Lynette Diaz, COTA/L
Monday, December 23rd, 2019
Stretching can be a very important part of recovery especially following a stroke, when feeling, sensation and movement are returning to a previously flaccid limb. However, is it possible to stretch too much or too hard? Yes it is.
Clinicians frequently see patients handle their affected limbs rather aggressively in an effort to “make it move” or “get it loose”, often stretching their fingers, wrist, elbows and shoulders too far too fast. This may partly be due to lack of sensation or awareness.
However, the way the affected limb is moved matters greatly for the recovery. All sensory input, such as touch, pressure, temperature give information to the brain about what is happening. Stretching forcefully or moving too aggressively activates the body’s natural defenses to “guard the limb” and may make the muscles in the limb tighter increasing spasticity and making it harder to intentionally move.
To avoid activating the body’s defenses to protect the limb and increase spasticity as a result of moving too far too fast, slow down. The key to decreasing spasticity during stretching is slow controlled sustained stretching. Moving slowly in and out of a stretched position, avoiding bouncing and jerky movements. Other factors to consider when spastic muscles are difficult to stretch are stress levels, positioning and environment (i.e. is it too hot or too cold). Consider creating a relaxing environment to perform daily stretching. Spasticity may still be present, but it can be greatly reduced and allow for more voluntary movement by bringing awareness to how the affected limb is being moved and stretched.