Podcast
Questions and Answers
What is the primary reason for avoiding stretching in areas outside the complaints of a hypermobile dancer?
What is the primary reason for avoiding stretching in areas outside the complaints of a hypermobile dancer?
Which of the following best describes the major difference between a myostatic contracture and a fibrotic contracture?
Which of the following best describes the major difference between a myostatic contracture and a fibrotic contracture?
Which of the following conditions is a contraindication for stretching?
Which of the following conditions is a contraindication for stretching?
What is the recommended approach for treating muscle guarding in a patient reluctant to stretch?
What is the recommended approach for treating muscle guarding in a patient reluctant to stretch?
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In terms of exercise sequencing, why is the order of stretching significant during a physical therapy session?
In terms of exercise sequencing, why is the order of stretching significant during a physical therapy session?
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Which type of stretching involves holding a position for a period of time to elongate muscles?
Which type of stretching involves holding a position for a period of time to elongate muscles?
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In patients with potential contractures, which two lower extremity muscle groups are most likely affected?
In patients with potential contractures, which two lower extremity muscle groups are most likely affected?
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What is a common indication that stretching may be contraindicated for a patient?
What is a common indication that stretching may be contraindicated for a patient?
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What muscle is primarily responsible for limiting ankle dorsiflexion?
What muscle is primarily responsible for limiting ankle dorsiflexion?
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Which stretching technique involves a combination of contraction and relaxation to improve range of motion?
Which stretching technique involves a combination of contraction and relaxation to improve range of motion?
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Regarding upper body positional shortening, which muscle group could be affected?
Regarding upper body positional shortening, which muscle group could be affected?
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What would you expect a patient to exhibit prior to initiating stretches during the chronic stage of healing?
What would you expect a patient to exhibit prior to initiating stretches during the chronic stage of healing?
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Which type of stretch is conducted quickly and is often used to warm up the muscles before activity?
Which type of stretch is conducted quickly and is often used to warm up the muscles before activity?
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What is the recommended duration for a single stretch cycle according to most literature?
What is the recommended duration for a single stretch cycle according to most literature?
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Which mode of stretching involves low-load intensity and is often performed in a passive manner?
Which mode of stretching involves low-load intensity and is often performed in a passive manner?
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What should be the focus of therapy when addressing contractures in patient care?
What should be the focus of therapy when addressing contractures in patient care?
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Which of the following is a contraindication for stretching?
Which of the following is a contraindication for stretching?
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To achieve greater flexibility gain, it is suggested to perform how many sessions of stretching per week?
To achieve greater flexibility gain, it is suggested to perform how many sessions of stretching per week?
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When incorporating active exercises post-stretching, what is the primary goal?
When incorporating active exercises post-stretching, what is the primary goal?
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Cyclic stretching can be effectively performed for what length of time per repetition?
Cyclic stretching can be effectively performed for what length of time per repetition?
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What technique should be used during a multi-joint stretch?
What technique should be used during a multi-joint stretch?
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In terms of speed, what is the general recommendation for applying stretch force?
In terms of speed, what is the general recommendation for applying stretch force?
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What might be an indicator for choosing surgical intervention when treating a contracture?
What might be an indicator for choosing surgical intervention when treating a contracture?
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In a physical therapy session, which scenario would necessitate avoiding stretching?
In a physical therapy session, which scenario would necessitate avoiding stretching?
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Which approach should be taken for a patient fearful of stretching and exhibiting muscle guarding?
Which approach should be taken for a patient fearful of stretching and exhibiting muscle guarding?
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What key factor should be prioritized when sequencing exercises in a physical therapy session involving stretching?
What key factor should be prioritized when sequencing exercises in a physical therapy session involving stretching?
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What type of injury would likely correspond with a grade III classification?
What type of injury would likely correspond with a grade III classification?
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Study Notes
Stretch Types
- Towel Stretch: Targets the gastrocnemius, involves using a towel pulled on the toes while seated.
- Quadriceps Stretch: Targets the quadriceps muscle group, involves holding the foot towards the buttock.
