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STRETCHING
THERAPY FORSPORTAND
MANUAL THERAPIES
Jari Ylinen
FOREWORD BY
Leon Chaitow
CHURCHILL
LIVINGSTONE
ELSEVIER
STRETCHING
TH E RAPY ~~~~~~~~~~2PIES
This textbook contains valuable information for physiotherapists,
masseurs, physical education instructors and teachers, trainers,
coaches, medical doctors, osteopaths, sportsmen and all those
who use stretching in their work.
Stretching has an important part to play in the care of soft tissues
after strain at work or in sport. It is used to promote recovery of
the tendo-muscular system after exercise or post acute trauma,
to treat overstrained muscles and for relaxation.
Within physiotherapy, manual stretching is used to remove
muscle tension or spasticity and to restore normal stretchability
of soft tissues. Stretching techniques are commonly used within
all manual therapies to treat the tendo-musular system.
This book contains a review of research into the effects of
stretching and comparisons of different stretching techniques.
The theoretical background and physiologic mechanisms are
also explained. Colour photographs show clearly how stretching
is applied while anatomical drawings illustrate the location and
direction of the muscles treated so that correct hand positions
can be readily adopted and the direction of the stretch is
clear. Both static and tension-relaxation stretching techniques
are described and special attention is given to possible
complications and contraindications.
The textbook contains over 160 colour photographs and over 200
drawings.
Jari Ylinen MD, PhD, MLCOM (member of London College of Osteopathic M edicine), specialist in
physical medicine and rehabilitation and registered remedial masseur. He is head
of the Department of Physical Medicine and Rehabilitation at the Central Hospital
of Central Finland, Jyvaskyla, private practitioner and teacher of mobilization and
manipulation techniques.
ISBN 978-0-443-10127-4
FOREWORD BY
Leon Chaitow
TRANSLATED BY
Julie Nurmenniemi
ILLUSTRATIONS BY
Sandie Hill
CHURCHILL
LIVINGSTONE
ELSEVIER
Edinburgh London New York Oxford Philadelphia
SI Louis Sydney Toronlo 2008
STRETCHING
TH E RAPY ~~~~~~~~~~£PIES
I CHURCHILL Note
Every effort has been made by the Author and the Publishers to
LIVINGSTONE ensure that the descriptions of the techniques included in th is book
ELSEVIER
are accurate and in conformity with the descriptions published by
their developers. The Publishers and the Authors do not assume any
First Edition published in Finnish under the title Manuaalinen lerapia
responsibility for any injury andlor damage to persons or property
Venytystekniikat I Uhas-jannesysteemi
arising out of or related to any use of the material contained in this
© 2002 Medirehabook Oy
book. It is the responsibility of the treating practitioner, relying on
independent experience and knowledge of the patient, to determine
First edition published in English
the best treatment and method of application for the patient, to make
© 2008, Elsevier limited. All rights reserved.
their own evaluation of their effectiveness and to check with the
developers or teachers of the techniques they wish to use that they
The right of Jari Ylinen to be identified as author of this work has
have understood them correctly.
been asserted by him in accordance with the Copyright, Designs and
The Publisher
Patents Act 1988.
No part of this publication may be reproduced , stored in a retrieval your source for books,
joumols and multimedia
system, or transmitted in any form or by any means, electronic, in the health sciences
mechanical, photocopying, recording or otherwise, without either the www.elsevierhealth.com
prior permission of the publishers or a licence permitting restricted
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policy is to use Development Editor. Claire Wilson
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Printed in China I Illustrations Manager: Bruce Hogarth
CONTENTS
This text is important because, arguably for the first time, What emerges is a sense that we now know a great deal
the topic is covered comprehensively (and well) - more about the subject than previously, including
incorporating as it does all essential features including important features such as the value of minimal effort,
anatomy, physiology, methodology, safety, variations, the ideal amoun t of time stretch should be held, the most
effects and research evidence, together with excellent appropriate number of repetitions, and the importance -
muscle-by-muscle illustrations and clearly described in therapeutic terms - of the phenomenon of increased
protocols. tolerance to stretch, and viscous and elastic behaviour of
Stretching may appear a simple enough procedure, connective tissue, and how these features influence
however it is deceptively complex, and there are a great stretching (with clear evidence that sufficient, but not
many ways of getting it wrong, and/or of producing excessive, force is needed, over tilne - with tissues at the
potentially harmful outcomes, as well as a variety of right temperature - for optimal effects) .
