Stretching Flashcards
Ability of a tissue to return to it’s previous shape or size following the application of a force.
Elasticity
Point of force beyond which tissue won’t return to former shape/size when force is removed.
Elastic Limit
Deformation
Plastic Stretch
Ability to deform without return to prior shape (can be normal property or secondary to damage)
Plasticity
Resistance, tension, tightness, pain, non-specific term probably referring to shortened muscles which limit joint motion.
Stiffness
Property of a fluid to resist loads that produce shear and flow.
Viscosity
Faster Movement = _______ viscosity.
Lower
Warming muscles increases viscosity (T/F)
False
Phenomenon of gels/solids where mechanical vibrations causes change from gel/solid to liquid
e.g. Quicksand
Thixotrophy
How does thixotrophy affect a muscle?
Muscle becomes stiff with disuse and more mobile with movement.
Example of mobility stretch.
Hamstring Stretch
Example of motor control stretch.
Hip Hinge, one legged balance
Example of functional patterning.
Pick up bag, squat, going to bathroom
What two things do our muscles/joints need?
Stability and Mobility
What type of factors restrict motion?
Extrinsic, Intrinsic, Sedentary lifestyle and habitual faulty or asymmetric postures, paralysis, postural misalignment.
Examples of extrinsic immobilization?
Casts, splints, skeletal traction
Examples of intrinsic immobilization?
Pain, Joint inflammation, muscle/tendon/fascial disorders, skin disorder, bony block, vascular disorders
Examples of sedentary/habitual immobilization?
Confinement to bed or wheelchair, occupation or work environment
Examples of Paralysis immobilization?
CNS/PNS disorders
Examples of postural misalignment immobilization?
Scoliosis, kyphosis
What are the indications for stretching?
• When ROM is limited due to loss of extensibility
from adhesions, contractures, and scar tissue
causing functional limitations or disabilities
• When restricted motion may lead to structural
deformities that are otherwise preventable
• When muscle weakness and shortening of
opposing tissue have led to limited ROM
• As part of a total fitness program designed to
prevent or reduce the risk of MSK injury
• Prior to and after vigorous exercise to minimize
soreness
What are the tight or overactive upper extremity muscles?
Pec Major/minor Anterior deltoid Subscapularis Latissimus dorsi Levator scapulae Upper trap Teres major SCM Scalenes Rectus Capitis
What are the weak or underactive upper extremity muscles?
Rhomboids Lower Traps Posterior Delt Teres minor Infraspinatus Serratus anterior Longus coli longus capitis
What are common joint dysfunctions of the upper extremity?
Sternoclavicular joint
AC joint
Thoracic and Cervical Facet joints
What are possible injuries of the upper extremities?
Rotator cuff Shoulder instability Bicep tendonitis TOS Headaches
What joints are prone to lose mobility? (stiff)
Ankle Hip Thoracic Gleno-humeral Upper Cervicals
What joints are prone to decreased stability?
Knee
Lumbar
Scapula
Lower Cervicals
What muscles are tight or overreactive in the lower extremities?
Fibularis Lateral Gastroc Soleus IT Band Lateral hamstring Adductor Psoas
What muscles are weak or underreactive in the lower extremities?
Post. Tibialis Flexor digitorum L. Flexor hallucis L. Ant. Tibialis Vastus Medialis Pes Anserine Gracilis Sartorius Semitendinosus Gluteus Medius Hip external rotators Gluteus Maximus Local lumbo-pelvic-hip stabilizers
What are common joint dysfunctions of the lower extremities?
1st MTP joint Subtalar joint Talocrural joint Prox. Tib/fib joint SI Joint Lumbar facet joints
What are the possible injuries to the lower extremity?
Plantar fasciitis
Post. Tib tendonitis
Anterior knee pain
Low back pain
What are the stretching contraindications?
• A bony block limits motion
• Recent fracture with non-union
• Acute inflammatory or infections process
• Soft-tissue healing could be disrupted due to stretch
• Sharp acute pain with jt movement or muscle elongation
• Hematoma or other tissue trauma indication
• Hypermobility already exists
• Shortened soft tissues provide support in stead of
neuromuscular control or normal structural stability
• Shortened soft tissues enable a paralyzed patient or one
with severe weakness to perform specific functional skills
Stretching prior to a vertical leaping test may (increase/decrease) performance?
decreased
Stretching prior to a bench press (increased/decreased) performance?
decreased
Calf muscle strength was (increased/decreased) after 15 minutes of stretching?
decreased
T/F Stretching causes an acute inhibition of maximal force produced by the muscle and this effect is more pronounced in activities performed at relatively slow velocities.
True
T/F Minimal contraction of the muscle prior to static stretch minimizes stretch-induced strength loss.
