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Modify stretches for the elderly, pregnant women, and active individuals

This is an excerpt from Therapeutic Stretching by Jane Johnson.


Almost anyone can receive stretching, and most people will benefit from it. However, there are certain groups of people for whom special consideration is required before implementing a stretching programme. The following sections provide tips to help you modify your stretches so they are safer and more effective when you are working with the elderly, pregnant women and active individuals.

Older Adults

Here are some common physical changes seen in older adults and tips for modifying a stretching programme.

Osteoporosis

Avoid stretches that place excessive stress on bones.

Osteoarthritis

  • Avoid stretches that load weight-bearing joints because this may cause pain.
  • Stretches to maintain and improve ROM are often beneficial, but remember there may be decreased ROM due to swelling or the formation of osteophytes.
  • Useful measurement tools include patient perceptions of the reduction of their joint stiffness and improved quality of life measures.
  • Provide stretches that may be done in a seated or lying position, in a chair or bed.
  • Provide aids such as a towel.
  • When applying passive stretches, it may be necessary to help clients onto and off of a treatment couch or plinth because standing on one leg may be painful. Providing a small stool may help.

Rheumatoid arthritis

  • Do no stretches at all during the inflammatory stage.
  • All stretching should be pain free during the stretch, in the hours following, and 24 hours after the stretching was performed.
  • Remember that joints may fuse, limiting joint ROM.
  • Gentle passive stretching may be beneficial, especially where the client is unable to get into the start position for a stretch, but only in the remission period.

Reduction in extensibility of soft tissues

Acknowledge that joint ROM is likely to be reduced in this age group, and modify stretching goals accordingly.

Reduced balance and proprioception

  • Minimize the number of stretches that rely on balance.
  • Where possible, select stretches that use a low centre of gravity, such as sitting, kneeling or lying.
  • For clients stretching independently, always recommend use of a support such as a handrail, table or sink for stability.
  • Avoid stretches that require the client to move from lying to standing positions, or vice versa.

Reduced hearing and vision changes

  • Keep verbal commands clear and precise.
  • Ensure the stretching environment is quiet.
  • Demonstrate all stretches, taking your time to reiterate important points.
  • Enlarge pictures that you provide as guides for active stretches.

Reduced strength

  • MET stretches may be helpful at maintaining or even improving muscle strength.
  • Avoid the use of stretches that rely on strength to maintain a stretching position.
  • Where the most appropriate stretch is best performed in a standing position, provide a perch stool or chair close by.

Increased medication

Where possible, time stretches to coincide with medication. For example, passive stretches may be more appropriate after medication that is sedative.

Pregnant Women

Here are some common physiological changes seen in pregnant women and tips for modifying a stretching programme.

Loosening of connective tissues

  • Avoid taking stretches to their point of maximum resistance.
  • Avoid stretches that involve weight bearing through joints that may be in a compromised position.
  • Avoid stretches to the hip adductor muscles.
  • Avoid stretches that involve excessive flexion or extension of the spine.

Altered balance

  • Choose stretches that involve a low centre of gravity, such as those in kneeling or sitting positions.
  • In early stages of pregnancy, supine, prone and side-lying positions may be possible provided they are comfortable.

Fatigue in back muscles

Avoid stretches that place additional load on muscles of the back.

Supine hypotension

Avoid stretches in the supine position, especially in late stages of pregnancy.

Active Individuals

Here are some common characteristics of people involved in sport and physical activity and tips for modifying a stretching programme.

There may be increased significance placed on stretching. Stretches may be performed as part of a sporting tradition but may not necessarily be beneficial physiologically.

  • Acknowledge the importance these clients place on stretching.
  • Respect the use of stretching as part of tradition.
  • Be wary of making too many changes too soon to an existing programme of stretches.
  • Avoid criticizing the tradition of stretching you believe to be inappropriate.

Regular participation in sporting activity may result in muscle imbalance specific to that sport.

Provide stretches that are sport specific rather than generalized.

An athlete may suffer emotionally when injury prevents training or participation in sport.

  • When providing stretches during rehabilitation, acknowledge the impact injury can have on the athlete.
  • Identify whether the athlete is demotivated or overly enthusiastic.

Many elite athletes have a good knowledge of stretching. At lower levels of competition, an athlete may be performing inadequate stretches or an inappropriate stretching programme.

  • Advice and explanations can be less detailed than those provided for other client groups.
  • Do not make assumptions about competency in stretching knowledge. Check in with your client regarding his knowledge of appropriate stretching.

Static stretching may be disadvantageous before a sporting event.

  • Avoid sustained static stretching in pre-event situations.
  • Use dynamic stretching before sporting events.

Some female athletes may be at risk of osteoporosis.

If in any doubt, avoid stretches that place undue load on vulnerable joints or bones.

Team players often stretch together.

Provide advice and demonstrations of suitable partner stretches.

Often an athlete is under the care of many other professionals.

Commit to working as part of a multidisciplinary team.


Read more from Therapeutic Stretching by Jane Johnson.



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