Stretching Flashcards
Stetching
- restore or increase the extensibility of the muscle-tendon unit
- regain or achieve the flexibility and ROM required for necessary or desired functional activities
Early vs. later in rehab stretching
Early: manual stretching and joint mobs may be most appropriate
Later: self-stretching and self mob exercises performed independently
If gain in ROM is to become ________, it must be used on a regular basis
permanent
3 types of stretching
- passive
- active
- active assisted
Mechanisms for stretch-induced gains in ROM include:
biomechanical and neural changes
Changes are the result of …
increased muscle extensibility and length or decreased muscle stiffness
Increased ROM following stretching may be the result of a change in an individual’s tolerance of the ________ associated with stretch
sensation
What region is permanent for changes?
Plastic
Deformation (stretch) requires breaking of collagen bonds and realignment of the fibers for there to be ___________
permanent increased flexibility
Deformation begins as _________ of fibrils and fibers before complete failure of tissue occurs
microfailure
Complete tissue failure can occur as a single ________ event or from repetitive _________ stress
- maximal
- submaximal
Remodeling capabilities allow the tissue to respond to ________ and ________ loads if time is allowed between bouts
repetitive
sustained
If remodeling time is not allowed, tissue _______ may occur
failure
During ______, mechanical disruption of the cross-bridges occurs as the filaments slide apart, leading to abrupt _______ of the sarcomeres
stretch
lengthening
When stretch force is released, the individual sarcomeres may return to their _______ length (elasticity)
resting
If longer lasting or more _________ (plastic) length increases are to occur, the stretch force must be maintained over an extended period of time
permanent
What are muscle spindles?
major sensory organ of muscle; sensitive to quick and sustained stretch
-protective component, constantly sensing tension
What happens in the stretch reflex?
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
When a stretch reflex is activated in a muscle being lengthened, inhibition in the muscle on the _______ side of the joint may occur
opposite
Slowly applied, low-intensity, prolonged stretch is preferable to minimize __________
activation of the stretch reflex
Golgi tendon organ function
is to monitor changes in tension of muscle-tendon units
-sensitive to even slight changes
-
When tension develops, how does the GTO decrease tension in the muscle-tendon unit being stretched (autogenic inhibition)?
the GTO fires and decreases tension in the muscle-tendon unit being stretched, enabling a muscle to be elongated against less muscle tension
If a low-intensity, slow stretch force is applied, the stretch reflex (muscle spindles) is less likely to…?
be activated as the GTO fires and inhibits tension
What does it mean for CT for stretching since it has viscoelastic properties?
the amount of time and the rate at which a stress (load) is applied will affect the behavior of the CT
What is creep?
when a load is applied for an extended period of time, the tissue elongates, and does not return to its original length
Amount of deformation depends on…
amount of force and the rate at which the force is applied
What kind of stretches increase the deformation of CT and allow gradual rearrangement of collagen fiber bonds?
Low load, long duration
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 _________
decrease
decreases
Permanent changes in length is dependent on the __________ the deformation is maintained
amount of deformation (load) and the length of time
Cyclic loading
This principle can be used for stretching by applying repetitive (cyclic) loads at a submaximal level on successive days
A _______ load is required for deformation
minimum
Greater the applied load, the fewer…
number of cycles needed for deformation
Time is allowed between bouts of cycle stretching to allow for _______ and ______ in the new range
remodeling
healing
repetitive tissue leads to increased ____ and increased tissue _________
heat
extensibility
Indications for stretching
- 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
Contraindications for stretching
- 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
Benefits to stretching
decreased flexibility has been shown to be associated with a greater risk of musculotendinous injuries in the lower extremities
A systematic review indicates acute stretching either has ______ muscle performance immediately following the stretching session
no effect or decrease
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)…
- increases flexibility
- appears to have beneficial effects on physical performance
Participating in a stretching program on a regular basis has been shown to improve:
- gait economy
- enhance sprinting and jumping abilties
Four broad categories of stretching exercises:
- Static stretching
- Cyclic stretching
- Ballistic stretching
- Proprioceptive neuromuscular facilitation (PNF) stretching
Parameters of stretching
- 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
Proper alignment of the patient and the muscles and joints to be stretched is necessary for …..
patient comfort and stability during exercise
Alignment influences the amount of _______ present in soft tissue
tension
To achieve an effective stretch, it is imperative to stabilize the …
proximal or distal attachment site of the muscle-tendon unit being elongated
Manual stretching
physical therapist commonly stabilize proximally and move distally
Self-stretching
often the distal attachment that is stabilized as the proximal segment moves
Intensity of a stretch force is determined by ….
the load placed on soft tissue
________ stretching makes the stretching maneuver more comfortable for the patient
Low-intensity
Low load, long duration results in…
optimal rates of improvement in ROM without exposing tissues to excessive loads and potential injury
Duration of stretching
there is a lack of agreement on the ideal duration of a single stretch cycle and the number of reps of stretch
Progressive static stretching
- 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
Cyclic stretching
a relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied
Cyclic stretching is shown to increase _______ as effectively or more effectively than ______ stretching
flexibility
static
What is prolonged low-intensity mechanical stretching? Examples?
