Chapter 8: ROM And Flexibility Flashcards
Define flexibility:
Ability to move a joint or series of joints through a full, non restricted pain free ROM
Flexibility is dependent on a combination of the following:
- Joint ROM
2. Muscle flexibility
What structures are most often responsible for limiting ROM?
Muscles, tendons, surrounding fascial sheaths
In what types of situations do ligaments and jt capsules lose some elasticity and shorten?
- long periods of immobilization
- after surgical repair of an unstable joint
- long periods of inactivity
Name different structures that can restrict ROM:
- connective tissue
- bony structure
- fat
- skin
- neural tissue tightness
What factors that limit flexibility cannot be altered?
- bone structure
- age
- gender
AROM aka
Dynamic flexibility
AROM applies to the ability to move a joint _____ with little _____ to motion.
- efficiently
- resistance
PROM aka
Static flexibility
If muscle does not have enough elasticity to compensate for the additional stretch associated with PROM, it is likely that the ____ ____ will be injured.
Musculotendinous unit
The goal of any effective stretching program should be to improve the ____ at a given articulation by altering the ______ of the ______ units that produce movement at the joint.
- ROM
- extensibility
- neuromusculotendinous
2 mechanoreceptors in stretch reflex:
- muscle spindle
- golgi tendon organ (GTO)
Muscle spindle is sensitive to changes in…
Muscle length
GTO is sensitive to changes in…
- muscle length
- muscle tension
Both muscle and tendon are composed largely of _____ _____ and _____ _____.
- noncontractile collagen
- elastin fibres
Collagen enables tissue to resist _______ forces and ______.
- mechanical
- deformation
Elastin composes ____ ____ tissues that assist in recovery from ______.
- highly elastic
- deformation
What are the 3 mechanical properties of collagen, and how does it help in withstanding high tensile stress?
- elasticity: capability to recover to normal length after elongation
- viscoelasticity: allows for slow return to normal length and shape after deformation
- plasticity: allows for permanent change or deformation
What are the 3 physical properties of collagen, and how does it help in withstanding high tensile stress?
- force-relaxation: decrease amount of force needed to maintain tissue at a set amount of displacement or deformation over time
- creep response: ability of a tissue to deform over time while a constant load is imposed
- hysteresis: amount of relaxation a tissue has undergone during deformation and displacement.
What happens if the mechanical and physical limitations of connective tissue are exceeded?
Injury
What are the 2 active contractile components that are in muscle but not tendons?
- actin myofilaments
- myosin myofilaments
What are the 2 factors that influence the % of contribution from contractile and non contractile components for flexibility?
- degree to which the muscle is stretched or deformed
- velocity of deformation
Non-contractile elements are primarily resistant to ….
The degree of lengthening
Contractile elements are resistant to …
High-velocity deformation
The greater the stretch, the more ______ components contribute.
Non contractile
Lengthening of a muscle via stretching allows for ______ and _____ changes to occur in the collagen and elastin fibres.
- viscoelastic
- plastic
The greater the velocity of deformation, the greater the chance for….
Exceeding the tissue’s capability to undergo viscoelastic and plastic change
Joint hypomobility ethology can often be traced back to:
- faulty posture
- muscular imbalances
- abnormal neuromuscular control
Muscle tightness and hypertonicity have a significant impact on _____ _____.
Neuromuscular control
How can muscle tightness cause reciprocal inhibition?
Increase muscle spindle activity in a specific muscle will cause decreased neural drive to that muscle’s functional antagonist.
Synergistic dominance:
Neuromuscular phenomenon that occurs when synergistic compensate for a weak and/or inhibited muscle to maintain force production capabilities.
Why is it important to increase muscle temp prior to stretching?
- positive effect on ability of collagen and elastin components to deform
- enhanced ability for GTO to reflexively relax through autogenic inhibition.
What is the optimal temp of muscle to achieve beneficial effects of stretching?
39 degrees C
It is recommended that ____ be used as the primary means for increasing intramuscular temperature.
Exercise
When would you use cold prior to stretching?
Decrease muscle guarding associated with DOMS
Dynamic stretching uses _____ _____ movements to stretch muscles.
Controlled functional
Synergestic muscle groups:
Muscles that work in concert with one another (ex. Quads contract and hams relax with knee flexion)
Agonist muscle:
Muscle that contracts to produce a movement
Antagonist muscle:
The muscle being stretched in response to contraction of the agonist muscle
What are the 4 types of stretching?
- ballistic
- dynamic
- static
- proprioceptive neuromuscular facilitation (PNF)
Why can the safety of ballistic stretching be of concern? What population is this especially significant for?
- creates somewhat uncontrolled forces within the muscle that can exceed the extensibility limits of of the muscle fibre = small micro tears within MT unit
- sedentary individuals or those who have sustained muscle injuries
What is the difference between ballistic stretching and dynamic stretching?
Controlled vs uncontrolled
What are the benefits of a progressive velocity flexibility program?
- velocity and degree of lengthening are progressively controlled
- pt controls both range and speed with no assistance
Static stretching:
- stretching antagonist muscle passively by placing it in a maximal position of stretch
- optimal time: 15-30s
- over 30s can become uncomfortable
- repeated 3-4 times
- can be accomplished by contraction of agonist muscle.
