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EPHE 355 > Principles for Stretching and Strengthening Exercises > Flashcards

Principles for Stretching and Strengthening Exercises Flashcards

1
Q

3 phases of tissue healing

A
  1. inflammation phase
  2. proliferative phase
  3. maturation or remodeling phase
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2
Q

how long does the inflammatory phase last?

A
  • 3-5 days, some say 4-6
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3
Q

what does the inflammatory phase look like?

A

pain, swelling, redness, and increased local temperature

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4
Q

5 things that happen in the inflammatory phase

A
  1. exudate and oedema accumulates (blood, plasma, and tissue fluid)
  2. blood clot forms and seals the area
  3. WBC infiltrate
  4. other chemical responses add to inflammatory response (histamine, bradykin, prostoglandins)
  5. migration of fibroblasts
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5
Q

explain the blood clot formation

A
  • platelets bind to collagen and stimulate the clotting mechanism. Fibrin and fibronectin form cross-links with tissue collagen to construct a fibrin lattice
    (weak tensile strength)
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6
Q

together WBC act as ?

A

macrophages to debride the injured area of necrotic tissue, debris, and foreign material

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7
Q

Fibro-elastic/Collagen-forming Phase is the what stage?

A

proliferative stage

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8
Q

how long does the proliferative stage last for

A

48 hours to 4-6 weeks

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9
Q

structures are rebuilt and regeneration occurs

A

proliferative stage

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10
Q

what happens in the proliferative stage

A

Fibroblasts migrate in begin to synthesise granulation tissue (scar tissue)

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11
Q

explain the steps of the scar tissue formation, via fibroblasts (5)

A
  1. replaces original fibrin clot, but still low tensile strength to start
  2. initially produces type 111 collagen
  3. random and immature giber organization
  4. capillary budding occurs, bringing nutrition
  5. collagen cross linking begins
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12
Q

ligaments and tendons have what type of assortment of there collagen fibers? this dose what?

A
  • irregular assortment

- makes them strong

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13
Q

what happens after 2 weeks of the proliferative stage ?

3

A
  • type 1 collagen start to replace type 111
  • fibers rearrange to more parallel organization in to increase strength
  • near the end of the phase the scar becomes more dense as vascularity decreases and matrix loses some fluid
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14
Q

the remodelling phase can last for how long?

A
  • up to 2 years
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15
Q

what happens in the remodeling phase?? (3)

A
  1. decrease # of fibroblasts, myoblasts, capillaries and macrophages
  2. water in the scar is reduced
  3. becomes primarily type 1 fibers
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16
Q

what does tensile strength correlate with?

A
  • maturity of collagen as well as the appropriate reorganization of fiber alignment
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17
Q

rearrangement of fibers dependant on ?

arrangement depends on?

A
  • appropriate tensile stressors

- tissues role

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18
Q

what is our worst healer? then what are the nest 3 from worst to best

A

hyaline cartilage becuase its avascular

- fibrocatilage (meniscus, IV discs), soft tissue (ligaments, tendons, capsule) , bone

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19
Q

there is no recipe book and each injury must be addressed ___ as well as the ___ involved

A
  • individually

- person

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20
Q

what are the 2 phases of rehab for a grade 11 ligament strain and how long do they last

A
  1. Acute (0-5 days)

2. Restoration (5+ days)

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21
Q

what is treatment in acute phase of grade 11 ligament strain

A

PRICE

  • protect (reduce stretch of torn tissue)
  • rest
  • ice
  • compress
  • elevate
  • physical modalities (ultrasounds, interferential)
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22
Q

if someone comes to you with a sprain from 3 weeks ago what phase will it be in?

A

we dont know!

you have to assess it as you seen them, it could still be int he acute phase because they didnt PRICE

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23
Q

what 3 things do you do in the restoration phase of the grade 11 ligament strain

A
  1. Isometric strengthening with Caution - as long as it is not disrupting healing. Other strengthening that does not tension the injured tissue
  2. add tensile stress to ligament around 4-6 weeks
  3. soft tissue mobilization of injured tissue (2-3 weeks)
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24
Q

after 4-6 weeks of grade 2 strain progress into ?

A

strengthening and ROM exercise to full function

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25
Q

tensile strength to tissue helps?

