Exam I, Manske Chapter 1-4, 15 and Kisner Chapter 1-5 (ROM, Stretching, Joint Mobs)

Maitland grades of oscillation

1. Grade I 2. Grade II 3. Grade III 4. Grade IV 5. Grade V

General flexibility tests

1. Sit and reach test 2. Standing toe touch for back and hamstrings test 3. Seated hip external rotation test (butterfly) 4. Standing recurvatum test

Random practice

Slight variations of the same task are carried out in an unpredictable order. More challenging, better for Associative Stage to get skill retention.

Grade IV oscillation

Small amplitude rhythmic oscillation that occurs at the very end range of the available joint motion, stressed into the tissue resistance. PTA can perform.

Types of feedback for motor learning

1. Knowledge of results feedback 2. Knowledge of performance feedback 3. Intrinsic feedback 4. Augmented feedback 5. Concurrent feedback 6. Immediate, delayed or summary feedback 7. Intermittent vs. continuous feedback

Grade I oscillation

Small amplitude rhythmic oscillations are performed at the beginning of the ROM. PTA can perform.

Indications for joint mobilization

1. Pain, muscle guarding and spasm 2. Reversible joint hypomobility 3. Positional faults caused by traumatic injury, muscle imbalances and periods of immobility. 4. Progressive limitations (from disease) 5. Functional immobility b/c patient cannot functionally move a joint for a period of time.

Types of practice

1. Part vs. whole practice 2. Blocked, random, and random-blocked practice 3. Physical vs. mental practice

Types of ROM exercise

1. Passive range of motion (PROM) 2. Active range of motion (AROM) 3. Active assisted range of motion (AAROM)

Types of Therapeutic Exercise

- Aerobic conditioning/reconditioning - Muscle performance exercise: strength power, endurance - Mobility Exercise and Stretching techniques - Neuromuscular control (Inhibitory/Facilitation techniques) - Balance, coordination and agility training - Postural control /stability exercise - Relaxation exercise - Breathing exercise/ventilatory retraining - Task specific functional training

Aspects of Physical Function

- Balance/Postural Equilibrium (move w/o falling) - Cardiopulmonary/Endurance (perform repetitive movements w/o tiring) - Muscle Performance (ability to produce tension and do work) - Mobility/Flexibility (move w/o restriction through ROM) - Neuromuscular Control/Coordination (use of sensory and motor systems) - Stability (hold a body part in stationary position)

Benefits of a warm up before stretching

- Blood Flow to working muscles is increased. - Temperature in working muscles is increased - Cardiovascular response to sudden dynamic exercise is improved - Breakdown of oxyhemoglobin for the delivery of oxygen to the working muscles is increased

Advantages of static stretching

- Decreased chance of exceeding strain limits - Decreased energy requirements - Decreased potential for muscle soreness - Easy to teach patients - Safe for patients to perform independently

Advantages of Proprioceptive Neuromuscular Facilitation (PNF) stretching

- Found to be more effective than static stretching

Benefits of stretching

- Increased flexibility if long term and routine - Relief of muscle soreness (though conflicting research) - Muscle relaxation - Injury prevention - Performance enhancement

Disadvantages of Proprioceptive Neuromuscular Facilitation (PNF) stretching

- More time consuming - Requires a skilled professional to perform it for it to be effective - May lead to mild complaints or muscle soreness

Goals of static stretching

- Prevent or minimize the risk of soft-tissue injury from participation in sports of physical activity - Improve movement and increase flexibility - Prevent contracture

Professionalism in PT core values

1. Accountability 2. Altruism 3. Compassion/caring 4. Excellence 5. Integrity 6. Professional duty 7. Social Responsibility

Passive range of motion (PROM) indications

1. Areas where there is acute, inflamed tissue 2. When a patient is not able to or not supposed to actively move a segment or segments of the body

Normal end feels

1. Bone to bone end feel 2. Soft tissue approximation end feel 3. Hard or springy-tissue stretch end feel

Stages of motor learning

1. Cognitive stage 2. Associative stage 3. Autonomous stage

Properties of connective tissue

1. Collagen 2. Elastin

Types of Proprioceptive Neuromuscular Facilitation (PNF) stretches

1. Contract relax 2. Contract relax with agonist contraction (don't need to know details) 3. Hold relax

Types of static stretching

1. Passive static stretch- force is applied externally 2. Active static stretch- an opposing muscle action is used to aid the stretch

Contract relax (PNF stretch)

1. Patient actively contracts restricted muscle against manual resistance for 5-8 seconds at end ROM. 2. Relaxes. 3. Therapist passively moves their limb to new ROM, holding stretch for 10-30 seconds. 4. Repeat until have no more ROM gain.