different ways of stretching correctly - depending on the As can be seen from the comments above, the infor-
effects that are required. mation provided is satisfyingly comprehensive and
What this excellent text has managed to combine is a current, and the layout of the book aesthetically pleaSing,
broad overview of the physiology, neurophysiology An important feature is the regular placement of self-
and methodology of stretching: with discussion of assessment concepts/ questions, a useful aide-memoire of
contexts as varied as application of stretching during key features of the preceding text, as well as being
immobilization, trauma, post-surgery, cramp, joint invaluable for students and practitioners/ therapists who
inflammation and restriction, as well as in relation to are new to these methods.
specific conditions such as back and neck pain, tennis And then we have the presentation of the techniques
elbow, carpal tunnel syndrome, disc problems, neural themselves.
damage and hypermobility. The illustrations are quite simply excellent, with
Most importantly the preventive features of appro- anatomical detail and technique clearly demonstrated.
priate stretching are dealt with in relation to sport, body Even experienced practitioners will find the illustrations
type, age, gender, inherited factors (hypermobility for helpful as many embrace unusual and clearly effective
example), and even the best times of day to stretch! positioning, both of the patient and the practitioner.
The effects of stretching on mobility, flexibility, strength, Whether the positions illustrated are used passively, or
muscle length, tendons, fascia, ligaments, nerves are all with the inclusion of isometric contractions, during one
evaluated. phase of the process or another, is clearly a matter of
Essential topics covered include motivation, prep- choice and previous training.
aration for stretching (including topics such as heat, cold, Each muscle is illustrated, with information provided
massage and vibration), circulatory effects, after-effects as to its nerve supply, origin, insertion and function - and
(soreness), and vitally, how to avoid complications. the technique for stretching is concisely described and
A variety of different stretching methods and systems beautifully photographed, with superimposed arrows to
are covered, including passive, active, active assisted, make absolutely sure that there is no misunderstanding
dynamic, ballistic, static, Proprioceptive Neuromuscular as to what is required. Cautions are offered wherever any
Facilitation (PNF), Muscle Energy Techniques (MET), risk might be involved - for example in stretching
Contract-Relax (C-R), Contract-Relax, Antagonist- sternocleidomastoid.
Contract (C-R A-C), as well as stretching in the context of Stretching in clinical practice can only be safer and
physiotherapy practice. more effective if this exceptional text is used as designed.
A great deal of information is provided as to the
research evidence of the effects and benefits relative to
different types of stretching. INowadays, where there is
an increasing demand for evidence relative to both safety Leon Chaitow ND DO
and the therapeutic value of the use of techniques such as Honorary Fellow,
stretching, the many pages devoted to research evidence University of Westminster,
is very welcome. London
The purpose of this book is to provide a comprehensive Since the know ledge of physiologic mechanisms of
volume of clinically well-tried stretching techniques in stretching has changed greatly during the past decade as
clear form and systematic order so that they can be easily a result of scientific research, the theory section is
adopted in studying and also used as a quick reference interesting reading for professionals having not been on
book in the clinic. the school bench lately. Thus, the first chap ter is devoted
Like joint manipulation which may be unspecific and to theory and research in stretching. It also includes
treat the whole spine or specifically directed to single recent recommendations abou t how stretching should be
joint, stretching can also be directed to the bulk of applied.
muscles or focused to a specific part of the muscle. Thus, This textbook has been wri tten with the intent to
the aim of this book is to provide more ad va need provide detailed study material for physiotherapy as
stretching techniques. well as the manual therapy profeSSions: chiropractic,
J also hope that this book will awake interest in the naprapthy, and osteopathy. However, this book is also
stud y of manual therapy, as it shows the importance of a essential reading in professions of physical education like
thorough knowledge of human anatomy for students, coach, personal trainer and PE teacher.
and thus inspires learning.
ACKNOWLEDGEMENTS
Stretching is one of the oldest therapy forms practiced insight to stretching techniques. We had many brilliant
among all ancient cultures. Manual therapy including teachers from different parts of Great Britain and even
manipulation, massage and stretching has a long some from USA. I thank them for their devoted teaching,
standing tradition in medical education. In Greece, as broad arsenal of techniques is important in practice
Hippocrates (460-377 BC), the father of medicine, even which one only fully realizes when one knows them.
prescribed its use in his writings, w hieh I discovered Since returning to Finland I have specialized in
during a course of medical history at the University of physical and rehabilitation medicine as well as pain
Turku. In the University library I found German medical treatments. Due to side effects of drugs I have become
textbooks from the beginning of the 1900s describing more and more convinced that manual therapies should
basic manual treatment techniques. In Finland, as well as be tried in many conditions before relying only on the
in many other European countries, these techniques were long-term medication for pain . I have also devoted
also taught to medical students, which they then myself to teaching manual therapy techniques to others.
commonly practiced to finance their studies. After the My students suggested that it would be easier to
Second World War, studies of manual therapy were memorize techniques if they are written. This induced
replaced by chemistry and pharmacology as well as me to write this book, and although manual therapy
constantly growing studies of many special fields made cannot be learned wholly from books I thank my
possible by the advancement of medicine. students for the initiation of this one.
