3-Dimensional Stretching Benjamin L. Kolly DPT, OMPT, ATC Xcel Physical Therapy, PLC

Bring spine roll Wedges, towels belts

Objectives Review Basic Concepts of Stretching Identify purpose for 3-Dimensional Stretching Describe two 3-D stretches for immediate use

6 Principles Force vs Time Prepositioning Avoid torque through stiff joint Follow up with AROM or activity

Tissues Muscles – Manual stretching, Hold-Relax, Reciprical inhibition Joints – Mobilizations, traction

Why 3-D Tissues do not move in 1 plane Avoid aberrant stresses on painful, restricted joints Maximize the lengthening of muscles Maximally open foramen Protect spinal segments

Mechanisms Traction joints Pre-position joints Stretch through 2 or more joints Glide (slow mobilization) through stretch

Thoracic Spine Stretch SDLY with SB over roll and knees bent up With top arm reach backwards causing a rotation opposite of side bending Add weight to arm as needed Vary amount of trunk flexion

Piriformis Roll under L/S promote anterior tilt = L/S extension Flex greater than 90 degrees, ER hip, glide hip posteriorly Flex to approximately 60 degrees, IR hip and stabilize ipsi ASIS (p237)

Hip Extensors Roll under L/S promote anterior tilt = L/S extension Flex hip and posterior gliding of hip joint Gluteus Medius & Minimus – Abduction and ER Gluteus Maximus – adduction and IR

Ilipsoas Prone on table, folded towel under abdomen to protect, wedge under foot Extend thigh, IR hip, apply ventral glide

Rectus Femoris Prone on table, folded towel under abdomen to protect, wedge under foot Extend the hip, flex the knee, apply ventral glide

Short Adductors Supine, stabilize straight leg Abduct thigh and traction force Prone, stabilize pelvis with belt Ventral glide femur

Long Adductors Posterior tilt with contra leg over table Extend knee and abduct hip (amt hip flexion or knee flexion )

Latissimus Dorsi Maximally flex the lumbar spine, flex shoulder, ER Also SB away and cranially glide humerus

Disc Traction Seated, prone, supine, SDLY options Preposition varying amount flexion, SB Stabilize caudal and pull cranial or vise versa (pg notebook)

Facet Stretching (Glide) Creates extension at 1 segment and flexion at others Mobilize cranial segment ventral cranial to create flexion moment on that segment and extension above

Coupling in the Spine Coupled movements Non-coupled movements Example:

Review 3-D stretches can be used on muscles and joints 3-D concept is useful to: – replicate normal movement patterns – Reduce painful, compressive loads – Maximize elongation – Protect the spine

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