STRETCHING THERAPY FOR SPORT AND MANUAL THERAPIES PDF
𝗣𝗗𝗙 | This textbook contains valuable information for physiotherapists, masseurs , physical education instructors and teachers, trainers. STRETCHING. THERAPY FOR SPORT AND. FOR SPORT AND. MANUAL THERAPIES. Jari Ylinen. Foreword by Leon Chaitow sppn.info Stretching Therapy: For Sport and Manual Therapies: Medicine & Health Science Books @ sppn.info
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Get this from a library! Stretching therapy: for sport and manual therapies. [Jari Ylinen] -- "This textbook contains valuable information for physiotherapists. Stretching Therapy: For Sport and Manual Therapies. Jari Juhani Ylinen sppn.info ISBN: Muscle Stretching in Manual Therapy I () - The Extremities Dokument: pdf ( MB) of treatment through "relaxation and stretching of shortened muscles For inst- ance, therapists may teach their patients self- stretching to speed recovery, and sports teams may employ therapists to treat athletes.
The general principles of manual therapy are outlined in Part 1, along with a guide to the organization of the therapy techniques.
The therapy techniques are fully described in Part 2 and Part 3, one to a page. Each description consists of a drawing showing the muscles in- volved, two photos showing the starting and final positions of the technique, and an explicit text giving positions, grips and procedures. The Movement Restriction Tables and Index of Muscles of ParI 4" list the muscles which may restrict movement and reference them to pages.
The two volumes of this book are intended primarily to be used as ready-reference clinical manuals and as texts on muscle stretching in manual therapy. However, we hope that they will also provide physiotherapists and medical doctors with a fresh, comprehensive approach to the entire subject of muscle stretching in manual therapy. Our underlying goal has been to contri- bute to improving the quality of the treatment of muscular-skeletal disorders, both for patients and for therapists.
We will be pleased if the users of this manual find it useful in realizing that goal. Nonessential activities, which now classify physiologically as exercise or stretching, evolved for reasons long forgotten or never recorded. Although dance and ritual were obvious progenitors, non-productive physical activity undoubtedly had utilitarian ori- gins: Its early practitioners felt better after stretching.
Historical confirmation of the origins of exercise and stretching is lacking. But there's ample evidence that stretching, such as that depicted by the year old statue shown in the frontispiece of this book, has been practiced since the dawn of history. Stretching now divides into therapeutic stretch- ing, the topic of this Manual and self-stretching, as used in exercise, athletic training, dance, and certain ritual exercises.
The two categories of stretching may supplement each other. For inst- ance, therapists may teach their patients self- stretching to speed recovery, and sports teams may employ therapists to treat athletes.
Yet there is good reason to differentiate. Controlled, proper stretching is beneficial. But uncontrolled stretch- ing of muscles and other structures may damage, such as through causing instability or pathological hypermobility.
In most such cases, self-stretching is involved. Unwary athletes and other persons exercising often self-stretch with great force at long lever arms, which easily injures. Some competitive athletic events, such as gymnastics in general and women's gymnastics in particular, require extreme movement and therefore frequently injure partici- pants. Other extreme activities, such as group exercises to music "jazzexercise" and "aerobic dance" are two also pose high hazard of stretch- ing damage.
Some exercises are faulted, but lack of knowledge is the leading underlying cause of self-stretching damage. Most people know little of the normal ranges of movement of the joints of their bodies.
The result is that when they stretch, normal structures are often overstretched, while shortened structures are seldom adequately stretched. An understano;ling of why, when and how muscles or other structures should be stretched is prerequisite to stretching to benefit rather than degrade body function.
The role of the therapist in stretching is then not just to understand and treat, but also to guide and teach patients self-stretching see references 6 and 7. In neurophysiologica l and radiological examinations, results are most often normal, if there are no structural problems. However, they may help in differential diagnosis of specific conditions, for example in cases of entrapment of peripheral nerves and stenosis of the spinal canal. Intense pain that is associated with increased muscle tension may be ca used by diseases of inner organs.
Diseases of organs located in the upper abdominal and thoracic region, such as the liver, gall bladder, spleen, stomach, oesophagus, h eart and lungs, can refer pain to the neck and shoulder area. Pain in these areas may extend to include the upper extremities. Organ disease in the mid- and lower abdomen, e. Psychologica l factors will, in some cases, cause areas of specific, localized pa in, and in others will involve the entire body.
Stretching can provide temporary relief but symptoms will only return if the actual ca use goes untreated. In one lifetime a va rie ty of minor and possibly more significan t trauma to connective tissue causing pain can be expected.
Trauma can include bruising, stretch injuries, burns, fros tbite, and chemical or radiation origins. Irritation of nerve endings in connective tissues, such as skin and joint ligaments, can stimulate a response in motor neurons responsible for muscle contraction.
