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Ther-ex Ch4 Stretch
DPT 729 Ch 4 Stretching
| Question | Answer |
|---|---|
| Stretching def | A general term to describe any therapeutic maneuver to increase extensibility of soft tissues thus improving flexibility by elongating (lengthening) structures that have adaptively shortened and become hypomobile over time. |
| Purpose of stretching | Increases an individual’s threshold to tolerate additional stretching |
| Stretching in Physical Therapy, why is it used? | -Intervention for impaired mobility-Preparation for more aggressive exercise-Increase mobility for functional activity-Elongate the contractile and noncontractile components of *Muscle-tendon units*Periarticular tissues |
| Flexibility for stretching | ability to move a single joint or series of joints smoothly and easily through unrestricted, pain-free ROM |
| Dynamic flexibility /mobility (active ROM)for stretching | The degree to which active muscle contraction moves a segment |
| Passive flexibility/mobility (passive ROM) for stretching | The degree to which a joint can be passively moved through available ROM |
| Hypomobility – for stretching | decreased mobility or restricted motionMany factors can contribute to hypomobilitySee Table 4.1 for details |
| Contracture – for stretching | adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint and offer significant resistance to passive or active stretchDesignation of contractures by location (shortened muscle) |
| Types of contracture | Myostatic contracture Pseudomyostatic contracture Arthrogenic and periarticular contractures Fibrotic contracture and irreversible contracture |
| Myostatic contracture – | no pathology, resolve with stretching |
| Pseudomyostatic contracture – | normally caused by hypertonicity due to CNS lesion. Respond to inhibitory procedures and then stretch |
| Arthrogenic and periarticular contractures – | intra-articular pathology – sometimes called adhesions |
| Fibrotic contracture and irreversible contracture | changes in connective tissue causing fibrosis. |
| Is contracture and contraction the same thing? | Contracture and ContractionNOT THE SAME THING! |
| Interventions to increase mobility of soft tissues | Manual or mechanical/passive or assisted stretchingSelf-stretchingNeuromuscular facilitation and inhibition techniquesME techniquesJt mob/manipulationSoft tis mob and manipulationNeural tissue mobilization (neuromeningeal mobilization) |
| Selective stretching – | clinical decision to allow shortening in some structures and stretch others |
| Overstretching and hypermobility – | - beyond normal length of muscle and ROM *Selective hypermobility may be needed in some cases |
| Indications for Stretching | ROM limited due to adhesion, contracture, and scar tissue formation restricting ROM or functionRestriction is contributing to preventable structural deformitiesMuscle weakness and shortening of antagonist musclesPart of total fitness program |
| Contraindications for Stretching | Bony block limiting motionAcute inflammatory responseAcute or chronic infection in tissuesSharp pain with movement of joint or muscleHematoma or tissue traumaHypermobilityShortened structures provide stability or enable function |
| Soft tissues | |
| Stretching def | A general term to describe any therapeutic maneuver to increase extensibility of soft tissues thus improving flexibility by elongating (lengthening) structures that have adaptively shortened and become hypomobile over time. |
| Purpose of stretching | Increases an individual’s threshold to tolerate additional stretching |
| Stretching in Physical Therapy, why is it used? | -Intervention for impaired mobility-Preparation for more aggressive exercise-Increase mobility for functional activity-Elongate the contractile and noncontractile components of *Muscle-tendon units*Periarticular tissues |
| Flexibility for stretching | ability to move a single joint or series of joints smoothly and easily through unrestricted, pain-free ROM |
| Dynamic flexibility /mobility (active ROM)for stretching | The degree to which active muscle contraction moves a segment |
| Passive flexibility/mobility (passive ROM) for stretching | The degree to which a joint can be passively moved through available ROM |
| Hypomobility – for stretching | decreased mobility or restricted motionMany factors can contribute to hypomobilitySee Table 4.1 for details |
| Contracture – for stretching | adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint and offer significant resistance to passive or active stretchDesignation of contractures by location (shortened muscle) |
