Stretching/ROM (wk 7) Flashcards
Muscle length, joint integrity and the extensibility of periarticular soft tissues determine what?
Flexibility - Ability to move a joint smoothly and easily through an unrestricted, pain-free ROM
What is functional ROM?
Enough available ROM for functional activities
T/F Functional ROM equals full or normal ROM.
False, functional ROM does not necessarily= full or normal ROM
T/F Decreased flexibility can range from mild muscle shortening to irreversible contractures.
True
Potential causes of decreased flexibility:
- Prolonged immobilization of a body segment
- Sedentary lifestyle
- Postural malalignment and muscle imbalances
- Impaired muscle performance (weakness) associated with musculoskeletal or neuromuscular disorders
- Tissue trauma resulting in inflammation and pain
- Congenital or acquired deformities
Immobilization can lead to decay of what and decrease in what 3 things?
- Decay of contractile protein in the immobilized muscle
- Decreases in muscle fiber diameter
- Decrease in number of myofibrils
- Decrease in intramuscular capillary density
As the immobilized muscle atrophies, increase in what two types of tissues occurs?
Fibrous and fatty tissue in muscle causing weakness and restricted ROM
What occurs to the muscle’s capacity to produce maximum tension at its normal resting length if immobilization in a shortened position occurs?
decreases the muscle’s capacity to produce maximum tension at its normal resting length as it contracts
Why would muscles be immobilized in a lengthened position in some surgical procedures, serial casts, or the use of a dynamic splint?
stretch a long-standing contracture and increase ROM
What type of formation will occur because of the greater cross-linking between disorganized collagen fibers in immobilized tissues?
Adhesion formation
ROM interventions are administered to ____ joint and soft tissue mobility
maintain
What is movement of a segment within the unrestricted ROM that is produced entirely by an external force; there is little to no voluntary muscle contraction?
PROM
What is movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint?
AROM
What is a type of AROM in which assistance is provided manually or mechanically by an outside force?
AAROM (active assistive)
Indications for using PROM?
- Acute, inflamed tissue
2. Patient is not able to or not supposed to actively move a segment(s) of the body
What are the goals of PROM?
- Maintain joint and connective tissue mobility
- Minimize the effects of the formation of contractures
- Maintain mechanical elasticity of muscle
- Assist circulation and vascular dynamics
- Enhance synovial movement for cartilage nutrition and diffusion of materials in the joint
- Decrease or inhibit pain
- Assist with the healing process after injury or surgery
PROM does not do what 3 things?
- Prevent muscle atrophy
- Increase strength or endurance
- Assist circulation to the extent that active, voluntary muscle contraction does
What is the indication for AROM?
Patient is able to contract the muscles actively and move a segment with or without assistance
What is the indication for AAROM?
Patient has weak musculature and is unable to move a joint through the desired range (usually against gravity)
When a segment of the body is immobilized for a period of time, AROM is used on what regions to maintain what?
on the regions above and below the immobilized segment to maintain the areas in as normal a condition as possible
If there is significant inflammation or contraindication to active motion would you use AROM?
No
T/F Same goals as PROM can be met with AROM
True
What are the specific goals of AROM?
- Maintain physiological elasticity and contractility of the participating muscles
- Provide sensory feedback from the contracting muscles
- Provide a stimulus for bone and joint tissue integrity
- Increase circulation and prevent thrombus formation
- Develop coordination and motor skills for functional activities
What are 2 limitations for AROM?
- For strong muscles, active ROM does not maintain or increase strength
- Does not develop skill or coordination except in the movement patterns used
What are 3 ROM Precautions/Contraindications?
- When motion is disruptive to the healing process- Signs of too much or the wrong motion include increased pain, inflammation, loss of ROM
- Immediately after acute tears, fractures, and surgery
- When patient response or the condition is life-threatening
What is the purpose of stretching?
restore or increase the extensibility of the muscle-tendon unit
What is the most appropriate type of stretching early in rehabilitation?
manual stretching and joint mobilizations may be the most appropriate
What is the most appropriate type of stretching later in rehabilitation?
self-stretching and self mobilization exercises performed independently by a patient
What are the 3 types of stretching?
