The document outlines various therapeutic interventions designed to enhance soft tissue mobility and flexibility, including manual stretching techniques, self-stretching, and neuromuscular facilitation. It discusses the importance of determining appropriate stretching methods based on patient needs and circumstances, including potential risks of overstretching and joint instability. Overall, the document emphasizes a balanced approach to stretching that conserves mobility while maintaining stability for optimal functional performance.

1. STRECHING FO
STRECHING FOR IMPAIRED
MOBILITY

2. Interventions to Increase
Mobility of Soft Tissues

3. Intervention to increase mobility
• Many therapeutic interventions have been
designed to improve the mobility of soft
tissues and consequently increase ROM and
flexibility.
• There are situations in which stretching
interventions are appropriate and safe.
• There are also instances when stretching
should not be implemented.

4. Interventions to Increase Mobility of
Soft Tissues
1. Manual or Mechanical/Passive or Assisted
Stretching
2. Self-Stretching
3. Neuromuscular Facilitation and Inhibition
Techniques
4. Soft Tissue Mobilization and Manipulation
5. Muscle Energy Techniques
6. Joint Mobilization/Manipulation
7. Neural Tissue Mobilization (Neuromeningeal
Mobilization)

7. Manual or Mechanical/Passive or Assisted
Stretching
• A sustained or intermittent external, end-range
stretch force, applied with overpressure and by
manual contact or a mechanical device, elongates a
shortened muscle tendon unit and periarticular
connective tissues by moving a restricted joint just
past the available ROM.
• If the patient is as relaxed as possible, it is called
passive stretching.
• If the patient assists in moving the joint through a
greater range, it is called assisted stretching.

8. Manual or Mechanical/Passive or
Assisted Stretching
• Passive Stretching
• Assisted Stretching.

9. Self-Stretching
• Any stretching exercise that is carried out
independently by a patient after
instruction and supervision by a therapist
is referred as self-stretching.
• Active stretching is another term
sometimes used to denote self-stretching
procedures.

10. Self-Stretching

11. Neuromuscular Facilitation and
Inhibition Techniques
• Neuromuscular facilitation and inhibition
procedures are designed to relax tension in
shortened muscles reflexively prior to or during
muscle elongation.
• Use of inhibition techniques to assist with muscle
elongation is associated with an approach to
exercise known as proprioceptive neuromuscular
facilitation (PNF).
• Authors called such stretches as PNF stretching

12. PNF STRECHES

13. Muscle Energy Techniques
• MET are manipulative procedures,
• evolved out of osteopathic medicine
• Designed to lengthen muscle and fascia
and to mobilize joints.

14. MET
• The procedures employ voluntary muscle
contractions by the patient in a precisely
controlled direction and intensity against a
counterforce applied by the practitioner.
• Principles of neuromuscular inhibition are
incorporated, another term used to
describe these techniques is Post isometric
relaxation.

15. Joint Mobilization/Manipulation
• Joint mobilization/manipulation methods are
manual therapy techniques.
• Specifically applied to joint structures.
• Used to stretch capsular restrictions or
reposition a subluxed or dislocated joint.

16. Soft Tissue Mobilization and
Manipulation
• These techniques are designed
– to improve muscle extensibility and involve the
application of specific and progressive manual
forces (e.g. by means of sustained manual
pressure or slow, deep stroking)
• To effect change in the myofascial structures that can
bind soft tissues and impair mobility.
• Techniques, including friction massage,
myofascial release acupressure and
trigger point therapy.

17. STM

18. Neural Tissue Mobilization
(Neuromeningeal Mobilization)
• After trauma or surgical procedures, adhesions
or scar tissue may form around the meninges
and nerve roots or at the site of injury at the plexus
or peripheral nerves.
• Tension placed on the adhesions or scar tissue
leads to pain or neurological symptoms.
• After tests to determine neural tissue mobility
are conducted, the neural pathway is mobilized
through selective procedures.

19. Selective Stretching
• Overall function improved by
applying stretching techniques
selectively to some muscles and
joints.
• When determining which muscles is
to stretch,
• PT must always keep in mind the
functional needs of the patient and
the importance of maintaining a
balance between mobility and
stability for maximum functional
performance.

20. • Decision to allow restrictions to develop in
selected musculotendon units and joints is
usually made in patients with permanent
paralysis.
• E.g.
• In spinal cord injury patient, stability of the
trunk is necessary for independence in
sitting.

21. • With thoracic and cervical lesions, the patient does not
have active control of the back extensors.
• If hamstrings are routinely stretched to improve or
maintain their extensibility and moderate hypomobility is
allowed to develop in the extensors of low back,
• it will enables a patient to lean into the slightly shortened
structures and have some trunk stability for long-term
sitting.
• Patient must still have enough flexibility for independence in
dressing and transfers.
• Too much limitation of motion in the low back can
decrease function.

22. Overstretching and Hypermobility
• A stretch well beyond the normal length of muscle and
ROM of a joint and the surrounding soft tissues.
• Resulting in hypermobility.
– May be necessary for certain healthy individuals
with normal strength and stability participating in
sports that require extensive flexibility
– Overstretching becomes detrimental and creates
joint instability when muscles and supporting
structures are insufficient.
- Instability of a joint often causes pain and may
predispose a person to musculoskeletal injury.