Types of Stretching

 Static stretching
 Cyclic/intermittent stretching
 Ballistic stretching
 Proprioceptive neuromuscular facilitation stretching procedures
 Manual stretching
 Mechanical stretching
 Self-stretching
 Passive stretching
 Active stretching
 Types of Stretching

• 1- Static Stretching:
• Stretch the muscle to the point of slight or mild
discomfort (overload)
• Hold each stretch for 10 to 30 seconds
• Repeat the stretch 4 times
• Flexibility exercise sessions should occur 3 to 5
times per week
• Used for Manual Stretching technique
• Other terms used interchangeably are sustained,
maintained, or prolonged stretching.
 Types of Stretching
2- Cyclic (Intermittent) Stretching
• A relatively short-duration stretch force
that is repeatedly but gradually applied ,
released, and then reapplied is described as
a cyclic (intermittent) stretch

• is applied for multiple repetitions (stretch

cycles) during single treatment session.

• With cyclic stretching the end-range stretch

force is applied at a slow velocity, in a
controlled manner, and at relatively low
intensity.
 Types of
Stretching

3- Ballistic Stretching
A rapid, forceful intermittent stretch that
is, a high-speed and high-intensity stretch
is commonly called ballistic stretching.
It is characterized using quick, bouncing
movements that create momentum to
carry the body segment through the ROM
to stretch shortened structures.
 ballistic stretching is thought to cause
greater trauma to stretched tissues and
greater residual muscle soreness than
static stretching.
it is not recommended for elderly or
sedentary individuals or patients with
musculoskeletal pathology or chronic
contractures.
 Types of Stretching

4.Dynamic Stretching:
• Most dangerous of the stretching
procedures
• Involves the use of repetitive, bouncing.
• Virtually abandoned
• May lead to soreness and muscle injury
Types of
Stretching
5. Proprioceptive neuromuscular facilitation (PNF) Involves:
• Hold the isometric contraction 6 seconds
• Repeat 4 times each session
• 3-5 times per week
• PNF stretching techniques, sometimes referred to as active
stretching or facilitative stretching, integrate active muscle
contractions into stretching maneuvers purportedly to inhibit or
facilitate muscle activation and to increase the likelihood that the
muscle to be lengthened remains as relaxed as possible as it is
stretched.

• Types of PNF Stretching

• There are several types of PNF stretching procedures, all which
have been shown to improve ROM. They include:
• ■Hold-relax (HR) or contract-relax (CR)
• ■Agonist contraction (AC)
• ■ Hold-relax with agonist contraction (HR-AC)
1. Hold-Relax or Contract-Relax
 Reach to the range limiting target muscle is first
lengthened to the point of tissue resistance
 The patient then performs a prestretch, end-range,
isometric contraction (for about 5 seconds) followed
by voluntary relaxation of the range-limiting target
muscle.
 The limb is then passively moved into the new range
as the range-limiting muscle is elongated.
 Multiple repetitions of maximal prestretch isometric
contractions have been shown to result in an acute
increase in arterial blood pressure, most notably
after the third repetition.
 To minimize the adverse effects of the Valsalva
maneuver , the patient breathe regularly while
performing submaximal (low-intensity) isometric
contractions held for about 5 seconds with each
repetition of the HR

 PRECAUTION: It is not necessary for the patient to

perform a maximal isometric contraction of the
range-limiting target muscle prior to stretch.
2. Hold-Relax with Agonist Contraction
 This stretching technique combines the HR and AC procedures.
 The HR-AC technique is also referred to as the CR-AC procedure or slow reversal hold-relax
technique.
 To perform the HR-AC procedure:
₋ move the limb to the point that tissue resistance is felt in the range-limiting target muscle
₋ the patient perform a resisted, prestretch isometric contraction of the range-limiting muscle
followed by voluntary relaxation of that muscle and an immediate concentric contraction of the
muscle opposite the range-limiting muscle.

 Example:
a. to stretch knee flexors, extend the patient’s knee to a comfortable, end-range position
b. the patient perform an isometric contraction of the knee flexors against resistance for about 5
seconds.
c. Tell the patient to voluntarily relax and then actively extend the knee as far as possible
d. holding the newly gained range for several seconds.

