STRETCHING OF UPPER

LIMB

MAHEFUZA KARUD (T.Y BPT)

 STRETCHING
Define ?
Stretching is a therapeutic design
to increase the extensibility of soft
tissue, thereby improving
flexibility and ROM by elongating
(lengthening) structures that have
adaptively shortened and have
 TYPES OF
STRETCHING
Static stretching
Cyclic/intermittent stretching
Ballistic stretching
Manual stretching
Mechanical stretching
Self stretching
Active stretching
Passive stretching
BASED ON IN WHICH THE
STRETCH FORCE APPLIED
1. Static stretching
2. Cyclic/intermittent stretching
3. Ballistic stretching
1.Static stretching:
 In which soft tissue are elongated just past the point of
tissue resistance and then held in the lengthened position
with a sustained stretch force over a period of time .

 Other term used are sustained, maintained, or prolong

stretching.

 Duration of static stretching based on the patient’s

tolerance and response during the stretching procedure.
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.

 Cyclic stretching is applied for multiple repetition

(stretch cycle) during a 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.
3. Ballistic stretching:
 A rapid, forceful intermittent stretch – that is, high-
speed and high-intensity stretch is commonly called
ballistic stretching.

 Ballistic stretching has been showen in increase

ROM safely in young, healthy subjects participating in
a conditioning program.
 BASED ON THE DEGREE OF
PATIENTS PARTICIPATION
1.Manual stretching
2.Mechanical stretching
3.Self stretching

1.Manual stretching:
 Manual stretching can be performed passively,
with assistance from the patient, or even
independently by the patients.

 Stretch applied at an intensity consistent with the

patient's comfort level.
2. Mechanical stretching:
 Mechanical stretching devices apply a very low-
intensity stretch force (low load) over a prolonged
period of time.

 Mechanical stretching devices provide either a

constant load with variable displacement or constant
displacement with variable loads.
3.Self stretching:
 Self stretching is a type of stretching procedure a
patient carries out independently after careful
instruction and supervised practice.
 BASED ON THE SOURCE OF
STRETCH FORCE
1.Active stretching
2.Passive stretching
1. Active stretching:
 Active stretching can b performed by the patient
independently.

 During active stretching, patient gives own force for stretch

to move the body segment.

2. Passive stretching:
 Passive stretching can be performed passively with
assistance from the therapist.

 In this stretching therapist applied the stretch force.

 INDICATIONS FOR STRETCHING

 ROM is limited because soft tissue have lost their

extensibility as the result of adhesion, contractures
and scar tissue formation.

 Restricted motion.

 Muscle weakness and shortening of opposing tissue

have led to limited ROM.

 May be used to prior to and after vigorous exercise

to reduce post exercise soreness.
 CONTRAINDICATION FOR STRETCHING

 A bony block limits joint motion.

 Recent fractures and bony union is incomplete.

 There is a sharp acute pain with joint movements with muscle

elongation.

 Hyper mobility already exists.

 Hematoma or other indication of tissue trauma is observed.

 There is evidence of an acute inflammatory or infectious

process (heat and swelling), or soft tissue healing could be
disrupted in the restricted tissue.
 MECHANISM OF STRETCHING

MECHANICAL RESPONSE TO
STRETCH
• When a muscle is stretched and elongates, the
stretch force is transmitted to the muscle fiber via
connective tissue (endomysium and perimysim) in
and around the fibers.

• It is hypothesized that molecular interaction link

these non contractile elements to contractile unit of
the muscle, the sarcomere.
• During passive stretch, both longitudinal and lateral
force transduction occurs.

• when initial lengthening occurs in the series elastic

(connective tissue) components, tension rises sharply.

• After a point, there is a mechanical disruption

(influence by neural biochemical changes) of the cross
bridges as the filaments slide a part, leading toabrpt
lengthening of sarcomere.

• When the stretch force is released, the individual

sarcomeres return to their resting length. [Fig.4.3]
• Tendency of muscle to return to its resting length
after short-term stretch is called elasticity.

