PT 113: INTRO TO THERAPEUTIC EXERCISE

Lecture 1: Stretching for Improved Mobility

Ms. Trisha Sandico, PT, PTRP, DPT – Faculty of Physical Therapy
1st Semester | Midterms | A.Y 2022 – 2023

INDICATIONS, CONTRAINDICATAIONS & OUTCOMES DETERMINANTS OF STRETCHING

Outcomes BOX 4.3 Determinants of Stretching Interventions

• Alignment – positioning a limb or the body such
➢ Restore or increase muscle-tendon unit extensibility
that the stretch force is directed to the
to regain or achieve the flexibility and ROM
appropriate muscle group
required for functional activities
o For Pt comfort and stability
Potential Benefits • Stabilization – fixation of a bony segment that
has an attachment of the muscle to be stretched
➢ Injury prevention and reduced post-exercise muscle
o w/o stabilization, attachment sites are
soreness
free to move with tissue, reducing the
➢ Enhanced performance
ability to effectively maximize the origin-
o increased muscular strength, power, or
insertion distance
endurance
• Intensity of stretch – magnitude of the stretch
o improvements in physical functioning
force is applied
BOX 4.1 INDICATIONS FOR STRETCHING o Apply at a low intensity by means of a
low load
1. ROM is limited because soft tissues have lost
▪ more comfortable for patient
their extensibility as the result of adhesions,
▪ minimizes voluntary or
contractures, and scar tissue formation, causing
involuntary muscle guarding,
activity limitations or participation restrictions
enabling the Pt to remain
2. Restricted motion may lead to structural
relaxed or assist with the
deformities that are otherwise preventable
stretching maneuver
3. Muscle weakness and shortening of opposing
• Duration of stretch – length of time the stretch
tissue have led to limited ROM
for is applied during a stretch cycle
4. May be a component of a total fitness or sport-
o Shorter duration of single stretch cycle,
specific conditioning program designed to
greater the number of repetitions
prevent or reduce the risk of musculoskeletal
needed during a stretch session
injuries
• Speed of stretch – rate of initial application of
5. May be used prior to and after vigorous exercise
the stretch force
o Slow rate = minimize muscle activation
BOX 4.2 CONTRAINDICATIONS TO STRETCHING during stretching and reduce the risk of
1. A bony block limits joint motion injury and post stretch muscle soreness
2. There was a recent fracture and bony union is • Frequency of stretch – number of stretching
incomplete sessions per day or per week
3. Evidence of acute inflammatory or infectious • Mode of stretch – form or manner in which the
process (heat and swelling), or soft tissue healing stretch force is applied
could be disrupted in the restricted tissues and
surrounding region
TYPES OF PNF STRETCHING
4. Sharp, acute pain w/ joint movement or muscle
elongation
5. Shortened soft tissues provide necessary joint Hold-Relax (HR) or Contract-Relax (CR)
stability in lieu of normal structural stability or
1. Lengthen range limiting muscle until point of tissue
neuromuscular control
resistant
6. Shortened soft tissues enable a patient with
2. Pt performs a pre stretch, end rage, isometric
paralysis or severe muscle weakness to perform
contraction of the range-limiting target muscle
specific functional skills otherwise not possible
against manual resistance applied by the PT