Shortening of muscles, and the resulting limi tations of joint mobility, may lead to Measurement set-up Figure 1.
Se ve ral parameters can be measured simultaneously with the aid of computer. Adapted with permission from Dr Peter Magnusson from his thesis Muscles, fasciae, tendon sheaths, tendons and ligaments, as well as joint capsules, are subject to friction and overloading. Gunn hypo thesized that the extra loading due to the shortening of muscles will not only cause muscle pain, but may also lead to a variety of disorders in the locomotor system such as epicondylitis tendinitis, tenosynovitis, bursitis, capsulitis and even osteochondritis.
Long-term overload may ultimately lead to joint degeneration and fracture. Intense pain also interferes with the balance of the autonomic nervous system by irritating nerves of the sympathetic nervous system. Hyperactivity in the sympathetic systenl reduces circulation in connective tiss ues by constricting arterioles.
Thus, Inuscles do not totally recover from training or work and become susceptible to overload. In research by Tomanck and Lund a normal soleus muscle reduced significantly in diameter during the first three weeks of immobilization, after which it remained almost the same.
Muscle cells of the calf are primarily of the slow type and appeared to be more susceptible to atrophy than the fast cells of the thigh muscle. Immobilization causes not only significant changes in structure, but also affects the neural mechanisms of muscle contraction. Thus, muscle strength may weaken much more during the early stages of immobilization than changes in size may suggest. Muscle atrophy is accompanied wi th an increase in other connective tissues, w hich are not able to contract a nd have lower related incidents.
As muscles automatically lengthen with bone growth, there is no need to operate on them. If stretching is removed, the length and number of sarcomeres return quickly to normal, as sho wn in labora tory stud ies Frankeny et al Muscles adapt more readily to biochemical changes due to immobilization in a stretched pOSition than in a shortened position.
The balance between protein synthesis and the breakdown of protein has a direct affect on the growth hypertrophy and muscle degeneration atrophy. Passive tension created by stretching has been stretchability. Long-lasting irrunobilization also causes changes in joint structure leading to stiffness and restriction in ROM as a result of constriction of joint capsule and ligaments. Thus, early mobilization has become com- shown to s low degenera tion of connective tissu es and mon practice after surgery and trauma.
Joint position and muscle tension during immobilization During immobiliza tion of a muscle in a semicontracted position, it is possible fo r the amount of following surgery or trauma may cause changes in muscle length. There is an increased risk of muscle atrophy if there is immobilization of the joint with muscle in the shortened position.
Muscle atrophy is noticeably faster than if the extremity is in a stretched position during immobilization with cast. Muscles also adap t to changes in length mechanically by producing most force from a new resting position.
M u scle composition also varies between individ uals and thus some people may be more vulnerable to degenerative effects of immobilization than others.
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The initial condition of muscles is important. In some cases, passive tension h as been shown to cause muscle growth Vandenburgh Connective tissue in muscle increases with the thickening of the endomysium and the epimysium. Ultimately, muscle flexibility wi ll be decreased with these changes. In order to best preserve muscle integrity, immobilization in a stretched position is preferable to a shortened position.
Physica l trauma or surgery, however, may prevent optimal positioning. Furthermore, it is likely that muscles immobilized in a shorten ed position sarcomere w hile muscles are immobilized in a stretched position loss can be prevented with as little as 30 min of intermittent stretching per day Wiliams Tabary et al , Williams and Goldspink and Frankeny et al have shown in their research that the positioning of the extremities during immobilization will noticeably affect muscle structure.
Positions in which muscles are slightly stretched cause an increase in the that the corresponding antagonists will be contracted. O ptimal treatment for one muscle group may have substantial, undesired effects on another.
To compromise, irrunobilization is usually in a position in which all muscle number of sarcomeres in the end portions of a muscle. The muscle adap ts by growing in length. Immobilization in a stretched position for 30 min a day after 6 weeks resulted in structural changes.
In addition to an increase in muscle length there was an increase in the amount of capillaries. When a muscle is stretched, the contact between actin and myosin filaments decreases, which in turn decreases maximum force of the muscle.
The increase in sarcomeres will slow the muscle from weakening; this process is considered a compensatory mechanism. Muscles are s uspended in long-term stretching posi tions in cases of bone lengthening surgery after birth defect or trauma groups are as close to n eutral or a res ting position as possible. In som e cases, it is possible to vary positions throughout the treatment of immobilization so that all muscle groups are in a stretched pOSition for some of the time.
It has been suggested that stretching of tense muscles requires more effort and increases the risk of trauma. Thus, adequate relaxation has been considered to be important to the success of stretching and in the prevention of possible complications.
