Lecture 4: Stretching for Impaired Mobility Flashcards
What are indications for PROM?
acute injury/inflamed tissue
patient is unable to perform AROM
What are goals of PROM?
prevent complications from immobility, mobility of joint and connective tissue
prevent contractures, maintain elasticity of muscle, promote circulation, cartilage nutrition, decrease pain
What are indications for AROM?
pt is able to contract muscles and move segment with or without assistance
What are goals for AROM?
maintain elasticity/ contractility of muscle, sensory feedback from contracting muscle (GTO), stimulus for bone, increase circulation, improve coordination motor skill
What are main contraindications/precautions of ROM exercises?
motion is disruptive to healing process
ex: post -op patients
What are benefits of a CPM machine?
prevent adhesions/contractures, decrease pain, assist healing for collagen formation (tendons, ligaments, incisions)
What are general guidelines for CPM?
immediate application
gradual increase in ROM 5-15 degrees a day
What is flexibility?
ability to move joint through unrestricted pain free ROM
What is dynamic flexibility?
amount of motion due to muscle contraction
What is passive flexibility?
amount of motion as a result of PROM
What is a myostatic contracture?
adaptive shortening of musculotendinous unit without muscle pathology
What is a pseudomyostatic contracture?
apparent contracture from constant contraction or hypertonicity (CVA, TBI, SCI)
What is a arthrogenic contracture?
intra articular pathology (mechanical block)
What is a fibrotic contracture?
prolonged immobilization causes irreversible contracture
What are interventions to increase mobility?
- manual/ mechanical stretching
- self stretching
- PNF techniques
- muscle energy- voluntary contractions against resistance
- joint mob/ manip
- soft tissue mob
What is elasticity?
ability of a soft tissue to return to pre stretch resting length
What is viscoelasticity?
soft tissues initially resists deformation, sustained force over time change in length occurs
low and long duration
What is plasticity?
soft tissue assumes new and increased length following a stretch
What are contractile tissues of a muscle?
muscle fibers, myofibrils, sarcomeres, actin and myosin filaments
What is mechanical response to a stretch of contractile units?
mechanical disruption of cross bridges and sarcomeres length
What is response to immobilization of contractile tissue?
morphological changes, atrophy occurs in less than 1 week
What are two types of neurophysiological properties of muscle?
- muscle spindle
2. Golgi tendon organ
What is a muscle spindle?
receive/convey information about changes in length and velocity
have afferent sensory fibers and efferent motor fiber endings
What is a GTO?
musculotendinous junctions of extrafusal fibers
monitors change in tension
What is connective tissue composed of?
collagen- strength and stiffness
elastin- extensiblity
reticulin fibers- provide bulk
ground substance- proteoglycans and glycoproteins
What is the stress vs strain graph?
consists of regions that your muscle experience during a stretch
What is toe region?
very beginning of stage where there is no load on tissue
What is elastic range- linear phase?
beginning to stretch but not long enough for change grade 1 mob
What is elastic limit-yield point?
the point where a change in muscle tissue will begin grade 2 mob
What is plastic range?
area where actual change in length will occur, grade 3-4 mob
What is failure?
tear in muscle
How long should we hold a stretch to see change?
30 seconds in plastic region, you will see diminishing returns with prolonged stretching
What are important procedural guidelines for stretching?
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