Stretching, Flexibility, and Peripheral Jt Mobs

Question 1

Define flexibility

Answer 1

the ability to move a joint or series of joints through unrestricted pain-free ROM.
Depends on joint arthrokinematics and muscle and connective tissue ability to elongate.

Question 2

Define contracture

Answer 2

Adaptive shortening of soft tissues and muscle tendon unit around a joint

Question 3

Define Elasticity

Answer 3

the ability of soft tissue to return to resting length after a stretch force is removed

Question 4

Define Plasticity

Answer 4

Tendency of soft tissue to assume greater length after stretch force is removed

Question 5

Define spasticity

Answer 5

A state of excessive muscle tone resulting from pathological conditions affecting the brain and/or spinal cord, in which the balance of facilitatory and inhibitory impulses is upset.

Question 6

Define range of motion (ROM)

Answer 6

The full motion possible between two bones.

Question 7

What are the causes for decreased mobility?

Answer 7

1. Injury
2. Surgery
3. Immobilization

Question 8

What are the effects of immobilization on connective tissue/muscles?

Answer 8

1. Time- longer immobilized the greater the muscle atrophy with structural and functional properties deteriorating withing the first week, with increased connective tissue.
2. Muscle composition: muscle fibers atrophy
3. Position specific: loss of sarcomeres, muslces become stiffer, less energy absorbed in shortened position

Question 9

What are the effects of immobilization on articular cartilage?

Answer 9

1. decreased loading and motion leads to degeneration of articular surface.
2. Increased water content increase softening of chondral surfaces.

Question 10

What are the effects of immobilization on bone?

Answer 10

1. bone resorption in early phases with decrease in bone mass. Loss greater in weight bearing bones than UE bones (compression fracture)
2. No stress so bone strength decreases (Wolff’s law)

Question 11

What are the activities used to increase ROM?

Answer 11

1. PROM
2. AAROM
3. AROM
4. SAROM
5. Stretching

Question 12

What is passive range of motion (PROM)?

Answer 12

1. movement of a segment within the unrestricted ROM that is produced by an entirely external force. Little to no voluntary m. contraction.
2. used as mobility exercise, used in acute healing

Question 13

What is active assisted ROM?

Answer 13

type of AROM in which assistance is provided manually or mechanically by an outside force because prime mover muscle needs assistance to complete the emotion.

Question 14

What is active ROM?

Answer 14

Movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing the joint.

Question 15

What is stretching?

Answer 15

Elongation of the tissue

Question 16

What are the goals for PROM?

Answer 16

1. Maintain jt and soft tissue integrity
2. Minimized effects of formation of contractures.
3. Maintain mechanical elasticity of m.
4. Assist circulation and vascular dynamics
5. Enhance synovial motion for cartilage nutrition and diffusion of materials in the joint
6. Decrease or inhibit pain.
7. Assist with the healing process after injury or surgery.
8. Help maintain the patient’s awareness of movement.

Question 17

What are the goals for AROM and AAROM?

Answer 17

1. Same as PROM with benefits of muscle contraction?
2. Maintain physiological elasticity and contractility of involved muscle
3. Provide stimulus for bone and joint tissue integrity
4. Provide sensory feedback for contracting muscles.
5. Increase circulation and prevent thrombus formation
6. Develop coordination and motor skills for functional activities.

Question 18

What are indications for PROM?

Answer 18

1. when active motion would be detrimental to the healing process
2. When a patient is not able or not supposed to actively move a segment of the body.

Question 19

What are indications for AROM and AAROM?

Answer 19

1. when a patient is able to contract the muscle actively and move a segment
2. to maintain as normal a condition above and below an area of injury
3. Aerobic conditioning
4. Relieve stress from sustained postures

Question 20

What are the precautions for ROM?

Answer 20

1. The type of muscle contraction must be safe for the specific condition. Ex isometric contraction for fracture
2. Range, speed, and tolerance of pt in acute injury stage
3. Precautions/contraindicated movement per post surgical considerations

Question 21

What are the contraindications for ROM?

Answer 21

1. When motion or contraction may disrupt the healing process or affect the person’s health status. Ex unstable cardio-pulmonary conditions.
2. Severe soft tissue trauma/thrombus

Question 22

What are the parameters of ROM?

Answer 22

1. Mode
2. Dosage
3. Frequency, Intensity, Duration

Question 23

Describe mode of ROM

Answer 23

1. Stage of healing primary consideration.
2. May take form of pulleys, CPM, household objects, canes, family members, etc
3. How are you going to accomplish ROM?

Question 24

Describe dosage of ROM

Answer 24

1. Consider stage of healing and tissue response to loading considerations
2. sequence may be part of warm-up, to teach exercises, or for the benefits of ROM from easier to more difficult
3. What loading are you doing with the issues?

Question 25

What is frequency of ROM?

Answer 25

how often

Question 26

What is intensity of ROM?

Answer 26

How hard are they working

Question 27

What is duration of ROM?

Answer 27

How long they will do ROM

Question 28

What is the relationship between frequency, intensity, and duration?

Answer 28

There is an inverse relationship, ex: high intensity and duration performed less frequently. ROM activities generally at lower intensity and shorter duration but 2-5x a day. Sets and reps dependent on frequency and number of exercises performed. Duration and intensity have an inverse relationship

Question 29

What does a muscle spindle do?