False, maximum contraction does.
What does static stretching without muscle activation do to performance?
Decreases
What are the types of static stretching?
- ) Self Stretch (active)
2. ) Passive Stretch (partner)
What are the types of dynamic stretching?
- ) Active Stretch
2. ) Ballistic Stretch
What are the types of pre-contraction stretching?
- ) Proprioceptive Neuromuscular Facilitation (PNF)
2. ) PIR, PFS
What are the types of static (active self stretches)?
Bands and stretch straps
What type of static stretch is described: slow and constant, 15-30 seconds, 2-4 reps, position patient for relaxing, decrease intensity if painful, careful with hypermobile joints, avoid combination movements of the spine.
Passive Partner Stretch
What is the acute increase in ROM immediately following a static stretch attributed to?
analgesic response
In 30 seconds of stretching viscoelasticity increase until the ___ rep.
4th
(T/F) A 30 second stretch per muscle group is
sufficient to increase ROM in most healthy
people, it is likely that longer periods or more
repetitions are required in some people, injuries,
and/or muscle groups.
True
Is there an additional benefit seen with holding a stretch for 60 seconds?
NO. 30 seconds is sufficient.
What is the downfall to stretching for 10 seconds?
It takes 10 weeks to reach plateau compared to 30 seconds takes 6-7 weeks to reach plateau.
What type of stretching is: Rapid alternating movements to end-range – “Bouncing” at end range – Increased injury risk • Immobilized or disused tissue are weak • Chronic contracture causes brittle tissue – May be used for certain sports in healthy athletes • Gymnastics • Martial arts – Not for injury recovery
Ballistic Stretching (Dynamic Stretching)
What type of stretching is: Movement through a full range – Start slow gradually pick up speed and increase ROM – Use sport / task-specific movements – Preparation / warmup
Active Dynamic Stretching
Who said it? “All human beings including those with disabilities, have untapped existing potential.”
KABAT, 1950
What is the theory with PNF?
Stimulating distal segments increased proprioception of proximal segments.
What type of patients did Herman Kabat use these techniques on?
Cerebral Palsy patients
What are the facilitation techniques of PNF?
– Motor Control – Increases excitability of the target muscles – Restore muscle function – Increase ability to move – Increase stability – Facilitate coordinated movement through timing – Increase patient’s stamina to avoid fatigue
What are the inhibition techniques of PNF?
– Motor control – Decrease motor neuron excitability – Reduction in spasticity – Improve motion
What are the PNF spiral-diagonal plane movements? (3 components)
- ) Flexion-Extension
- ) Rotation
- ) Toward and Across Midline – Across and Away from Midline
Stretching the hamstrings is an example of what plane stretch for PNF?
Single Plane
T/F Single plane stretching (PNF) is just as effective as multi-plane stretching (PNF)?
False it is effective but not as functional as multi-plane
• Form the basis for all movement • Alternating agonist/antagonist control • Multiple planes of movement • Create control, with alternating mobility and stability
PNF patterns
Each extremity has ___ patterns of motion.
2
The motions of the extremity are _____ _____ motions.
Mirror image
Shoulder Flexion, external rotation, adduction
Forearm supination
Wrist Flexion
Finger Flexion
D1 Flexion
Shoulder–Extension, Internal Rotation, Abduction
Forearm–Pronation
Wrist–Extension
Fingers–Extension
D1 Extension
Shoulder–Flexion, External Rotation,
Abduction
Forearm–Supination
Wrist– Extension
Fingers—Extension
D2 Flexion
Shoulder–Extension,
Internal Rotation,
Adduction
Forearm–Pronation
Wrist– Flexion
Fingers–Flexion
D2 Extension
Grab Seat Belt to fasten seat belt.
D1
Arm finishes in flexion, adduction and external rotation.
D1 Flexion
Arm finishes in extension, abduction and internal rotation
D1 Extension
Sword from the sheath to the air.
D2
Arm finishes in flexion, abduction, and external rotation
D2 Flexion
Arm finishes in extension,
adduction, and internal rotation
D2 Extension
Soccer Kick
D1
Leg finishes in
flexion, adduction, and
external rotation
D1 Flexion
Leg finishes in
extension, abduction and
internal rotation
D1 Extension
Snow Plow (up and out to down and in)
D2
Leg finishes in
flexion, abduction, and
internal rotation
D2 Flexion
Leg finishes in
extension, adduction and
external rotation
D2 Extension
Hip--Flexion Adduction External Rotation Foot--Dorsiflexion Inversion Toes--Extension
D1 Flexion
Hip--Extension Abduction Internal Rotation Foot--Plantar flexion Eversion Toes--Flexion
D1 Extension
Hip--Flexion Abduction Internal Rotation Foot--Dorsiflexion Eversion Toes--Extension
D2 Flexion
Hip--Extension Adduction External Rotation Foot--Plantar flexion Inversion Toes--Flexion
D2 Extension
Spread of excitation in the central nervous
system that causes contraction of synergistic
muscles in a specific pattern”
Irradiation
-Surburg
Contraction of the agonist simultaneously inhibits the action of the antagonist
Sherrington’s Law of Reciprocal Inhibition
Technique that uses Sherrington’s Law?
