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Therapeutic Interventions > Range of Motion & Stretching > Flashcards

Range of Motion & Stretching Flashcards

1
Q

Mobility

A

ability of a body segment to move or be moved

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2
Q

Exercises that might be prescribed to maintain mobility or address mobility impairments

A

ROM or stretching exercises

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3
Q

2 types of mobility

A

joint mobility

functional mobility

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4
Q

Joint mobility

A

capacity of a joint to be moved or influenced by the structure and integrity of the joint surface along with soft tissue characteristics

arthrokinematic motion: motion occurring at joint surfaces

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5
Q

Functional mobility

A

ability to initiate and execute motor tasks to move in one’s environment

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6
Q

What influences functional mobility?

A

the patient, task and environment

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7
Q

Range of motion (ROM)

A

amount of motion a segment moves

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8
Q

2 ways ROM can be assessed

A

visual assessment or objectively measured using a goniometer or inclinometer

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9
Q

Available ROM

A

amount of motion a person demonstrates

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10
Q

3 categories of available ROM

A

normal, impaired or functional

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11
Q

Normal ROM

A

ability of a body segment to move or be moved through the full amount of motion at a particular joint

generally accepted values for the full amount of ROM at a particular joint

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12
Q

What are normal values of ROM based on?

A

the average amount of ROM in a healthy population

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13
Q

Impaired, decreased, limited or restricted ROM

A

less than normal range of motion

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14
Q

Functional ROM

A

ability of a body segment to move or be moved through an adequate range of motion needed for functional activities

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15
Q

Flexibility

A

ability to move a single joint or a series of joints through an unrestricted, pain-free ROM

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16
Q

Flexibility is influenced by what 2 factors?

A

extensibility of soft tissue(s) that surround or cross the joints

joint integrity

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17
Q

The amount of flexibility a patient needs depends on…

A

the functional activity

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18
Q

What must support flexibility in order to have optimal function?

A

strength, endurance and neuromuscular control

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19
Q

2 types of flexibility

A

dynamic flexibility

passive flexibility

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20
Q

Dynamic flexibility

A

another term for AROM

the extent active muscle contraction can cause a body segment to move through its ROM

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21
Q

Passive flexibility

A

another term for PROM

the extent a bony segment can be moved passively through its available ROM

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22
Q

What is required in order to have good active flexibility?

A

good passive flexibility

BUT having good passive flexibility does not ensure good active flexibility

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23
Q

2 main joint mobility deficits

A

hypermobility and hypermobility

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24
Q

Hypomobility

A

restricted or limited motion at a single joint or series of joints

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25
Q

Hypermobility

A

ability to move a joint beyond the normal ROM

excessive motion at a single or series of joints

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26
Q

Beighton criteria

A

general tool to measure joint looseness (laxity) or hypermobility

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27
Q

What is the classification of a contracture?

A

a joint hypomobility deficit

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28
Q

Contracture

A

loss of full PROM due to joint, muscle or other soft tissue limitations or alterations

loss of PROM ranges from minimal, severe or complete where two bones are fused together

there is no definite point where the loss of PROM is considered a contracture

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29
Q

Contraction

A

neuromuscular process that leads to tension development in muscles due to the interaction of actin and myosin (proteins)

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30
Q

3 ways contractures are named

A

by the action of the shortened muscle

by the motion caused by the shortened tissue(s)

motion opposite to the motion limited

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31
Q

What does the type of contracture influence?

A

whether ROM or stretching is needed

the parameters of exercise

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32
Q

Myostatic contracture

A

musculotendinous (MT) unit is shortened causing a significant loss of ROM

there is NO muscle pathology

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33
Q

Pseudomyostatic contracture

A

muscles appear to be constantly contracted due to a CNS lesion or response to pain/injury

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34
Q

Arthrogenic contracture

A

due to a joint pathology

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35
Q

Periarticular contracture

A

decreased extensibility of ligaments or the joint capsule

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36
Q

Fibrotic contracture

A

connective tissue changes (excessive deposition of ECM components, collagen)

may result in a permanent loss of extensibility

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37
Q

ROM as a therapeutic exercise

A

planned, structured and repetitive movement of a segment within an unrestricted pattern

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38
Q

Planned

A

designed in advance

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39
Q

Structured

A

activity has an organization, pattern or parameters

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40
Q

Repetitive

A

activity is done more than once

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41
Q

When ROM is used as a therapeutic exercise, how should patients move within the unrestricted pattern?

