AIS clinical application

Assisted, self managed routines for low-back pain with active isolated stretching
Paul John Elliott
December 20, 2016
By Paul John Elliott
AIS clinical application
Photo: Fotolia
In my last article, I discussed how active isolated stretching can help extend practice potential for massage therapists and improve treatment outcomes for patients. As earlier stated, active isolated stretching (AIS) is a vital component for injury prevention and rehabilitation.

While AIS can be an important tool for massage therapists in promoting injury prevention, performance enhancement and rehabilitation among clients, it also provides clients a means for implementing safe and effective self-care protocols.

To put this into a functional perspective that readers can apply, let’s consider a pathology that massage therapists are called upon to address from time to time: low-back pain.

Pelvic girdle inflexibility can affect our bipedal stance and gait. Any residual limitations can cause unnecessary tensions elsewhere in the lumbar region. Naturally, re-establishing fascial alignment in the pelvic girdle is crucial to reducing these pain patterns.

Many of the flexors and extensors of the hips are intrinsically related to the low back and knees, and tight hamstrings are often a significant contributor to low-back pain.

For the sake of this article I will narrow the many low back protocols down to the hamstrings. With active isolated stretching (AIS), the hamstring stretch is a three-phase protocol. In order to gain access to the hamstring bellies, it’s essential for the therapist to open the distal and proximal tendons first. The sequential photos below illustrate the distal, proximal and belly phases.

The first protocol demonstrates the steps for assisted stretching, while the second set of photographs illustrates self-stretching for the client. It is important to work bilaterally – alternating sides.

Assisted stretching
Distal hamstrings
In position 1, the client’s thigh is lifted to height that they know they can safely achieve full extension.

In position 2, the therapist helps to stabilize the thigh from any anterior/posterior movement as the client lifts the foot above their knee in to full extension.

In position 3, the therapist continues to stabilize the knee with one hand while adding a gentle assisted pressure with the other. It’s important that the client continues to actively contract their quadriceps during the assisted phase.

Do two sets of six to eight repetitions.

Proximal hamstrings
Position 1: The client holds thigh at 90 degrees to the waist, and the knee is also bent to a 90-degree angle.

Position 2: The client contracts the hip flexors, aiming the knee toward the shoulder.

Position 3: At end range, the therapist can assist the stretch by applying pressure on the active leg at the foot. The unexercised leg can be isolated from movement either by the therapist or with the aid of a stabilizing belt.

Do two sets of six to eight repetitions.

Hamstring belly
Position 1: Client should tighten their abdominals with each lifting of the exercised leg. If there is a known or suspected lumbar issue, it is wise to have the client bend the unexercised leg so that the foot is flat on the table.

Position 2: Have client lock the leg at the knee and then raise the leg to end range.

Position 3: At end range (position 2), client continues to contract their quads and hip flexors, reaching their thigh gently back towards their same-side shoulder as they and therapist apply gentle assisted pressure, while stabilizing the unexercised leg.

Do two sets of six to eight repetitions.

When working with active therapeutic stretching, keep in mind these important tips:
  • The active movement on the part of the client should be a smooth and easy effort. If you or they find they’re shaking in their exertion, they are working too hard.
  • Assisted pressure – when assisting your client (or yourself) through a difficult or restricted structure, your assisted pressure should be light and nurturing.


Self-stretching

The self-stretching technique applies the same principles as the assisted stretching protocols, but without the therapist to assist the client.

Hamstrings
Proximal hamstrings: Do two sets of six to eight repetitions

Distal hamstrings: Do two sets of six to eight repetitions

Hamstring belly: Do two sets of six to eight repetitions

The physiological benefits of stretching are diverse and, combined with most manual therapies, can be very powerful.

The sound reasoning behind active isolated stretching suggests that strengthening joint tissues would also help in the prevention of injuries.

The active approach will build local stamina and stability around the weakest and therefore most vulnerable regions of a structure. Improving mobility, joint function and strength can decrease the client’s potential for injuries.

So, how do you define health?


Paul John Elliott has been a registered massage therapist since 2003 and is the founder of both PJE Therapeutic Services and Stretching Canada. You can contact him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


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