Therapeutic Stretching: Towards a Functional Approach

Dedication
Therapeutic Stretching
Copyright page
Preface
	The Website
1 Introduction to Therapeutic and  Functional Stretching
	What Is Stretching?
	Therapeutic, Sports and  Recreational Stretching
		Is stretching essential for normalization of ROM?
		Is stretching useful therapeutically?
	Towards a Functional? Behavioural Approach
		Advantages of functional challenges
	Towards a Process Approach
		Processes underpinning ROM recovery
	Classification of Stretching
		What about traditional forms of stretching?
	Summary
	References
2 Functional and Dysfunctional ROM
	ROM Ingredients
		Active end-range
		Passive end-range
		ROM and sensitivity
	Defining functional and  dysfunctional ROM
		Functional ROM
		Dysfunctional ROM
	Functional and clinical ROM ideals
	Summary
	References
3 Causes of ROM Loss and Therapeutic Potential of Rehabilitation
	Defining the Boundary of ROM Rehabilitation
		Self-limiting conditions
		Persistent conditions
		Progressive conditions
	Summary
	References
4 Adaptation in ROM Loss and Recovery
	The Wonders of Mechanotransduction
	Dysfunctional Adaptation and ROM Losses
		Connective tissue and intracapsular structures
		Muscle changes
		Connective tissue change in muscle
	Adaptation in ROM Recovery
		Recovery in connective tissue
		Adaptive recovery in muscle
			Muscle connective tissue
	Adaptation in Other Tissues/ Systems/Dimensions
	What Really Drives  Adaptation in Recovery
	Summary
	References
5 Specificity in ROM Rehabilitation
	Specificity and Generalization
		Transfer of training
		Measuring similarities
	Studies of Specificity and Transfer
		Transfer in stretching
	Studies of Specificity and  Transfer in Patients
	Implications for ROM Rehabilitation
	Promoting Generalization and Transfer in ROM Rehabilitation
	A Note on Sensory Specificity
	Summary
	References
6 The Overloading Condition for Recovery
	Loading Levels and Thresholds
		Overloading in relation to ROM loss and recovery
		Impediments to overloading
		The “inconsequential? elongation
		Rate of stretching
		The “undesirable? plastic ROM change
	Graded Challenge and the Task Parameters
	The Fallacy of Specific Tissue Stretching/Loading
	Summary
	References
7 Exposure and Scheduling the ROM Challenge
	Duration of Challenge
		Duration in the presence of ROM pathology
		Competition in ROM adaptation
		Ratio between maintaining and recuperating signals
		Termination of ROM challenge
	Scheduling in Functional and Extra-Functional Approaches
		A note on control of active ROM and task exposure
	Adherence to THE Programme
	Summary
	References
8 Rehabilitating the Active ROM:
	Goals and Focus of Attention
		External?internal focus in ROM rehabilitation
			Regression from goal to movement level
	Task-specific Muscle Recruitment
		Integrate or fragment?
		Synergy in pathology
	Focus of ROM Rehabilitation
	Importance of Cognition
		Cognition and feedback
	Limitations of Extra-Functional Stretching Approaches
		Motor control during active and passive stretching
		Autogenic inhibition
		Reciprocal inhibition
	Summary
	References
9 Pain Management and ROM Desensitization
	ROM Sensitization
		Persistent sensitization
	ROM Desensitization
		When is ROM desensitization beneficial?
		Factors supporting ROM desensitization
			Psychological dimension
				Emotional factors
				Cognitive?behavioural factors
				Contextual effects
			Physical components
				Active movement
				Passive movement and stretching
		Transient nature of desensitization
	Stretching and Pain Control
	Clinical Reasoning in ROM Rehabilitation in the Presence of Pain
	Summary
	References
10 Stretch-tolerance Model
	Origin of Stretch-Tolerance Model
	Stiff versus Long
	Is a Tolerance Model Logical?
	Stretch-Tolerance Relevance to ROM Rehabilitation
	Implication for Agility Training
	Summary
	References
11 Psychological and Behavioural Considerations in ROM Rehabilitation
	Activity Avoidance as ROM Limitation
	Reassurance
		Cognitive reassurance
		Behavioural reassurance
			Reassurance for the therapist
	ROM Loss and Psychological Distress
	Summary
	References
12 Towards a Functional Approach
	The Potency of ROM Challenge
	Determining the Level and Form of ROM Rehabilitation
		Recovery behaviour
			Managed recovery behaviour
			Assisted recovery behaviour
		Management at extra-functional level
	Progressive and Regressive Management
	The Context Short-cut
	Co-creating a ROM Recovery Environment
		Prioritizing managment
	Summary
13 Demonstration of Functional Approach in ROM Rehabilitation
	General principles for  functional stretching
	Contents of THE demonstration
	13.1. Demonstration of principles
		13.1.1 Amplifying the movement parameters during  a dynamic task
		13.1.2 Amplifying movement parameters during  a static task
		13.1.3 Alternating between dynamic and static tasks
		13.1.4 Context and localization of amplification
		13.1.5 Mixing ranges and planes
		13.1.6 Overcoming compensatory movement patterns
		13.1.7 Therapist’s stance and patient handling
	13.2. Shoulder ROM challenges
		13.2.1 ROM challenge during dynamic tasks
		13.2.2 ROM challenges during static tasks
		13.2.3 Guided challenge within a functional task
		13.2.4 Assisted supine ROM challenges
	13.3. Elbow ROM Challenges
		13.3.1 Assisted supine
	13.4. Trunk ROM Challenges
		13.4.1 Standing challenges
		13.4.2 Seated challenges
14 Summary
	What is Therapeutic Stretching?
	What Model is Used for  Therapeutic Stretching?
	How are Therapeutic Stretching Techniques Classified?
	Why do We Need a Functional Approach?
	When do We Use a Functional Approach or Traditional Stretching?
	What Defines End-range?
	When is Movement Considered Functional Normal or Dysfunctional Abnormal?
	What Causes ROM Loss?
	What is the Potential for ROM Recovery?
	What Happens in Adaptive ROM Loss  and Recovery?
	What Drives Adaptive Recovery?
	Why is Specificity Important?
	How Much Force is Required  for Stretching?
	Can Tissue Loading be Made Safe?
	How long and how often should the Exposure to Stretching be?
	What do We Aim to Recover in the  Active Range?
	Should Movement be Fragmented or Rehabilitated as a Whole?
	Can Passive Movement or Stretching Improve the Active Range?
	Can Traditional Active Approaches Improve Motor Control and Functionality?
	Is it Possible to have ROM Loss without TISSUE CHANGES?
	How do We DESENSITIZE ROM or  Alleviate Pain?
	Stretch or Wait?
	What is Stretch Tolerance?
	What is the Contribution of Psychological Factors to ROM  Loss and Recovery?
	How can We Improve Adherence?
	What’s not in This Book?
	Finally
Index
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