CFP 2012 Session 2013 Using Facilitated Stretching in the Gym

1. CFP 2012 Session 2013Using Facilitated Stretching in the Gym Stay for the book giveaway! Presented by Bob McAtee, CSCS, C-PT, RMT Pro-Active Massage Therapy Colorado Springs, CO USA www.stretchman.com

3. Learning Objectives 1. Clearly understand the theoretical basis and principles underlying the development and use of Facilitated Stretching. 2. Be able to perform effective facilitated stretches for the muscle groups covered in class. 3. Be confident in using partner-stretching techniques with clients and self-stretching techniques to teach them to use at home. 4. Understand safety factors in the use of facilitated stretches. 5. Be able to demonstrate proper biomechanics for the practitioner.

4. What is Flexibility ? • Flexibility can be defined as the range of motion about a joint or series of joints. • Flexibility is specific to the joint and plane of movement.

5. Flexibility<<< >>>> Stability • Increased flexibility results in decreased stability. • A certain minimum range is required to safely and optimally carry out a given activity. • Training goal: develop flexibility within the needs and abilities of the client.

6. A Brief Review:Types of Stretching • Passive Static or Ballistic • Active Ballistic Dynamic • Active-Assisted AIS Facilitated Stretching

7. What isFacilitated Stretching? • Based on PNF, a Physiotherapy modality developed in the 1950’s. • PNF is designed for rehabilitating function rather than individual muscles. • PNF is designed to integrate the neuromuscular system: • Employs active, active-assisted, and passive techniques. • Teaches complex movement patterns.

8. How is Facilitated Stretching Different? • Facilitated Stretching is an active-assisted technique based on PNF principles • Uses an isometric contraction of the target muscle to prepare it to stretch. • Encourages active stretching on the part of the athlete, avoiding additional passive stretching when possible. • Can be done with a partner or alone.

9. Facilitated Stretching in Three Easy Steps • Step 1. Stretcher actively moves the limb to lengthen the target muscle to the end of range. • Step 2. Stretcher isometrically contracts the target muscle for 6 seconds. • Step 3. Stretcher actively stretches to a new range of motion.

10. Rhomboids Self-Stretch • Stretch by reaching across your chest, feeling the stretch in your upper back. • Keep your low-back flat. • Isometrically contract rhomboids (pull your scapula toward your spine).

11. Abductors/Low Back Self-Stretch 2 • Cross left knee over right. • Keep sacrum on the floor and drop the inside of the right knee toward the floor. • Resist isometric abduction of the right leg with left leg. • To stretch the low back, allow sacrum to roll up off the floor.

12. Facilitated Stretching in Three Easy Steps • Step 1. Stretcher actively moves the limb to lengthen the target muscle to the end of range. • Step 2. Stretcher isometrically contracts the target muscle for 6 seconds. • Step 3. Stretcher actively stretches to a new range of motion.

13. Facilitated StretchingThree-Step Protocol • The protocol has evolved over many years of clinical practice. • In client sessions, repeat each stretch up to three times. In today’s seminar, just do two reps. • Use proper biomechanics for the partner and the stretcher to isolate the target muscles, to avoid injury, and to prevent compensation.

14. Classic Physiological Explanation • The success of PNF is based on eliciting: • Reciprocal Inhibition during active movement (muscle spindles). • and • Autogenic Inhibition as a result of the isometric contraction (Golgi tendon organs).

15. Reciprocal Inhibition • Voluntary contraction of the opposing muscle results in an inhibition of the motor neurons of the target muscle. • Reciprocal inhibition can depress the amplitude of stretch reflex.

16. Autogenic Inhibition • Refers to reduction in excitability of a contracting or stretched muscle. • Often attributed to increased inhibitory input from Golgi Tendon Organ (GTO) • Located in tendons and tendinous junctions of muscle. • Provides sensory info about changes in muscle tension. • Responds to overload by relaxing (inhibiting) the muscle.

17. Theory Reality • "There is nothing so sad as the destruction of a beautiful theory by an ugly fact.” Thomas Henry Huxley.

18. Does Reciprocal Inhibition Play a Role? • Conflicting research results. • This reflex is not as automatic as once believed, but is task-related. • It may be at work in facilitated stretching.