Gentile's Taxonomy of Motor Tasks

1. Environment in which the task is performed (closed/open) 2. Inter-trial variability of the environment (absent/present) 3. The need for person's body to move or remain stationary during the task (stable/transport) 4. Presence or absence of manipulation of objects during the task.

Shoulder capsular pattern

1. External rotation (most limited) 2. Abduction (less limited) 3. Internal rotation (still less limited) 4. Flexion (least limited)

Contraindications for joint mobilization

1. Hypermobility (necrosis of ligaments or capsule) 2. Joint effusion (swelling 2° trauma or disease) 3. Inflammation from acute injury (Grade I) 4. Conditions requiring special precautions (malignancy, bone disease, unhealed fracture, excessive pain, total joint replacements, arthritis, newly formed or weakened connective tissue, elderly). 5. Anatomy and physiology factors listed in table 15-4 6. Clinical and patient factors listed in Box 15-1

Possible causes of non-capsular patterns

1. Ligament adhesions 2. Internal derangements (displaced or loose cartilaginous or bony fragments) 3. Extra-articular lesions (result from injury outside joint)

Passive range of motion (PROM) goals

1. Maintain joint and connective tissue mobility 2. Minimize the effects of the formation of contractures 3. Maintain mechanical elasticity of muscle 4. Assist circulation 5. Enhance synovial movement for cartilage nutrition 6. Decrease pain 7. Assist with healing 8. Help maintain patient kinesthetics

Active/active assisted range of motion (AROM/AAROM) goals

1. Maintain physiological elasticity and contractility of muscles. 2. Provide sensory feedback from the contracting muscles. 3. Provide a stimulus for bone and joint tissue integrity 4. Increase circulation and prevent thrombus 5. Develop coordination and motor skills for functional activities.

How to measure flexibility

1. Measure joint ROM with a universal goniometer. 2. Measure joint stability with special tests that assess ligament stability, joint capsule flexibility etc.

Principles of stretching

1. Mechanical effects 2. Neurophysiologic effects

Abnormal end feels

1. Muscle spasm end feel 2. Springy block end feel 3. Empty end feel 4. Loose end feel 5. Capsular end feel

Sensory receptors that monitor muscle activity

1. Muscle spindles 2. Golgi tendon organ

Types of end feels

1. Normal end feels 2. Abnormal end feels

Types of probing questions

1. Open ended questions 2. Closed ended questions 3. Summary- type statements

Goals of therapeutic exercise

1. Remediate or prevent impairments 2. Improve, restore, or enhance physical function 3. Prevent or reduce health-related risk factors 4. Optimize overall health, fitness, or sense of well being.

Types of accessory (arthrokinematic) movements

1. Roll 2. Slide/glide 3. Spin

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: shoulder flexion (shoulder motion that occurs when you reach for something above your head)

1. Rule #1 (convex moving on fixed concave = opposite) 2. Anterior to posterior movement (arthro) 3. Posterior to anterior movement (osteo) Mobilization: posterior glide to improve motion.

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: ankle plantar flexion (ankle motion that occurs when push gas pedal on car)

1. Rule #1 (convex moving on fixed concave = opposite) 2. Posterior to anterior movement (arthro) 3. Anterior to posterior movement (osteo) Mobilization: anterior glide to improve motion.

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: wrist extension (wrist motion that occurs when you admire your manicure)

1. Rule #1 (convex moving on fixed concave = opposite) 2. Posterior to anterior movement (arthro) 3. Anterior to posterior movement (osteo) Mobilization: anterior glide to improve motion.

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: shoulder abduction (shoulder motion that occurs when you make the "M" for the "YMCA" song)

1. Rule #1 (convex moving on fixed concave = opposite) 2. Superior to inferior movement (arthro) 3. Inferior to superior movement (osteo) Mobilization: inferior glide to improve motion.

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: knee extension- closed chain (knee motion that occurs from sitting to standing)

1. Rule #1 (convex moving on fixed concave = opposite) 2. Anterior to posterior movement (arthro) 3. Posterior to anterior movement (osteo) Mobilization: posterior glide to improve knee extension.

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: forearm supination (the forearm motion that occurs when you start your car)

1. Rule #2 (concave moving on fixed convex = same) 2. Anterior to posterior movement (arthro) 3. Anterior to posterior movement (osteo) Mobilization: posterior glide to improve motion.