Answer 29

senses change in length of muscle and how quickly the change occurs. Fires when the muscle is to long and sends the message to the spinal cord that the muscle needs to contract, then spinal cord sends a message to muscle to contract. The more sudden the change in length the stronger the muscle contraction will be.

Question 30

Where is the muscle spindle located?

Answer 30

in the muscle belly

Question 31

What is the break down of a muscle.

Answer 31

muscle- muscle fiber- bundle of myofirbil- myofibril- sarcomere

Question 32

What does the golgi tendon organ do?

Answer 32

sensitive to tension in muscle caused by passive stretch or muscle contraction. With a quick stretch tension is increased through alpha motorneurons in spinal cord (monosynaptic stretch reflex) With a slow stretch GTOs inhibit tension allowing the sarcomere (elastic component) to lengthen (autogenic inhibition)-- overrides message from muscle spindles

Question 33

How do collagen fibers respond to stretching?

Answer 33

they absorb most of teh stress and lengthen quickly under light but long load. (myofasical release)

Question 34

What are responses of connective tissue need to be considered?

Answer 34

1. allow time between stretching episodes to allow healing. 2. Caution with elderly because of loss of elasticity of collagen and decreased blood supply for healing. Need lighter loads and more healing time) 3. consider the stress strain curve

Question 35

Describe the stress strain curve.

Answer 35

``` As stress (load) increases the strain (% deformation) increases. Toe region- considerable deformation without the use of much force; where functional activities normally occur Elastic range- fibers line up with the applied force; there is complete recovery from deformation, tissue returns to original size Elastic limit- point where tissue doesn't return to its original shape Plastic range- tissue has permanent deformation when stress released. collagen fibers actually rupture which increase length Necking- considerable weakening of the tissue Failure- rupture of the integrity of the tissue ```

Question 36

What is the convex on concave rule?

Answer 36

When convex joint surface moves on a concave joint surface, the roll and slide move in opposite directions

Question 37

What is the concave on convex rule?

Answer 37

when concave joint surface moves on a convex joint surface, the roll and slide move in the same direction

Question 38

What are they types of stretching?

Answer 38

1. Static/passive 2. Ballistic 3. Active Inhibition

Question 39

What is static/passive stretching?

Answer 39

- Muscle and connective tissue are held at their greatest length for a minimum of 30 seconds by a force other than active agonist muscle contraction. - Patient taken to passive stretch then held then relaxed, then repeated - Can be manual or mechanical (20mins up to a few hours)

Question 40

What is ballistic stretching?

Answer 40

Quick movements by active contraction of antagonist muscle. | Sometimes used with athletes- must be used selectively

Question 41

What is active inhibition stretching?

Answer 41

1. Hold-relax (autogenic inhibition)- lengthen, then isometric contraction (10-20%) against resistance, then relax, then lengthened and repreated 2-3 times. 2. Agonist Contraction (reciprocal inhibition)- opposite muscle concentric contraction to improve relaxation of range limiting muscle during mild stretch to tight muscle. 3. Hold relax with agonist contraction- move muscle to lengthened range, have patient contract range-limiting muscle for 5 seconds, pt relax range limiting muscle and actively contract agonist for several seconds holding new range.

Question 42

What are the precautions for stretching?

Answer 42

1. Do not stretch past normal ROM. 2. Protect fracture sites/surgical sites- ex. don't put force through surgical site. 3. Consider effects of osteoporosis, age, inactivity, immobilization, steroids, or other meds. 4. If soreness lasts longer than 24 hours, intensity too great. 5. Strengthen any new range acquired 6. pregnancy

Question 43

What are the contraindications for stretching?

Answer 43

1. Bony blocks 2. fracture less than 6 weeks old 3. Inflamed, infected, or edematous tissue 4. Sharp, acute pain 5. hematoma or tissue trauma 6. functional contractures 7. Hypermobility

Question 44

What are the parameters of stretching?

Answer 44

1. intensity 2. duration 3. Frequency 4. Mode

Question 45

Describe intensity as it relates to stretching.

Answer 45

Low intensity via low load is preferred. It will increase patient comfort, tolerance, and compliance, and safety of stretch

Question 46

Describe duration as it relates to stretching.

Answer 46

Research supports longer hold times get greater gains but diminishes after 1 minute. Has an inverse relationship with intensity.

Question 47

Describe frequency as it relates to stretching.

Answer 47

Must consider underlying causes, quality and level of healing, age, corticosteroids, previous response Limited research on optimal sessions per day or week Per week frequency usually 2-5 times

Question 48

What are the modes of stretching?

Answer 48

1. manual 2. mechanical 3. self-stretching 4. passive, assisted, active stretching

Question 49

What are the indications for joint mobilization?

Answer 49

1. reduce pain 2. reversible joint hypomobility 3. prevent progressive limitation 4. functional immobility

Question 50

What are the contraindications for joint mobilizations?

Answer 50

1. hypermobility 2. joint effusion 3. inflammation

Question 51

What are the precautions for joint mobilizations?

Answer 51

1. malignancy 2. bone disease detectable on x-ray; high chance of fx 3. unhealed fracture 4. excessive pain 5. hypermobility in associated joints 6. total joint replacements 7. newly formed or weak connective tissue 8. systemic connective tissue disease 9. elderly individuals with weakened connective tissue and or decreased circulation