PROM
AROM
AAROM
T/F Deformation (stretch) requires breaking of collagen bonds and realignment of the fibers for there to be permanent increased flexibility
True
During stretch, what type of mechanical disruption are you applying to the tissues?
disruption of the cross-bridges occurs as the filaments slide apart, leading to abrupt lengthening of the sarcomeres
If the lengthened sarcomeres return to resting length after stretch force is release, you were stretching in what region of stress strain curve?
Elastic region
How do muscle spindles react to length changes of tissues?
stretch force is applied muscle spindles sense the length changes and activate the stretch reflex by increasing tension in the muscle being stretched
Describe reciprocal inhibition of stretch reflex:
stretch reflex is activated in a muscle being lengthened, inhibition in the muscle on the opposite side of the joint may occur
T/F Slowly applied, low-intensity, prolonged stretch is preferable to minimize activation of the stretch reflex
True
Describe autogenic inhibition of the golgi tendon organ during tension
When tension develops, the GTO fires and decreases tension in the muscle-tendon unit being stretched (autogenic inhibition), enabling a muscle to be elongated against less muscle tension
If a low-intensity, slow stretch force is applied, what happens to the stretch reflex (muscle spindles) and the GTO?
the stretch reflex (muscle spindles) is less likely to be activated as the GTO fires and inhibits tension
Describe the stretch method of creep:
When a load is applied for an extended period of time, the tissue elongates, and does not return to its original length
Low load long duration stretched (decrease/increase) the deformation of connective tissue and allow what to occur to the collagen fiber bonds?
Increase
allow gradual rearrangement of collagen fiber bonds (remodeling)
T/F Recovery from creep and single strain occur at the same speed
False, Complete recovery from creep may occur over time, but not as rapidly as a single strain
Describe cyclic loading:
- repetitive loading of tissue leads to increased heat and increased tissue extensibility (requires min load for deformation)
Why is time allowed between bouts of cyclic stretching?
to allow for remodeling and healing in the new range
Contraindications of stretching:
- Hard end feel – bone on bone -> will break bone
- Recent fracture in the area
- Acute inflammation or infection in the area – don’t want to increase blood flow to area
- Hematoma in the area
- Hypermobility in the area
- Shortened tissues enable a patient with paralysis or severe muscle weakness to perform a functional activity
Decreased flexibility has been shown to be associated with a greater risk of what type of injuries?
musculotendinous injuries in the lower extremities
systematic review indicates acute stretching has what effect on muscles performance immediately following?
has no effect or decreases
Participating in a stretching program on a regular basis has been shown to improve what two things?
- Gait economy
2. Enhance sprinting and jumping abilities
Describe stabilization during manual stretching:
physical therapist commonly stabilize proximally and move distally
Describe stabilization during self-stretching:
often the distal attachment that is stabilized as the proximal segment moves
What type of intensity and load results in optimal rates of improvement in ROM without exposing tissues to excessive loads and potential injury?
Low load long duration stretch
T/F Low-intensity stretching has been shown to elongate dense connective tissue (contractures), more effectively and with less soft tissue damage than high-intensity
True
How long do you hold a progressive static stretch?
30-60 s
How long do you hold a cyclic stretch?
10-15 s
If an area is easily irritated, what type of stretch should be used?
cyclic stretching
What is prolonged low-intensity mechanical stretching?
Low load force applied over 15-30 minutes to several hours (i.e. gravity or 5-15lb to 10% body weight)
WHat is a dynamic splint?
Maintains limb position at end range and often applied for 8-10 hours
What is serial casting? When often used?