- Adductor Stretch: Targets the adductor muscles, involves crossing one leg over the other.
- Triceps Stretch: Targets the triceps muscle group, involves reaching across the back and touching the shoulder blade.
- Soleus Stretch: Targets the soleus muscle, involves stretching the calf with a bent knee.
- Hamstring Stretch: Targets the hamstring muscles, involves reaching down toward the toes with a straight leg.
- Hamstring Stretch: Targets the hamstring muscles, involves reaching down toward the toes with a bent knee.
Applying Stretching to Patient Care
- Lower Extremity Muscle Groups Affected: Hip flexors and knee extensors are likely affected in a patient with contractures at the hips and knees.
- Cyclic Stretching: This involves repeatedly taking the muscle to its end range of motion, and then returning to a neutral position. In DJ's case, this could be used for stretching the hip flexors.
- Static Progressive Stretching: This involves slowly and gradually increasing the stretch by holding the muscle in an elongated position over time. In DJ's case, this could be used for stretching the knee extensors.
- Upper Body Muscles: Shoulder flexors, shoulder adductors, and shoulder extensors are potential areas for positional shortening.
- Static, Progressive Stretching for Upper Body: Use this method for a muscle group like the shoulder flexors - stretch the muscle slowly and gradually increase the stretch by holding it in an elongated position.
- Contraindications for Stretching: Signs of inflammation, increased joint hypermobility, and bony limitations would contraindicate stretching.
- Type of Contracture: DJ likely has a myostatic contracture. This is a type of contracture where the muscle is shortened but there is no underlying tissue pathology.
Achilles Tendinitis
- Ankle Dorsiflexion: Gastrocnemius and soleus muscles are likely limiting ankle dorsiflexion.
- Hip Abduction: TFL, gluteus medius, and gluteus minimus muscles are likely limiting hip abduction.
- Hold-Relax Technique: This involves contracting the muscle against resistance followed by relaxation and stretching. For the soleus, a therapist would push the foot into dorsiflexion (contraction), then have the patient relax and then move into a deeper stretch.
- Contract-Relax Technique: This involves isometric contraction of the muscle followed by relaxation and stretching. For the gastrocnemius, have the patient point their toes and then relax, followed by a stretch into dorsiflexion.
- Ballistic Stretching: This involves bouncing or swinging the body part to take it through its range of motion. For the adductor magnus and longus, the patient would gently swing their legs into abduction.
- Signs and Symptoms: In the chronic phase of healing, signs such as pain, stiffness, and reduced range of motion are expected.
- Hypermobility: In a hypermobile dancer, avoid ballistic stretching, as it can put excessive stress on joints.
- Static Stretching: Static stretching is generally preferred to ballistic stretching for most patients.
Stretching in Physical Therapy
- Stretching after Injury: Stretching is recommended after tissue injury once inflammation has subsided.
- PROM vs Stretching: PROM (Passive Range of Motion) focuses on moving the joint through its range of motion without a muscle contraction while stretching involves moving the joint through its range of motion using a muscle contraction. PROM is generally done within a comfortable range.
- Myostatic vs Fibrotic Contracture: Myostatic contractures occur due to muscle tightness, while fibrotic contractures involve changes in the connective tissue requiring surgical intervention.
- Stretching Contraindications: Inflammation, hypermobility, bony limitation, fractures (in healing stage), and soft tissue providing joint stability are key contraindications.
- Grade III Injury: This involves a complete tear of the tissue.
- Stretching Dosage: Generally, 2-5 sessions per week is recommended.
- Ballistic Stretching Application: Use this type of stretching to improve flexibility and range of motion but only if a patient has a full range of motion (ROM) without discomfort.
- Encouraging Active Stretching: Use the hold-relax technique to help patients with muscle guarding engage in active stretching.
- Hold-Relax vs Contact-Relax: Hold-relax involves a passive stretch after the muscle contracts while contract-relax involves an active muscle contraction followed by a passive stretch.
- Stretching Sequencing: Warm-up with light cardio, then perform strengthening exercises, and finish with stretching.
