Podcast
Questions and Answers
What is the primary cause of decreased range of motion (ROM) in most cases?
What is the primary cause of decreased range of motion (ROM) in most cases?
Which of the following is NOT an intrinsic factor that limits range of motion?
Which of the following is NOT an intrinsic factor that limits range of motion?
Which intervention is specifically aimed at improving mobility?
Which intervention is specifically aimed at improving mobility?
Which of the following factors is considered an extrinsic limitation to range of motion?
Which of the following factors is considered an extrinsic limitation to range of motion?
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How can physical agents assist in improving mobility?
How can physical agents assist in improving mobility?
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What characterizes non-capsular restriction?
What characterizes non-capsular restriction?
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Which of the following is a potential cause of capsular restriction?
Which of the following is a potential cause of capsular restriction?
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What is the primary advantage of a slow stretch compared to a high-velocity stretch?
What is the primary advantage of a slow stretch compared to a high-velocity stretch?
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Which mode of stretching involves applying a short-duration stretch force repeatedly?
Which mode of stretching involves applying a short-duration stretch force repeatedly?
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Which type of stretch is characterized by fast joint movement that quickly elongates muscles?
Which type of stretch is characterized by fast joint movement that quickly elongates muscles?
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What is the main characteristic of static-progressive stretching?
What is the main characteristic of static-progressive stretching?
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Which technique uses reciprocal inhibition to promote stretching?
Which technique uses reciprocal inhibition to promote stretching?
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How does active inhibition benefit muscle stretching?
How does active inhibition benefit muscle stretching?
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Which type of contracture results from disuse or prolonged immobilization?
Which type of contracture results from disuse or prolonged immobilization?
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What characterizes a fibrotic contracture?
What characterizes a fibrotic contracture?
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What does selective stretching focus on?
What does selective stretching focus on?
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Which stretching technique is not recommended for elderly or sedentary patients?
Which stretching technique is not recommended for elderly or sedentary patients?
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What factor does NOT influence soft tissue extensibility?
What factor does NOT influence soft tissue extensibility?
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What term describes tissue that initially resists stretch but will lengthen with sustained force?
What term describes tissue that initially resists stretch but will lengthen with sustained force?
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Which fibers are primarily responsible for the strength and stiffness of connective tissue?
Which fibers are primarily responsible for the strength and stiffness of connective tissue?
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What is the main goal of stretching exercises?
What is the main goal of stretching exercises?
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What should be the focus when stretching connective tissue to increase extensibility?
What should be the focus when stretching connective tissue to increase extensibility?
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Which of the following correctly describes 'tight weakness'?
Which of the following correctly describes 'tight weakness'?
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What action is contraindicated when dealing with a joint that has a bony block?
What action is contraindicated when dealing with a joint that has a bony block?
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What prevention measure is recommended for a patient with osteoporosis during stretching?
What prevention measure is recommended for a patient with osteoporosis during stretching?
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In the procedure for hamstring stretching, what position does the patient assume?
In the procedure for hamstring stretching, what position does the patient assume?
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Which structure helps to stabilize the posterior aspect of the distal tibia during end-range knee extension?
Which structure helps to stabilize the posterior aspect of the distal tibia during end-range knee extension?
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What is a key indicator that too much stretch force has been applied during stretching?
What is a key indicator that too much stretch force has been applied during stretching?
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What are the primary considerations while performing a standing dorsiflexion stretch?
What are the primary considerations while performing a standing dorsiflexion stretch?
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Which property of soft tissue allows it to return to its pre-stretch position after the stretching force is removed?
Which property of soft tissue allows it to return to its pre-stretch position after the stretching force is removed?
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What fibers provide extensibility in connective tissues?
What fibers provide extensibility in connective tissues?
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Which stretching condition is indicated for limited ROM due to agonist weakness?
Which stretching condition is indicated for limited ROM due to agonist weakness?
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Study Notes
Stretching Principles and Procedures
- Stretching is a technique to increase range of motion (ROM) and improve flexibility.
- Prolonged immobilization decreases ROM in soft tissues and joints, primarily due to inactivity.
- Immobilization can be related to inactivity, pain, or post-surgical/injury protocols like immobilization after a fracture.
- Extrinsic factors that limit ROM include casts, orthotics, and external fixators, as well as skeletal traction.
