Lecture 1 Flashcards

1
Q

Stretching

A

an exercise or therapeutic activity intended to increase the extensibility of shortened tissue

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2
Q

indications for stretching

A

limited ROM that affects function or causes structural deformity

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3
Q

goals for stretching

A
  1. improve joint ROM
  2. increase extensibility of structures around the joint
  3. prevent contractures
  4. decrease injury to neuromuscular structures
  5. improve flexibility prior to vigorous activity
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4
Q

flexibilty

A

ability to move a single joint series of joints smoothly through an unrestricted, pain-free ROM
a relaxed muscle’s ability to lengthen (passive flexibility)

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5
Q

dynamic flexibility (active mobility)

A

active ROM a joint; dependent upon amount of muscle contraction and amount of tissue resistance to movement

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6
Q

contraindications to stretching

A
  • recent fracture
  • acute strain, inflammation (anything acute)
  • hypermobility
  • post-surgical
  • acute pain with joint mobility
  • muscle tightness for c5 spinal cord injury in finger flexors – want to keep this grasping reflex
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7
Q

hypomobility

A

decreased mobility or restricted motion; can be due to a variety of pathological processes which – loss of motion

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8
Q

Effects of immobilization

A
  1. decay in contractile protein and decreased # of myofibrils = atrophy and weakness
  2. disorganized collagen laid down may lead to adhesions and decreased tensile strength
  3. shortened position = decreased sarcomere, increased tissue stiffness and increased CT
  4. lengthened position = increased sarcomeres - maintain optimal action/myosin overlap
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9
Q

contracture

A

adaptive shortening of the muscle-tendon unit and the other soft tissues that cross or surround the joint

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10
Q

how contractures are described by

A

identifying the action of the shortened muscle OR

the side of the joint that has decreased tissue extensibility

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11
Q

myostatic contracture

A

shortening of normal muscle tendon length; no specific muscle pathology noted

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12
Q

how fast does myostatic contractures resolve

A

-short time w/ angular stretching

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13
Q

pseudomyostatic (hypertonicity) contracture

A

occurs with CNS lesion or constant muscle spasm and pain

-muscle appear to be in a constant state of contraction

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14
Q

Arthogenic (adhesions) contracture

A

intra-articular pathology; may see with joint effusion and osteophyte formation
-often times surgery is required

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15
Q

periarticular (capsular) contracture

A

when connective tissue that crosses/attaches to the joint loses mobility or when the joint capsule loses mobility - the joint becomes stiff resulting in arthokinematic motion restrictions

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16
Q

Fibrotic contracture

A

fibrous changes in the muscle or periarticular tissue; difficult to re-establish optimal tissue length

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17
Q

general response to stretching

A

actin and myosin crossbridges relax and sarcomere of the muscle fiber lengthens and “gives way” and then returns to a resting length

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18
Q

if post-stretch resting length is the same as pre-stretch resting length

A

elasticity

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19
Q

if post-stretch resting length is changed (increased) compared to pre-stretch resting length

A

effect of plasticity

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20
Q

the golgi tendon organ is located near

A

muscle/tendon junction of extrafusal muscle fibers

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21
Q

golgi tendon organ gives information about

A

muscle tension during an active muscle contraction

22
Q

when tension develops in the muscle:

A

GTO fires – inhibits alpha motor neuron activity – decreases tension in the muscle to allow a subsequent stretch to occur (via relaxation of sarcomeres)

23
Q

autogenic inhibition

A

protective mechanism that inhibits the muscle/tendon junction in which is lites

24
Q

muscle spindle gives information about

A

muscle length and rate (velocity) of length changes

25
Q

muscle spindle synpases with:

reciprocal inhibition

A

alpha and gamma motor neurons –> increase in extrafusal and its own intrafusal fiber contraction and inhibits the activity of the muscle’s antagonist

Think: as biceps contract, the triceps relax

26
Q

monosynaptic stretch reflex

autogenic excitation

A

if the rate of stretch of a muscle is determined to be too quick by the muscle spindle - afferents send a message to the spinal cord causing facilitation of contraction – tension in the muscle