| Types of contracture | Myostatic contracture Pseudomyostatic contracture Arthrogenic and periarticular contractures Fibrotic contracture and irreversible contracture |
| Myostatic contracture – | no pathology, resolve with stretching |
| Pseudomyostatic contracture – | normally caused by hypertonicity due to CNS lesion. Respond to inhibitory procedures and then stretch |
| Arthrogenic and periarticular contractures – | intra-articular pathology – sometimes called adhesions |
| Fibrotic contracture and irreversible contracture | changes in connective tissue causing fibrosis. |
| Is contracture and contraction the same thing? | Contracture and ContractionNOT THE SAME THING! |
| Interventions to increase mobility of soft tissues | Manual or mechanical/passive or assisted stretchingSelf-stretchingNeuromuscular facilitation and inhibition techniquesME techniquesJt mob/manipulationSoft tis mob and manipulationNeural tissue mobilization (neuromeningeal mobilization) |
| Selective stretching – | clinical decision to allow shortening in some structures and stretch others |
| Overstretching and hypermobility – | - beyond normal length of muscle and ROM *Selective hypermobility may be needed in some cases |
| Indications for Stretching | ROM limited due to adhesion, contracture, and scar tissue formation restricting ROM or functionRestriction is contributing to preventable structural deformitiesMuscle weakness and shortening of antagonist musclesPart of total fitness program |
| Contraindications for Stretching | Bony block limiting motionAcute inflammatory responseAcute or chronic infection in tissuesSharp pain with movement of joint or muscleHematoma or tissue traumaHypermobilityShortened structures provide stability or enable function |
| Soft tissues | Contractile TissuesNon-Contractile |
| Contractile Tissues (soft tissue) | Muscles |
| Non-Contractile (soft tissue) | TendonsLigamentsJoint capsulesFasciaSkin |
| Most (soft tissue) limitations are due to | decreased extensibility of the non-contractile tissues |
| Mechanical response of the contractile unit to stretch and immobilization | Response to stretchResponse to immobilization and remobilization |
| Mechanical response of the contractile unit to stretch and immobilization-Response to stretch: | Elasticity – return to pre-stretch lengthSarcomere give |
| Mechanical response of the contractile unit to stretch and immobilization-Response to immobilization and remobilization: | Morphological changes lead to atrophy and weaknessImmobilization in a shortened positionSarcomere absorptionImmobilization in a lengthened positionSarcomere increase (myofibrillogenesis)Changes last only 3-5 weeks after immobilization |
| Neurophysiological properties of contractile tissue | Muscle spindle Golgi tendon organ (GTO) |
| Muscle spindle | a mechanoreceptor, sensory organ, sensitive to quick and sustained (tonic) stretch. Relays changes about length of a muscle and velocity of length change |
| Golgi tendon organ (GTO) | a mechan-oreceptor sensory organ in the musculotendinous junctions of extrafusal muscle fibers. Monitors changes in tension of muscle-tendon units and in response to stretch fires a inhibitory response. |
| Mechanical Properties of Noncontractile Soft Tissue, Composition of connective tissue | Collagen fibersElastin fibersReticulin fibersGround substance |
| The only way to increase extensibility of connective tissue is to | remodel its basic architecture |
| Collagen fibers do what? | Provide strength and stiffness of tissueResists tensile deformationFibers bind together as they matureTissues with greater proportion of collagen provide greater stability |
| Elastin fibers do what? | Provide extensibilityAllow elongation with small loadsFail abruptly without deformation at higher loads |
| Reticulin Fibers | Provide bulk |
| Ground Substance | Organic gel compoundProteoglycans (PGs) and glycoproteinsHydrate the matrix of fibersStabilize the collagen networksResist compressive forces (intervertebral discs and collagen) |
| Mechanical behavior of noncontractile tissue Determined by: | proportion of collagen and elastin fibers and the |
| Mechanical behavior of noncontractile tissue-Proportion of proteoglycans influence mechanical properties | - High collagen and low PGs resist high tensile loads- High collagen and high PGs withstand greater compressive loads- High PGs are necessary to withstand high compressive loads |
| Interpreting mechanical behavior of connective tissue: the stress–strain curve | Stress = force per unit areaStrain = amount of deformation or lengthening that occurs when stress or stretch is applied |
| Stressess | TensionCompressionShear |
| The stress-strain curve illustrates | The stress-strain curve illustrates what happens to connective tissue under stress loads |
