Soft Tissue Mobilization and Stretching

Question 1

Flexibility and Hamstring injury

Answer 1

No correlation that more flexibility will decrease injury

Question 2

Flexibiltiy and DOMS

Answer 2

Does not correlate; Does not delay

Question 3

Flexibility and improve performance

Answer 3

No correlation

Question 4

Flexibility and ROM symmetry correlation with risk

Answer 4

No unless over 20%

Question 5

Flexibility is specific to….

Answer 5

an individual. Match what person needs to the ROM they have.

Question 6

Why is stretching important?

Answer 6

Feels good! Physiological response.

Gets people moving.

Question 7

What are the 3 types of stretching?

Answer 7

• Static
• Dynamic
• Proprioceptive Neuromuscular Faciliation (PNF)

Question 8

Static Stretching - What is it?

Answer 8

• PT or patient applied force
• Muscle is held at a lengthened position for a period of time
• Hold time: typically 30 seconds
• 2-4 repetitions

Question 9

Static Stretching: Advantages vs Disadvantages

Answer 9

Advantages:
* More vigorous
* Perform when collagen changes occur in muscle/tissue (period of immobilization or scar formation)
* Safe

Disadvantages:
* Boring
* Questionable effectiveness on mm with increase tone/pain

Question 10

Dynamic Stretching - What is it?

Answer 10

Movement through the range of motion but not held

Question 11

Dynamic Stretching - Advantages vs Disadvantages

Answer 11

Advantages:
* Variability of vigor based on how much pressure used to apply a stretch
* Incorporates activation of agonist muscle (reciprocal inhibition and motor training)

Disadvantages:
* Possibility of reinjury to muscle already injured
* May facilitate the muscle spindle thus increasing the contractile elements resistance to stretch

Question 12

Agonist

Answer 12

Muscle acting to cause joint action

Question 13

Antagonist

Answer 13

• Opposes the joint action
• Being Stretched
• “Range limiting muscle”

Question 14

PNF Stretching: What are the 3 types

Answer 14

• Contract-relax stretching (CR) OR Hold-relax stretching (HR)
• Agonist contraction (AC)
• Contract-relax agonist contraction (CR-AC)

Question 15

PNF: Contract-relax (CR) or Hold- relax stretching (HR)

Answer 15

• Limb taken to resistance and held
• Patient then contracts the muscle which is being stretched
• Holds 5 seconds
• Patient relaxes and passively moved further into range of motion
• Total of 4 repetitions for a total stretch time of 30 to 60 seconds
• Benefits: ENGAGES THE PATIENT, patient and PT get a better sense of mm GUARDING

Question 16

Contract Relax is held by

Answer 16

Therapist

Question 17

Hold relax is held by

Answer 17

Patient

Question 18

PNF: Agonist Contraction (AC)

Answer 18

• Works on principle of reciprocal inhibition
• Patient contracts the agonist muscle to facilitate a stretch of the antagonist muscle
• Holds 30 seconds (Longer hold for reciprical inhibition)
• Total of 2-4 repetitions
• 1-2 sets
• Benefits:
  – THE PATIENT
  – recruitment of the AGONIST mm (phasic)
  – patient has control of aggressiveness of stretch

Want more wrist flexion: do wrist flexion with contraction and stretch to inhibit extensors

Question 19

PNF: CR - AC

Answer 19

• Combines CR and AC
• Limb taken to resistance and held
• Patient performs isometric contraction of antagonist muscle. Holds 5 seconds
• Immediately performs a concentric contraction of the agonist muscle
• Total of 4 repetitions for a total stretch time of 30 to 60 seconds
• Benefits: same as CR and AC

ACTIVELY moving into the direction with the agionist muscle

Question 20

How does PNF work? - Physiological

Answer 20

Autogenic Inhibition
Soft Tissue Lengthening
Reciprical Inhibition

Question 21

Autogenic Inhibition

Answer 21

Fire the GTO during antagonist mm contraction to facilitate a relaxation of the muscle and then get a greater stretch (less resistance to stretch)

Question 22

Soft tissue lengthening

Answer 22

If antagonist mm (contractile component) contracts and shortens with the distal segment STABLE, imparts a greater tension on the connective tissue (parallel and series elastic components)

Question 23

Reciprocal Inhibition

Answer 23

By contracting the agonist muscle, it relaxes the antagonist muscle (being stretched)

Question 24

Keys to Effective Stretching

Answer 24

1 .Know the anatomy (origin and insertion) and what joint the muscles cross
2. Know the tissue!!! (Nature of pain, end feel, pain pattern)
3. Rarely stretch into painful range (the range which reproduces their pain or increases mm tone)
4. Proximal segment must be stable:
– For mm attached to pelvis in LE, pelvic position is key
– For mm attached to thorax in UE
5. When teaching a stretch:
– Always have the patient demonstrate the stretch (See compensations)
– Ask where they feel the stretch (no leading questions)
– Provide specific parameters if doing at home (Type of stretch, duration, etc)

Question 25

Precautions for Stretching

Answer 25

• Over motivated patient
• Reproduction of symptoms and unable to alleviate?
• Instability (joints and or fracture sights)
• Reproducing neurological symptoms?

Question 26

Treatment based on irritability and pain

Answer 26

High irritability and pain:
* Teach postures to alleviate strain on muscle
* Gentle self-stretching. Patient self-stretching or CR - AC stretching. SHORT HOLD TIMES
* Integrate with STM, superficial MANUAL soft tissue techniques with muscle in shortened position

Moderate irritability and pain
* More vigorous stretching. Self-stretching or PT stretching. Static, dynamic or CR-AC
* More vigorous soft tissue techniques (manual or Instrumented) with muscle in resting position.

Low irritability and pain
* Static or dynamic stretching. Self-stretching or PT stretching
* Vigorous Instrumented soft tissue techniques (I-STM) with mm in lengthened position.