LECTURE EIGHT: Flexibility Training Flashcards
What does the term flexibility refer to?
Flexibility refers to the amount of ROM about a joint or multiple joints at any age
True or False:
Flexibility and exercise is most important for older adults.
ANSWER: FALSE
Flexibility and exercise is important at all ages
True or False
Flexibility exercises will improve joint ROM only until around 68 years of age.
ANSWER: FALSE
Flexibility exercises will improve joint Rom at any age (even centenarian!)
Which specific area of the body shows the greatest decline in ROM due to age?
Spinal EXTENSION
What does range of motion refer to?
Total excursion possible at a joint form the beginning of movement to the end of it
Joint ROM decreases as we age; fill in the amount of decline between the ages of 20 -70 years old in…
Spinal Extension:
Hip Extension:
Knee Flexion:
Spinal extension: decline by 50%
Hip extension: decline by 20%
Knee flexion: decline by 2%
Is the rate of decline of Range of motion joint specific? Or can the same rate of decline be applied generally to all joints of the body?
The rate of decline is JOINT SPECIFIC
Knee flexion ROM has only a loss of 2%. Why?
Knee flexion is a common action (walking) – is used every day, therefore ROM loss is minimal.
On average, is the decrease in ROM greater in the lower or upper extremity?
Lower extremity typically has a larger decrease in ROM
Ex: Hamstring flexibility decreases in both genders by +/- 14% per decade
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.
Joint stiffness __________ with age, leads to _________ ROM and is one of the most ____________ _____________ of older adults.
Joint stiffness INCREASES with age, leads to DECREASED ROM and is one of the MOST COMMON COMPLAINTS of older adults.
What is the relationship between joint pain and joint stiffness? Fill in the blanks:
Joint pain to Decrease in joint movement to Disuse atrophy to Joint stiffness
How can the joint pain / joint stiffness cycle be broken down?
Joint pain
Maintain joint movement
(PM exercise is better for OA)
No (or Limited) Disuse atrophy
No (or Limited) Joint stiffness
Maintain function
What physiological factors contribute to stiffness in OA? (4)
- Decrease in MUSCLE MASS (with age – decrease in number of muscle fibres).
- Increase in surrounding CONNECTIVE TISSUE and connective tissue in muscle (with age)
- Change in CHEMICAL COMPOSITION of CT matrix & COLLAGEN (loss of water content= CT less extensible, & more resistant to being deformed)
- Breakdown of ARTICULAR SURFACES in the weight-bearing joints (By age 75, 85% OA have osteoarthritic changes)
When articular cartilage breaks down, is pain directly coming from the cartilage?
No! There are no pain receptors in cartilage, only in soft tissues.
What enzyme is produced and used to form cartilage?
Glucosamine
Many people take glucosamine supplements believing this to help them rebuild cartilage better and faster thus enhancing their skill in sport. What does the Cochrane review reveal about that when looking at a number of double-blind studies?
GLUCOSAMINE works as good as placebo.
Is putting on clothes a BADL or IADL?
Basic ADL
What are four common functional losses that occur as a consequence of decreased flexibility in OAs?
- Getting out of car (SUV vs. Car)
- Stepping off or on a curb
- Bending down to pick something up
- Putting on clothes
An increase in number of functional limitations of an OA leads to… ?
A LOSS OF INDEPENDENCE
When OA improve flexibility, they typically improve on what two things?
Basic and Instrumental ADL’s (BADL’s and IADL’s)
Do adults with Daily Activity Limitations have a higher limitation in Basic or instrumental ADL’s?
HIGHER limitation in IADLs
17.9% Limitation in Instrumental ADL’s
9% Limitation in Basic ADL’s,
What types of tasks Do Basic ADL’s consist of?
BADL’s consist of self-care tasks
Name some BADL’s.
