Go to Basic Stretch & Strengthen Patient Handouts
Stretching is the deliberate lengthening of muscles, fascia & soft tissues, in order to increase flexibility and range of motion (tissue contracture or scar formation can be reduced); it is crucial to ask patients to demonstrate the stretches they are performing to ensure proper technique & injury avoidance (during the initial visit and on follow up visits)
Stretches should be held for 15-30 seconds or if the tissue release is felt & performed after a mild warm up (after activity or 5 minute walk or jumping on place). Long held stretches prior to physical activity actually increases the risk of injury! You are far better off to perform a range of motion warm-up prior and stretch following activity.
Dr. Nikita Vizniak
Stretching is a fundamental way to improve your overall health & fitness, possible effects include:
- Increased flexibility, range of motion & circulation; muscle relaxation
- Reduced risk for injury, reduced muscle imbalance & joint hypomobility
- Decreased anxiety & stress; can give patients an overall feeling of well being
- Basic yoga is an excellent way to bring stretching with balance into your body
Warm up – do a large muscle warm-up such as brisk walking for 5-10 minutes before stretching
Basic technique – simply move the origin & insertion of a muscle away from each other until tension is felt in the muscle (this basic premise can be applied to every muscle or any other tissue in the body)
Perform balanced stretching – always stretch the muscles on both sides of your body evenly; do not stretch one side more than the other side – balance is key
Avoid over stretching – never stretch to the point of extreme pain or discomfort (over stretching can cause a muscle strain or even ligament sprain). Recent studies have shown that over stretching before physical activity may actually increase the risk of injury (sprain/strain)
Go slow – stretch slowly & hold the stretch for about ~30 seconds & release slowly as well
Do not bounce or jerk while stretching – this can cause injury as a muscle is pushed beyond its normal anatomical range (stretches should be smooth, & slow)
Breathe – flexibility exercises should be relaxing; deep, easy, even breathing is key to relaxation (never hold your breath while you stretch)
Selected Stretching Techniques
Passive stretching is a form of static stretching in which an external force exerts upon the limb to move it into the new position. Passive stretching resistance is normally achieved through the force of gravity on the limb or on the body weighing down on it.
Active stretching involves the use of muscle contraction to facilitate increased stretching & is usually based around the two main principles of reciprocal inhibition & autogenic inhibition
Static stretching is used to stretch muscles while the body is at rest. Muscles are gradually lengthened to an elongated position (to the point of mild discomfort) & hold that position for 10-30 seconds. When done properly, static stretching slightly lessens the sensitivity of tension receptors, which allows the muscle to relax & to be stretched to greater length – this may also predispose to potential injury if long stretches are held prior to vigorous physical activity.
Dynamic stretching is a form of moving stretches similar to what one does when they wake from sleep; the body is moving through ranges of motion. Dynamic stretches are useful in developing neuro-muscular coordination for movements such as leg lifts, dance movements, kicks, & development of speed & power. Forcing static-passive stretching ability beyond this range of motion becomes ballistic stretching.
Ballistic stretching (or bouncing stretches) forces the limb into an extended range of motion when the muscle has not relaxed enough to enter it. This may cause injury if not controlled properly or there is no adequate preparation or warming up. Some believe that controlled ballistic stretching in the form of bouncing can increase flexibility. This is true to a certain extent, but this could cause injury & is not the safest method of stretching (though it may lead to quick gains). It may also lead to higher levels of flexibility that may not normally be attainable.
Pin & Stretch and Muscle Energy Technique
Pin & Stretch treatments can be adapted & applied to any myofascial or soft tissue structure if the clinician has a detailed understanding of basic anatomy & biomechanics
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Clinician places muscle in shortened position (origin & insertion as close together as possible) & pins specific myofascial fibers with other hand
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Patient is then passively moved to lengthen muscle or other soft tissue (move insertion away from origin) while pinning force is maintained
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Hold at tension for ~10 sec or until release is felt; repeat & reassess as needed
Reference: Vizniak, NA.Physical Medicine. Professional Health Systems Inc. 2014
