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CP 2 > Mobilization and stretching > Flashcards

Mobilization and stretching Flashcards

1
Q

define muscle guarding

A

increased resting activity in the muscle in response to:

  • protective response to painful stimuli
  • neurologic dysfunction
  • emotional stress, anxiety, fear
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2
Q

what is a trigger point?

A

hyperirritable area of tissue chemonociceptors and mechanoreceptors located within the muscle

can be active and latent

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3
Q

what is the difference between an active and latent trigger point?

A
  1. Active - symptomatic and refers pain at rest and during motion
  2. Latent - do not cause patient’s pain unless they are activated by palpation
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4
Q

describe Travell’s Energy Deficit hypothesis

A
  1. after injury/trauma inflammation cascade initiated
  2. IL factors, cytokines, CGRP, lactic acid build up
  3. metabolites increase acidity which increases muscle spindle excitability via alpha motor neuron, gamma gain
  4. tonic, low grade muscle contraction, can lead to trigger point development
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5
Q

List several goals of Manual therapy

A
  1. pain reduction
  2. increase soft tissue extensibility
  3. improve quality of motion in a restricted area
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6
Q

why has it been difficult to validate manual therapy studies?

A
  1. strong placebo effect associated with laying hands on individual
  2. many MSK conditions are self-limiting
  3. difficult to blind conditions and patients to intervention
  4. clear-cut definitions of when one technique is preferred over another is lacking
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7
Q

List indications for manual therapy

A
  1. pain reported w/activity and that is relieved by rest
  2. pain that is relieved or provoked by a particular motion or positions (mechanical pain)
  3. pain altered by changes related to sitting or standing posture
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8
Q

List contraindications to manual therapy

A
  1. systemic or localized infection
  2. acute circulatory conditions (DVT, etc.)
  3. malignancy in the area
  4. open wound at site
  5. recent fracture at the site
  6. hematoma
  7. hypersentive skin
  8. advanced diabetes
  9. RA (if in a flare)
  10. cellulitis
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9
Q

List precautions to manual therapy

A
  1. joint effusion or inflammation
  2. RA (if not in a flare)
  3. osteoporosis
  4. steroid or anticoagulant therapy
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10
Q

describe transverse friction massage

A

use light pressure in a perpendicular direction to normal orientation of fibers

  • speed: 2-3 cycles per second in rhythmic manner
  • duration: 5-10 minutes
  • discontinue once wound has healed or no improvement observed after 3 sessions
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11
Q

what are the proposed effects of transverse friction massage?

A
  1. traumatic hyperemia (increase blood flow)
  2. pain relief (gate control theory)
  3. assist with collagen formation/orientation
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12
Q

list indications and contraindications for transverse friction massage

A
  1. indications → acute, subacute, or chronic ligament, tendon, or muscle injuries
  2. contraindications → hematomas, open skin, frail skin
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13
Q

what is the difference between scar massage and transverse friction massage?

A

not as much pressure with scar massage

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14
Q

what are the 3 types of fascia?

A
  1. Superficial → lying directly below the dermis
  2. Deep → surrounding and infusing with muscle, bone, nerve, blood vessels and organs to the cellular level
  3. Visceral → deepest layer comprising the dura of the craniosacral system, which encases the CNS
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15
Q

describe the theory behind myofascial release

A

trauma or structural abnormalities create inappropriate fascial strain due to inability of deep fascia to absorb or distribute forces

strains to deep fascia results in slow tightening of the fascia; these fascial restrictions eventually lead to postural impairments

apply gentle sustained pressure to deep fascia to release restrictions and restore normal pain-free function

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16
Q

what are the different types of myofascial release strokes?

A
  1. J stroke
  2. Vertical stroke (going parallel to fibers)
  3. transverse stroke (going perpendicular)
  4. cross-hands technique
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17
Q

what is ischemic compression?

A

applying pressure to center of trigger point and holding it (10-60 sec) to deprive region of O2 and promote reactive hyperemia to reduce overall energy crisis and break pain cycle

18
Q

define soft tissue mobilization (STM)

A

systematic, therapeutic, and functional stroking and kneading of the body

3 types (effleurage, petissage, strumming)

19
Q

describe effleurage STM

A

superficial broad circular strokes distal to proximal

useful in initial assessment of superficial tissues

possible mechanism in assisting venous and lymphatic drainage and reducing tension

20
Q

describe petrissage STM

A

increases mobility of underlying tissue

4 techniques:

  1. Kneading
  2. Pulling/lifting
  3. wringing
  4. rolling
21
Q

describe retrograde massage

What is it good for? Where do you typically use it?

A

sustained pressure going distally to proximally

intention is to push fluid back towards the lymphatic system and assist with edema control

typically seen at the knee

22
Q

what is the difference between functional ROM and full/normal ROM?