- Bathing and showering (washing the body)
- Bowel and bladder management (recognizing the need to relieve oneself)
- Dressing
- Eating (including chewing and swallowing)
- Feeding (setting up food and bringing it to the mouth)
- Functional mobility (moving from one place to another while performing activities)
- Personal hygiene and grooming (including brushing /combing / styling hair)
- Toilet hygiene (completing the act of urinating / defecating)
Mnemonic:
DEATH: Dressing / Bathing, Eating, Ambulating (walking), Toileting, Hygiene
What do instrumental activities of daily living (IADL’s) allow OAs to do?
IADL’s are not necessary for fundamental functioning but they let an individual live independently in a community.
Name some Instrumental ADL’s
- Housework
- Taking medications as prescribed
- Managing money
- Shopping for groceries or clothing
- Use of telephone or other form or communication
- Using technology (as applicable)
- Transportation within the community
Mnemonic:
SHAFT: Shopping, Housekeeping, Accounting, Food preparation / meds, Telephone / Transportation.
When an OA improves on flexibility, they typically improve on what?
Muscular strength.
What is the mechanism which improves muscular strength as a by-product of improving flexibility?
- Effort spent to gain ROM is sufficient to challenge the surrounding musculature and slightly increase strength
- Increasing joints ROM may release the muscles to such an extent that they can be used more readily and more efficiently.
80% of hip fractures are from what type of fall?
Fragility fracture - contact with the floor after falling from standing height.
20 % of hip fractures happen when?
While moving.
What is “Critical Ranges” when referring to ROM?
Critical Ranges: Absolute minimum ROM required to perform a certain activity
When is it important to consider critical ranges (ROM)?
Important when designing physical activity programs to improve OA’s function
When may there be special considerations for critical ranges of ROM? And what are they?
There may be special considerations after knee / hip surgery
Knee replacement:
1. Rarely flex more than 110 °
Hip replacement:
1. No hip flexion part 90 °
- No hip adduction past midline( no leg crossing)
- No internal rotation of hip
What do some OA do as a preventative measure after hip surgery to ensure they do not cross or internally rotate their legs in the middle of the night?
Some OA sleep with a pillow between their legs.
Which movements are needed from the shoulder for putting on clothes overhead?
90 ° elevation (including flexion and abduction)
45° external rotation
Which movements are needed from the shoulder for fastening or unfastening clothes in the back?
45° Abduction
70° Internal Rotation
10° extension
Which movements are needed from the hip joint for walking at 3 mph (4.8 km/hr)?
30° flexion + 10° extension
Which movements are needed from the knee joint for walking at 3 mph (4.8 km/hr)?
70° flexion +
Which movements are needed from the ankle joint for walking at 3 mph (4.8 km/hr)?
10° dorsiflexion
Which movements are needed from the hip joint for ascending the stairs?
70° flexion ++
Which movements are needed from the knee joint for ascending the stairs?
90° flexion ++
Which movements are needed from the ankle joint for ascending the stairs?
10° dorsiflexion
Which movements are needed from the hip joint getting down onto and up from the floor and / or in and out of the tub.
120° flexion +++
Which movements are needed from the knee joint getting down onto and up from the floor and / or in and out of the tub.
135° flexion +++
Which movements are needed from the ankle joint getting down onto and up from the floor and / or in and out of the tub.
10° dorsiflexion
From the following, which activity requires the greatest excursion at hip?
A) Walking at 3 mph/ (4.8 km/hr)
B) Ascending stairs
C) Getting down onto and up from the floor in and out of the tub
ANSWER: C) Getting down onto and up from the floor in and out of the tub
From the following, which activity requires the greatest excursion at knee?
A) Walking at 3 mph/ (4.8 km/hr)
B) Ascending stairs
C) Getting down onto and up from the floor in and out of the tub
ANSWER: C) Getting down onto and up from the floor in and out of the tub
From the following, which activity requires the greatest excursion at ankle?
