Therapeutic Muscle Stretching: General Guidelines for Treatment

Treatment plans that include Therapeutic Muscle Stretching (TMS) should be developed as a result of a thorough examination. This may only involve the addition of specific observations and muscle flexibility checks, while performing the initial examination of your new patients.

Range of motion can be influenced by several structures: skin, subcutaneous tissue (fascia, adipose, etc.), muscles, ligaments, joint capsules, joint surfaces, and intra-articular structures. All should be considered when evaluating an abnormal range of motion.

One would expect to find normal muscle tissue to be pain free, with good tone, strength, and elasticity. Movement, contractions and relaxation should be unrestricted and smooth. Testing should reveal normal innervation and circulation.

If a biomechanical examination, which should include assessment of joint play and "end feel," identifies shortened muscles, then a "trial treatment" may be performed. If the treatment results in a reduction of pain and restoration of normal ROM, the "working diagnosis" is confirmed, and treatment may proceed.

Misuse, disuse, and overuse frequently occur and many times result in muscle shortening and impaired function.

Shortened muscles may cause local pain in periosteal attachment, tendons or the muscle itself, or it may result in referred pain to other structures and/or organs.

Stiff muscles are often activated in movements in which they otherwise would not take part. This overuse in turn leads to injury and/or excess inhibition of their antagonists. Thus, the shorter the muscle, the greater its potential for inhibition of its antagonists.

Therefore, stimulating and strengthening a shortened muscle's antagonist always aids in treatment. However, the shortened muscle should always be stretched before its antagonists are strengthened.

With experience, careful observation and palpation, one can detect specific muscles that are shortened and restrict the ROM. In addition to the office procedure, properly instructed home stretching exercises should be taught to the patient, with care directed to isolating the shortened muscular tissue. Often over-zealous self-stretching is nonspecific and may do more harm than good.

In some cases, irreversible changes may have occurred, e.g., collagen replacement of sarcomeres. Normal ROM and movement patterns may not be completely restored. However, even in cases where increases in ROM are very limited, stretching can still be valuable, particularly because of its pain reducing effect.