 PRECAUTIONS: the same precautions as described for both the HR and AC procedures.
3. Agonist contraction (AC)

 The “agonist” refers to the muscle opposite the range-limiting target muscle.
 “Antagonist,” therefore, refers to the range-limiting muscle.
 To perform the AC procedure:
 the patient concentrically contracts (shortens) the muscle opposite the range-
limiting muscle and then holds the end-range position for at least several
seconds.
 The movement of the limb is controlled independently by the patient and is
deliberate and slow.
 the shortening contraction is performed without the addition of resistance.
 After a brief rest period, the patient repeats the procedure.
 For example: if the hip flexors are the range-limiting target muscle group, the
patient performs end-range, prone leg lifts by contracting the hip extensors
concentrically; the end-range contraction of the hip extensors is held for several
seconds.

 PRECAUTIONS:
₋ Avoid full-range
₋ Rest after each repetition to avoid muscle cramping
 Mode of Stretching

• Manual Stretching

• Self-Stretching

• Mechanical Stretching

• PNF stretching techniques

 Manual Stretching
• a therapist or other trained practitioner applies an external force to
move the involved body segment slightly beyond the point of tissue
resistance and available ROM.
• The therapist manually controls the site of stabilization as well as the
direction, speed, intensity, and duration of stretch.
• Stretching takes soft tissue structures beyond their available length to
increase ROM.
• Manual stretching usually employs a controlled, end-range, static or
progressive stretch applied at an intensity consistent with the patient’s
comfort level, held for 15 to 60 seconds and repeated for at least several
repetitions.
• Manual stretching may be most appropriate in the early stages of a
stretching program
• Manual stretching performed passively is an appropriate choice for a
therapist or caregiver if a patient cannot perform self-stretching
 Self-Stretching
• Self-stretching (also referred to as flexibility
exercises)
• is a type of stretching procedure a patient carries
out independently after careful instruction and
supervised practice.
• This form of stretching is often an integral
component of a home exercise program.
• Teaching a patient to carry out self-stretching
procedures correctly and safely is fundamental for
preventing re-injury or future dysfunction.
• Proper alignment of the body or body segments is
critical for effective self-stretching.
• Every effort should be made to see that restricted
structures are stretched specifically
• Static stretching with a 30- to 60-second duration
per repetition is considered the safest type of
stretching for a self-stretching program.
 Mechanical Stretching
• Mechanical stretching devices apply a very low intensity stretch
force (low load) over a prolonged period to create relatively
permanent lengthening of soft tissues.
• The equipment can be as simple as a cuff weight or weight-pulley
system
• These mechanical stretching devices provide either a constant
load with variable displacement or constant displacement with
variable loads.
• Mechanical stretching involves a substantially longer overall
duration of stretch than is practical with manual stretching or
self-stretching exercises.
• The duration of mechanical stretch ranges from 15 to 30 minutes.
• The longer durations of stretch are required for patients with
chronic contractures as the result of neurological or
musculoskeletal disorders
• Devices are commonly used for mechanical stretching:
₋ weight cuffs
₋ mechanical pulley devices with springs
₋ CPM and orthosis such as serial casts
₋ splints Mechanical device applying a static progressive stretch to
elbow flexors.
 serial cast

weight cuffs

mechanical pulley devices

splint
 Precautions for Stretching
1. Do not passively force a joint beyond its normal ROM.
2. Use extra caution in patients with:
o known or suspected osteoporosis due to disease
o prolonged bed rest
o age
o prolonged use of steroids.
3. Protect newly united fractures
4. Avoid vigorous stretching of muscles and connective
tissues(tendons and ligaments) 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.
6. Avoid stretching edematous tissue
7. Avoid overstretching weak muscles
 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.
 Principles of Stretching
1. Alignment: positioning a limb or the body such that the stretch force is directed to the
appropriate muscle group.
2. Stabilization: fixation of one site of attachment of the muscle as the stretch force is applied to
the other bony attachment.
3. Intensity of stretch: magnitude of the stretch force applied (stretching should be applied at a
low intensity by means of a low load.)
4. Duration of stretch: length of time the stretch force is applied during a stretch cycle (the
period of time a stretch force is applied, and shortened tissues are held in a lengthened
position).
5. Speed of stretch: speed of initial application of the stretch force (should be slow and
released gradually)
6. Frequency of stretch: number of stretching sessions per day or per week.
 The recommended frequency of stretching is often based on:
 the underlying cause of impaired mobility
 the quality and level of healing of tissues
 the chronicity and severity of a contracture
 a patient’s age.
 3 to 5 repetitions per session and done 3 times a week is considered as adequate for gaining
improvements in the flexibility of soft tissues.