Effective Lower Limb Stretching Techniques

Class Notes on Stretching Series Part Two: Stretching of Lower Limbs

Summary

This lecture focused on the effective methods to stretch various lower limb muscles, emphasizing the correct techniques and the anatomical rationale behind each stretching method. The session covered stretching exercises for the piriformis, hip adductors, sartorius, calf muscles (soleus and gastrocnemius), tibialis anterior, extensor digitorum longus, extensor hallucis longus, and intrinsics of the foot.

Piriformis Stretching

• Functions: Abduction, extension, external rotation of the hip.
• Stretching Method:
  • Counter the muscle's functions: Patient lies in supine position, hips and knees flexed, then externally rotate the hip and adduct the hip, pushing the knee towards the opposite shoulder.
  • Rationale: Beyond 90 degrees of hip flexion, piriformis acts as an internal rotator; therefore, an external rotation combined with flexion beyond 90 degrees stretches it effectively.

Hip Adductors Stretching

• Muscles Involved: Adductor magnus, minimus, longus, brevis, pectineus, gracilis.
• Bilateral Stretch:
  • Patient in a crook lying position.
  • Abduct both limbs simultaneously.
• Unilateral Stretch:
  • Stabilize ASIS (anterior superior iliac spine) with one hand.
  • The other hand applies abducting force.
  • Hold for 15-20 seconds; perform 5-6 repetitions.
  • Faber's Test: Used to identify sacroiliac joint dysfunction through this stretch.

Sartorius Muscle Stretching

• Functions: Hip - flexion, abduction, external rotation; Knee - flexion, internal rotation.
• Stretching Method:
  • Perform opposite functions: Adduct and internally rotate the hip, then flex the knee.

Calf Muscles Stretching

Soleus Muscle

• Function: Plantar flexion at the ankle.
• Stretching Technique:
  • Flex the knee 20-30 degrees to deactivate gastrocnemius and apply dorsiflexion.

Gastrocnemius Muscle

• Stretching Technique:
  • Keep the knees extended and apply dorsiflexion.

Tibialis Anterior Stretching

• Functions: Dorsiflexion and supination of the ankle.
• Stretching Method:
  • Plantar flex and pronate the ankle, while applying stretching pressure opposite to the muscle's insertion.

Extensor Digitorum Longus Stretching

• Functions: Dorsiflexion at the toes and ankle, and pronation at the ankle.
• Stretching Method:
  • Perform plantar flexion at the toes and ankle, and supination at the ankle.
  • Differentiate actions for extensor digitorum brevis (only toes involved, no ankle movement).

Extensor Hallucis Longus Stretching

• Functions: Dorsiflexion at the big toe and ankle, supination at the ankle.
• Stretching Method:
  • Plantar flexion at the big toe and ankle, pronation at the ankle while stretching the muscle away from its insertion.

Intrinsics Muscle Stretching

Intrusive Dorsalis and Plantaris Muscle

• Functions: Abduction of toes, plantar flexion at MTP joint.
• Stretching Method:
  • Adduct the toes and perform dorsiflexion at MTP joint for both muscle groups.
  • Note: Stretching also influences lumbrical muscles.

The physiotherapist emphasized understanding the muscle functions to correctly perform the opposing actions for effective stretching.