Lectures #5 and #6 (ROM and Flexibility) Flashcards
What is the musculotendinous unit’s ability to elongate with the application of a stretching force?
Flexibility
What is the amount of mobility of a joint as determined by the soft tissue and bony structures in the area?
ROM
True or false:
If a pt has decreased flexibility, they will also have decreased ROM.
True
True or false:
Flexibility and ROM are measured the same and are used interchangeably.
True
What is connective tissue composed of?
Collagen, elastin, reticulin, and ground substance
What provides support, connections, and the framework of the body and also determines the mobility of the musculoskeletal system?
Connective tissue
What substance provides the tissue with strength and stiffness. This also has a high tensile strength.
Collagen
What substances provides the structure with extensibility and withtstands elongation and allows the tissue to return to its normal length?
Elastin
What are the fibers that are the weaker form of collagen fibers (type III)? The are temporary and occur during the healing process.
Recticulin
What is the gel-like substance that reduces friction, prevents cross-linking, and maintains spacing, and provides nutrients to the fibers?
Ground substance
What is a loose connective tissue in which the fiber arrangement is unorganized and has larger areas between crosslinks? This tissue provides strength and pliability and permits motion in all directions. What is an example?
Areolar tissue; ex = skin
What is highly organized tissue with short spacing between cross-links and parallel fibers that has high tensile strength with some flexibility? What is an example?
Dense connective tissue; tendons and ligaments
True or false:
Tendons have more cross-links and greater organization that ligament tissue.
False–ligaments have greater cross links and greater organization.
What is the loss of motion due to immobilization due to? (x5)
Increases collagen cross linking, loss of ground substance, fibrosis, wound contraction, and collagen misalignment
True or false:
Connective tissue is almost continually replaced and reorganized.
True…daily motion of the body can affect the tissue by allowing it to shorten or stretch. This is why immobilization is bad because the tissue will just shorten and not be stretched, resulting in mobility problems.
What causes fibrosis to increase during immobilization and edema?
Decreased local metabolism…so the collagen doesn’t reorganize to the line of pull since it will bind to other structures
True or false:
Immobilization causes an increase in muscle fiber size.
False, it causes a decrease because it decreases the number of myofibrils, increases in fibrosis and fatty tissue, reduced intramuscular capillary density
How long will muscle atrophy occur during immobilization?
Two weeks or less
What are some noticable changes in the muscles during immobilization?
Atrophy, weaker contraction, less endurance, slower response to stimulus, patient apprehension or inability to use.
True or fasle:
Lactic acid is higher once the immobilized muscle begins to work once again.
True, because of the decreased mitrochondrial production and size
What does an increased fibrofatty tissue typically result in?
Scar tissue
With immobilization on articular cartilage, how well does the tissue heal?
They are slow to recover and there is a strong tendency that the tissue may never fully recover. Often there are only passive ROM at first to decrease joint compressive forces
Describe the balancing act in regards to mobility during rehabilitation.
There is a constant struggle to provide mobility that will enhance healing and reduce connective tissue adhesions while still allowing the healing process to continue and to protect the healing tissue.
True or false:
Remobilization enhances recovery
True
How does remobilization help in regards to articular cartilage?
Motion and stress improve proteoglycan and chondrocyte production…this motion helps nourish the cartilage with the synovium
What mechanical property of tissue is improved with warming up?
The viscoelastity—the fluid moves easier so the tissues can slide along one another and accept the loads easier)
What mechanical tissue property stores potential energy and allows the tissue to be able to be stretched and return back to its previous length?
Elasticity
What mechanical property allows for fluid-like, permanent deformation from outside resistance?
Viscoelasticity
What mechanical property results in a permanent change in the size or shape of the muscle, and allows for deformation to occur when the force applied overcomes the this property/.
Plasticity
What is creep?
Low load, long duration—the elongation of tissue when the stress is at a low level over a long period of time. It often involves an increase in plasticity
What states that the strain of an object is directly related to the object’s ability to resist the stress?
Hooke’s law
What is the toe region of the stress-strain curve? How much of the collagen lengthening does it account for?
The initial part of the curve in which the fibers are stretched to the elastic region. It accounts for 1.5-4% of collagen lengthening.
How much of the tissue’s total elongation does the elastic range of the stress-strain curve account for? What can happen in this range?
2-5%…in this range the tissue can be stretched but it will still return to its prestretch length. No deformation will occur
What region of the stress-strain curve will physical deformation begin to occur?
The plastic region. This is the region in which flexibility changes will take place.
What is the yield point of the stress-strain curve?
The point at which tissue failure will begin if the stress is continued.
What is the necking region of the stress-strain curve?
Where the tissue strength decreases prior to reaching failure
What is hysteresis?
Repetitive stretching at a sub-max load that can result in an increase in tissue length
What is composed of intrafusal muscle fibers that lie between other muscle fibers and provide the body with sensory stimulation and motor responses by its afferent and efferent motor supply (alpha, beta, and gamma fibers)?
