ROM & Stretching Flashcards
1
Q
How should you begin ROM with a patient, what are your steps?
A
- communicate, explain to them what you’re going to do
- clear the area
- position the patient for comfort and support
- position yourself with proper body mechanics
2
Q
When doing ROM, what is important to support?
A
the proximal structure
3
Q
What position should you have the patient when doing knee ROM?
A
sitting, to support the proximal femur
4
Q
What position should you have the patient when doing ankle ROM?
A
long sitting, with towel underneath leg
5
Q
What position should you have the patient when doing wrist ROM?
A
sitting by the table with arm on it, towel under arm, and wrist hanging off table
6
Q
When is PROM indicated?
A
- if patient is too weak
- if active contraction causes pain
- if area is inflammed
- post-op
7
Q
What are the goals/benefits for PROM? (4)
A
to reduce the complications that occur w/ immobilization
- maintain joint mobility
- increase circulation slightly
- maintain mechanical elasticity
- minimize contracture formation
8
Q
What are the contraindications for AAROM?
A
any pain or inflammation
9
Q
T/F: PROM prevents muscle atrophy.
A
false, it doesnt prevent atrophy, and it can’t increase muscle strength
10
Q
What are the indications for using AAROM?
A
- when pt can’t get full range themselves; can’t do an active muscle contraction for the full way
- we want to promote independence in our pts but help them get to full ROM if they can’t themselves
11
Q
What are some limitations of AAROM?
A
- minimal strength gains unless VERY weak
- not as much circulation benefit vs AROM
12
Q
T/F: For strong muscles, AROM does not maintain or increase strength.
A
true, this is a limitation of AROM
- skill and coordination besides in that movement pattern won’t develop either
13
Q
Why do we use ROM if it doesn’t help with strength?
A
- maintains muscle elasticity
- nourishes joint
- prevents contractures
- does all this while the healing process occurs
14
Q
Wall climbing is an example of what kind of ROM, and is used for what movements?
A
AAROM, used for shoulder flexion and abduction
15
Q
Why do therapists need to be careful when using the overhead pulley for ROM?
A
pt can substitute pretty easily (side bend, etc) or have improper alignment, making this therapy not as effective
16
Q
What does a CPM machine do?
A
decreases the swelling in joint and helps get the joint ready for movement quicker following surgery
- doesn’t give any strength gains though
17
Q
In what way can we warm up the tissue for lower and upper extremity?
A
using an upper body ergometer or lower body ergometer (bike)
- but this won’t be aerobic exercise unless you get your heart rate up
18
Q
What do you need to remember when doing ROM in sitting for GH rotation?
A
TOWEL BETWEEN ARM AND BODY
19
Q
A man who had a stroke is limited in L elbow extension and L shoulder extension, as well as muscle weakness in that arm and ipsilateral leg. He is unable to get himself out of bed to go to the bathroom or cook for himself.
- what is the impairment, participation, and activity limit in this scenario?
A
impairment: limited ROM and strength in L extremities
activity limitation: standing and getting out of bed
participation: going to the bathroom independently, cooking
20
Q
What is functional mobility?
A
ability to initiate, control, or sustain active movement of the body to complete simple to complex motor skills
21
Q
What is dynamic flexibility vs passive?
A
- dynamic flexibility = AROM, how far an active muscle contraction can move a joint through its available ROM
- passive flexibility = PROM, how far an outside force can move a joint through its available ROM
22
Q
T/F: Mobility is linked to motor skill.
A
true
23
Q
What’s the difference between functional range and functional mobility?
A
functional range focuses on what you’re able to do at one joint; functional mobility looks at a motor skill as a whole and all the combined joint movements to do that skill
24
Q
What is radiculopathy?
A
disease of the root of a nerve, causes pain and eventually atrophy due to less movement
25
What is the difference between a myostatic contracture and a pseudomyostatic contracture?
myostatic = muscle actually shortens
pseudomyostatic = muscle is guarding or in spasm, hasn't actually shortened but appears to be
26
What are arthrogenic/periarticular contractures?
adhesions or osteophytes in the joint capsule limit motion (ex: frozen shoulder)
27
Is a myostatic contracture reversible?
yes
28
What contractures aren't reversible?
fibrotic contractures and irreversible contractures
| - may start out as myostatic
29
If you can get the pt into full ROM, even though the patient may not be able to actively, what kind of contracture is that called?
pseudomyostatic (pt is probably guarding and won't get there themselves)
30
T/F: Always address a contracture in your patient.
false, not if it helps them do functional activities (ex: tenodesis grip to grip cups)
31
1-3 degrees of play at an end feel would be documented as what?
