Physical Therapy Technician Protocol:

Stretching

Level 3Technical Skill

Prerequisites

Physical Therapy Technician Knowledge Protocols

AnatomyCanine Biomechanics & GaitPROM

Benefits of Stretching

RelaxationDecreases painPrevents joint contracturePrevents adaptive muscle shorteningEnhances blood & lymphatic flowMaintains mobility of the soft tissue layersInjury prevention

Joint Contracture

Permanent shortening of a muscle, resulting in decreased range of motion of a joint, due to spasticity, ischemia, or prolonged immobility.

Adaptive Muscle Shortening

When a muscle is shortened for a prolonged period of time, it loses sarcomeres & loses length permanently, resulting in joint contracture.

Flexibility

The ability of the muscles to relax & respond to an elongation force

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.

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.

Contraindications for Stretching

Unstable or unstabilized fractures.

Unstable ligament or tendon injuries.

Pain due to stretching.

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.

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.

Stretching ProcedureInvite 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 handsThe patient should be relaxed. Be gentle.

– Your hands relay your level of stress, anxiety, or relaxation to the patient.

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.

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.

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.

Stretching the Teres MajorThe 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.

Stretching the TricepsThe 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.

Stretching the BicepsThe 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.

Stretching the Carpal FlexorsThe 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.

Stretching the HamstringsThe 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.

Stretching the QuadricepsThe 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.

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.

Stretching the GastrocnemiusThe 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.

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.