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: For: knee extension- open chain (knee motion that occurs when you kick a ball)

1. Rule #2 (concave moving on fixed convex = same) 2. Posterior to anterior movement (arthro) 3. Posterior to anterior movement (osteo) Mobilization: anterior glide to improve motion.

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: elbow flexion (elbow motion that occurs when you are taking a bite out of an apple)

1. Rule #2 (concave moving on fixed convex = same) 2. Posterior to anterior movement (arthro) 3. Posterior to anterior movement (osteo) Mobilization: anterior glide to improve motion.

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: hip flexion (hip motion that occurs when you bend over to touch your toes)

1. Rule #2 (concave moving on fixed convex = same) 2. Posterior to anterior movement (arthro) 3. Posterior to anterior movement (osteo) Mobilization: anterior glide to improve motion.

Stage/grades of traction

1. Stage/grade I 2. Stage/grade II 3. Stage/grade III

Types of stretching techniques

1. Static stretching 2. Ballistic stretching 3. Dynamic stretching 4. Proprioceptive Neuromuscular Facilitation (PNF) stretching

Effects of joint mobilization

1. Stimulates biological activity by moving synovial fluid which brings nutrients to avascular articular cartilage and menisci. 2. Maintains extensibility and tensile strength of tissues within and surrounding the joint. 3. Improves kinesthetic awareness and proprioception. Joint receptors transmit info to CNS about joint position & speed of movement.

Components of flexibility

1. Stretching or elongation of soft tissue 2. Joint ROM

Types of stress

1. Tension 2. Compression 3. Shear

Critical components for stretching injured soft tissue

1. Time - scar depends on time and stress 2. Fragility of new immature adaptable scar- takes almost a year to get back to 100% strength 3. Appropriately applied stress for remodeling unorganized scar- new scar tissue aligns itself along lines of stress. 4. Most effective technique- low load, long duration stretching of contractures with thermal agents to preheat tissues

Types of collagen (most common)

1. Type I- thick, gathered in bundles, little elongation 2. Type II-thinner, less tensile strength, found in cartilage and nucleus pulposus 3. Type III- expansible organs

Active/active assisted range of motion (AROM/AAROM) indications

1. Whenever a patient is able to contract muscle actively and move with or w/out assistance. 2. When patient has weak muscle and is unable to move thru the full ROM. 3. AROM is often used for aerobic conditioning 4. When a body part is immobilized AROM is used above and below it to maintain ROM.

Active/active assisted range of motion (AROM/AAROM) limitations

1. Won't maintain or increase strength for strong muscles (3+/5) 2. Won't develop skill or coordination except in the movement patterns used

Passive range of motion (PROM) limitations

1. Won't prevent muscle atrophy 2. Won't increase strength or endurance of muscle 3. Won't assist circulation to the extent that active voluntary muscle contractions do

Blocked practice

The same task or series of exercises is performed repeatedly under the same conditions in a predictable order. Better in the Cognitive Stage to improve performance.

In which phase of motor learning is the patient learning how to do the task, making lots of mistakes, needing knowledge of results feedback because they don't realize when they make a mistake? A. Associative Phase B. Cognitive Phase C. Initial learning D. Autonomous Phase

B. Cognitive Phase

Adhesion

A development of scar tissue between two or more structures that causes limitation of motion, such as near a joint. Sometimes desirable if the MD is trying to add stability to a hypermobile joint.

Grade II oscillation

A larger amplitude oscillation from the beginning of the ROM to near midrange. PTA can perform.

Viscosity

A material's ability to resist a change in form or to dampen shearing forces, such as a change in length. Tissues exhibiting viscosity have time dependent and rate dependent properties when forces are applied to them.

Elasticity

A material's ability to return to its original state following strain or deformation after a removal of a stress or load. It stretches and goes back.

Grade V oscillation

A small amplitude high velocity thrust at the end of the available ROM that is used to snap adhesions or manipulate tissue. NOT to be performed by PTA's.

Stage/grade I traction

A small amplitude traction is applied when no stress is placed on capsule. The minimal force used is not enough to separate the joint surface, rather loosen it. Also called piccolo traction.

Scar tissue

A union of two injured or torn parts that replaces normal tissue after surgery/injury.

Exaggerated, activity specific movements that are done under control to prepare muscles for a specific sport are called: A. Dynamic stretches B. Ballistic stretches C. Active static stretches D. PNF hold relax stretches E. PNF contract relax stretches

A. Dynamic stretches

Standards of Ethical Conduct for PTA's

Tool developed by the APTA to delineate ethical obligations of all PTA's. There are 8 standards.

