Stretching Flashcards
Flexibility
ability to move through an unrestricted, pain-free ROM
Flexibility includes
extensibility, arthrokinematics, deformation
Stretching
any therapeutic maneuver used to lengthen soft tissue structure & thereby increase ROM
Stretching includes
passive, active/dynamic, active inhibition, selective stretching
soft tissue fibers include
collagen, elastin, reticulin, ground substance
collagen
responsible for strength & stiffness
Elastin
provides extensibility
reticulin
provides bulk
Ground substance
reduces friction between fibers
soft connective tissue include
tendons, ligaments, joint capsule, fascia, skin
tendon fibers are
parallel
ligaments fibers
vary between parallel & random
joint capsule fibers
vary between parallel & random
Fascia fibers
vary between parallel and random
Skin fiber
are random
properties of connective tissue
elasticity & plasticity
Elasticity
the ability to return to resting length
Plasticity
ability to assume a new & greater length
muscles are primarily what type of tissue
contractile
Muscles attach to what and interwoven with ?
attached to tendon & interwoven with (fascia) non-contractile tissue
what is the primary source of resistance to passive elongation of muscle
non-contractile components of muscle
what are the mechanical response to stretch
- lengthening occurs in the elastic component of the muscle & tension rises
- When stretch is released, the sarcomere return to their resting length (elasticity)
- after a point, mechanical disruption of the cross bridges with lengthening of the sarcomeres
what happens during a quick stretch
- muscle spindle triggers a m monosynaptic stretch reflex
- stim of alpha motor neurons
- contraction of the extrafusal muscle fibers
what happens during a slow stretch
- GTO fires & inhibits alpha motor neurons
- tension decreases
- sacromeres and muscle lengthen
what are the mechanical properties of non-contractile tissue
material strength
stress
strain
Material strength of non contractile tissue
the ability to resist a load or stress
Stress of non contractile tissue
The force per unit area.
mechanical stress
internal reaction or resistance to an external load
examples of stress
tension
compression
shear
strain
the amt. of deformation that occurs when a load (stress) is applied
factors affecting stress strain response
- immobilzation, inactivity
- age
- corticosteroids
- Prior injury
- Other conditions
immobilization, inactivity causes weakening of tissues by
collagen turnover, weak bonding
immobilization, inactivity causes adhesion formation by
greater cross-linking & diminished effectiveness of ground substance
How does age affect stress-strain response
- decrease in max tensile strength
- decrease in elastin
- decrease in rate of adaptation to stress
what are indications to stretching
- limited joint ROM, restricted motion
- Adhesions, contractures, scars
- muscle weakness with shortening of opposing tissue
Contraindications/ precautions for stretching
- bony block
- recent fx, union is incomplete
- inflammtion, infection, hematoma
- sharp/acute pain
- shortened tissue provides stability to allows function
- hypermobility
effects of stretching
- injury prevention
- muscle function
the lower the intensity of stretch
the longer it is tolerated and the longer the CT can be held in a lengthened position
Longer total duration of passive stretch yield
longer lasting decreases in muscle -tendon stiffness
how long do you hold duration stretches to improve flexibility
30 s
permanent stretch-induced gains can only be achieved by
maintaining a stretching program and/or using the new ROM in functional activities
application of passive stretching
- stretching should be preceded by some low intensity active exercise or therapeutic heat
- patient should be as relaxed as possible
factors to be controlled by passive stretching
- direction
- intensity
- duration
- speed
Dynamic stretching uses?
speed of movement, momentum and active muscular effort to bring about a stretch
when do some therapist use dynamic stretching
warm up
low load prolonged stretch (LLPS)
low intensity external force (5-15 lbs or 5-10% BW) usually with equipment
Duration of LLPS
at least 20 minutes
Examples of LLPS
splinting, serial casting, weighted traction or pulleys, positioning
Advantages of LLPS
time management, patient comfort
Disadvantages of LLPS
skin breakdown, requires frequent reassessment of joint & soft tissue, imposes mobility restrictions
Ballistic stretching
- high potential for rupturing weak structures
- increased susceptibility to microtrauma
- facilitation of increased muscle tension & stretch reflex
cycle (intermittent) stretching
short duration stretch applied slowly and gradually, released and reapplied
Proprioceptive neuromuscular facilitano (PNF) stretching
an active muscle stretching approach that uses the principles of autogenic and reciprocal inhibition to promote muscle length
PNF stretching Techniques
- Hold relax
- contract relax
- agonist contraction
- hold relax - agonist contraction
hold relax
End-range isometric contraction of the muscle to be passively lengthened
What is the hypothesis of hold relax
contraction will cause the muscle to relax thru “autogenic inhibition”
contract relax
end range isotonic contraction of the muscle to be passively lengthen
agonist contraction
isotonic contraction of the muscle opposite the tight muscle, against resistance
hypothesis to agonist contraction
reciprocal inhibition of the tight muscle
when is agonist contraction effective
when tight muscle is painful,
when is agonist contraction least effective
when pt has close to normal ROM
Hold relax with agonist contraction
isometric contraction of the tight muscle, followed by concentric, isotonic contraction of the muscle opposite the tight muscle
how to improve function with stretching
- use gain in ROM during functional activities
- stretch induced gains can be maintained through routine stretching
- strengthen muscle that have been stretched
