Week 7 - Flexibility Training Flashcards
What is flexibility?
amount of range of motion (ROM) about a joint or multiple joints at any age
Can flexibility exercises improve joint ROM at any age?
Yes! and flexibility is important at all ages.
The greatest decline in ROM with age is observed in…
spinal extension
What is range of motion (ROM)?
total excursion possible at a joint from the beginning of movement to end of it
Between the ages of 20-70, joint ROM in spinal extension, hip extension and knee flexion will decline by…
- spinal extension = 50%
- hip extension = 20%
- knee flexion = 2%
Why a loss of only 2% in knee flexion?
Because we use it every day when walking
On average, is the decrease in ROM greater in lower or upper extremity?
Lower.
In men and women, by how much does hamstring flexibility decrease per decade?
~14% per decade
What is joint stiffness?
sensation of difficulty moving a joint or the apparent loss of ROM. It often accompanies joint pain and swelling.
Does joint stiffness increase with age?
Yes
What does joint stiffness lead to?
decrease in ROM
Is joint stiffness one of the most common complaints of OA?
Yes
What is the vicious joint stiffness cycle?
joint pain –> decrease joint movement –> disuse atrophy –> joint stiffness –> joint pain
How do we break the joint stiffness vicious cycle?
Join pain –> maintain joint movement –> no or limited disuse atrophy –> no or limited joint stiffness –> maintain function
When is it better for OA to train flexibility?
in the afternoon. This is the window where symptoms go down.
What age-related factors contribute to stiffness in OA?
- decrease in muscle mass due to decrease in number of fibers
- increase in connective tissue surrounding and within muscle
- change in the chemical composition of the connective tissue matrix and collagen
What are the connective tissues involved in mobility (joint movement)?
ligament, tendons, fascia, joint capsules
Which changes in the connective tissue matrix and collagen chemical composition occur?
- loss of water content
- less extensible connective tissues
- connective tissues are more resistant to being deformed
What factors contribute to stiffness in OA?
breakdown or articular surfaces in the weight-bearing joints.
By age of 75, what is the percentage of OA that have osteoarthritic changes?
85% but some people do not report pain
Is pain directly coming from the breakdown or articular cartilage?
No, pain receptors are located in connective tissues + bones
What are the functional consequences of a loss of flexibility?
Affects ADLs:
- getting out of a car
- stepping off or on a curb
- bending down to pick smth up
- putting clothes on
Increase in number of functional limitations leads to loss of independence
Basic ADLs (self-care tasks)
DEATH:
- dressing/bathing
- eating
- ambulating (walking)
- toileting
- hygiene
Give examples of instrumental ADLs (not necessary for fundamental functioning but let an individual live independently in a community). Recall accronym.
SHAFT:
- shopping
- housekeeping
- accounting (managing money)
- food preparation/taking medications as prescribed
- telephone/transportation
When OA improve flexibility, they typically improve on…
muscular strength
What is the mechanism behind improvement of strength when training flexibility?
- effort spent to gain ROM is sufficient to challenge surrounding musculature and slightly increase strength
- increasing joint’s ROM may release the muscles to such an extent that they can be used more readily and more efficiently
What are critical ranges?
- absolute minimum ROM required to perform a certain activity
- important when designing PA programs to improve OA’s function
What are special considerations for critical ranges after knee/hip replacement surgery?
Knee: rarely flex past 110 degrees
Hip:
- no hip flexion past 90 degrees
- no internal rotation
- no hip adduction past midline (no leg crossing)
What is the purpose of OA sleeping with a pillow between their legs?
To prevent legs from crossing or internally rotating in the middle of the night
What are critical ranges of flexibility for putting on clothes overhead and which joint is used?
Shoulder joint: flexion, abduction and external rotation
What are critical ranges of flexibility for fastening or unfastening clothes in the back and which joint is used?
Shoulder joint: abduction, internal rotation, extension
What are critical ranges of flexibility for walking at 3mph (4.8 km/h) and which joint is used?
Hip joint: flexion and extension
Knee joint: flexion
Ankle joint: dorsiflexion
What are critical ranges of flexibility for ascending stairs and which joint is used?
Hip joint: flexion
Knee joint: flexion
Ankle joint: dorsiflexion
What are critical ranges of flexibility for getting down onto and up from floor, in and out of tub and which joint is used?
Hip joint: flexion
Knee joint: flexion
Ankle joint: dorsiflexion
How to put on a shirt with shoulder limitation?
- locate front of side and place shirt with this side down on lap
- Full sleeve all the way up along weak arm, past elbow
- Insert strong hand/arm into sleeve and also past the elbow
- Lean forward slightly and pull collar over head
Who benefits from the shirt trick?
OA with one-sided weakness or injury (painful shoulders) to done a shirt with ease.
Help people with a frozen shoulder or people that are hemiparesis.
Can OA with ROM deficits improve their flexibility?
Yes
What mode of flexibility exercises are used to improve ROM?
- traditional stretching exercises
- dance
- tai chi
- aquatic exercise (water reduces spasms)
What is the most important when performing flexibility exercises?
stressing the end range of joint motion (maximal distance a joint can be moved until a point of discomfort)
2 types of stretching
Static and dynamic
What are the characteristics of static stretching and when is it best used?
- targeting 1 muscle group
- moving into a specific range until end range
- holding 10-90sec.
- very safe type of stretching
- best for improving range of motion (best to do during cool-down)
What are the characteristics of dynamic stretching and when is it best used?
- moving through specific ROM + holding for 2-5 sec then returning to start position
- progressively increases joint ROM with each rep
- more functional to ADLs which are usually dynamic and require movement in multiple planes (reaching down into dishwasher, cleaning windows, etc.)
Best for warming up body and muscles
Static vs PNF: YA respond better to contract-relax stretching (PNF) while OA…
benefit more from static stretching
Dynamic stretches can be introduced…
- when muscles are warmer
- to participants with poor body awareness
(repeated limb movements seems to be helpful)
Examples of seated activities
- floor reach: bend forward toward floor
- seated tucked: slowly rotate trunk and head to right until you can see an imaginary car in right line. repeat with left
- seated abduction
- alternate knee to chest
Examples of standing activities.
- reach and curl
- picking apples
- climbing rope
- knees up, mother brown: exaggerate march
- side lunges with (a) spinal flexion, (b) arm reach across body and (c) forward arm reach
- walking with 6 to 7 alternating bouts of long and short strides
What are the 4 flexibility exercise guidelines?
- emphasize joints that have significant decreases in joint ROM (recall more likely to be lower limb joints)
- stretch to a point of gentle tension, but not pain
- do not jerk, bounce or force a stretch because this could lead to injury
- breathing
Should we breath during stretching?
- inhale before start of the stretch
- exhale during stretch
- breath evenly while holding the stretch
