Microsoft Word - STRETCHING PARTICIPANT MANUAL_070110.doc€¦ · Web viewMicrosoft Word - STRETCHING PARTICIPANT MANUAL_070110.doc Author: armasj Last modified by: Sarah Corey

STRETCHINGfor the metabolic syndromepractice manual

UNIVERSITY OF CALIFORNIA, SAN FRANCISCOWOMEN’S HEALTH CLINICAL RESEARCH CENTERPracticing Restorative Yoga or Stretching for the Metabolic Syndrome Trial

Text © 2009-2010 by Sarah Pawlowsky, PT, DPT, OCS Photos © 2009 by Alex Chousa, Reprinted by Permission

Practicing Restorative Yoga or Stretching for the Metabolic Syndrome (PRYSMS) Research TrialUniversity of California, San Francisco, Women’s Health Clinical Research Center

Funded By: National Center for Complementary and Alternative Medicine Principal Investigator: Alka Kanaya, M.D.

Photo Model: Cora WenVersion: February 22, 2010

TABLE OF CONTENTS

INTRODUCTION ………………………………………………………….1

OVERVIEW.….…………………………………………………………….1

what it is……………………………………………………………...……..1

sustained stretching………………………………………………...……..1

GENERAL PRACTICE TIPS ...………………………………………….1

STRETCHES .…………………………………………………….……….2

posture correction and stretches……………………………..………..2-4

neck and arm stretches………………………………………...……..5-14

back and leg stretches……………………………………….………15-28

list of sitting and standing stretches………………………….………...29

recommended combinations of stretches for home practice.…...30-31

SOURCES .……………………………………………..…….….……...32

stretching manual ● 1

© UNIVERSITY OF CALIFORNIA, SAN FRANCISCO WOMEN’S HEALTH CLINICAL RESEARCH CENTER

practicing restorative yoga or stretching for the metabolic syndrome trial

INTRODUCTIONIn order to study the effect of stretching specifically on metabolic syndrome it is important that all participants in the study practice similar stretches. These stretches have been chosen by a physical therapist, Sarah Pawlowsky, PT, DPT, OCS.

Each of you will be taught how to practice these stretches in a way that is comfortable. Do not worry if you don't look exactly like the photo! Your instructor will show you how to practice a variation of the stretch that you can do. We’d like you to practice these stretches at least three times a week at home for 30 minutes. With practice, the stretches will become easier.

OVERVIEW

what it isStretching is a term used to describe any maneuver that increases mobility of the soft tissues in your body. Depending on the activities you do in your daily life, the length of your muscles may shorten. Stretching exercises are designed to lengthen these shortened muscles. Stretching helps you to restore the range of motion needed for pain-free movement of your body during daily tasks. It also may help prevent musculoskeletal injuries and minimize post-exercise muscle soreness.

sustained stretchingThe type of stretching you will be performing is called sustained stretching. These stretches should be applied gently, at a low intensity. The stretch force should be applied slowly and gradually. This will help make the stretching comfortable for you, and it will also help minimize muscle guarding during the stretching maneuvers. This type of sustained stretching helps improve muscle length without exposing your tissues to excessive load and potential injury.

GENERAL PRACTICE TIPS• Wear loose, comfortable clothing.• Dedicate at least ½ hour at a time, 3 days each week to your stretches.• You will need to use two chairs (preferably ones without arms) and have some

empty wall space nearby. You will also need your stretch strap.• Each stretch will be held for 30 seconds, and you will be performing 3 repetitions

of each stretch.




STRETCHES

posture correctionBegin in standing. The posture correction will begin at the feet and move up

toward the head. First, you want to make sure that both the ball of your foot and the heel of your foot are pressing into the floor. Do not shift your weight forward or backward.

Second, unlock your knees by bending them slightly.

Next, make certain that your pelvis is in neutral. First, tilt your pelvis as far forward as it will go, making your lower back arch.

Then do the opposite – tuck your tailbone under, causing the arch in your back to be reduced. Make certain that you are only moving from the waist down; your upper body should not be moving as you perform this motion.




Now you want to find the middle point between those two positions. In other words, your lower back and pelvis should be halfway in between the forward and the backward tilt. This middle point is called the neutral position. Your goal is to maintain the pelvis in this neutral position.

Now you want to engage your abdominal muscles by pulling your belly button toward your spine. Think of how you would suck your belly in if you were putting on a pair of tight pants. Be certain that you are still keeping your pelvis in the neutral position as you contract your abdominal muscles.

Keeping your belly tight, place your hands on your waist. Try to lift your ribcage up and off your pelvis to make your waist longer.