o Hold for 5 seconds → voluntary relaxation
of the target muscle
o Limb is then passively moved by the
clinician into the new range as the range-
limiting muscle is elongated
Agonist Contraction - Dynamic ROM or active stretching MANUAL STRETCHING TECHNIQUE IN ANATOMICAL
1. Pt concentrically contracts the muscle opposite the POM
range-limiting muscle
2. holds the end-range position for at least several
UPPER EXTREMITY STRETCHING
seconds
3. Movement of the limb is controlled by patient
(deliberate and slow) Shoulder: Special Considerations
• Agonist – muscle opposite the range-limiting muscle ➢ When muscles of the shoulder girdle are
• Antagonist – range limiting muscle stretched = stabilize scapula
o W/o this, some of the stretch force will be
Hold-Relax with Agonist Contraction transmitted to the ST muscles
1. Move the limb to the point of tissue resistance of the ▪ Limits effectiveness of applied
range limiting muscle stretch
2. Pt perform a resisted, pre-stretch isometric ▪ Disguise the actual ROM of GH
contraction of the range limiting muscle join
3. Voluntary relaxation of that muscle and an ➢ Remember
immediate concentric contraction of the muscle o Stabilized scapula (no protraction or UR)
opposite the range-limiting muscle = only 120 degrees of shoulder flexion
and abduction
APPLICATION FOR MANUAL STRETCHING o Humerus should be in ER to gain full ROM
of abduction
➢ Move the extremity slowly through the free range to o Muscles most apt to be shorten are those
the point of tissue restriction that prevent full shoulder flexion,
➢ Grasp the areas proximal and distal to the joint in abduction, and ER
which motion is to occur
➢ Firmly stabilize the proximal segment (manually or
Shoulder Flexion
with equipment) and move the distal segment
➢ To stretch a multi-joint muscle, stabilize either the ➢ Increase GH flexion = stretching extensors
proximal or distal segment to which the range-
limiting muscle attaches. Stretch the muscle over Hand Placement and Procedure
one joint at a time and then over all joints 1. Grasp the posterior aspect of the distal humerus just
simultaneously until the optimal length of soft above the elbow
tissues is achieved 2. Stabilize the axillary border of the scapula to stretch
➢ Consider incorporating a pre-stretch, isometric the teres major or stabilize the lateral aspect of the
contraction of the range-limiting muscle (the HR thorax and superior aspect of the pelvis to stretch
procedure) the latissimus dorsi.
➢ To minimize joint compression during the stretch, a 3. Move the patient’s arm into full shoulder flexion to
gentle (grade I) distraction to the moving joint can elongate the shoulder extensors
be applied
➢ Apply the stretch using a slow, sustained rate.
o Remember, the direction of the stretching
movement is directly opposite the line of
pull of the range-limiting muscle
➢ Maintain the stretch position for 30 seconds or
longer.
➢ Gradually release the stretch force and allow the
patient and therapist to rest momentarily while
maintaining the range-limiting tissues in a
comfortably elongated position.
o Then repeat the sequence several times.
➢ If the patient does not seem to tolerate a sustained
stretch, use several very slow, gentle, intermittent
stretches with the muscle in a lengthened position
 SHOULDER HYPEREXTENSION SHOULDER EXTERNAL ROTATION

