Joint mobility and stretching

Question 1

Definition of Therapeutic exercise

Answer 1

Systematic performance of planned physical movements, postures or activities

Question 2

Therapeutic exercises is to enable (4):

Answer 2

Remediate or prevent impairments
enhance function
reduce risk (reinjury, new injury, illness)
optimise health

Question 3

Reasons for reduced ROM - 6

Answer 3

Pain
muscle weakness
nerve injury 
fear avoidance 
joint stiffness 
muscle tightness

Question 4

Joints lose ROM when:

Answer 4

They are not regularly moved through full range

Question 5

Reasons for reduced ROM conditions

Answer 5

injury 
surgery 
joint disease - OA
neuromuscular disease 
nerve injury 
loss of consciousness 
immobilisation 
prolonged fixed postures

Question 6

Reasons for reduced ROM symptoms:

Answer 6

Pain
Muscle weakness
swelling

Question 7

Effects of immobilization on ligaments

Answer 7

Total collagen mass decreases
tensile strength decreases - resistance to deformation.
shorten “adaptive shortening” - collagen is laid down in short position effectively shortening ligament

Question 8

Effects of immobilization on joint capsule

Answer 8

decrease tensile strength and stiffness
shortens
adheres to underlying hyaline cartilage and other intra-articular structures

Question 9

Effects of immobilization on cartilage

Answer 9

decrease proteoglycan content and increase water content
leads to softening –chondrocyte loss, collagen fibre splitting – OA.
Adhesions between joint surfaces

Question 10

Benefits of joint mobility exercise

Answer 10

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

Question 11

Types of joint mobility exercise

Answer 11

Active - do yourself

Active-assisted

Question 12

Active exercises

Answer 12

Active contraction of muscles surrounding the joint w/out external assistance

Question 13

Active Assisted

Answer 13

performed by some active contraction and some external force

Question 14

AA exercises indicated when

Answer 14

Patient not allowed to fully activate muscle
weakness
extra force required to obtain desired range.

Question 15

Principles of mobility exercises

Answer 15

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

Question 16

Contraindications

Answer 16

when disrupt healing process or surgical repair
increases pain
increases inflammation

Question 17

Muscle extensibility exercises increase?

what is the extensibility?

Answer 17

increase the extensibility of the muscle-tendon unit

extensibility = muscle extend to a predetermined endpoint

Question 18

Immobilisation in shortened position

Answer 18

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

Question 19

4 main types of stretching

Answer 19

PNF
Static
Ballistic
dynamic

Question 20

PNF aims

Answer 20

Get muscle to contract cause muscle relaxation so that the muscle can be stretched

Question 21

Static stretching

Answer 21

Muscle being stretched in stationary position at greatest length for specified period of time

Question 22

Ballistic stretching

Answer 22

quick, uncontrolled movements to impose a rapid change in muscle length
can include bouncing
theorised greater risk of muscle soreness and injury

Question 23

Dynamic stretching

Answer 23

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

Question 24

Principles of Static stretching

Answer 24

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

Question 25

Pre stretch warm up

Answer 25

increase intra-muscular temp leads to increase extensibility of muscle
reduces force required to stretch muscle
increase muscle relaxation during stretching through increasing golgi tendon organ firing causes muscle relaxation
reduces muscle spindle firing - making it more likely to relax

Question 26

Warm up methods:

Answer 26

Heat pack if they are immobile
low intensity exercise - simple mvmts - walk
dynamic stretching

Question 27

Contraindications

Answer 27

acute inflammation 
local infection 
bony block 
haematoma 
disrupt healing process or surgical repair 
increases pain 
increases inflammation

Question 28

Precautions

Answer 28

Recent fracture 
osteoperosis - not forceful
elderly 
recent prolonged immobilisation 
severe muscle weakness