A

organize fibers and strength of the scar is further enhanced

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26
Q
  • If it will disrupt healing or result in injury or deterioration of the condition
  • Myositis Ossificans
  • Recent fracture and bony union is incomplete -Evidence of acute inflammatory, oedema or infectious process (precaution to contraindication)
  • -> examples of?
A

contraindications to stretching- Do not even assess with these ones (no ROM testing)

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27
Q
  • Bony block limits joint motion ( eg loose bone chip or subluxed joint)
  • Sharp acute pain with joint movement or muscle elongation
  • Hypermobility already exists
  • Shortened soft tissues provide necessary joint stability in lieu of normal structural stability or neuromuscular control (ie weak muscle)
  • Shortened soft tissue enable a patient with paralysis or severe muscle weakness to perform specific functional skills otherwise not possible (tenodesis)
A

contraindications to stretching

28
Q

7 general precautions to stretching

1,2,3,4,6, are precautions to ROM testing as well

A
  1. know typical ROM and do not push beyond it
  2. not to vigorous with age or after long immobilization (CT loses its tensile strength and more prone to injury)
  3. osteoporosis
  4. newly “healed” fractures
  5. if soreness greater than 24 hours post stretching then too agressive
  6. avoid overstretching edematous tissue
  7. ensure cool down after exercise before stretching (do not want to stretch an engorged muscle- full of blood)
29
Q

what is it called when the length of the tissue has changed?

A

hysteresis

30
Q

what percent of stretch toe phase, elastic region, plastic region and failure

A
  • 2%
  • 5%
  • 10%
  • > 10%
31
Q

3 interventions to increase mobility of soft tissues

A
  1. passive stretching
  2. active or active assisted stretching
  3. Proprioceptive neuromuscular facilitation (PNF)
32
Q

explain the contract relax PNF

A

Contraction of tight muscle (8-10 seconds) followed by Maximal relaxation allows further stretch to tight muscle (caution contraction should be around 30% if near end range, more if not at end range)

33
Q

explain the contract relax contract PNF

A

Contraction of tight muscle followed by maximal relaxation followed by contraction of antagonist of tight muscle (reciprocal inhibition of tight muscle

34
Q

4 types of stretching

A

static, dynamic, cyclic, balistic

35
Q

ballistic vs static stretching (4)

A
  1. Applied and released slowly does not activate stretch reflex.
  2. Tension in static stretching is half of ballistic
  3. Ballistic was effective in young healthy and athletes
  4. Both increase flexibility equally, but greater risk of injury with ballistic particularly as we age or with previous injury, contracture or immobilization
36
Q

principle of frequency of stretch

- frequency, what you need time for, if too often?

A
  • 2-7 x week
  • need time for tissue breakdown and repair
  • if to often can have failure or excessive collagen formation and hypertrophic scarring
37
Q

intensity and duration of static stretching depends on?

A

depends on stage of healing

38
Q

what intensity and duration results on optimal rates of tissue lengthening

A

low intensity, long duration

39
Q

what is better cyclic 60 s or continuous 60s and why ?

A

cyclic

- continuous= heat build up

40
Q

4 principles of designing a stretch program

A
  1. determine which soft tissue to target
  2. Evaluate irritability of tissue and stage of healing- determines the intensity and duration of stretching
  3. Assess underlying strength. Need capability to retrain strength in the newly gained range to safely use new range
  4. Determine outcome goals with patient
41
Q

9 applications to manual stretching haha

A
  1. Review the goals and obtain consent
  2. Select technique
  3. Warm up soft tissue (heat or low intensity exercise)
  4. Proper alignment to maximize tension and prevent injury
  5. Stabilization proximal attachment site
  6. If stretching Multi-joint muscle- stretch over both joints .
  7. Can incorporate arthrokinematic mobilization with the stretch if capsule tight
  8. To avoid joint compression during stretch can apply gentle distraction to the moving joint while stretching
  9. Do not try to gain all ROM in 1 or 2 sessions
42
Q

sustained low intensity stretch just beyond point of firm resistance, patient should feel? but no?

A

pulling but no pain

43
Q

if patient does not tolerate prolonged stretch?

A

do more cycles of short duration stretches

44
Q

4 things to do after stretching

A
  1. Do AROM and Strengthening in new ROM immediately after stretch
  2. Develop a balance in strength with agonists and antagonists in new ROM
  3. can apply cold
  4. incorporate new ROM into functional activities during their day
45
Q

considerations for teaching self stretches

A
  • Teach all elements of safe self stretching
  • Slow sustained stretch
  • Provide written instructions with figures
  • -Teach to maintain proper alignment and carry out stretches on a firm stable comfortable surface.
  • Observe and make corrections to ensure safe and effective performance of all stretches.
  • Emphasize importance of warm-up to reduce risk of injuring tissues
  • If appropriate teach PNF
  • Emphasize importance of using gained ROM in functional activities
46
Q

high intensity low reps (3-9) training for?

