Lecture 5 Flashcards
Flexibility
ability to move a single joint or series of joints smoothly and easily through an unrestricted pain-free ROM
Dynamic Flexibility
degree to which a muscle contraction can actively move a body part through available joint ROM
Passive Flexibility
degree to which body part can be moved through available joint ROM by means of assistance. causes more flexibility
ROM assesses
osteokinematics (voluntary motions)
Joint play assesses
arthrokinematics (involuntary motions)
Mobility
used to describe movement of body segments, joints, and tissues as well as locomotion
AROM assesses
contractile tissue performance
PROM assesses
non-contractile tissue
Hypomobility
decreased mobility or restricted motion
caused by extrinsic or intrinsic forces
Extrinsic forces
casts, fixators, splints
outside of the body
Intrinsic forces
pain, inflammation, bony deformities
sedentary lifestyle
paralysis
postural malalignment
Adaptive shortening
shortening of soft tissue relative to its normal resting length
Causes of adaptive shortening
prolonged period of time
immobilization
sedentary lifestyle
tissue trauma (results in disuse)
Contracture
joint is in a fixed position and highly resistant to passive stretch. May be a complete or partial loss of ROM
caused by surgery, immobilization, burns, paralysis, joint disease
results in remodeling of tissue (bone growing in soft tissue)
How can you determine its a contracture or adaptive shortening?
Intrinsic/extrinsic factors
Observation
ROM testing (end feel is different)
MMT (very weak or spastic)
Palpation
AS can be ruled out AROM/PROM are normal
Hypermobility
joint mobility, laxity, length of a tissue that is beyond normal range. It is neither painful nor dysfunctional. No associated impairments
Instability
osteokinematic and/or arthrokinematic movement that is excessive resulting in dysfunction, pain, and/or impairment
joint is uncontrollable
marfann’s syndrome
Joint mobility is controlled by
dynamic muscle contraction
proprioception
non-contractile tissues
Normal mobility
osteokinematic motion, arthrokinematic motion, and neuromuscular coordination to achieve purposeful movement
requires:
roll, spin, glide
structural integrity
muscle ROM
normal CNS/PNS
requires healthy muscle units
Cycle of immobility
Injury
Immobility
Decreased loading
adaptive shortening
decreased mobility/function
disuse & substitution
pain increase
Immobility effects….
all tissue types
muscle
tendon
ligament
articular cartilage
bone
Immobilization on muscle
muscle fiber atrophy
decrease in electrical activity
increased connective tissue
fatty infiltration
position effects # of sarcomeres
Mobilization on muscle
lengthy rehab necessary to restore muscle performance
Immobilization on tendon
reduced collagen fiber bundles, disorganized fibers
decreased tensile strength and elasticity
lower tissue turnover compared to muscle
Mobilization on tendon
early: improvement of tensile strength and energy absorption capacity
facilitates normal gliding and soft tissue relationships
prevents excessive scar formation
Immobilization on ligament
decreased collagen mass, strength, stiffness
increase stiffness in joint
disproportionate increase in young collagen (becomes weak)
bony resorption & weakening at insertion sites
Immobilization on Articular Cartilage
degeneration of articular surfaces
collage fiber splitting and fibrillation
subchondral bone sclerosis
osteophyte development
Mobilization on ligament
exercise and loading restore mechanical and structural properties of insertion sites
tissue response is dependent on immobilization period
Mobilization on Articular Cartilage
prevent degeneration, degradation, progression to osteoarthritis
Mobilization on bone
bone changes may not be reversible
depends on bone quality
response exceeds that of all other tissues
Immobilization on bone
decreased bone mass and synthesis
greater loss occurs in weight-bearing bones
Collagen changes
immobilization = weak
inactivity = decreased size of fibers
steroids = degeneration
age = slower rate of adapting
Interventions to increase mobility
stretching
joint mobilizations
soft tissue mobilization
neural glides
hold relax
Stretching
therapeutic maneuver that increases the extensibility of soft tissues
goal is to produce elongation of muscle tendon unit, collagen, connective tissues
Indications for stretching
ROM loss due to adhesions/scars
Adaptive shortening
Muscle weakness
sport requires ROM
Precautions for stretching
don’t exceed normal range
recent fractures
osteoporosis
frail elderly
prolonged immobilization
very weak musculature
chronic steroid use
Contraindications for stretching
bone block
recent fracture that is unstable
inflammatory or infection
sharp/acute pain
hematoma/tissue trauma
shortened soft tissues
Elasticity
ability of soft tissue to return to its pre-stretch resting length directly after short-duration stretch has been removed
Viscoelasticity
time dependent property, resists deformation at first. Allows a change in length then a gradual return to pre-stretch state
Plasticity
tendency of soft tissue to assume a new and greater length after stretch force has been removed
Elastic range is a ____stretch
COMFORTABLE
Static stretching
tissue is elongated past point of tissue resistance
held in that position for a period of time
Static progressive stretching
stretch is applied, relaxation is felt, new end range is held
Cyclic stretching
short duration of hold, slow application
good if pt is uncomfortable
Ballistic stretching
rapid, forceful, high-speed, high-intensity stretch
bouncy movements
athletic populations
Determinants of Stretching
alignment
stabilization
intensity
duration
speed
frequency
mode
Intensity
low-moderate
low load
Duration
90 seconds
Frequency of stretching
increase: 6 times a week
maintain: 2-3 a week
