Stretching/ROM

Question 1

what is flexibility and what characteristics contribute to it?

Answer 1

ability to move a joint smoothly and easily through pain free ROM
-muscle length
-joint integrity
-extensibility of periarticular soft tissue

Question 2

what are potential causes for a decrease in flexibility?

Answer 2

prolonged immobilization or sedentary lifestyle
postural malalignment and muscle imbalance
weakness caused by MSK or neuro disorders
tissue trauma>inflammation and pain
deformity (congenital or acquired)

Question 3

Describe the MOA for how immobilization contributes to decreased flexibility.

Answer 3

breakdown of contractile protein
decrease in fiber diameter
decrease in myofibrils
decrease in intramuscular capillary density

Question 4

During atrophy of immobilized muscle, the is an increase in ____ and ____tissue that produces weakness and restricted ROM.

Answer 4

fibrous and fatty tissue

Question 5

How does the position of immobilization impact strength and/or ROM?

Answer 5

shortened>decreases strength bc its unable to produce max tension
lengthened> increases ROM but it could potentially result in reinjury

Question 6

What is the functional difference between ROM and stretching? When do we care?

Answer 6

ROM-keeping what they have vs Stretch increases it
we care when it comes to hypermobility and/or surgical precautions.

Question 7

list and describe the 3 types of ROM. Same categories apply for stretching.

Answer 7

PROM-completely externally controlled within unrestricted range
AAROM-manual or mechanical ext assistance
AROM- active contraction of muscles produce movement in unrestricted range

Question 8

when is PROM indicated?

Answer 8

acute, inflamed tissue
pt is nuable or not suppoed to actively contract

Question 9

what are the goals of PROM

Answer 9

maintain joint mobility and mechanical elasticity of muscle
minimize contractures
assist circulation
lubricate the joint
decrease pain
assist healing process

Question 10

what are the limitations of PROM

Answer 10

prevent atrophy
increase strength or endurance
assist circulation as much as AROM

Question 11

what are indications for AAROM?

Answer 11

pt can actively contract and then move w/ or w/o assistance
often above and below immobilized segments
pt weakness (esp vs gravity) through desired range

Question 12

what are the goals of AAROM?

Answer 12

PROM goals +
maintain eslasticity and contractility
sensory feedback from contraction
stimulate bone and joint integrity
increase circulation
develop coordination + motor skill

Question 13

what are the limitations of AROM

Answer 13

no maintenance or strength gains
ONLY develops skill and coordination in movement patterns used

Question 14

what kinds of stretching are most appropriate early in rehab? later?

Answer 14

manual stretching. and joint mobes; self-stretching and mobilization

Question 15

For longer lasting (plastic) length increase to be permanent, stretch force must be ______.

Answer 15

maintained over an extended period of time

Question 16

what types of movement are muscle spindles sensitive to? what is their related reflex?

Answer 16

they are sensitive to quick and sustained stretch. they react by increasing tension in the muscle being stretched and produce reciprocal inhibition in the opposing muscle group. slow and low intensity stretch prevents this.

Question 17

what types of movement are golgi tendon organs sensitive to? what is their related reflex?

Answer 17

sensitive to slight changes of tension on unit. they react by decreasing tension via autogenic inhibition (basically, it gives in)

Question 18

what are the 6 contraindications for stretch/ROM?

Answer 18

hard end feel
recent fracture
when the shortened tissue enable function
acute inflammation
hemotoma
hypermobility

Question 19

what are the 4 broad categories of stretching exercises?

Answer 19

static stretching
cyclic stretching
ballistic stretch
proprioceptive neuromuscular facilitation (PNF)

Question 20

what are the 8 parameters of stretching we should consider?

Answer 20

alignment
stabilization during stretch)
intensity
duration
frequency
speed
mode (type)
integrations of neuromusc inhibitioncor faciliatation

Question 21

what is the optimal intensity/duration relationship for improving ROM?

Answer 21

low load, long duration; if there isn’t time and ability to do so in the clinic, educate the pt for their HEP

Question 22

Ballistic stretching is beneficial to what population? Who is is contraindicated for?

Answer 22

athletes; elderly, sedentary, or pts w/ msk pathology

Question 23

what are some examples of stretching modes?

Answer 23

manual, mechanical, self, active,assisted

Question 24

Describe scenarios for when PNF stretching is appropriate vs inappropriate.

Answer 24

appropriate when muscle spasms are the limiting factor, inappropriate for long standing fibrotic contractures

Question 25

PNF requires these 3 green lights:

Answer 25

pt is cognitively capable of. following directions
pt has normal innervation and voluntary ctrl of the agonist or antagonist

Question 26

what are the 4 PNF techniques we covered in class?

Answer 26

hold-relax direct treatment
hold-relax indirect treatment
contract-relax direct treatment
contract-relax indirect treatment

Question 27

Define agonist and antagonist in a PNF context

Answer 27

antagonist: shortened muscle being stretched
agonist :muscle opposite shortened muscle, prime mover i that direction

Question 28

Describe HR Direct Treatment procedure

Answer 28

1. lengthen target muscle until resist/pt comfort
2. pt performs end-range submax isometric contraction (5-10)
3. pt voluntarily relaxes and is moved passively into new range

Question 29

Describe HR Indirect Treatment procedure

Answer 29

1.lengthen target muscle until resist/pt comfort
2. pt performs end-range submax isometric contraction (5-10s) of OPP muscle
3. pt voluntarily relaxes and is moved passively into new range

Question 30

Describe CR Direct Treatment

Answer 30

1.lengthen target muscle until resist/pt comfort
2. pt performs end-range submax slow concentric contraction (5-10s)
3. pt voluntarily relaxes and is moved passively into new range

Question 31

Describe CR Indirect Treatment

Answer 31

1.lengthen target muscle until resist/pt comfort
2. pt performs end-range submax slow concentric contractioin (5-10s) of OPP muscle
3. pt voluntarily relaxes and is moved passively into new range

Question 32

About how long do ROM and flexibility gains last after cessation of stretching?

Answer 32

only about 4 weeks