➢ Increase GH hyperextension = stretch GH flexors ➢ Increase GH ER = stretch IRs

Hand Placement and Procedure Hand Placement and Procedure

1. Support the forearm and grasp the distal humerus.
2. Stabilize the posterior aspect of the scapula to
prevent substitute movements.
3. Move the patient’s arm into full hyperextension of
the shoulder to elongate the shoulder flexors
1. Abduct the shoulder to a comfortable position—
initially 30° or 45° and later to 90° if the GH joint is
stable—or place the arm at the patient’s side.
2. Flex the elbow to 90° so the forearm can be used as
a lever.
3. Grasp the volar surface of the mid-forearm with one
hand.
4. Stabilization of the scapula is provided by the table
on which the patient is lying.
5. Externally rotate the patient’s shoulder by moving
the patient’s forearm closer to the table. This fully
lengthens the internal rotators.

SHOULDER ABDUCTION

➢ Increase GH
abduction = stretch
adductors

Hand Placement and

Procedure

1. With the elbow flexed

SHOULDER INTERNAL ROTATION
to 90°, grasp the
distal humerus. ➢ To increase internal rotation of the shoulder, stretch
2. Stabilize the axillary the external rotators
border of the scapula.
Hand Placement and Procedure
3. Move the patient into
full shoulder 1. Abduct the shoulder to a comfortable position that
abduction to lengthen allows internal rotation to occur without the thorax
the adductors of the shoulder blocking the motion (initially to 45° and eventually
to 90°).
SHOULDER ADDUCTION
2. Flex the elbow to 90° so the forearm can be used as
➢ To increase adduction of the shoulder, stretch the a lever.
abductors 3. Grasp the dorsal surface of the mid-forearm with
➢ It is rare when a patient is unable to adduct the one hand, stabilize the anterior aspect of the
shoulder fully to 0° (so the upper arm is at the shoulder, and support he elbow with your other
patient’s side). forearm and hand.
➢ Even if a patient has worn an abduction orthotic 4. Move the patient’s arm into an internal rotation to
after a soft tissue or joint injury of the shoulder, lengthen the external rotators of the shoulder
when he or she is upright the constant pull of
gravity elongates the shoulder abductors so the
patient can adduct to a neutral position.
 SHOULDER HORIZONTAL ABDUCTION Patient Position, Hand Placement, and Procedure

➢ To increase horizontal abduction of the shoulder, 1. With the patient sitting

stretch the pectoralis muscles or lying supine with the
arm at the edge of the
Patient Position - To reach full horizontal abduction in the
table, flex the patient’s
supine position, the patient’s shoulder must be at the edge
shoulder as far as
of the table. Begin with the shoulder in 60° to 90° of
possible
abduction. The patient’s elbow may also be flexed
2. While maintaining
Hand Placement and Procedure shoulder flexion, grasp
the distal forearm and
1. Grasp the anterior aspect of the distal humerus. flex the elbow just past
2. Stabilize the anterior aspect of the shoulder. the point of resistance
3. Move the patient’s arm below the edge of the table to lengthen the long
into full horizontal abduction to stretch the head of the triceps.
horizontal adductors
ELBOW EXTENSION

➢ To increase elbow extension, stretch the elbow

flexors

Hand Placement and Procedure

1. Grasp the distal forearm.

2. With the upper arm at the patient’s side supported
on the table, stabilize the scapula and anterior
aspect of the proximal humerus.
3. Extend the elbow just past the point of tissue
resistance to lengthen the elbow flexors
SCAPULAR MOBILITY
NOTE: Be sure to do this with the forearm in supination,
➢ To have full shoulder motion, a patient must have
pronation, and neutral position to stretch each of the elbow
normal scapular mobility. (See the scapular
flexors
mobilization/manipulation techniques in Chapter 5.)
Patient Position, Hand Placement, and Procedure
The Elbow and Forearm: Special Consideration
➢ Several muscles that cross the elbow, such as the 1. With the patient lying supine close to the side of the
biceps brachii and brachioradialis, also influence table, stabilize the anterior aspect of the shoulder,
supination and pronation of the forearm or with the patient lying prone, stabilize the scapula.
➢ Therefore, when stretching the elbow flexors and 2. Pronate the forearm, extend the elbow, and then
extensors, the techniques should be performed extend the shoulder
with the forearm pronated as well as supinated.

ELBOW FLEXION

➢ To increase elbow flexion, stretch the one-joint

elbow extensors.

