Stretching Flashcards
Term: ability of structures or segments of the body to move or be moved to allow the presence of ROM for functional activities
Mobility
Term: ability to move a single joint or a series of joints smoothly and easily through an unrestricted pain-free ROM
Flexibility
Q: What does flexibility depend on?
Extensiblity of soft tissues that cross/surround the joint (muscles, tendons, fascia, joint capsules, ligaments
Term: Decreased mobility or restricted motion
Hypomobility
Q: What is one of the causes of hypomobility?
Contractures
Term: adaptive shortening of the muscle-tendon uint and other soft tissues that cross/surround the joint and results in significant resistance to PROM or AROM and limited ROM
Contracture
Content: 5 types of contractures
- Myostatic
- Periarticular
- Arthrogenic
- Pseudomyostatic
- Fibrotic/Irreversible
Term: adaptive muscle shortening with reduction in the number of sarcomeres units in series, individual sarcomere length is also shortened
Myostatic contracture
Term: loss of mobility in the connective tissues that cross or attach to a joint or joint capsule (restriction of the arthrokinematic)
Periarticular contracture
Term: result from intra-articular pathology (adhesions, synovial proliferation, joint effusion, irregularities in the articular cartilage or osteophyte formation
Arthrogenic contracture
Term: limited ROM due to hypertonicity (i.e., spasticity and rigidity) associated with the central nervous system
Pseudomyostatic contracture
Term: the connective tissues are replaced by great amount of non-extensible tissue: fibrotic adhesions, scar tissue, and heterotopic bone
Fibrotic/Irreversible contracture
Content: Interventions to increase flexibility (6)
- Manual
- Self-stretching
- PNF
- MET
- Mobilization/manipulation
- Neural tissue mobilization
Q: What are the two components of muscle stretching (2)
- Contractile tissue (sacromere, myofibril, myofilament)
- Non-contractile tissue (epi, peri, endomysium)
Diagram: Soft tissue response to stretch
Regions: Toe, Elastic, Plastic, Failure
- past elastic region doesn’t return to resting position
- In plastic range some fibers fail/microruptures
- Necking - when tissue becomes very weak just before failure
- In elastic range not pushing the muscle thus requires a longer hold
Diagram: Muscle neurophysiological properties
Get the structures to work for you
If you stretch too fast the structures will work against you
Content: changes affecting flexibility (5)
- Injuries (tendon, ligaments, mm, bone, n., joint cap, etc.)
- Immobilization
- Inactivity
- Aging
- Postural patterns (scoliosis, kyphosis, etc)
Content: Indication for use of stretching (5)
- Decreased ROM
- Restricted motion
- Postural deviations (weakness vs. shortening)
- Preventing musculoskeletal injuries (before - not plastic changes)
- Minimize post exercise soreness (after)
Content: Contraindications to stretching (6)
- Bone block limits joint motions
- Recent fx - incomplete union
- Acute inflammatory or infection processes
- Sharp or actue pain to elongation
- Hypermobility
- Shortened soft tissue that is necessary for stability or neuromuscular control
Content: Determinants of stretching interventions (6)
- Alignment and stabilization
- Intensity of stretch
- Duration of stretch
- Speed of stretch
- Frequency of stretch
- Mode of stretch
Content: Alignment and stabilization
Avoid compensation
Content: Intensity of stretch (4)
- Low intensity (low load)
- Comfortable
- Minimize voluntary/involuntary muscle guarding
- Avoid risk of injuries
Content: Duration of stretch (2)
- Static stretching
- Cyclic stretching
Content: Static stretching (4)
- Progressive or not
- 30-60 sec, 1-3 times (could be 5 times)
- Noncontractile soft tissues yield more readily to low intensity continuous applied stretch force
- GTO inhibits tension during stretch
Content: Cyclic stretching (like ballistic stretch) (2)
- Low velocity, low intensity
- Held between 5 to 10 seconds several times
Q: What is the typical speed of stretch?
Low
Q: What is another type of speed of stretch?
Ballistic stretching
Term: Quick, bouncing movements that create momentum to carry the body segment through the ROM
Ballistic stretching
Q: Who is ballistic stretching contraindicated for?
older people
Content: Frequency of strecth depends on (4)
- Impaired mobility
- Tissues healing
- Severity of contracture
- Age
Content: Frequency of stretching (2)
- 2-5 sessions a week
- Be aware of breakdown of tissues
Content: Mode of stretch (6)
- Manual
- Mechanical
- Self stretching
- Passive
- Assisted
- Active
Content: Mode of stretching indications - Manual (4)
- Early stages
- Patient cannot perform
- Stabilize compensations
- Applying “proprioceptive” techniques
Content: Mode of stretching indications - Self-stretching
Maintain of increase ROM gained by PT (HEP)
Content: Mode of stretching indications - Mechanical
Prolonged time, 30 min to 10 hours
Content: Examination and evaluation of the patient (4)
- Determine available ROM (passive or active)
- Soft tissue sources of impaired mobility (end feel and muscle length)
- Evaluate irritability of involved tissue (healing)
- Determine outcome goals pt. wants to achieve (realistic?)
Content: Application of manual stretching procedures (11)
- Move slowly through the free range to the point of restriction
- Grasp the areas proximal and distal to the joint (use broad surfaces of you hand)
- Stabilize the proximal segment and move the distal
- For the multijoint muscle, stabilizes segment to which the range-limiting muscle attaches.
- Consider using “proprioceptive” techniques.
- Avoid joint compression, apply gentle distraction
- Apply low intensity stretching in a low, sustained manner. Increase tension gradually
- Maintain position for 30 sec. or longer tension in the tissues should decrease, then move a little further.
- Gradually release the stretch force while maintaining the range-limiting tissues in a comfortable elongated position
- If the patient can’t tolerate, use very low, gentle, intermittent stretches.
- If appropriated apply selected soft tissues mobilization near the sites of adhesion during the stretch
Content: Precautions for Stretching (4)
- Osteoporosis, prolonged bed rest, age, or prolonged use of steroids.
- Protect nearly united fractures
- Avoid vigorous stretching of muscles and connective tissue that have been immobilized for an extended period of time.
- Progress the dosage gradually (watch pain and soreness)
Content: Adjuncts to stretching intervention (5)
- Relaxation training
- Heat
- Massage (friction, myofascial release/massage)
- Biofeedback
- Joint traction or oscillation
Term: PT method basedon the global stretching of anti-gravitational muscles and the stretching of muscles that are organized on muscle kinetic chains
Global Postural Reeducation (GPR)
T/F: With GPR compensations are allowed
False, not allowed
Content: Basic Principle of GPR (2)
- Antigravity muscles
- Muscle assisted by gravity
Content: Anti-Gravity muscles (2)
- Posture maintenance
- Became tight and then weak
Content: Muscles assisted by gravity (2)
- Locomotion
- Susceptible to atrophy and then weakness
Term: Connecting several joints and overlapping withouth interruptionin the linkage
Muscular chain
Content: Posterior muscular chain (4)
Erector spinae > deep pelvic trochanter mm > hamstrings > triceps surae
Diagram: Posterior muscular chain
Cotent: Anterior Muscular Chain (6)
Sternocleidomastoid/scalenes > anterior fascial tissues of the thoracic spine > diaphragm > psoas > adductors > soleus (NOT anterior tib like you may want to think)
Diagram: Anterior Muscular Chain
Content: Treating postures (4)
Hold postures for 30-60 minutes
- Opening hips, arms down
- Opening hips, arms up
- Closing hips, arms down
- Closing hips, arms up
