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28 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 24 PRINCIPLES OF GRADED EXPOSURE STRETCHING The underlying principle of GE stretching comes from cognitive behavioral therapy, where gradual contact with anxiety-producing stimuli promotes healing from phobias and anxiety disorders. If a person avoids movement, they inadvertently reinforce their fear. Over time, this avoidance behavior becomes deeply entrenched. GE stretching works by systematically subjecting the person to the feared stimulus in a controlled manner, helping them break the cycle of avoidance and fear reinforcement. PROCEDURE To perform a GE stretch, the therapist moves the client's body to the first mild pain barrier and instructs the client to contract their muscles against the therapist's resistance for a count of five, then relax. The therapist then moves the client's body to the next mild pain barrier and repeats the sequence. The therapist might repeat the stretch multiple times until the client becomes comfortable with the movement. MOVEMENT ENHANCERS GE stretching also employs "movement enhancers" with appropriate stretches. The therapist starts in a position that targets the desired muscle group or joint and then instructs the client to introduce additional dynamic movements. For example, the therapist might ask the client to tilt their pelvis, twist their torso, or move other body areas that aren't the primary focus of the stretch. Exploring different movements and angles of movement produces a comprehensive stretch. Similarly, activating opposing muscles with movement can help relax and lengthen the targeted muscles through reciprocal inhibition. Dynamic movements further stimulate proprioceptors, potentially leading to deeper relaxation and lengthening of MYOSKELETAL ALIGNMENT TECHNIQUES By Erik Dalton, PhD Overcoming Movement Barriers An Introduction to Graded Exposure Stretching KEY POINT • Graded exposure stretching works by systematically subjecting a client to their feared stimulus in a controlled manner, helping them break the cycle of avoidance and fear reinforcement. TECHNIQUE Bodyworkers know chronic musculoskeletal pain often follows a pattern. First, an injury causes pain. Clients fear that any movement will aggravate the pain or cause more damage to the area, so they alter their movement patterns and reduce their activity levels. At some point, the injury heals, but for many clients, the pain pattern becomes ingrained and disability persists. Some clients fall into sedentary lifestyles where a lack of movement further exacerbates their physical condition. Other clients attempt to return to chores, work, exercise, and activities they once enjoyed, but they encounter challenges. One challenge arises when feelings of anger, grief, and anxiety about the condition increase pain sensations. Additionally, people living with chronic pain are prone to central sensitization, a broad term referring to nervous system hyperexcitability. Clients might experience hyperalgesia (increased sensitivity to pain) and allodynia (the perception of pain from exposure to nonpainful stimuli). Central sensitization may result in defensive muscle spasms, muscle imbalances, and ongoing compensatory issues. Living with ongoing pain is also exhausting and may lead to decreased energy levels that make physical activity daunting. In Myoskeletal Alignment Techniques (MAT), therapists use graded exposure (GE) stretches to improve f lexibility and help clients engage with painful movement barriers. GE stretching reduces the anxiety associated with a particular movement pattern or situation.