poor
32
A fixed contracture would have what kind of end feel?
rock hard, no play at all
33
7-10 degrees of play at an end feel would be documented as what?
good
34
Do static stretches warm up tissue?
no, dynamic stretches do though
35
What are examples of high SSC (stretch shortening cycles) sports?
soccer, football, rugby = any sport with lots of bouncing and jumping
36
What are low SSC sports, and what does that mean?
low = jogging, swimming, cycling
| - there's less rapid change from eccentric to concentric contractions with those sports' motions
37
What is a stretch shortening cycle?
natural muscle function where concentric muscle activity is preceded by eccentric, which actually increases the concentric activity's torque
- think plyos
38
T/F: Stretching increases flexibility.
true
39
Is flexibility a risk factor for injury?
yes, at extremes
40
What research did Zakaria et al find in 2015 regarding dynamic stretching?
dynamic stretching can prevent soccer injuries (and static stretching really has no added benefit when also done)
41
How long and how many times should you static stretch?
2x 30s
42
What can decreased ROM lead to?
- loss of soft tissue extensibility
- structural deformity
- muscle weakness and shortening of opposing muscles
43
When would stretching be contraindicated?
- bony blocks
- recent fracture
- inflammation
- sharp pain
- hypermobility
- if shortened tissue provides stability, control, or a function for the pt
- hematoma is present (or other obvious tissue trauma)
44
In what position, shortened or lengthened, should we immobilize?
lengthened position to reduce so much atrophy and weakness
45
What fibers are most affected by immobilization?
slow twitch
46
T/F: Atrophy is more significant if pt is immobilized in a shortened position.
true, sarcomere absorption occurs
47
What is PNF?
proprioceptive neuromuscular fascilitation
48
When is stretching indicated?
- when ROM is limited due to the soft tissues losing their extensibility (contractures, scar tissue)
- muscle weakness and shortening of opposing muscles has occurred
49
What is plasticity?
the tendency of soft tissue to assume a new and greater length after the stretch force has been removed
50
What are intrafusal fibers in a muscle?
the muscle spindles
| - 10-12 fibers in the belly of the muscle
51
What are the two types of intrafusal fibers?
1) nuclear bag fibers
| 2) nuclear chain fibers
52
Where do afferent axons travel with info?
afferent goes out to the spinal cord with info on the muscle
53
Which afferent axons, flowerspray or annulospiral, are quicker to react?
annulospiral: group Ia
54
What do intrafusal fibers do?
detect muscle length; then they send that info to afferent axons which run to the spinal cord and to the brain
55
The Y motorneuron, is it an afferent or efferent axon?
efferent axon, tells the muscle what to do according to the brain/spinal cord's instructions
56
What are primary afferent axon endings also called? Secondary?
```
primary = annulospiral (group Ia)
secondary = flowerspray (group II)
```
57
Do intrafusal fibers help contract the muscle?
no, they only detect it's length
| - the extrafusal fibers are the contractile portion of muscle
58
What is the muscle spindle and what does it do?
muscle spindle = muscle's major sensory organ, sensitive to quick and sustained (tonic) stretch
- it receives and conveys info about changes in the length of the muscle and the velocity of those changes
59
T/F: When a muscle is stretched, intrafusal fibers stay put but detect that stretch.
false, intrafusal fibers also undergo that stretch
60
Annulospiral and flowerspray axon endings are what type of axons, efferent or afferent?
afferent, they go up to the spinal cord
61
Is efferent synonymous with motor or sensory?
motor
62
What motor neurons innervate the contractile portions of the muscle spindle (intrafusal fibers)?
gamma motor neurons
63
What motor neurons innervate the extrafusal fibers?
alpha motor neurons
64
What are the two types of intrafusal fibers?
nuclear bag and nuclear chain fibers
65
What are afferent neurons, motor or sensory?
sensory
66
What are the motor neurons for the muscle spindle vs the sensory?
motor neurons:
- extrafusal = alpha motor neurons
- intrafusal = gamma motor neurons
sensory neurons:
- annulospiral and flowerspray endings
67
What are all the names synonymous with annulospiral endings? What about flowerspray?
annulospiral = primary = type Ia
flowerspray = secondary = type II
68
What is the difference between group Ia sensory fibers and group II sensory fibers?
- group 1a = originate from annulospiral endings, wrap both chain and bag intrafusal fibers
- group II = originate from flowerspray endings, wrap ONLY chain intrafusal fibers
69
What is the GTO? Where is it?
