5010 Stretching

Question 1

Stretching

Answer 1

techniques used to lengthen hypo mobile soft tissue structures (muscle, skin, joint capsule, ligament, fascia, tendons) that have adaptively shortened. Goal is to increase tissue etensibility –> to increase ROM/flexibility.

Question 2

Adaptive Shortening

Answer 2

process that results in loss of joint motion

If you don’t use it, you lose it.

Question 3

4 Maint categories of stretching

Answer 3

1. Manual
2. Mechanical
3. Self-stretching
4. Neuromuscular inhibition

Question 4

Overstretching

Answer 4

stretching applied that produces ROM greater than normal –> causes hypermobility

Question 5

Selective stretch

Answer 5

situation where a limitation of RoM is allowed or preferred to exist in order to increase overall function of the individual
Quadriplegia–> do not stretch wrist extensors

Question 6

Contracture

Answer 6

Shortening of muscle or soft tissue that results in decreased ROM. Must determine what is causing ROM restriction. Usually named for the position that they are “stuck” in.
i.e: unable to fully extend knee = knee flexion contracture

Question 7

Myostatic contracture:

Answer 7

no specific pathology or trauma but still have a loss of ROM

Often due to poor, prolonged postures that result in “tightness”. More often in 2-joint-muscles rather than 1-joint-muscle.

Question 8

Pseudomyostatic contracture

Answer 8

increased muscle tone or spasticity will limit ROM. Soft tissue restriction is NOT the problem: it is an increased muscle tone problem. i.e. toe walking, trigger points

Question 9

Neuromuscular inhibition

Answer 9

used to decrease the tone within the muscle to increase ROM

Question 10

Fibrotic Contractures/ Scar-tissue Adhesion

Answer 10

following injury & inflammation, scar formation begins w/ collagen laid down randomly. Excessive scar tissue can form –> causing stiff tissue w/ little elasticity. Scar may bind to surrounding tissue –> ADHESION

Question 11

Window of Opportunity

Answer 11

21days/3wks to 3mo.
Sufficient tissue healing has occurred, and tissue can be safely stretched.

If you wait longer than 3mo, that is too long and too much scar tissue has developed.

Question 12

Irreversible contracture

Answer 12

ROM restriction limited by abnormal tissue formed in response to injury.
i.e. fibrotic contracture that has matured into shortened position
bony tissue- myositis ossificans - deep contusion of muscle (excessive bleeding that ossifies/calcifies, limiting ROM)

Question 13

Morpholgic changes w/ immobilization

Answer 13

a. lack of physical stress leads to muscle atrophy

b. Immobilization in shortened position:
- sarcomere absorption
- length-tension curve shifts to the left

Question 14

Main Parameters of Stretching

Answer 14

1. Force and Velocity
2. Duration
3. Reps per Session
   Clinic Imp: 4 or less w/ 30sec. hold
4. Number of stretching sessions per day
   1-3 times per day
5. Move through active ROM after stretching
6. Number of days per week
   2 for healthy indiv, more for injuries
7. How long to continue stretch program

Question 15

Ranges of Stress vs. Strain Curve

Answer 15

Toe region

Elastic Range: No net change in length

Plastic: Permanent deformation to get length
PT goal range

Necking –> failure: moving up in plastic range may cause tissue damage

Question 16

Force and Velocity

Answer 16

Low load force protects against injury & seems to be most effective @ producing long-term changes in flexibility

Question 17

Static Stretching

Answer 17

slow, steady street to the point of tissue resistance w/ a constant pressure

15-30sec to produce ROM change

If pt >65yo, then 60 sec. more effective

Question 18

Static progressive stretching

Answer 18

long, slow stretch followed by increase in pressure

Question 19

Ballistic Stretching

Answer 19

rapid, forceful movement to limit of motion w/ no hold

Okay for young, healthy subjects, but more post-stretching soreness.

Not clinically recommended for injury and older patients

Question 20

Cyclic (intermittent) Stretching

Answer 20

repeated movement to end of range w/ short hold times.

Few studies on this, esp in patient population

Question 21

Detraining Effect

Answer 21

Occurs 4-6wks after stretching program ends

patient goes back to old posture/habit

Question 22

Indications and Goals of Stretching

Answer 22

Indications:
ROM is limited
Restricted Motion
Muscle weakness/ Shortening of Tissues

Goals:
Achieve full ROM
Reduce Pain
Reduce Injury Risk

Question 23

Precautions and Contraindications of Stretching

Answer 23

Bony block limiting joint motion
Recent FX, and bony union is incomplete
Evidence of acute inflame or infection (heat/swelling)
Sharp, acute pain w/ joint mvmnt
Hematoma/ Other evident tissue trauma
Hyper-mobility
Shortened soft tissue provides necessary joint stability
(C4 injuries) and/or helps w/ functional mvmnt