Determine if hypomobility is related to other impairments of body structure or function and if it is causing activity limitations or participation restrictions

Evaluate the extensibility of the involved tissues and estimate their stage of healing

Warm up the soft tissues to be stretched by the application of local hear or by active, high-intensity exercises

Grasp the areas proximal to the joint in which motion is to occur

Firmly stabilize the proximal segment and move the distal segment

To stretch a multijoint muscle, stabilize either the proximal or distal segment to which the range-limiting muscle attaches

Consider incorporating a poststretch, isometric contraction of range-limiting muscle

To minimize joint compression during the stretch, a gentle (grade 1) distraction to the moving joint can be applied

Maintain the stretch position for 30 seconds max

If the patient does not seem to tolerate a sustained stretch, use several very slow, gentle, ballistic stretches with the muscle in a lengthened position

After stretching, apply cold to the tissues that have been stretched and allow these structures to cool in a shortened position

Strengthen the agonistic muscles in the newly gained range to ensure adequate neuromuscular control and stability as flexibility increases

Do not passively force a joint beyond its normal ROM

Avoid stretching edematous tissue

Review the patient’s history

Select and perform appropriate tests and measurements

Determine if hypomobility is related to other impairments of body structure

Determine if soft tissues are the source of the impaired mobility

Evaluate the irritability

Assess the strength of the muscles

Consider the outcome goals

Analyze the impact of any factors

Review the goals and desired outcomes

Select the most effective and efficient techniques

Warm up the soft tissues

Have the pt assume a comfortable, stable position

Explain the procedure to the patient

Free the area to be stretched

Explain to the patient that it is important to be as relaxed as possible

Move the extremity slowly

Grasp the areas proximal and distal to the joints in which movements occur

Firmly stabilize proximal segment

Incorporate a prestretch

Apply gentle grade 1 distraction

Stretch using a slow, sustained rate

Maintain position for 30 secs or longer

Gradually release the stretch force

Use several very slow, gentle, intermittent stretches

Apply selected soft tissue mobilization procedures

Apply cold to the soft tissues

Perform active ROM and strengthening exercise through gained range immediately

Strengthen the antagonistic muscles in the newly gained range

End range isometric(antagonist) - relax - AROM(w)

AAROM(antagonist) - relax - PROM(w)

End range isometric(agonist) - relax

AROM(antagonist) - isometric - relax - AROM(w)