A

only move until the point of tissue resistance and NOT beyond (that would be stretching)

patients should not feel any tension, pull or stretch

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42
Q

3 types of ROM

A

PROM, AROM and AAROM

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43
Q

PROM

A

movement of a body segment within an unrestricted pattern or ROM that is produced entirely by an external force

little to no muscle activity because the external force should produce all of the movement

assess AFTER AROM

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44
Q

AROM

A

movement of a body segment within an unrestricted pattern or ROM that is produced entirely by the contraction of muscles that cross the joint

assess BEFORE PROM

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45
Q

AAROM

A

movement of a body segment within an unrestricted pattern or ROM that is produced by both the contraction of muscles AND an external force

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46
Q

Indications of PROM

A

patient has a health condition where active motion might negatively affect the healing process (when acute inflammation is present or in the event of contractile tissue repair)

patient is not able to actively move a body segment (not enough strength or force)

patient has poor understanding of the desired movement pattern (can be used as a method of education)

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47
Q

Goals of PROM

A

maintain joint mobility and soft tissue extensibility

maintain movement awareness

minimize and prevent contractures

assist blood circulation, vascular dynamics and synovial fluid movement

minimize pain

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48
Q

Limitations of PROM

A

does not prevent muscle trophy or increase muscle strength/endurance because there is little to no muscle activity

does not assist circulation as well as movements with muscle contraction (AROM or AAROM)

49
Q

The methods of performing PROM as an intervention are based on what?

A

who or what provides the external force

50
Q

Therapist or caregiver generated PROM

A

external force is provided by another person

51
Q

Patient/self generated PROM

A

patient provides the force themselves with an uninvolved body part or via a piece of equipment

52
Q

Gravity PROM

A

gravity provides the external force

53
Q

Machine PROM

A

a CPM (constant passive motion) machine provides the external force

54
Q

Indications of AROM and AAROM

A

patient is able to contract muscles and move the body segment with or without assistance

contraction of muscles is NOT contraindicated

to improve muscle performance in patients who are weak due to active muscle contraction

aerobic conditioning and warm-ups

relieve stress from sustained posture

55
Q

When should AROM be used vs AAROM?

A

AROM: patients who are weak, but can move through the desired ROM

AAROM: patients who are weak, but cannot move through the desired ROM

56
Q

Is AROM/AAROM or PROM better for assisting vascular dynamics?

A

AROM/AAROM

57
Q

Goals of AROM/AAROM

A

same as PROM, BUT it assists vascular dynamics better than PROM

prevent thrombus formation

develop motor skills and coordination

prevent disuse atrophy of soft tissues due to active muscle contraction

58
Q

Limitations of AROM/AAROM

A

only develops skills in the patterns used

does not improve or maintain strength in muscles with normal strength

59
Q

The methods of performing AAROM as an intervention are based on what?

A

who or what provides assistance

60
Q

Therapist or caregiver assisted AAROM

A

therapist or caregivers assists AROM

61
Q

Patient or self assisted AAROM

A

patient assists the AROM themselves

62
Q

What is the difference between therapist/caregiver generated PROM and therapist/caregiver generated AAROM?

A

in AAROM, the patient is allowed actively contract their muscles and is instructed to use the involved segment as much as possible and the external force is provided as much as needed to move the limb through the desired ROM

in PROM, there is NO muscle contraction and the external force produces all of the movement

63
Q

Device AAROM

A

a device assists the AROM

64
Q

When should ROM not be performed as an intervention?

