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CP2 > Stretching > Flashcards

Stretching Flashcards

1
Q

Stetching

A
  • restore or increase the extensibility of the muscle-tendon unit
  • regain or achieve the flexibility and ROM required for necessary or desired functional activities
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2
Q

Early vs. later in rehab stretching

A

Early: manual stretching and joint mobs may be most appropriate
Later: self-stretching and self mob exercises performed independently

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3
Q

If gain in ROM is to become ________, it must be used on a regular basis

A

permanent

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4
Q

3 types of stretching

A
  • passive
  • active
  • active assisted
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5
Q

Mechanisms for stretch-induced gains in ROM include:

A

biomechanical and neural changes

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6
Q

Changes are the result of …

A

increased muscle extensibility and length or decreased muscle stiffness

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7
Q

Increased ROM following stretching may be the result of a change in an individual’s tolerance of the ________ associated with stretch

A

sensation

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8
Q

What region is permanent for changes?

A

Plastic

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9
Q

Deformation (stretch) requires breaking of collagen bonds and realignment of the fibers for there to be ___________

A

permanent increased flexibility

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10
Q

Deformation begins as _________ of fibrils and fibers before complete failure of tissue occurs

A

microfailure

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11
Q

Complete tissue failure can occur as a single ________ event or from repetitive _________ stress

A
  • maximal

- submaximal

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12
Q

Remodeling capabilities allow the tissue to respond to ________ and ________ loads if time is allowed between bouts

A

repetitive

sustained

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13
Q

If remodeling time is not allowed, tissue _______ may occur

A

failure

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14
Q

During ______, mechanical disruption of the cross-bridges occurs as the filaments slide apart, leading to abrupt _______ of the sarcomeres

A

stretch

lengthening

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15
Q

When stretch force is released, the individual sarcomeres may return to their _______ length (elasticity)

A

resting

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16
Q

If longer lasting or more _________ (plastic) length increases are to occur, the stretch force must be maintained over an extended period of time

A

permanent

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17
Q

What are muscle spindles?

A

major sensory organ of muscle; sensitive to quick and sustained stretch
-protective component, constantly sensing tension

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18
Q

What happens in the stretch reflex?

A

when a stretch force is applied, muscle spindles sense the length changes and activate the stretch reflex by increasing tension in the muscle being stretched

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19
Q

When a stretch reflex is activated in a muscle being lengthened, inhibition in the muscle on the _______ side of the joint may occur

A

opposite

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20
Q

Slowly applied, low-intensity, prolonged stretch is preferable to minimize __________

A

activation of the stretch reflex

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21
Q

Golgi tendon organ function

A

is to monitor changes in tension of muscle-tendon units
-sensitive to even slight changes
-

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22
Q

When tension develops, how does the GTO decrease tension in the muscle-tendon unit being stretched (autogenic inhibition)?

A

the GTO fires and decreases tension in the muscle-tendon unit being stretched, enabling a muscle to be elongated against less muscle tension

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23
Q

If a low-intensity, slow stretch force is applied, the stretch reflex (muscle spindles) is less likely to…?

A

be activated as the GTO fires and inhibits tension

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24
Q

What does it mean for CT for stretching since it has viscoelastic properties?

A

the amount of time and the rate at which a stress (load) is applied will affect the behavior of the CT

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25
Q

What is creep?

A

when a load is applied for an extended period of time, the tissue elongates, and does not return to its original length

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26
Q

Amount of deformation depends on…

A

amount of force and the rate at which the force is applied

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27
Q

What kind of stretches increase the deformation of CT and allow gradual rearrangement of collagen fiber bonds?

A

Low load, long duration

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28
Q

Stress-relaxation:
when a force is applied the length of the tissue is kept constant, after the initial creep, there is a _______ in the force required to maintain the length, and then tension in the tissue _________

A

decrease

decreases

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29
Q

Permanent changes in length is dependent on the __________ the deformation is maintained

A

amount of deformation (load) and the length of time

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30
Q

Cyclic loading

A

This principle can be used for stretching by applying repetitive (cyclic) loads at a submaximal level on successive days

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31
Q

A _______ load is required for deformation

A

minimum

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32
Q

Greater the applied load, the fewer…

A

number of cycles needed for deformation

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33
Q

Time is allowed between bouts of cycle stretching to allow for _______ and ______ in the new range

A

remodeling

healing

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34
Q

repetitive tissue leads to increased ____ and increased tissue _________

A

heat

extensibility

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35
Q

Indications for stretching

A
  • ROM is limited secondary to adhesions, contractures, scar tissue leading to functional limitations
  • Restricted ROM may lead to structural deformities which are otherwise preventable
  • Muscle weakness and shortening of opposing tissues led to limited ROM
  • As component of total fitness program
  • Prior to and after vigorous exercise
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36
Q

