Mobilization, stretching, and exercise

Question 1

joint mobilization

Answer 1

Indications: restricted joint mobility, restricted accessory mobility, desired neurophysiological effects.
Contraindications: active disease, infection, advanced osteoporosis, articular hypermobility, fracture, acute inflammation, muscle guarding, joint replacement.
*mobilization activities are generally performed initially when the joint is in a loose packed position.

Question 2

Grades of joint mob

Answer 2

Grade I: small amplitude movement at the beginning of the range
Grade II: large amplitude movement at the beginning of the range
Grade III: large amplitude movement performed at the limit of range
Grade IV: small amplitude movement performed at the limit of range
Grade V: small amplitude, high velocity thrust technique performed to snap adhesions at the limit of range

Question 3

Concave-convex rule

Answer 3

Convex surface moving on a concave surface:
• roll and slide occur in the opposite direction
•mobilizing force should be applied in the opposite direction of bone movement.
Concave surface moving on a convex surface:
•roll and slide occurs in the same direction
•mobilizing force should be applied in the same direction as the bone movement

Question 4

ROM

Answer 4

ROM is classified as active, active-assisted, or active
Contraindications: ROM activities should not be performed when movement is detrimental to the healing of tissues. However, controlled motion within a pain-free range has been shown to be beneficial in the early stages of healing. Increased pain or inflammation are signs that ROM activities may be too aggressive.

Question 5

PROM

Answer 5

produced by external force without muscular activation. Only performed up to end-range. Any movement beyond end-range is considered stretching.
Indications:
•the pt is unable to physically move the body segment
•pt is cognitively impaired and unable to move body part
•active movement is contraindicated (post-op)
•active movement is painful for the pt
• therapist is preparing the joint for stretching
•therapist is teaching active movement to the pt

Benefits:
•improves the mobility of CT and muscles
•prevents joint contracture formation
•improves circulation
•improves synovial fluid movement
• decreases pain
•improves the pt’s awareness of movement

Question 6

AAROM

Answer 6

movement produced by pt with some external assistance
Indications:
•pt is unable to fully contract a muscle
•full activation of a muscle is contraindicated
•performed prior to active movement

Benefits:
• improves the mobility of CT and muscles
• prevents joint contracture
•improves circulation
• decreases pain
• improves neuromuscular activity
• improves kinesthesia and proprioception

Question 7

AROM

Answer 7

produced by the pt without external assistance
Indications:
• pt is able to contract a muscle, but demos weakness
•performed prior to initiating resistance training to teach desired movement

Benefits:
• improves mobility
•prevents joint contractures
•improves circulation
•decreases pain
•improves neuromuscular activity
• improves kinesthesia and proprioception
•improves strength in very weak muscles (3/5 strength)

Question 8

Stretching indications and contraindications

Answer 8

used to improve joint ROM and muscle flexibility
Indications:
• decreased ROM
Contraindications:
• acute inflammation
• during soft tissue healing (e.g. following a tendon repair)
• ROM limited by bone-on-bone contact
•recent fracture
•hypermobility
•hypomobility that allows for improved function (tenodesis grip)
• acute pain associated with stretching

Question 9

Principles of stretching- elasticity

Answer 9

the ability of soft tissue to return to its previous length after a stretch is no longer applied

Question 10

Principles of stretching- viscoelasticity

Answer 10

a time-dependent property of soft tissue that results in resistance to stretch when it is initially applied, but allows for tissue elongation as the stretch is held for longer durations. As with elasticity, the tissue will return to its previous length after the stretch is no longer applied.

Question 11

Principles of stretching- plasticity

Answer 11

a property of soft tissue that allows for tissue elongation even after a stretch is no longer applied.

Question 12

Stress-strain curve

Answer 12

a graphic representation that depicts the relationship between the amount of force (stress) applied to CT and the amount of deformation (strain) it experiences.

Question 13

Creep

Answer 13

due to the viscoelastic property, soft tissue that is stretched for a sustained duration will elongate and not return to its original length after the load has been removed. The principle of creep is the basis for stretching.

Question 14

Stress-relationship

Answer 14

the longer a stretching force is maintained, the more the tension within the tissue decreases, therefore less force is required to maintain the same tissue length.

Question 15

Stress-strain curve: toe region

Answer 15

initial stress that results in the wavy collagen fibers becoming straight and aligning with one another

Question 16

Stress-strain curve: elastic region

Answer 16

added stress to the tissue results in greater deformation, though the tissue returns to its resting length id the stretch force is not maintained. Tissues with greater stiffness will have a steeper slope in this portion of the curve.