A

if the patient is experiencing a life-threatening condition (once managed, ROM may be initiated with close monitoring)

if motion would be detrimental to the healing process (protective or controlled motion might aid the healing process)

if motion puts that at risk for injury or re-injury

if the patient experiences muscle guarding

if the patient experiences increased effusion or inflammation

65
Q

Protective or controlled motion

A

minimize the physical stress applied to healing tissues by limiting the type of ROM, the specific ROM performed and the amount of ROM to protect the healing process

66
Q

Why is complete immobilization avoided?

A

due to its negative effects: contractures, adhesions, decreased circulation, edema and decreased flow of synovial fluid within the joint(s), causing poor nutrition

BUT after surgery, too much motion may be detrimental to the healing process (use protective and controlled motion)

67
Q

Stretching

A

application of a force at the end of the available ROM causing soft tissues to elongate just beyond the point of resistance

planned, structured and repetitive just like ROM

68
Q

When is stretching prescribed by PTs?

A

when the restricted ROM is due to shortened tissues or when soft tissues have lost their extensibility

when restricted ROM may lead to structural deformities that are preventable

before/after vigorous exercise to educe muscle soreness

component of fitness

69
Q

2 types of stretching

A

static

dynamic

70
Q

Static stretching

A

elongating tissues just beyond the point of resistance and holding this stretch for a period of time

71
Q

Dynamic stretching

A

actively moving the limb just beyond the point of resistance and it is performed several times in a controlled manner

72
Q

How does static stretching impact physical performance immediately before activity?

A

does not improve or may even negatively impact physical performance before activity

73
Q

How does dynamic stretching impact physical performance immediately before activity?

A

may improve physical performance before activity

74
Q

When can both static and dynamic stretching have long-term benefits on physical performance?

A

if they are performed on a regular basis

75
Q

Parameters of stretching

A

FITT Principle

volume, speed and mode

76
Q

Frequency of stretching

A

number of sessions per day or per week

depends on the type or severity of contracture, the cause of motion loss and the stage of healing and tissue quality

77
Q

Intensity of stretch

A

amount of force applied to a tissue

ORDINAL (numbers do not have real meaning, as it is related to a perception or feeling with the use of descriptors)

78
Q

What is the difference between low intensity and high intensity stretching?

A

low: more effective, safe and comfortable
high: more soft tissue damage and worse post-exercise soreness (more recovery time)

79
Q

4 types of stretching

A

passive
dynamic
ballistic
pre-contraction

80
Q

Static stretching

A

elongating a tissue just beyond the point of resistance and holding the stretch for a period of time

81
Q

2 types of static stretching

A

static-active

static-passive

82
Q

Static-active stretching

A

elongating a tissue just beyond the point of resistance and holding the stretch for a period of time while the patient contracts muscles opposite to the short or stiff structures (what is being stretched)

83
Q

Static-passive stretching

A

elongating a tissue just beyond the point of resistance and holding the stretch for a period of time using another body part, equipment or assistance from another person

84
Q

Dynamic stretching

A

elongating a tissue just beyond the point of resistance and actively moving the body part in a controlled manner through the full ROM just beyond the point of tissue resistance at a slow velocity and then holding it for a (very) short period of time (a few seconds or less)

85
Q

Ballistic stretching

A

elongating a tissue just beyond the point of resistance and then rapid, alternating movements or bouncing is performed at the end of the ROM

generally NOT recommended due to the risk of injury

86
Q

Pre-contraction stretching

A

contraction of the muscle being stretched followed by stretching or contraction of muscles opposite to short or stiff muscles in order promote relaxation of muscle being stretched

87
Q

3 types of pre-contraction stretching

A

proprioceptive neuromuscular facilitation and inhibition techniques

post-isometric relaxation

post-facilitation stretch

88
Q

Duration of stretching

A

time a stretch force is applied and tissues are maintained in a lengthened position

89
Q

Short duration stretching

A

60 seconds

90
Q

Long duration stretching

A

minutes to hours

91
Q

Relationship between the intensity and duration of stretching

A

low intensity, high duration

high intensity, low duration

92
Q

Relationship between the intensity and frequency of stretching

A

low intensity, more frequency

high intensity, less frequency (to allow for tissue healing and prevent residual muscle soreness)

93
Q

Duration of static-passive stretching

A

long duration

94
Q

Duration of static-active stretching

A

short duration

95
Q

Volume of stretching

A

total end range (elongation) time

includes the duration of stretch, number of reps and number of times per day

96
Q

How do you increase volume?

