Indications

• Stretching chronic or subacute restricted, fibrotic, contracted soft tissues (fascia, muscle) or tissues housing active myofascial trigger points.
• This approach is chosen if contracting the agonist is contraindicated because of pain.

Contraction starting point

A little short of the resistance barrier.

Modus  Operandi

The antagonist(s) to the affected muscles are used in isometric contraction, therefore the shortened muscles subsequently relax via reciprocal inhibition, allowing an easier stretch to be performed.  The patient is attempting to push towards the barrier of restriction, against the operator’s precisely matched counter-effort.

Forces

Operator’s and patient’s forces are matched.  Initial effort involves approximately 30% of the patient’s strength; this can be increased on subsequent contractions to no more than 40%.

Duration of contraction

Initially 7-10 seconds, increasing up to 15 seconds in subsequent contractions if greater effort is required.

CAUTION:  Longer, stronger contractions may predispose towards onset of cramping and so should be used with care.

Action following contraction

There should be a rest period of 5 seconds or so, to ensure complete relaxation before commencing the stretch.  On exhalation, the area (muscle) is taken to its new restriction barrier, and a small degree beyond, painlessly, and held in this position for at least 30 and up to 60    seconds.  The patient should, if possible, participate in assisting in the move to, and through, the barrier, effectively inhibiting the structure being stretched and retarding the likelihood of a myotatic stretch reflex.

Repetitions

Repeat 3 times, or until no further gain in range of motion is possible, with each isometric contraction commencing from a position just short of the restriction barrier.