Pt tech protocol stretching
- 1. Physical Therapy Technician Protocol: Stretching Level 3 Technical Skill
- 2. Prerequisites Physical Therapy Technician Knowledge Protocols Anatomy Canine Biomechanics & Gait PROM
- 3. Benefits of Stretching Relaxation Decreases pain Prevents joint contracture Prevents adaptive muscle shortening Enhances blood & lymphatic flow Maintains mobility of the soft tissue layers Injury prevention
- 4. Joint Contracture Permanent shortening of a muscle, resulting in decreased range of motion of a joint, due to spasticity, ischemia, or prolonged immobility.
- 5. Adaptive Muscle Shortening When a muscle is shortened for a prolonged period of time, it loses sarcomeres & loses length permanently, resulting in joint contracture.
- 6. Flexibility The ability of the muscles to relax & respond to an elongation force
- 7. Stretching •Stretching can be active or passive, even in the animal patient. •Passive stretching techniques taught in this module are skilled 'hands on' manual techniques. •PROM occurs at the joint surface, ligament, & joint capsule. •Stretching is performed to the muscle, tendon, ligament, joint capsule, & fascia.
- 8. Indications for Stretching Immediately post-operatively. Post-injury (following resolution of the acute, inflammatory stage). Geriatric patients (due to reduced flexibility). Immobile patients, especially those prescribed crate rest.
- 9. Contraindications for Stretching Unstable or unstabilized fractures. Unstable ligament or tendon injuries. Pain due to stretching.
- 10. Remember to Warm Up First! Take the patient on a walk to warm up his body & muscles. Use a heating pad or hot pack (but be aware of the potential for burns). Massage the muscles to be stretched to increase blood flow to the area.
- 11. Patient Positioning for Stretching •Sidelying or laterally recumbent – This is the optimal position for both you & the patient. – Position yourself behind the patient, if possible, for most efficient body mechanics. •Standing – For fractious, nervous, or dominant dog, this may be the only option. – Be sure to support your patient's body when performing standing stretching as he/she will be balancing on three legs.
- 12. Stretching Procedure Invite the patient to lie down & relax. Give positive feedback & prepare, relax, or distract the patient through: – Petting or massage. – Treats. – Toys for distraction. Position your body & your hands The patient should be relaxed. Be gentle. – Your hands relay your level of stress, anxiety, or relaxation to the patient.
- 13. Stretching Procedure •Support the limbs so that the patient can relax as much as possible. •Consider the length of “lever arms” & adjust your stretch based on physics. – If the “lever” is long, be more gentle! •Avoid handling painful areas such as wounds or incisions. •The motion should be slow, smooth, & steady. •Stretch to the point of tissue resistance, not patient discomfort.
- 14. Method of Stretching Find the “end range” stretch where there is comfortable tissue resistance. Hold for 15-60 seconds. Repeat 3 times. Repeat 1-3 times daily.
- 15. Stretching the Cervical Spine Muscles The pet should be seated or standing. Lead him to reach for a treat by his left hip. Gently hold back his right shoulder blade. Hold for 15-60 seconds. Repeat to the right.
- 16. Stretching the Teres Major The pet should be lying in lateral recumbency. Hold a hand behind his elbow. Reach forwards, up, & out. – Extension, abduction, & external rotation. Gently rock his shoulder blade back with the other hand. Hold for 15-60 seconds.
- 17. Stretching the Triceps The pet should be lying in lateral recumbency. Hold a hand behind his elbow & the other at the wrist/paw. Reach the leg forwards into extension (towards the head) & gently flex the elbow. Hold for 15-60 seconds.
- 18. Stretching the Biceps The pet should be lying in lateral recumbency. Hold at his shoulder with the other hand at the carpus/paw. Reach the leg backwards into flexion (towards the hip) & gently extend the elbow. Hold for 15-60 seconds.
- 19. Stretching the Carpal Flexors The pet should be lying in lateral recumbency. Hold at his elbow & the other hand at the paw. Extend/straighten the elbow & extend/straighten the carpus. Hold for 15-60 seconds. THEN flex the elbow & extend/straighten the carpus.
- 20. Stretching the Hamstrings The pet should be lying in lateral recumbency. Hold his thigh with one hand & the tarsus with the other. Flex the hip & gently extend the stifle to reach the paw towards the shoulder. Hold 15-60 seconds.
- 21. Stretching the Quadriceps The pet should be lying in lateral recumbency. Hold his thigh with one hand & the tarsus with the other. Bring the hip in a 90 degree/perpendicular position from the body, gently flex the stifle, bringing the tarsus towards the ischial tuberosity/hip. Hold 15-60 seconds.
- 22. Stretching the Iliopsoas The pet should be lying in lateral recumbency. Hold his hip with one hand & the stifle with the other. Rub his belly as you gently extend the hip Hold 15-60 seconds.
- 23. Stretching the Gastrocnemius The pet should be lying in lateral recumbency. Hold his stifle in extension with one hand & the paw with the other. Without flexing the stifle, flex the tarsus. The leg will tighten but there will be little motion of the joints Hold 15-60 seconds.
- 24. Stretching Stretching can be a valuable therapeutic tool & an activity taught to pet owners as well. A rehabilitation practitioner should assess the pet initially to determine which stretches are appropriate & safe to perform with each pet. Regardless, if a stretch causes pain or discomfort, it should be discontinued until a veterinarian or rehabilitation practitioner is able to be consulted.