Recovery

Ability of tissues to return to their previous resting state.

Why is a muscle better when warm?

Able to contract more forcefully and relax more quickly, also ROM increases. Risk of tissue damage also decreases.

Loose end feel

Abnormal end feel associated with joint hypermobility. No resistance felt at normal end ROM.

Capsular end feel

Abnormal end feel where feel is similar to normal tissue stretch but elastic resistance is felt before the normal ROM. Limited by a tight joint capsule.

Springy block end feel

Abnormal end feel where full ROM is limited by a soft or springy sensation sometimes with pain. Example: if a meniscus is torn in the knee.

Empty end feel

Abnormal end feel where motion very limited by significant pain without muscle spasm. Can't bring joint to end of ROM so don't know if limitation beyond the point of pain or determine type of tissue causing issue.

Muscle spasm end feel

Abnormal end feel where pain accompanied by a sudden halt of movement that prevents ROM.

Stretch tolerance

Accommodation to the discomfort of stretching over time. With this philosophy, the aim of stretching is to inhibit the reflex activity, subsequently decreasing the resistance and improving ROM.

Mobilization

An attempt to restore joint motion or mobility, or decrease pain associated with joint structures using manual, passive accessory joint movement. Can also be called manipulation.

Loose-packed position

Any joint position other than close-packed. There is an increase in intracapsular space and ligaments are relaxed, so its ideal for joint mobilizations.

Plastic region/range

Area on the stress strain curve beyond the elastic region/range to the point of failure, where strain begins to cause permanent tissue deformation. The microscopic failure of tissue and rupturing of fibers results in increased changes in tissue length, they will not return to their original resting length when stress is removed.

Failure

Area on the stress strain curve beyond the plastic region/range where tissue ruptures and loses its integrity.

Elastic limit

Area on the stress strain curve that represents the end of the elastic region/range. Beyond this, tissue does not return to original shape and size.

Toe region

Area on the stress strain curve that shows that a slightly stretched tissue (ligament) produces only small amount of tension and how the slack will be pulled taut before a stretch is encountered. The range where most functional activity happens.

Elastic region/range

Area on the stress strain curve where strain is directly proportional to the ability of tissue to resist the force. Occurs when tissue is taken to the end of its ROM and gentle stretch is applied. The tissue can still recover and return to its original shape and size when load is released in this region. Example: a rubberband stretching.

Roll

Arthrokinematic movement when one bone rolls on another. New points on one surface meet new points on the other surface. Happens when joint surfaces are incongruent.

Slide/glide

Arthrokinematic movement when one bone slides across another. The same point on one surface comes in contact with new points on the opposing surface. Direction of slide depends on concave convex rule. Most common motion.

Spin

Arthrokinematic movement when one bone spins on another. The same point on one surface creates an arc of a circle as the bone spins. Usually happens in combination with rolling and glide/sliding. Examples: hip & shoulder flexion/extension, pronation/supination, rotation.

Active assisted range of motion (AAROM)

Assistance is provided manually or mechanically by an outside force.

A large amplitude joint mobilization oscillation that occurs from the start of the available motion to the mid-range of motion is a: A. Grade I Mobilization B. Grade II Mobilization C. Grade III Mobilization D. Grade IV mobilization E. Grade V Mobilization

B. Grade II Mobilization

When the patient is in a lunge position and shifts weight forward on the front leg, they are stretching the: A. quadriceps B. iliopsoas C. gluteus maximus D. hamstrings E. gluteus medius

B. iliopsoas

The two viscoelastic properties of connective tissue are: A. rate and tension B. plastic and elastic deformation C. stress and strain D. the muscle spindle and golgi tendon organ

B. plastic and elastic deformation

Disadvantages of ballistic stretching

Cannot be used on injured tissue because it potentially places the tissue at risk due to the bouncing, jerking movements at the end of the ROM to stretch mm. Increased risk of injury and difficult for patients to perform correctly.

