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07 - Therapeutic Exercise I > 07-04: Stretching > Flashcards

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
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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
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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
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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
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5
Q

Contractures

A
  • Action of shortened muscles; normal
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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
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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
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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
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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
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10
Q

Selective Stretching

A

permanent

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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
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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
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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
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13
Q

Neurophysiological properties of contractile tissue

A
  • Muscle spindle
  • Golgi tendon organ
  • Mechanosensors send signals to nervous system, regulate stretch
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14
Q

Muscle spindle

A
  • Reacts to changes in length and changes in velocity of change
  • Activated by quick stretch to increase tension
  • Ballistic
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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

07 - Therapeutic Exercise I (11 decks)

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