Before performing the stretch
• Before commencing a stretching programme, ensure that your assessment has not identified any contraindications to stretching.
• Ensure that there is a logical, reasoned basis for your stretching programme. For example, there is a bony block to movement caused by osteophytes , stretching is not appropriate.
• Consider how you will get the patient to assist in his or her own stretching programme at home.
• Explain how and why you are performing the stretch to ensure maximum compliance and minimal resistance.
• Consider how the stretch might be made more comfortable prior to stretching (eg. Use of a hot pack or hydrotherapy).
During the stretch
• Make your handling firm but maintain patient comfort. Reassure the patient that you will stop the stretch at his or her command.
• Stabilise the joints as necessary.
• Stretch across one joint at a time for two joint muscles.
• Make the stretch slow and sustained - do not bounce.
• The patient should experience a pulling sensation, not pain.
• Hold the position for 30 seconds.
• If tension releases, take the movement a little further.
• Release slowly.
After the stretch
• Warn the patient what feelings to expect following the Stretch.
• Remember that once movement has been regained, active muscle control throughout that range will be needed as well as some form of maintaining the stretch in long term.
