Stretching Flashcards
The ability of the body structures or segments to move so that ROM for functional activities is allowed
MOBILITY
The most effective means of stretching the latissimus dorsi in order to increase flexion of the shoulder is to:
Select one:
a. Place the patient in a prone position; stabilize the scapula and hyperextend the shoulder.
b. Place the patient in a supine position; stabilize the lateral border of the scapula as you flex the shoulder.
c. Place the patient in the supine position with hips and knees flexed; stabilize the pelvis at the iliac crest and flex the shoulder.
c. Place the patient in the supine position with hips and knees flexed; stabilize the pelvis at the iliac crest and flex the shoulder.
The goal of this exercise is to increase the flexibility (extensibility) of the pectoralis major muscle. You teach the patient to stand facing a corner with the shoulders abducted to 90°, elbows flexed to 90°, and hands and forearms placed on the walls. You tell the patient to relax into the stretch (by leaning into the corner) for 30 seconds; push his forearms into the walls for a count of six; then relax and lean forward toward the corner again and hold for 30 seconds. The self-stretching technique the patient is using is:
Hold–relax (contract–relax).
During a stretching maneuver, you apply a 30-second stretch of a shortened muscle group just up to the point of tissue resistance. After this maneuver, rather than relaxing with the patient and returning the body segment to a neutral position, you move the body segment into the newly gained range to apply another stretch of the same muscle group and hold the stretch for an additional 30 seconds. What term best describes this type of stretching?
Static-progressive
Each of the following is a contraindication to stretching adaptively shortened tissues except:
Select one:
a. Sharp, acute pain during ROM.
b. When ROM is limited because scar tissue has reduced soft tissue extensibility.
c. A bony block.
d. When tight (shortened) soft tissues provide functional stability of a body segment affected by paralysis.
b. When ROM is limited because scar tissue has reduced soft tissue extensibility.
T or F
Functional ROM; ROM required for functional activities
Functional mobility; ability of a community to initiate, control, sustain active
FALSE
Functional ROM; ROM required for functional activities
Functional mobility; ability of an individual to initiate, control, sustain active
FACTORS LEADING TO HYPOMOBILITY
Prolonged immobilization of a segment
Sedentary lifestyle
Postural malalignment with muscle length alterations
Impaired muscle performance
Tissue trauma resulting in inflammation and pain
Congenital or acquired deformities
The three interactions that brings flexibility
Involves interaction of the following:
muscle length
joint integrity
periarticular soft tissue extensibility (soft tissue surrounding the joint)
Ability to rotate a single joint or series of joints smoothly and easily through an unrestricted, pain-free ROM.
FLEXIBILITY
T or F
Mobility is Maximized when the muscle-tendon units that cross a joint have adequate extensibility to deform and yield to a stretch force.
FALSE
Flexibility Maximized when the muscle-tendon units that cross a joint have adequate extensibility to deform and yield to a stretch force.
Each of the following is true about joint mobilization/manipulation techniques except:
Select one:
a. Techniques can be applied using gliding or oscillation techniques that involve low or high amplitudes and velocities.
b. Techniques involve the application of accessory joint movements but not physiological movements.
c. They are appropriate to use if a joint is painful or inflamed to decrease or inhibit the perception of pain.
c. They are appropriate to use if a joint is painful or inflamed to decrease or inhibit the perception of pain.
To achieve permanent lengthening of connective tissue:
Select one:
a. The collagen fibers must line up in a parallel fashion.
b. The region of necking, or macrofailure, must be reached.
c. Bonds between collagen fibers must be remodeled in the lengthened position.
d. The ground substance between the fibers must be reduced.
c. Bonds between collagen fibers must be remodeled in the lengthened position.
The glycosaminoglycans and water in the ground substance of connective tissue are important for connective tissue health because:
They reduce friction and transport nutrients and metabolites.
To increase terminal knee extension, you position the patient prone so the lower leg is not supported on the treatment table. The patient relaxes while the lower leg and foot “hang” off the end of the table. The therapist adds a cuff weight around the ankle. What type of stretching procedure is being applied?
Mechanical
Stress within the elastic range of tissue deformation may cause all of the following except:
Select one:
a. Straining of bonds (cross-links) between collagen fibers.
b. Microfailure between collagen bonds.
c. squeezing water out of the ground substance.
d. Grade II ligament injuries.
d. Grade II ligament injuries.
