Contraindications to stretching
These are some of the contraindications:
• Bony block or end - feel to movement of the joint in question.
• Recent or unstable fractures.
• The presence of infection or hematoma in the tissues.
• After some surgical repairs and other procedures, such as skin grafting
and tendon repair.
• Patient refusal.
d) Hold/relax techniques
Hold/relax (or contract /relax) is a principle used when applying
proprioceptive neuro muscular facilitation (PNF) and can be effective when
trying to mobilize muscles. PNF stretching techniques may produce greater
increases in range of motion than passive, ballistic or static stretching
methods. PNF is a form of treatment that was
devised to manually rehabilitate movement in specific patterns using
number of physiological principles to enhance its effectiveness.
A core principle of PNF is that after a muscle has contracted maximally it will then relax maximally. This principle can be used when using exercises to
mobilize muscles which are in a shortened position. The patient is asked to
contract the tight muscle strongly and hold the contraction isometrically for
around 10 seconds, then relax. Following a short period of 2-3 seconds the
physiotherapist then applies a stretch to the muscle, which is maintained for
20-30 seconds. Following a period of recovery this sequence is repeated
Another useful principle used in PNF is that of reciprocal inhibition, which
states that when a muscle (the agonist) contracts maximally, its opposite
counter - part (antagonist) will relax maximally.
The two principles can also be Combined with a hold/relax as described above followed by an active contraction or the antagonist of the muscle to be mobilzed.
The principle of reciprocal inhibition can also prove useful and is worth
Considering during static stretching exercises where a contraction of the
muscle's antagonist can act to relax and lengthen it.