Lecture 9: Flexibility Training Flashcards
What are the joints and movement involved in putting clothes over the head
Shoulder joint
- Elevation (flexion and abduction)
- External rotation
What are seated dynamic stretches (4)
- Floor reach: bend forward toward floor reaching as far as possible toward the floor or touching the floor if ROM permits
- Seated trunk rotation: slowly rotate trunk and head until you can see an imaginary car
- Seated abduction
- Alternate knee to chest
What percentage of OA at the age of 75 have osteoarthritic changes
85%
What factors contribute to Stiffness in OA (4)
- With age
- Connective tissues involved in mobility
- With age change in chemical composition of the connective tissue matrix and collagen
- Breakdown of articular surfaces in the weight bearing joints
What are the joints and movements involved in fastening or unfastening clothes in the back
Shoulder Joint
- Abduction
- Internal rotation
- Extension
Functional consequence of less of flexibility can greatly affect what ADLS (4)
- Getting out of a car
- Stepping on or off a curb
- Bending down to pick something up
- Putting on clothes
What are the joints and movements involved in walking, ascending stairs and getting down onto and up from the floor/tub
Hip, Knee and Ankle joint
Walking: least demanding
Hip flexion and extension
Knee flexion
Ankle dorsiflexion
Stairs:
Hip flexion
Knee flexion
Ankle dorsiflexion
Tub: most demanding
Hip flexion
Knee flexion
Ankle dorsiflexion
Critical ranges are important when designing PA program to?
To improve OA’s function
Spinal ext will decrease by ____%
Hip ext will decrease by ___%
Knee flexion will decrease by ____%
Spinal ext will decrease by 50%
Hip ext will decrease by 20%
Knee flexion will decrease by 2%
Give examples of BADLs
- Bathing and showering
- Bowel and bladder management
- Dressing
- Eating
- Feeding
- Functional mobility
- Personal hygiene
- Toilet hygiene
Which SFT test can be used to test fastening and unfastening clothes in the back
Back scratch test
What is ROM
Total excursion possible at a joint from the beginning of movement to the end of it
Increase in number of functional limitations leads to?
Loss of independence
What are some modes of exercise used to improve their flexibility
- Traditional stretching
- Dance
- Tai Chi
- Aquatic exercise
All good to inc ROM and dec stiffness
What are the special considerations after knee surgery
- Can rarely flex past 110 degrees
On AVG is the dec. in ROM greater in upper or lower extremity
LOWER
What are the special consideration after hip surgery
- No hip flexion past 90 degrees
- No hip adduction past midline (no leg crossing)
- No internal rotation of the hip
Is putting on clothes a BADL or a IADL
BADL
Why do some OA sleep with a pillow between their legs
So that they do not cross on internally rotate in the middle of the night
Give some examples of IADL’s
- Housework
- Taking meds as prescribed
- Managing money
- Shopping for groceries or clothing
- Use of telephone or other form of communication
- Using technology
- Transportation within the community
Dynamic stretches can be introduced when muscles are _______ and to participants with poor ______
Dynamic stretches can be introduced when muscles are warmer and to participants with poor body awareness
What are 4 exercise flexibility guidelines
- Emphasize joints that have significant decrease in joint ROM
- Stretch to a point of gentle tension, but not paint
- Do not jerk, bounce or force a stretch because this could result in injury
- Breath during stretching
What are some standing dynamic stretched (6)
- Reach and curl: from a standing position, reach arms overhead
- Picking apples: reach up with single arm to pick imaginary fruit
- Climbing rope: clients climb and imaginary rope
- Knees up Mother Brown: Exaggerated march in place
- Side lunges with a) spinal flexion b) arm reach across body c) forward arm reach
- Walking with six to seven alternating bouts of long and short strides
What is the mnemonic for BADls and what does it stand for
DEATH D: dressing/bathing E: eating A: amulating T: toileting H: hygiene
Can flexibility exercises improve ROM at any age?
