Stretching
 Also known as flexibility exercises or active stretching.
 Self stretching is a type of flexibility exercise that a patient
can carry out himself as an integral component of a home
exercise program.
 It may involve relaxation of muscle and a passive stretch
applied through the weight of the body.
 Self stretching can also be carried out actively by the patient
first inhibiting and then lengthening the tight muscle.

22. 4- Ballistic stretching
 A rapid, forceful intermittent, high-speed and high-
intensity stretch.
 Vigorous bouncing movement to force the body
segment beyond its range of motion to stretch shortened
structures.
 It is not advised because the high-velocity and high-
intensity movements are difficult to control and can
lead to injury in weakened tissues.

23. Goals of Stretching
1- Regain normal range of motion of joints and mobility of
soft tissue that surrounding that joint.
2- Prevent irreversible contractures.
3- Increase the general flexibility of muscle and soft tissues
before vigorous strengthening exercises.
4- Minimize and prevent the risk of musculo-tendinous
injuries related to specific physical activities and sports.

24. Indications of Stretching
1- Limited range of motion due to contractures, adhesions and scar
tissue formation leading to shortening of muscles, ligaments,
connective tissue and skin.
2- When there are structural (skeletal) deformities as a result of
limitation.
3- Whenever contracture interfere with activities of daily living
(ADL).
4- When there is muscle imbalance (muscle weakness and opposing
tissue tightness). Tight muscle must be stretched first before
strength of weak muscle.
5- As part o a total fitness program.
6- Prior to and after vigorous exercise to minimize postexercise
muscle soreness.

25. Contra-indications of Stretching
1- Presence of bony block that limits joint motion.
2- Recent fracture.
3- Cases of acute inflammation or infection
(presence of heat swelling around the joint).
4- Presence of acute sharp pain with joint
movement or muscle elongation.
5- in case of hematoma and hypermobility.

26. The Overload / FITT Principle
 (F) Frequency Stretch each muscle group daily or at least
3 times a week.
 (I) Intensity You must stretch the muscle beyond its
normal length.
 (T) Time Hold each stretch for 10-30 seconds, rest
for 10 seconds and repeat 3 to 4 times.
 (T) Type Static Stretching for various muscles

27. Safety Concerns
 Always Warm-up prior to stretching.
 Do not stretch swollen joints or joints that are
hyper-mobile.
 Stop if you are feeling pain.
 Avoid dangerous exercises
(especially with the back and neck.)

28. Principle of Progression
 Gradually Increase the intensity –stretch farther and hold
longer as you progress.

29. Principle of Specificity
 Flexibility exercises improve
only the specific muscles at
the specific joints that you
stretch. To develop overall
flexibility, you must stretch
all the muscles that need
stretching.

30. Establish Good Habits
 Remember:
What you do, determines what your flexibility is
like.
Poor posture and lack of flexibility can become
permanent.

31. Flexibility is Important!!!
Stretch daily and test yourself often for improved
function and improved health and wellness.

32. TECHNIQUES

33. STRETCH OF PECTORALIS MUSCLE
 TEST PECTORALIS FLEXIBILITY

34. PECTORALIS FLEXIBILITY

35. SHOULDER ROTATOR CUFF
The Rotator Cuff: the Teres Minor, the
Infraspinatus, the Supraspinatus and the
Subscapularis.

36. PECTORALIS TARGET STRETCH
place your palm flat
on the wall, keep
your weight in your
heels, and lean the
whole body forward.
Use the hand on the
wall as your anchor,
and feel the stretch
along the front of
the chest and
armpit.

37. PECTORALIS TARGET STRETCH
• Lower your hand to about
shoulder height, palm facing the
wall, stretching the hand behind
you. Then turn the whole body
away from the wall, pointing the
feet, knees, and hips away from
the hand. Feel the stretch across
the front of the chest and inner
arm.

38. STRETCH OF PECTORALIS
MUSCLE
• 1- FROM STANDING POSITION

48. Stretching of Lower Limb
 Test of hip flexors shortening (Thomas test)

49. Iliopsoas Stretching

50. Passive Stretch of The Hip Flexors

52. OBER'S TEST FOR ILIOTIBIAL BAND
FLEXIBILITY
 Ober's test is the test for tightness of the ITB.
 The subject is placed on their side, healthy side down. The knee is
flexed 90 degrees and the hip extended to neutral (no flexion).

53. OBER'S TEST FOR ILIOTIBIAL BAND
FLEXIBILITY
 The PHYSIOTHERAPIST holds the leg up by the
foot. Normally, the knee falls down to the exam
table. If the ITB is very tight, the leg hangs up in
the air (very impressive). If it's moderately tight,
the knee falls halfway to the table.

54. MODIFIED OBER'S TEST

55. Iliotibial Band Flexibility

56. STRETCHING OF HIP ADDUCTORS

57. STRETCHING OF HIP ADDUCTORS AND
HAMSTRING

58. TEST OF HAMSTRING FLEXIBILITY

60. HAMSTRING FLEXIBILITY

61. FLEXIBILITY OF HAMSTRING AND CALF
MUSCLES

62. FLEXIBILITY OF HAMSTRING AND CALF
MUSCLES

63. STRETCHING OF CALF MUSCLE

64. Calf Stretching

65. SELF STRETCHING

66. Stretch of Upper Trunk

67. Lower back flexibility

68. Gluteus flexibility

69. Iliopsoas Flexibility

70. Iliopsoas Flexibility

71. Iliotibial Band flexibility

72. Iliotibial Band flexibility

73. Hamstring Stretching

74. Hip Adductors Stretching

75. Calf stretching