TI Week 4

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Questions and Answers

How do stretching exercises primarily increase range of motion (ROM)?

  • By stimulating synovial fluid production within the joint.
  • By taking soft tissue structures beyond their available length. (correct)
  • By actively contracting muscles through the entire ROM.
  • By strengthening the joint's bony structures.

Which factor most directly affects dynamic flexibility?

  • The muscle's ability to contract through the ROM and tissue extensibility. (correct)
  • The temperature of the room where exercises are performed.
  • The patient's motivation to perform the exercise.
  • The atmospheric pressure surrounding the joint.

A patient has full passive ROM in their shoulder but struggles to reach overhead actively. Which of the following is the MOST likely limiting factor?

  • Inadequate extensibility of soft tissues surrounding the shoulder.
  • Insufficient muscle strength to move the arm against gravity. (correct)
  • An arthrokinematic restriction.
  • The patient is not motivated to move their arm.

What is the primary characteristic of a contracture, distinguishing it from general hypomobility?

<p>Adaptive shortening of soft tissues leading to significant resistance and limited ROM. (A)</p> Signup and view all the answers

Which of these conditions is MOST likely to result in a contracture?

<p>Prolonged joint positioning due to neurological conditions. (A)</p> Signup and view all the answers

What are the primary effects of immobilization on connective tissue?

<p>Reduced energy absorption and decreased tissue stiffness before failure. (C)</p> Signup and view all the answers

How does inactivity impact collagen fibers within connective tissue?

<p>It decreases the size and amount of collagen fibers, weakening the tissue. (C)</p> Signup and view all the answers

Approximately how long does it take for connective tissues to recover from the effects of inactivity with regular cyclic loading?

<p>5 months (C)</p> Signup and view all the answers

What is the combined effect of increased age on connective tissue?

<p>Decreased tensile strength and slower adaptation to loading. (D)</p> Signup and view all the answers

What are the long-term effects of corticosteroids on collagen?

<p>A long-lasting deleterious effect with decreased tensile strength. (C)</p> Signup and view all the answers

Following an injury, newly synthesized collagen bridges the injury site. What type of collagen is initially present and how does it change over time?

<p>Type III collagen, which matures into Type I collagen through remodeling. (A)</p> Signup and view all the answers

How does a slowly applied stretch minimize muscle activation?

<p>By allowing the muscle to adapt gradually, reducing the activation of the stretch reflex. (C)</p> Signup and view all the answers

Why is a slowly applied stretch recommended to reduce the risk of tissue injury and post-stretch muscle soreness?

<p>It minimizes muscle activation and reduces tensile stresses on connective tissues. (C)</p> Signup and view all the answers

Why is a low-velocity stretch generally considered safer than a high-velocity stretch?

<p>Low-velocity stretches allow for better control by either the therapist or the patient. (D)</p> Signup and view all the answers

What is a key characteristic that differentiates dynamic stretching from ballistic stretching?

<p>Dynamic stretching uses controlled movements at lower velocities, while ballistic stretching involves high-velocity movements. (C)</p> Signup and view all the answers

Which of the following is a potential risk associated with ballistic stretching?

<p>Increased risk of tissue trauma and muscle soreness. (D)</p> Signup and view all the answers

For whom is ballistic stretching generally NOT recommended?

<p>Elderly or sedentary individuals, or patients with musculoskeletal pathologies. (D)</p> Signup and view all the answers

What is the primary reason why high-intensity, short-duration stretching may be detrimental to tissues weakened by immobilization or disuse?

<p>It can make dense connective tissue more brittle and prone to tearing. (A)</p> Signup and view all the answers

In what scenario might high-velocity stretching be considered appropriate during rehabilitation?

<p>During the final phase, for a young, active patient returning to high-demand activities. (C)</p> Signup and view all the answers

Which athlete would most likely benefit from incorporating high-velocity stretching into their conditioning program?

<p>A gymnast who requires significant dynamic flexibility. (B)</p> Signup and view all the answers

A patient has a chronic contracture. What type of stretching should be avoided?