CRAC
Triceps is inhibited and Biceps Contracts
Reciprocal Inhibition
After a muscle is contracted, it is automatically
in a relaxed state for a brief, latent period
Postcontraction inhibition
Techniques that use postcontraction inhibition?
Hold Relax, Postisometric relaxation (PIR), and Postfaciliation stretch
What are the facilitated PNF techniques?
– Rhythmic Stabilization
– Slow Reversal
– Fast Reversal
What are the inhibited PNF techniques?
Hold Relax
– Contract Relax
– Contract Relax Agonist Contract (CRAC)
Alternating between isometric actions of the
agonistic and antagonistic muscles
Rhythmic Stabilization
Concentric action of the antagonist,
followed by a concentric action of the
agonist
Slow Reversal
Concentric action of the antagonist,
followed by a concentric action of the
agonist (same but faster)
Fast Reversal
- 10-15 seconds of stretch
- Isometric action of the antagonist for 6 seconds
- Followed by relaxation
- Passive stretching antagonist for 10-15 seconds
Hold Relax
- Stretch for 10-15 seconds
- Maximal concentric action of the antagonist against resistance
- Followed by relaxation
- Stretch for another 10-15 seconds
- Repeat if needed
Contract Relax
Utilizes reciprocal inhibition by having the agonist contract while
stretching the antagonist
CRAC (Contract Relax Agonist Contract)
What are other techniques that use pre-contraction stretching?
- ) Post-isometric Relaxation (PIR)
- ) Post Facilitation Stretch
- ) Muscle Energy Techniques
- ) Active Isolated Stretching (Mattes Method)
– Passively stretch mm to point of tension
– Contract mm (isometric) gently for ~10 sec
– Breathe out & relax mm
– Doctor feels for decrease resistance
– Gently stretch to next point of tension
– Repeat 3-5 reps
PIR (post-isometric relaxation)
– Hold mm midway between neutral and point of tension
– Contract (isometric) with maximum or near maximum
effort for ~10 sec
– Relax completely
– Doctor feels for decreased resistance
– Move quickly to new point of tension (careful)
– Hold stretch for 20 seconds
– Move back to midrange and rest 20 – 30 seconds
– Repeat 3 – 5 times.
Post-Facilitation Stretch (PFS)
– Stretching procedure involving voluntary
contraction of a muscle in precise and controlled
direction and variations in intensity
Muscle Energy Technique (MET)
Uses include
– Lengthening a shortened muscle, contracture or
spastic muscles, strengthen weakened muscles,
reduce localized edema, mobilize joint
articulations with restricted mobility, TrP
Muscle Energy Technique (MET)
Particularly helpful with postural muscles
MET (muscle energy technique)
Helps strengthen muscles with isometric actions • Relaxes muscles, useful for spasms • Regains muscle control through continual use • Reduce localized edema
MET (muscle energy technique)
What is the protocol for MET?
Position of comfort, take muscle or movement to
the point of barrier. Should be pain free point when
stretch begins
– Ask pt. to contract muscle he feels the stretch, max
of 25%, while the Dr. matches effort with
resistance. May use less when patient is in early
stages of rehabilitation following injury
– After 10 seconds of action have patient relax and
within 3-5 seconds gently move to next barrier
Who developed Active Isolated Stretching?
Aaron Mattes
Takes advantage of the principle of reciprocal
inhibition
Active Isolated Stretching
Stretch gently (1 pound of pressure) to prevent activation of muscle spindles and Golgi bodies
Active Isolated Stretching
• Lengthening with a gentle pressure at end range
to microscopically loosen scar tissue and allow
restoration of proper muscle length.
Active Isolated Stretching
What is the protocol for active isolated stretching?
The patient positions the part in the proper position and initiates voluntary movement toward end range • Doc applies a gradual tension of no more than 1 pound of pressure to stretch • Stretch for no more than 2 seconds • Return to start position • Repeat 8 to 10 reps – more repetitions may lead to local ischemia
T/F Older adults, 65 yrs and older, should
incorporate a static stretching into daily routine
True
T/F Orthopedic patients only benefit from PNF types
of stretching
False, they may benefit from any type of stretching
T/F Stretching may be beneficial in myofascial pain
management
True.
