ch 4 stretching

3 other factors that affect hypomobility

sedentary lifestyle paralysis posture malalignment

Define elasticity

ability of soft tissues to return to pre stretch length directly after short duration of stretch is removed

flexibility

ability to move a single joint or series of joints smoothly and easily through an unrestricted pain free ROM ability to relax and deform muscles

contracture

shortened muscle

What is static stretching? How is it performed?

soft tissues elongated just past the point of tissue resistance, held in lengthened pos'n w/ stretch 5 sec to 5 min per rep for manual/self stretch half tension created compared to ballistic

what is cyclic/intermittent stretching?

-relatively short stretch, repeatedly applied/released/applied end range stretch force applied at slow speed, low controlled intensity -each cycle 5-10 sec -#reps based on tolerance

What can be done after stretching to maximize lengthening?

- apply cold to soft tissue that was stretched (cool in the lenghtened position to minimize post ex soreness and increases of ROM maintained) -have pt perform AROM, strengthening exercises through newly gained range immediately after stretch -develop balance in stretch in antagonistic muscles in new range, so adequate neuromuscular control and stability as flexibility increases

List special considerations for mechanical stretching devices

- be familiar with product info -familiarity with stretching protocols from manufacturer; evidence of efficacy -determine if modifying protocol is warranted by pt's needs -check fit of device before sending pt home; teach pt safe way to apply and adjust device; make sure pt has contact info if defective -teac pt weher/ how to inspect skin to determine areas of excessive pressure/skin irritation -check to see if equipment is safe, effective - have the pt keep a daily record of stretching device - reexamine, reeval pt and equipment periodically; effectiveness of mech stretching program; modify progress - be sure pt complements use of mech stretching with active exercise

What is HRAC?

- move limb to point where tissue resistance is felt in range limiting muscle -have pt perform resisted prestretch iso contraction followed by voluntary relax of muscle -immediate concentric contraction of muscle opposite to limiting muscle

What are some ways to decrease the risk of mass market flexibility programs?

-assess appropriatness, safety of prepackaged flexibility programs -review exercises in program, determine what's safe for your pt -stay up to date on programs, products , trends; monitor safety and content - determine what age program is geared toward -eliminate/modify exercises inconsistent w/ intervention plan for you pt -make sure program maintains balance, mobility btw antagonistic groups and employs stretching groups that become shorter w/ age, posture, sedentary life -teach pt basic self stretching, how to do safe/appropriate stretches and to avoid others -make sure pt knows how to provide self stabilization to isolate/stretch specific muscle groups -teach pt how to determine appropriate intensity; make sure they know most muscle soreness should be mild, last no longer than 24 hr

What is AC?

-concentrically contract opposite muscle to range limiting muscle and hold end range for a few seconds -movement controlled by pt, slow and usually w/o resistance

What are methods of cold?

-decreases muscle tone; makes muscle less sensitive during stretch - if soft tissue healing,scar formation, cold makes healing tissues less extensible, more microtrauma possible -cooling after lengthened position= promote lasting increases in soft tissue length, minimize soreness

What is Hold Relax?

-lengthen to point of tissue resistance or pt comfort -pt performs pre-stretch, end range, iso contraction for 5 sec followed by voluntary relax of range limiting muscle -passively move limb into new range as muscle elongates

Why are some mass market flexibility programs ineffective?

-nonselective/poorly balanced stretching activities -insufficient warm up -ineffective stabilization -use of ballistic stretching -excessive intensity -abnormal biomechanics -insuffiencient info about age related differences

irreversible contracture

-permanent loss of extensibility of soft tissues, can't be reversed by nonsurgical interventions -normal muscle tissue, organized CT replaced w/ non extensible, fibrotic adhesions, scar tissue, hetertrophic bone -long immobilization in shortened pos'n after trauma, inflammatory response -longer it exists, greater adhesions, more difficult to regain mobility

What is static progressive stretching? How is it performed?

-stretch applied for max effectiveness -shortened soft tissues held in comfortable lengthened position until relaxation felt by PT, lengthened farther, held in new range

What are methods of heat?

-superficial heat (hot pack, paraffin); deep heat (ultrasound, diathermy) -low intensity active exercises= increase circulation, core temp *use of heat alone w/o stretching shows little/no effect on improving flexibility

How is heat incorporated into stretching?

-warmup prior to treatment -increases intramuscular temp-->increases extensibility of contractile/noncontractile tissues, amount of force needed decreases -decrease in rate of firing of type II efferents from muscle spindles, increase sensitivity of GTO- more likely to fire -tissues relax more, more easily lengthen= less muscle guarding, pt more comfortable

List the contraindications for stretching

1. Bony block limits motion 2. Recent fx and bony union incomplete 3. Active inflammatory/infectious process or healing disrupted in restricted tissues, surrounding area 4. Sharp, acute pain w/ jt movement and muscle elongation 5. Hematoma/other indication of tissue trauma 6. Hypermobility already exists 7. Shortened soft tissues provide necessary joint stability in lieu of normal structural stability/ neuromuscular control 8. shortened soft tissues allow pt with paralysis/severe muscle weakness to perform specific functional skills otherwise not possible

What are the advantages of HRAC?