<p>Ballistic stretching involving high-velocity movements. (B)</p> Signup and view all the answers

When implementing high-velocity stretching, which progression order ensures patient safety and effective tissue adaptation?

<p>Static stretching → Slow, short end-range stretching → Slow, full-range stretching → Fast, short end-range stretching → Fast, full-range stretching. (A)</p> Signup and view all the answers

What is the primary recommendation for initiating the stretch force during active stretching?

<p>Actively contracting the muscle group opposite the muscle to be stretched. (D)</p> Signup and view all the answers

Which of the following factors should be considered when determining the optimal frequency of stretching interventions?

<p>Underlying cause of impaired mobility, tissue healing status, and patient's age. (A)</p> Signup and view all the answers

Why is achieving the correct balance between collagen tissue microfailure and subsequent repair important in a stretching program?

<p>To allow an increase in soft tissue lengthening. (D)</p> Signup and view all the answers

What should precede stretching to ensure the shortened muscle remains relaxed and the restricted connective tissues yield more easily?

<p>Either low-intensity active exercise or therapeutic heat to warm the tissues. (C)</p> Signup and view all the answers

During manual stretching, what aspects does the therapist actively control?

<p>Site of stabilization, direction, rate of application, intensity, and duration of stretch. (C)</p> Signup and view all the answers

What is the typical duration a controlled, static stretch should be held during a manual stretching intervention, according to the information?

<p>15 to 60 seconds (A)</p> Signup and view all the answers

In the context of stretching, what does the 'mode of stretch' refer to?

<p>How the stretch force is applied and who is actively participating in the process. (C)</p> Signup and view all the answers

Which of the following is the MOST important reason for a patient to perform self-stretching exercises as part of a comprehensive treatment plan?

<p>To maintain and enhance gains in tissue extensibility achieved through direct interventions. (B)</p> Signup and view all the answers

A physical therapist is designing a home exercise program for a patient with limited shoulder flexion. What duration of static stretch is generally recommended for self-stretching to ensure safety and effectiveness?

<p>30 to 60 seconds per repetition (D)</p> Signup and view all the answers

A patient is using a weight-pulley system to apply a low-intensity stretch to the knee joint over a prolonged period. What physiological change is the mechanical stretching aiming to achieve in the soft tissues?

<p>Relatively permanent lengthening of soft tissues due to plastic deformation. (C)</p> Signup and view all the answers

What is a critical consideration when interpreting the results of studies that report 'permanent' lengthening of tissues achieved through mechanical stretching devices?

<p>The term 'permanent' may refer to length increases maintained for only a short period after discontinuing the device. (A)</p> Signup and view all the answers

A physical therapist is instructing a patient on self-stretching techniques for the hamstring muscles. Which instruction is MOST important to ensure the patient's safety and the effectiveness of the exercise:

<p>Hold the stretch at the point of mild discomfort and maintain it consistently. (D)</p> Signup and view all the answers

Which statement correctly differentiates between 'contracture' and 'contraction' in a musculoskeletal context?

<p>Contraction refers to the development of active muscle tension, while contracture describes a shortening of the muscle. (D)</p> Signup and view all the answers

What is the primary mechanism by which stretching leads to increased flexibility and range of motion?

<p>Through biomechanical and neural changes in the contractile and non-contractile elements of the muscle-tendon unit and surrounding fascia. (A)</p> Signup and view all the answers

Which of the following is MOST accurate regarding the use of stretching?

<p>Chronic stretching is not only increases flexibility but also appears to have beneficial effects on physical performance. (C)</p> Signup and view all the answers

How does immobilization affect collagen within soft tissues?

<p>Decreases stiffness due to weak bonding between new collagen fibers and adhesion formation. (A)</p> Signup and view all the answers

What is the MOST important factor to consider when aiming to induce positive changes in muscle tissue through stretching exercises?

<p>Dosing of the stretching protocols implemented. (D)</p> Signup and view all the answers

An athlete who has been immobilised following a fracture asks how long it will take for their tissues to return to their normal tensile strength. Which is the MOST appropriate answer?

