Assessment and Corrective Stretches

As mentioned in the previous article " Posture - Client Assessment Ideas"  most of the assessment stretches are the same as the corrective stretches, however some of the assessment procedures are to gauge mobility and will require mobilization exercises as part of the programme and not stretches.

Neck

Side Flexor Stretch (Static)

Client is seated with good upright posture. Hold the right side of the chair seat with the right hand; drop the head to the left as if trying to touch the shoulder with the ear until a stretch is felt. Hold for 15-30 seconds, as the stretch eases slowly depress the shoulder to increase the power of the stretch and hold once more.

CR

Client is seated with good upright posture. Hold the right side of the chair seat with the right hand; drop the head to the left as if trying to touch the shoulder with the ear until a stretch is felt. Now gently hold the side of the head with the left hand and slowly draw the neck away from the fixed shoulder until a stretch is felt. Gently push the head into the hand without allowing any movement to create an isometric contraction (no more than1-2Lbs of force should be applied) and hold for 5-10 seconds. Release the contraction and gently pull the head deeper into flexion while depressing the fixed shoulder. 

Normal range of motion for side flexion is around 40°

Rotation Static

With client sitting or standing maintaining good upright posture turn the head to one side as if to look over the shoulder. Once a stretch is felt hold for 15-30 seconds, as the stretch eases turn the head a little more to active a deeper stretch. 

CR

With client sitting or standing maintaining good upright posture turn the head to one side as if to look over the shoulder. Now place the opposite hand on the cheek/jaw and turn the head back into the hand to create the isometric contraction. Hold for 5-10 second and then relax the contraction and immediately rotate the head into a deeper stretch. Do not force the head round. Normal ROM for rotation is 80°

Apley Scratch

Rotator Cuff (Static)

If the client fails the Apley scratch test by not being able to reach over the shoulder they have poor abduction and external rotation. To correct this we need to stretch the muscles of the rotator cuff. With the client standing take a small towel in the right hand and pass it over the right shoulder so it is hanging down the back. Take the left hand behind the back and grip the bottom of the towel. Slowly pull the towel down until a stretch is felt in the right shoulder and hold for 15-30 seconds. When the stretch eases gently pull further down with the left hand to increase the stretch.

CR 

Use the same procedure as with the static stretch but now once the stretch is felt pull up with the right hand while pulling down with the left to create the isometric contraction. Hold for 5-10 seconds and release the contraction then gently pull further down with the left hand.

If the client fails the test by being unable to reach behind the back they have poor adduction and internal rotation. This can be due to over development of the anterior deltoid shortness in the pec minor and poor medial rotators. 

Pec Minor & Medial Rotators (Static)

Using a Swiss Ball get your client to kneel down on all fours placing the left hand and arm over the ball. Let the shoulder rest on the ball keeping a right angle at the elbow. Now let the supporting arm bend allowing the shoulders to drop until a stretch is felt through the pec minor. Hold for 15-30 seconds until the stretch eases then bend the supporting arm a little more and move into a deeper stretch exhaling as they go.

CR 

As above but this time once the stretch is felt press the arm and shoulder into the ball to create the isometric contraction. Hold for 5-10 seconds then relax and immediately bend the supporting arm to drop down into a deep stretch.

For both the above stretches it is important to keep the shoulders square to the floor and not to rotate the body.

*Spinal Rotation (Lumbar) Static Stretch

With the client lying on the floor raise the knees to a 90° angle at the hip and knee. Slowly begin to lower the knees toward the floor on the right until a stretch is felt in the lower back. Once the stretch is felt use the right hand to support the knees in that position until the stretch eases. Now gently allow the knees to drop a little further maintaining support until a mild stretch is felt once again. Very slowly return to centre and repeat on the left.

CR 

Due to the vulnerability of the lumbar spine during rotation, we would not recommend that you attempt any CR stretching for this area.

*Latissimus Stretch 

Static

With the client seated with good posture take the left hand behind the head as if to do a traditional tricep stretch. Take the elbow with the right hand and gently draw down. Keeping the hips facing forward begin to gently bend to the right until the stretch is felt down the left hand side, hold until the stretch eases then increase the side flexion to increase the stretch. Slowly return to centre and repeat on the right hand side.

CR

Begin as with the static stretch but this time once you have drawn the elbow down, push back against the hand to create the isometric contraction. Hold for 5-10 seconds and then release drawing the elbow further down and applying side flexion. 

Side Bend

Static

Get the client to lie sideways over a Swiss ball using their feet against the skirting for stabilization. If they are likely to fall off the ball hold it steady while they conduct the stretch. With the client in position get them to bring the uppermost arm over the head and extend it as far as possible. Upper arm should be flat against the ear. Now take the wrist of the upper arm with the opposite hand and gently pull down until a stretch is felt. Hold the stretch for 15-30 seconds or until they feel the stretch ease and then pull down a little more. 

CR

Exactly the same as above only this time when a stretch is felt try to bring the body upright to resist the downward tugging of the lower hand. This will create the isometric contraction, hold for 5-10 seconds and release pulling down further with the lower hand.