However, old customs inspired me to study in private The aim is of this book is not only to show a selection
massage school, Juntunen at Lahti, and thus I become a of stretching techniques, but to systematically present the
registered remedial masseur. Thanks belong to deceased techniques found to be most effective during three
Kauko Juntunen, who was the director of the massage decades that J have taught and studied manual therapy.
school as well as the enthusiastic fellow students with As manual therapy is not 'alternative medicine' but
whom training often took place past ordinary hours. original medicine the scientific basis of the therapy is
There I found a good basis for studies in manual therapy, important. Thus, research in the area has been dealt with
anatomy and dissection studies for which I thank all my extensively. Although, there is still much to be done in
teachers and especially Professor Risto Santti. research, we now know physiologic effects of stretching
Afte~ this course J was able to obtain many good better than many medications. I want to thank all those
results in musculoskeletal disorders by treating patients researchers, who have put much effort into evaluating
with only hands using soft tissue massage and stretching physiologic mechanisms as well as the effects of
techniques. After graduation as medical doctor I worked stretching.
for a few years but still wanted to learn more about Finally, I also want to thank Julie Nurmenniemi for
manual therapy and so J entered the London College of translating tms book, originally written in Finnish and
Osteopathic Medicine. There J learned further joint called 'Venytystekniikat', to English; Hilkka Virtapohja,
mobilization and manipulation techniques as well as soft PT, MSc, specialist in manual therapy, who is the
tissue techniques used by osteopaths, which differed therapist performing the stretching techniques through-
very much from Finnish and Swedish massage out the book, and models Jouni Leppanen, Juuso Sillanpaa
techniques. I become also familiar with muscle energy and Vesa Vahiisalo.
and positional release techniques, which gave me new
SECTION 1 STRETCHING THEORY
Self-assessment: mobility
referred to as spastic. However, spasticity is a condition Tension with spasticity and rigidi ty is not always
directly related to nerve damage or nerve diseases entirely the result of nerve damage. Changes in muscles
involving the upper motor neuron system. Damage will w ill appear, as use will concentrate on slow motor
be loca ted in the pyramidal corticospinal nerve neurons. The rapid motor cells are not activated and they
pathways: the spinal cord, brain stem or the cerebral w ill tend to shorten, atrophy and become less frequent.
cortex. Minor damage will appear as minimal spasticity Minimal use of joint range will lead to shortening of joint
towards the middle phase of a given action while connective tissue as well as in muscles. The changes
extremities are moved quickly back and forth while in a become gradually permanent, as normally elastic fibres
relaxed state. More severe spasticity will involve the will be replaced by tougher fibrou s tissue. Care should be
entire joint area. Intense stretching may suddenly release taken to preserve mobility with regular active and
spasticity and is known as the clasp-knife effect. passive exercises at the onset of disease in order to mini-
Spasticity wi ll affect either the muscles of extension or mize the extent of movement limitation.
flexion depending upon which area of the nervous Spontaneous activa ti0{l of individual motor neurons
system has been damaged. Hyper-reflex is the term used may cause a twit~hing effect, fasciculation, but may not
to describe the over-active nature of spasticity. In the produce actual mov~ment. This OCCurS most often with
clinica l exa mina tion, the muscle-tendon system is partial paralysis and in spastic muscles. A mild form of a
stretched with minimal force to check if the reflex similar phenomenon occurring in healthy people is
response is exaggerated. Repetition of reflex response commonly called a twitch or myokymia. The most typical
contractions often leads to lesser jerking movements, form of twitching occurs in the upper eyelid, but it may
known as clonus. Damage to the pyramidal corticospinal appear in any muscle and the affected muscle may vary.
nerve pathways may also involve a change in the Damage to lower motor neurons, i.e. those nerves
Babinski reflex from negative to positive. Applying pressure ex iting the spinal cord, will result in flaccidity. Muscles
to the heel with a blwlt object and drawing it swiftly along will become partly or completely paralyzed. Limb
the outer edge of the foot towards the toes will cause the big muscles also have reduced tone, i.e. they are hypotonic.
toe to flex. Violent extension of the big toe is an indicator This suggests that these patients should have good range
of pyramidal pathway damage. This reaction, however, is of movement in the affected joint. However, mobility
normal in children under the age of 7 years. often becomes restricted in joints, because they may not
Damage to the extrapyramidal nerve pathways of the have been moved regularly throughout whole ROM.