Contraindications for stretching

A
  • Hard end feel
  • Recent fracture in the area
  • Acute inflammation or infection in the area
  • Hematoma in the area
  • Hypermobility in the area
  • Shortened tissues enable a patient with paralysis or severe muscle weakness to perform a functional activity
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37
Q

Benefits to stretching

A

decreased flexibility has been shown to be associated with a greater risk of musculotendinous injuries in the lower extremities

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38
Q

A systematic review indicates acute stretching either has ______ muscle performance immediately following the stretching session

A

no effect or decrease

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39
Q

Based on a limited number of studies, performing stretching exercises as part of a comprehensive conditioning program on a regular basis over a period of weeks (chronic stretching)…

A
  • increases flexibility

- appears to have beneficial effects on physical performance

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40
Q

Participating in a stretching program on a regular basis has been shown to improve:

A
  • gait economy

- enhance sprinting and jumping abilties

41
Q

Four broad categories of stretching exercises:

A
  • Static stretching
  • Cyclic stretching
  • Ballistic stretching
  • Proprioceptive neuromuscular facilitation (PNF) stretching
42
Q

Parameters of stretching

A
  • alignment
  • stabilization of the body during stretching
  • intensity
  • duration
  • speed
  • frequency
  • mode (type) of stretch
  • integration of neuromuscular inhibition or facilitation and functional activities into stretching programs
43
Q

Proper alignment of the patient and the muscles and joints to be stretched is necessary for …..

A

patient comfort and stability during exercise

44
Q

Alignment influences the amount of _______ present in soft tissue

A

tension

45
Q

To achieve an effective stretch, it is imperative to stabilize the …

A

proximal or distal attachment site of the muscle-tendon unit being elongated

46
Q

Manual stretching

A

physical therapist commonly stabilize proximally and move distally

47
Q

Self-stretching

A

often the distal attachment that is stabilized as the proximal segment moves

48
Q

Intensity of a stretch force is determined by ….

A

the load placed on soft tissue

49
Q

________ stretching makes the stretching maneuver more comfortable for the patient

A

Low-intensity

50
Q

Low load, long duration results in…

A

optimal rates of improvement in ROM without exposing tissues to excessive loads and potential injury

51
Q

Duration of stretching

A

there is a lack of agreement on the ideal duration of a single stretch cycle and the number of reps of stretch

52
Q

Progressive static stretching

A
  • Shortened soft tissues are held in a comfortably lengthened position until a degree of relaxation is felt by the patient or therapist
  • Then the tissues are incrementally lengthened even further and again held in the new end-range position for an additional duration of time
53
Q

Cyclic stretching

A

a relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied

54
Q

Cyclic stretching is shown to increase _______ as effectively or more effectively than ______ stretching

A

flexibility

static

55
Q

What is prolonged low-intensity mechanical stretching? Examples?

A
  • low load force applied over 15-30 minutes to several hours
  • dynamic splint
  • serial casting
56
Q

Slow speed stretch

A

minimizes muscle tension and reduces risk of injury to tissues and post stretch muscle soreness
-easier for therapist or patient to control

57
Q

Ballistic stretching (high-velocity movements)

A

thought to cause greater trauma to stretched tissues and greater muscle soreness

58
Q

What pops are ballistic stretches not generally recommended for?

A
  • elderly
  • sedentary individuals
  • or patients with MSK pathology or chronic contractures
59
Q

Static stretching and ballistic stretching have both shown to improve flexibility _______

A

equally

60
Q

Frequency

A

number of bouts (sessions) per day or week a patient carries out a stretching regimen
-Few studies have attempted to determine the optimal frequency of stretching within a day or a week, most suggestions are based on opinion

61
Q

Frequency needs to allow time for rest between sessions for tissue _______ and to minimize ________

A

healing

soreness

62
Q

Fine balance between collagen tissue breakdown and repair is needed to allow an increase in _________

A

soft tissue lengthening

63
Q

Mode of stretch

A

form of stretch or manner in which stretching exercises are carried out

64
Q

Mode of stretch is defined by…

A

whom or what is applying the stretch force or whether the patient is actively participating in the stretching maneuver

65
Q

Modes of stretching categories

A
  • Manual
  • Mechanical stretching
  • Self-stretching
  • Passive
  • Assisted
  • Active stretching
66
Q

Manual stretching is when …

A

the therapist applies external force

67
Q

When is manual stretching best?

