Flexibility (chap 4) Flashcards
Connective tissue
- bone - tendon - mm - skin - hyaline cartilage - joint capsule - fascia
Collagen
Found in all connective tissues
- building block of connective tissues
- provides tensile strength
Elastin
<1%
- recoil of tissues
Stress
Amount of tension or load placed on the tissues (load / unit area)
Strain
Proportional degree of elongation that occurs during stress
Recovery
Ability of tissues to return to their previous resting state
Creep
Gradual lengthening of tissues when they are subjected to constant or repeated stress over a long duration
Speed
Slower stress = greater strain
***
Faster rates of stress = less elongation
Connective tissue properties
- Elastic deformaiton: ability of a tissue to return to its original resting length when stress is removed
- Plastic deformation: tendency of tissue to assume a new and greater length after the stretch force has been removed
- ex plastic spoon: fast bend and snap, slow bend and bent
Connective tissue retraints
- connective tissue is a passive restraint to joint motion.
- muscle tissue is an active restraint to joint motion (guarding or contracture)
- greater flexibility with warmer temps
Flexibility
The ability of a mm to relax and yield to a stretch force
- ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain-free ROM
ROM
Amount. Of movement available to a joint moving within its anatomical range
Flexibility determinants
- mm length
- joint ROM
- joint mobility
- extensibility of surrounding soft tissues (skin, tendons, ligaments, joint capsule)
- joint arthrokinematics and osteokinematics
- strength (stability, control, position)
Dynamic flexibility
Active mobility or active ROM
- limited by strength
Passive flexibility
Passive mobility or passive ROM
- dependent on tissue surrounding joint
- can be a prerequisite, but does not ensure, dynamic flexibility
Static stretching
Placing a mm in a fully elongated position and holding that position for a period of time
- prevent or minimize the risk of soft-tissue injury during activity
- improve flexibility
- prevent contracture
- takes 6+ weeks to increase
- manual stretch hold at least 60 seconds to produce change
- low load, long duration takes 20-30 min, best results, decreased injury
Dynamic stretching
Performed actively by moving joints (pre activity)
- body weighted or eliminated position
- through available ROM
- gradually increase range and speed
- does not diminish torque production
Ballistic stretching
Will not use in therapy, not good
- bounce at end of ROM
- high risk of injry to the connective and contractile tissue
- used for cramps
Types of stress
- Tension: the resistance to a force applied i a manner that will lengthen the tissue. A stretching force results in tension stress
- Compression: resistance to a force applied in a manner that approximates tissue. Weight bearing througha joint will produce compression stresses
- Shear: resistance to 2+ forces that are applied in opposing directions
Muscle spindle
Major sensory organ of mm and is sensitive to quick and sustained (tonic) stretch
- detect and convey information about mm length changes and the velocity of those chagnes
Golgi tendon organ
Monitor chagnes in tension of mm-tendon units
- sensitive even slight chagnes of tensions ona mm-tendon unit brought on by passive stretch or active mm contractions during normal movement
Proprioceptive neuromuscular facilitation (PNF)
Reflex inhibition and subsequent elongation of the contractile elements of the mm
- involves the GTO in the myotendious junction, and the mm spindles
Autogenic inhibition
PNF principle
- a reglex relation that occurs in the same mm wehere the Golgi tendon organ is stimulated
- via isometric or isotonic contraction
Reciprocal inhibition
PNF principle
- contracting the opposing mm group to that being stretched in order to achieve a reflex muscular relation that occurs in the mm that is opposite the mm where the GTO is stimulated
Types of PNF
- Hold relax: gentle isometric contraction of mm being stretched. 6-10 seconds followed by stretch into new range
- Contract relax: gentle isotonic contraction of mm being stretched. 6-10 seconds flood by stretch into new range
- Slow reversal hold: isometric contraction of mm being stretched followed by active contraction of opposing mm into gained range
Parameters for stretching/flexibility/ROM
- always warm up 5-10 min
- mode: you determine
- intensity: mild to moderate stretch, no pain! Push to and just past the tissue barrier, SLOWLY
- duration: 30-60 seconds, 3-5x per series
- frequency: daily! One needs to stretch at least 3x/week to gain and 1x per week to maintain
- ignoring stretching can lead to injury, adhesions, and contractures
Adhesions
Due to scar tissue formation between tissue structure and results from the healing or union of two injured or torn parts
- collagen fibers are highly unorganized initially but organize based on stresses place on it
- must wait until car tissue is strong enough (nothing first 5 days, after that, get at it to maintain stretch and movement. 14 weeks post op, too difficult)
Contractures
Adaptive shortening of the mm-tendon unit and other soft tissues that cross or surround a joint which results in significant resistance to passive or active stretch and limitation of ROM
- low load, long duration stretches
Irreversible contractures
Longer a contracture exists OR the greater % of normal tissue replaced by scar tissue or bone, the more difficult it becomes to regain optimal mobility of soft tissues = more likely contracture will become irreversible
***EDU to pts and family!
Stretch parameters for contractures
Requires low load, long duration LLLD
- aggressive
- prolonged stretch into restriction x 20-60 min
- may be done in conjunction with heating
- bracing
- serial casting
Precautions to stretching
- avoid ballistic stretching to allow relaxation and prevent injry
- avoid oversretching
- do not force a joint beyond its normal ROM and do not excessively stretch weak mm
- use causation with known diseases (osteoporosis, prolonged bedrest, prolonged steroid use, advancing age)
- stretch carefully if swelling/edema present or if pt has been immobilized for a prolonged length of time
- residual soreness should not last 24+ hours
- *dont stretch out functional tightness
Contras to stretching
- if motion is limited by bony block
- across an acute or a non-unioned fracture
- acutely inflamed and infected tissue
- hypermobile tissues or joints
- hypomobile tissues that provide structural or neuromuscular support (subluxation)