central nervous system will result in rigidity. It affects the Instability refers to the occurrence of abnormal joint
entire joint area involving both the flexor and extensor mobility due to lack of support normally supplied by the
muscles. Stiffness is felt with slow movements and does surrounding tissues to maintain the integrity of the joint;
not depend to the same degree on the speed of movement testing can reveal laxity of joint ligaments. Hypennobility
as it would w ith spasticity. Reflexes are not oversensitive refers to an exaggerated mobility in ROM but movement
and the Babinski reflex is negative. During passive remains in the normal line of joint action (Figure 1.10).
flexion and extension of a joint, muscle te nsion Hypermobility may appear in one or more joints, and
repeatedly increases and decreases rapidly, causing jerky may indicate hypermobility syndrome. Instability and
movements. The degree of resistance depends on how hypermobility are often confused with one another. Hyper-
quickly the joint is bent and the muscles are stretched. mobility involves exaggerated ROM within the normal
Mild rigidity, for example in the early stages of function of a joint. Instability, on the other hand, can be
Parkinson's disease, may be undetectable except as a classified as a symptom of disease involving the pathology
stuttered resistance to fast movements. in the joint stabilizing system. A hypermobile joint is
Disease of the central nervous system may only involve more vulnerable to trauma and thus hypermobility may
spasticity of certain muscles and involuntary movement lead to joint instability more readily, compared with a
known as dyskinesia. Spasmodic torticollis is an example of joint with normal ROM and stability.
spas ticity that often affects the muscles on only one side Instability may also ap pear in joints with normal
of the neck, resulting in exaggerated rotation that can be ROM, and/ or even limited ROM. Hypermobility and
temporarily relieved with stretching for a few seconds instability have also been defined acco rding to type of
but the neck will then quickly return to the same position. movement (Figure 1.9). Arthritis and rheumatism, over
SECT ION 1 STRETCHING THEORY
Figure 1.6 Instability of the knee due to inward Figure 1.8 Instability of the knee due to exaggerated
deviation: valgus deformity. bending of the back: hyperextension.
Direction of motion
- Angular Translatory
~
l Hypermobility
J [ Instability
J
Figure 1.9 Instability in relation to type of motion.
Figure 1.11
A: Shoulder joint in tack, joint surfaces in opposition
to each other and joint shows maximal stability, which
depends on muscle activity and support of other
connective tissues.
B: Subluxation of shoulder joint with joint surfaces
only partially opposite each other. Orthopaedic
instability, this may often correct itself with the active
movement of the upper arm.
e: Dislocation of shoulder joint; joint surfaces w ithout
any contact to one another. Manipulative
repositioning is commonly needed to correct the
displacement.
SECTION 1 STRETCHING THEORY
/
Nerve irritation [ Pain
]
\ Increased
muscle stiffness
Flexibility of the locomotor system has specific charac-
teristics that vary, both between individuals and between
joints. Joint mobility depends on physical anatomy and
connechve tissue structure, which are greatly determined
by hereditary factors. The normal development of joints
\ Increased load
J is assisted with physical activity and load. Genetic defects,
deficiency disease, infection and toxins, especially during
the early growth phase, as well as prolonged immobility,
may cause pathologiC structural changes. Excessive load-
ing, trauma and/or inflammation of joints and their
Figure 1.12 A vicious circle may develop as nerve surrounding soft tissues may cause structural changes,
irritation caused by pain leads to muscle tension, resulting in permanent mobility limitations or instability.
which leads to increased loading and impaired Joint mobility is based on joint type that involves surface
circulation, which again increases muscle tension. shapes and structure of connective tissue.
• Pivot joint allows one surface to rotate arowld the joint mobility are the bony structure and protective layer
other as in the superior radio-ulnar and atlanto- of cartilage. Damage and inflammation fo llowing trauma
axial (between anterior arch and dens) joints. or operation may limit mobility, which usually becomes
• Plane joint, in which opposing surfaces glide or slide evident when the cast or splint has been removed .
against each other to produce movement; surfaces Immobil ization due to trauma often leads to shortening
are flat or may be slightly curved, as in the facet of connective tissue, the formation of adhesions, scar
joints of the spine and intercarpal joints. tissue, cheloids, and fibrotic contracture of muscles,
tendons or other connective tissues. In these cases,
stretching caused by normal movements may cause severe
pain, and mobility may not spontaneously return with-
FACTORS AFFECTING .JOINT
out a specific stretching treatment.
