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Clinical skills > joint mobility and extensibility > Flashcards

joint mobility and extensibility Flashcards

1
Q

what do mobility exercises also improve?

A
  • range of motion
  • muscle extensibility
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2
Q

what are the five reasons for reduced range of motion?

A
  • pain
  • muscle weakness
  • fear avoidance
  • joint stiffness
  • muscle tightness
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3
Q

what is fear avoidance?

A
  • scared to move in case it hurts/ causes damage
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4
Q

what are range of motion exercises?

A
  • specific exercises performed to increase functional range of motion about a joint
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5
Q

what are the six components of mobility?

A
  • muscle strength
  • flexibility
  • joint health
  • motor control
  • proprioception
  • agility
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6
Q

what is used in fitness routines? what is it used as?

A
  • mobility training
  • used as dynamic/ body weight or ROM exercises
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7
Q

what does mobility training do for muscles?

A
  • strengthens muscles
  • lengthens muscles
  • relieves muscle tightness
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8
Q

what does mobility training improve and reduce?

A
  • improves posture
  • reduces joint deterioration
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9
Q

what are the conditions that prevent joints being regularly moved through full range? (3)

A
  • immobilisation
  • loss of consciousness
  • prolonged, fixed posture
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10
Q

what causes muscle weakness and stiffness?

A
  • neuromuscular disease
  • nerve injury
  • surgery
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11
Q

what other disease can also contribute to the prevention of joints being moved through full ROM?

A
  • joint disease
    e.g., osteoarthritis
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12
Q

what are the three main symptoms?

A
  • muscle weakness
  • pain
  • swelling
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13
Q

what three structures are effected due to immobilisation ?

A
  • ligaments
  • joint capsule
  • hyaline cartilage
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14
Q

what mass decreases in ligaments due to immobilisation? what does this stop happening?

A
  • total collagen mass decreases as no longer stressed through normal movement
  • so can’t remodel and lay down new collagen hence becomes weaker
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15
Q

what else is decreased in ligaments due to immobilisation? why does this happen

A
  • decreased tensile strength and stiffness
  • resistance to deformation > stops dislocation of joints
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16
Q

what do the ligaments do during immobilisation?

A
  • shorten
  • as they’re not moved through full ROM
  • adaptive shortening
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17
Q

what is reduced in the joint capsule due to immobilisation?

A
  • reduced tensile strength and stiffness
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18
Q

what happens to the size of the joint capsule? what does it adhere to?

A
  • shortens
  • adheres to underlying hyaline cartilage and other intra- articular structures e.g., menisci
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19
Q

what is reduced in hyaline cartilage due to immobilisation?

A
  • proteoglycan content and water content is reduced
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20
Q

what are the two main things that happen in hyaline cartilage due to immobilisation?

A
  • softening causes chondrocyte loss
  • collagen fibre splits causing osteoarthritis
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21
Q

what happens between surfaces in hyaline cartilage due to immobilisation?

A
  • adhesion formation between joint surfaces
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22
Q

what are the two factors that are increased by joint mobility exercises?

A
  • increased range of motion
  • improved proprioception
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23
Q

what are the two things that are prevented due to joint mobility exercises?

A
  • prevents cartilage degeneration due to ^ proteoglycan content & thickness
  • prevents DVT
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24
Q

what do joint mobility exercises maintain? what do they reduce?

A
  • maintains elasticity and contractility of muscles
  • reduce pain
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25
Q

what does joint mobility exercises restore? what do they enhance?

A
  • restore mechanical & structural properties of ligaments, joint capsules and tendons ^ tensile strength, stiffness and total weight
  • enhances synovial diffusion
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26
Q

what are the contraindications of joint mobility exercises?

A

where AROM/PROM could disrupt healing
- interrupting healing process after injury/ surgery
- suspected fracture/ dislocation/ subluxation
- suspected myositis ossificans or ectopic ossification

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27
Q

what are the cautions of joint mobility exercises?

A
  • pain
  • inflammation
  • medications for pain/ muscle relaxants
  • osteoporosis
  • hypertension
  • haemophilia
  • in the region of a haematoma
  • suspected bony ankylosis
  • soft tissue disruption
  • recently healed fracture
  • after prolonged immobilisation
28
Q

what is active mobility exercises? - with example

A
  • mobility exercises performed by active contraction of the muscles surrounding the joint
  • without external assistance
    e.g., knee flexion
29
Q

what is active- assisted mobility exercises? give examples

A
  • mobility exercises performed by some other contraction of the muscles surrounding the joint and some external force
    e.g., limb, belt, therapist
30
Q

what are the three reasons that active- assisted mobility exercises would be indicated?