Hand Placement and Procedure

1. Grasp the distal forearm just proximal to the wrist.

2. With the arm at the patient’s side supported on the
table, stabilize the proximal humerus.
3. Flex the patient’s elbow just past the point of tissue
resistance to lengthen the elbow extensors.
➢ To increase elbow flexion with the shoulder flexed,
stretch the long head of the triceps
 FOREARM SUPINATION OR PRONATION
➢ To increase supination or pronation of the forearm
Hand Placement and Procedure
1. With the patient’s humerus supported on the table
and the elbow flexed to 90°, grasp the distal
forearm.
2. Stabilize the humerus.
3. Supinate or pronate the forearm just beyond the
point of tissue resistance.
4. Be sure the stretch force is applied to the radius
rotating around the ulna. Do not twist the hand,
thereby avoiding stress to the wrist articulations.
5. Repeat the procedure with the elbow extended. Be
sure to stabilize the humerus to prevent internal or
external rotation of the shoulder
The Wrist and Hand: Special Considerations
➢ The extrinsic muscles of the fingers cross the
wrist joint and therefore may influence the ROM
of the wrist.
➢ Wrist motion may also be influenced by the
position of the elbow and forearm because the
wrist flexors and extensors attach proximally on
the epicondyles of the humerus.
➢ When stretching the musculature of the wrist, the
stretch force should be applied proximal to the
metacarpophalangeal (MCP) joints, and the
fingers should be relaxed
Patient Position
➢ When stretching the muscles of the wrist and hand,
have the patient sit in a chair adjacent to you with
the forearm supported on a table to stabilize the
forearm effectively.
WRIST EXTENSION
➢ To increase wrist extension
Hand Placement and Procedure
1. Pronate the forearm or place it in mid-position and
grasp the patient at the palmar aspect of the hand.
If there is a severe wrist flexion contracture, it may
be necessary to place the patient’s hand over the
edge of the treatment table.
2. Stabilize the forearm against the table.
3. To lengthen the wrist flexors, extend the patient’s
wrist, allowing the fingers to flex passively
WRIST FLEXION
➢ To increase wrist flexion
Hand Placement and Procedure
1. The forearm may be supinated, in mid-position, or
pronated.
2. Stabilize the forearm against the table and grasp
the dorsal aspect of the patient’s hand.
3. To elongate the wrist extensors, flex the patient’s
wrist and allow the fingers to extend passively.
4. To further elongate the wrist extensors, extend the
patient’s elbow
RADIAL DEVIATION
➢ To increase radial deviation
Hand Placement and Procedure
1. Grasp the ulnar aspect of the hand along the fifth
metacarpal.
2. Hold the wrist in midposition.
3. Stabilize the forearm.
4. Radially deviate the wrist to lengthen the ulnar
deviators of the wrist
ULNAR DEVIATION
➢ To increase ulnar deviation.
Hand Placement and Procedure
1. Grasp the radial aspect of the hand along the
second metacarpal, not the thumb.
2. Stabilize the forearm.
3. Ulnarly deviate the wrist to lengthen the radial
deviators
The Digits: Special Considerations
➢ The complexity of the relationships among the
joint structures and the intrinsic and multijoint
extrinsic muscles of the digits requires careful
examination and evaluation of the factors that
contribute to loss of function in the hand because
of motion limitations.
➢ The therapist must determine if a limitation is
from joint restrictions, decreased muscle-tendon
unit extensibility, or adhesions of tendons or
ligaments.
➢ The digits should always be stretched
individually, not simultaneously.
➢ If an extrinsic muscle limits motion, lengthen it
over one joint while stabilizing the other joints.
Then, hold the lengthened position and stretch it
over the second joint, and so forth, until normal
length is obtained.
➢ Begin the motion with the most distal joint to
minimize shearing and compressive stresses to
the surfaces of the small joints of the digits
 CMC JOINT OF THE THUMB LOWER EXTREMITY STRETCHING

