stretching Flashcards
what is mobility
ability to move ROM for functional abilites - functional ROM
assoc with joint integ and tissue extensibility
what is stretching
therapeutic maneuver to inc extensibility of soft tissues - imrpoving flexibility
elongating the structures that have adaptively shortened and became hypomobile
what is flexibility
ability to rotate a single joint or series of joints smoothly and easily through an unrestricted, pain-free ROM
exp dynamic flexibility
AROM - active muscle contraction and depends on contraction and tissue resistance
exp passive flexibility
PROM - external force and depends on muscle and connective tissue extensibility
prereq for AROM but does not ensure AROM
what are the contributing factors for hypomobility
prolonged immob
sedentary or habitual postures
postural or muscle imbalances
paralysis or weakness
compare contracture to tightness
both are adaptive shortening of muscle-tendon unit = LOM
contractures - almost complete loss
tightness - mild shortening lng
types of contracature
myostatic
pseudomyostatic
arthrogenic and periarticular
fibrotic and irreversible
exp myostatic contracture
shortened musculotendinous unit and can be resolved with stretching excericises easily
exp pseudomyostatic contrcture
hypertonicity assoc c CNS lesions, muscle spasm/guarding, pain
excessive resistance to passive stretch and can be reduced temoporarlily w neuromuscular inhib
exp arthrogenic and periarticular contracture
intra-articular pathology d/t adhesion, joint effusion, osteophyte formation - knee oa
connective tissue around joint becomes stiff
exp fibrotic and irreversible contracture
fibrotic - connective tissue becomes fibrous = adherence & fibrotic tissue
irreversible - permanent loss of extensibility s surgery
possible naman to stretch but vv hard to re-establish optimal tissue length
exp concept of selective stretching
stretching some muscles but allows LOM to some for stability or function - usually in pt’s c paralysis
SCI paraplegic - LOM of trunk motion but stretching on hams
what is overstretching
stretching beyond normal length of muscle and ROM of joint = hypermob
type of tissue that has elastic and plastic qualities
contractile and non-contractile
type of tissue that has visoelastic qualities
non-contractile only
what is the response of soft tissues to stretch
elastic - viscoelastic - plastic
what is elasticity
ablity of soft tissue to return to its pre-stretched resting length directly after a short duration stretch force
what is viscoelasticity
for non-contractile
time dependent - resists deformation initially and allows change in length if sustained then gradually return after stretch
what is plasticitiy
tendency of soft tissue to assume a greater length after stretch
grade 1 strain
microfailure - some ruptures at early plastic
grade 2 strain
macrofailure - inc ruptured fibers at latter plastic
grade 3 strain
complete rupture beyond plastic range
how does immob affect collagen
causes weakening of collagen bonding and forms adhesion - dec space and lub
how does inactivity affect collagen
dec size and amount of collagen - weak
how does age affect collagen
dec in maximal tensile strength and slower adaption
how does sterioids affect collagen
dec in tensile strength
how does injury affect collagen
excessive loading = rupture of ligaments and tendons
newly made collagen is weaker
discuss significance of stretch reflex in stretching
inc tension resists lengthening
to minimize stretch reflex - slow and low intensity prolonged stretch is preferred kesa ballistic
what is reciprocal inhib
contraction of agonist = reflex relaxation antagonist = stretch and protect it from injury
what is autogeninc inhib
GTO inhibs contraction = relaxation during stretching = easier
indications of stretching
LOM
to prevent structural deformities
muscle weakness and shortening of opposing tissue
for prevention of risk in sports
prior or after exercise
contraindic for stretching
bony blocks
recent fractires or malunion
acute stage
sharp acute pain
hematoma or trauma
hypermob
contractures that provide stab or fucntion
main rationale of stretching
regain normal ROM of joints and mobility of soft tissues that surround a joint
goals of stretching
inc flexibility and ROM
general fitness
injury prevention and reductions of soreness
precautions of stretching
do not force beyond normal ROM
newly united fractures
osteoporosis
vigorous stretching esp if immmob for a long time
avoid ballistic
progress gradually
joint pain and muscle soreness > 24 hrs after stretching
avoid stretching edematous tissue and weak muscles
what are the determinants of stretching
alignment
stabilization
intensity
duration
speed
frequency
mode
discuss alignment in stretching
pos so that stretch force is directed to muscle group - stretch rectus fem dapat neutral pelvis and spine with knee flexed and hip extended
discuss stablization in stretching
fixation of body segment para ma stretch yung muscle properly - stab hip when stretching rectus fem in prone
discuss intensity in stretching
low instensity dapat - more comfy and minimizes MG, soreness and tissue damage
discuss time in stretching
15 secs x 5
30 secs x 3
45 secs x 2
discuss static stretching
GPS - most common type
slowly elongated and held
discuss cyclic or intermittent stretching
repeated but gradual - 5-10 secs each cycle
not same as ballistic slow stretch and low intensity pdin but in cycles
discuss speed in stretching
slow applied is better that ballistic - less like to activate stretch reflex
discuss frequency for stretching
2-5 sessions per week
discuss mode for stretching
manual passive
self-stretching
mechanical strethcing
discuss manual passive stretching
PT applies external force - gains in ROM are transient d/t sarcomere give or connective tissue recovery from creep
discuss self stretching
importans aspect of HEP - enables pt to independently inc/maintain ROM
discuss prolonged mechanical passive stretching
use of equipments - ankle weights
low intensity for long time - 15-30 mins or 8-10 hrs
what is active inhibition or PNF stretching
facilitative or active stretching - uses muscle contraction to faci or inhib and inc stretch
discuss hold-relax
pt elongates - isometric contraction of opposite action of desired ROM against PT for 6 sec - relax - PT passively stretches to new range and holds for 15 secs - repeat
for tight hamstrings
pt does SLR - pushes down or flex hams against PT for 6 secs - relax - PT passively SLR more and holds for 15 secs
x 3 reps
autogenic inhib
discuss agonist contraction
pt elongates - isometric contraction of agonist of muscle of desired ROM against PT for 6 sec - relax - PT passively stretches to new range and holds for 15 secs - repeat
for tight hams
pt does SLR - pt extends leg or extends quads against PT for 6 secs - relax - PT passively SLR more and holds for 15 secs
x 3 reps
reciprocal inhib
discuss HR-AC
combi of autogenic and reciprocal inhib
Pre-stretch isometric contraction of the antagonist → relaxation of antagonist → concentric contraction of the agonist (combination of HR/AR and AC)
what should we do after stretching
cryo to minimize post stretch soreness
have pt perform active exercise and functional activities that uses gained ROM
strengthen agonist muscle