A

functional ROM → enough available ROM for functional activities, doesn’t necessarily have to equal full/normal ROM

23
Q

List common causes for decreased flexibility

A
  1. prolonged immobilization of a body segment
  2. sedentary lifestyle
  3. postural malalignment and muscle imbalances
  4. impaired muscle performance (weakness) associated with MSK or NM disorders
  5. tissue trauma resulting in inflammation and pain
  6. congenital or acquired deformities
24
Q

what is the impact of immobilization?

A
  1. can result in:
    1. decay of contractile protein in the immobilized muscle
    2. decreases in muscle fiber diameter
    3. decrease in # of myofibrils
    4. decrease in intramuscular capillary densities
  2. as immobilized muscle atrophies, there is an increase in fibrous and fatty tissue in muscle = weakness and reduced ROM
25
Q

T/F: ROM and stretching are the same thing

A

FALSE
ROM → technique used for exam of movement. ROM interventions are given to maintain joint and soft tissue mobility

stretching → aims to increase tissue flexibility and soft tissue mobility/motion at the joint

26
Q

List indications for PROM

A
  1. acute, inflammed tissue
  2. patient is not able to/not supposed to actively move a segment(s) of the body
27
Q

list limitations to PROM

A
  1. doesn’t prevent muscle atrophy
  2. doesn’t increase strength/endurance
  3. doesn’t assist with circulation to the extent that active, voluntary muscle contraction does
28
Q

what are the goals of PROM?

A

decrease complications that would occur with immobilization

  1. maintain joint and CT mobility
  2. minimize effects or formation of contracture
  3. maintain mechanical elasticity of muscle
  4. assist circulation and vascular dynamics
  5. enhance synovial movement for cartilage nutrition and diffusion of materials in joint
  6. decrease/inhibit pain
  7. assist with healing process after injury/surgery
29
Q

list some goals for AROM

A
  1. maintain physiologic elasticity and contractility of the participating muscles
  2. provide sensory feedback from the contracting muscles
  3. provide a stimulus for bone and joint tissue integrity
  4. increase circulation and prevent thrombus formation
  5. develop coordination and motor skills for functional activities
30
Q

what is the role of muscle spindles?

A

stretch reflex

when this reflex is activated in a muscle being lengthened, inhibition in the muscle in the opposite side of the joint may occur (reciprocal inhibition)

31
Q

what is the role of golgi tendon organ?

A

sensitive to tension

when tension develops the GTO fires and decreases tension in the muscle-tendon unit being stretched (autogenic inhibition)

32
Q

what is creep?

A

when a load is applied for an extended time, the tissue elongates and doesn’t return to its original length

effects non-contractile tissue since they have viscoelastic properties

33
Q

what is low load long duration stretching?

A

a type of stretching that increases the deformation of CT and allows for gradual rearrangement of collagen fiber bonds (remodeling)

34
Q

what is cyclic loading?

A

repetitive loading of tissues leads to increased heat and increased tissue extensibility

minimum load is applied

time is allowed beteween bouts of cyclic stretching to allow for remodeling and healing in the new range

35
Q

list indications for stretching

A
  1. ROM is limited to adhesions, contractures, scar tissue leading to functional limitations
  2. restricted ROM may lead to structural deformities which are otherwise preventable
  3. muscle weakness and shortening of opposing tissues led to limited ROM
  4. as component of total fitness program
  5. prior to and after vigorous exercise
36
Q

list contraindications to stretching

A
  1. hard end feel
  2. recent fracture in the area
  3. acute inflammation or infection in the area
  4. hematoma in the area
  5. hypermobility the area
  6. shortened tissue enable a pt with paralysis or severe muscle weakness to perform a functional activity
37
Q

list the parameters to stretching

A
  1. alignment
  2. stabilization of the body during stretching
  3. intensity (magnitude)
  4. duration
  5. speed
  6. frequency
  7. mode (type) of stretch
  8. integration of NMI or facilitation and functional activities into stretching programs
38
Q

what is PNF stretching?

A

integrates active muscle contractions into stretching with intention of inhibiting muscle activation of the muscle being stretched and to keep it relaxed

39
Q

what are the 2 types of PNF stretching?

A
  1. antagonist contraction/hold-relax (HR)
  2. agonist contraction/contract relax
40
Q

what is the antagonist and agonist muscle during PNF stretching?

A

antagonist → shortened muscle being stretched

agonist → the muscle opposite of the range limiting target muscle, prime mover in that direction

41
Q

List relative contraindications to IASTM

A
  1. cancer
  2. kidney dysfunction
  3. pregnancy
  4. RA
  5. varicose veins
  6. osteoporosis
  7. lymphedema
  8. fracture
  9. chronic regional pain syndrom
  10. use of certain medications
42
Q

list absolute contraindications to IASTM

A
  1. open wound
  2. unhealed suture sites
  3. thrombophlebitis
  4. uncontrolled hypertension
  5. skin infection
  6. hematoma
  7. myositis ossificans
  8. unstable fractures

CP 2 (13 decks)

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