MOBILITY
A basic knowledge of an atomy, kinesiology, connective
Genetic factors form the basis of connective tissue s truc- tissue, joint function and the nature of the pathology
ture and therefore will affect mobility in a number of involved are essential in the treatment and rehabilitation
ways. Genetic factors decide the composition, of restricted joint mobility. Joint capsules and their
organization, shape and basic size of tissues; they also ligaments are responsible for almost half of the total
determine the shape of jOint surfaces and their size. Race resistance in joint mobiHty. Both passive joint stability
w ill fundamentally affect joint mobility. Natives to South and joint mobility depend on the structure formed by
Asia clearly have more flexible joints, and Africans have joint surfaces~ capsules~ and ligaments. In cases of limited
broader joint mobility than Europeans (Wordsworth et al mobility, effective stretching is an important treatment
1987). Many other factors will affect joint mobility method, w hich can usually restore normal function if
including exercise, hormonal factors, e nviro nment and applied during the early stages. Treatment should not
body temperature. focus only on the relief of pain with medication and
Factors affecting joint mobility may be divided into passive physiotherapy. Active stability depends on
two categories: internal and external. Passive extensibility muscle function: shortened and tight muscles will cause
refers to those internal factors affecting joint mobility dysfunction tha t can be corrected with proper stretching
including: elasticity of surrounding corUlective tissue; its and exercising. Prolonged immobility may, however, lead
amount and thickness; muscles; fascia; tendons; synovial to structural changes as elastic fibres are replaced by
sheets; aponeuroses; joint capsule and liga ments. Flexi- tougher fibrous tissue to such an extent that stretching
bility may be limited by anyone of these stru ctures, and treatments are no longer effective and such tissue must
may possibly involve pathological dysfunction of a parti- be manipulated while the patient is anaesthetized.
cular structure. Disease, injury and surgery will cause changes in the
Restriction of normal joint mobility depends on joint tissue mobility. Changes will also arise following intense
type and surrounding tissues. Passive resistance of the stretching and as a result of prolonged immobilization.
wrist joint is foremost a result of the condition of the joint Furthermore, hyperactivity of the neuromuscular system
capsule and joint ligaments. Restriction has been measured may be involved, for instance, in the pathologic myotatic
at 47 % joint capsule in vo lvement, 41 % surrounding reflex, which responds to stretching, or there may be local
muscles and intermuscular fasciae, 10% tendons and 2% mechanical hindrance such as in disc prolapse, causing
skin tissue Gohns and Wright 1962). That is very different sciatica.
from the elbow joint, as muscles and tendons have During joint mobilization, it is apparent that joint
accounted for 84% of the variance in elbow stiffness position can affect restrictions in mobility. Movement is
(Chleboun et al 1997). Thus, factors restricting mobility easiest in a neutral position when ligaments are most
may differ greatly from joint to joint depending on loose. Ligaments will begin to tighten and joint surfaces
anatomy. press against each other as joints are taken to their
Excess fat may interfere with normal movement. furthest limits of ROM. Movement in other directions
Included in the category of internal fa ctors that may limit will decrease or disappear completely.
SECTION 1 STRETCHING THEORY
atrophy of the vastus lateralis muscle was much less and related incidents. As muscles automatically lengthen
considerably slower. Muscle cells of the calf are primarily with bone growth, there is no need to operate on them.
of the slow type and appeared to be more susceptible to If stretching is removed, the length and number of
atrophy than the fast cells of the thigh muscle. sarcomeres return quickly to normal, as sho wn in
Immobilization causes not only significant changes in labora tory stud ies (Frankeny et al 1993).
structure, but also affects the neural mechanisms of Muscles adapt more readily to biochemical changes
muscle contraction. Thus, muscle strength may weaken due to immobilization in a stretched pOSition than in a
much more during the early stages of immobilization shortened position . The balance between protein syn-
than changes in size may suggest. Muscle atrophy is thesis and the breakdown of protein has a direct affect on
accompanied wi th an increase in other connective the growth (hypertrophy) and muscle degeneration
tissues, w hich are not able to contract a nd have lower (atrophy). Passive tension created by stretching has been
stretchability. Long-lasting irrunobilization also causes shown to s low degenera tion of connective tissu es and
changes in joint structure leading to stiffness and restric- reduce the breakdown of proteins in muscle tissue. In
tion in ROM as a result of constriction of joint capsule some cases, passive tension h as been shown to cause
and ligaments. Thus, early mobilization has become com- muscle growth (Vandenburgh 1987).
mon practice after surgery and trauma. During immobiliza tion of a muscle in a semi-
Joint position and muscle tension during immobilization contracted position, it is possible fo r the amount of
following surgery or trauma may cause changes in muscle sarcomeres to reduce by as much as 35% while shorten-
length. There is an increased risk of muscle atrophy if ing in length, and muscle strength will be reduced.