| Connective tissue responses to loads | *Creep*Stress-relaxation*Cyclic loading and connective tissue fatigue |
| Creep – | permanent elongation |
| Stress-relaxation – | after initial creep, less tension is needed to maintain |
| Changes in collagen affecting stress–strain response | Immobilization -Inactivity Age –Corticosteroids – |
| Changes in collagen affecting stress–strain response:Immobilization - | Weakening, adhesions, rate of return slow |
| Changes in collagen affecting stress–strain response:Inactivity (decrease of normal activity) | decrease in size & amount of collagen |
| Changes in collagen affecting stress–strain response:Age – | decrease in max tensile strength, adaptation to stress is slower |
| Changes in collagen affecting stress–strain response:Corticosteroids – | dec tensile strengthInjury – healed area is weaker |
| Determinants of Stretching Interventions (Dosing) | - Alignment- Stabilization- Intensity of stretch- Duration of stretch- Speed of stretch- Frequency of stretch |
| Determinants of Stretching Interventions | Duration of stretchSpeed of stretch |
| Determinants of Stretching Interventions: Duration of stretch | - Static stretching- Static progressive stretching- Cyclic (intermittent) stretching |
| Determinants of Stretching Interventions: Frequency of stretch- | - Importance of a slowly applied stretch- Ballistic stretching- High-velocity stretching in conditioning programs and advanced-phase rehabilitation |
| Types of Stretching Interventions:Mode (another word for type) of stretch- | Manual stretchingSelf-stretchingMechanical stretching |
| Types of Stretching Interventions:Proprioceptive neuromuscular facilitation stretching techniques- | Types of PNF stretchingHold–relax and Contract–relaxAgonist contractionHold–relax with agonist contraction |
| Effects of Stretching Interventions: Integration of function into stretching | Importance of strength and muscle enduranceUse of increased mobility for functional activities |
| Procedural Guidelines for Application of Stretching Interventions | Examination and evaluation of the patientPreparation for stretchingApplication of manual stretching proceduresAfter stretching |
| Examination and Evaluation | Review history and perform system reviewSelect & complete appropriate tests and measures, establish baseline ROM, determine underlying strengthIs hypomobility a co-morbidity causing functional limitation or disability?What soft tissues are involved |
| Preparation for Stretching | Review goals and outcomesSelect most effective and efficient techniques and positionWarm up tissues (thermal or low-intensity exercise)Explain procedure to patientExpose the areaReinforce relaxation to the patient during the procedure |
| Examination and Evaluation | Review history and perform system reviewSelect & complete appropriate tests and measures, establish baseline ROM, determine underlying strengthIs hypomobility a co-morbidity causing functional limitation or disability?What soft tissues are involved |
| Preparation for Stretching | Review goals and outcomesSelect most effective and efficient techniques and positionWarm up tissues (thermal or low-intensity exercise)Explain procedure to patientExpose the areaReinforce relaxation to the patient during the procedure |
| Application of Manual Stretching Procedures | Move through range slowly to point of restrictionHold prox + dist to jtStabilize the prox segment, move the dist segApply gentle distraction to the moving jtApply low intensity stretch in slow sustained manner for 30 secGradually increase stretc |
| After Stretchin | Apply cold to area in elongated positionIntegrate volitional movement using the gained rangePromote functional use of range |
| Precautions for Stretching, general precautions | Do not passively force beyond normal ROMUse extra caution in patients with known or suspected osteoporosis from any causeProtect new fractures with precise stabilizationAvoid vigorous stretch of tissues that have been immobilized for an extended per |
| Special precautions for mass-market flexibility programs- Common errors and potential problems | Nonselective or poorly balanced stretching activitiesInsufficient warm-upIneffective stabilizationUse of ballistic stretchingExcessive intensityAbnormal biomechanicsInsufficient information about age-related differences |
| Adjuncts to Stretching Interventions- Relaxation training | Common elements of relaxation trainingExamples of approaches to relaxation trainingAutogenic trainingAwareness through movementSequence for progressive relaxation techniquesIndicators of relaxation |
Created by:
NicoleB
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