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Soft Tissue > Stretching > Flashcards

Stretching Flashcards

1
Q

Indications for Stretching

A

ROM is limited by:
Adhesions
Contractures
Scar tissue formation

Prevention of possible structural deformities

Muscle weakness in antagonist muscles

Reduce post exercise muscle soreness

Fitness or sport specific exercise program

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2
Q

Contraindications

A

Bony block limiting ROM (End feel)

Recent fracture

Evidence of acute inflammation, infection

Sharp, acute pain with movement or muscle elongation

Hematoma or other indications of trauma

Contracture improves joint stability, function that otherwise would limit activity or participation functions

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3
Q

Neurophysiology of Stretching: Stretch Reflex

A

Stimulation of mechanoreceptors to CNS which provide information on muscle length and tension

Mechanoreceptors: Muscle Spindle and GTO’s

Protect muscle from becoming injured during stretching

A quick stretch will facilitate a reflex contraction

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4
Q

Muscle Spindle

A

Respond to changes in length and velocity of the length change
Stretch occurs
Impulse goes to brain telling it the amount of stretch
Impulse returns to muscle spindle from spinal cord to cause a reflexive contraction of the muscle

Especially sensitive to rapid changes such as what occurs with ballistic stretching

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5
Q

GTO’s

A

Located in the musculotendinous junction
Respond to muscle length and muscle tension
Detects increase in tension
Sends message to CNS to cause reflexive relation of muscle tissue
Stretch > 8 seconds overrides muscle spindle and will get relaxation of the muscle being stretched
Autogenic inhibition

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6
Q

Effects of Stretching

A

Short Term
Muscle relaxation
Elongation of elastic components

Long Term
Plastic deformation
Addition of sarcomeres

Failure
Stretched beyond limits
Fibers become brittle and rupture

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7
Q

Changes in Collagen Affecting the Stress-Strain Curve: Immobilization

A

Weak tissue
Weak bonding of new tissue
Adhesion formation

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8
Q

Changes in Collagen Affecting the Stress-Strain Curve: Inactivity

A

Decrease in size and amount of collagen fibers
Weak tissue
Increase in elastin fibers

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9
Q

Changes in Collagen Affecting the Stress-Strain Curve: Age

A 
Decrease in tensile strength
Decrease in elastin
Rate of adaptation to stress is slower
Increase in overuse syndromes
Tears and fatigue failure
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10
Q

Changes in Collagen Affecting the Stress-Strain Curve: Corticosteroids

A

Decrease in tensile strength

Fibrocyte death next to injection site

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11
Q

Changes in Collagen Affecting the Stress-Strain Curve: Injury

A

Follows predictable pattern if fibers have been disrupted

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12
Q

Changes in Collagen Affecting the Stress-Strain Curve: Other Co-morbidities

A

Nutritional deficits
Diabetes
Hormonal imbalances - thyroid

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13
Q

Good Stretching Fundamentals

A

Alignment

Stabilization

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14
Q

Alignment

A

positioning of the limb or body in such a way as to direct the force of the stretch to the appropriate muscle

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15
Q

Stabilization

A

obtain proper fixation of one side of the joint/muscle while applying an appropriate stretch on the other side

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16
Q

Influences on Elastic or Plastic Deformation: Intensity

A

Low-Load
Decreased muscle guarding
Patient relaxes more

High-Load
More painful
May cause tissue failure

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17
Q

Influences on Elastic or Plastic Deformation: Duration

A

Shorter the duration the greater number of reps are needed.
Lack of agreement of the ideal combo of duration and reps.
Common prescription 3 x 30 seconds
Up to 1-2 minutes

18
Q

Optimal rate of improving ROM

A

Low-load with long-duration

19
Q

Long Duration

A

Long duration stretch 5 seconds to 5 minutes to hours/days

Joint mobilizations, sustained

20
Q

Short Duration

A 
Cyclic stretching
Repeated and gradually applied 
Low velocity, low intensity
Stretch cycle is 5-10 seconds
Joint mobilizations, oscillations
21
Q

Influences on Elastic or Plastic Deformation: Velocity

A

Slow speed to minimize risk to tissue and DOMS
Not just on application but with release as well
Slow decreases activation of stretch reflex

22
Q

Influences on Elastic or Plastic Deformation: Frequency

A

Based on…

Underlying cause of the impaired mobility
Quality and level of healing tissues
Chronicity and severity of the contracture
Age
Corticosteroid use
Previous response to stretch