If motor neuron activity is abundant, relaxation during stretching will be more difficult.
Pain, in particular, can present a problem by stimulating motor neuron activity, causing muscle contraction and, in the worst case, preventing any stretching at all. Heat treatments are also used to produce local or systemic analgesia, hyperaemia and hyper thermia.
Normal body temperature is approximately 37"C. A temperature rise of only a few degrees causes a clear increase in blood flow and nerve conduction velocity. Superficial treatments may also raise temperatures of the deeper tissues, as a result of the increased circulation and direct conduction in tissues.
There is a natural response within the body to actively balance the local rise of tissue temperature by transferring heat to other areas of the body with circulation. Methods of superficial heat treatments include heat lamps, hot packs, paraffin, parafango, clay, hydrotherapy, and sauna to broader areas of the body. With heat lamps, the treatment time depends on the wattage of the lamp and the distance between the skin and lamp. An inlra-red heat lamp is placed about cm from the subject.
Hydrocollator packs are suspended on racks in 7 J When removed from the bath, water is drained off and the pack is wrapped in an insulating towel.
The pack cools slowly and it is commonly applied for 30 min. Paraffin baths are commonly used for the hands. The bath consists of a mixture of mineral oil and paraffin and its temperature is "C. High temperatures are well tolerated, because of the minimal heat conveying property of the bath. Hands are immersed in the bath and removed to allow the wax to solidify, and this is repeated times.
Hands are then wrapped in a towel for min before mobilization and stretching. The temperature of parafango is "C and it is also applied directly to the skin. It may be covered with a blanket and treatment time is commonly min.
PDF Stretching Therapy: For Sport and Manual Therapies 1e EBook
Opened circulation in the skin increases heat loss by the body in general; heat is released by evaporation at the skin surface. Covering body surfaces can prevent heat loss. Furthermore, room temperature and dampness will affect the loss of heat.
Hydrotherapy is one of the oldest relaxation and treatment methods. Full body immersion is usually restricted to "C, while limited portions of the body may be immersed in water with a temperature ranging from "C.
Treatment time depends on the condition of the subject. Tn a sauna, the optimum temperature for maximum perspiration and for speeding up circulation in the skin is "C.
Temperatures higher than "C are tolerable if the air is dry, but if the heat is augmented with humidity, e. The temperature in a steam bath is at "C. Microwave ovens are commonly used in househo lds now, but lrucrowave machines are rarely used in physiotherapy practices nowadays. US is now the most common method of deep heat treatment. US therapy occurs at 0. Effects depend on a number of factors.
Penetration of the US decreases as the frequency increases. There should be sufficient amount of coupling gel between the applicator and the skin. The compression force is important and should be 0. The applicator is moved slowly, cm per sec, and in order to cover an area of cm' the treatment should last about min.
A significant problem in US therapy is that with identical US treatment parameters, different devices produce different intramuscular temperatures Merrick et al Thus, the results from a clinical study obtained with the device of a certain make cannot be applied generally, as a device produced by a different manufacturer ma y produce different results. It ma y cause electrical interference and therefore shortwave therapy machines are restricted to operate at 27 MHz. There are several types of inductive applicators, which are placed over the treatment area for min.
Continuous output is used when the goa l is heating and pulsed output when nonthermal treatment effects are the primary aim. The average output power may be the same.
Continuous output tends to heat more water-poor substances such as fatty tissue, and it is possible to overheat subcutaneous fat tissue, if the layer is thick. Heat is released by evaporation at the skin surface.
Stretching therapy : for sport and manual therapies
Perspiration is conductive and, if present in the electromagnetic field, heats the skin excessively. The skin must be examined prior to treatment, thus, clothes and all metal, including jewellery, shou Id be taken off. Surgical stitches, implants, contact lenses, metallic intrauterine devices, and the menstruating or pregnant uterus should not be exposed to diathenmy.
Although this treatment method was popular in the past, it is now seldom used. Heat treatments are not recommended as routine with all stretching.
Inflammation or damage of nerves when combined with heat treatments only irritates The suboccipital area, cervical ganglia, eyes, thyroid, heart, gravid uterus, tumours, cervical ganglia, laminectomy sites, and patients with a pacemaker and other devices should not be treated with SWD. Based on clinical research, it is often impossible to determine whether pain is purely of nerve or muscular origin.
Muscle length increases considerably while muscle tissue temperature is raised, making applications of heat recommendable prior to stretching. Wessling et al studied the effects of US combined with SS in healthy people. Continuous US was given for 7 min at intensity of 1. SS was applied during the last minute of treatment at a force of 23 kiloponds. The second group received the same stretch without US.
Both increases were statistically significant. Studies have shown that active and passive muscles can tolerate greater stretching force at lower temperatures.
