The term mobility is often 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).41,116 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.
Sufficient soft tissue mobility and joint ROM must also be supported by a requisite level of muscle function, including strength, endurance, and neuromuscular control. Not only does adequate muscle function enable functional mobility, it also helps manage imposed physical loads and may help prevent musculoskeletal injury.58,66,71,120,132,159
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, and (6) congenital or acquired deformities. Any factor that limits mobility by decreasing the extensibility of soft tissues may also lead to impaired muscular performance.82 Hypomobility can contribute to activity limitations and participation restrictions in a person's life.10,18
Stretching interventions become an integral component of an individualized rehabilitation program when restricted mobility adversely affects function or 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.58,120,132,159 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) structures that have adaptively shortened and have become hypomobile.70,155
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 a more suitable intervention. 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 ...