23
Q

Modes/Types of Stretching

A 
Static Stretching
Cyclic/Intermittent Stretching
Ballistic Stretching
PNF Stretching
Manual Stretching
Mechanical Stretching
Self-Stretching
Active/Dynamic Stretching
24
Q

Static Stretch

A

“Low-Load Long Duration”

Typically the most common type you’ll see in the clinic

25
Q

Cyclic / Intermittent Stretch

A

Short-duration that is repeated and gradually applied, released, and then reapplied.
Multiple repetitions
Duration not clearly defined
Some literature 5-10 seconds
Some literature states 5-10 seconds is static

26
Q

Ballistic Stretching

A

High speed
High intensity
Not recommended for elderly or sedentary patients
Avoid in most cases
If used, rapid, low intensity stretches should occur

27
Q

PNF Stretching

A

Hold-Relax
Contract-Relax
Agonist Contraction
Combination of these

28
Q

Manual Stretching

A 
Therapist controls... 
Site of stabilization
Direction 
Speed
Intensity
Duration of stretch
29
Q

Mechanical Stretching

A

Device applies a stretching force typically at home

Dynasplint
Low load long duration
Hours

ERMI (End Range Motion Improvement)
High load short duration
Used from 10-15 minutes

Can use free weights in clinic

30
Q

Self-Stretching

A

Patient performs independent of therapy site
Can use surfaces to help support during the stretch
Can use towels, belts, cane’s etc to help with the stretch
HEP

31
Q

Active/Dynamic Stretching

A

Different than ballistic stretching

Momentum from static-active stretching

Doesn’t exceed the static-passive stretching ability

Commonly used prior to athletic events

32
Q

Teaching Self-Stretching Exercises

A 
Teach all elements of a stretch
Alignment
Stabilization
Intensity
Duration
Frequency

Utilize an appropriate surface for the stretch
Ensure the patient can perform the stretch at home
Watch the patient perform the exercise and make corrections
Warming up tissue prior to stretching
Written instructions with pictures
Review it with patient at next visit

33
Q

Different Dynamic Stretches

A 
Knee to Chests
Straight Leg Kicks
Straight Leg Kick Cross-Overs
Bottom Kicks
Lunges
Side Lunges
Karaoke

UE too!

34
Q

Stretching Considerations

A

Avoid poor / dangerous spinal and extremity positions

Keep in mind unnecessary tension on…
Peripheral nerves
Articular cartilage
Intervertebral discs

Protect the smaller joints

Protect the pathological joints

Don’t stretch beyond normal ROM

Should only feel it where it’s supposed to be felt
ASK! – not just if they feel it but where!

Progress dosage

If pain/soreness > 24 hours after stretching, then too much force

Inflammatory response=increased scar tissue formation

Avoid overstretching weak muscles

35
Q

Effects of Modalities on Stretching

A

Superficial Heat

Deep Heat

Cryotherapy

Primarily heat / cool small areas…
Individual joints
Muscle groups
Tendons

36
Q

Cryotherapy

A

Applied only with muscle guarding or muscle spasms
Decreases tone
Less sensitive to stretch

After healing and scar formation begin
Less extensibility
More susceptible to microtrauma

37
Q

Spray and Stretch

A

Applies cold spray with static stretching at the same time
Flouri-methane or ethyl chloride sprays produce the cold
Decreased patient discomfort
Trigger Point technique

38
Q

Thermotherapy

A

Increases tissue extensibility
Stretching window: about 3.3 minutes following removal of deep heat, may be shorter with superficial heat
Heating combined with stretch more beneficial than heat alone
Deep heat more effective than superficial heat

39
Q

Thermo- vs Cryo-therapy

A

Research does support either – chronic issues

General Rules for Acute Injury…
Ice for 1st 24-48 hours post injury to minimize edema, muscle spasm, and pain
At this time stretching is contraindicated
After inflammation subsides, warming prior or during stretching is effective
Can apply cold to the soft tissues held in the lengthened position
Minimizes soreness
Promote longer-lasting gains in ROM

40
Q

Active Warm-Up

A

Low-intensity active exercises that the patient does prior to stretching

Increases tissue temperatures
Core and circulation
Allows for plastic change to occur
Muscle spindle activity is decreased
Golgi tendon organ activity is stimulated

It is recommended that an active warm-up for be performed for at least 10-15 minutes prior to stretching

Soft Tissue (8 decks)

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