Question 17

Stress-strain curve: plastic region

Answer 17

the addition of more stress results in permanent deformation even after the stretch force is no longer applied due to failure of bonds between the collagen fibers.
*after this you reach failure point

Question 18

Spastic stretching

Answer 18

involves placing the muscle at its maximal length and holding the position against an external force for a prolonged period of time.
• Characterized by low intensity and long duration
•Considered to be the safest form of stretching and results in the greatest gains in tissue extensibility.
• this form of stretching results in less activation of the muscle spindles (as compared to ballistic stretching)
•Though there is no consensus for the optimal duration of static stretching, 30 seconds is a commonly cited value that has been shown to result in significant ROM gains

Question 19

Ballistic stretching

Answer 19

• characterized by quick , jerky movements that result in rapid change in muscle length
• the muscle is placed near the end of ROM and then the pt bounces back and forth to place repetitive stretch on the muscle (high intensity, short duration)
• because ballistic stretching occurs quickly, it activates the muscle spindles and results in greater resistance to stretch. Therefore, it is not as effective when preparing the muscles for athletic activity.
• ballistic stretching is more likely to lead to muscle soreness and injury due to the high intensity of stretch force

Question 20

Proprioceptive Neuromuscular Facilitation

Answer 20

• incorporates active muscle contractions into stretching techniques
• muscular contraction is thought to lead to muscle relaxation through the principles of autogenic or reciprocal inhibition and results in greater gains in muscle flexibility
• because these techniques exert their effects on muscle fibers, they are more effective at treating ROM limitations due to muscle spasm as opposed to CT tightness
• other theories for PNF’s effects on improved flexibility include increased patient tolerance to the stretch and length changes secondary to the viscoelastic properties of muscle. Because PNF requires active muscular control from the pt, it is not an effective technique for patients with paralysis or spasticity
• common PNF techniques include contract-relax, agonist contraction, and contract-relax with agonist contraction.

Question 21

Dynamic stretching

Answer 21

• involves the pt actively moving a body segment to the end of range (but not beyond this limit) while the antagonistic muscle relaxes and stretches
• unlike static stretching the end-range position is held only briefly and is performed repeatedly
• commonly used as a warm up to prep the body for athletic activity
• most effective preparing the body for for explosive movements when compared to static stretching
• emphasizes a movement based approach, while ballistic stretching emphasizes bouncing movements

Question 22

Isometric exercise

Answer 22

muscular force is generated without change in muscle length. Isometric exercises are often performed against an immovable object . Submaximal isometric exercises are traditionally used in rehab programs.

Question 23

Isotonic exercises

Answer 23

muscular contraction is generated with the muscle exerting a constant tension. This can also be thought of as muscle movement with a constant load Isotonic exercises are performed against resistance, often employing equipment such as handheld weights. There are two types of isotonic contractions: concentric and eccentric.

Question 24

Isokinetic exercise

Answer 24

contraction is generated with a constant max speed and variable load. In isokinetic exercise, the reaction force is identical to the force applied to the equipment. Requires special equipment.

Question 25

Intensisty

Answer 25

intensity chosen will depend on the goals of the training program. If increased strength is the goal then lower reps (6-12) of a higher intensity load should be prescribed. If increased endurance is the goal, then higher reps (20+) of a lower intensity load should be prescribed. When training for power, low reps (1-3) of a very high intensity load are used.

Question 26

Volume

Answer 26

the total amount of work performed and is calculated as the total number of reps is inversely related to intensity. 2-4 set of reps is a common exercise prescription, with the number of reps within a single set dependent on the goals of treatment

Question 27

Frequency

Answer 27

the number of times per week resistance exercises are performed and is dependent on the intensity and volume of exercise. For more intense exercise, training should be performed less frequently (2-3 times per week), the same applies for pt’s with low exercise tolerance

Question 28

Exercise sequence

Answer 28

large muscle groups should be exercised before small muscle groups, multi-joint exercises should be performed before single joint exercises, and high intensity exercises should be performed before low intensity. (these rules can be flexible)

Question 29

Rest interval

Answer 29

for high intensity a longer rest time is needed (3 or more minutes). For low intensity exercises, a shorter rest interval is adequate (one to two minutes)

Question 30

Overload principle

Answer 30

in order for a muscle to adapt and become stronger, the load that is placed on it must be greater than what it is normally accustomed to. Increasing volume (sets, reps) or intensity (resistance) can accomplish this goal.