*McKenzie Press up

As mentioned previously the McKenzie press up is a mobilization exercise in its own right, anyone who fails the initial test by being unable to straighten their arms should be prescribed the press up as part of their programme to restore normal lumbar mobility. It is not uncommon for clients to find this mobilization exercise uncomfortable at the end of their ROM for the first few reps. If however your client is feeling discomfort for every rep out of a set of ten, discontinue the exercise and review their test results. If they failed the Side Bend, Spinal Rotation and showed signs of poor thoracic mobility during the Latissimus test you should consider referring them to a Physio, Osteopath or other medically qualified back care professional for further assessment and/or treatment.

Groin (Adductors)

Static

If the client failed the groin test it would indicate short or tight Adductors. The static stretch is conducted with the client sitting on the floor with good upright posture and then bringing the soles of the feet together. Taking the ankles slowly pull the feet towards the body, keeping good postural form (maintain lordosis) concentrate on relaxing the legs and letting gravity pull the legs down. Gently place the elbows at the crease of the knee and apply gentle downward pressure until a mild stretch is felt, hold for 15-30 seconds or until the stretch begins to ease and then gently take the stretch further with additional downward pressure from the elbows.

CR 

As above but this time once the stretch is felt push back up against the elbows to create the isometric contraction. Hold for 5-10 seconds then relax and immediately apply increased downward pressure from the elbows.

*Hips

90-90 Static

With the client seated on the floor and both front and back legs bent at 90°. Place one hand on the floor level with the hip and grasp the ankle of the front leg with the other. Now move the upper body forward over the front leg. It is vital to maintain a correct lumbar curve throughout this movement, keep the chest and head up until a stretch is felt in the hip. Hold until the stretch eases and then lean in a little more exhaling as you go.

CR  

As above but this time when you lean in and begin to feel the stretch go as far as you comfortably can and then press the knee and ankle of the front leg into the floor. Hold for 5-10 seconds then release and immediately move forward over the front leg. It is vitally important that lordosis is maintained throughout. If your client is having trouble maintaining the correct posture you may consider taping the back.

*Hamstrings

Static

With the client sitting on the floor bend one leg, the toes of the straight leg should be pointing to the ceiling. Keeping good lordosis and the chest and head up reach down towards the toes of the straight leg exhaling as you go. Once a stretch is felt in the hamstring hold for 15-30 seconds or until the stretch eases then relax out of it. Take a deep breath and reach forward once more exhaling and going deeper into the stretch.

CR

With the client lying supine get them to lift a leg as high as possible keeping the leg straight. You should now kneel to the side of the lifted leg and move toward the client until the leg is resting on your shoulder. Get the client to push the straight leg down on your shoulder as hard as they can avoiding hyperextension of the knee joint. Hold the pressure for 10-15 seconds and then release. The client should lift the leg as high as possible once the push is released. Do not assist the client to lift the leg.

*Quads

Static

With the client standing or lying on one side take the ankle of one leg and bend the knee to bring the heel towards the buttocks. It is vital that the knees stay together and the hips remain pressed forwards. Pull the heel in to the buttock until a stretch is felt. If the heel can be pulled into the buttock with just a little help this indicates normal ROM.

CR

If the client has short quads get them to perform the above movement but once a stretch is felt push the foot back against the hand to create the isometric contraction, hold for 5-10 seconds and release immediately pulling the heel in to the buttock. Remember that stretching short quads can put additional stress on the knee, if any undue discomfort is felt relax out of the stretch immediately.

*Iliopsoas

Static

With the client in a kneeling lunge position (making sure that the distance between the front foot and the rear knee is sufficient to induce a psoas stretch) bend the leading leg and allow the hips to travel forward. Keep the chest and head upright and maintain lordosis through out. Lean in far enough to feel the stretch at the top of the quads, some may feel the stretch extend into the hip or lower abdominal area. As the stretch eases relax out into the start position, inhale deeply and lean into the stretch once more exhaling as they go.

CR

With the client lying prone place a pillow under the hips. Now get them to bend the leg to create a 90° at the knee. They should now lift the upper leg as high as possible to create a psoas stretch. Place your hand under the leg just above the knee and get the client to push down against your hand. Prevent the leg from moving to create an isometric contraction, hold for 5-10 seconds and then relax getting the client to lift the leg once again. Repeat 3-5 times. It is important to make sure that the client resists the urge to lift the hips as they lift the leg. Some work may be needed with the client to create body awareness allow them to stabilise the hips.

Calves

Static

Standing on a block or step move one foot back until the ball of the foot is on the edge and the heel is free to move up and down. Slowly transfer your body weight onto this foot until you are fully supporting yourself, keep the leg straight but soft at the knee. Slowly drop the heel until a stretch is felt and hold for 15-30 seconds, as the sensation of stretching wears off drop the heel a little more. This will primarily target the Gastrocnemius; if you bend the supporting leg and then drop the heel it will shift the stretch more into the Soleus. Be careful not to allow this stretch to extend to far down into the Achilles. It is important that you are supporting the body by holding on to a handrail or someone’s shoulder, this will allow you to fully relax the calve. If the body is not supported in this way it will be very difficult allow the calves to relax enough to initiate a stretch.

CR

Sitting on the floor with the legs extended and the feet together take a towel and pass it around both feet. Holding tightly to the towel and maintaining good posture try to plant flex the feet while at the same time pulling the towel to prevent the movement. This will initiate the isometric contraction. Hold for 5-10 seconds then relax and dorsiflex the feet by pulling the towel back.