Which of the following is true about the golgi tendon organ? A. It is what is activated when deep tendon reflexes are tested. B. It is located deep within the muscle tissue, parallel to the muscle fibers C. When there is excessive tension at the tendon of a muscle, it inhibits that muscle and facilitates the antagonist to contract D. It is a sensory receptor that responds to a quick stretch of a muscle E. A and B are true

C. When there is excessive tension at the tendon of a muscle, it inhibits that muscle and facilitates the antagonist to contract

What is the accessory (arthrokinematic) motion that occurs with shoulder abduction? A. anterior glide B. posterior glide C. inferior glide D. spin E. posterior roll

C. inferior glide

An example of concave/convex rule #1 is: A. elbow extension (humeroulnar joint) B. Knee flexion (open chain) C. wrist flexion D. Hip flexion- bending over to touch your toes E. all of the above are rule #1

C. wrist flexion

Devices used to perform active assisted range of motion (AAROM)

Can be performed using therapist, own body parts for help, a cane, towels, pulleys, wobble or skateboard, etc.

Viscoelasticity

Combination of the properties of viscosity and elasticity.

Motor learning

Complex set of internal processes that involves the acquisition and relatively permanent retention of a skilled movement or task through practice.

Concave-convex rule #2 short

Concave moving on fixed convex = same.

Concurrent feedback

Concurrent occurs during the performance of the task, "real-time". Post-response occurs after completing the task.

Concave-convex rule #1 short

Convex moving on fixed concave = opposite.

Stress strain curve

Curve that represents the mechanical strength of structures and is used to interpret what is happening to connective tissue under stress from externally applied loads. Shows the relationship between the stress and strain all the way to the point of tissue failure.

Which piece of equipment works best for AAROM for weak, sagittal plane UE and LE motions? A. Reciprocal pulleys B. Codman's exercises C. Wobble board D. Powder Board E. CPM

D. Powder Board

Scar tissue that develops between two separate structures that limits AROM is called a contracture. T. True F. False

F. False

Standing recurvatum test

Flexibility test where measure knee hyperextension in standing and supine.

Sit and reach test

Flexibility test where sit in long sitting with UE's in 90 degree of shoulder flexion, then try to reach toes.

To stretch the triceps you would put the UE in a position of: A. Shoulder extension with elbow extension B. shoulder flexion with elbow extension C. shoulder extension with elbow flexion D. Shoulder flexion with elbow flexion

D. Shoulder flexion with elbow flexion

Seated hip external rotation test (butterfly)

Flexibility test where sit with hips externally rotated and feet together.

Standing toe touch for back and hamstrings test

Flexibility test where stand, then bend at hips to touch toes.

Hypomobility

Decreased mobility or restricted motion.

Give an example of a closed ended question

Did your pain increase after doing your exercises? Did you work today? Do you live alone?

Closed ended questions

Directed towards finding facts and obtaining specific responses. (Yes/No)

Ballistic stretching

Dynamic, high velocity and motions at the end ROM to stretch but also facilitate a muscle contraction. Usually seen as bounce at ending ROM. Often used before and during sporting events by athletes.

Your patient is limited in shoulder extension due to a tight joint capsule. Which rule is this and what type of joint mobilization would you do? A. Rule #1, posterior glide, Grade III or IV B. Rule #2, posterior glide Grade I or II C. Rule #1, anterior glide Grade I or II D. Rule #2, anterior glide Grade III or IV E. Rule #1, anterior glide Grade III or IV

E. Rule #1, anterior glide Grade III or IV

What is the capsular pattern for the shoulder?

ER most limited, then ABD , then IR then Flexion.

Knowledge of performance feedback

Either intrinsic feedback sensed during a task or immediate extrinsic feedback about the quality of the performance of a motor task.

Stretching

Elongating the muscles and tendons to the end of the available ROM. Applying a tensile force to a muscle results in a transient deformation, which elongates the musculotendinous unit, resulting in a stretch. The amount that takes place depends on the type of connective tissue present.

Muscle spindles

Excitatory fibers located within the muscle belly that are responds to rapid changes in muscle length.

Ballistic stretching and dynamic stretching are the same thing. T. True F. False

F. False

Icing a muscle prior to stretching has proven to improve plastic deformation and increase ROM. T. True F. False

F. False

If a patient's AROM for knee flexion has improved from 84 degrees at the eval to 118 degrees after 4 weeks of bid stretching, elastic deformation has occurred at their soft tissue. T. True F. False

F. False

Maitland grades of joint mobilization

Grades of physiologic and accessory joint motions used in mobilization. Velocity, oscillation, and amplitude are used to describe degree of force and rate of motion applied during different grades. There are 5 grades.

Function of muscle spindles

Helps prevent muscles from stretching too far or too fast. If a muscle is stretched too quickly, sends a message to higher brain centers and spinal cord which signals muscle to contract. Agonist contracts.