27
Q

toe region

A

taking the slack up

28
Q

elastic range

A

can stretch and it will come back to its normal length; minimal deformation

29
Q

plastic range

A

inability for tissue to return back to its shape. need to elongate tissue

30
Q

necking region

A

where micro-traumas build up; start to see a weakness in the muscle. don’t want to be there in PT

31
Q

failure

A

don’t want to be there as a PT

32
Q

creep

A

tissue intitially lengthens and stays; focusing on time

33
Q

determinants of stretching

A
  • alignment: watch for substitutions; correct alignment of force
  • stabilization: usually proximal but can be distal
  • intensity: most often low intensity
  • duraation:
  • passive stretching: 30-60s for all muscles except for neck 15s – may need to modify based on pt’s pain
  • active stretching: 10s
  • speed: gradual
  • mode: mechanical, manual/hands on, self-stretch, passive, active
34
Q

passive stretching

A
  • always warm up
  • NOT PROM; go beyond current ROM
  • therapist applied external force
  • hold stretch force…?
35
Q

types of passive stretching

A
  1. static stretching
  2. static progressive stretching
  3. cyclic (intermittent) stretching
  4. ballsitic stretching
36
Q

static stretching

A

tissue is lengthened just past the point of resistance and held there for a period of time

37
Q

static progressive stretching

A

shortened tissue is held in comfortable lengthened position until a degree of relaxation is felt, then the therapist incrementally lengthens the tissue even further and the stretch is held again in the new end-range

38
Q

cyclic (intermittent) stretching

A

**functional

short duration, low intensity stretch which is applied gradually, but released and reapplied every 5-10 seconds

39
Q

ballistic stretching

A

rapid, forceful intermittment stretch that uses momentum to carry the body segment through a ROM
-looks like “bouncing movements”

40
Q

active stretching is __ a progression of passive stretching

A

not

41
Q

true or false: active stretching can be done in combination of passive stretching

A

true

42
Q

true or false: you can do active stretching before passive stretching

A

true

43
Q

can you do active stretching in isolation?

A

yes

44
Q

active stretching integrates

A

active muscle contraction into the stretching manuever to subsequently relax the muscle for improved liklihood of lengthening

45
Q

pt’s who are experiencing muscle gaurding would benefit from:

A

active stretching

46
Q

hold-relax active stretch

A

shortened muscle lengthened to current end-range; an isometric contraction against resistance is applied to the shortened muscle (hold for 5 seconds); followed by a voluntary relaxation of the muscle and stretch by the therapist for 10seconds

Autogenic inhibition: GTO firing –> inhibition of contractile force

47
Q

Contract-relax active stretch

A
  • variation of hold-relax
  • shortened muscle is passively lengthned to its current end range; pt produces a controlled concentric contraction against therapist’s resistance through a small amount of motion for a few seconds (motion is visbily seen)
  • pt voluntarily releases the contraction while the therapist elongates the muscles and holds the stretch for 10s
  • autogenic inhibition (GTO fires - inhibition of contractile force)
48
Q

agonist contraction

A

concentric contraction of the agonist (against tapping, light, or no resistance) causes relaxation of the antagonist
-pt holds for “at least several seconds” at the end range position

-reciprocal inhibition: muscle spindle firing of the agonist (contracting muscle) – inhibition of the antagonist

49
Q

hold-relax with agonist contraction

A

autogenic inhibition & reciprocal inhibition
-get autogenic inhibiition from the biceps GTOs (hold relax) and reciprocal inhibition of the biceps from the tricep’s muscles spindles (agonist muscle contraction)

50
Q

precautions of stretching

A
  • recently healed fracatures
  • osteoperosis
  • prolonged immobilization
  • vigorous stretching to structures that have decreased tensile abilites
  • joint pain/soreness for > 24 hours
  • edematous tissue
  • bony block
  • valsalva
51
Q

contraindications of stretching

A

recent, unhealed fracture

  • acute inflammation or infection
  • sharp/acute pain with mption or muscle enlongation
  • hematoma
  • shrotened structures providing functional or joint stability