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MSK 1 > 9/16 - Stretching for Impaired Mobility > Flashcards

9/16 - Stretching for Impaired Mobility Flashcards

1
Q

what questions do you ask to define an impairment

A

how much of a limitation is present?
which tissue is responsible for the limitation?

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2
Q

why is it important to quantify the limitation

A

need know if the intervention is actually working
- can see change in sx but want to see change in tissues

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3
Q

what are 3 ways to quantify a limitation

A

goniometry/inclometer
length testing
joint play assessment

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4
Q

what are indications for PROM

A

acute injury & inflamed tissue
pt unable to perform AROM

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5
Q

what is the goal of PROM

A

maintain balance and homeostasis, prevent complications from immobilization

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6
Q

what are 6 goals/ways that PROM prevents complications from immobilization

A
  1. mobility of joint & connective tissue
  2. prevent contractures
  3. maintain elasticity of ms
  4. promote circulation
  5. cartilage nutrition
  6. dec pain
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7
Q

what is an indication for AROM and AAROM

A

able to contract ms and move segment independently (AROM) or w assistance (AAROM)

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8
Q

what are 5 goals for AROM

A
  1. maintain elasticity & contractility of ms
  2. sensory feedback from contracting ms
  3. stim for bone & joint tissue integrity
  4. inc circulation
  5. improve coordination & motor skill
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9
Q

precautions & contraindications of ROM exercises

A

motion is disruptive to healing process
- pain is indicator of too aggressive

post-op presentations & orders
- ex: s/p Bankart repair

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10
Q

what are 3 benefits of CPM

A
  1. prevent adhesions/contractures
  2. dec pain
  3. assist healing
    - tendons/ligaments
    - skin incisions
    - articular cartilage
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11
Q

what are 2 guidelines for CPM

A

immediate application
gradual inc in ROM (5-15deg/day)

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12
Q

what is flexibility

A

ability to move joint(s) thru unrestricted, pain-free ROM

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13
Q

what are 2 types of flexibility

A

dynamic
passive

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14
Q

dynamic flexibility

A

amt of motion as result of ms contraction

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15
Q

passive flexibility

A

amt of motion as result of PROM

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16
Q

hypomobility

A

dec mobility / restricted motion

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17
Q

contracture

A

adaptive shortening of ms - tendon unit & other soft tissues

designated by location
- action of shortened ms

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18
Q

what are 4 types of contractures

A
  1. myostatic
  2. pseudomyostatic
  3. arthrogenic & periarticular
  4. fibrotic & irreversible
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19
Q

what is a myostatic contracture

A

adaptive shortening of musculotendinous unit w/o ms pathology

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20
Q

what is a pseudomyostatic contracture

A

apparent contracture from constant contraction
- hypertonicity (CVA, TBI, SCI), ms spasm

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21
Q

what are arthrogenic & periarticular contractures

A

d/t intra-articular pathology

  • ex: meniscal tear in knee doesn’t allow for normal mobility -» leading to flexion contracture
22
Q

what are fibrotic and irreversible contractures caused by

A

prolonged immobilization

23
Q

what are 7 interventions to inc mobility

A
  1. manual / mechanical / assisted stretching
  2. self-stretching
  3. nm facilitation/inhibition techniques
  4. ms energy techniques
  5. joint mob/manip
  6. soft tissue mob/manip
  7. neural tissue mob
24
Q

depending on the soft tissue, what are 3 possible responses to immobilization and stretch

A

elasticity
viscoelasticity
plasticity

25
Q

what is elasticity

A

ability of soft tissue to return to pre-stretch resting length

26
Q

what is viscoelasticity

A

soft tissue initially resists deformation
sustained force over time change in length occurs

27
Q

what is plasticity

A

soft tissue assumes new & inc length following a stretch

28
Q

what 4 properties of soft tissues can determine the response to immobilization and stretch

A
  1. mechanical properties of contractile tissue
  2. neurophysiological properties of contractile tissue
  3. mechanical properties of noncontractile soft tissue
  4. stress and strain
29
Q

what are contractile elements of ms (4)

A

ms fibers
myofibrils
sarcomeres
actin & myosin myofilaments

30
Q

describe the mechanical response of the contractile unit to stretch

A

mechanical disruption of cross bridges & sarcomeres lengthen

31
Q

describe the mechanical response of the contractile unit to immobilization

A

morphological changes
atrophy occurs in <1wk

32
Q

what are the 2 main neurophysiological elements in contractile tissue

A

ms spindle
golgi tendon organ

33
Q

describe the ms spindle’s neurophysiological role in contractile tissue

A

receive/convey info ab changes in length & velocity

contains afferent sensory and efferent motor fiber endings

34
Q

describe the GTO’s neurophysiological role in contractile tissue

A

monitors changes in tension

35
Q

where are GTOs located

A

musculotendinous junctions of extrafusal fibers

36
Q

what are 4 main components of connective tissue

A

collagen fibers
elastin fibers
reticulin fibers
ground substance

37
Q

what is the role of collagen fibers in connective tissue

A

strength and stiffness

38
Q

what is the role of elastin fibers in connective tissue

A

extensibility

39
Q

what is the role of reticulin fibers in connective tissue

A

provide bulk

40
Q

what is the role of ground substance in connective tissue

A

proteoglycans
glycoproteins

41
Q

describe the progression of the stress and strain curve

A

toe region
elastic range / linear phase
elastic limit / yield point
plastic range
ultimate strength
failure

42
Q

what is the toe region in the stress and strain curve

A

nothing is really happening
free motion
won’t see a change
using available motion

43
Q

what is happening in the elastic range of the stress strain curve

A

start to load tissue and get tissue resistance

44
Q

what is the yield point (elastic limit)

A

where you start to get to start to make change

45
Q

what is happening in the plastic region

A

stretching with enough force to be in the plastic region leads to lasting changes in tissue length

46
Q

what is the ultimate strength on the stress strain

A

most amt of stress/strain tolerated before point of failure

47
Q

what does failure mean on the stress strain curve

A

external forces will probably push tissue to failure point
- tissue will rupture or tear

48
Q

what are 7 components of stretching interventions

A
  1. alignment - isolate desired ms
  2. stabilization
  3. intensity - magnitude
  4. duration - how long to hold
  5. speed
  6. frequency
  7. types of stretch
49
Q

what are 3 types of stretch

A

static stretching
manual
PNF

50
Q

how long do we want to hold a stretch for

A

30-60sec
- not necessarily a linear benefit after this time
- just want to maintain in plastic region for some duration of time

51
Q

why do you avoid bouncing w stretching

A

first contraction can limit amt of stretch

52
Q

once you do something to inc mobility, what do you do next

A

do something to actively engage the ms now using that new ROM

MSK 1 (31 decks)

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