Chapter 4: Stretching for Impaired Mobility

Introduction

The term mobility can be described based on two different but interrelated parameters. It is often defined as the ability of structures or segments of the body to move or be moved to allow the presence of range of motion for functional activities (functional ROM).² It can also be defined as the ability of an individual to initiate, control, or sustain active movements of the body to perform simple to complex motor skills (functional mobility).^42,124 Mobility, as it relates to functional ROM, is associated with joint integrity as well as the flexibility (i.e., extensibility of soft tissues that cross or surround joints—muscles, tendons, fascia, joint capsules, ligaments, nerves, blood vessels, skin), which are necessary for unrestricted, pain-free movements of the body during functional tasks of daily living. The ROM needed for the performance of functional activities does not necessarily mean full or "normal" ROM.

Sufficient mobility of soft tissues and ROM of joints must be supported by a requisite level of muscle strength and endurance and neuromuscular control to allow the body to accommodate to imposed stresses placed upon it during functional movement and, thus, to enable an individual to be functionally mobile. Moreover, soft tissue mobility, neuromuscular control, and muscular endurance and strength consistent with demand are thought to be an important factor in the prevention of injury or re-injury of the musculoskeletal system.^{62,72,76,81,128,139,169}

Hypomobility (restricted motion) caused by adaptive shortening of soft tissues can occur as the result of many disorders or situations. Factors include: (1) prolonged immobilization of a body segment; (2) sedentary lifestyle; (3) postural malalignment and muscle imbalances; (4) impaired muscle performance (weakness) associated with an array of musculoskeletal or neuromuscular disorders; (5) tissue trauma resulting in inflammation and pain; and (6) congenital or acquired deformities. Any factor that limits mobility—that is, causes decreased extensibility of soft tissues—may also impair muscular performance.⁸⁷ Hypomobility, in turn, can lead to activity limitations (functional limitations) and participation restrictions (disability) in a person's life.^9,20

Just as strength and endurance exercises are essential interventions to improve impaired muscle performance or reduce the risk of injury, stretching interventions become an integral component of an individualized rehabilitation program when restricted mobility adversely affects function and increases the risk of injury. Stretching exercises also are considered an important element of fitness and sport-specific conditioning programs designed to promote wellness and reduce the risk of injury or re-injury.^{62,128,139,169} Stretching is a general term used to describe any therapeutic maneuver designed to increase the extensibility of soft tissues, thereby improving flexibility and ROM by elongating (lengthening) structures that have adaptively shortened and have become hypomobile over time.^75,165

Only through a systematic examination, evaluation, and diagnosis of a patient's presenting problems can a therapist ...