GTO = monitors changes in tension in muscle-tendon units
| - found in the musculotendinous junctions of extrafusal fibers
70
How does the muscle spindle change length?
it lengthens in response to the extrafusal fibers changing in length
71
Describe the alpha/gamma coactivation pattern.
- the muscle spindle needs to match the length of the extrafusal fibers
- so when the extrafusals get stimulated by the alpha motor neuron, the gamma motor neuron stimulates the intrafusal fibers to adjust their length accordingly
72
What are the sensory fibers called in the GTO?
1-b fibers
73
When tension develops in a muscle, what's the role of the GTO?
tension develops in a muscle -> GTO fires -> inhibits alpha motor neuron activity -> tension decreases in the unit being stretched
74
What is the state of inhibition, in regards to the neuromuscular system?
state of decreased neuronal activity and altered synaptic potential, which decreases the ability of a muscle to contract
75
What does the GTO do?
- monitors and adjusts the force of active contractions
| - monitors and adjusts the tension in muscle during passive stretch
76
What is reciprocal inhibition?
activate stretch reflex via muscle spindles during muscle lengthening, and you get relaxation in muscles on opposite side
77
Stretching the hamstrings to inhibit the quadriceps in order to gain more hamstring ROM is an example of what kind of inhibition?
reciprical inhibition
78
Why do we prefer longer duration, slow stretches vs quick ones?
we minimize the stretch reflex (which makes the muscle resistant to lengthening, with tension increased) by slowly and nicely applying a stretch
79
What is autogenic inhibition?
muscle relaxes as it is being stretched
- GTO inhibits contractile components of muscle that are causing the tension
- muscle can now elongate against less tension
80
Describe stress and strain.
```
stress = force applied to the muscle (tension, compression, shear)
strain = amount of change or deformation
```
81
At what part of the stress and strain curve do we stretch our patients in so that they get more flexible?
plastic zone: deformation occurs here
82
Where on the stress and strain curve does activity like walking, squats, and lunges take place?
functional activity occurs in the toe region: no real stretch to tissue
83
T/F: All tissue has the same rate of strain.
false, different types of tissues have different rates of strain
84
Where is the ultimate strength of tissue at, in regards to load?
greatest load is the point of greatest strength of the tissue
- you get ultimate strain or strength without an increase in stress
85
At what length can a muscle generate 100% of its tension?
100% length = 100% tension
| - sarcomeres are in their best position
86
At low lengths of muscle, why can't optimal tension be produced? (think contraction-wise)
sarcomeres overlap too much to get optimal contraction
87
What is creep? What constants are involved?
creep = length will increase over time when force is constant
88
What does the stress-relaxation curve say? What variables are involved?
if length is constant, the amount of force needed to keep the muscle at that length decreases overtime
89
Energy lost in unloading and loading a muscle is called what?
hysteresis
90
How do we minimize hysteresis?
by warming up the tissue, you can minimize energy lost with contraction (hysteresis)
91
What kind of stretching favors elastic and long term plastic deformation for muscle?
low force, long duration
92
What kind of stretching can cause necking?
high force, short duration
93
T/F: Neural inhibition of the muscle can decrease ROM.
false, increase ROM (autogenic inhibition)
| - we're decreasing that stretch reflex to increase ROM
94
What has negative impact on collagen fibers?
- poor body alignment
- immobilization
- excessive stress/trauma
- age, poor nutrition
- chronic corticosteroids
need to be careful with these pts and use less force, be gentle!
95
Do we use passive or active inefficiency to stretch a muscle?
passive
96
What's the passive insufficiency position for the wrist flexors?
wrist extended, fingers extended
97
When doing manual stretching on your patient, what's important to keep in mind?
- your hand placement
- patient comfort (so they don't guard)
- positioning
- stabilization
- isolating a muscle
- determining force needed
98
What heart rate should your warm up get to?
40% max heart rate (aka 40% VO2 max)
99
T/F: Increasing temp results in a better stretch.
true
100
How can we warm up temp in muscles to get a better stretch? (ext vs internal)
```
external = heating pad, ultrasound
internal = jogging in place, jumping
```
101
When does the literature say to stretch patients after their warm up to reap the benefits of the warm up?
within 5 minutes of their warm up being done
102
What is strain/counterstrain? (aka muscle energy)
use of muscle contraction to move another segment (ex. vertebra) to a better alignment
103
List some common errors with stretching.
- lack of warm up
- too much/ not enough force
- too short/ too long of time
- bouncing
- not isolating the muscle intended
- lack of stabilization
basically everything you need to keep in mind when doing a manual stretch
