Massage & Bodywork

MAY | JUNE 2019

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70 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 9 so forcefully that it might tear its own tendons. Stretching that utilizes the GTO reflex is described as contract relax (CR) stretching because the client is asked to contract the musculature and then relax it. CR stretching is also known as post-isometric relaxation (PIR) stretching, because the contraction of the target musculature is usually isometric. And, as stated earlier, it is often referred to as proprioceptive neuromuscular facilitation (PNF) stretching. Note that the GTO reflex has classically been described as the sole underlying neural mechanism of CR stretching, but recent research has cast some doubt on this. It is likely that the GTO reflex is part of the underlying neural mechanism of CR stretching technique, but that other aspects of the nervous system are involved. CR stretching technique will be demonstrated later in the article (Images 18A–18C). PUTTING THE TERMS TOGETHER Looking at these many terms, we can see that they are not mutually exclusive, and that any one stretching protocol can be described by many of them. For example, if a client actively moves their right arm across the front of their body into horizontal flexion to stretch the horizontal extensors (for example, posterior deltoid, as seen in Image 3A), and then supplements the stretch by using their left arm to pull the right arm farther into horizontal flexion (Image 3B), then it is a client self-care stretch because the client does this themselves; it is an active stretch because they used the musculature of their right arm to initially move into the stretch; it was supplemented with a passive stretch because they completed the protocol by having that joint's musculature passive as their left arm further stretched the target musculature; Using a rubber band to figure out a stretch. 6A: Placing the rubber band at the attachments of the muscle. 6B: Stretching the rubber band. Stretching the right coracobrachialis muscle. The coracobrachialis muscle's joint actions are flexion and adduction of the arm at the shoulder joint, so it is stretched with the opposite joint actions—extension and abduction of the arm. 6A 6B 7 and it is an AC neural inhibition stretch because the active movement of horizontal flexion reciprocally inhibited the target horizontal extensor musculature! HOW DO WE FIGURE OUT STRETCHES? Stretching is extremely simple. We should never have to memorize a stretching protocol. Instead, we can figure out how to stretch any target myofascial tissue in the body. There are two simple ways to approach this: 1. Bring the attachments of the tissue away from each other. 2. For musculature, do the opposite of the muscle's joint action(s). Bring the Attachments Away from Each Other If we know the attachment points of the tissue, given that stretching is simply making the tissue longer, then we need to visualize how we would bring the two attachments of the tissue farther away from each other. Picture the tissue as being a rubber band on the client's body. Picture the attachment points of this rubber band, and then ask yourself: How do we bring these two attachments away from each other (Images 6A and 6B)? If we can see this for a rubber band, we can transpose this concept to any myofascial tissue. So, for any myofascial tissue/muscle, if we know its attachments, we can figure out what motion(s) of the body would bring them away from each other. Do the Opposite of the Joint Actions The other method for stretching that obviates the need to memorize stretching protocols, at least for a muscle, is to take advantage of the joint actions we have learned for that muscle. A joint action is a concentric shortening function of a muscle; stretching is making the muscle

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