joint mobility and extensibility Flashcards
what do mobility exercises also improve?
- range of motion
- muscle extensibility
what are the five reasons for reduced range of motion?
- pain
- muscle weakness
- fear avoidance
- joint stiffness
- muscle tightness
what is fear avoidance?
- scared to move in case it hurts/ causes damage
what are range of motion exercises?
- specific exercises performed to increase functional range of motion about a joint
what are the six components of mobility?
- muscle strength
- flexibility
- joint health
- motor control
- proprioception
- agility
what is used in fitness routines? what is it used as?
- mobility training
- used as dynamic/ body weight or ROM exercises
what does mobility training do for muscles?
- strengthens muscles
- lengthens muscles
- relieves muscle tightness
what does mobility training improve and reduce?
- improves posture
- reduces joint deterioration
what are the conditions that prevent joints being regularly moved through full range? (3)
- immobilisation
- loss of consciousness
- prolonged, fixed posture
what causes muscle weakness and stiffness?
- neuromuscular disease
- nerve injury
- surgery
what other disease can also contribute to the prevention of joints being moved through full ROM?
- joint disease
e.g., osteoarthritis
what are the three main symptoms?
- muscle weakness
- pain
- swelling
what three structures are effected due to immobilisation ?
- ligaments
- joint capsule
- hyaline cartilage
what mass decreases in ligaments due to immobilisation? what does this stop happening?
- total collagen mass decreases as no longer stressed through normal movement
- so can’t remodel and lay down new collagen hence becomes weaker
what else is decreased in ligaments due to immobilisation? why does this happen
- decreased tensile strength and stiffness
- resistance to deformation > stops dislocation of joints
what do the ligaments do during immobilisation?
- shorten
- as they’re not moved through full ROM
- adaptive shortening
what is reduced in the joint capsule due to immobilisation?
- reduced tensile strength and stiffness
what happens to the size of the joint capsule? what does it adhere to?
- shortens
- adheres to underlying hyaline cartilage and other intra- articular structures e.g., menisci
what is reduced in hyaline cartilage due to immobilisation?
- proteoglycan content and water content is reduced
what are the two main things that happen in hyaline cartilage due to immobilisation?
- softening causes chondrocyte loss
- collagen fibre splits causing osteoarthritis
what happens between surfaces in hyaline cartilage due to immobilisation?
- adhesion formation between joint surfaces
what are the two factors that are increased by joint mobility exercises?
- increased range of motion
- improved proprioception
what are the two things that are prevented due to joint mobility exercises?
- prevents cartilage degeneration due to ^ proteoglycan content & thickness
- prevents DVT
what do joint mobility exercises maintain? what do they reduce?
- maintains elasticity and contractility of muscles
- reduce pain
what does joint mobility exercises restore? what do they enhance?
- restore mechanical & structural properties of ligaments, joint capsules and tendons ^ tensile strength, stiffness and total weight
- enhances synovial diffusion
what are the contraindications of joint mobility exercises?
where AROM/PROM could disrupt healing
- interrupting healing process after injury/ surgery
- suspected fracture/ dislocation/ subluxation
- suspected myositis ossificans or ectopic ossification
what are the cautions of joint mobility exercises?
- 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
what is active mobility exercises? - with example
- mobility exercises performed by active contraction of the muscles surrounding the joint
- without external assistance
e.g., knee flexion
what is active- assisted mobility exercises? give examples
- mobility exercises performed by some other contraction of the muscles surrounding the joint and some external force
e.g., limb, belt, therapist
what are the three reasons that active- assisted mobility exercises would be indicated?
- patient not allowed to fully activate muscles
- patient unable to fully activate muscle
- extra force required to obtain desired range
when would a patient not be allowed to fully activate muscle vs unable to fully activate muscle ?
not allowed - surgical repair of tendon
unable - muscle weakness
what are the main reasons for bothering with joint mobility exercises?
+ enhances activities of daily living
+ reduced susceptibility to injury
+ sensitive to change
+ improves athletic performance
+ older age- reduced mobility
+ improves physical wellbeing
what do the principles of mobility exercises involve?
- patient in stable, safe & comfortable position
- area free from restrictive clothing
- isolate specific joint and movement
- move through complete range
how long should you hold mobility exercises?
- short hold
- approx 3 seconds
how many reps of joint mobility exercises?
- 5 to 10 reps
- repeated approx. 3 x a day on a day to day basis
what do muscle extensibility exercises increase?
- extensibility of muscle- tendon unit
what is extensibility?
- ability of a muscle to extend to a predetermined endpoint
what is flexibility?
- ability to lengthen/ hold a muscle in a stretch (static)
what three things does immobilisation in a shortened position reduce?
- reduced net number of sarcomeres
- reduced muscle length
- reduced extensibility
what happens to remaining sarcomeres when immobilised in shortened position?
- remaining sarcomeres lengthen
what does immobilisation in a shortened position increase and why?
- increased stiffness
- less energy absorbed before failure
what has been found to reverse changes of immobilisation?
- stretching
what are the four different types of stretching?
- PNF
- Ballistic
- Static
- Dynamic
what does PNF stand for?
Proprioceptive neuromuscular facilitation
what does PNF aim to cause?
- aims to cause muscle relaxation so that the muscle can be stretched
what does PNF usually require?
- assistance
what does ballistic stretching use? give an example
- quick, uncontrolled movements to impose a rapid change in muscle length
e.g., bouncing
what is theorised in ballistic stretching?
- greater risk of muscle soreness & injury
what is static stretching?
- muscle being stretched is held in a stationary position at greatest length for specific period of time
what does static stretching allow?
- patient in position allows muscle relaxation
- move limb slowly through range to point of gentle stretching sensation
how long should you hold static stretching and how frequent?
- hold for min 30 seconds
- approx 3 repetitions
- perform regularly
what is dynamic stretching? is there any force?
- limb repeatedly taken through ROM in controlled manner
- not forced past end of range
- no hold
what is dynamic stretching often used for? what does it increase?
- often used as warm- up for sport
- can increase short term athletic performance whereas other forms can reduce this
what is the most prescribed method of stretching?
- static stretching
what do warm up methods include ? (3)
- low intensity exercise
- heat pack
- dynamic stretching
what does a pre- stretch warm up increase?
- intra- muscular temperature increased
what does increased intra- muscular temperature lead to? (3)
- 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
what are the 7 contraindications of stretching?
- acute inflammation
- local infection
- bony block
- haemotoma
- when will disrupt healing healing process/ surgical repair
- when increases pain
- when increases inflammation
what are the 6 precautions of stretching?
- recent fracture
- osteoporosis
- elderly
- recent prolonged immobilisation
- severe muscle weakness
- hypermobility
what is important to check for before beginning?
- check you are in an appropriate position
what are the two things you should ask the patient?
- ask about pain at rest
- ask patient for feedback
what range do you start and finish with? what must happen to the movement?
- go from inner to outer ROM
- isolate movement if possible
what is important to observe and watch for?
- observe patient i.e., signs of discomfort/ pain
- watch for compensatory movements
what should you note?
- ROM
- slow, controlled movements
what should you do after the movement?
- return limb to starting position
- active assisted