Question 31

SAID principle

Answer 31

specific adaptation to imposed demands
the body will adapt according to the specific type of training that is used. Ex: if a pt needs more power focus on improving muscular power.

Question 32

Transfer of training principle

Answer 32

there can be carryover effect from one exercise or task to another. For example, a pt who performs exercises to improve muscular strength may also see improvement in muscular endurance. However, these carryovers are less beneficial than adaptations that result from specific training.

Question 33

Reversibility

Answer 33

adaptations seen with resistance training are reversible if the body is not regularly challenges with the same level or greater resistance. These reversible effects can begin within 1-2 weeks of stopping an exercise program.

Question 34

length-tension relationship

Answer 34

a principle that states that the ability of a muscle to produce force depends on the length of the muscle. a muscle can usually produce a max force near its normal resting length. If the muscle is lengthened or shortened, it will likely produce less force.

Question 35

force-velocity relationship

Answer 35

the speed of a muscle contraction affects the force that the muscle can produce. During a concentric contraction, as the speed of contraction increases, the force of the contraction decreases. During an eccentric contraction, as the speed of the contraction increases the force also increases

Question 36

Moment arm

Answer 36

the linear distance from the axis of rotation to the site of the external load.

Question 37

power

Answer 37

the rate at which work is performed (work divided by time= power).

Question 38

strength

Answer 38

the greatest amount of force that can be produced within a muscle during a single contraction, which may be assessed clinically by determining a pt’s 1 RM (i.e. rep max- the maximum amount of weight that can be lifted at once)

Question 39

torque

Answer 39

the ability of an external load to produce rotation around an axis, calculated by multiplying the magnitude of the load by the moment arm.

Question 40

work

Answer 40

the magnitude of a load (weight) multiplied by the distance the load is moved (ROM used)

Question 41

Muscular fatigue

Answer 41

decreased ability of a muscle to produce force against a load with increasing reps, reversible after a rest period. Type I (slow twitch) muscle fibers are able to generate a low level of force for long durations, while type II (fast twitch) muscle fibers produce large amounts of force over short durations and are therefore more prone to fatigue.
Myasthenia gravis and MS as well as cardiovascular or pulmonary issues can lead to quick fatigue.

Question 42

Delayed onset muscle soreness (DOMS)

Answer 42

specific type of soreness that is thought to result from microtrauma to the muscle and its CT that occurs during resistance training. Most commonly noted with high intensity, eccentric strengthening exercises, especially with patients not used to this type of training.
Characterized by tenderness to palpation in the muscle belly or at the muscle tendon junction, soreness with passive stretching or active contraction of the muscle, and decreased ROM and strength. These symptoms usually reach their peak two days after exercise and can last for several days. Slowly increasing the time and intensity minimizes the impact of DOMS, and performing only concentric and isometric exercises significantly decreases the likelihood that DOMS will occur.

Question 43

Valsalva Maneuver

Answer 43

often used to increase intra-abdominal and intrathoracic pressures during anaerobic activities that require a large effort. The maneuver is performed by forcefully exhaling against a closed glottis, nose, and mouth while simultaneously contracting the abdominal muscles. The increase in internal pressures helps to stabilize the spine during heavy exertion and is therefore employed during powerlifting to help improve performance.
Though useful in some situations is leads to undesirable effects on the cardiovascular system. Because of its negative effects the Valsalva manuever should be avoided in all patients, but especially those with cardiovascular disease (HTN, CAD, CVA), with intervertebral disk pathology or who have recently undergone eye surgery. To avoid Valsalva pts should be taught to breathe rhythmically and to exhale during the portion of the exercise that requires more exertion.

Question 44

Adaptations to resistance training: strength training

Answer 44

• muscle fiber hypertrophy
• fiber type remodeling from type IIB to IIA
• increased neuromuscular activity (number of motor units, firing rate)
• decreased or no change in capillary bed density
• decreased mitochondrial density
• increased stores of ATP, creatine phosphate, and other energy sources
• increased tensile strength of tendons and ligaments
• increased bone mineral density
• increased lean body mass
• decreased body fat percentage

Question 45

Adaptations to resistance training: endurance training

Answer 45

• increased capillary bed density
• increased mitochondrial density
• increased stores of ATP, creatine phosphate, and other energy sources
• increased tensile strength of tendons and ligaments
• increased bone mineral density
• decreased body fat percentage