Muscle spindles…they are sensitive to a stretch and the rate of change in a muscle’s length
What is a nuclear bag fiber?
One of the two types of muscle fibers that is more sensitive to the velocity of the stretch due to the increased elasticity
What are nuclear chain fibers?
One of the two types of muscle fibers that are shorter and thinner that is sensitive only to stretch
What are the three types of muscle spindle innervations?
1) Type Ia fibers (afferent) (annulospiral endings) that respond to quick and static stretch
2) Type IIa fibers (afferent) (flower-spray endings) that respond to static stretch only
3) One efferent nerve that sends response to intrafusal (gamma) and extrafusal (alpha) muscle fibers so the muscle can react
What are long, delicate tubular capsules located at the distal and proximal musculo-tendon junctions that are sensitive to muscle contraction?
GTOs
What do GTOs due?
Autogenic inhibition of the muscle when they are stimulated to function as a protective mechanism
If a muscle is stretched quickly (ballistic), what occurs to prevent the muscle from overstretching?
The muscle contracts reflexively to halt the stretch by action of first the GTO then the muscle spindle
If a muscle is stretched slowly (static, PNF) what inhibits its muscular contraction?
GTOs
What is the accuracy of goniometric measurements?
Within 3-5 degrees
True or false:
In rehab, if a pt doesn’t really need a certain ROM or flexibility then don’t push it.
True…take into consideration their sport and what requirements they need for their position
What are some of the influencing factors when you are trying to work with the ROM and flexibility with a patient?
Patient position, voluntary resistance to movement, type of motion (active, passive, assistive), pt’s willingness to move, pain/spasm, and wound healing
When the antagonist muscle is weak, what happens to the agonist?
It becomes shortened and lacks flexibility, which will prevent an imbalance between the muscles
What occurs when the antagonist becomes inhibited allowing for restoration of normal flexibility and balance?
Reciprocal inhibition
True or false:
Stretching can be active, passive, or a combo of both.
True, the combo would be PNF
How long should a patient hold an active stretch?
15-30 seconds for 4-5 reps
How long should a passive stretch be applied by the clinician?
15 sec for 4-6 reps
What is the progression for stretching (flexibility) during rehab?
Active –> passive –> PNF
What is the progression for ROM during rehab?
Passive –> active –> restricted
What is the best technique to improve flexibility quickly?
PNF (proprioceptive neuromuscular facilitation)
What are the three types of PNF stretching?
1) Slow-reversal-hold-relax
2) Contract-relax
3) Hold-relax
What does PNF stretching utilize?
Autogenic (push = tension; quads) and reciprocal (pull = relax; hamstrings) inhibition
How does the hold-relax PNF technique work?
The muscle is brought to the end of its motion, isometrically contracts, and then the antagonist contracts to allow the agonist to relax
How does the contract-relax PNF technique work?
The muscle is brought to the end of its motion, an isotonic contraction occurs (lower leg to floor) and then relax the muscle and passively bring the leg up to its new end range
How does the slow-reversal-hold-relax PNF technique work?
The pt is gradually stretched until a point of slight discomfort, then they actively contract the muscle being stretched for 10 sec, relax and muscle and passively pushed into new end point for greater stretch, and help for sec, then repeat cycle 2 more times
What is a bouncing movement in which repetitive contractions of agonist muscles work to stretch the antagonist muscles?
Ballistic stretching—it uses the body weight to stretch
What is an example of ballistic stretching?
Dynamic stretching (it more closely mimics sport activity and so it isn’t used as much in rehab
What types of assistive devices are used in gaining flexibilty and ROM?
Pulleys, weights, straps, CPM, mechanical arms, canes, and sticks
What is stretching indicated for?
-Shortened ligaments, capsules, muscles, fascia, skin, or other soft tissue affected by scar tissue, adhesions, or contractures
What are the contraindications for stretching? (x7)
- when immobilization is needed
- recent fractures
- acute inflammation present (ligament/tendon/muscle tears or joint irritation)
- boney-block that restricts motion
- neural tension
- when a lax person needs soft tissue to provide stability
- when extreme or sharp pain (C fibers) are present
During stretching, how far should the forces go to still be sufficient and provide tension?
Uncomfortable but not extrremely painful
After the first week of injury or surgery, what types of things can be done in regards to ROM or flexibility?
Active exercises and CPMs; mild short-term passive stretches begin from day 7- day 21
True or false:
Re-injuries usually have increased scar tissue reformation and ROM is often more painful and longer
True
True or false:
Revision surgeries will often achieve ROM easier than first time surgeries.
True…this is because the pt will already know what to expect the second time around
What joint is the worst to regain motion? Why?
Elbows because the swelling builds up in the pockets (fossas) and results in more pain and slower progression
