Lecture 4: Stretching for Impaired Mobility

Question 1

What are indications for PROM?

Answer 1

acute injury/inflamed tissue

patient is unable to perform AROM

Question 2

What are goals of PROM?

Answer 2

prevent complications from immobility, mobility of joint and connective tissue

prevent contractures, maintain elasticity of muscle, promote circulation, cartilage nutrition, decrease pain

Question 3

What are indications for AROM?

Answer 3

pt is able to contract muscles and move segment with or without assistance

Question 4

What are goals for AROM?

Answer 4

maintain elasticity/ contractility of muscle, sensory feedback from contracting muscle (GTO), stimulus for bone, increase circulation, improve coordination motor skill

Question 5

What are main contraindications/precautions of ROM exercises?

Answer 5

motion is disruptive to healing process

ex: post -op patients

Question 6

What are benefits of a CPM machine?

Answer 6

prevent adhesions/contractures, decrease pain, assist healing for collagen formation (tendons, ligaments, incisions)

Question 7

What are general guidelines for CPM?

Answer 7

immediate application

gradual increase in ROM 5-15 degrees a day

Question 8

What is flexibility?

Answer 8

ability to move joint through unrestricted pain free ROM

Question 9

What is dynamic flexibility?

Answer 9

amount of motion due to muscle contraction

Question 10

What is passive flexibility?

Answer 10

amount of motion as a result of PROM

Question 11

What is a myostatic contracture?

Answer 11

adaptive shortening of musculotendinous unit without muscle pathology

Question 12

What is a pseudomyostatic contracture?

Answer 12

apparent contracture from constant contraction or hypertonicity (CVA, TBI, SCI)

Question 13

What is a arthrogenic contracture?

Answer 13

intra articular pathology (mechanical block)

Question 14

What is a fibrotic contracture?

Answer 14

prolonged immobilization causes irreversible contracture

Question 15

What are interventions to increase mobility?

Answer 15

1. manual/ mechanical stretching
2. self stretching
3. PNF techniques
4. muscle energy- voluntary contractions against resistance
5. joint mob/ manip
6. soft tissue mob

Question 16

What is elasticity?

Answer 16

ability of a soft tissue to return to pre stretch resting length

Question 17

What is viscoelasticity?

Answer 17

soft tissues initially resists deformation, sustained force over time change in length occurs

low and long duration

Question 18

What is plasticity?

Answer 18

soft tissue assumes new and increased length following a stretch

Question 19

What are contractile tissues of a muscle?

Answer 19

muscle fibers, myofibrils, sarcomeres, actin and myosin filaments

Question 20

What is mechanical response to a stretch of contractile units?

Answer 20

mechanical disruption of cross bridges and sarcomeres length

Question 21

What is response to immobilization of contractile tissue?

Answer 21

morphological changes, atrophy occurs in less than 1 week

Question 22

What are two types of neurophysiological properties of muscle?

Answer 22

1. muscle spindle

2. Golgi tendon organ

Question 23

What is a muscle spindle?

Answer 23

receive/convey information about changes in length and velocity
have afferent sensory fibers and efferent motor fiber endings

Question 24

What is a GTO?

Answer 24

musculotendinous junctions of extrafusal fibers

monitors change in tension

Question 25

What is connective tissue composed of?

Answer 25

collagen- strength and stiffness elastin- extensiblity reticulin fibers- provide bulk ground substance- proteoglycans and glycoproteins

Question 26

What is the stress vs strain graph?

Answer 26

consists of regions that your muscle experience during a stretch

Question 27

What is toe region?

Answer 27

very beginning of stage where there is no load on tissue

Question 28

What is elastic range- linear phase?

Answer 28

beginning to stretch but not long enough for change grade 1 mob

Question 29

What is elastic limit-yield point?

Answer 29

the point where a change in muscle tissue will begin grade 2 mob

Question 30

What is plastic range?

Answer 30

area where actual change in length will occur, grade 3-4 mob

Question 31

What is failure?

Answer 31

tear in muscle

Question 32

How long should we hold a stretch to see change?

Answer 32

30 seconds in plastic region, you will see diminishing returns with prolonged stretching

Question 33

What are important procedural guidelines for stretching?

Answer 33

make sure it is muscle length that is causing the problem, prepare tissue for stretching by warming up after stretching complete AROM and strength in new ROM