Joint mobility and stretching Flashcards
Definition of Therapeutic exercise
Systematic performance of planned physical movements, postures or activities
Therapeutic exercises is to enable (4):
Remediate or prevent impairments
enhance function
reduce risk (reinjury, new injury, illness)
optimise health
Reasons for reduced ROM - 6
Pain muscle weakness nerve injury fear avoidance joint stiffness muscle tightness
Joints lose ROM when:
They are not regularly moved through full range
Reasons for reduced ROM conditions
injury surgery joint disease - OA neuromuscular disease nerve injury loss of consciousness immobilisation prolonged fixed postures
Reasons for reduced ROM symptoms:
Pain
Muscle weakness
swelling
Effects of immobilization on ligaments
Total collagen mass decreases
tensile strength decreases - resistance to deformation.
shorten “adaptive shortening” - collagen is laid down in short position effectively shortening ligament
Effects of immobilization on joint capsule
decrease tensile strength and stiffness
shortens
adheres to underlying hyaline cartilage and other intra-articular structures
Effects of immobilization on cartilage
decrease proteoglycan content and increase water content
leads to softening –chondrocyte loss, collagen fibre splitting – OA.
Adhesions between joint surfaces
Benefits of joint mobility exercise
Increase/maintain ROM
Maintain elasticity of muscles and contractility
prevent cartilage degeneration through increase proteoglycan content and thickness
restore mechanical and structural properties of ligaments, joint capsules and tendons by increasing tensile strength, stiffness and total weight
improve proprioception
reduce pain
prevent DVT
enhance synovial diffusion
Types of joint mobility exercise
Active - do yourself
Active-assisted
Active exercises
Active contraction of muscles surrounding the joint w/out external assistance
Active Assisted
performed by some active contraction and some external force
AA exercises indicated when
Patient not allowed to fully activate muscle
weakness
extra force required to obtain desired range.
Principles of mobility exercises
stable , safe and comfortable free from restrictive clothing isolate specific joint and movement move through the complete range short hold approx 3 secs 5-10 reps repeat 3 times perform regularly - daily
Contraindications
when disrupt healing process or surgical repair
increases pain
increases inflammation
Muscle extensibility exercises increase?
what is the extensibility?
increase the extensibility of the muscle-tendon unit
extensibility = muscle extend to a predetermined endpoint
Immobilisation in shortened position
net loss of sarcomere (although remaining sarcomeres lengthen) reduces muscle length
reduces extensibility
increase stiffness= less energy absorbed before failure - more likely to tear
stretching can reverse these changes
4 main types of stretching
PNF
Static
Ballistic
dynamic
PNF aims
Get muscle to contract cause muscle relaxation so that the muscle can be stretched
Static stretching
Muscle being stretched in stationary position at greatest length for specified period of time
Ballistic stretching
quick, uncontrolled movements to impose a rapid change in muscle length
can include bouncing
theorised greater risk of muscle soreness and injury
Dynamic stretching
limb repeatedly taken into full ROM in controlled manner
not forced past end of range
No hold
can increase short term athletic performance whereas other forms can cause decrease
NOT APPROPRIATE FOR EVERYONE - need good balance
Principles of Static stretching
patient in position to allow muscle relaxation
limb slowly moved through range - to prevent muscle spindle reacting and causing a reflex contraction
minimum hold for 30 seconds
research says older people 1 min is better byt they may not hold that
Approx 3 repetitions
perform regularly - daily initially maintanence - weekly