19. Does Autogenic Inhibition Play a Role? • In some cases the GTO can excite the same muscle and inhibit or excite opposing muscle. • GTOs cease or significantly decrease firing as soon as muscle relaxes after contraction. • Unclear to what extent GTO is involved in relaxation response. • We have clinical evidence of a “post-isometric relaxation” effect, but currently do not have an accepted physiological explanation for why it occurs.

20. Current Thinking about Stretching • Stretch Tolerance Improves: • Stretching is believed to alter the point at which stretch is perceived or tolerated. • Inhibition of stretch reflex? • Sensory perception may diminish, allowing the stretch to go farther before reaching a soft-tissue barrier. • Growing support for the contention that PNF may influence stretch tolerance to a greater extent than other stretching methods (Sharman et al., 2006).

22. Working With a Partner

23. Hamstrings Stretch • Client keeps both hips on the mat. • Maintain straight knee during isometric. • Actively stretch pain-free.

24. Bent Knee Hamstring 1 • Client keeps the thigh vertical throughout the sequence. • During the isometric contraction, client pushes the heel toward the buttocks as if bending the knee.

25. Bent Knee Hamstring 2 • Client holds thigh close to chest throughout the sequence. • During the isometric contraction, client pushes the heel toward the buttocks as if bending the knee.

26. Hamstrings, Self-Stretch • Use the strap only to resist the isometric contraction, never to lift the leg.

27. Quadriceps • Keep the lower leg in good alignment to avoid stressing the knee. Passively stretch the quad. • Client keeps the low back flat; use a pillow under the hips if necessary.

28. Hip Flexors Client keeps both hips flat on the mat. Watch for lumbar hypermobility. Glutes relax during the isometric contraction of the hip flexors.

29. Quadriceps Self-Stretch • Keep the back flat & the weight-bearing knee slightly bent. • Phase one: focus on heel to buttocks. • Phase two: focus on hip extension.

30. Hip Flexors Self-Stretch • Keep the low back flat. • Feel the stretch high on the front of the thigh. • Relax the glutes during the isometric phase.

31. So Many Stretches,So Little Time!

32. Pectoralis Major • Prevent trunk rotation. • Stretcher relaxes rhomboids and contracts pecs, leading from the elbow (Butterfly). • Changing the angle of abduction of the arm emphasizes different fibers of the pectoralis major.

33. Triceps • Client stretches by touching the scapula on the same side. • Trainer stabilizes posterior shoulder during the isometric phase.

34. Subscapularis • This stretch is used to improve external rotation. • Client focuses on pure rotation of the arm. • Verbal cue for isometric: “Try to roll your wrist toward the floor.”

35. Pec Major Self-Stretch • Keep low-back flat by using a lunge stance. • Use the post for resistance during the isometric phase, but stretch the pecs actively.

36. Triceps Self-Stretch • Reach toward the shoulder blade to stretch. • Keep the upper arm close to the ear. • Don’t arch your back.

37. Subscapularis Self-Stretch • Elbow stays against side. • During the isometric, press toward the belly as if swinging a gate closed. • Stretch actively by externally rotating the humerus.

39. Oblique Abdominals Client sits tall, breathes and rotates to increase ROM Trainers hands are placed to emphasize trunk motion, not shoulder motion.

40. QL/Obliques on a Stability Ball • Stabilize yourself sidelying on left side on the ball. • Sidebend with arm overhead to stretch QL. • Raise up slightly to isometrically contract QL. • To target obliques, add a forward rotation to the sidebend.

41. Hip Abductors One leg crossed to move it out of the way. Athlete stretches by adducting straight leg as far as possible. Resist isometric abduction by holding across the lateral knee, counterbalance the opposite hip. p. 48

42. Adductors Both hips stay flat. Knee points toward the ceiling to prevent leg rotation. Place hand/foot across inside of knee joint to provide resistance. p. 52

43. Gastrocnemius Stretch Client keeps knee straight and heel on the floor. Trainer resists isometric plantarflexion by holding across the ball of the foot.

44. Adductors, Self-Stretch

45. Hip AbductorsSelf-Stretch

46. Calf Self-Stretch Gastrocnemius Soleus

47. Further Reading • Facilitated Stretching, 3rd edition • PNF Stretching and Strengthening Made Easy • McAtee and Charland • Human Kinetics Publishers 2007

48. Abductors/Low Back Self-Stretch • Place left ankle outside right knee, keeping sacrum on the floor. • Resist isometric abduction with right hand on left knee. • To stretch the low back, allow sacrum to roll up off the floor.