1. Concave-convex rule 2. Direction of arthrokinematic glide 3. Osteokinematic movement For: hip, knee, and ankle motion that occurs when you do a squat

Hip: 1. Rule #1 (convex moving on fixed concave = opposite) 2. Posterior to anterior movement (arthro) 3. Anterior to posterior movement (osteo) Knee: 1. Rule #1 (convex moving on fixed concave = opposite) 2. Posterior to anterior movement (arthro) 3. Anterior to posterior movement (osteo) Ankle: 1. Rule #2 (concave moving on fixed convex = same) 2. Posterior to anterior movement (arthro) 3. Posterior to anterior movement (osteo)

Duration of stretching

Hold in fully elongated position 10-60 seconds.

Capsular patterns

How certain limitations of motion are caused by lesions or injury specific to the joint capsule or synovial tissues of a joint. All joints controlled by muscle activity have a characteristic capsular pattern of limitation.

Immediate, delayed or summary feedback

Immediate -given directly after task is completed. Delayed- given after a short interval of time has passed. Summary information that is given about the average performance of several repetitions.

Knowledge of results feedback

Immediate post-task, extrinsic feedback about the outcome of the motor task.

Golgi tendon organ

Inhibitory sensory receptors located in series with the muscle fibers and within the myotendinous junction. Responds to excessive and prolonged stretches and by muscle contractions.

Open ended questions

Invites the patient to share feelings, thoughts and opinions. Promotes personal interaction between pt and PTA.

Body transport

Involves patient moving from one place to another. Example: transfer, bed mobility, ambulation

Grade III oscillation

Large amplitude occurs from midrange to end of the available range, stressed in the tissue resistance. PTA can perform.

Associative stage

Learning how to do the task. Fine tuning of the task with less errors. Patient can detect errors but may not know how to correct.

Cognitive stage

Learning what to do. Patient need to concentrate on each detail of the task. Lots of error with feedback needed to correct.

Hard or springy-tissue stretch end feel

Normal end feel that results in "elastic resistance" or rising tension that stops the motion. Most common normal feel. Example: knee extension and wrist flexion.

Bone to bone end feel

Normal end feel when sudden, hard non-yielding sensation at end ROM. Generally not painful. Example: elbow extension.

Body stable

Maintaining the body in a stationary position, simple task usually done in a closed environment. Example: sitting, standing

Manipulation of objects

Makes a task much more challenging. Adding a functional activity or skills to a task, especially in an open environment can be very difficult. Example: standing on a bosu ball and then playing catch

Function of golgi tendon organ

Monitors muscle contraction. When a muscle is stretched, sends a message to the spinal cord to inhibit contraction. This causes a reflex response which protects against damage to the tissue. Agonist shuts off, antagonist contracts.

Present inter-trial variability

More challenging when there is variability in the environmental conditions and the task. Example: elliptical machine when program set to random

Static stretching

Most common type of stretching used to safely increase joint ROM. PT sustains a controlled stretch by placing a muscle in a fully elongated position and holding the position for at least 30 seconds.

Part practice

Most effective in cognitive stage. Breaking the task up into parts. More difficult components are practiced.

Practice

Motor learning occurs as a result of this. The amount, type and variability of directly affect patient success and retention.

Accessory (arthrokinematic) movement

Movement that happens at the joint surfaces during physiologic (osteokinematic) movement. Rarely occur alone, more in combination with each other. Not under voluntary control.

Passive range of motion (PROM)

Movement within the unrestricted ROM that is produced entirely by an external force. There is little or no voluntary muscle contraction. External force may be from gravity, a machine, a PTA or another part of the individual's body.

Active range of motion (AROM)

Movement within unrestricted motion for a segment that is produced by active contraction of the mm crossing that joint.

What structures influence flexibility?

Muscles, tendons, ligaments, skin, joint capsule and bone geometry.

Warm up and stretching

Necessary to help prepare the tissue for activity by increasing core body and intramuscular temperature. Usually lasts 10 - 25 minutes and should be intense enough to cause an increase in body temp but not so intense to cause fatigue.

Soft tissue approximation end feel

Normal end feel that results from muscle or soft tissue compression stopping the motion during joint flexion. Example: elbow and knee flexion.

Open environment

Objects, other people or the support surface are in motion during the task. The movement is not under the control of the patient.

Stress relaxation

Occurs when a tissue experiences a constant strain but no deformation or change in length occurs. A high initial stress placed on a tissue decreases over time until equilibrium is reached and the stress equals zero, resulting in relaxation of the tissue.

Whole practice

Performing the whole task from start to finish. Better for associative phase, especially for task like walking or stairs that require speed or momentum.