Now, imagine that you are wearing a necklace. Show off your necklace by lifting your breastbone.




Try to make your shoulder blades wider by spreading your right shoulder blade toward the right side of the room, and your left shoulder blade toward the left side of the room.

Now, let’s move up toward your head. The back of your neck should feel very long, as if someone is pulling you up toward the ceiling at the base of your skull. Your chin should be level. Try to lift from the back of your head, not from your chin.

Finally, imagine that there is a string running from the top of your head up toward the ceiling. Stand taller by letting the string pull your head up toward the ceiling. Remember to keep your chin level with the ground.

Now take 5 deep breaths while maintaining this posture. On each exhale, think of standing taller by lifting your head toward the ceiling.




neck and arm stretchesLevator scapulae stretch:

• Step A: Sit tall in a chair. Hold the bottom of the chair with your right hand. Look toward your left armpit. If you feel a stretch in this position, hold the stretch.

• Step B: If you need to increase the stretch, use your left hand to gently pull your chin further toward your left armpit.

Step A Step B Step B (alternate view)

• Repeat on the other side.

.

• Perform 2 more repetitions on each side.

Upper trapezius stretch:

• Step A: Sit tall in a chair. Hold the bottom of the chair with your right hand. Tilt your head to the left so that your left ear is moving closer to your left shoulder. If you feel a stretch in this position, hold the stretch.




• Step B: To increase the stretch, use your left hand to gently pull your left ear closer to your left shoulder. Be careful not to allow your head to turn; keep your chin pointing straight ahead. Hold for 30 seconds.

Step A Step B


Step A Step B

• Repeat 2 more times on each side.

Scalene stretch:• Step A: Sit tall in a chair. Hold the bottom of the chair with your right

hand. Tilt your head so that your left ear moves closer to your left shoulder. Then turn your chin to the right.

• Step B: If you need to increase the stretch, use your left hand to gently pull on the head. Hold for 30 seconds.

Step A Step B




Repeat on the other side.

Step A Step B

Repeat 2 more times on each side.

Triceps stretch:

• Step A: Sit tall in a chair. Raise your right arm overhead with your elbow bent.

• Step B: Use your left hand to grab your right elbow and gently pull the elbow toward the ceiling. Hold for 30 seconds.

Step A Step B


Step A Step B


Shoulder stretch into horizontal adduction: Sit tall in a chair. Your back should not be touching the back support.

• Reach your right arm in front of your body and over toward the left. Use your left hand to gently pull the right arm across your body. Hold for 30 seconds.



Pectoral stretch: Sit tall in a chair. Place your hands behind your head.

• Gently press your elbows back to feel a stretch in the front of your shoulders and chest. Hold for 30 seconds.

• Perform this stretch 3 times.

Hand behind back stretch: Sit tall in a chair. Hold the stretch strap in your right hand and toss the strap over your right shoulder. Reach your left hand behind your back and grasp the strap. Pull with your right (top) hand to bring your left (bottom) hand up your back, aiming to reach your left hand to your shoulder blade. Hold for 30 seconds.

• Repeat on the other side. Hold for 30 seconds.

• Repeat 2 more times on each side. Note that the top hand is pulling forward in front of your shoulder.

Pectoral stretch with strap: Sit tall in a chair. Hold the stretch strap with 2 hands behind your back.

• Gently lift your hands up until you feel a stretch in the front of your chest.Hold for 30 seconds.

• Repeat 3 times.

Stretch for wrist flexors: Straighten your right arm out in front of you with your palm facing up. Use your left hand to grasp the palm of your right hand, and pull the wrist down. Be certain to keep your fingers relaxed. Hold for 30 seconds.


• Repeat 2 more times each side.

Stretch for wrist extensors: Straighten your right arm out in front of you with your palm facing down. Use your left hand to grasp the back of your right hand, and pull the wrist down. Be certain to keep your fingers relaxed. Hold for 30 seconds.

• Repeat with the left arm.


Shoulder flexion stretch on wall: Stand facing a wall.

• Place your right hand on the wall with the pinky side of your hand touching the wall.

• Step A: Slide your right arm up the wall as high as you can.• Step B: To increase the stretch, lean into the wall and/or step closer to the

wall. Hold for 30 seconds.

• Repeat with the left arm. Hold for 30 seconds.

• Repeat 2 more times on each arm.

Shoulder abduction stretch on wall: Stand with your right side toward the wall. Slide your right arm up the wall sideways. The pinky side of your hand should be against the wall. To increase the stretch, lean into the wall and/or step closer to the wall. Hold for 30 seconds.

• Repeat with the left arm.