➢ To increase flexion, extension, abduction, or

adduction of the carpometacarpal (CMC) joint of The Hip: Special Considerations
the thumb ➢ Because muscles of the hip attach to the pelvis or
lumbar spine, the pelvis must always be stabilized
Hand Placement and Procedure
when lengthening muscles about the hip.
1. Stabilize the trapezium with your thumb and index ➢ If the pelvis is not stabilized, the stretch force is
finger. transferred to the lumbar spine and unwanted
2. Grasp the first metacarpal (not the first phalanx) compensatory motion results
with your other thumb and index finger.
3. Move the first metacarpal in the desired direction to
HIP FLEXION
increase CMC flexion, extension, abduction, and
adduction. ➢ To increase flexion of the hip with the knee flexed,
stretch the gluteus maximus
MCP JOINTS OF THE DIGITS
Hand Placement and Procedure
➢ To increase flexion, extension, abduction, or
adduction of the MCP joints of the digits 1. Flex the hip and knee simultaneously.
2. Stabilize the opposite femur in extension to prevent
Hand Placement and Procedure
posterior tilt of the pelvis
1. Stabilize the metacarpal with your thumb and index 3. Move the patient’s hip and knee into full flexion to
finger. lengthen the one-joint hip extensor
2. Grasp the proximal phalanx with your other thumb
HIP FLEXION W/ KNEE EXTENSION
and index finger.
3. Keep the wrist in midposition. ➢ To increase flexion of the hip with the knee
4. Move the MCP joint in the desired direction for extended, stretch the hamstrings
stretch.
Hand Placement and Procedure
5. Allow the interphalangeal (IP) joints to flex or
extend passively 1. With the patient’s knee fully extended, support the
patient’s lower leg with your arm or shoulder
PIP AND DIP JOINTS OF THE DIGITS
2. Stabilize the opposite extremity along the anterior
➢ To increase flexion or extension of the proximal and aspect of the thigh with your other hand or a belt or
distal interphalangeal (PIP and DIP) joints with the assistance of another person
3. With the knee at 0°
Hand Placement and Procedure
extension and the hip
1. Grasp the middle or distal phalanx with your thumb in neutral rotation, flex
and finger. the hip as far as
2. Stabilize the proximal or middle phalanx with your possible.
other thumb and finger.
3. Move the PIP or DIP joint in the desired direction for
stretch

Stretching Specific Extrinsic and Intrinsic Muscles of the

Fingers
➢ Elongation of extrinsic and intrinsic muscles of
the hand is described in Chapter 3.
➢ To stretch these muscles beyond their available
range, the same hand placement and Alternative Therapist
stabilization are used as with passive ROM. Position
➢ The only difference in technique is that the
➢ Kneel on the mat and place the patient’s heel or
therapist moves each segment into the stretch
distal tibia against your shoulder (see Fig. 4.25 B).
range
➢ Place both of your hands along the anterior aspect
of the distal thigh to keep the knee extended.
➢ The opposite extremity is stabilized in extension by
a belt or towel around the distal thigh and held in
place by the therapist’s knee.
 HIP EXTENSION HIP ABDUCTION

➢ To increase hip extension, stretch the iliopsoas ➢ To increase abduction of the hip, stretch the
adductors
Patient Position - Have the patient positioned close to the
edge of the treatment table so the hip being stretched can Hand Placement and Procedure
be extended beyond neutral. The opposite hip and knee are
1. Support the distal thigh with your arm and forearm.
flexed toward the patient’s chest to stabilize the pelvis and
2. Stabilize the pelvis by placing pressure on the
spine
opposite anterior iliac crest or by maintaining the
Hand Placement and Procedure opposite lower extremity in slight abduction.
3. Abduct the hip as far as possible to stretch the
1. Stabilize the opposite leg against the patient’s chest
adductors
with one hand or, if possible, have the patient assist
by grasping around the thigh and holding it to the
chest to prevent an anterior tilt of the pelvis during
stretching.
2. Move the hip to be stretched into extension or
hyperextension by placing downward pressure on
the anterior aspect of the distal thigh with your
other hand.
o Allow the knee to extend so the two-joint
rectus femoris does not restrict the range

Alternate Position - prone-lying position

HIP ADDUCTION
Hand Placement and Procedure
➢ To increase adduction of the hip, stretch the tensor
1. Support and grasp the anterior aspect of the
fasciae latae and iliotibial (IT) band
patient’s distal femur
2. Stabilize the patient’s pelvis with a downward force Patient Position - Place the patient in a side-lying position
on their buttocks. with the hip to be stretched uppermost. Flex the bottom hip
3. Extend the patient’s hip by lifting the femur off the and knee to stabilize the patient
table.
Hand Placement and Procedure