- Intrinsic factors that limit ROM include pain, inflammation (local or systemic), joint effusion, muscle/tendon/fascial disorders such as adhesions and tendonitis, skin disorders like burns and scleroderma, bony/mechanical blocks like osteophytes or spinal disk herniation, vascular disorders, and contractures.
- Other factors that limit ROM include muscle weakness, psychological factors like kinesiophobia, sedentary lifestyle/inactivity, tone abnormalities/muscle imbalances such as spasticity or muscle weakness, and postural misalignments like scoliosis or kyphosis.
- Interventions to improve mobility include stretching, PROM (passive range of motion), AAROM (active assisted range of motion) and AROM (active range of motion), and surgery.
- Physical agents can increase soft tissue extensibility, control inflammation, limit adhesion formation, control pain/discomfort during stretching, and facilitate motion.
- Flexibility is the ability to move a joint or series of joints smoothly through an unrestricted, pain-free range of motion.
- Capsular restrictions are due to tightness, restriction, or adherence of the joint capsule. Motions are limited in multiple planes, and each synovial joint has a unique capsular pattern with firm, capsular end-feel.
Capsular vs. Non-Capsular Restriction
- Capsular restriction relates to limitations in joint movement caused by the joint capsule.
- Non-capsular restriction relates to limitations in joint movement unrelated to the joint capsule.
Capsular Restriction (Continued)
- Potential causes of capsular restriction include prolonged immobilization, joint effusion, tissue fibrosis, and local or systemic inflammation (e.g., DJD, RA, OA).
Non-Capsular Restriction
- Motion loss unrelated to joint capsule or a specific pattern.
- Potential causes include ligamentous adhesion, internal joint derangement, and extra-articular lesions.
Speed of Stretch
- Slow stretching is safer than high-velocity stretching.
- It reduces injury risk, stress on connective tissues, active stretch reflex (muscle spindle), and is easier to control.
Modes of Stretching
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Stretching techniques include static/static progressive, cyclic/intermittent, ballistic, proprioceptive neuromuscular facilitation (PNF), manual, mechanical, self-stretching, passive, and active methods.
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Passive stretching involves the patient being relaxed and the stretch being applied manually or mechanically.
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Static/Static progressive stretching involves lengthening the tissue while held in a sustained position just beyond the point of tissue resistance to allow for longer duration of stretch. Static progressive is a continuation of this where the tissue will be incrementally lengthened into range and held.
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Cyclic/intermittent stretching involves short durations of stretch force repeatedly and is relatively low intensity.
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Ballistic stretching involves high velocity and high intensity and is not recommended for the elderly or those with chronic conditions.
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Manual stretching uses a clinician or patient to apply stretch to the target tissue.
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Mechanical stretching utilizes external mechanical devices which can provide consistent low-intensity stretching over time like cuff weights, weighted pulley systems, and Flexionator/Extensionator.
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Self-stretching is done independently by the patient, after instruction and supervised practice, maintaining or increasing extensibility. It's a part of home exercise programs and is essential for long-term self-management.
Neuromuscular Facilitation/Inhibition Techniques
- These techniques involve reflexively decreasing tension in shortened muscles before or during stretching.
- Common techniques include hold-relax (contract-relax), agonist contraction, and hold-relax with agonist contraction.
Hold-Relax/Contract-Relax
- Uses autogenic inhibition to relax target muscles; target muscle is lengthened to the point of tissue resistance or patient comfort; patient actively contracts target muscle against resistance for 5 seconds; then relax and stretch further, holding for several more seconds.
Active Inhibition
- Uses reciprocal inhibition to relax target muscles, allowing for greater elongation
- Stretches the target muscle passively to point of resistance while the opposite muscle is activated and contracted against resistance.
- Holds the contraction for 5 seconds, relaxes the opposite muscle, and passively stretches the target muscle into the range again. Procedure is repeated.
Agonist Contraction
- Uses reciprocal inhibition to relax target muscles.
- Patient contracts the muscle opposite the target muscle for several seconds without resistance.
- The patient independently performs the movement deliberately and slowly.
Selective Stretching
- Apply stretching techniques to specific muscles and joints to improve function.
- Stretching one group of muscles while preserving limited flexibility in other groups.
Overstretching
- Lengthening muscles beyond their normal length.