Heat treatments do not decrease the risk of stretch related injury, because with an increase in stretch heat will reduce ability of tissues to withstand force. Knight et al studied the effects of moist deep heat at 74'C applied for 15 min to the calf muscles of one control group of healthy individuals; and on a second group the effects of US with frequency of 1 MHz and intensity of 1.
These had been earlier proved to raise calf muscle temperature by ' C, and cause changes in tissue elasticity Draper and Ricard et al Following the heat treatment, the muscles underwent SS techniques. Treatments were repeated three times a week for 6 weeks. Passive dorsiflexion of ankle mobility increased in those who stretched without heat by 6' , in those who received superficial heat by 5' , and in those who received deep heat by 7'.
A fourth group used dynamic calf muscle activity by rising up on toes 40 tin1es prior to stretch as a warm up, resulting in a mobility increase of 4'. There was no s tatistically s ig nificant difference between treatment groups. The change in those who did not stretcl1 at all was only 1'. Thus, stretching improved mobility, but heat treatments had no significant additional effect. In a randomized study, joints were treated with US followed by 10 min of passive stretching, while control joints received placebo US treatments a nd stretching.
Treatments were performed every other day throughout a 2-week study period. There were no differences in ROM or perceived pain between the two groups. Funk et al studied the effects of moist hea t on ham string stretching.
Applications of moist heat for 30 min prior to 30 sec of SS technique proved more effective than stretching for 30 sec without heat. Sawyer et al found tha t after ap plication of a moist heat pack on hamstring muscles, it took min to increase intramuscular temperature by O. Hamstring flexibility was measured using an active knee extension test. No Significant increase was found in the ROM compared to the controls.
Draper et al compared changes in hamstring flexibility after treatments of pu lsed shortwave in healthy subjects with tight hamstrings. Subjects were assigned to diathermy and stretch, sham diathermy and stretch, and there was a control group. A straight leg-raise stretch was performed using a mechanical apparatus.
The diathermy unit with an operating frequency of 27 MHz and the unit houses dual cm2 induction drum coil electrodes with 2 cm space plates were used for treatment.
Subjects were lying down and diathermy was applied for 10 min followed by 5 min of simultaneous diathermy and stretch, fo llowed by 5 min of stretching only with a pulley-andweight system of 4.
Increases in knee extension after 5 days were 16' for the diathermy,S' for the sham-diathermy and no change in the control group.
Results suggest that effectiveness of stretching can be greatly improved with SWD, but the effect is shortlived, if the stretcl1ing is not repeated soon.
These findings should be taken into consideration when using heat to increase muscle flexibility. Temperature has an effect on the mechanical properties of tissues and may thus affect the results of stretching. However, treatments of heat alone will not affect mobility and need to be used in combination with stretching. Applications of heat should be for a long enough period of time to raise tissue temperature during or inlfnediately prior to stretcl1ing.
Various stretching techniques often combine application of heat in different ways. In many studies heat has improved the elasticity of connective tissue. Heat can be used prior to or during the stretching process. Heat and stretching prior to exercise is not advisable because, according to previous studies, it ma y increase injury risk.
The increase in compliance of warmed muscles is associated with a reduction in their energy-absorbing capabilities. Thus a protective effect may be decreased with increased elasticity.
Muscle Stretching in Manual Therapy I - The Extremities[Team Nanban][TPB]
Heat improves the speed of sensory and motor neuron conductivity; it reduces proprioceptive sensitivity to stretch and therefore encourages muscle relaxation.
Cold Treatments Cold decreases the speed of neuron conductivity, but increases muscle activity. Overall exposure to cold results in hypertonic muscles throughout the body and shivering. Collagen fibres can stabilize a change in length during this cooling process.
H owever, the same process has not been reproduced in individuals in vivo and thus best results remain with treatments of heat only. The practical difference between the laboratory and clinical tests is evident, in that the human body wil l actively regulate tissue temperature and it is thus difficult to manipulate, while temperature can be maintained and controlled in the laboratory testing of tissue sample.
Cold treatments are effecti ve in reducing inflammation and swelling. Cooling anaesthetizes the area of trauma and decreases conductivity of sensory neurons. Effecti ve cold therapy prevents muscle tension due to pain, and speeds recovery time.The study also used a visual analog scale to measure the most intense perception of pain as a proxy measurement at the point of greatest stretch tolerance, immediately and one hour after the performance of SS and DOS techniques in asymptomatic young adults.
Although the temporo-mandibular joint is anato- mically removed from the spine, it is therapeuti- cally recognized as being closely connected to the cervical spine and therefore is included in Volume II.
See Box 1. Tension can be reduced with stretching and massage. Most people know little of the normal ranges of movement of the joints of their bodies. If P is ve ry stro ng.
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