A passive stretch requires the use of one of the following:
- body weight
- assistance from a partner
- use of a t-bar (UE)
3 different PNF techniques used to stretching:
- contract-relax
- hold-relax
- slow reversal-hold relax
Contract relax PNF:
- body part moved passively into agonist pattern
- pt pushes by contracting the antagonist (Mm being stretched) isotonically against resistance of AT
- pt relaxes while AT moves passively into more range until limitation is felt again
Contract-relax PNF is beneficial when…
ROM is limited by muscle tightness
Hold-relax PNF:
Isometric contraction of antagonist (Mm being stretched) against resistance + light pressure from therapist to produce max stretch.
When is hold-relax PNF beneficial?
When there is muscle tension on one side of a joint. Can be used with either the agonist or the antagonist.
Hold-relax PNF is aka
Muscle energy technique
Slow reversal-hold-relax PNF:
- isotonic contraction of the agonist
- isometric contraction of the antagonist (Mm that will be stretched) during push phase.
- antagonists relaxed and agonist contract during relax phase.
When is slow reversal-hold-relax PNF beneficial?
For increasing ROM when primary limiting factor is the antagonistic muscle group.
PNF stretching techniques can be done with a _____ or a _____ as resistance.
- partner
- wall
PNF stretching is capable of producing …
Greater improvement in flexibility over an extended training period
Disadvantage of PNF stretching
Partner is usually required
To see improvement in flexibility, stretching must be done ____ times per week.
3-5
AT should perform both active and passive movements that create tension in neural structures that are…
- exacerbating pain
- limiting ROM
- increasing neural symptoms (n/t)
Pilates method of stretching:
- conditioning program that improves muscle control, flexibility, coordination, strength, and muscle tone
- make pt more aware of their bodies as single integrated units
- improve body alignment and breathing
- increase efficiency of movements
- does not require repetition. Has a sequence of carefully performed movements
- specific breathing patterns for each exercise
Yoga:
- stress can be reduced through combined mental and physical approaches
- unite body and mind to reduce stress
- body postures and breathing exercises (slow deep)
- positions increase mobility and flexibility
- Can be dangerous for those that are inexperienced
Name some manual therapy techniques for increasing mobility:
- myofascial release
- strain-counter strain technique
- positional release therapy
- active release technique
- graston technique
- massage
- structural integration
- postural restoration
Myofascial release
- relieving soft tissue from abnormal grip of tight fascia
- fascia: composed primarily of collagen and some elastic fibres
- aka soft tissue mobes
- superficial to deep
- add in stretching of MT unit
- can be done manually by AT or foam roller
Strain-counter strain technique:
- an approach to decreasing muscle tension and guarding to normalize muscle function
- AT finds tendon points (often in painless area opposite to site of pain). Then let go.
- passive, places the body in a position of greatest comfort = pain relief. Hold position for min. 90s.
- slowly return to neutral position
- explained by stretch reflex
Positional release therapy:
- based on strain-counter strain technique
- difference: use of a facilitating force (compression) to enhance effect of positioning
- Maintain contact with tender point during treatment period
Active release technique (ART)
- to correct soft tissue problems in muscle, tendon, and fascia caused by formation of fibrotic/scar adhesions that result from acute injury, overuse injuries, constant pressure, tension injuries
- palpate and locate adhesions.
- trap affected muscle by applying pressure with thumb over lesions in the direction of fibres
- ask pt to actively move the body part so that the musculature is elongated from a shortened position while continually applying tension to the lesion
- repeat 3-5x/treatment session
- softens and stretches scar tissue
- can be uncomfortable during
Graston technique:
- instrument assisted soft tissue mobes
- break down scar tissue and fascial restrictions + stretch connective tissue and muscle fibres
- stainless steel instruments
- palpate, find painful spots and unusual nodules, tensions or barriers.
- apply precise pressure with special lubricant on skin to decrease irritation
- cross friction massage - initiate/promote healing process
- pt may experience discomfort or bruising
Types of massage that can help with flexibility:
- Hoffa (Swedish) massage (classic form of massage)
- friction massage
- acupressure
- connective tissue massage: stroking that affects circulatory pathologies
- myofascial release techniques
- Rolfing
- Trager
Structural integration:
- uses manual therapy and sensorimotor movement education
- based on Rolfing (massage)
- focuses on connective tissue or fascia
- 10 hour-long sessions.
- Practitioner identifies habitual patterns and imbalances to educate patient about corrective changes
Structural integration attempts to lengthen, stretch, soften, release fascial adhesions to reduce ______ stress and _______ irritation, restore ______ balance, and, thus, ______ of movement
- mechanical
- nociceptive
- postural
- efficiency
Postural restoration is a treatment technique that is used to identify and correct ______ postural patterns that negatively influence normal ______, ______, ______, and _____.
- asymmetrical
- sitting
- standing
- walking
- breathing
Any asymmetries found with postural restoration can create adaptive and compensatory changes in ____ _____ and ____ ____ that eventually result in movement patterns that restrict ____ ____ and negatively influence _____ _____ and, thus, ______ control.
- soft tissue
- bone structures
- functional range
- structural alignment
- postural
Several muscles such as the _____ and ____ _____ are important for both postural control/stabilization and for respiration.
- diaphragm
- transversus abdominis
A goal of PRI is to maintain what is referred to as a zone of ______ which is an area of the diaphragm that directly opposes the ____ _____.
- apposition
- rib cage
What has PRI been used to treat?
- low back pain
- SI jt pain
- acetabular labral tear
- anterior knee pain
- thoracic outlet syndrome
- sciatica
- asthma
- COPD
PRI treatment focuses on ______ patterns and _____ joint muscles in combination with ______ breathing.
- asymmetrical
- multiple
- diaphragmatic