there is immobilization of the joint with muscle in the Muscles also adap t to changes in length mechanically by
shortened position. Muscle atrophy is noticeably faster producing most force from a new resting position.
than if the extremity is in a stretched position during Connective tissue in muscle increases with the thickening
immobilization with cast. Slow muscle cells will atrophy of the endomysium and the epimysium. Ultimately,
quicker than fast cells making tissue changes vary muscle flexibility wi ll be decreased with these changes.
between muscles. M u scle composition also varies In order to best preserve muscle integrity, immobil-
between individ uals and thus some people may be more ization in a stretched position is preferable to a shortened
vulnerable to degenerative effects of immobilization than position . Physica l trauma or surgery, however, may
others. The initial condition of muscles is important. in prevent optimal positioning. Furthermore, it is likely that
muscles immobilized in a shorten ed position sarcomere w hile muscles are immobilized in a stretched position
loss can be prevented with as little as 30 min of that the corresponding antagonists will be contracted.
intermittent stretching per day (Wiliams 1988). O ptimal treatment for one muscle group may have sub-
Tabary et al (1972), Williams and Goldspink (1978) and stantial, undesired effects on another. To compromise,
Frankeny et al (1983) have shown in their research that irrunobilization is usually in a position in which all muscle
the positioning of the extremities during immobilization groups are as close to n eutral or a res ting position as
will noticeably affect muscle structure. Positions in which possible . In som e cases, it is possible to vary positions
muscles are slightly stretched cause an increase in the throughout the treatment of immobilization so that all
number of sarcomeres in the end portions of a muscle. muscle groups are in a stretched pOSition for some of the
The muscle adap ts by growing in length. Immobilization time.
in a stretched position for 30 min a day after 6 weeks
resulted in structural changes. In addition to an increase
in muscle length there was an increase in the amount of Self-assessment: immobilization and mobilization
capillaries. When a muscle is stretched, the contact • How does joint position during immobilization
between actin and myosin filaments decreases, which in affect muscle structure and function?
turn decreases maximum force of the muscle. The increase • List structural and environmental factors
in sarcomeres will slow the muscle from weakening; this affecting stretch ability of the connective t issues.
process is considered a compensatory mechanism. Muscles • Describe factors that may cause muscle imbalance
are s uspended in long-term stretching posi tions in cases and how the balance should be restored.
of bone lengthening surgery after birth defect or trauma
PHYSIOTHERAPY TREATMENTS PRIOR TO STRETCHING
and muscle, but only a few tenths of a millimetre in bone. The suboccipital area, cervical ganglia, eyes, thyroid,
The applicator is moved slowly, 1-2 cm per sec, and in heart, gravid uterus, tumours, cervical ganglia, lamin-
order to cover an area of 100 cm' the treatment should ectomy sites, and patients with a pacemaker and other
last about 5-10 min. A significant problem in US therapy devices should not be treated with SWD.
is that with identical US treatment parameters, different
devices produce different intramuscular temperatures Contraindications to treatments
(Merrick et al 2003). Thus, the results from a clinical of heat
study obtained with the device of a certain make cannot
• Acute compartment syndrome, inflammation,
be applied generally, as a device produced by a different
trauma or haemorrhage
manufacturer ma y produce different results.
• Arrythmia
A SWD (Short Wave Doathermy) machine is a radio
• Bleeding disorders, especially haemophilia
transmitter producing radio frequency electromagnetic
• Bursitis
waves. It ma y cause electrical interference and therefore
• Cardiac insufficiency
shortwave therapy machines are restricted to operate at
·Oedelna
27 MHz. There are several types of inductive applicators,
which are placed over the treatment area for 10-20 min. • Disc prolapse
• Fibromyalgia
Continuous output is used when the goa l is heating and
• Heat urticaria
pulsed output when nonthermal treatment effects are the
• High blood pressure
primary aim. The average output power may be the
• Infection
same. Continuous output tends to heat more water-poor
• Intra-articular swelling
substances such as fatty tissue, and it is possible to
• Insensitivity
overheat subcutaneous fat tissue, if the layer is thick.
• Ischaemia due to weak circulation related to
Heat is released by evaporation at the skin surface.
arteriosclerosis
Perspiration is conductive and, if present in the electro-
• Malignancy
magnetic field, heats the skin excessively. The skin must
• Nerve entrapment
be examined prior to treatment, thus, clothes and all
• Neuropathic pain
metal, including jewellery, shou Id be taken off. Surgical
• Pacemaker
stitches, implants, contact lenses, metallic intrauterine
• Skin conditions: atrophy, eczema or skin tissue
devices, and the menstruating or pregnant uterus should
damage
not be exposed to diathenmy. Although this treatment
• Stimu lator
method was popular in the past, it is now seldom used.