<p>The return to normal tensile strength for immobilised tissue is typically a slow process. (B)</p> Signup and view all the answers

A conditioning coach is designing a comprehensive program for a runner. Which of the following statements BEST reflects the current understanding of stretching's role in enhancing performance?

<p>Regular stretching as part of a long-term program can positively affect physical performance. (A)</p> Signup and view all the answers

A physical therapist is treating a patient who has developed adhesions due to prolonged immobilization. Which of the following accurately describes how immobilization contributes to adhesion formation?

<p>Decreased effectiveness of the ground substance in maintaining space and lubrication between fibers. (C)</p> Signup and view all the answers

What is a primary function of fibrocartilage, such as meniscus?

<p>Adding stability to the joint (B)</p> Signup and view all the answers

Where should the PT provide stability duringa a stretch?

<p>Proximal (B)</p> Signup and view all the answers

Flashcards

Flexibility

The ability to move joints through a full, pain-free range of motion.

Dynamic Flexibility

The ability of muscles to actively rotate a joint through its available ROM.

Passive Flexibility

The ability to rotate a joint passively through its available ROM without muscle contraction.

Hypomobility

Decreased mobility or restricted motion at one or more joints.

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Contracture

Adaptive shortening of muscles and soft tissues leading to resistance to movement and limited ROM.

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Contraction

The development of active muscle tension.

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Benefits of Stretching

Improves flexibility and range of motion (ROM) through biomechanical changes.

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Increased Muscle Extensibility

Greater muscle length and decreased stiffness achieved through stretching.

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Warm-up before Activity

Stretching is recommended as part of a warm-up to prevent injuries.

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Chronic Stretching

Regular stretching over time which enhances flexibility and performance.

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Acute Stretching

Stretching done immediately before an activity with little evidence of performance enhancement.

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Soft Tissue Injury Prevention

Stretching may help reduce the risk of injuries, although evidence is not strong.

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Effects of Immobilization on Collagen

Leads to weak bonding and cross-linking of disorganized collagen fibers.

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Effects of Inactivity

Inactivity leads to the weakening of connective tissue due to reduced collagen size and amount.

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Recovery Time after Inactivity

Recovery from inactivity changes takes about 5 months of regular cyclic loading.

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Age effects on Connective Tissue

Aging decreases tensile strength and stiffness, and adaptation to stress is slower.

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Corticosteroids Impact

Corticosteroids negatively affect collagen properties, decreasing tensile strength and causing tissue death.

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Healing Pattern After Injury

Tissue damage follows a specific healing pattern, involving Type III collagen before maturing to Type I.

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Remodeling Phase Duration

Remodeling of injured connective tissue begins around 3 weeks post-injury and lasts months to years.

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Effects of Nutritional Deficiencies

Nutritional deficiencies and hormonal imbalances can make connective tissue more susceptible to injury.

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Importance of Slow Stretching

Slowly applied stretching minimizes muscle activation and reduces risks of injury and soreness.

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Low-Velocity Stretch

A controlled stretch force applied slowly, making it safer to execute.

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Ballistic Stretching

Rapid, forceful intermittent stretching that uses high velocity and intensity.

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Soft Tissue Trauma

Injury to muscles caused by high-velocity ballistic stretching.

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Dynamic Stretching

Controlled movement that actively stretches muscle groups at low speeds.

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Appropriate High-Velocity Stretch

High-velocity stretching that is suitable for highly trained athletes or active patients.

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Rehabilitation High-Velocity Stretch

Used in the final phase of rehabilitation for active patients to prepare for sport.

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Risks of High-Intensity Stretch

Can cause injury if used with weakened tissues or chronic contractures.

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Not Recommended for Certain Populations

High-velocity stretching is discouraged for elderly or sedentary individuals.

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Self-Stretching

A technique where patients stretch independently to maintain extensibility after therapy.

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Static Stretching

Stretching held for 30-60 seconds; considered safest for self-stretching.

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Mechanical Stretching

Using devices to apply low-intensity stretch for prolonged periods for soft tissue lengthening.

