Mobility through Stretching
Definition and purpose of stretching.
any therapeutic maneuver designed to increase soft tissue extensibility and subsequently improve flexibility and ROM by elongating structures that have adaptively shortened and have become hypomobile
Neurophysiologic Basis of Stretching role of mechanoreceptors.
are in muscle and tell CNS what is happening w/in that muscle
what is manual passive stretch?
a low intensity manual stretch applied for as long a duration as possible will be more comfortable and more readily tolerate by the patient
Define Laxity
ability of a joint; excessive joint laxity can be a result of injury or some sort of hereditary condition
Types of Flexibility what is static/passive flexibility?
ability to hold an extended position at one end in a joints ROM; dependent on your ability to tolerate stretched muscles, joint structure and tightness of connective tissue
Types of Flexibility what is dynamic (functional) flexibility?
ability to move a joint through its ROM with little resistance
what is dynamic stretching?
active movement that takes the body through full ROM
Stress-Strain Curve Define stress.
amount of force or load put on tissue
Define muscle spindle.
sensitive to changes in muscle length; sends a sensory impulse to spinal cord that is sent back to muscle spindle causing the muscle to reflexively contract
what is autogenic inhibition?
serves a protective role which allows muscle to not be damaged through action of GTO
Dynamic stretch Handwalks work what muscles?
shoulders, core muscles and hamstrings
Advantages of dynamic stretching.
-focused on sport specific movement -development of dynamic flexibility -increase temp -muscle is active
disadvantages of dynamic stretching
-inadequate tissue adaptation (ROM) -soreness after first session -inadequate neurological adaptation
What are the 7 CONTRAINDICATIONS to stretching:
1) bony block 2) nonunion fracture 3) acute inflamm or infection 4) sharp or acute pain with elongation 5) hematoma or tissue trauma 6) hypermob 7) hypomob provides stability or control
Disadvantages of Manual Passive Stretching:
1) boring 2) may overly dominate routine due to time needed 3) allows body to cool during warm up
Advantages to Manual Passive Stretching:
1) historical preference 2) effective and optimal 3) decrease possibility of exceeding normal ROM
what are the 4 types of PNF stretches?
1) hold relax 2) contract relax 3) agonist contraction 4) hold relax with agonist contraction
Benefits of Flexibility:
1) increase blood supply and nutrients to joint structure 2) increase quality and quantity of joint synovial fluid 3) increase muscular coordination 4) relaxation 5) improve ease and efficiency of movement 6) reduce muscular soreness 7) joint health 8) prevent of low back pain and injuries 9) relief of aches and pains 10) relief of muscle cramps 11) improved body position and strength for sports 12) maintenance of good posture and balance
7 Factors that influence flexibility.
1) joint structure 2) age 3) gender 4) exercise 5) muscle mass 6) temp 7) pregnancy
Limits due to Connective tissue Aging: what happens w/ joints, collagen?
1) joints become less stable and less mobile 2) degradation fo collagen, joint surface, and decreased viscosty of synovial fluid 3) increased collagen diameter and more collagen cross-links (cause tissue to become less tensible)
what are the indications of stretching?
1) limited ROM due to adhesions and scar tissue formation leading to shortening of muscle, connective tissue and skin 2) prevention of structural (neglected soft tissue > shortening > structural limitation > skeletal deformities) 3) when contractures interfere with every day functional activities 4) when there muscle muscle weakness and opposing tissue tightness
Causes of soft tissue shortening:
1) prolonged immobilization due to intrinsic or extrinsic factors 2) sedentary lifestyle due to bed rest, work environment 3) muscle imbalance, paralysis or tone abnormality 4) postural malalignment which may be congenital, acquired (EX: scoliosis or kyphosis)
what are the goals of stretching?
1) regain normal ROM of joints and mobility of soft tissue surrounding the joint 2) prevent irreversible contractures 3) increase the general flexibility of muscle and soft tissues before vigorous strengthening exercises 4) minimize and prevent the risk of musculotendinous injuries related to specific physical activities and sports
what are the guidelines for proper stretching:
1) stretch muscles that are warm- unless dynamic stretching exercises warm up the muscles and improve elongation with flexibility 2) warm up before stretching 3) do not rush stretch 4) stretch gentle and slow and smooth, avoid ballistic 5) do not bounce 6) should breathe 7) stretch muscle group and perform stretch 3-4 times
what are the 6different types of stretching. NAME THEM
1)manual passive stretching 2)PNF - active neuromuscular inhibition 3)self stretch 4)mechanical stretch 5)ballistic stretching 6)dynamic stretching
FITT principle for stretching Time:
15 to 30 sec, perform 2 to 4 time; aim to hold for a minute
FITT principle for stretching Frequency:
2-3 days a week
Connective tissue deformation and neural inhibitory effects does require how many seconds to effect tissue change and relaxation?
30 to 90 sec
flexibility should be held for how many seconds in order to achieve the elastic region?