• Superficial peripheral nerves (peroneal nerve and
Heat treatments are not recommended as routine
ulnar nerve)
with all stretching. Inflammation or damage of nerves
• Synovitis.
when combined with heat treatments only irritates
nerves further, increasing pain and muscle tension. Based
on clinical research, it is often impossible to determine According to research by Noonan et al (1993), an
whether pain is purely of nerve or muscular origin. increase in muscle temperature from 25 to 45°C reduces
tension in the muscle-tendon system, improving the
Factors affecting applications of results of stretching. Muscle length increases considerably
heat while muscle tissue temperature is raised, making appli-
cations of heat recommendable prior to stretching.
• Origin of heat Wessling et al (1987) studied the effects of US com-
• Intensity of treatment bined with SS in healthy people. Continuous US was
• Duration of treatment given for 7 min at intensity of 1.5 W / cm' on triceps surae.
• Coupling agent SS was applied during the last minute of treatment at a
• Thickness of different tissue layers force of 23 kiloponds. The second group received the
• State of tissues same stretch without US. A combination of US and
• Circula tion. s tretching increased dorsiflexion an average of 1.2° more
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wegblies. Nur das Allerfeinste war stehen geblieben. Hierauf rief er
den Wirbelwind, der den Acker ganz frei fegte. Tatutunpa bat die
Papageien um Samen, sie kamen aber mit untauglichen
Samenkörnern, die alle entzwei waren. Als er sah, daß diese Samen
nichts taugten, bat er die Enten und Tauben und die ganz kleinen
Tauben, sie möchten mit allerlei Samen kommen, und diese taten es
auch. Sie säeten sogar selbst. Als die Saat beendet war, begab sich
Tatutunpa auf dem Wege, der nach seinem Hause führte, heim. Er
war noch nicht weit gekommen, da drehte er sich um, um nach
seinem Acker zu sehen. Er sah, daß die Pflanzen schon zu keimen
begannen. Wieder ging er ein Stück und wendete sich wieder um,
um nach seinem Acker zu sehen. Die Pflanzen waren schon groß.
Wieder ging er weiter und drehte sich wieder um. Da fand er seinen
Acker schon in Blüte. In der Nähe seines Hauses wandte sich
Tatutunpa wieder um, um nach seinem Acker zu sehen, und fand,
daß alles, was er gesäet hatte, schon reife Früchte trug.
Bei Aguaratunpa, der so fleißig gearbeitet hatte, war noch nichts
reif oder in Blüte.
Am folgenden Tage sagte Tatutunpa zu seiner Frau: „Wir wollen
gehen, um nach unserem Acker zu sehen. Sie gingen nach dem
Acker und die Frau sah, daß alle Früchte reif waren. Tatutunpa gebot
ihr, ein Feuer anzumachen, um Mais und alle anderen Früchte zu
rösten. Er sagte ihr, sie solle einen Maiskolben, zwei Bohnen und
einen Kürbis ausgraben, aber nicht mehr. Nicht einmal dies
vermochten sie aufzuessen.
Danach gingen sie nach Hause und sagten zu der Alten, sie solle
mit ihnen kommen und alles abernten, was sie zu essen wünsche.
Die Alte glaubte ihnen nicht, sondern glaubte, sie hätten gestohlen.
Sie konnte nicht glauben, daß sie etwas zu ernten hätten, da sie
nicht gearbeitet hatten. „Ich gehe lieber zu meiner anderen Tochter,
die fleißig gearbeitet hat“, sagte die Alte.
Aguaratunpa begab sich nun zu Tatutunpas Acker und stahl
Kürbisse, die er nach seiner Anpflanzung brachte. Mit Stäbchen und
Dornen befestigte er die Kürbisse an den halbgewachsenen
Kürbisstengeln. In der Dämmerung kehrte er heim und sagte zu
seiner Frau, sie solle ihre Mutter bitten, in seinem Acker Kürbisse zu
ernten. Die Tochter ging zu ihrer Mutter und sagte: „Wir wollen nach
dem Acker gehen, um Kürbisse zu holen.“ Vergnügt machte die Alte
sich auf den Weg, denn sie hatte gesehen, daß sie viel gearbeitet
hatten, und sie glaubte ihrer Tochter. Sie gingen, fanden aber nicht
mehr Kürbisse, als wie sie in einer Getreideschwinge einernten
konnten.
