Chapter 5 - Therapeutic Exercise

Collagen is targeted with stretching exercises to increase motion. a. True b. False

A

Connective tissue surrounding muscle, tendons, and ligaments is viscoelastic, so it has both plastic and elastic qualities. a. True b. False

A

Continuous passive motion machines are often used following acute injuries to counteract the inflammatory process. a. True b. False

A

Creep is time dependent, so a load that is applied for a longer time is more effective in causing a change in tissue length than a quickly applied load. a. True b. False

A

Ground substance helps to keep the collagen fibers separated and prevents excessive cross-link formations. a. True b. False

A

Ligament and tendon tissue obtain their strength primarily from a. collagen b. elastin c. reticulin d. ground substance e. none of these

A

Plasticity relates to the ability of a substance to undergo a permanent change in size or shape. a. True b. False

A

Range of motion and flexibility are terms that are commonly used interchangeably but do not mean the same thing. a. True b. False

A

The GTO inhibits muscle contraction if a stretch is applied slowly. a. True b. False

A

The key to accuracy in measuring range of motion is consistency in the operator's technique. a. True b. False

A

Describe the following stretches as they are applied to the hamstrings: (1) an active stretch; (2) a short-term passive stretch (not PNF); (3) a long-term passive stretch; (4) a PNF stretch.

Active: stand or lay on table; reach for opposite leg On floor in door for short term passive Long term: sitting on chair and foot on table

As long as one is consistent, the patient's position during range-of-motion measurements is inconsequential. a. True b. False

B

If the patient is to stretch the hamstrings, the best way to achieve an optimal stretch is with the patient in the standing position and bending over from the waist to touch the toes. a. True b. False

B

Ligament and tendon tissue obtain their extensibility primarily from a. collagen b. elastin c. reticulin d. ground substance e. none of these

B

Tendons contain dense connective tissue, whereas ligaments contain areolar connective tissue. a. True b. False

B

The GTO acts to protect the muscle from sudden stretches, but the muscle spindle (doesn't like quick stretches) permits such a stretch. a. True b. False

B

The Golgi tendon organ is responsible for the monosynaptic stretch reflex. a. True b. False

B

The best way to stretch the gastrocnemius is with the knee positioned in flexion and the ankle in dorsiflexion. a. True b. False

B

The stress-strain curve indicates the relationship between stresses and strains of tissue. Strain is a. the amount of force applied to tissue b. the amount of deformation tissue undergoes c. the rate of improvement when a stretch is applied d. the breaking point of the tissue e. the tissue's initial response to outside forces

B

Tissue temperature affects creep, so cold applied before stretching will increase the stretch's effectiveness. a. True b. False

B

When measuring range of motion, one should expect to be accurate within a. 0°-3° b. 3°-5° c. 5°-8° d. 5°-10° e. none of these

B

A 20-year old basketball player underwent an anterior cruciate reconstruction in March but never participated in postoperative rehabilitation. Her surgery was 10 months ago. She lacks 20° of full extension in the knee. One of the most effective methods to stretch the knee to regain motion is a. active stretches b. passive stretches c. prolonged stretches d. PNF stretches e. a and b

C

Autogenic inhibition occurs a. as a result of the Golgi tendon organ allowing the muscle to stretch b. after the muscle spindle relaxes the muscle c. when the Golgi tendon organ prevents an overstretch of the muscle d. when the muscle spindle controls how many fibers are stretched e. none of these is correct

C

Soft-tissue changes seen after 1 week of immobilization include a. a decrease in ground substance b. an increase in dead tissue removal c. an increase in cross-link formation d. a and b only e. a and c only

E

The physical property that affects how any tissue reacts to a stretch force is a. creep b. fatigue c. stress-strain d. a and c only e. all of these

E

List three precautions for stretching.

If a stretch is painful, gentle traction applied to the joint during the stretch may relieve the pain. If this does not relieve the pain, reduce the stretch load. A stretch should not be painful. The release of a stretch force is as important as its application. Both the application and the release should be performed slowly. A quick application or release of a stretch, especially release of a prolonged stretch, can be very uncomfortable. Vigorous stretching of areas that recently have been immobilized for a while should be performed with extreme caution and even avoided in the early stretching stages. Stabilization of the area is necessary to properly apply the stretch force in the correct direction and to the correct structures. During both active and passive stretches, the part is positioned so the stretch force affects only the targeted structures.

Identify the effects of immobilization on the tissues listed and the macroscopic results seen following immobilization of an injury: ground substance, new collagen fibers, muscle, articular cartilage, and periarticular connective tissue.

Rapid changes in the structure and function of connective tissue occur. Immobilization and disuse following injury are some- times necessary to protect the area and permit the healing process to occur unimpeded. It can also be detrimental. The longer a part is immobilized, the more difficult restoring the part to normal becomes. Soft-tissue changes are seen following even 1 week of immobilization and are increased by edema, trauma, and impaired circulation. Immobilization causes a loss of ground substance, which in turn results in less separation and more cross-link formations between collagen fibers. The fiber meshwork contracts and the tissue becomes dense, hard, and less supple. Even if an uninjured joint is immobilized for 4 weeks, the dense connective tissue that forms prevents normal motion. Following an injury, the newly formed fibrin and collagen fibers arrange themselves in a haphazard way when the injury is immobilized. An increase in the formation of cross-links impairs motion. Changes in muscle tissue following immobilization and disuse include reductions in muscle fiber size, number of myofibrils in the muscle, and oxidative capacity. As these changes occur, there is an increase in the fibrous and fatty tissue in the muscle and a reduction in the intramuscular capillary density. These changes, which cause the muscle to become smaller and weaker, occur after 2 weeks of immobilization. Articular cartilage also suffers changes from immo- bilization. These changes depend on the position of immobilization, the duration of immobilization, and whether the joint bears weight or not during immobili- zation. With immobilization, the mechanical properties decay: The cartilage becomes thinner, the proteoglycan concentration decreases, and the matrix organization declines.Articular cartilage of joint surfaces that are not in contact with each other also changes. In addition, necrosis of articular cartilage occurs when constant pressure between the joint surfaces is maintained during immobilization. Immobilization also increases the amount of fibrofatty tissue that ultimately becomes scar tissue within the joint. Periarticular connective tissue is soft tissue sur- rounding the joint, including structures such as lig- aments, joint capsule, fascia, tendons, and synovial membranes. As with muscle and articular cartilage, all these structures are adversely affected by immobilization, and their connective tissue becomes thick and fibrotic. The clinical impact of these changes is a loss of motion and weakened structures in the affected joint. With all these dramatic changes from immobilization, it makes sense to minimize the duration of immobilization.

List one contraindication for stretching.

Recent fractures when immobilization is necessary for healing and movement is detrimental to it, a bony block that restricts motion, infection in a joint, acute inflammation in a joint, extreme or sharp pain with motion, and when tightness of soft tissue actually contributes to an area's stability.