30 to 90 sec
GTO or muscle spindle? serves as a protective function and allows the muscle to relax so it is not overstretched or damaged
GTO
GTO or muscle spindle? sensitive to changes in muscle TENSION
GTO (T=tension)
what are 2 mechanoreceptors important in stretch reflex?
GTO and muscle spindle
Manual Passive stretch vs. ballistic stretch
Manual= inhibit stretch reflex, decrease muscle tension ballistic= facilitate muscle contraction, increase tension
Define Hypermobility
ROM that is in excess of acceptable ROM of most of the joints; exceeding the normal of for a particular joint
ROM vs. stretching.
ROM= movement of joints; can have limited ROM due to periarticular structures, due to joint issues, or joint integrity stretching= contractile tissues impacted and muscles, fascia, periarticular tissue around a joint
Men or Women are more flexible ?
Women
3 components of ballistic stretching
bouncing, quick lengthening, very short duration
Advantages of PNF stretching
capable of producing greater improvements in flexibility
Stress-Strain Curve what is the toe region?
collagen fibers unwrinkled and straighten out with force applied; there is an automatic elongation of tissue; this is the range where most functional activities occur
what surrounds muscle fibers (fascia) and is in major component of tendons and ligaments?
connective tissue
what is reciprocal inhibition?
contraction of agonist muscle that causes a reflex relaxation in antagonist muscle
Define Hypomobility
decrease mobility/restricted motion at series of joints; result of joint issue, contractile issue and a non-contractile issue
ROM bay be selected as as therapeutic exercise in order to:
decrease pain, prevent contractures, promote circulation/brings nutrients to joint, increase mobility of synovial fluid
Stress-Strain Curve Define relaxation.
describes how soft tissue length decreases when load is removed
advantages of ballistic stretching
development of dynamic flexibility, effectiveness
stretching will not impact a muscle working w/ what type of contraction- eccentric or concentric?
eccentric; most injuries occur with eccentric
Stress-Strain Curve Name region "tissue sustains the elongation achieved"
elastic region
Stretching may be selected as a therapeutic exercise in order to:
elongate the tissue will increase ROM, correct postural impairments, decrease pain, reduce functional mobility impairments
Define flexibility
extensibility of periarticular tissues to allow pain free, normal or physiological motion
Stress-Strain Curve Name region "point of injury"
failure point
Dynamic Stretching Straight leg march works what muscles?
hamstrings and glute medius
Stress-Strain Curve Define Creep.
how soft tissue will become increasingly stretched over time when load on soft tissue is constant
More muscle mass= more flexible or less flexible?
less flexible
is elastic deformation linear or nonlinear?
linear
if the stretch is held for how long then the impulse is from the GTO and will begin to override the muscle spindle?
longer than 6 sec
Dynamic stretching Scorpion works what muscles?
low back, hip flexors and gluteus muscles
what is a mechanical stretch?
low intensity external force (5 to 15 lb) applied to shortened tissues over a prolonged period by mechanical equipment stretch force is applied through positioning with weighted traction, pulley system, dynamic split and serial casts
Define agonist W/ PNF
muscle opposite to the tight muscle
GTO or muscle spindle? sensitive to change in muscle LENGTH
muscle spindle
is plastic deformation linear or nonlinear?
nonlinear
Stress-Strain Curve Define strain.
percentage of deformation you are going to achieve/elongation you will see when you do stretch
Stress-Strain Curve Name region "point of NO return"
plastic
Dynamic stretch Lunge works what muscles?
quads, gluteals, hams, VMO, soleus and gastro
what is ballistic stretching?
repetitive contractions of agonist used to produce quick stretches of antagonist
Disadvantages of PNF stretching
requires a partner
Define Contracture.
restriction in motion caused by adaptive shortening of the musculotendinous unit and other soft tissues that cross or surround a joint resulting in significant resistance to passive or active stretch resulting in limited ROM
disadvantages of ballistic stretching
soreness and injury and initiation of stretch reflex; there is inadequate neural adaptation, the brain or muscle does not keep tissue in elongated state
Early healing ROM follows a predictable sequence:
start with PROM > AAROM > AROM type of ROM is based on the tissue healing stages surrounding the joint
FITT principle for stretching intensity:
stretch to the point of mild discomfort BUT NOT PAIN
define antagonist w/ PNF
tight muscle
Tightness vs. Muscle Tightness
tightness/shortness= motion restricted due to shortening of soft tissue muscle tightness= adaptive shortening of contractile tissue (muscle) and noncontractile elements (fascia, tendons)
Types of Flexibility what is ballistic flexibility?
usually associate with bobbing or bounding motion
3 components of manual stretching
very slow, maintained & gentle, prolonged 15 to 30 sec or more
Stress-Strain Curve Name region "when soft tissue will NO longer return to original resting position"
yield point
Stress-Strain Curve Name region "where you would stop/end range of tissue; going beyond this will cause tear in the structure and discomfort."
yield point