• Repeat 2 more times each side. Do not allow the shoulder to rise up toward your ear during this stretch.

back and leg stretches

Spine flexion stretch: Sit tall in a chair, without touching the back support.Clasp your hands in front of you with your elbows straight.

• Round your spine forward to create a C-shaped curve with your back. Let your head relax forward. Hold for 30 seconds.


Spine extension stretch: Sit tall in a chair. Clasp your hands behind your head.

• Lean back to create an arch in your spine. Hold for 30 seconds. Note that the arch should be in your middle back, without causing excessive movement in your neck. Use your hands to support your head.


Sidebending stretch: Sit tall in a chair. Lift your right hand to the ceiling. Bend your spine to the left side. Be certain to keep both sides of your buttocks on the chair. Hold for 30 seconds.

• Repeat on the other side. Lift your left hand to the ceiling. Bend your spine to the right side. Hold for 30 seconds.

• Repeat 2 more times on each side. If for any reason you experience shoulder pain or numbness/tingling in your arms with this stretch, an alternative option is to cross your arms.

Spine rotation stretch: Sit tall in a chair.

• Twist your body to the right side. Keep both sides of your buttocks on the chair. Hold the position for 30 seconds.

• Repeat on the left side. Hold for 30 seconds.

• Repeat 2 more times each side.

Quadratus lumborum stretch: Sit on a chair with the left side of your body on the chair and the right side of your body hanging off the chair. Your left leg is in front of you. Your right leg is behind you with your knee bent. Drop the right side of your pelvis toward the floor. Maintain this drop while you reach your right arm overhead and toward the left side. Hold for 30 seconds.

• Perform this stretch 3 times on each side. It is important that your right thigh is pointing toward the floor. Do not allow your leg to point forward.

• If you experience pain or numbness in your arm, an alternative arm position is:

Single knee to chest stretch: Sit tall in a chair. Rest your left foot on the floor.Place your right foot on a second chair, keeping your left knee bent.

• If you need to increase the stretch, wrap the stretch strap around your right thigh. Pull on the stretch strap to draw your right knee closer to your chest. Hold for 30 seconds.

• Perform 3 repetitions on each side.

Hamstring stretch: For this stretch, you will be performing one of two versions– Level A or Level B. Begin with Level A. When Level A feels easy, you are ready to progress to Level B.

Level A : Sit tall in a chair. Straighten your right knee completely. Lean your chest forward slightly, making certain to keep your back straight. Hold for 30 seconds.


• Perform 2 more repetitions on each side.

Once Level A becomes easy for you, you are ready to progress to Level B.



Hamstring Stretch

Level B : Begin with 2 chairs facing each other. Sit tall in one of the chairs.

• Place your right foot on the chair in front of you, keeping the knee straight.Hold in this position if you feel a stretch in the back of your thigh.

• If you do not feel a stretch, gently lean your chest forward, making certain to keep your back straight. Hold for 30 seconds. Perform 3 times on each side.



Seated calf stretch: Sit tall in a chair. Hook your stretch strap around the ball of your right foot.

• Use your hands to pull on the stretch strap in order to draw your toes up (toward your trunk). Be certain to keep your right ankle relaxed and your right knee straight. Hold for 30 seconds.

• Repeat with the left foot.

• Perform 3 times on each side.



Figure 4 stretch: Sit tall in a chair. Cross your left ankle over your right knee.Use your left hand to rotate your left thigh in an outward direction. Be certain to apply the pressure on your thigh bone – not at your knee. You should feel a stretch in your left buttock. Hold for 30 seconds.

• Repeat with your right leg. Hold for 30 seconds.

• Perform the stretch 3 times on each side.



Standing gastrocnemius stretch: Stand facing a wall in a lunge position with your left leg in front. Make certain your right knee is straight and your right heel is on the floor.

• Lunge forward until you feel a stretch in your right calf. Be certain that your left leg is far enough forward so that your toes are in front of your knee. Hold for 30 seconds.


Standing soleus stretch: Assume the same position as in the standing gastrocnemius stretch (with left foot forward), except the back (right) knee is bent with the heel on the floor. Hold for 30 seconds.



• Repeat with the right foot in front. Hold for 30 seconds.

• Repeat 2 more times on each side, for a total of 3 stretches on each side.

Standing hip flexor stretch:• Step A: Stand facing a wall in a lunge position with your left leg in front.

Your back (right) heel should be off the floor.• Step B: Bend both knees.• Step C: Tuck your tailbone under to tilt your pelvis. Imagine you have a

tail and you are tucking it between your legs. Hold for 30 seconds.

