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I prescribe stretches for gastroc and soleus, as well as Hamstrings regularly, but I was wondering, what other stretches do you prescribe? Particularly for children?
Lauren this question is bit like How long is a piece of string.ie every patient will have different needs.
1. what activity is the person undertaking
2. what the balance between muscle length. left-right, posterior-anterior, medial-lateral (ie medial and lateral hamstrings)
3. there is no normal length of muscle it depends on person, activity etc
4. also important to consider nerve mobility not just muscle length.
then once you have worked out when the problem lies there are many different streches. ie for the ITB I have 5 different stretches that I might use of some but I always get them to stretch the gluteals, hamstrings and quads at the same time even if I have made a diagnosis of ITBFS.
The most effective stretching in my opinion, is post-isometric stretch. You help yourself with a contracion against-resistance of the antagonistic musulature.5 second tension and stretch the target muscle without stopping. Repeat this 3 or 4 times and you will get an amazing result.
In contrast, this type of stretching is not very usefull to do it at home, but try with auto-passive stretch.
Check out the Piriformis and Lumbar Square also.Not only Gastroc,Soleus and Hamstrings!
For children? BALLET CLASSES!!!! I'm still a student, but I will send all kids with toe in, equinus or any biomechanical problem to a strict ballet teacher. Since I have been studying anatomy, I realize just why ballet is so good for you (me. 10 years 3 to 4 or more times a week) each muscle is stretched in order. Ballet teachers are fond of saying if you are flexible, do strength exercises, if you are strong, do flexibility exercises....it works....it really works. You can even pursuade little boys to do it if you say that's what the top footballers do once a week. Carole
ITB stretches a must. this with very deep muscle massage is effective ( but painful!)
Psoas and Gluteal muscle group often
"Tennis ball technique" ..very often
and for children, investigating what behaviours encourage contraction or overstretching and acting on these behaviours when noticed is very useful.
For example, children who have an intoeing problem and after establishing if the casue is functional, then I would eductate parents to
discourage sitting on shins,
sleeping on stomach and
sitting in the reverse W postion.
I'd also educate the parents to stretch the psoas muscle by
getting the child to lay on the stomach
abduct the thighs and flex the knees
grasp both feet while the soles of the feet are facing each other with one hand and pull downwards while
the second hand rests on the sacrum and acts like a warning system where if the sacrum lifts, then the pressure from the grasping hand should ease.
the sitting adductors stretch postion should also be encouraged.
then theres different stretching techniques like a PNF stretch which is very useful for a short term increase in muscle length.
Hope this helps .
ps . excuse me if i don't make sense. i'm just about to doze off..
as a f/time paeds therapist, I'd say satretches are absolutley essential. However so is strengthtening and re-balancing antagonist/agaonist realtionships. Growth must always be considered. I measure all my patients at every visit. They grow so fast. Also ask about it in thier history. Musscle tightness is only relative to their bone length - if they've just shot up, that can explain a lot. Don't underestimate it.
Prior to any exercise prescription is the need for a full and thorough examination, as mentioned earlier. You need to know the joint ranges required for non-compensated gait (see section titled this in Michaud, T "Foot orthoses and other forms of Cconservative care" (check title). Very roughly, the way I would examine is this:
*via history determine likely cause and extent of problem
*gait (walk and run) examination - muscle imblances will manifest in this. Look in the gait to see what you suspect may be tight / weak
*plinth examination -
- go through all your joint and muscle testing, esp. looking at the things you suspect from the gait assessment
You will soon gather a good picture of what is going on and can prescribe you exercise program accordingly. Bear in mind the age of the child.
With paeds, the way that you would address this will be different at every age. M Weber's earlier post was excellent and I couldn't agree more. You need to have an amoury of stretches and strengthining exercises to prescribe, moreso for paeds. There are certain exercises that are suitable for different ages of children, and a large part of the skill in beng a paediatric clinician is finding the most suitable for the age of the child.
For children under age 6 sometimes ballet is suitable for in-toe (where of hip origin, and if weak gluteus medius, I think it would be detrimental if the in-toe was of knee origin) and core stability. I would not receommend it for other things, as a simple exersise or two can solve the biomechanical problem in only 10 minute a day in a few weeks. It is more intense and focuseed. Ballet is too general for a specific problem.
Always demonstrate, practice and describe exercises to your patients, give them clear written information and instructions with pictures. Don't give any more than 3, choose the ones that are most likely to have the biggest impact. You can work on the rest later if you need to. They will always forget most of what you tell them, so this reingorces it. Failure to improve comes from not doing them frequently enought, not holding them long enough, or poor technique. Tell them this in your appointment and compliance will go up.
Patient (age 6) "Mum, I know you're pregnant, but why is your bum big too?"