Joint Mobility and Muscle Extensibility

Question 1

Reasons for reduced ROM (6)

Answer 1

• pain
• fear of pain
• joint stiffness
• muscle tightness
• muscle weakness
• neurological injuries/conditions

Question 2

what are range of movement exercises?

Answer 2

specific exercises performed to increase the functional range of movement around a joint

Question 3

how do joints lose their ROM?

Answer 3

when they are not regularly moved through their full range of motion

Question 4

reasons for reduced joint mobility/increased joint stiffness (7)

Answer 4

• 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)

Question 5

effects of immobilisation on structures around the joints

Answer 5

• 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

Question 6

benefits of joint mobility exercises (8)

Answer 6

• 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

Question 7

when should active assisted exercises be used instead of active exercises? (3)

Answer 7

• 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

Question 8

what are contraindications to joint mobility exercises?

Answer 8

• when will disrupt healing process/surgical repair

- when increase pain/inflammation

Question 9

what defines muscle extensibility exercises?

Answer 9

• exercises which increase the extensibility of the muscle tendon-unit

Question 10

definition of extensibility

Answer 10

ability of muscle to extend to a pre-determined endpoint

Question 11

what are the effects of immobilisation of muscles in a shortened position? (4)

Answer 11

• net loss of sarcomeres, with the remaining sarcomeres lengthening
• decrease in muscle length
• decrease in muscle extensibility
• increase in muscle stiffness

Question 12

what are the 4 main types of muscle stretching?

Answer 12

• PNF
• ballistic
• static
• dynamic

Question 13

what is the aim of PNF stretching and why is it not usually prescribed to patients for home exercise?

Answer 13

• aim: cause muscle relaxation to stretch muscles

- reason: usually stretching requires assistance

Question 14

Aim of ballistic stretch, risk of it

Answer 14

aim: use quick uncontrolled movements to impose rapid change in muscle length
risk: greater risk of muscle soreness and injury

Question 15

what is the purpose of static stretch?

Answer 15

• muscle stretched is held in its stationary position at its greatest length for a specified period of time

Question 16

what happens in dynamic stretch and what is its aim?

why is it not appropriate for some patients?

Answer 16

• 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

Question 17

what are the advantages to pre-stretch warm ups

Answer 17

• 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)

Question 18

what are ways to provide pre-stretch warm ups

Answer 18

• heat packs (if patients have trouble moving/have balance problems)
• low intensity exercises
• dynamic stretching

Question 19

contraindications to stretching

Answer 19

• when affects healing process/surgical repair
• when increases pain and/or inflammation
• when patient has acute inflammation
• abnormal bony block
• haematoma

Question 20

precautions to stretching

Answer 20

• recent fracture
• osteoporosis
• poor balance (eg: elderly patients)
• recent prolonged immobilisation
• severe muscle weakness

Question 21

on a microscopic level, what happens to the muscle during stretching

Answer 21

• 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