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Permanent Lengthening

Refers to lasting length increases in tissues after mechanical stretching, but may not be truly permanent.

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Home Exercise Program

An integral part of managing musculoskeletal disorders, including self-stretching techniques.

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Stretching Progression

A sequence of stretching techniques from static to fast.

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Stretch Initiation

Stretch force begins by contracting the opposing muscle group.

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Frequency of Stretching

How often the stretching sessions occur within a time frame.

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Mode of Stretching

Refers to how stretch force is applied and who is involved.

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Manual Stretching

Therapist applies external force to lengthen tissues beyond resistance.

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Stretch Duration

Holding a stretch for 15 to 60 seconds, repeated several times.

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Low-Intensity Exercise

Light activities recommended before stretching to warm the tissues.

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Signs of Tissue Damage

Indicators a therapist must watch for during repetitive stretching.

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Study Notes

Stretching and Flexibility Outline

  • Stretching and range of motion (ROM) exercises are not synonymous. Stretching increases tissue length beyond available length, while ROM exercises stay within limits.
  • Flexibility is the ability to smoothly rotate a joint(s) in a pain-free range of motion (ROM). The interaction of muscle length and joint integrity affects flexibility, as does the extensibility of surrounding periarticular tissue.
  • Dynamic flexibility (active ROM) is the ability of muscles to rotate a joint through an available range of motion. It depends on muscle contraction and tissue extensibility.
  • Passive flexibility (passive ROM) is the extent to which a joint can be passively rotated, determined by the extensibility of the surrounding tissues. This is a prerequisite for, but not a guarantee of, active flexibility.
  • Hypomobility is decreased mobility or restricted movement at a joint(s).
  • Contracture is adaptive shortening of muscle-tendon units and surrounding tissue, limiting mobility as a result of significant resistance from the contracting tissues. Contractures develop with prolonged joint positioning and trauma.

Indications and Contraindications for Stretching

  • Indications include limited ROM due to adhesions, contractures, scar tissue formation, structural deformities, muscle weakness and shortening, and prevention/reduction of musculoskeletal injuries.
  • Contraindications include bony blocks limiting joint motion, recent fractures (incomplete bony union), acute inflammation/infection, healing restricted adjacent tissues, acute pain with joint movement, hematomas, hypermobility, and shortened soft tissues providing joint stability.

Potential Benefits and Outcomes of Stretching

  • Good evidence supports increased flexibility and ROM.
  • Benefits include biomechanical and neural changes in muscle-tendon units and surrounding fascia, increasing muscle extensibility and decreasing stiffness.
  • Stretching is recommended as part of warm-up/cool-down routines and in fitness regimens.

Changes in Collagen Affecting the Stress-Strain Response

  • Immobilization decreases collagen bonding strength, leading to stiffness and slow rate of return to normal tensile strength
  • Prolonged inactivity decreases collagen fiber size and quantity, resulting in reduced tissue strength.
  • Physical activity enhances the strength of connective tissues.

Effects of Age, Corticosteroids, and Injuries

  • Aging decreases maximum tensile strength and stiffness, increasing the risk of injuries.
  • Corticosteroids negatively affect collagen synthesis and organization, decreasing tensile strength.
  • Injury follows a predictable pattern, utilizing new collagen. This collagen is initially weaker than mature collagen; subsequent remodeling takes several weeks-years to restore the connective tissue to its prior state.

Stretching Interventions

  • Alignment, stabilization, intensity, duration, speed, frequency, and mode are determinants of effective stretching interventions.
  • Various stretching modes exist (static, ballistic, PNF, etc.).
  • Maintaining optimal speed of stretch is important for preventing injury and muscle soreness. Slow, controlled movements are preferable.
  • The optimal frequency and mode vary depending on factors like the patient's condition, nature of the injury, and prior response to stretching.
  • Manual stretching involves a clinician or caregiver applying external forces to lengthen tissue.
  • Self-stretching involves the individual performing the stretching technique with proper instruction and supervision.
  • Mechanical stretching uses devices for low-intensity stretching.

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