After completion of this chapter, the physical therapist should be able to do the following:
Define flexibility and describe its importance in injury rehabilitation.
Identify factors that limit flexibility.
Differentiate between active and passive range of motion.
Explain the difference between ballistic, dynamic, static, and proprioceptive neuromuscular facilitation (PNF) stretching.
Discuss the neurophysiologic principles of stretching.
Describe stretching exercises that may be used to improve flexibility at specific joints throughout the body.
Compare and contrast the various manual therapy techniques including myofascial release, strain-counterstrain, positional release, Active Release Technique®, massage, structural integration, and postural restoration, all of which may be used to improve mobility and range of motion.
When injury occurs, there is almost always some associated loss of the ability to move normally. Loss of motion may be a result of pain, swelling, muscle guarding, or spasm; inactivity resulting in shortening of connective tissue and muscle; loss of neuromuscular control; or some combination of these factors. Restoring normal range of motion (ROM) following injury is one of the primary goals in any rehabilitation program.1 Thus, the therapist must routinely include interventions designed to restore normal ROM to regain normal function.
Flexibility has been defined as the ability to move a joint or series of joints through a full, nonrestricted, pain-free ROM.2–6 Flexibility is dependent on a combination of (a) joint ROM, which may be limited by the shape of the articulating surfaces and by capsular and ligamentous structures surrounding that joint, and (b) muscle flexibility, or the ability of the musculotendinous unit to lengthen.7
Flexibility involves the ability of the neuromuscular system to allow for efficient movement of a joint through a ROM.2,8,9 Flexibility can be discussed in relation to movement involving only one joint, such as the knees, or movement involving a whole series of joints, such as the spinal vertebral joints, that must all move together to allow smooth flexion, extension, side-bending, or rotation of the trunk.10 Lack of flexibility in one joint or movement can affect the entire kinetic chain. A person might have good ROM in the ankles, knees, hips, back, and one shoulder joint but lack normal movement in the other shoulder joint; this is a problem that needs to be corrected before the person can function normally.11
This chapter concentrates primarily on rehabilitative techniques used to increase the length of the musculotendinous unit and its associated fascia, as well as restricted neural tissue. In addition, a discussion of a variety of manual therapy techniques including myofascial release, strain/counterstrain, positional release therapy, soft-tissue mobilization, massage, structural integration, and postural restoration (PRI) as they relate to improving mobility will be included. Joint mobilization and traction techniques used to address tightness in the joint capsule and surrounding ligaments are discussed in Chapter 13. Loss of the ability to control movement as a result of impairment ...