Am folgenden Tage bat wieder Tatutunpas Frau ihre Mutter, mit
aufs Feld zu kommen. Die Alte glaubte ihr gar nicht, als aber der
Alte, ihr Mann, sah, daß sie so hartnäckig waren, befahl er ihr, zu
gehen. Ärgerlich machte sich die Alte auf den Weg. Tatutunpa ging
vor ihr, auf seiner Pfeife flötend. Als sie auf den Acker kamen, sah
die Alte, daß er voll von allerlei Früchten, Mais, Kürbissen, Bohnen
und Kalebassen war. Die Alte wurde richtig vergnügt, sie konnte ihre
Freude kaum mäßigen.
Als sie nach dem Ackerrain kam, sah sie eine gewaltige
Kalebasse und sagte zu ihrer Tochter, diese wünsche sie für sich.
Während sie plauderten, fiel die Kalebasse auf die Alte, diese fiel hin
und konnte sich infolge der schweren Kalebasse, die sie drückte,
kaum bewegen. Die Tochter kam ihr zu Hilfe und versuchte die
Kalebasse zu heben, sie vermochte es aber nicht. Sie rief ihrem
Manne zu, er solle kommen und ihr helfen. Dieser blieb jedoch eine
lange Weile fort, und erst als die Alte dem Tode nahe war, kam er,
hob die Kalebasse auf und setzte sie wieder an ihrem alten Platze
fest. Die halbtote Alte hob er auf.
Als sie sich nach einem Weilchen erholt hatte, sahen sie sich
weiter den Acker an. Die Alte wollte einen Maiskolben abbrechen.
Tatutunpa sagte ihr, sie solle seinen Acker schonen und nur den
Kolben abbrechen. Sie erntete nun zwei Maiskolben und zwei von
allen anderen Früchten, ohne etwas zu zerstören. Alles, was sie
abgeerntet hatte, setzte sofort wieder reife Früchte an. Mit den
Früchten beladen, ging sie nach Hause. Sie erzählte ihrem Manne,
daß Tatutunpa schon einen großen Acker habe. „Das ist somit der
Tatutunpa, den wir haben kommen lassen“, sagte der Alte.
„Aguaratunpa hat uns betrogen.“
Am folgenden Tag sagte Tatutunpa zu seiner Frau: „Wir wollen
nach unserem Acker gehen.“ Sie gingen dorthin. Er grub nun ein
Loch, in welchem er ein Feuer machte. Als das Loch richtig warm,
richtig rot war, nahm er eine sehr große Kalebasse und kroch in
dieselbe hinein. Er bat seine Frau, die Kalebasse zuzustopfen, in die
warme Grube zu legen und die Kalebasse, wenn er pfeife,
umzudrehen, damit er hinaus könne. Die Frau tat so, wie er gesagt
hatte. Als er pfiff, drehte sie die Kalebasse um und Tatutunpa kam
heraus, schön und jung, mit allen seinen alten Schmucksachen
geschmückt.
Nach einem Weilchen wärmte Tatutunpa die Grube wieder und
seine Frau kroch in die Kalebasse. Er bedeckte diese und warf sie in
die Grube. Als sie pfiff, drehte er die Kalebasse um. Jung und schön
kam sie aus derselben.
Sie kehrten nach Hause zurück und nahmen ein
Quebrachostäbchen mit, um damit Feuer anzumachen. Als sie nach
Hause kamen, war die Alte mit dem Brauen von Maisbier
beschäftigt.
„In dieser Nacht wird es sehr kalt und deshalb habe ich dieses
Stäbchen mitgenommen, damit wir etwas haben, woran wir uns
wärmen können“, sagte Tatutunpa. Aguaratunpa hatte viel „Tartago“-
Holz mit nach Hause genommen, es reichte aber nicht die ganze
Nacht. Mitten in der Nacht war das Holz zu Ende. Er ging zur
Feuerstätte seiner Schwiegermutter, die beim Maisbierkochen war.
Als die Alte sah, daß ein Fuchs sich zu ihrem Feuer schlich, steckte
sie ein Stück Holz in Aguaratunpas Hinteren. Mit dem Holz im
Hinteren sprang er davon, für immer in einen Fuchs verwandelt.
Ü b e r d e n S o h n v o n Ta t u t u n p a u n d w i e e r s e i n e
Mutter gerettet hat.
D e r M a n n , d e r s i c h m i t d e r To c h t e r d e s
Donnergottes, Chiqueritunpa, verheiratete.
„Choihuihuis“ Frauenraub.
W i e A g u a r a t u n p a Ta t u t u n p a t ö t e t e u n d d a n n s e l b s t
getötet wurde.
Abb. 130. Silberne Nadel zur Befestigung des Tiru. Die Form indianisch, die
Ornamente spanisch. Chiriguano. Parapiti. ⅓.