STRETCHING Flashcards
the ability of the body structure to move so that ROM for functional activities is allowed
mobility
maneuver designed to inc soft tissue extensibility; improves the flexibility and ROM of structures that have adaptively shortened and became hypomobile after time
stretching
ability to rotate a single jt or series of jts smoothly and easily through an unrestricted and pain-free ROM
flexibility
components to consider in determining flexibility
muscle length, joint integrity, and periarticular soft tissue extensibility
degree to which an active muscle contraction moves a segment and is dependent on the amount of contraction and tissue resistance present
dynamic flexibility
dependent on extensibility of muscle and connective tissue surrounding the joint
passive flexibility
t/f: passive flexibility is not a prerequisite for dynamic flexibility
false, it is a prerequisite but does not ensure
contributing factors for hypomobility (give 3)
- prolonged immobilization
- sedentary lifestyle/habitual postures
- postural malalignment/muscle imbalances
- paralysis/weakness
- tissue trauma resulting in inflammation & pain
- congenital/acquired deformities
adaptive shortening of muscle-tendon unit and other ST that cross or surround a jt, resulting in complete LOM
contracture
term commonly used in the clinic and fitness settings to describe restricted motion d/t adaptive shortening of STs
tightness
how are contractures described/named
the side of the joint that has the tissue tightness
ex: flexion contracture = tightness is on the flexion side which results in a flexed position of the joint
types of contracture
- myostatic/myogenic
- pseudomyostatic
- arthrogenic & periarticular
- fibrotic and irreversible
type of contracture that occurs on shortened musculotendinous unit c no specific muscle pathology present
myostatic/myogenic
hypertonicity associated c CNS lesions, mm spasm/guarding, and pain
pseudomyostatic
type of contracture common in knee OA pts
arthrogenic & periarticular
develops when connective tissues that attach to a joint capsule become stiff
periarticular
CT becomes fibrous and causes adherence & development of fibrotic tissue
fibrotic
permanent loss of soft tissue extensibility that can’t be released by non-surgical procedures
irreversible
process whereby the overall function may be improved by applying stretching to some muscles but allowing LOM to occur in other muscles
selective stretching
selective stretching is common for patients c
permanent paralysis
stretching beyond the normal length of muscle and ROM of a joint resulting in hypermobility
overstretching
advantage of overstretching
- to those c normal strength & stability participating in sports that require flexibility (e.g. gymnasts & ballerinas)
disadvantage of overstretching
creates detrimental joint instability if both static supporting structures and dynamic muscular control units are unable to maintain jt’s stability, causing pain & predisposing a MSK injury
types of flexibility training programs
- stretching
- self-stretching
- neuromuscular facilitation & inhibition
- muscle energy techniques
- joint mobilization/manipulation
- ST mobilization/manipulation
- neural tissue mobilization
this technique relaxes tension in muscles reflexively prior or during muscle elongation
Neuromuscular facilitation & inhibition / PNF
response to immobilization and stretch
elasticity > viscoelasticity > plasticity
primary cause of LOM as a result of any injury or surgery
dec extensibility of CTs, not the contractile element
the only type of tissue that has the viscoelastic property
non-contractile connective tissues
tendency of STs to assume a new and greater length after removal of a force
plasticity
time-dependent property of soft tissues that resist deformation initially
viscoelasticity
ability of STs to return to its original state directly after a short duration force has been removed
elasticity
composition of connective tissues
- collagen fibers
- elastin fibers
- reticulin fibers
- ground substance
responsible for strength and stiffness of tissue and resists tensile deformation
collagen fibers
organic gel containing water and is made up of proteoglycans and glycoproteins
ground substance
provides bulk to the tissues
reticulin fibers
tissues with higher amounts of this substance have greater flexibility
elastin fibers
force/load per unit area
stress
reistance to a force applied in a manner that will lengthen the tissue
tension
resistance to a force applied in a manner that approximates tissues
compression
resistance of two or more forces that are applied in opposing directions
shear
amount of deformation or lengthening that occurs when an external load is applied
strain
max strain the tissue can sustain
ultimate strength
some ruptures after the early part of the plastic range
grade 1 strain
this factor causes weakening of the tissue and weak collagen bonding between the new, nonstressed fibers
immobility
rupture or tissue failure after deformation beyond plastic range
grade 3 strain
rupture & partial failure after deformation into the latter part of the plastic range
grade 2 strain
this factor dec size & amount of collagen fibers which results in weakening of tissue
inactivity
adverse effects of this factor include decreased collagen synthesis and organization, necrosis, and an increased ratio of type III to type I collagen
corticosteroids
this factor dec the max tensile strength which causes slower adaptation to stress
agr
major sensory organ of muscle that is sensitive to quick and sustained stretch
muscle spindle
small, encapsulated receptors composed of afferent sensory fiber endings, efferent motor fiber endings, and specialized muscle fibers called intrafusal fibers
muscle spindle
these fibers connect at their ends to extrafusal muscle fibers
intrafusal fibers
contractile region of intrafusal fibers
plar regions (ends)
sensory organ located near the musculotendinous junctions of extrafusal muscle fibers
golgi tendon organ
sensitive to even slight changes of tension on a muscle-tendon unit brought on by passive stretch or active mm contractions during normal movement
GTO
when muscle tension develops, GTO sends activation signals to the SC which inhibits ______, which then _______
alpha motor neuron activity; decrease tension in the muscle-tendon unit
how does the stretch reflex work?