yes
When OA improve flexibility they can improve on what types of ADLS
Basic and Instrumental
Are IADLs necessary for fundamental functioning
No, but they let an individual live independently in a community
What is the most important when doing flexibility exercises
Stressing the end range of joint motion
Joint stiffness inc/dec with age
Leads to inc/dec in ROM
One of the most common complaints of ____
Joint stiffness INC with age
Leads to DEC ROM
One of the most common complaints of older adults
What i the purpose of donning a pullover shirt for an OA with shoulder limitations
To allow OA w one sided weakness to don a shirt with ease
What is a critical range
The absolute minimum required to perform a certain activity
Example: Hamstring flexibility dec. in both male and female by +/- _____%?
Example: Hamstring flexibility dec. in both male and female by +/- 14% per decade
What is dynamic stretching
Moving through a specific ROM and holding for 2-5 sec then returning to the start position
Progressively increasing joint ROM with each rep
More functional to ADLs (require dynamic movement in multiple planes)
Best for warming up the body and muscles
What do BADLs consist of
Self care tasks
What are the chemical changes with age
- Loss of water content
- Connective tissue becomes less extensible and more resistant to being deformed
What connective tissues are involved in mobility (joint movement)
Tendons, Ligaments, Fascia, Joint capsules
What is the end range of motion
The maximal distance a joint can be moved until a point of discomfort
Joint ROM decreases w age between was age
20-70 year olds
Is pain directly coming from the breakdown of articular cartilage?
No - because there are no pain receptors in the cartilage
How should we breath during stretching
- inhale before the start of the stretch
- exhale during the stretch
- breathe evenly during the stretch
With age what happens to the muscle mass and connective tissue
- DEC in muscle mass due to dec in # of muscle fibers (type 2)
- INC in connective tissue surrounding and within muscle
What is the relation btwn joint pain and stiffness
Joint pain –> DEC. joint mvmnt –> Disuse atrophy –> joint stiffness –> joint pain
What is the mnemonic for IADLs
SHAFT
S: shopping H: housekeeping A: accounting F: food prep/med T: telephone/transportation
What is flexibility
Refers to the amount of ROM about any joint or multiple joints at any age
Important at all stages
What are the precautions to this method
Patients with poor sitting balance must be supervised
What is the greatest decline in ROM w age associated with?
Spinal extension
What are the 4 steps in order
- Locate the front side of the shirt. Place the shirt front side down on the lap, with the bottom of the shirt close to the body
- Pull sleeve all the way up along weak arm, past the elbow
- Insert strong hand/arm into the sleeve, also past the elbow
- Lean forward slightly and pull collar over head
What is the clinical definition of joint stiffness
Sensation of difficulty moving a joint or the apparent loss of ROM. Often accompanies joint pain and swelling
When an OA improves flexibility, they particularly improve on?
Muscular strength
Is rate of decrease joint specific
yes
This method can also be used in OA w?
Painful shoulders
How to break this cycle
Joint pain –> MAINTAIN movement –> NO/LIMITED disuse atrophy –> NO/LIMITED joint stiffness –> MAINTAIN function
Can OA with ROM deficits improve their flexibility?
Yes!
the mechanism for improving muscular strength is that the effort to gain ROM is sufficient to _______?
the mechanism for improving muscular strength is that the effort to gain ROM is sufficient to challenge the surrounding musculature and slightly increase strength
Why does knee flexion only decrease by 2%
Because we use if for every day walking
What is static stretching
Targeting one muscle group
Moving into a specific range until end range
Holding 10-90 sex
Very safe
Best for improving ROM
As you get older are there more limitations?
Yes, more limitations in basic and instrumental ADL
What are the 2 types of stretching
Static and Dynamic
What is better for OA, static or PNF
YA respond better to contract real stretching while OA benefit more from static stretching
the mechanism for improving muscular strength is increasing the joints ROM may release the muscles to such an extent that they can be used more ______ and ______
the mechanism for improving muscular strength is increasing the joints ROM may release the muscles to such an extent that they can be used more readily and efficiently