Step A Step B Step C

Repeat on the other side, placing your right leg in front and your left leg behind.

Step A Step B Step CPerform the stretch 3 times on each side.



Standing quadriceps stretch: Set up two chairs facing the same direction, with one in front of the other. Stand tall, holding the back of one chair.

• Step A: Bend your left knee so that your left foot rests on a chair behind you.Be certain that your knees are together.

• Step B: Tuck your tailbone under. Hold here if you feel a stretch.• Step C: To increase the stretch, bend your standing leg. Hold for 30 seconds.


• Repeat with the other leg. Perform 3 stretches on each side.




Standing adductor stretch: Stand tall facing a chair with your left leg on a chair.

• Keeping your leg on the chair, twist your hips to the right side, pivoting on your right leg. Hold for 30 seconds.

• Repeat on the other side. Face the chair and place your right foot on the chair. Pivot on your left leg to the left. Hold for 30 seconds.




Standing Hamstring Stretch: Stand and face your chair.• Step A: Place your left foot on the chair. Your left knee should be

straight. Make certain your back is straight. If you feel a stretch in the back of your left thigh, hold this position for 30 seconds.

• Step B: If you need to increase the stretch, lean your chest forward, making certain to keep your back straight. Hold for 30 seconds.

• Repeat with the right leg, holding for 30 seconds.

• Perform 3 stretches with each leg. Be certain that you do not allow your back to round into a C-shaped curve:



list of sitting and standing stretches

stretches in standing:• posture correction: pages 2-4• shoulder flexion stretch on wall: page 12-13• shoulder abduction stretch on wall: page 13-14• standing gastrocnemius stretch: page 24• standing soleus stretch: page 24-25• standing hip flexor stretch: page 25• standing quadriceps stretch: page 26• standing adductor stretch: page 27• standing hamstring stretch: page 28

stretches in sitting:• levator scapulae stretch: page 5• upper trapezius stretch: page 5-6• scalene stretch: page 6-7• triceps stretch: page 7• pectoral stretch: page 9• hand behind back stretch: page 9-10• pectoral stretch with strap: page 10-11• shoulder stretch into horizontal adduction: page 8• stretch for wrist flexors: page 11• stretch for wrist extensors: page 12• spine flexion stretch: page 15• spine extension stretch: page 15-16• sidebending stretch: page 16-17• spine rotation stretch: page 17-18• quadratus lumborum stretch: page 18-19• single knee to chest stretch: page 19• figure 4 stretch: page 23• seated hamstring stretch (2 options): page 28• seated calf stretch: page 22



recommended combinations of stretches for home practice sessions

Remember that these sessions should last approximately 30 minutes. These 5 stretching routines are also depicted on the DVD.

neck and arm stretches (option A):• levator scapulae stretch: page 5• upper trapezius stretch: page 5-6• triceps stretch: page 7• hand behind back stretch: page 9-10• stretch for wrist flexors: page 11• stretch for wrist extensors: page 12

neck and arm stretches (option B):• levator scapulae stretch: page 5• scalene stretch: page 6-7• pectoral stretch: page 9• shoulder stretch into horizontal adduction: page 8• pectoral stretch with strap: page 10-11• shoulder flexion stretch on wall: page 12-13• shoulder abduction stretch on wall: page 13-14

back and leg stretches (option A):• spine extension stretch: page 15• spine rotation stretch: page 17• figure 4 stretch: page 23• single knee to chest stretch: page 19• standing hip flexor stretch: page 25• standing quadriceps stretch: page 26

back and leg stretches (option B):• spine flexion stretch: page 15• spine extension stretch: page 15-16• sidebending stretch: page 16-17• seated hamstring stretch: pages 20-21• quadratus lumborum stretch: page 18-19• standing gastrocnemius stretch: page 24• standing soleus stretch: page 24-25



whole body stretching:• upper trapezius stretch: page 5-6• pectoral stretch: page 9• spine flexion stretch: page 15• quadratus lumborum stretch: page 18-19• seated calf stretch: page 22• standing hamstring stretch: page 28• standing adductor stretch: page 27



SOURCESAnderson, Bob. Stretchin g . 20th Anniversary Revised Edition. Bolinas: ShelterPublications, 2000.

Carolyn Kisner & Lynn Allen Colby. Therapeutic Exercise: Foundations andTechniques. 4th Edition. Philadelphia: F.A. Davis Company, 2002.

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Microsoft Word - STRETCHING PARTICIPANT MANUAL_070110.doc€¦ · Web viewMicrosoft Word - STRETCHING PARTICIPANT MANUAL_070110.doc Author: armasj Last modified by: Sarah Corey