Upon completion of this chapter, the learner should be able to demonstrate the following competencies and proficiencies concerning stretching:
Describe the limitations to joint flexibility and range of motion
Understand terminology related to stretching
Describe the factors related to muscle length and function
Describe connective tissue properties related to stretching
Describe the neurophysiology of stretching
Understand the effects of stretching on soft tissue
Describe the effects of modalities on stretching
Describe the many stretching techniques, including proprioceptive neuromuscular facilitation (PNF) stretching and neural tension techniques
Describe and understand stretching guidelines, indications, precautions, and contraindications
Many factors can contribute to limitations in range of motion. Limitations in passive and active range of motion may be the result of soft tissue shortening, joint capsule tightness, joint disorders, musculotendinous limitations, systemic disease, surgical intervention, or trauma.1 Immobilization or simple inactivity also can result in limitations to passive and active range of motion. Among these limiting factors, one of the most commonly observed in the physically active population is decreased extensibility of muscles and tendons around the involved joint.2,3 The inability to elongate the soft tissue surrounding the joint results in limitations of the patient's flexibility. These limitations are most easily recognized during the evaluation of active and passive range of motion.4 However, flexibility issues also may become apparent when assessing the patient's posture and strength. In addition, many special tests, such as the 90-90 straight leg raise test, the Ober test, and the Thomas test, are designed to assess for limitations in soft tissue flexibility (Fig. 5-1).
Special tests that are used to assess soft tissue flexibility. A, Straight leg test. B, Thomas test. C, Ober test.
RANGE OF MOTION LIMITATIONS
Limitations in range of motion require a careful assessment to determine the underlying cause of the limitation prior to initiating treatment for the patient. For example, a patient with limited ankle dorsiflexion range of motion may be limited because of muscle tightness of the gastrocnemius or soleus muscles, requiring a concentrated stretching program aimed at isolating one or both of these muscles. However, the limitation also may result from joint capsule tightness at the talocrural joint, requiring the use of range of motion (see Chapter 4) and joint mobilization (see Chapter 6) techniques to restore normal range of motion. Furthermore, a limitation in active ankle dorsiflexion range of motion might be the result of weakness of the tibialis anterior, fibularis tertius musculature, or both, requiring the prescription of appropriate strengthening exercises (see Chapter 7). Last, active and passive range of motion limitation could be the result of internal joint derangement associated with joint trauma or dysfunction. Examples of joint internal derangement might include osteochondritis dissecans (...