muscle spindle detects stretch > sends signals to alpha motor neuron > alpha motor neuron activates extrafusal fibers
mechanism of reciprocal inhibition
muscle spindle detects stretch in agonist > efferent send signals to alpha motor neuron > afferent send signals to inhibit the antagonist muscle
autogenic inhibition mechanism
muscle contraction activates GTO > GTO send signals to SC via type Ib fibers > inhibitory interneuron hyperpolarizes alpha motor neuron > muscle inhibition
indications for stretching exercises
- limitation of motion
- limitations which may lead to structural deformities
- muscle weakness and shortening of opposing tissues
- component of total fitness/sport-specific program
- used prior to and after vigorous exercise
contraindications for stretching (give at least 2)
- bony block
- recent fx/incomplete bony union
- acute inflammation/infectious process
- sharp, acute pain c joint movement/muscle elongation
- hematoma/tissue trauma
- hypermobility
- contractures/shortened tissues
which of the following is not a precaution for stretching exercises:
- newly united fractures
- shortened tissue
- known/suspected osteoporosis
- avoid vigorous stretching of muscles and connective tissues that may have been immobilized for a long time
- avoid ballistic stretching
- jt pain/muscle soreness lasting more than 24 hrs post-stretch
- avoid stretching edematous tissues
- avoid stretching weak muscles
shortened tissues ( these are contraindications)
specific goals of stretching
- inc general flexibility and ROM
- general fitness (warm-up & cooldown)
- injury prevention/reduction post-exercise muscle soreness
- enhance physical performance
determinants of stretching exercises
- alignment
- stabilization
- intensity
- duration
- speed of stretch
- frequency
- mode
most common type of stretching
static stretching
STs are elongated just beyond the point of tissue resistance -> held in a lengthened position for a certain period of time
GPS / Gentle Passive Stretch
stretching technique wherein shortened STs are held in a lengthened position until a degree of relaxation is felt
static progressive stretching
technique with a relatively short duration stretch force & is reapplied multiple times during a single session
cyclic/intermittent stretching
give the 3 modes of stretching
- manual passive
- self-stretching
- mechanical stretching
this mode of stretching is an important aspect of HEP
self-stretching
parameters for manual passive stretching
15-60 seconds; repeated for at least several repetitions
stretching technique which is used to inhibit/facilitate muscle activation
PNF stretching
PNF stretching that includes isometric contraction for 6 secs & hold, followed by voluntary relaxation of target muscle
Hold-relax/contract-relax
in agonist contraction, what is considered as the agonist muscle?
the muscle opposite the range-limiting target muscle
(ex: tight hamstrings, agonist is quads)
type of inhibition in agonist contract
reciprocal
procedure for hold-relax c agonist-contraction
pre-stretch isometric contraction of the antagonist -> relaxation of antagonist -> concentric contraction of the agonist
(ex: isometric contraction of hamstrings for 6 secs -> relax -> concentrically contract quads to stretch hamstrings towards knee extension)
inhibition in hold-relax c agonist-contract
autogenic and reciprocal
general procedures prior to application of stretching
- examine & evaluate pt
- determine ROM & cause of hypomobility
- evaluate irritability & assess strength
- consider the best type of stretching to increase ROM
- determine outcome goals
- position pt in a comfortable and stable position
- warm up soft tissues to be stretched to increase extensibility and decrease risk of injury
- explain procedures
- free the area to be stretched of any restrictive clothing, bandages, or splints
- Pt should be relaxed as possible
- employ relaxation techniques prior to stretching
what to do after stretching?
- cryotherapy to minimize post-stretch muscle soreness
- have pt perform active exercises and functional activities that use the gained ROM
- strength of the antagonist muscle
adjuncts to stretching interventions
- relaxation training
- heat
- cold
- massage
- biofeedback
- joint traction/oscillation
how to document stretching?
type of stretching x muscle x position x 15-30 sec hold x 2-3 reps to (rationale)
