Joint Mobility and Muscle Extensibility Flashcards
Reasons for reduced ROM (6)
- pain
- fear of pain
- joint stiffness
- muscle tightness
- muscle weakness
- neurological injuries/conditions
what are range of movement exercises?
specific exercises performed to increase the functional range of movement around a joint
how do joints lose their ROM?
when they are not regularly moved through their full range of motion
reasons for reduced joint mobility/increased joint stiffness (7)
- immobilisation (due to cast)
- unconscious
- maintain a position for a prolonged period of time
- neuromuscular disease/nerve injury (cause muscle weakness -> reduce joint mobility)
- injury which causes pain and swelling
- surgery
- joint disease (eg: OA)
effects of immobilisation on structures around the joints
- ligaments get weaker and shorter (decrease in tensile strength and stiffness)
- joint capsule gets weaker and shorter (decrease in tensile strength and stiffness), also starts to stick to hyaline cartilage + other intra-articular structures
- hyaline cartilage softens and starts to degenerate + sticks to hyaline cartilage on other joint
benefits of joint mobility exercises (8)
- increase/maintain ROM
- maintain elasticity and contractility of muscles
- prevent cartilage degeneration
- increases stiffness and tensile strength of ligaments, joint capsules and tendons (restore mechanical and structural properties)
- improve proprioception
- reduce pain
- prevent DVT
- enhance synovial diffusion
when should active assisted exercises be used instead of active exercises? (3)
- patients aren’t allowed to fully activate muscles (surgical repair)
- patients unable to fully activate muscles (muscle weakness)
- when extra force is required to obtain desired range
what are contraindications to joint mobility exercises?
- when will disrupt healing process/surgical repair
- when increase pain/inflammation
what defines muscle extensibility exercises?
- exercises which increase the extensibility of the muscle tendon-unit
definition of extensibility
ability of muscle to extend to a pre-determined endpoint
what are the effects of immobilisation of muscles in a shortened position? (4)
- net loss of sarcomeres, with the remaining sarcomeres lengthening
- decrease in muscle length
- decrease in muscle extensibility
- increase in muscle stiffness
what are the 4 main types of muscle stretching?
- PNF
- ballistic
- static
- dynamic
what is the aim of PNF stretching and why is it not usually prescribed to patients for home exercise?
- aim: cause muscle relaxation to stretch muscles
- reason: usually stretching requires assistance
Aim of ballistic stretch, risk of it
aim: use quick uncontrolled movements to impose rapid change in muscle length
risk: greater risk of muscle soreness and injury
what is the purpose of static stretch?
- muscle stretched is held in its stationary position at its greatest length for a specified period of time
what happens in dynamic stretch and what is its aim?
why is it not appropriate for some patients?
- joint is taken through its ROM in a controlled manner, with no hold at the end of range
- aim: used as warm-up for sport to increase athletic performance momentarily
- inappropriate for patients who do not have good balance
what are the advantages to pre-stretch warm ups
- increases intra-muscular temperature
- increases extensibility of soft tissue
- decreases force and time needed to stretch muscles
- increase muscle relaxation during stretching (increase GTO firing but decreases muscle spindle firing)
what are ways to provide pre-stretch warm ups
- heat packs (if patients have trouble moving/have balance problems)
- low intensity exercises
- dynamic stretching
contraindications to stretching
- when affects healing process/surgical repair
- when increases pain and/or inflammation
- when patient has acute inflammation
- abnormal bony block
- haematoma
precautions to stretching
- recent fracture
- osteoporosis
- poor balance (eg: elderly patients)
- recent prolonged immobilisation
- severe muscle weakness
on a microscopic level, what happens to the muscle during stretching
- muscle fibres experience a stretch force
- cause actin and myosin in sarcomere to detach (cross-bridges are disrupted)
- increase in sarcomere length
- if stretching is for short time, sarcomere goes back to its initial length once stretch force is removed (sarcomere is elastic)
- if stretching is for a long time, sarcomere remains elongated (lose some elasticity)
- thus, muscle fibres and hence muscle length increases
