Improving ROM and Flexibility Flashcards
What is range of motion?
the distance and the direction a joint can move
What is flexibility?
the ability to move a joint or series of joints through a full, non-restricted, injury and pain-free ROM
Inactivity results in what?
A shortening of connective tissue and muscle and loss of neuromuscular control
What is joint play?
the amount of joint ROM, the arthrokinematic glide that occurs at the joint surfaces
What is flexibility determined by?
The degree of extensibility of the periarticular and connective tissues that cross the joint
6 factors that limit the ability of a joint to move through full ROM
- Muscles and tendons
- Connective tissue
- Bone
- Adipose tissue
- Skin
- Neural tissue
What is static flexibility?
The range or motion available to a joint or series of joints
What does decreased static flexibility indicate?
loss of motion
What is dynamic flexibility?
the ease of movement within the obtainable ROM
______ is the measurement of dynamic stability and is defined as the resistance of a structure to deformation.
Stiffness
What is hypertonus?
An increase in tone and subsequent adaptive shortening of a soft tissue, typically after injury
What are the 2 factors that influence connective tissue deformation?
- sensory receptors such as muscle spindles and GTOs
- tissue temperature
How do sensory receptors influence connective tissue deformation?
muscle spindles and GTOs are stretched they send sensory impulses to the brain notifying it that the muscle is being stretched. Impulses return to the muscle from the spinal cord causing the muscle to reflexively contract, thus resisting the stretch
What happens if the stretch of a muscle continues for 6 seconds or more?
The GTOs begin to override muscle spindle impulses and cause a reflex relaxation of the antagonist muscles (autogenic inhibition)
What is the autogenic inhibition reflex?
A sudden relaxation of muscle on development of high magnitude of tension
What occurs if body temperatures go above 98.6 degrees F?
the cross-links between collagen fibrils are broken more easily and rapidly
As temperature increases the time it takes for collagen to deform _____.
decreases
The higher the temperature, the ____the load that collagen is able to tolerate before failure.
greater
The higher the temperature, the ____ the amount of deformation possible before collagen failure occurs.
greater
What is the difference between stretching and warming up?
Stretching places neuromusculoteninous units and their fascia under tension. Whereas a Warm-up requires the performance of an activity that raises total body and muscle temperatures to prepare the body for exercise
Should you stretch before or after the warm-up and why?
After because beforehand the tissue temps are too low for optimal muscle-tendon function, and are less compliant and less prepared for activity
In order for plastic changes in muscle to occur the application of ___ load, ____ duration forces is recommended
low-load
long-duration
In what direction should stretch be applied?
Parallel to the muscle fibers, which is typically parallel to the bone in the UEs
What are the 4 stretching techniques that can be used to increase the extensibility of the soft tissues?
- static stretching
- dynamic stretching
- proprioceptive neuromuscular facilitation (PNF)
- ballistic stretching
What is static stretching?
A stretch in which steady force is applied for a sustained period
Which type of static stretch would produce greater residual lengthening: small loads/long duration or heavy loads/short duration
Small loads applied for longer periods of time
What does dynamic stretching involve?
Stretching via a muscle contraction to increase or decrease the joint angle where the muscle crosses, thereby elongating the muscle-tendon unit as the end ROM is obtained
What are a few dynamic stretching methods?
- Contraction of the antagonist muscle group which allows the agonist to elongate naturally in a relaxed state
- Eccentrically training a muscle through its full ROM
What are the 3 PNF techniques?
- Contract-Relax (CR)
- Agonist Contraction (AC)
- Contract-Relax-Agonist-Contraction (CRAC)
Describe the process of a contract-relax stretch
1) PT brings limb to the end of ROM until gentle stretching is felt
2) PT asks the patient to provide an isometric contraction of the muscle being stretched (agonist) for 2-5 seconds after which the patient is asked to relax the muscle
3) PT moves the limb passively into the new range of motion until a limitation is felt again
4) Repeat the process
Describe the process of a agonist contraction stretch
1) PT moves the limb to the position of gentle stretch
2) The patient is asked to contract the muscle opposite the muscle being stretched (the antagonist)
3) Contraction is held for 2-5 seconds
4) Technique is repeated 2-4 times
Describe the process of a contract-relax-agonist-contraction stretch
1) PT takes the limb to the point of gentle stretch and perform a CR sequence
2) After contracting the muscle being stretched, the patient is asked to relax this muscle while contracting the opposing muscle group (antagonist), this facilitating the stretch
Which form of stretch is shown to be most effective for increasing ROM through muscle lengthening?
PNF techniques
What is ballistic stretching?
Bouncing movements are used to stretch a muscle or group of muscles which engages a neurological component called active resistance
Research has shown that 80% of length changes occur in the first four stretches of __ seconds each
30
What are a few other techniques that can assist in lengthening of contractile tissue?
- Application of heat
- Massage
- Biofeedback
Continuous passive motion (CPM) machine has been shown to help regain what in post-TKA patients?
Knee flexion, not typically seen in extension gains
What are the indications for a CPM?
- Decrease soft tissue stiffness
- Increase short-term ROM
- Promote healing of the joint surfaces and soft tissue
- Prevention of adhesions and contractures and thus joint stiffness
- Decrease postoperative pain
What are the contraindications for a CPM?
- Non-stable fracture sites
- Excessive edema
- Patient intolerance