A

strength

47
Q

low intensity high reps (20+ at 70% RM) training for?

A

endurance

48
Q

exercise at ___% of 1 RM provide gains in both strength and endurance

A

70-90%

49
Q

contraindications to strengthening (7)

A
  1. Acute pain (out of proportion with musculo-tendinous pathology)
  2. Fracture
  3. If acute inflammatory or infectious process in the joint or tissues in the region
  4. If strengthening disrupts soft tissue healing
  5. Inflammatory muscle disease or inflammatory neuromuscular disease (Guillain-Barre)
  6. Acute severe cardiac or respiratory disease
  7. Caution with recent surgery or conditions where increase strain could be damaging or overly fatiguing. (eg Myositis Ossificans , recent myocardial infarction (MI)
50
Q

precautions to strengthening (7)

2-6 precautions to ROM testing as well

A
  1. Avoid High-load, high volume training
  2. Know medical conditions eg osteoporosis, past joint replacements etc
  3. Avoid high-impact activities
  4. Avoid high-velocity movements of the spine
  5. Avoid trunk flexion with rotation and end-range flexion resisted exercise (risk of anterior vertebral fractures or herniated discs)
  6. Avoid high risk of fall ex in elderly
  7. Watch for signs of fatigue
51
Q

(principle) strengthening program needs to challenge the injured structure in a ___ and ___ way that always takes into consideration the ____

A

safe, effective, stage of healing

52
Q

start time and progression of strengthening program depends on ? (5)

A
  1. injury severity
  2. tissue injured
  3. healing time
  4. surgeons preference
  5. patient tolerance
53
Q

(principle) progressions in intensity, load, overload ect are ___ determined

A

individually determined

54
Q

(principle) By the end of the rehab program it should be applicable to clients’ activity/work/sport
- -> what principle relates to this

A

SAID principle

- Specific, Adaptation to Imposed Demands

55
Q

(principle) strengthening should not increase ? at the injured sight

A

pain

56
Q

the ABCDE of program design (strengthening)

A

A. Know the current strength of each muscle (start here then progress)
B. Intensity (load) and repetition and frequency (ACSM guidelines)
C. rest intervals (dependent on intensity, reps, freq)
D. Mode of exercise (strengthen muscle then get into more task specific exercises)
E. Task specificity of training (SAID principle)

57
Q

clinically do not use 1RM max approach to determine load, load set is based on??

A

Assessment (determine the resistance that patient can do 1 set of 15 reps and not reach fatigue)

58
Q

signs of fatigue (6)

A
  • inability to complete full ROM,
  • the movement becomes uncoordinated,
  • tremulous contraction,
  • jerky movements (unsmooth),
  • substitute motions,
  • decline in peak torque
59
Q

With low intensity and low reps, do them several times a day. Progress to 3 x ? reps
–? days/week

A

10-15,

5-7 days/ week

60
Q

high intensity = ? rest
low intensity =
between sets low-moderate load ? min and high intensity ? min

A
  • 48hours
  • daily exercise
  • 2-3 min
  • 4-5 min
61
Q

task specificity: adaptations specific to? (4)

A
  1. velocity of contraction
  2. body position
  3. joint postion
  4. type of contraction
62
Q

3 systems involved in the functional stability of the joint:

A
  1. Neural system (sensory receptors, nerves, spinal cord, supraspinal centers)
  2. active system (muscles)
  3. passive system (osseous, capsule, ligaments, negative intra-articular pressure)
63
Q

sensory feedback system is active in all?

A

ranges

64
Q

in mid range, stability is provided by?

A

muscle activity (feedback loops from sensory receptors)

65
Q

at end range, stability is is provided by?

A

labrum, capsule and ligaments (more passive)

–> muscles are also recruited due to feedback loop from sensory receptors in ligaments capsule and joint receptors

66
Q

after injury what components of functional stability do you need to address

A

passive active and neural (all 3)

67
Q

what is the key to retrain with strengthening the control system

A

proprioception

EPHE 355 (5 decks)

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