Stretching, Flexibility, and Peripheral Jt Mobs Flashcards
Define flexibility
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.
Define contracture
Adaptive shortening of soft tissues and muscle tendon unit around a joint
Define Elasticity
the ability of soft tissue to return to resting length after a stretch force is removed
Define Plasticity
Tendency of soft tissue to assume greater length after stretch force is removed
Define spasticity
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.
Define range of motion (ROM)
The full motion possible between two bones.
What are the causes for decreased mobility?
- Injury
- Surgery
- Immobilization
What are the effects of immobilization on connective tissue/muscles?
- Time- longer immobilized the greater the muscle atrophy with structural and functional properties deteriorating withing the first week, with increased connective tissue.
- Muscle composition: muscle fibers atrophy
- Position specific: loss of sarcomeres, muslces become stiffer, less energy absorbed in shortened position
What are the effects of immobilization on articular cartilage?
- decreased loading and motion leads to degeneration of articular surface.
- Increased water content increase softening of chondral surfaces.
What are the effects of immobilization on bone?
- bone resorption in early phases with decrease in bone mass. Loss greater in weight bearing bones than UE bones (compression fracture)
- No stress so bone strength decreases (Wolff’s law)
What are the activities used to increase ROM?
- PROM
- AAROM
- AROM
- SAROM
- Stretching
What is passive range of motion (PROM)?
- movement of a segment within the unrestricted ROM that is produced by an entirely external force. Little to no voluntary m. contraction.
- used as mobility exercise, used in acute healing
What is active assisted ROM?
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.
What is active ROM?
Movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing the joint.
What is stretching?
Elongation of the tissue
What are the goals for PROM?
- Maintain jt and soft tissue integrity
- Minimized effects of formation of contractures.
- Maintain mechanical elasticity of m.
- Assist circulation and vascular dynamics
- Enhance synovial motion for cartilage nutrition and diffusion of materials in the joint
- Decrease or inhibit pain.
- Assist with the healing process after injury or surgery.
- Help maintain the patient’s awareness of movement.
What are the goals for AROM and AAROM?
- Same as PROM with benefits of muscle contraction?
- Maintain physiological elasticity and contractility of involved muscle
- Provide stimulus for bone and joint tissue integrity
- Provide sensory feedback for contracting muscles.
- Increase circulation and prevent thrombus formation
- Develop coordination and motor skills for functional activities.
What are indications for PROM?
- when active motion would be detrimental to the healing process
- When a patient is not able or not supposed to actively move a segment of the body.
What are indications for AROM and AAROM?
- when a patient is able to contract the muscle actively and move a segment
- to maintain as normal a condition above and below an area of injury
- Aerobic conditioning
- Relieve stress from sustained postures
What are the precautions for ROM?
- The type of muscle contraction must be safe for the specific condition. Ex isometric contraction for fracture
- Range, speed, and tolerance of pt in acute injury stage
- Precautions/contraindicated movement per post surgical considerations
What are the contraindications for ROM?
- When motion or contraction may disrupt the healing process or affect the person’s health status. Ex unstable cardio-pulmonary conditions.
- Severe soft tissue trauma/thrombus
What are the parameters of ROM?
- Mode
- Dosage
- Frequency, Intensity, Duration
Describe mode of ROM
- Stage of healing primary consideration.
- May take form of pulleys, CPM, household objects, canes, family members, etc
- How are you going to accomplish ROM?
Describe dosage of ROM
- Consider stage of healing and tissue response to loading considerations
- sequence may be part of warm-up, to teach exercises, or for the benefits of ROM from easier to more difficult
- What loading are you doing with the issues?
What is frequency of ROM?
how often
What is intensity of ROM?
How hard are they working
What is duration of ROM?
How long they will do ROM
What is the relationship between frequency, intensity, and duration?
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
What does a muscle spindle do?
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.
Where is the muscle spindle located?
in the muscle belly
What is the break down of a muscle.
muscle- muscle fiber- bundle of myofirbil- myofibril- sarcomere
What does the golgi tendon organ do?
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
How do collagen fibers respond to stretching?
they absorb most of teh stress and lengthen quickly under light but long load. (myofasical release)
What are responses of connective tissue need to be considered?
- allow time between stretching episodes to allow healing.
- Caution with elderly because of loss of elasticity of collagen and decreased blood supply for healing. Need lighter loads and more healing time)
- consider the stress strain curve
Describe the stress strain curve.
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
What is the convex on concave rule?
When convex joint surface moves on a concave joint surface, the roll and slide move in opposite directions
What is the concave on convex rule?
when concave joint surface moves on a convex joint surface, the roll and slide move in the same direction
What are they types of stretching?
- Static/passive
- Ballistic
- Active Inhibition
What is static/passive stretching?
- 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)
What is ballistic stretching?
Quick movements by active contraction of antagonist muscle.
Sometimes used with athletes- must be used selectively
What is active inhibition stretching?
- Hold-relax (autogenic inhibition)- lengthen, then isometric contraction (10-20%) against resistance, then relax, then lengthened and repreated 2-3 times.
- Agonist Contraction (reciprocal inhibition)- opposite muscle concentric contraction to improve relaxation of range limiting muscle during mild stretch to tight muscle.
- 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.
What are the precautions for stretching?
- Do not stretch past normal ROM.
- Protect fracture sites/surgical sites- ex. don’t put force through surgical site.
- Consider effects of osteoporosis, age, inactivity, immobilization, steroids, or other meds.
- If soreness lasts longer than 24 hours, intensity too great.
- Strengthen any new range acquired
- pregnancy
What are the contraindications for stretching?
- Bony blocks
- fracture less than 6 weeks old
- Inflamed, infected, or edematous tissue
- Sharp, acute pain
- hematoma or tissue trauma
- functional contractures
- Hypermobility
What are the parameters of stretching?
- intensity
- duration
- Frequency
- Mode
Describe intensity as it relates to stretching.
Low intensity via low load is preferred. It will increase patient comfort, tolerance, and compliance, and safety of stretch
Describe duration as it relates to stretching.
Research supports longer hold times get greater gains but diminishes after 1 minute.
Has an inverse relationship with intensity.
Describe frequency as it relates to stretching.
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
What are the modes of stretching?
- manual
- mechanical
- self-stretching
- passive, assisted, active stretching
What are the indications for joint mobilization?
- reduce pain
- reversible joint hypomobility
- prevent progressive limitation
- functional immobility
What are the contraindications for joint mobilizations?
- hypermobility
- joint effusion
- inflammation
What are the precautions for joint mobilizations?
- malignancy
- bone disease detectable on x-ray; high chance of fx
- unhealed fracture
- excessive pain
- hypermobility in associated joints
- total joint replacements
- newly formed or weak connective tissue
- systemic connective tissue disease
- elderly individuals with weakened connective tissue and or decreased circulation
