9/16 - Stretching for Impaired Mobility Flashcards
what questions do you ask to define an impairment
how much of a limitation is present?
which tissue is responsible for the limitation?
why is it important to quantify the limitation
need know if the intervention is actually working
- can see change in sx but want to see change in tissues
what are 3 ways to quantify a limitation
goniometry/inclometer
length testing
joint play assessment
what are indications for PROM
acute injury & inflamed tissue
pt unable to perform AROM
what is the goal of PROM
maintain balance and homeostasis, prevent complications from immobilization
what are 6 goals/ways that PROM prevents complications from immobilization
- mobility of joint & connective tissue
- prevent contractures
- maintain elasticity of ms
- promote circulation
- cartilage nutrition
- dec pain
what is an indication for AROM and AAROM
able to contract ms and move segment independently (AROM) or w assistance (AAROM)
what are 5 goals for AROM
- maintain elasticity & contractility of ms
- sensory feedback from contracting ms
- stim for bone & joint tissue integrity
- inc circulation
- improve coordination & motor skill
precautions & contraindications of ROM exercises
motion is disruptive to healing process
- pain is indicator of too aggressive
post-op presentations & orders
- ex: s/p Bankart repair
what are 3 benefits of CPM
- prevent adhesions/contractures
- dec pain
- assist healing
- tendons/ligaments
- skin incisions
- articular cartilage
what are 2 guidelines for CPM
immediate application
gradual inc in ROM (5-15deg/day)
what is flexibility
ability to move joint(s) thru unrestricted, pain-free ROM
what are 2 types of flexibility
dynamic
passive
dynamic flexibility
amt of motion as result of ms contraction
passive flexibility
amt of motion as result of PROM
hypomobility
dec mobility / restricted motion
contracture
adaptive shortening of ms - tendon unit & other soft tissues
designated by location
- action of shortened ms
what are 4 types of contractures
- myostatic
- pseudomyostatic
- arthrogenic & periarticular
- fibrotic & irreversible
what is a myostatic contracture
adaptive shortening of musculotendinous unit w/o ms pathology
what is a pseudomyostatic contracture
apparent contracture from constant contraction
- hypertonicity (CVA, TBI, SCI), ms spasm
what are arthrogenic & periarticular contractures
d/t intra-articular pathology
- ex: meniscal tear in knee doesn’t allow for normal mobility -» leading to flexion contracture
what are fibrotic and irreversible contractures caused by
prolonged immobilization
what are 7 interventions to inc mobility
- manual / mechanical / assisted stretching
- self-stretching
- nm facilitation/inhibition techniques
- ms energy techniques
- joint mob/manip
- soft tissue mob/manip
- neural tissue mob
depending on the soft tissue, what are 3 possible responses to immobilization and stretch
elasticity
viscoelasticity
plasticity
what is elasticity
ability of soft tissue to return to pre-stretch resting length
what is viscoelasticity
soft tissue initially resists deformation
sustained force over time change in length occurs
what is plasticity
soft tissue assumes new & inc length following a stretch
what 4 properties of soft tissues can determine the response to immobilization and stretch
- mechanical properties of contractile tissue
- neurophysiological properties of contractile tissue
- mechanical properties of noncontractile soft tissue
- stress and strain
what are contractile elements of ms (4)
ms fibers
myofibrils
sarcomeres
actin & myosin myofilaments
describe the mechanical response of the contractile unit to stretch
mechanical disruption of cross bridges & sarcomeres lengthen
describe the mechanical response of the contractile unit to immobilization
morphological changes
atrophy occurs in <1wk
what are the 2 main neurophysiological elements in contractile tissue
ms spindle
golgi tendon organ
describe the ms spindle’s neurophysiological role in contractile tissue
receive/convey info ab changes in length & velocity
contains afferent sensory and efferent motor fiber endings
describe the GTO’s neurophysiological role in contractile tissue
monitors changes in tension
where are GTOs located
musculotendinous junctions of extrafusal fibers
what are 4 main components of connective tissue
collagen fibers
elastin fibers
reticulin fibers
ground substance
what is the role of collagen fibers in connective tissue
strength and stiffness
what is the role of elastin fibers in connective tissue
extensibility
what is the role of reticulin fibers in connective tissue
provide bulk
what is the role of ground substance in connective tissue
proteoglycans
glycoproteins
describe the progression of the stress and strain curve
toe region
elastic range / linear phase
elastic limit / yield point
plastic range
ultimate strength
failure
what is the toe region in the stress and strain curve
nothing is really happening
free motion
won’t see a change
using available motion
what is happening in the elastic range of the stress strain curve
start to load tissue and get tissue resistance
what is the yield point (elastic limit)
where you start to get to start to make change
what is happening in the plastic region
stretching with enough force to be in the plastic region leads to lasting changes in tissue length
what is the ultimate strength on the stress strain
most amt of stress/strain tolerated before point of failure
what does failure mean on the stress strain curve
external forces will probably push tissue to failure point
- tissue will rupture or tear
what are 7 components of stretching interventions
- alignment - isolate desired ms
- stabilization
- intensity - magnitude
- duration - how long to hold
- speed
- frequency
- types of stretch
what are 3 types of stretch
static stretching
manual
PNF
how long do we want to hold a stretch for
30-60sec
- not necessarily a linear benefit after this time
- just want to maintain in plastic region for some duration of time
why do you avoid bouncing w stretching
first contraction can limit amt of stretch
once you do something to inc mobility, what do you do next
do something to actively engage the ms now using that new ROM