1. Stabilize the pelvis at the iliac crest with your

proximal hand.
2. With the knee flexed, extend the patient’s hip to
neutral or into slight hyperextension, if possible.
o Moving the hip into a small amount of
flexion and abduction prior to extending it
may help orient the IT band for the stretch.
3. Let the patient’s hip adduct with gravity and apply
an additional stretch force with your other hand to
the lateral aspect of the distal femur to further
HIP EXTENSION W/ KNEE FLEXION
adduct the hip
➢ To increase hip extension and knee flexion
simultaneously, stretch the rectus femoris

Patient Position - Use either of the positions previously

described for increasing hip extension in the supine or prone
positions (see Figs. 4.26 and 4.27)

Hand Placement and Procedure

1. With the hip held in full extension on the side to be

stretched, move your hand to the distal tibia and
gently flex the knee of that extremity as far as
possible
NOTE: If the patient’s hip cannot be extended to neutral, the
2. Do not allow the hip to abduct or rotate
hip flexors must be stretched before the tensor fasciae latae
can be stretched.
 HIP EXTERNAL ROTATION KNEE FLEXION

➢ To increase external rotation of the hip, stretch the ➢ To increase knee flexion, stretch the knee extensors
internal rotators
Patient Position - Have the patient assume a prone position
Patient Position - Place the
Hand Placement and Procedure
patient in a prone position
with the hips extended and 1. Stabilize the pelvis by applying downward pressure
knee flexed to 90° across the buttocks
2. Grasp the anterior aspect of the distal tibia and flex
Hand Placement and
the patient’s knee
Procedure
PRECAUTION: Place a rolled towel under the thigh just
1. Grasp the distal tibia
above the knee to prevent compression of the patella
of the extremity to
against the table during the stretch. Stretching the knee
be stretched.
extensors too vigorously in the prone position can
2. Stabilize the pelvis
traumatize the knee joint and cause swelling
by applying pressure
with your other hand Alternate Position and Procedure
across the buttocks.
3. Apply pressure to the 1. Have the patient sit with the thigh supported on the
lateral malleolus or lateral aspect of the tibia and treatment table and leg flexed over the edge as far
externally rotate the hip as far as possible as possible.
2. Stabilize the anterior aspect of the proximal femur
Alternate Position and Procedure - Sitting at the edge of a with one hand.
table with hips and knees flexed to 90° 3. Apply the stretch force to the anterior aspect of the
distal tibia and flex the patient’s knee just past the
1. Stabilize the pelvis by applying pressure to the iliac
point of tissue resistance
crest with one hand.
2. Apply the stretch force to the lateral malleolus or NOTE: This position is
lateral aspect of the lower leg and externally rotate useful when working
the hip in the 0° to 100°
range of knee
NOTE: When you apply the stretch force against the lower
flexion. The prone
leg in this manner, thus crossing the knee joint, the knee
position is best for
must be stable and pain-free. If the knee is not stable, it is
increasing knee
possible to apply the stretch force by grasping the distal
flexion from 90° to
thigh, but the leverage is poor and there is a tendency to
135°
twist the skin
KNEE EXTENSION
HIP INTERNAL ROTATION
➢ To increase knee extension in the midrange, stretch
➢ To increase internal rotation of the hip, stretch the
the knee flexors
external rotators
Patient Position - Place the patient in a prone position and
Patient Position and Stabilization - Position the patient the
put a small, rolled towel under the patient’s distal femur, just
same as when increasing external rotation, described
above the patella
previously
Hand Placement and
Hand Placement and Procedure
Procedure
1. Apply pressure to the medial malleolus or medial
1. Grasp the
aspect of the tibia and internally rotate the hip as
distal tibia
far as possible
with one hand
The Knee: Special Considerations and stabilize
➢ The position of the hip during stretching the buttocks