- Leads to hypermobility potentially causing joint instability.
Contracture
- Adaptive shortening of muscle-tendon units and other soft tissues surrounding a joint; commonly caused by prolonged immobilization or spasticity.
Types of Contracture
- Myostatic: no specific muscle pathology; resolvable in a short time with stretching.
- Pseudomyostatic: results from muscle being in a constant state of contraction. Can resolve with neuromuscular inhibition to reduce muscle tension.
- Arthrogenic/peri-articular: Caused by intra-articular pathology like adhesions, or periarticular tightness in connective tissue.
- Fibrotic/irreversible: tissue extensibility loss; not usually resolved without surgery; typically due to extensive fibrosis or bone formation, prolonged immobilization, or inflammatory response.
Soft Tissue Extensibility
- Several factors can influence a tissue’s ability to regain extensibility following immobilization.
- Tissue type, velocity, intensity of stretch, duration of force, and temperature at the time of stretch.
Soft Tissue Properties
- Elasticity: soft tissue returns to its pre-stretch position after the force is removed.
- Viscoelasticity: initial resistance to stretch that gradually lengthens with sustained force. Time dependent.
- Plasticity: Ability of soft tissue to retain a new and greater length after the force is removed. Result of prolonged, progressive stretching.
Contractile Soft Tissue (Skeletal Muscle)
- Elasticity, contractility, and extensibility are mechanical properties influencing muscle responses to stretch.
- Muscle spindle and Golgi tendon organ are neurophysiological properties.
Connective (Noncontractile) Soft Tissue
- Includes ligaments, tendons, joint capsules, fascia, and noncontractile tissues in muscles and skin.
- Responds to stretching differently, so remodeling is needed for effective extensibility increases.
- Collagen fibers provide strength and stiffness, resisting stretch/tension. Elastin fibers provide extensibility.
Connective Tissue: Mechanical Behavior
- Tendo, ligaments/joint capsules/fascia have varying abilities to withstand tension, differing in collagen fiber alignment. Collagen fiber orientation, tensile strength, and area of cross-section all contribute to resistance from differing forces. Skin has a limited ability to resist higher levels of tension.
Stress-Strain Curve
- Shows the relationship between stress (load) and strain (deformation) of tissues.
- Toe region, elastic range, elastic limit, plastic range, necking, and failure are key points.
Stretching: Goals
- Prevents irreversible contracture.
- Increases general flexibility of a part before strengthening exercises.
- Prevents or minimizes the risk of musculoskeletal injuries during specific exercises or physical activities.
- Regains or achieves necessary flexibility and ROM for functional activities.
Stretching: Indications
- Limited range of motion due to decreased tissue extensibility, preventable structural deformities (like a contracture), or agonist weakness.
- Preventing musculoskeletal injury during or following fitness and conditioning programs; or used in warm-up and cool-down activities.
Stretching: Contraindications
- Joint motion limited by a bony block, recent fracture with incomplete union, signs of active inflammation or infection, tissue healing concerns, joint hypermobility, or a hematoma or other injury.
- Shortened tissues may provide compensatory joint stability.
Stretching: Precautions
- Avoid forcing beyond normal ROM.
- Stabilize fracture sites during stretching.
- Avoid vigorously stretching tissues after long-term immobilization.
- Don't stretch if pain/soreness lasts more than 24 hours post-stretch.
- Consider edema, and don't overstretch weak points (muscles that are often used as stabilizers).
Stretch Weakness and Tight Weakness
- Muscles kept in highly stretched positions tend to be weaker. Muscles habitually kept in a shortened position lose elasticity; they are strongest in their shortened position and weak in the lengthened position.
- Example: prolonged spinal curve exaggeration, causing postural problems, muscle strength/flexibility imbalances.
Stretching Procedures
- Examples of stretching procedures for different body segments (Hamstring, End-Range Knee Extension, Gastrocnemius/Soleus, Shoulder Flexion, Wrist Extension). Instructions for patient position, stabilization, hand placement, and stretch direction are included.
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Description
This quiz explores the essential principles and procedures of stretching, highlighting its significance in increasing range of motion and flexibility. It addresses factors that can limit movement, including extrinsic and intrinsic influences, as well as the impact of immobilization on recovery. Gain better insights into the intricacies of stretching techniques and their applications.