- Cast applied for 5-7 days then removed and new one reapplied with limb in newly gained ROM position
- Extreme contractures often
Describe slow speed stretch:
- Minimizes muscle tension and reduces risk of injury to tissues and post stretch muscle soreness
- Easier for the therapist or patient to control
Describe ballistic stretching:
high-velocity movements
what two populations not recommended for ballistic stretching?
elderly or sedentary individuals or patients with musculoskeletal pathology or chronic contractures
T/F Static stretching and ballistic stretching have both shown to improve flexibility equally
True
T/F Few studies have attempted to determine the optimal frequency of stretching within a day or a week, most suggestions are based on opinion
True
What type of manual stretching is appropriate if a patient cannot perform self-stretching safely/effectively?
Passive
What type of manual stretching is appropriate if a patient has poor control of the body segment, particularly if the patient is apprehensive about moving and is having difficulty relaxing?
Assisted manual
What is mechanical stretching?
utilizing a piece of equipment or device to assist with stretching
Duration ranges of mechanical stretching?
from 15-30 minutes to 8-10 hours at a time
T/F Mechanical stretching shown to be more effective than manual stretching
True
If AROM > PROM, what type of stretch should they perform?
self-stretch
What type of stretching integrates active muscle contractions into stretching with intention of inhibiting muscle activation of the muscle being stretched and to keep it relaxed?
Proprioceptive Neuromuscular Facilitation (PNF)
When is PNF stretching more appropriate?
when muscle spasm limits motion
When is PNF less appropriate?
stretching long-standing, fibrotic contractures
PNF stretching techniques requirements:
- Patient has normal innervation and voluntary control of either the shortened muscle (the range-limiting target muscle) or the muscle on the opposite side of the joint
- Patient is cognitively intact enough to follow the directions
T/F Studies show PNF stretching yields greater gains in ROM than static stretching
True
What muscle is the antagonist?
the range-limiting muscle, shortened muscle being stretched
What muscle is the agonist?
the muscle opposite the range-limiting target muscle, prime mover in that direction
Autogenic inhibition relies on what?
GTOs
Describe the mechanism behind autogenic PNF stretching:
- Tension causes activation of Ib afferent fibers within the GTOs
- Afferent fibers send signals to the spinal cord causing activation of inhibitory interneurons within the spinal cord
- Interneurons place an inhibitory stimulus upon the alpha motoneuron
- Decreasing the nerves’ excitability and decreasing the muscles’ efferent motor drive in the antagonist
Describe the mechanism behind reciprocal inhibition of agonist muscle during PNF:
- Ia afferent fibers from agonist enter the spinal cord and give off collateral branches that interact with interneurons in the spine
- Interneurons send signals to the alpha-motor neuron in the GTOs of the antagonist muscle
- Effect of this connection is inhibitory and causes relaxation of the antagonist muscle
Antagonist Contract/Hold Relax (autogenic inhibition) steps:
- Range-limiting target muscle is first lengthened to the point of tissue resistance or to the extent that is comfortable for the patient
- Patient then performs a prestretch, end-range, submaximal isometric contraction (for about 5-10 seconds) of the range limiting target muscle (antagonist)
- Followed by voluntary relaxation of the range-limiting target muscle (antagonist)
- Limb is then moved into the new range as the antagonist muscle is elongated
Agonist Contraction/Contract Relax (reciprocal inhibition):
- Range-limiting target muscle is first lengthened to the point of tissue resistance or to the extent that is comfortable for the patient
- Patient submaximally isometrically contracts the muscle opposite the range-limiting muscle (agonist) (for about 5-10 seconds) of the range limiting target muscle (antagonist)
- Followed by voluntary relaxation of the range-limiting target muscle (antagonist)
- Limb is then moved into the new range as the antagonist muscle is elongated
Agonist contraction technique especially effective when what?
when a patient cannot generate a strong, pain-free contraction of the antagonist, which must be done during the HR procedures
PNF stretching is less effective in reducing what?
less effective in reducing chronic contractures
PNF stretching is least effective is what?
if a patient has close to normal flexibility
After new ROM is gained, what should you do?
- Strengthen in new ROM
2. appropriate balance of strength between agonists and antagonists throughout the ROM
T/F Gains in flexibility and ROM achieved last 2 weeks after cessation of stretching
False, 4 weeks
