therapeutic exercise

1. Stretching for impaired
mobility
Procedural Guidelines for
Application of Stretching
Interventions
Precautions for Stretching
Adjuncts to Stretching
Interventions
Manual Stretching Techniques
in Anatomical Planes of
Motion

2. Procedural Guidelines for Application of
Stretching Interventions
 Examination and evaluation
 Preparation for stretching
 Application manual stretching procedure
 After stretching

3.  Examination and evaluation
History Tests and
measurement
Limitation
ROM
How it will affect
mobility

4. Determine source of limitation differentiate between muscle, joint
capsule, ligament tendon or intra-articular structure.
Evaluate the irritability of the involved tissues and determine their stage
of healing
Assess the underlying strength of muscles
Through evaluation we had to determine the out come required from
stretching

5.  Preparation for stretching
Select the stretching techniques
Warm up the soft tissues to be
stretched
Positioning for patient
Explain the procedure to the patient
Free the area to be stretched of any
restrictive clothing, bandages, or
splints

6.  Application manual stretching procedure
1-Move the extremity slowly through the free range to the point of tissue
restriction.
2-Grasp the areas proximal and distal to the joint in which motion is to occur.
3-Firmly stabilize the proximal segment (manually or with equipment) and
move the distal segment.
4-To stretch a multi-joint muscle
a. stabilize either the proximal or distal segment to which the range-limiting muscle
attaches.
b. Stretch the muscle over one joint at a time and then over all joints simultaneously until
the optimal length of soft tissues is achieved.
c. To minimize compressive forces in small joints, stretch the distal joints first and
proceed proximally.

7. 5-Consider incorporating a pre-stretch, isometric contraction of the range-limiting muscle
(the hold-relax procedure) theoretically designed to relax the muscle reflexively prior to
stretching it.
6-To avoid joint compression during the stretching procedure, apply gentle (grade I)
distraction to the moving joint.
7-Apply a low-intensity stretch in a slow, sustained manner.
8-Maintain the stretched position for 30 seconds or longer.
9-Gradually release the stretch force.

8.  After stretching
Cold application
Strengthening
exercise
Antagonist Agonist

9. Precautions for Stretching
1-Do not passively force a joint beyond its normal ROM.
2-Use extra caution in patients with known or suspected osteoporosis
3-Protect newly united fractures.
4-Avoid vigorous stretching of muscles and connective tissues that have been
immobilized for an extended period of time.
5-Progress the dosage (intensity, duration, and frequency) of stretching
interventions gradually to minimize soft tissue trauma and post exercise
muscle soreness.

10. 6-Progress the dosage (intensity, duration, and frequency) of stretching
interventions gradually to minimize soft tissue trauma and post exercise
muscle soreness.
If a patient experiences joint pain or muscle soreness lasting more than
24 hours after stretching, too much force has been used during
stretching, causing an inflammatory response. This, in turn, causes
increased scar tissue formation. Patients should experience no more
residual discomfort than a transitory feeling of tenderness

11. 7-Avoid stretching edematous tissue.
8-Avoid overstretching weak muscles, particularly those that support body
structures in relation to gravity.
Common Errors and Potential Problems
1-Nonselective or poorly balanced stretching activities.
2-Insufficient warm-up.
3-Use of ballistic stretching.
4-Excessive intensity.(no pain no gain)
5-Abnormal biomechanics.
6-Insufficient information about age-related differences.

12. • the “hurdler’s” stretch is
designed to stretch unilaterally
the hamstrings of one lower
extremity and the quadriceps
of the opposite extremity but
imposes unsafe stresses on the
medial capsule and ligaments
of the flexed knee

13. Adjuncts to Stretching Interventions
• Relaxation Training
 Complementary Exercise Approaches
• Pilates
 Heat
 Cold
 Massage
 Biofeedback
 Joint Traction or Oscillation

14. Manual Stretching Techniques in Anatomical
Planes of Motion