- low load force applied over 15-30 minutes to several hours
- dynamic splint
- serial casting
Slow speed stretch
minimizes muscle tension and reduces risk of injury to tissues and post stretch muscle soreness
-easier for therapist or patient to control
Ballistic stretching (high-velocity movements)
thought to cause greater trauma to stretched tissues and greater muscle soreness
What pops are ballistic stretches not generally recommended for?
- elderly
- sedentary individuals
- or patients with MSK pathology or chronic contractures
Static stretching and ballistic stretching have both shown to improve flexibility _______
equally
Frequency
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
Frequency needs to allow time for rest between sessions for tissue _______ and to minimize ________
healing
soreness
Fine balance between collagen tissue breakdown and repair is needed to allow an increase in _________
soft tissue lengthening
Mode of stretch
form of stretch or manner in which stretching exercises are carried out
Mode of stretch is defined by…
whom or what is applying the stretch force or whether the patient is actively participating in the stretching maneuver
Modes of stretching categories
- Manual
- Mechanical stretching
- Self-stretching
- Passive
- Assisted
- Active stretching
Manual stretching is when …
the therapist applies external force
When is manual stretching best?
early stage of a stretching program when want to determine pt response to intensities or durations of stretch and when optimal stabilization is critical
Passive manual stretching is appropriate if…
a patient cannot perform self-stretching safely/effectively
Assisted manual stretching is appropriate if …
a pt has poor control of the body segment, particularly if the pt is apprehensive about moving and is having difficulty relaxing
Self-stretching
patient carries out independently after careful instruction and supervised practice
Self-stretching enables a patient to …
maintain or increase the ROM gained as the result of direct intervention by a therapist
Mechanical stretching
utilizing a piece of equipment or device to assist with stretching
-duration: ranges 15-30 minutes to 8-10 hours at a time
Which is more effective and comfortable, manual or mechanical stretching?
mechanical
Proprioceptive Neuromuscular Facilitation (PNF) stretching
integrates active muscle contractions into stretching with intention of inhibiting muscle activation of the muscle being stretched and to keep it relaxed
PNF is designed to affect the ________ elements of muscle, not the ________ connective tissues
contractile
non-contractile
When is PNF more or less appropriate?
- More appropriate when muscle spasm limits motion
- Less appropriate for stretching long-standing, fibrotic contractures
PNF stretching techniques requirements:
- 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
Results of numerous studies demonstrate that PNF stretching techniques increase ________ and ____
flexibility
ROM
Studies show PNF stretching yields greater gains in ROM than _____ stretching
static
Two main types of PNF stretching procedures
- Antagonist Contraction/Hold-relax (HR)
- Agonist Contraction/Contract Relax
PNF antagonist
the range-limiting muscle, shortened muscle being stretched
PNF agonist
the muscle opposite the range-limiting target muscle, prime mover in that direction
Autogenic inhibition
contraction of the range limiting muscle (antagonist)
Autogenic inhibition relies on the body’s…
self-regulatory mechanisms of the GTOs in order to protect structures
Autogenic inhibition occurs in stretched muscle in the form of ….
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
Reciprocal inhibition
contraction of muscle opposite range limiting muscle (agonist)
-way in which agonist and its antagonist work together
Reciprocal inhibition occurs in the _________ muscle (range limiting muscle) when the opposing muscle (agonist) is contracted voluntarily
antagonist
Neural activity in the antagonist muscle ________ in order to maximize the contraction of the agonist force
decreases
Hold relax procedure (autogenic inhibition)
- 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
Agonist Contraction procedure (Contract relax)
- 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
Example of Hold relax procedure
When standing and flexing forward with your legs straight, you activate your hamstrings and hang there for a second
Example of Contract relax procedure
When standing and flexing forward with your legs straight, you activate the quads and hip flexors (agonist)
Agonist contraction technique especially effective when ….
significant muscle guarding restricts muscle lengthening and joint movement
When is the agonist contraction technique useful?
when a patient cannot generate a strong, pain-free contraction of the antagonist, which must be done during the HR procedures
When is Agonist contraction technique is less effective?
- in reducing chronic contractures
- if a pt has close to normal flexibility
After stretching, use the new available ROM to allow pt to elongate the hypomobile structures ______
passively
To achieve __________ in ROM and reduce functional limitations, must integrate functional activities and use gained range on a regular basis
permanent increases
As ROM approaches a “normal” or functional level, the muscles must also be strengthened to maintain….
appropriate balance of strength between agonists and antagonists throughout the ROM
Gains in _______ and ____ achieved as the result of a stretching program are transient
flexibility
ROM