Plastic deformation

Permanent deformity of a tissue which is force dependent under slow rates of stress. At low degrees of stress, tissue will slowly deform or lengthen but will ultimately break if stress is applied too fast and with too much force. Example: bending a plastic spoon.

Contracture

Permanent or transient limitation of movement or shortening of muscle, tendon, or other soft tissue around a joint.

Clinical application of grade III/IV oscillation

Primarily used for stretching or to treat restrictive joint motion caused by tightness is joint capsule and other soft tissue.

Evaluation

Process in which clinical judgments are made from the base of data, including the possibility of referral. Reserved solely for PT's.

Collagen

Protein building block of connective tissue that provides the strength needed to withstand high levels of tension and force during movement and exercise. Found in all connective tissue.

Physical practice

Physically performing the task. Proven to be superior to learning compared to mental practice alone.

Explain how you would perform a Contract Relax PNF stretch for the hamstrings. Include pt position, PTA position, what the patient is doing and specifically what the PTA is doing

Pt is supine, PTA is standing on kneeling on the mat. PTA rests heel of straight leg on their shoulder and has pt isometrically contract the hamstrings for 5-8 seconds. The PTA says relax and then passively moves pt's leg into more hip flexion to stretch the hamstrings and holds stretch for 30 seconds. Repeat to end ROM.

Activities in physical therapy to improve flexibility

ROM, Stretching, joint mobilization, and soft tissue mobilization.

Intermittent vs. continuous feedback

Randomly occurring or constant.

Frequency of stretching

Recommended 3-5 reps for each stretch exercise. Approximately 6 weeks of stretching is necessary for change and lasting improvement.

Joint congruence

Refers to the articular position with regard to concave and convex joint surfaces. A joint is congruent when both articulating surfaces are in contact throughout the total surface area of the joint. Joints are rarely in total congruence.

Mental practice

Rehearsing motor tasks in your mind. In sports research, when done in conjunction with physical practice the skills is learned faster.

Stiffness

Relates to a tissue's ability to resist stretch and indicates the amount deformation proportional to the load applied. More = less compliance.

APTA Guide to Physical Therapy Practice

Resource tool developed by the APTA to describe PT practice in general. PTA is a "technically educated health care provider who assists in the provision of the physical therapy interventions."

Mature scar tissue

Scar tissue that becomes quite inextensible and inadaptable. Happens after 14 weeks.

Immature scar tissue

Scar tissue that is adaptable, highly vascular and has a high rate of remodeling. It is adaptable for up to 8 weeks.

Augmented feedback

Sensory cues from an external source, person or mechanical. Extrinsic.

Intrinsic feedback

Sensory cues that arise from performing or attempting the task. Involves proprioceptors , kinesthetic tactile visual or auditory dues.

Hold relax (PNF stretch)

Similar to contract-relax. 1. Patient actively moves limb to end pain-free ROM. 2. Patient isometrically contracts against therapist resistance for 5-8 seconds at end ROM. 3. Relaxes. 4. Patient actively stretches limb to new limit of motion for 10-30 seconds. 5. Repeat until have no more ROM gain.

Neurophysiologic effects of stretching

Some stretches resulting a neural inhibition of the muscle being stretched, resulting in decreased resistance to stretch. Researchers believe has an important role in the ability of stretching to increase flexibility.

Name two general flexibility tests that can be done in PT

Standing Toe touch, sit and reach, seated hip ER

Intensity of stretching

Stretch slowly and hold at low force. Make sure pain free during duration.

Elastin

Structural protein found in connective tissue that gives it flexibility/recovery. Tissues with greater amounts have greater amounts of flexibility. Less than 1% in tendons. Assists collagen in the recovery of tissues after stress.

Therapeutic exercise

Systematic, planned performance of physical movements, postures, or physical activities intended to provide patient/client ability to reach goals.

Accessory joint motion means the same as arthrokinematic motion, that occurs at the joint surfaces. (glides, rolls spins etc.). T. True F. False

T. True

Active exercise is an effective way to warm up muscles before stretching as long as it is intense enough to cause an increase in tissue temperature. T. True F. False

T. True

Splinting is an example of a low load prolonged stretch. T. True F. False

T. True

What are some advantages of static stretching? T. True F. False

T. True Pt can perform them independently, safe, no mm soreness,

Effect of heat with stretching

Temperatures from 98.6 F (37 C) - 104 F (40 C) affect the viscoelastic properties of CT causing a greater degree of elongation when stress is applied before tissue failure. Less tissue damage occurs. Can increase by active exercise or heating modalities. Avoid cold therapy!

