07-04: Stretching Flashcards
1
Q
Definition and purpose of stretching
A
- Any therapeutic maneuver designed to increase mobility of soft tissues and subsequently improve ROM by elongating (lengthening) structures that have adaptively shortened and have become hypomobile over time
- Increases mobility of soft tissue
- Improves ROM by elongating adaptively shortened, hypomobile structures
2
Q
Flexibility
A
- Ability to move a single joint or series of joints smoothly and easily through unrestricted, pain-free motion
- Factors: Muscle length and soft tissue extensibility around the jt; Jt integrity and arthrokinematics (rolls, spins, glides); PROM and AROM flexibility
3
Q
Hypomobility
A
- Decreased mobility or restricted motion
- Factors: adaptive shortening; jt pathology; soft tissue changes
- Causes: prolonged immobilization, sedentary lifestyle, postural malalignment, muscle imbalances, muscle weakness, tissue trauma, paralysis, prolonged positioning
4
Q
Contracture
A
- Adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint that results in a limitation of ROM; abnormal
- Resists passive or active stretching
5
Q
Contractures
A
- Action of shortened muscles; normal
6
Q
Types of contractures
A
- Myostatic: No muscle deformation or pathology; can be resolved in short time - exercise stretching
- Pseudomyostatic: Due to hypertonicity - respond well to neuromuscular inhibition procedures
- Arthrogenic: Disruption within jt itself or in periarticular structures - adhesions, jt proliferation jt effusion
- Fibrotic: Due to fibrotic changes in tissue; may increase ROM, but not to optimal tissue length - prolonged immobilization, inflammation, or postures
- Irreversible: Fibrotic changes that leave permanent loss extensibility of soft tissue
7
Q
Stretching - Indications
A
- ROM Loss due to soft tissue restrictions
- Muscle weakness with shortening of opposing muscle
- Preventative measures for musculoskeletal injuries
- Minimize DOMS post workout
8
Q
Stretching - Contraindications
A
- Bony block
- Non-union Fx or recent fracture with incomplete bony union
- Acute inflammation
- Sharp, acute pain with PROM
- Hematoma
- Hypermobility
- Shortened soft tissue provides stability, but no other neuromuscular control
- Shortened soft tissue provides for function-like teanodesis grip
9
Q
Interventions to increase mobility of soft tissue
A
- Stretching: Manual or mechanical, passive or assisted
- Self-stretching
- PNF/Inhibition techniques
- MET
- Joint mobilization/manipulation, MWM (mobility with movement)
- Soft tissue mobilization
- Neuro issue mobilization
10
Q
Selective Stretching
A
permanent
11
Q
Overstretching
A
- sometimes necessary for certain individuals for participation in sports activities that require extensive flexibility
- can create instability in joint, results in pain/injury
11
Q
Structure of Skeletal Muscle
A
- Muscle –> Single fiber –> Myofibrils –> Myofilaments
- Endomysium: separates muscle fibers
- Perimysium: encases fascicles
- Epimysium: fascial sheath around entire muscle
12
Q
Immobilization
A
- Results in atrophy and weakness
- decay of contractile protein
- decrease in muscle fiber
- decrease in number of Myofibrils
- decrease in intramuscular capillary density
- increase on fibrous and fatty tissue within muscle
- Greater in tonic than phasia
13
Q
Neurophysiological properties of contractile tissue
A
- Muscle spindle
- Golgi tendon organ
- Mechanosensors send signals to nervous system, regulate stretch
14
Q
Muscle spindle
A
- Reacts to changes in length and changes in velocity of change
- Activated by quick stretch to increase tension
- Ballistic
15
Q
Golgi Tendon Organ
A
- Monitors tension at musculo-tendinous junction
- Activated by slow, low intensity, prolonged stretch that stimulates relaxation
16
Q
Types of noncontractile soft tissue
A
- Ligaments
- Tendons
- Joint capsule
- Fascia
- Noncontractile components of muscle
- Skin
17
Q
Types of Collagen
A
- Collagen: Type 1 (Tensile), Type 2 (Compression); strength, stiffness of tissue
- Elastin: extensibility; small load, fails at high loads
- Reticulin: Type 3 (provides bulk of ground substance - GAG - which reduce friction between tissue fibers, transports nutrients)
18
Q
Stress-Strain Curve
A
- What happens to connective tissue under stress loads
- Toe region
- Elastic range
- Plastic range
- Necking
- Failure
19
Q
SS - Toe Region
A
- normal function of tissue
- collagen fiber not taut, wavy
20
Q
SS - Elastic Range
A
- Tissue is taken to end of range, gentle stretch applied
- Force releases, tissue goes back to original state
21
Q
SS - Elastic Limit
A
- Point at which tissue cannot return to original shape
22
Q
SS - Plastic Range
A
- Permanent deformation, occurs during stretching
- Taking end of elastin to failure
- Must reach for effective stretching
23
Q
SS - Necking
A
- Weakening of tissue, rapidly fails
24
Q
SS - Failure
A
- Complete rupture of the tissue
25
Q
Viscoelasticity
A
- Time-dependent property of soft tissue
- Initially resists change when stress first applied, but allows lengthening if sustained stretch
- Returns to pre-stretch state gradually after force removed
26
Q
Creep
A
- Constant stress load (force) over time that allows gradual rearrangement of collagen bonds and redistribution of water to surrounding tissues
- Allows tissue to lengthen
- Recovery does not occur as fast as afte one brief stretch
27
Q
PNF techniques
A
- Hold-Relax
- Agonist Contraction
- Hold- Relax with Agonist Contraction
28
Q
PNF Hold-Relax (Contract-Relax)
A
- Passive
- Rotational components, diagonal patterns
- Take to end range, perform isometric contractions of limiting range for 5 seconds, release and take up slack to new range, repeat
29
Q
PNF Agonist Contraction
A
- Active
- Pt contracts opposite muscle to limiting range, slowly for several seconds, relaxes and takes into new range
30
Q
PNF Hold-Relax with Agonist Contraction
A
- Active movement into new range
- Slow reversal hold
- Pt takes to end range, have contract range limiting muscle, relax and use agonist to actively take into new range
32
Q
Determinants (Parameters) of Stretching
A
- Alignment
- Stabilization
- Intensity (Low load)
- Duration (2 x 30 sec or 6 x 10 sec)
- Speed
- Frequency
- PNF - Reciprocal Inhibition