A
  • patient not allowed to fully activate muscles
  • patient unable to fully activate muscle
  • extra force required to obtain desired range
31
Q

when would a patient not be allowed to fully activate muscle vs unable to fully activate muscle ?

A

not allowed - surgical repair of tendon
unable - muscle weakness

32
Q

what are the main reasons for bothering with joint mobility exercises?

A

+ enhances activities of daily living
+ reduced susceptibility to injury
+ sensitive to change
+ improves athletic performance
+ older age- reduced mobility
+ improves physical wellbeing

33
Q

what do the principles of mobility exercises involve?

A
  • patient in stable, safe & comfortable position
  • area free from restrictive clothing
  • isolate specific joint and movement
  • move through complete range
34
Q

how long should you hold mobility exercises?

A
  • short hold
  • approx 3 seconds
35
Q

how many reps of joint mobility exercises?

A
  • 5 to 10 reps
  • repeated approx. 3 x a day on a day to day basis
36
Q

what do muscle extensibility exercises increase?

A
  • extensibility of muscle- tendon unit
37
Q

what is extensibility?

A
  • ability of a muscle to extend to a predetermined endpoint
38
Q

what is flexibility?

A
  • ability to lengthen/ hold a muscle in a stretch (static)
39
Q

what three things does immobilisation in a shortened position reduce?

A
  • reduced net number of sarcomeres
  • reduced muscle length
  • reduced extensibility
40
Q

what happens to remaining sarcomeres when immobilised in shortened position?

A
  • remaining sarcomeres lengthen
41
Q

what does immobilisation in a shortened position increase and why?

A
  • increased stiffness
  • less energy absorbed before failure
42
Q

what has been found to reverse changes of immobilisation?

A
  • stretching
43
Q

what are the four different types of stretching?

A
  • PNF
  • Ballistic
  • Static
  • Dynamic
44
Q

what does PNF stand for?

A

Proprioceptive neuromuscular facilitation

45
Q

what does PNF aim to cause?

A
  • aims to cause muscle relaxation so that the muscle can be stretched
46
Q

what does PNF usually require?

A
  • assistance
47
Q

what does ballistic stretching use? give an example

A
  • quick, uncontrolled movements to impose a rapid change in muscle length
    e.g., bouncing
48
Q

what is theorised in ballistic stretching?

A
  • greater risk of muscle soreness & injury
49
Q

what is static stretching?

A
  • muscle being stretched is held in a stationary position at greatest length for specific period of time
50
Q

what does static stretching allow?

A
  • patient in position allows muscle relaxation
  • move limb slowly through range to point of gentle stretching sensation
51
Q

how long should you hold static stretching and how frequent?

A
  • hold for min 30 seconds
  • approx 3 repetitions
  • perform regularly
52
Q

what is dynamic stretching? is there any force?

A
  • limb repeatedly taken through ROM in controlled manner
  • not forced past end of range
  • no hold
53
Q

what is dynamic stretching often used for? what does it increase?

A
  • often used as warm- up for sport
  • can increase short term athletic performance whereas other forms can reduce this
54
Q

what is the most prescribed method of stretching?

A
  • static stretching
55
Q

what do warm up methods include ? (3)

A
  • low intensity exercise
  • heat pack
  • dynamic stretching
56
Q

what does a pre- stretch warm up increase?

A
  • intra- muscular temperature increased
57
Q

what does increased intra- muscular temperature lead to? (3)

A
  • increased extensibility of soft tissues
  • reduced force and time required to stretch muscle
  • increased muscle relaxation during stretching
    > increased golgi tendon firing and reduced muscle spindle firing
58
Q

what are the 7 contraindications of stretching?

A
  • acute inflammation
  • local infection
  • bony block
  • haemotoma
  • when will disrupt healing healing process/ surgical repair
  • when increases pain
  • when increases inflammation
59
Q

what are the 6 precautions of stretching?

A
  • recent fracture
  • osteoporosis
  • elderly
  • recent prolonged immobilisation
  • severe muscle weakness
  • hypermobility
60
Q

what is important to check for before beginning?

A
  • check you are in an appropriate position
61
Q

what are the two things you should ask the patient?

A
  • ask about pain at rest
  • ask patient for feedback
62
Q

what range do you start and finish with? what must happen to the movement?

A
  • go from inner to outer ROM
  • isolate movement if possible
63
Q

what is important to observe and watch for?

A
  • observe patient i.e., signs of discomfort/ pain
  • watch for compensatory movements
64
Q

what should you note?

A
  • ROM
  • slow, controlled movements
65
Q

what should you do after the movement?

A
  • return limb to starting position
  • active assisted

Clinical skills (13 decks)

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