Lecture 1 Flashcards
Stretching
an exercise or therapeutic activity intended to increase the extensibility of shortened tissue
indications for stretching
limited ROM that affects function or causes structural deformity
goals for stretching
- improve joint ROM
- increase extensibility of structures around the joint
- prevent contractures
- decrease injury to neuromuscular structures
- improve flexibility prior to vigorous activity
flexibilty
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)
dynamic flexibility (active mobility)
active ROM a joint; dependent upon amount of muscle contraction and amount of tissue resistance to movement
contraindications to stretching
- 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
hypomobility
decreased mobility or restricted motion; can be due to a variety of pathological processes which – loss of motion
Effects of immobilization
- decay in contractile protein and decreased # of myofibrils = atrophy and weakness
- disorganized collagen laid down may lead to adhesions and decreased tensile strength
- shortened position = decreased sarcomere, increased tissue stiffness and increased CT
- lengthened position = increased sarcomeres - maintain optimal action/myosin overlap
contracture
adaptive shortening of the muscle-tendon unit and the other soft tissues that cross or surround the joint
how contractures are described by
identifying the action of the shortened muscle OR
the side of the joint that has decreased tissue extensibility
myostatic contracture
shortening of normal muscle tendon length; no specific muscle pathology noted
how fast does myostatic contractures resolve
-short time w/ angular stretching
pseudomyostatic (hypertonicity) contracture
occurs with CNS lesion or constant muscle spasm and pain
-muscle appear to be in a constant state of contraction
Arthogenic (adhesions) contracture
intra-articular pathology; may see with joint effusion and osteophyte formation
-often times surgery is required
periarticular (capsular) contracture
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
Fibrotic contracture
fibrous changes in the muscle or periarticular tissue; difficult to re-establish optimal tissue length
general response to stretching
actin and myosin crossbridges relax and sarcomere of the muscle fiber lengthens and “gives way” and then returns to a resting length
if post-stretch resting length is the same as pre-stretch resting length
elasticity
if post-stretch resting length is changed (increased) compared to pre-stretch resting length
effect of plasticity
the golgi tendon organ is located near
muscle/tendon junction of extrafusal muscle fibers
golgi tendon organ gives information about
muscle tension during an active muscle contraction
when tension develops in the muscle:
GTO fires – inhibits alpha motor neuron activity – decreases tension in the muscle to allow a subsequent stretch to occur (via relaxation of sarcomeres)
autogenic inhibition
protective mechanism that inhibits the muscle/tendon junction in which is lites
muscle spindle gives information about
muscle length and rate (velocity) of length changes
muscle spindle synpases with:
reciprocal inhibition
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
monosynaptic stretch reflex
autogenic excitation
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
toe region
taking the slack up
elastic range
can stretch and it will come back to its normal length; minimal deformation
plastic range
inability for tissue to return back to its shape. need to elongate tissue
necking region
where micro-traumas build up; start to see a weakness in the muscle. don’t want to be there in PT
failure
don’t want to be there as a PT
creep
tissue intitially lengthens and stays; focusing on time
determinants of stretching
- 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
passive stretching
- always warm up
- NOT PROM; go beyond current ROM
- therapist applied external force
- hold stretch force…?
types of passive stretching
- static stretching
- static progressive stretching
- cyclic (intermittent) stretching
- ballsitic stretching
static stretching
tissue is lengthened just past the point of resistance and held there for a period of time
static progressive stretching
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
cyclic (intermittent) stretching
**functional
short duration, low intensity stretch which is applied gradually, but released and reapplied every 5-10 seconds
ballistic stretching
rapid, forceful intermittment stretch that uses momentum to carry the body segment through a ROM
-looks like “bouncing movements”
active stretching is __ a progression of passive stretching
not
true or false: active stretching can be done in combination of passive stretching
true
true or false: you can do active stretching before passive stretching
true
can you do active stretching in isolation?
yes
active stretching integrates
active muscle contraction into the stretching manuever to subsequently relax the muscle for improved liklihood of lengthening
pt’s who are experiencing muscle gaurding would benefit from:
active stretching
hold-relax active stretch
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
Contract-relax active stretch
- 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)
agonist contraction
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
hold-relax with agonist contraction
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)
precautions of stretching
- 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
contraindications of stretching
recent, unhealed fracture
- acute inflammation or infection
- sharp/acute pain with mption or muscle enlongation
- hematoma
- shrotened structures providing functional or joint stability