A

early stage of a stretching program when want to determine pt response to intensities or durations of stretch and when optimal stabilization is critical

68
Q

Passive manual stretching is appropriate if…

A

a patient cannot perform self-stretching safely/effectively

69
Q

Assisted manual stretching is appropriate if …

A

a pt has poor control of the body segment, particularly if the pt is apprehensive about moving and is having difficulty relaxing

70
Q

Self-stretching

A

patient carries out independently after careful instruction and supervised practice

71
Q

Self-stretching enables a patient to …

A

maintain or increase the ROM gained as the result of direct intervention by a therapist

72
Q

Mechanical stretching

A

utilizing a piece of equipment or device to assist with stretching
-duration: ranges 15-30 minutes to 8-10 hours at a time

73
Q

Which is more effective and comfortable, manual or mechanical stretching?

A

mechanical

74
Q

Proprioceptive Neuromuscular Facilitation (PNF) stretching

A

integrates active muscle contractions into stretching with intention of inhibiting muscle activation of the muscle being stretched and to keep it relaxed

75
Q

PNF is designed to affect the ________ elements of muscle, not the ________ connective tissues

A

contractile

non-contractile

76
Q

When is PNF more or less appropriate?

A
  • More appropriate when muscle spasm limits motion

- Less appropriate for stretching long-standing, fibrotic contractures

77
Q

PNF stretching techniques requirements:

A
  • Patient has normal innervation and voluntary control of either the shortened muscle (the range-limiting target muscle) or the muscle on the opposite side of the joint
  • Patient is cognitively intact enough to follow the directions
78
Q

Results of numerous studies demonstrate that PNF stretching techniques increase ________ and ____

A

flexibility

ROM

79
Q

Studies show PNF stretching yields greater gains in ROM than _____ stretching

A

static

80
Q

Two main types of PNF stretching procedures

A
  • Antagonist Contraction/Hold-relax (HR)

- Agonist Contraction/Contract Relax

81
Q

PNF antagonist

A

the range-limiting muscle, shortened muscle being stretched

82
Q

PNF agonist

A

the muscle opposite the range-limiting target muscle, prime mover in that direction

83
Q

Autogenic inhibition

A

contraction of the range limiting muscle (antagonist)

84
Q

Autogenic inhibition relies on the body’s…

A

self-regulatory mechanisms of the GTOs in order to protect structures

85
Q

Autogenic inhibition occurs in stretched muscle in the form of ….

A

a decrease in the excitability due to inhibitory signals sent from the GTOs of the same muscle (antagonist) allowing it to relax and be stretched farther

86
Q

Reciprocal inhibition

A

contraction of muscle opposite range limiting muscle (agonist)
-way in which agonist and its antagonist work together

87
Q

Reciprocal inhibition occurs in the _________ muscle (range limiting muscle) when the opposing muscle (agonist) is contracted voluntarily

A

antagonist

88
Q

Neural activity in the antagonist muscle ________ in order to maximize the contraction of the agonist force

A

decreases

89
Q

Hold relax procedure (autogenic inhibition)

A
  • Range-limiting target muscle is first lengthened to the point of tissue resistance or to the extent that is comfortable for the patient
  • Patient then performs a prestretch, end-range, submaximal isometric contraction (for about 5-10 seconds) of the range limiting target muscle (antagonist)
  • Followed by voluntary relaxation of the range-limiting target muscle (antagonist)
  • Limb is then moved into the new range as the antagonist muscle is elongated
90
Q

Agonist Contraction procedure (Contract relax)

A
  • Range-limiting target muscle is first lengthened to the point of tissue resistance or to the extent that is comfortable for the patient
  • Patient submaximally isometrically contracts the muscle opposite the range-limiting muscle (agonist) (for about 5-10 seconds) of the range limiting target muscle (antagonist)
  • Followed by voluntary relaxation of the range-limiting target muscle (antagonist)
  • Limb is then moved into the new range as the antagonist muscle is elongated
91
Q

Example of Hold relax procedure

A

When standing and flexing forward with your legs straight, you activate your hamstrings and hang there for a second

92
Q

Example of Contract relax procedure

A

When standing and flexing forward with your legs straight, you activate the quads and hip flexors (agonist)

93
Q

Agonist contraction technique especially effective when ….

A

significant muscle guarding restricts muscle lengthening and joint movement

94
Q

When is the agonist contraction technique useful?

A

when a patient cannot generate a strong, pain-free contraction of the antagonist, which must be done during the HR procedures

95
Q

When is Agonist contraction technique is less effective?

A
  • in reducing chronic contractures

- if a pt has close to normal flexibility

96
Q

After stretching, use the new available ROM to allow pt to elongate the hypomobile structures ______

A

passively

97
Q

To achieve __________ in ROM and reduce functional limitations, must integrate functional activities and use gained range on a regular basis

A

permanent increases

98
Q

As ROM approaches a “normal” or functional level, the muscles must also be strengthened to maintain….

A

appropriate balance of strength between agonists and antagonists throughout the ROM

99
Q

Gains in _______ and ____ achieved as the result of a stretching program are transient

A

flexibility

ROM

CP2 (4 decks)

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