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Introduction

The term mobility is defined as the ability of body structures or segments to move so that range of motion (ROM) for functional activities is allowed (functional ROM).3 It can also be defined as the ability of an individual to initiate, control, or sustain active movements of the body to perform motor tasks (functional mobility).42,111 Mobility, as it relates to functional ROM, is associated with both joint integrity and soft tissue flexibility. In this context, the soft tissues that cross or surround joints must have sufficient extensibility to allow an individual to perform their functional tasks and activities. Importantly, the ROM needed to perform functional activities does not necessarily mean full or “normal” ROM.

Hypomobility, or reduced functional motion, is often caused by adaptive shortening or decreased extensibility in soft tissues. Potential factors leading to hypomobility include (1) prolonged immobilization of a body segment, (2) sedentary lifestyle, (3) postural malalignment with muscle length alterations, (4) impaired muscle performance (weakness) associated with musculoskeletal or neuromuscular disorders, (5) tissue trauma resulting in inflammation and pain, (6) congenital or acquired deformities, and (7) age-related decreases in tissue extensibility. Hypomobility can contribute to activity limitations and participation restrictions in a person’s life.12,19

Stretching interventions are an integral component of an individualized rehabilitation program when restricted mobility adversely affects function or increases injury risk. Stretching is also considered an important element of fitness and sport-specific conditioning programs designed to promote wellness and reduce the risk of injury or reinjury.56,115,127,154 Stretching is a general term used to describe any therapeutic maneuver designed to increase soft tissue extensibility with the intent of improving flexibility and ROM by elongating (lengthening) adaptively shortened and hypomobile structures.66,150

Only through a systematic examination, evaluation, and diagnosis of a patient’s problems can a therapist determine what structures are restricting motion and if, when, and what types of stretching procedures are indicated. Early in the rehabilitation process, manual stretching and joint mobilization/manipulation, which involve direct, “hands-on” intervention by a practitioner, may be the most appropriate techniques. Later, self-stretching exercises performed independently by a patient after careful instruction and close supervision may be more suitable. In some situations, the use of a mechanical stretching device is indicated, particularly when manual therapies have been ineffective. Regardless of the types of stretching used as an intervention, when gains in ROM are made, functional activities and strengthening exercises should be performed in the new range. The stretching interventions described in this chapter are designed to improve extensibility of the contractile and noncontractile components of muscle-tendon units and periarticular structures. The efficacy of these interventions is explored throughout the chapter. In addition to the stretching procedures for the extremities illustrated in this chapter, self-stretching exercises for each region of the body are described and illustrated in Chapters 16, ...

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