Flexibility Training - Part 3

Total Hip and Glute Stretch

• Major muscles being stretched: gluteus maximus, medius, minimus and the lateral hip rotators, aka piriformis, gemellus superior and inferior, obturator externus and internus and the quadratus femoris

A good way to start with this stretch is to do it on yourself. This will give you an appreciation of how many different muscle fibers you can stretch, depending on the angle at which you move the femur. It will also give you an idea of how your client feels with this stretch; as well as how you may be "pinching” muscle fibers that inhibit the comfort and/or quality of the desired stretch.

Lie supine on the floor with your right leg flexed at the hip and the knee to 90 degrees. Laterally rotate the femur. Passive flexibility in this position is approximately 80 to 90 degrees of rotation. If your gluteus medius and minimus are tight, you may feel them stretching as you laterally rotate. Maintaining the lateral rotation, take the right knee and aim it towards your left shoulder. Observe where you feel the muscles stretching. Then take your knee and aim it towards your chest and then your right shoulder. Feel how the stretch changes. This is important in feeling all of the various muscle fibers you can be stretching with this one position.

Figure 1	Figure 2

Cue your client to now flex the hip and knee to 90 degrees. Put your left hand above the knee, and your right hand at the outside of the ankle. Be certain that your right hand is on the ankle and not on the foot as this may be uncomfortable for the ankle (see Figure 1).

Support the femur and cue the client to laterally rotate the femur at the hip. If your client has knee problems that do not allow them to rotate without discomfort, then you may not be able to do this stretch.

Cue the client to pull the right knee towards the left shoulder. As you assist in this movement, be certain that the whole leg is moving at the same time, and not only the knee, as that may lose the lateral rotation at the hip. Go to the endpoint, where the client feels a stretch in the glutes and/or lateral rotators. With your hands on the femur and the shin, cue the client to gently push against you with the entire leg with 50 percent effort for four to six seconds. As the client stops pushing, you may feel a release of the muscle fibers, enabling you to achieve a new endpoint. Be certain that the client is pushing with the entire leg, so as not to place force on the knee. Start at this new endpoint with one or two more cycles (see Figure 2).

You may want to move the limb towards the chest and then towards the right shoulder. Ask the client where they feel the stretch and to point to where they feel it to give you an indication of which muscles you are stretching.

This is an important stretch for our clients who experience low back tightness, sit most of the day and also for those who spend time running or cycling. In other words, this is a valuable stretch for all of our clients!

Straight Leg Adductor Stretch

• Major muscles being stretched: pectineus, adductor brevis, adductor longus, adductor magnus and the gracilis. Passive flexibility of the adductors is approximately 30-45 degrees.

All of the adductor muscles act at the hip. The gracilis, however, also crosses the knee. We therefore need to keep the knee straight if we want to effectively stretch the fibers of the gracilis muscle. This is the same in strength training exercises, i.e. to effectively train all of the adductors, we need to keep the knee straight.

Cue the client to lie supine, with the both legs straight. Cue the client to laterally rotate the right leg. This increases the available range of motion at the hip. The client should attempt to keep the left leg still. Inability to do this could be due to many reasons (e.g., a lack of core strength, tight adductors on the right side or tight adductors/hip flexors on the left side). You may find it helpful to place your right hand lightly on the client’s left leg so as to give them a tactile cue in keeping the left leg still (see Figure 3).

Always ask the client where they feel the stretch and to point to the area. Be certain that the stretching leg is not too high as the client will feel a hamstring stretch instead of an adductor stretch, although both muscle groups are very close to each other on the femur.

At the endpoint, cue the client to breathe in as they gently push towards you with approximately 50 percent effort for four to six seconds. Cue them to breathe out as they stop pushing. You may feel a release in the tension of the adductors at which point you can make a minute increase to the endpoint. This is your new starting point for the next one to two cycles of stretching. If the client feels uncomfortable in the low back or has a difficult time in keeping the non-stretching leg still, try to cue them to keep the abdominals tight or simply bend the opposite knee.

Straight Leg Calf Stretch

• Major muscles stretching: gastrocnemius, soleus

Figure 4	Figure 5

The gastrocnemius crosses the ankle and the knee, whereas the soleus only crosses the ankle. It is therefore important to have the knee straight in order to stretch both of these muscles. Bending the knee will put the gastrocnemius in slack, reducing the efficiency of the stretch. Passive flexibility for these plantar flexors is approximately 35 degrees.

Cue the client to lie supine with both legs straight. Passive flexibility for these muscles is approximately 45 degrees dorsiflexion. A safe way to start this stretch is to ask the client to actively dorsiflex the right ankle while both legs are straight on the table (i.e., “pull your toes towards your knee”). You can determine how tight the calves are and make a decision as to whether you need to flex the hip, i.e. raise the leg off the table. Raising the leg so as to flex the hip will increase the stretch in the calves as well as get into the hamstring muscles. Clients with very tight calves, however will not appreciate this if the position results in a calf stretch that is too aggressive! If your client says they do not feel much of a stretch in the fully supine position, then lift the leg a little bit at a time, until they feel a stretch in the calves when you ask them to pull the toes towards the knee (see Figure 4).

Once you are at the endpoint with your hand on the bottom of their foot, cue the client to gently push the foot towards you (into plantar flexion) with less than 50 percent effort for four to six seconds. As they stop pushing, feel whether the muscles have released to enable you to attain a new endpoint. It is advisable to cue the client to push with less than 50 percent effort, since the calves are powerful muscles, and it can be difficult for you to resist against the isometric contraction (see Figure 5).

References:

1. Alter, M. (1988). Science of Stretching. Champagne, IL: Human Kinetic Books.
2. Brotzman, S.B., (1996). Handbook of Orthopedic Rehabilitation. St. Louis, MI: Mosby-YearBook.
3. McAtee, Robert E. (1993). Facilitated Stretching; Human Kinetics
4. Nordin, M., Frankel, V. (1989). Basic Biomechanics of the Musculoskeletal System. Philadelphia: Lea & Febiger.
5. Norris, Christopher M. (1994) Flexibility Principles & Practice; A & C Black
6. Trew, M., Everett, T. (1997). Human Movement: An Introductory Text. Churchill Livingstone
7. Wharton, Jim and Phil. (1996). The Wharton’s Stretch book; Random House