Flexibility

The ability of a muscle to relax and yield to a stretch force, or the ability to move muscles and joint through a full ROM.

Oscillation

The act or state of swinging back and forth with a steady, uninterrupted rhythm that's used in joint mobilizations.

Stress

The amount of force/load per unit area, which is placed on tissues. Can be pounds/square inch or Newtons/square cm).

Strain (deformation)

The amount of lengthening (deformation) that occurs during stress when a stretch force is applied to a structure. Affected by the rate of the stress. (fast/slow).

Range of motion (ROM)

The amount of movement available to a joint moving in its anatomical range.

Creep phenomenon

The gradual permanent deformation/increase in tissue length that occurs when maintaining a constant stress for extended time The longer the duration of the applied force, the greater the deformation or stretching of the tissue. Occurs with low-load, long duration stretching.

Close-packed position

The most congruent position of a joint, where joint surfaces are aligned and the capsule and ligaments are taut. This is used for testing the integrity and stability of ligaments and capsule.

Physiologic (osteokinematic) movement

The movement of bones in a joint system that can be measured with a goniometer. Can be seen by naked eye and occur under voluntary control.

Closed environment

The objects around the patient and the support surface do not move. Self paced by client.

Remodeling scar tissue

The process of tissue restructuring in response to stress or immobilization.

Traction

Used as a manual therapy technique either by itself or with other joint mobilization techniques. It occurs when there is tension, pull, or traction placed on a joint away from the treatment plane. Classified into 3 stage/grades.

Summary- type statements

Used by PTA to check understanding and help the patient clarify thinking, and provide direction for the PTA.

Splinting

Used for low-load prolonged stretch of soft tissue contractures but must be comfortable enough for a patient to wear for long periods of time. Important to check for skin breakdown or other issues.

Clinical application of stage/grade I traction

Used to decrease pain and compression force.

Clinical application of stage/grade III traction

Used to stretch the joint structures and increase joint play.

Clinical application of grade I/II oscillation

Used to treat joints limited by pain. Oscillations stimulate mechanoreceptors That block nocioceptive pathways at spinal cord or brain stem.

Clinical application of stage/grade II traction

Used to treat pain and for the initial treatment to determine sensitivity of the joint. May also be used to maintain joint play when ROM is not allowed.

Proprioceptive Neuromuscular Facilitation (PNF) stretching

Uses different techniques of volitional contractions to increase ROM by decreasing resistance caused by the spinal reflex pathways. Promotes neuromuscular responses via stimulation of the proprioceptive system. Based on the stretch reflex using muscle spindle/GTO.

Non-capsular patterns

When a restriction of joint movement does not fit a predictable pattern. Cyriax listed 3 possible causes.

Stage/grade III traction

When a traction or glide is applied with amplitude large enough to place stretch on the joint capsule and surrounding soft tissue structures. Performed with grade III & IV oscillations.

Dynamic stretching

When an active muscular contraction is used to stretch a muscle and the effect is to increase or decrease the joint angle where the muscle crosses, thereby elongating the musculotendinous unit as the end ROM is obtained. Uses activity-specific movements, preparing muscles for a specific sport. (ie, sprinter -exaggerated strides).

Stage/grade II traction

When enough traction or glide is applied to tighten the tissues around the joint, or "taking up the slack" in the joint capsule.

Concave-convex rule #1

When the CONCAVE surface is STATIONARY and the CONVEX surface is MOVING, the gliding movement in the joint occurs in a direction OPPOSITE to the bone movement.

Concave-convex rule #2

When the CONVEX surface is STATIONARY while the CONCAVE surface is MOVING, the gliding movement in the joint occurs in the SAME direction as the bone movement. This occurs because the convex surface always maintains an axis of rotation during joint motion.

Absent inter-trial variability

When the environmental conditions are unchanging and predictable. Example: treadmill

Mechanical effects of stretching

When the muscle-tendon unit responds viscoelastically during stretching. Researchers believe has an important role in the ability of stretching to increase flexibility.

Elastic deformation

When tissue rapidly conforms to a new length and is able to return to its resting length when the stress is removed. But can break if the stress exceeds the strain capabilities. Example: a rubberband stretching.

Autonomous stage

Where movements are automatic, independent with error correction, can adapt to variations in the task. Can do other tasks simultaneously.

List the contraindications for joint mobilization

hypermobility, joint effusion, acute inflammation, unhealed fractures, cancer or bone disease in the area etc.