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  • An overview of facilitatedstretching. . . . . . . . . . . . . . . .

    Robert E. McAtee

    This article offers a brief look at facilitated stretching, an active-assisted form of

    stretching based on proprioceptive neuromuscular facilitation. It describes the

    method, the rationale for its development and use, and gives detailed instructions for

    performing several stretches, both with a facilitator and alone. r 2001 Harcourt

    Publishers Ltd

    Introduction

    Flexibility and coordination make iteasier to accomplish any task thatrequires the use of muscles. They aremajor components of optimumathletic performance and also playan important role in our daily lives.Flexibility and coordination arecritical to preventing injuries,whether on the playing field, in thewarehouse, or in front of thecomputer. Overuse injuries, orrepetitive stress injuries, occur inpart because of soft tissuerestrictions that limit flexibility(Cash 1996, Benjamin & Lamp1996).Over the past 20 years,

    proprioceptive neuromuscularfacilitation (PNF) stretching hasgained popularity, especially in theathletic and therapeutic communityand increasingly with the generalpublic. PNF stretching uses anisometric contraction prior to thestretch to achieve greater gains thanare typically achieved from staticstretching alone. PNF stretching isgenerally done passively; that is, afacilitator administers the stretch tothe stretcher.

    Facilitated stretching is based onPNF principles and techniques butis an active form of stretching, inwhich the stretcher does most or allof the work. When a facilitator isinvolved, the facilitators job is tomonitor and direct the stretchersactivity. Facilitated stretching is alsoknown as CRAC stretching, anacronym for contract-relax, agonist-contract (The muscle that moves thebody segment in the desireddirection is the agonist, the musclebeing stretched is the antagonist).

    Facilitated stretchingsequence: simpliedversion

    Facilitated stretching is active-assisted stretching, which uses activemotion and isometric work toimprove flexibility and enhancemotor learning in the process.Simplified, the steps involved infacilitated stretching are:

    1. Actively lengthen the targetmuscle to its end-range,

    2. Isometrically contract the targetmuscle, and

    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    Journal of Bodywork and Movement Therapies (2002)6(1), 000^000r 2002 Harcourt Publishers Ltddoi: 10.1054/jbmt.2000.0225, available online athttp://www.idealibrary.com on

    Robert E. McAtee NCTMB,CSCSPro-Active Massage Therapy, 1119 N. Wahsatch

    Ave., Suite 1, Colorado Springs, CO 80903, USA

    Correspondence to: R.E. McAtee

    Tel/fax: +1 719 475 1172;

    E-mail: stretchman@stretchman.com

    B W M T

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  • 3. Actively lengthen the targetmuscle again to a new range ofmotion.

    Rationale for use

    The developers of PNF therapybased some of their work onactivating several physiologicalmechanisms in the body (Voss et al.1985). For facilitated stretching,interest lies in two of them:reciprocal innervation and theinverse stretch reflex. Research intowhether these mechanisms areactually responsible for the effectsattributed to them in PNF hasproduced mixed results (Sapega etal. 1981, Taylor et al. 1990, Moore& Hutton 1980, Condon & Hutton1987, Cornelius 1983, Osternig et al.1987, 1990).Reciprocal innervation (reciprocal

    inhibition) is a reflex loop betweenopposing muscles (Alter 1996, Adleret al. 1993). When one musclecontracts, reciprocal innervationsimultaneously inhibits the opposingmuscle on the other side of the joint.This allows movement to occuraround the joint. For instance, whenthe quadriceps muscle contracts, thehamstring is reciprocally inhibited,thereby allowing the knee tostraighten.In facilitated stretching, the

    stretcher uses active motion tostimulate the reciprocal innervationresponse thereby maximizing thelengthening of the target muscle.The inverse stretch reflex (also

    called autogenic inhibition) causes amuscle under tension, either from astrong stretch or a strongcontraction, to suddenly give way.This reflex was originally thought tobe mediated by the Golgi tendonorgans (GTOs), which are located inthe musculotendinous junction andthe tendon. The developers of PNFused maximal isometric contractionsbased on their belief that doing sowould stimulate the GTOs to fire the

    inverse stretch reflex. Altersummarizes a plethora ofsubsequent research on theneurophysiology of PNF. Regardingautogenic inhibition, he says, It[autogenic inhibition] is nowbelieved to be the result of afferentinput from Group II nerve fiberscoming from the muscle spindlesand perhaps from thinly myelinatedfibers subserving pain sensationfrom the joints (Alter 1996).It is known that one of the

    functions of the GTOs is to monitorthe load on the tendon. GTOs aremore sensitive to tendon loadingfrom muscular contraction thanfrom passive stretch, they have a lowstimulation threshold and have adynamic sensitivity that allows themto report small changes in musclecontractile forces (Alter 1996).These factors may help explain thephenomenon of post isometricrelaxation (PIR).