1. Greater increase in range compared to just HR 2. Both HR and HRAC are better than passive manual stretch

List the indications for the use of stretching

1. ROM limited b/c soft tissues have lost extensibility, causing activity limitations (functional limitation) and participation restrictions (disabilities) 2. Restricted motion may lead to structural deformities that are otherwise preventable 3. Muscle weakness and shortening of opposing tissue have led to limited ROM 4. Fitness, sport specific conditioning program to prevent/reduce risk of MS injury 5. Prior to/after vigorus exercise to prevent post ex muscle soreness

What are 6 adjuncts to stretching?

1. complementary exercise approaches ( relaxation training, pilates) 2. heat 3. cold 4. massage 5. biofeedback 6. jt traction oscillation

what are advantages of AC?

1. effective when significant muscle guarding restricts muscle lengthening/jt movement and when pt can't generate strong pain free contraction of range limiting muscle which must be done for HR 2. useful for initiating neuromuscular control in newly gained range to re-establish dynamic flexibility 3. Increases ROM and muscle length

What are disadvantages of AC?

1. least effective if pt has close to normal flexibility 2. Less effective in reducing chronic contractures

How can tissues be prepared for stretching?

1. move slowly through range to point of restriction 2. grasp proximal and distal areas of joint, use padding and use broad surfaces of hand to apply pressure 3. firmly stabilize proximal segment, move distal segment 4. consider doing a prestretch iso contraction 5. avoid compression during stretch procedure (apply grade I distraction to moving jt) 6. apply low intensity slow stretch. ask pt to assist or be passive 7. maintain stretch for 30 sec or more. Tension should decrease. As it decreases, move jt a little farther to progressively lengthen 8. gradually release stretch force and allow pt and PT to rest 9. if pt can't tolerate stretch, use very low gentle, intermittent stretche w/muscle in lengthened position 10. use facial massage/cross fiber friction massage if appropriate, near adhesion

Describe 7 different interventions to increase mobility of soft tissue

1. stretch- manual, mechanical/passive 2. self stretch 3. Neuromuscular facilitation and inhibition 4. muscle energy 5. joint mobs/manips 6. soft tissue mobs/manips 7. neural tissue mobs

What are the special considerations for teaching self stretching exercises?

1. teach pt all elements of self stretching (emphasize slow not ballsitic) 2. teach pt to carry out stretching on firm, stable, comfortable surface 3. supervise pt; make suggestions/corrections 4. stress the importance of warming up tissues w/ low intensity rhythmic activity prior to stretch 5. teach pt how to incorporate neuromuscular inhibition; hold relax 6. written instructions w/ pics so pt can refer to when self stretch 7. demonstrate how household items can be used to assist 8. emphasize importance of using gained ROM during appropriately progressed functional activities

Frequency of stretching depends on what 6 factors?

1. underlying cause of impaired mobility 2. quality of level of healing of tissue 3. chonicity and severity of contracture 4. pt age 5. use of corticosteroids 6. previous response to stretching

Benefits of cyclic/intermittent stretching?

Increases flexibility as effectively/more effective than static stretching

List the precautions for stretching (NOPAPAA)

No passive force beyond normal ROM Extra caution w/ known osteoporosis Protect newly joined fx, make sure to stabilize enough Avoid vigorous muscle/CT stretch that have been immobilized for extended period Progress dosage gradually to minimize trauma, post ex soreness Avoid stretching edema (more susceptible to injury) Avoid overstretching weak muscles

Why is selective stretching important?

can give functional needs to patient, balance btw mobility and stability

Extrinsic contributing factors for hypomobility

casts, splints skeletal traction

What are the benefits of progressive stretching

continuous displacement of limb; varying stretch load to capitalize stress relaxation of soft tissue

passive flexibility

degree a body segment can be passively moved through ROM depends on muscle extensiblity, connective tissue that crosses and surrounds the joint prereq for dynamic

dynamic flexibilty

degree an active muscle contraction moves a body segment through available ROM

periarticular contracture

develops w/in connective tissue crosses or attaches to joint or joint capsule, lose mobility restricts normal arthrokinematic motion

fibrotic contracture

fibrous changes in CT, periarticular structures causes adherence of tissues difficult to reestabilish optimal tissue length

pseudomyostatic contracture

impaired mobility, limited ROM result in hypertonicity w/CNS lesion muscle spasm, guarding, pain may be a cause constant state of contraction- excessive resistance to passive stretch passive elongation possible if neuromuscular inhibition to reduce muscle tension in applied

What are the advantages of hold relax?

makes massive elongation of muscles, more comfortable for a patent than manual passive stretching

what tissues contribute to flexibility

muscle length jt integrity periarticular soft tissues

myostatic contracture

no specific pathology present. reduction of sarcomeres in series, no decrease in sarcomere length resolved in short time w/ stretching

Intrinsic contributing factors for hypomobility

pain joint inflammation/effusion muscle, tendon, fascial disorders skin disorders bony block vascular disorders

What is selective stretching?

process of overall function of pt improved by applying stretching selectively to some muscles/jt but allowing motion to develop @ other muslces

contraction

process of tension developing in a muscle during shorteninglengthening

arthrogenic contracture

result of intraarticular pathology adhesions, synovial proliferation, jt effusion, irregular articular cart, osteophyte formation

What is overstretching

stretch well beyond normal ROM, not always detrimental (may be necessary for healthy people in sports)

Define plasticity

tendency of soft tissue to assume new/greater length after stretch removed

When is overstretching detrimental?

when it creates jt instability= muscles around can't support the joint, cause pain, predispose to MS injury