influences the flexibility of the flexors and to prevent hip
extensors of the knee. flexion with
➢ The flexibility of the hamstrings and the rectus the other
femoris must be examined and evaluated hand.
separately from the one-joint muscles that affect 2. Slowly extend the knee to stretch the knee flexors
knee motion
 END-RANGE KNEE EXTENSION
➢ To increase end-range knee extension
Patient Position - Patient assumes a supine position
Hand Placement and Procedure
1. Grasp the distal tibia of the knee to be stretched.
2. Stabilize the hip by placing your hand or forearm
across the anterior thigh.
o This prevents hip flexion during stretching.
3. Apply the stretch force to the posterior aspect of
the distal tibia and extend the patient’s knee
The Ankle and Foot: Special Considerations
➢ The ankle and foot are composed of multiple
joints.
➢ Consider the mobility of these joints (see Chapter
5) as well as the multi-joint muscles that cross
these joints when increasing ankle and foot ROM.
ANKLE DORSIFLEXION
➢ To increase dorsiflexion of the ankle with the knee
extended, stretch the gastrocnemius muscle
Hand Placement and Procedure
1. Grasp the patient’s
heel (calcaneus) with
one hand, maintain
the subtalar joint in a
neutral position, and
place your forearm
along the plantar
surface of the foot.
2. Stabilize the anterior aspect of the tibia with your
other hand.
3. Dorsiflex the talocrural joint of the ankle by pulling
the calcaneus in an inferior direction with your
thumb and fingers
4. while gently applying pressure in a superior
direction just proximal to the heads of the
metatarsals with your forearm
To increase dorsiflexion of the ankle with the knee flexed
stretch the soleus muscle. The knee must be flexed to
eliminate the effect of the two-joint gastrocnemius
muscle. Hand placement, stabilization, and stretch force
are the same as when stretching the gastrocnemius
ANKLE PLANTARFLEXION
➢ To increase plantarflexion of the ankle
Hand Placement and Procedure
1. Support the posterior aspect of the distal tibia with
one hand.
2. Grasp the foot along the tarsal and metatarsal
areas.
3. Apply the stretch force to the anterior aspect of the
foot and plantarflex the foot
ANKLE INVERSON AND EVERSION
➢ To increase inversion and eversion of the ankle.
➢ Inversion and eversion of the ankle occur at the
subtalar joint as a component of pronation and
supination.
➢ Mobility of the subtalar joint (with appropriate
strength) is particularly important for walking on
uneven surfaces
Hand Placement and Procedure
1. Stabilize the talus by grasping just distal to the
malleoli with one hand.
2. Grasp the calcaneus with your other hand and move
it medially and laterally at the subtalar joint
STRETCHING SPECIFC MUSCLES OF THE ANKLE AND FOOT
Hand Placement and Procedure
1. Stabilize the distal tibia with your proximal hand.
2. Grasp around the foot with your other hand and
align the motion and force opposite the line of pull
of the tendons. Apply the stretch force against the
bone to which the muscle attaches distally.
o To stretch the tibialis anterior (which inverts
and dorsiflexes the ankle), grasp the dorsal
aspect of the foot across the tarsals and
metatarsals and plantarflex and abduct the
foot.
o To stretch the tibialis posterior (which
plantarflexes and inverts the foot), grasp
the plantar surface of the foo around the
tarsals and metatarsals and dorsiflex and
abduct the foot.
o To stretch the peroneals (which evert the
foot), grasp the lateral aspect of the foot at
the tarsals and metatarsal and invert the
foot.
TOE FLEXION AND EXTENSION
1. To increase flexion and extension of the toes. It is
best to stretch any musculature that limits motion in
the toes individually.
2. With one hand, stabilize the bone proximal to the
restricted joint, and with the other hand, move the
phalanx in the desired direction
 PT 113: INTRO TO THERAPEUTIC EXERCISE
Lecture 2: Peripheral Joint Mobilization/Manipulation
Ms. Trisha Sandico, PT, PTRP, DPT – Faculty of Physical Therapy
1st Semester | Midterms | A.Y 2022 – 2023