Based on the neurophysiological properties of the contractile components of muscle, a high-intensity, quick stretch of a muscle-tendon unit is believed to create phasic elevation of tension in the stretched muscle by:
Facilitating the muscle spindle via the Ib fibers.
In a patient’s medical record you see “knee flexion contracture.” What does it mean?
Select one:
a. The patient is unable to actively extend the knee through the full range of motion (ROM) despite full passive knee extension.
b. The quadriceps muscle group is tight and limits full, passive knee flexion.
c. Full, passive knee extension is not possible.
c. Full, passive knee extension is not possible.
What is Dynamic Flexibility?
Active mobility, active ROM
Axtent to which an active muscle contraction can rotate a joint through its available ROM
Flexibility that is limited by ability of a muscle to contract through ROM
degree and quality of tissue extensibility
Dynamic
What is Static Flexibility?
passive mobility, passive ROM
extent to which a joint can be passively rotated through its available ROM
Passive flexibility is a prerequisite for—but does not ensure—dynamic flexibility.
Type of flexibility that depends on the extensibility of soft tissues that cross and surround a joint
STATIC/PASSIVE FLEXIBILITY
Significant resistance to stretch
CONTRACTURE
Adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint, resulting in significant resistance to passive or active stretch and limited ROM.
CONTRACTURE
Contracture vs Shortness
Contracture: almost complete loss of motion
Shortness: partial loss of motion
clinical and fitness settings to describe restricted motion due to adaptive shortening of soft tissue, in particular, mild muscle shortening
Tightness
How DESIGNATION OF CONTRACTURES BY LOCATION
Joint - motion - contracture
Elbow flexors contracture
Types of contractures
Myostatic/Myogenic
Pseudomyostatic /apparent
Atherogenic
Periarticular
Fibrotic
Irreversible
Myostatic vs pseudomyostatic contracture
pseudomyostatic has a muscle pathology, resolved with neuromuscular inhibition
myostatic is resolved with stretching
intra-articular pathology
problem is within the joint
changes within the joint: adhesions, synovial proliferation, joint effusion, irregularities in articular cartilage, or osteophyte formation
Atherogenic
connective tissue of muscle and periarticular structures can cause adherence of these tissues
Fibrotic
T or F
Fibrotic contractures are possible to stretch a fibrotic contracture and eventually increase ROM, it is often difficult to re-establish optimal tissue length.
TRUE
A process whereby the overall function of a patient may be improved by applying stretching techniques to some muscles and joints while allowing motion limitations to develop in other muscles or joints.
SELECTIVE STRETCHING
: a process whereby the overall function of a patient may be improved by applying stretching techniques to some muscles and joints while allowing motion limitations to develop in other muscles or joints.
Overstretching
T or F
An end-range stretch force will elongate shortened muscle-tendon units and/or periarticular connective tissues when a restricted joint is rotated just beyond its available ROM
TRUE
Passive vs assisted stretching
passive: relaxed as possible during the stretch
assisted: patient assists in moving the joint through a greater range
Any stretching exercise that is carried out independently by a patient after instruction and supervision by a therapist
SELF-STRETCHING:
founded on the concept of reflexively decreasing tension in shortened muscles prior or during the stretch
NEUROMUSCULAR FACILITATION AND INHIBITION
manipulative procedures that evolved out of osteopathic medicine designed to lengthen muscle and fascia and to mobilize joints.
employ voluntary muscle contractions by the patient in a precisely controlled direction and intensity against a counterforce applied by the practitioner
MUSCULAR ENERGY TECHNIQUES:
Skilled manual therapy interventions specifically applied to joint structures by the clinician to modulate pain and treat joint impairments that limit ROM.
JOINT MOBILIZATION/MANIPULATION
: initially resists deformation, such as a change in length, when a stretch force is applied but will slowly lengthen if the force is sustained. The viscoelastic tissue will gradually return to its prestretch configuration after the stretch force is removed
VISCOELASTICITY
T or F
Both contractile and noncontractile tissues have elastic, plastic qualities, and viscoelastic properties.
FASLE
Both contractile and noncontractile tissues have elastic and plastic qualities, while only noncontractile connective tissues have viscoelastic properties.
What force does these fibers resist:
COLLAGEN FIBERS
GROUND SUBSTANCE; proteoglycans
COLLAGEN FIBERS; Tensile strength
Proteoglycans; Compressive Forces
Application of specific and progressive manual forces using sustained manual pressure or slow, deep stroking.