    Post isometric relaxation

    PIR is another way of describingwhat results from an isometriccontraction. Chaitow, in his text onmuscle energy techniques, describesPIR as follows: Following on froman isometric contraction . . . there isa refractory, or latency, period ofapproximately 15 seconds duringwhich there can be an easier (due toreduced tone) movement towardsthe new position (new resistancebarrier) of a joint or muscle(Chaitow 1996). In muscle energywork, the patient may be asked touse as little as 10% of his maximumstrength during the isometriccontraction, yet the relaxation effectis still achieved.So, although the developers of

    PNF based their work onstimulating the inverse stretch reflexthrough a maximal contraction ofthe target muscles, the resultsobtained in facilitated stretching,which uses less than maximal effortin the isometric phase, may be the

    result of PIR, or some othermechanism, or combination ofeffects not yet understood. Furtherresearch in this area would shedwelcome light.

    Lewit and PIR technique

    Besides being the name of thephysiological result of an isometriccontraction, PIR is also the namegiven to a technique introduced byKarel Lewit for the treatment ofmyofascial pain. The protocol issimilar to facilitated stretching, butthe goal of Lewits PIR technique isnormalizing the tone of hypertonicmuscles, not stretching. In Lewitstechnique, the hypertonic muscle ispassively lengthened to its resistancebarrier, then isometricallycontracted, using only 1020% of itsstrength, for 510 seconds. After thecontraction, the patient completelyrelaxes and the practitioner movesthe limb to the new resistancebarrier, taking up any slack nowavailable, but not stretching themuscle tissue. This process isrepeated several times (Lewit &Simons 1984, Chaitow 1996).

    Facilitated stretchingsequence: detailed version

    (Editors note : the descriptions in theremainder of the article are written ininstructional style in which secondand third person narrative is used)

    As mentioned earlier, facilitatedstretching is frequently done with afacilitator, although many of thestretches can be done alone, assistedby accessories. The detailed stepsinvolved in a facilitator-assistedfacilitated stretch are as follows:

    1. The stretcher actively lengthensthe muscle to be stretched (thetarget muscle) to its maximalpain-free end range. This is alsocalled the soft tissue barrier orrestriction barrier (Chaitow

    McAtee

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  • 1996). This active movementincorporates reciprocalinhibition.For example, if you wish tostretch the hamstring, have thestretcher lie on his back andcontract his quadriceps and psoas(hip flexors) to actively lift the legas high as possible, keeping theknee straight. You may need tohold the knee straight as thestretcher lifts his leg. Thisstretches the hamstrings to theirend range. As the hip flexorscontract to lift the leg, thehamstrings are reciprocallyinhibited.

    2. As the facilitator, you thenposition yourself to offerresistance for the stretcher toisometrically contract the targetmuscle against. For stretching thehamstring, support the lower legagainst your shoulder or byholding it with both hands.

    3. Direct the stretcher to beginslowly and push or pull toisometrically contract the targetmuscle as you provide matchingresistance. You want thestretcher to work, but not with somuch effort that he overpowersyou. When the stretcher hasachieved the proper level ofisometric contraction, hold it for6 to 10 seconds. The stretcher

    breathes normally throughout.This isometric contractioncauses post isometricrelaxation.

    4. The stretcher then relaxes theisometric contraction and inhalesdeeply. During this time,maintain the limb in the startingposition.

    5. On the exhale, the stretchercontracts the opposingmuscleFin this case the quadsand psoas and pulls the targetmuscle into a deeper stretch, onceagain using reciprocal inhibitionto enhance the stretch. As thefacilitator, dont push or pull todeepen the stretch. (Facilitatedstretching is an active techniquewhenever possible. If thefacilitator aids in the stretch, itbecomes a passive stretch, andthe stretcher loses theopportunity to improve hismuscular coordination andactivation through activemovement. There is also theadded risk of injury inherentwhen a facilitator is passivelymoving the