• If longer lasting or more permanent (plastic) length

increase are to occur, the stretch force must be
maintained over an extended period of time.
[Elongation and shortening of the sarcomere, the
contractile unit of muscle .]
PRINCIPLES OR DETERMINANTS
OF STRETCHING

1.Alignment
2.Stabilization
3.Intensity of stretch
4.Duration of stretch
5.Speed of stretch
6.Frequency of stretch
7.Mode of stretch
1. Alignment:
 Positioning a limb or the body such that the stretch force is
directed to the appropriate muscle group.
 Proper alignment or positioning is must for patient’s
comfort and stability during stretching.
 Positioning is must for specific muscles and joints to be
stretch is necessary.
 It affects the ROM available in joints.

2. Stabilization:
 Fixation of the one site of attachment of the muscle as the
stretch force is applied to the other bony attachment.
 It necessary to achieve an effective stretch of specific
muscle or muscle group.
 For a therapist to stabilize proximal segment and move
the distal segment.[Fig. 4a]
 During self stretching ,often the distal attachment that is
stabilize as the proximal segment moves.[Fig. 4b]
 Stabilizationof multiple segment of patient’s body also help
maintain the proper alignment necessary for an effective stretch.
 SOURCE OF STABILIZATION including: manual contact,
body weight, or firm surface, such as stable, wall, or floor.
[4a]Proximal attachment femur
and pelvis is stabilized and
distal segment knees is moves.
[quadriceps stretching]
[4b]distal segment tibia is
stabilized and proximal
segment femur is moves.
[quadriceps stretching]
3.Intensity of stretch:
 Magnitude of the stretch force applied.
 The intensity of stretch force is determined by the load
placed on the soft tissue to elongate it.
 Stretching should be applied at low-intensity by means low-
load.
 low-intensity stretching is more comfortable for the patients
and it also minimize voluntary and involuntary muscle guarding
so patient can remain relaxed.

4. Duration of stretch:
 It is length of time the stretch force is applied during a stretch
cycle.
 In this, one of the most important decisions a therapist must
take when giving stretching exercise by manually or with
mechanical stretching device to determine the duration of the
stretch that is expected to be safe, effective, practical, and
efficient for each situation.
 The duration of stretch refers to the period of time a
stretch force is applied and shortened tissues are held in
lengthened position.
 In general, the shorter the duration of a single stretch
cycle, the greater the number of repetitions applied during a
stretching session.

5. Speed of stretch:
 Speed of initial application of stretch force.
 Speed of stretch should be slow, helpful to minimize
muscle activation during stretching and reduce risk of injury
to tissues and post stretch muscle soreness.
 Stretch force applied at a low-velocity is easier for
therapist or patient to control than is safer than high-
velocity stretch.

6. Frequency of stretch:
Number of stretching sessions per day or per week.
of impaired mobility, the quality and level of healing tissues,
chronicity and severity of a contracture, as well as patient’s
age, use of corticosteroids, and Previous response to
stretching.
 The decision is based on therapist and response and needs
of patient.

7. Mode of stretch:
 Mode of stretch is refers to form of stretch in which stretching
exercise are carried out.
 Is the manner in which the stretch force is applied (static,
cyclic, ballistic) ; degree of patient’s participation (active,
passive, assisted)
; or the source of the stretch force (manual, mechanical, self).
 Mode of stretch can be defined by whom or what is applying
stretch force or whether patients is actively participating in
stretching maneuver.
 There is no best form or type of stretching.
STRETCHING OF UPPER LIMB
MUSCLES

STRETCHING SELF
WITH HELP OF STRETCHING
THERAPIST

1. TRAPEZIUS
2. LATISSIMUS DORSI
3. STERNOCLEIDOMASTOID [SCM]
4. PECTORALIS MAJOR
5. PECTORALIS MINOR
6. BICEPS
7. TRICEPS
8. WRIST FLEXORS