SOFT TISSUE MOBILIZATION/MANIPULATION
POTENTIAL BENEFITS AND OUTCOMES OF STRETCHING
INCREASED FLEXIBILITY AND ROM
GENERAL FITNESS
Injury prevention
Reduced post-exercise muscle soreness
Enhanced performance
improve or restore nerve tissue mobility
restricted by tissue adhesions or scar tissue following trauma or surgical procedures
NEURAL TISSUE MOBILIZATION (NEUROMENINGEAL MOBILIZATION):
T or F
Soft tissues that can become restricted and impair mobility include muscles with their contractile and noncontractile elements and various types of connective tissue (tendons, ligaments, joint capsules, fascia, and skin)
TRUE
if it returns to its prestretch resting length directly after a short-duration stretch force is removed.
ELASTICITY
is the tendency of soft tissue to assume a new and greater length after a stretch force is removed
PLASTICITY
provide linkage between the main tissue matrix components and between the cells and the matrix opponents
Glycoproteins
Responsible for the strength and stiffness of tissue and resist tensile deformation.
Erranged in an organized relationship and dimension
Tissue with a larger proportion of collagen provides greater stability
COLLAGEN FIBERS
Great deal of elongation with small loads and fail abruptly without deformation at higher loads. Tissues with higher amounts of elastin have greater flexibility.
ELASTIC FIBERS
MECHANICAL PROPERTIOES OF NONCONTRACTILE SOFT TISSUE
Summary
When load is applied, Collagen fibers Elongate -> Stiffen -> begins to break -> failure
Provide tissue with bulk.
RETICULAR FIBERS
Force (or load) per unit area. Mechanical stress is the internal reaction or resistance to an externally applied load.
reaction or resistance
Stress
The amount of deformation or lengthening that occurs when an external load (such as a stretch force) is applied to a structure
change in length
Strain
resistance to a force applied in a manner that approximates tissue. Weight-bearing through a joint will produce compression stresses.
Compression
the resistance to a force applied in a manner that will lengthen the tissue. A stretching force results in tension stress.
Tension
Regions of the Stress-Strain Curve
Toe
Elastic - Elastic Limit
Plastic - Necking
Failure
first response to loading is to straighten and align.
occurs with minimally applied force and results in small increases in tissue stress.
functional
TOE REGION
resistance to two or more forces that are applied in opposing direction
Shear
end of the linear region and the point beyond which the tissue does not return to its original shape and size.
ELASTIC LIMIT
reached when the tissue rupture sand loses its integrity
FAILURE
Strain beyond the elastic limit begins to cause permanent tissue deformation.
Plastic deformation results from sequential failure (micro failure) of the bonds between collagen fibrils and eventually of collagen fibers
PLASTIC RANGE
With respect to stretching, tissue stress beyond the toe region aligned collagen fibers in the direction of applied force.
ELASTIC RANGE/LINEAR PHASE
The maximum strain the tissue can sus- tain is its ultimate strength. Once this point is reached, further increase in strain does not result in increased stress due to tissue macro failure.
ULTIMATE STRENGTH
Effects of immobilization:
Weakening of the tissue
Adhesion formation
Slow rate of return for tensile strength
Reduction in energy absorption
Increase in Compliance (decreased stiffness
is reached in which there is considerable weakening of the tissue, and it rapidly fails.
region of necking
Effects of inactivity
Decrease in the size and amount of collagen fibers
Proportional increase in the predominance of elastin fibers
Slower recover
These responds to what?
Muscle Spindle
Golgi Tendon Organ
Muscle Spindle - respond to stretch (quick stretch);
Golgi Tendon Organ - respond to tension (prolonged tension)
T or F
Firing of the GTO causes inhibition of gamma motor neuron
FALSE
Firing of the GTO causes inhibition of alpha motor neuron
T or F
Type III collagen is weaker than Type I collagen
TRUE
Intrafusal vs Extrafusal Muscle fibers in terms of innervation
Intrafusal: innervated by gamma motor neurons (small-diameter)
Extrafusal: alpha motor neurons
Nuclear bag vs nuclear chain
Nuclear Bag: sensitive to quick & sustained (tonic stretch)
Nuclear Chain: sensitive only to tonic stretch