A) Walking at 3 mph/ (4.8 km/hr)
B) Ascending stairs
C) Getting down onto and up from the floor in and out of the tub
D) All of the above (they require the same)
ANSWER D) They all require 10° dorsiflexion
What is the purpose of the instruction for donning a pullover shirt for an OA with shoulder limitations?
To allow OA with one-sided weakness, painful shoulder to don a shirt with ease.
Put the “Donning a pullover shirt” instructions in order (A-E):
- _____ _____
- Gather up ‘weak-side’ sleeve, from the bottom of the shirt to the edge of the sleeve. Maintain grasp of sleeve hole.
- Bend forward and allow weak arm / hand to hang between the knees. Thread weak hand through sleeve hole.
- ________
- _________
- Gather back-side of collar, all the way to the bottom of the shirt
- _________
- Pull shirt down on the body and fix as necessary
A) Insert strong hand / arm in to the sleeve, also up past the elbow.
B) Lean forward slightly and pull collar over head
C) Locate the front side of the shirt.
D) Place the shirt front side down on the lap, with the bottom of the shirt close to the body
E) Pull sleeve all the way up along weak arm, past the elbow.
ANSWER:
- C, D: 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
- Gather up ‘weak-side’ sleeve, from the bottom of the shirt to the edge of the sleeve. Maintain grasp of sleeve hole.
- Bend forward and allow weak arm / hand to hang between the knees. Thread weak hand through sleeve hole.
- E: Pull sleeve all the way up along weak arm, past the elbow.
- A: Insert strong hand / arm in to the sleeve, also past the elbow.
- Gather back-side of collar, all the way to the bottom of the shirt
- B: Lean forward slightly and pull collar overhead.
- Pull shirt down on the body and fix as necessary
True or False:
The instructions for donning a pullover shirt for an OA with shoulder limitations and / or injury are a great way for someone to continue putting their clothes on with ease but should not be considered a permanent solution.
ANSWER: TRUE!
What are 4 modes of exercise suitable to an OA to help increase their ROM and decrease their body stiffness?
- Traditional stretching exercises
- Dance
- Tai chi
- Aquatic Exercise
When doing a flexibility program focusing on ROM what is the most important ?
It is important to stress the END RANGE of joint motion (i.e. the maximal distance a joint can be moved until a point of discomfort)
What is static stretching typically best for and which part of the workout does it fit best into?
Improving range of motion – during cool down
What type of stretch is typically best for warming up the body and muscles?
Dynamic stretch.
How long should one hold a static stretch?
10-90 sec
Is a static stretch typically targeting one muscle group at a time or is it a more general effect?
Static stretching typically targets one specific muscle group at a time.
When static stretching – where in the range of motion should the stretch be held?
Within a specific range until end of range.
What is dynamic stretching?
Moving through a specific ROM and holding for 2-5 sec then returning to the start position
How is dynamic stretching related to ADL’s?
Dynamic stretching is more functional to ADL’s; ADL’s are normally dynamic and require movement in multiple planes (e.g. reaching into dishwasher, cleaning windows etc.… )
What type of stretching would there be a progressive increase in joint range of motion with each rep?
Dynamic stretching
What type of stretching is more appropriate for young adults vs. older adults?
YA respond better to contract-Relax PNF stretching while OA benefit more from static stretching
What limb joints (upper or lower) are more likely to have significant decreases in joint ROM?
Lower limb joints are more likely to have significant decreases in ROM
True or False:
When stretching your muscle you should stretch to a point of gentle tension, but not pain.
ANSWER: TRUE
Jerking, bouncing or forcing a stretch is : RECOMMENDED / NOT RECOMMENDED because this could : RESULT IN INJURY, STRENGTHEN THE MUSCLES.
ANSWER: Jerking, bouncing or forcing a stretch is : NOT RECOMMENDED because this could : RESULT IN INJURY.
Should we breath during stretching? (3)
YES:
- Inhale before the start of the stretch
- Exhale during the stretch
- Breath evenly while holding the stretch
