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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 dynamic, static, and proprioceptive neuromuscular facilitation 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, soft tissue mobilization, and massage that can 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 following injury is one of the primary goals in any rehabilitation program.90 Thus the therapist must routinely include exercise designed to restore normal range of motion 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 range of motion.2,3,28,40,46,72,88 Flexibility is dependent on a combination of (a) joint range of motion, 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.102 Flexibility involves the ability of the neuromuscular system to allow for efficient movement of a joint through a range of motion.3,31,48,52,83,105

Flexibility can be discussed in relation to movement involving only 1 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 bending or rotation of the trunk. Lack of flexibility in 1 joint or movement can affect the entire kinetic chain. A person might have good range of motion 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.11,20

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, and massage 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 ...

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