A

by increasing the frequency and repetitions

97
Q

Speed or velocity of stretching

A

rate at which a limb is moved or stretch force is applied

98
Q

Slow stretch velocity

A

minimizes muscle activity, as less force is required to deform connective tissue

less likely to active muscle spindles and the muscle stretch reflex, causing tension and resistance to stretching

easier to control, making it safer (reduced risk of injury or soreness)

99
Q

High stretch velocity

A

controversial (may be appropriate for highly trained individuals or high-demand athletes at the end of rehab)

progression should be done slowly (static, dynamic and then ballistic)

100
Q

3 modes of stretching

A

manual
self-assisted
mechanical

101
Q

Manual stretching

A

force is applied by the therapist or caregiver at the end of the ROM

102
Q

Self-assisted stretching

A

force is applied independently by the patient

can be a part of either the treatment session or a HEP (home exercise program)

103
Q

Mechanical stretching

A

force is applied by a device to stretch tissues

104
Q

What are the indications of manual stretching?

A

when the therapist wants to determine how a patient responds to stretch intensities

when optimal stabilization is needed

when patient lacks the capacity to perform self-stretch either physically or cognitively

105
Q

What is the benefit of including self-stretching in an HEP?

A

enables patients to maintain gains that result from interventions provided during the treatment session

can increase mobility and extensibility in between sessions

106
Q

What must we educate patients on regarding self-stretching?

A

appropriate technique: alignment/position, stabilization and parameters of stretching

107
Q

When should stretching be used with caution?

A

patients with poor bone health

patients with muscles and connective tissues that have been immobilized for an extended period of time due to poor tissue quality

108
Q

What are the contraindications of stretching?

A

bony block

incomplete bony union after fracture

joint hypermobility (could lead to subluxation or dislocation)

acute inflammation

tissue trauma

intense sharp pain with movement

when there are shortened soft tissues needed for joint stability or functional tasks with paralysis or other neuromuscular conditions

109
Q

Pre-stretching

A

warm-up to increase tissue temperature via low-intensity active exercise (walking for LE and AROM for UE)

superficial heat or deep-heating physical agents

can increase soft tissue extensibility and decrease stiffness in risk of complete tissue failure with stretching

110
Q

Post-stretching

A

have the patient perform AROM/stretching exercises through the gained ROM

ensures adequate neuromuscular control and stability as flexibility increases

111
Q

Purpose of joint mobilizations in addition to stretching

A

to reduce pain and promote relaxation prior to stretching

112
Q

Purpose of soft tissue mobilization/massage in addition to stretching

A

to reduce pain, promote relaxation and reduce muscle tone prior to stretching

113
Q

Purpose of cold application in addition to stretching

A

given prior to stretching to patients with spasticity to reduce tone and can reduce pain, therefore increasing pain tolerance

114
Q

What precautions should be taken when applying cold?

A

caution should be taken when applying cold prior to stretching, especially in the early stages of healing (cold may decrease elasticity and increase stiffness, increasing the risk of trauma during stretching)

115
Q

How can cold be used after stretching?

A

cold can be applied to soft tissues in the lengthened position after stretching, which may lead to improved maintenance in tissue length and less risk for post-stretching soreness

116
Q

Parameters for ROM

A

type, pattern and dosage

117
Q

What frequency of stretching exercises can improve ROM in healthy individuals?

A

2-3 times per week

118
Q

What is considered the safest form of stretch and yields the most effective changes in tissues?

A

low intensity, long duration stretching

Therapeutic Interventions (2 decks)

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