- Biceps Contracture: Teach the patient to stretch their biceps by extending their arm backward and pulling their elbow into their back.
- Full PROM and AROM: Progress to strengthening exercises and continue to monitor for any limitations or pain. Document this progression in the SOAP note.
Stretching Principles
- Intensity, Duration, Speed, Frequency, and Mode: These are the basic elements of a stretching program.
- Low-Load, 30-second hold, Slow speed, 2-5 sessions per week, Various modes: These are the generally recommended guidelines for stretching.
Considerations for Safe Stretching
- Preparation: Prepare for the stretch by warming up the tissues and knowing the goals.
- Positioning: Position the patient safely for comfort and access.
- Performance: Use proximal stabilization, move the distal segment, and stretch one joint at a time for multi-joint stretches. Apply low-load in the direction opposite the line of pull.
- Post-Stretch: Implement active exercises to utilize the newfound range of motion.
- Safety: Monitor patient tolerance throughout the session, asking about comfort and pain levels.
Dosage
- Stretching Duration: 30-60 seconds, can be divided into multiple repetitions.
- Frequency: 1-3 sessions per day, 2-5 days per week.
Stretching Recommendations
- Recommended for patients after tissue injury during the sub-acute phase, when pain is minimal and inflammation has subsided.
PROM vs. Stretching
- PROM (Passive Range of Motion): Performed by the therapist, moving the joint through its range of motion within a comfortable range.
- Stretching: Involves taking the joint beyond its current range of motion, targeting tissue lengthening.
Myostatic vs. Fibrotic Contractures
- Myostatic Contracture: Limited range of motion due to muscle tightness with no underlying pathology.
- Fibrotic Contracture: Limited range of motion due to scar tissue and tissue changes, often requiring surgical intervention.
- Treatment for myostatic contracture may include stretching techniques, while fibrotic contracture often demands surgical procedures.
Stretching Contraindications
- Inflammation: Stretching can exacerbate inflammation, making it unwise during the acute phase.
- Hypermobility: Stretching can increase joint instability in individuals with hypermobility.
- Bony Infill/Limitation: Stretching can be ineffective or harmful if bony structures limit joint movement.
- Fracture (Healing Stage): Stretching can disrupt healing, causing complications.
- Soft Tissue Providing Stability: Stretching can compromise joint stability, especially if surrounding tissues are already compromised.
Grade III Injury
- A grade III injury signifies a complete tear of the affected tissue.
Stretching Dosage
- General recommendation: Hold each stretch for 15-30 seconds, performing 3-5 repetitions.
Ballistic Stretching
- Use ballistic stretching cautiously, and only when tissue tolerance is established.
- Best suited for athletes or individuals with high tissue flexibility.
Encouraging Active Stretching
- Use gentle mobilization and facilitation techniques to encourage active stretching in fearful patients, building confidence and improving range of motion.
Hold-Relax vs. Contract-Relax Stretch
- Hold-Relax: Patient relaxes the muscle while the therapist holds the stretch.
- Contract-Relax: Patient contracts the muscle briefly before relaxing into the stretch, facilitating deeper tissue lengthening.
Sequencing Stretches During a Session
- Include stretching after warm-up and before strength training. It's crucial to prepare the tissue for activity.
- Postural Education should be incorporated during the session to address any postural imbalances contributing to limitations.
Bicep Contracture Home Stretch
- Patient can self-stretch by raising their arm overhead and gently bending the elbow towards the opposite shoulder.
- Hold the stretch for 15-30 seconds and repeat 3-5 times.
Full PROM and AROM
- If a patient has achieved full PROM and AROM after a myostatic contracture, the next session could focus on muscle strengthening and functional exercises.
- Document this progress in the objective section of the SOAP note: (S) subjective, (O) objective, (A) assessment, and (P) plan.
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Description
This quiz focuses on various stretching techniques and their application in patient care, specifically targeting lower extremity muscle groups. Learn about different stretches and their benefits for specific muscles, enhancing understanding of therapeutic practices for individuals with contractures.
