Research has struggled to find any benefit to stretching exercises in the rehabilitation of people who have cerebral palsy, stroke or brain injuries. A typical stretching program won't increase muscle length, it won't improve spasticity and it won't help you reach any new goals (unless your goal is to stretch more).
It's time consuming, the kids hate it and now research says it doesn't work!
Why on earth would you do it as part of your home exercise program?
BECAUSE IT'S SO IMPORTANT! That's why!
Mammals were born to stretch...
Spend a bit of time watching animals (and even people) and you'll notice that they all take some time to stretch it out.
Check any professional athletes training and you'll notice that they're also stretching.
It's just simply good for you and good to do!
We stretch to feel good, to make movement easier and to prevent muscles getting tight. Most times when you've been in a position for any length of time, you get up, you stretch, you breath and then you move.
The research is asking the wrong questions.
Just like you wouldn't expect research to show brushing teeth improved chewing, research that asks if stretching improves function is missing the point. If you didn't brush your teeth, eventually they'd fall out and chewing would be hard, but brushing your teeth won't make you a better chewer.
If you help your child stretch regularly, you'll keep their muscles and joints moving optimally and make things easier for them.
That's it ...
But if you don't, and you have a child that's strapped into seating systems and splints all day or constantly using poor postures because of spasticity or bad habits, their teeth will get rotten and fall out ...
just checking you're paying attention!
I see the difference in the kids I treat and I know that kids grow into the shape they spend the most time in.
If spasticity or bad habits hold their bodies and muscles in tight, unchanging positions for any length of time, their growing bodies will grow into those positions permanently.
So stretching is important, but it should never be painful and it should never be the only thing you're doing for your child's therapy. It's an adjunct to therapy, not a a therapy in it's self.
Stretching should be done regularly and comfortably, just as you would stretch your own body.
There are two main types of stretching:
Static stretches - when you hold a position without moving.
This is important for maintaining muscle length and joint range and it best done with positioning equipment like splints and standing frames because the stretches often need to be held for 30 minutes or more.
Many therapists will give static stretches as part of a home program and advise a hold for 30 seconds to a minute. You will neither increase or maintain range with only this kind of stretching, but it will help you feel when there is tightness or a change in muscle flexibility (that may occur with growth, stress or pain), enabling you to address it before it becomes a problem. It also has great value in keeping muscles and joints healthy and happy. My older kids report feeling better and finding movement easier if they have a regular stretching routine, making it a worthwhile exercise to help with exercising! Here's a great post by Dr Karen Pape explaining in more detail (link)
Dynamic stretches - when you move a muscle as far as it will go. Usually it refers to active movement (where the person is participating in the movement)
This type of stretching can improve muscle length and joint range when done correctly. It is more technical however and can also cause injury or worsen existing problems when attention is not paid to the correct alignment, sequence and patterns of movement.
Click here for a detailed post on this (link)
Your physical therapist should work with you to make sure you are comfortable doing dynamic stretches if it is part of your home program.
Just a reminder, stretching should never be painful and is not effective as a way of addressing established contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints)
Stretching and flexibility exercises can decrease tone and spasticity, increase movement efficiency and enhancing balance by making movement easier.
So it's well worth dedicating some time to stretch it out.
We've used these activities in the Fun Zone to focus on stretching this week
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