Transcript Application of Manual Stretching Procedures

Dpt 5th semester
AZRA NAHEED MEDICAL COLLEGE
PNF technique (PNF stretching) integrate
 active muscle contractions into stretching
procedure
 muscle fibers are reflexively inhibited through
autogenic or reciprocal inhibition,
 Results in less resistance to elongation by the
contractile
elements of the muscle
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types of PNF stretching procedures include:
Hold–relax (HR) or contract–relax (CR)
Agonist contraction (AC)
Hold–relax with agonist contraction (HR-AC).
hold–relax (HR) procedure,
range-limiting muscle is first lengthened to the
point of limitation.
 patient then performs a prestretch, end-range,
isometric contraction (for 5 to 10 seconds)
 followed by voluntary relaxation of the tight
muscle.
 limb is then passively moved into the new range
as the range-limiting muscle is elongated.
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The “agonist”refers to the muscle opposite
the range-limiting muscle.
“Antagonist,” therefore, refers to the rangelimiting muscle.
short muscle (the antagonist) preventing the
full movement of the prime mover (the
agonist).
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procedure
patient concentrically contracts (shortens)
the muscle opposite the rangelimiting muscle and then holds the end-range
position
the antagonist (the range- limiting muscle) is
reciprocally inhibited, allowing it to relax and
lengthen
Contraction is slow, not ballistic.
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if the hip flexors are tight, prone leg lifts by
contracting the hip extensors
end-range contraction is held for a number
of seconds.
After a brief rest period, the patient repeats
the procedure.
The HR-AC stretching technique combines the HR
and
AC procedures.
HR-AC procedure
 move the limb to the point that tissue resistance is
felt in the tight (range-limiting) muscle
 prestretch isometric contraction of the rangelimiting muscle
 followed by relaxation of that muscle and
 immediate concentric contraction of the muscle
opposite the tight muscle.
(A, B) Stretching-induced gains in ROM are used during
daily activities
Examination and Evaluation of the Patient
 review the patient’s history and perform a
thorough systems review.
 perform appropriate tests
 Determine the ROM
 Evaluate which soft tissues are the source
of the impaired mobility.
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differentiate between joint capsule,
periarticular noncontractile tissue, and
muscle length restrictions as the cause of
limited ROM.
assess joint play and fascial mobility.
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Evaluate the irritability of the involved tissues
determine their stage of healing.
patient’s reaction to movements.
stage of healing of involved tissues, helps to
determine the probable dosage (such as intensity
and duration)
Assess strength of muscles in which there is
limitation.
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determine what outcome goals (i.e.,
functional improvements) the patient wants
Analyze any factors that could adversely
affect the outcomes of the stretching
program.
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Review the goals & outcomes of the stretching
Obtain the patient’s consent
Select the stretching techniques
Warm up the soft tissues to be stretched
Warming up tight structures increase their
extensibility and decrease the injury risk from
stretching.
patient asssume a comfortable, stable position
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Explain the procedure to the patient
Free the of any restrictive clothing,bandages,
or splints.
Explain to the patient to be as relaxed as
possible or assist when requested.
Explain that stretching procedures is upto
tolerance level of patient
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Move the extremity to the point of tissue
restriction.
Grasp the areas proximal and distal to the
joint.
The grasp should be firm but not
uncomfortable for the patient.
Use padding, if necessary
Use the broad surfaces of your hands to
apply all forces.
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To stretch a multijoint muscle, stabilize either
the proximal or distal segment to which the
range-limiting muscle attaches.
incorporate prestretch, isometric contraction
of the range-limiting muscle (the hold–relax
procedure) to relax the muscle.
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To avoid joint compression during the
stretching procedure, apply gentle (grade I)
distraction
Apply a low-intensity stretch in a slow,
sustained manner.
Maintain the stretched position for 30
seconds or longer.
Gradually release the stretch force
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use slow, gentle, intermittent stretches If the
patient can not tolerate a sustained stretch,
apply soft tissue mobilization procedures,
such as fascial massage or cross-fiber friction
massage, at or near the sites of adhesion
during the stretching
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Apply cold to the soft tissues that have been
stretched
allow these structures to cool in a lengthened
posi-tion.
Cold may minimize poststretch muscle
soreness
cooled in a lengthened position, increases in
ROM are more readily maintained.
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use the gained range by performing
functional movement patterns
Develop a balance in strength in the muscles
in the new range
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General Precautions
Do not passively force a joint beyond its normal
ROM.
 Use extra caution in patients with known or
suspected osteoporosis
 Protect newly united fractures; be certain
there is appropriate stabilization between the
fracture site and the joint
 Avoid vigorous stretching of muscles and
connective tissues that immobilized for an
extended period of time.
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Progress the dosage (intensity, duration, and
frequency) of stretching gradually to prevent
injury.
joint pain or muscle soreness lasting more
than 24 hours after stretching, too much
force has been used during stretching,
causing an an inflammatory response.
This causes increased scar tissue formation.
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Avoid stretching edematous tissue, as it is
more suscepti-ble to injury than normal
tissue.
Avoid overstretching weak muscles
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Proprioceptive Neuromuscular
Facilitation Stretching Techniques
Procedural guidelines for application of
stretching interventions
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Examination and Evaluation of the Patient
Preparation for Stretching
Application of Manual Stretching Procedures
After Stretching
PRECAUTIONS FOR STRETCHING
 General precaution