a.
COLLEGE OF PHYSICAL THERAPY
DMMC-IHS
Definition of terms
Mobility: Ability to move.
Functional ROM
• The ability of structures or segments of the body to
move or be moved to allow the presence of range of
motion for functional activities
Functional mobility
• The ability of an individual to initiate, control, or
sustain active movements of the body to perform
simple to complex motor skills
Flexibility
 The ability to move a single joint or series of joints
smoothly and easily through an unrestricted, pain-free
ROM
Dynamic flexibility
• Active mobility or active ROM
• The degree to which an active muscle contraction
moves a body segment through the available ROM of a
joint
Passive flexibility
• Also referred to as passive mobility or passive ROM
• The degree to which a joint can be passively moved
through the available ROM and is dependent on the
extensibility of muscles and connective tissues that
cross and surround a joint.
Stretching
• is a general term used to describe any therapeutic
maneuver designed to increase the extensibility of soft
tissues, thereby improving flexibility by elongating
(lengthening) structures that have adaptively
shortened and have become hypomobile overtime.
Hypomobility (restricted motion)
• Caused by adaptive shortening of soft tissues can
occur as the result of many disorders or situations
FACTORS FOR HYPOMOBILITY
1. Prolonged Bed rest/immobilization of a body segment.
2. Sedentary lifestyle
3. Postural mal alignment and muscle imbalances
4. Impaired muscle performance (weakness)
associated with an array of musculoskeletal or
neuromuscular disorders.
5. Tissue trauma resulting in inflammation and pain
6. Congenital or acquired deformities
Contractures
• Adaptive shortening of the muscle-tendon unit and
other soft tissues that cross or surround a joint that
results in significant resistance to passive or active
stretch and limitation of ROM, and it may compromise
functional abilities
Interventions to Increase Mobility of Soft Tissues
 Manual or Mechanical/Passive or Assisted
Stretchingpassive stretching and Assisted stretching
 Self-Stretching/Active Stretching
 Neuromuscular Facilitation and Inhibition Techniques
 Muscle Energy Techniques
 Joint Mobilization/Manipulation
 Soft Tissue Mobilization and Manipulation
Copyright 2021
Subject: Therapeutic Exercises 101
Notes on: Stretching Exercise
Muscle tightness: Adaptive shortening of the contractile and
non contractile elements of muscle.
Shortness is used to denote partial loss of motion.
Types of contracture
 Myostatic Contracture:(myogenic) contracture
 Pseudomyostatic Contracture
 Arthrogenic Contractures
 Periarticular Contractures
 Fibrotic Contracture and Irreversible Contracture
Indications and contraindications
Indications for Use of Stretching
 ROM is limited because soft tissues have lost their
extensibility as the result of adhesions, contractures,
and scar tissue formation, causing functional
limitations or disabilities.
 Restricted motion may lead to structural deformities
that are otherwise preventable.
 There is muscle weakness and shortening of opposing
tissue.
 May be used as part of a total fitness program
designed to prevent musculoskeletal injuries.
 May be used prior to and after vigorous exercise
potentially to minimize post-exercise muscle soreness.
Contraindications to Stretching
 A bony block limits joint motion.
 There was a recent fracture, and bony union is
incomplete.
 There is evidence of an acute inflammatory or infectious
process (heat and swelling) or soft tissue healing could
be disrupted in the tight tissues and surrounding
region.
 There is sharp, acute pain with joint movement or
muscle elongation.
 A hematoma or other indication of tissue trauma is
observed.
 Hypermobility already exists.
 Shortened soft tissues provide necessary joint stability
in lieu of normal structural stability or neuromuscular
control.
 Shortened soft tissues enable a patient with paralysis
or severe muscle weakness to perform specific
functional skills otherwise not possible.
 Neural Tissue Mobilization (Neuromeningeal
Mobilization)
Selective Stretching
• Is a process whereby the overall function of a patient
may be improved by applying stretching techniques
selectively to some muscles and joints but allowing
limitation of motion to develop in other muscles or
joints.
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 Failure
Mechanical Behavior of the connective tissue
• Rupture of the integrity of the tissue

Stress
Connective Tissue Responses to Loads
• Is force per unit area.
• Mechanical stress is the internal reaction or resistance
CREEP: Permanent elongation after application of load for an
to an external load.
extended time.

There are three kinds of stress:

• Tension: a force applied perpendicular to the cross-
sectional area of the tissue in a direction away from
the tissue.
• Compression: a force applied perpendicular to the
cross-sectional area of the tissue in a direction
toward the tissue.
• Shear: a force applied parallel to the cross-sectional
area of the tissue.
Cyclic loading and connective tissue fatigue: Repetitive
loading of tissue increases heat production and may cause
failure below the yield point.
STRESS RELAXATION: Decrease of muscle tension upon
prolonged stretch load.
DETERMINANTS, TYPES, AND EFFECTS OF STRETCHING
INTERVENTIONS

Strain 1. Alignment and Stabilization

 The amount of deformation or lengthening that occurs 2. Intensity of Stretch
when a load (stress) or stretch force is applied 3. Duration of Stretch
4. Speed of Stretch
Regions in the Stress and strain curve 5. Frequency of stretch
6. Mode of stretch
TOE REGION Types of stretching
• This is the range where most functional activity
normally occurs.  Static stretching
• Collagen fibers at rest are wavy and are situated in a  Cyclic/intermittent stretching
three-dimensional matrix, so some distensibility in the  Ballistic stretching
tissue occurs by straightening aligning the fibers  Proprioceptive neuromuscular facilitation stretching
Elastic range procedures(PNF stretching)
Definition  Manual stretching
• At the end of the ROM  Mechanical stretching
• Also known as the linear phase  Static stretching
Elastic Limit
 Cyclic/intermittent stretching
• Point Beyond which tissue does not return to its
 Ballistic stretching
original shape and size.
 Proprioceptive neuromuscular facilitation stretching
Plastic Range
procedures(PNF stretching)
 Range beyond the elastic limit extending to the point of
 Manual stretching
Rupture.
 Mechanical stretching
Ultimate strength
• The greatest load the tissue can sustain
ADJUNCTS TO STRETCHING INTERVENTIONS

 Relaxation Training
 Heat
 Biofeedback
 Massage
 Joint Traction or Oscillation

Suggestion:

Read the Therapeutic Exercise 6th edition by Kisner and Colby

for a more detailed discussions

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Copyright 2021