MIDTERM-L2-THERAEX-STRETCHING Mobility and Stretching Exercises PDF

MOBILITY AND STRETCHING EXERCISES DEFINITION OF TERMS Mobility – ability to move or be moved freely and easily Flexibility – quality of bending easily without breaking Elasticity – ability to return to its pre-stretch resting length Viscoelasticity – time-dependent property, a...

MOBILITY AND STRETCHING EXERCISES DEFINITION OF TERMS Mobility – ability to move or be moved freely and easily Flexibility – quality of bending easily without breaking Elasticity – ability to return to its pre-stretch resting length Viscoelasticity – time-dependent property, ability to initially resist then gradually return (It gains length when stretched for a certain period of time); improves with heat application Plasticity – ability to assume new and greater length Hypomobility – decreased mobility or restricted motion. ○ Extrinsic ○ Intrinsic Contracture – adaptive shortening of muscle or other structures that cross a joint. Chronological order: 1. Shortness – mild form of tightness 2. Tightness 3. Contracture ○ Muscle tightness – contributory to contracture; shortening of contractile and non-contractile (tendon, fascia) units. Overstretching – stretch beyond the normal ROM of a joint resulting in hypermobility ○ Hypermobility predisposes injury Sprain 1. Microtearing – occurs in the first 50% of plastic range 2. Macrotearing – anatomic disruption in the ligament; 25-70% of tear; 51-100% of plastic range 3. Rupture – total disruption in the anatomical continuity of the structure; occurs in failure stage. CONCEPTS Sarcomere give - occurs when there is a long, sustained stretch, therefore improving spastic muscles Length-Tension Curve of a Muscle Resting length – muscle generates optimal force Shortened muscle – muscle generates less force (because the muscle is already contracted) Lengthened muscle – muscle generates less force (because the muscle is already stretched) Stress-Strain Curve ○ Toe region - point where collagens are uncoiled or straightened ○ Linear region or Elastic range - point wherein you are able to stretch the tissue and it will recoil to their previous length. ○ Elastic limit - beginning of plastic range; point where the muscle is stretched and will not return to its original length; overstretching beyond this point will cause a tear in the musculotendinous unit. TYPES OF FORCES Stress – force or load Tension Strain – deformation occurring in the muscle Compression that occurs when a load is applied Shear Strain TYPES OF FLEXIBILITY Dynamic – ROM during movements particularly fast-paced movements Passive – passively takes a muscle to the point of tension for a short period of time (at least 20 seconds) TYPES OF CONTRACTURE 1. Myostatic/Myogenic contracture - problem is with the muscle itself; tendons have adaptively shortened with significant loss of ROM without specific muscle pathology present. (e.g Casts) 2. Pseudomyostatic contracture - impaired mobility and limited ROM resulting from hypertonicity (rigidity, spasticity); associated with CNS lesion (CVA, SCI, TBI, PD). 3. Arthrogenic/Periarticular contracture - problem is within the joint itself (adhesions, synovial proliferation, joint effusion, etc.) ; result of any intraarticular pathology. 4. Fibrotic contracture – irreversible; a combination of contracture in the muscle and periarticular structures (synovium, ligaments, fascia); difficult to re-establish optimal tissue length. MUSCLE CONTRACTION When titin is overstretched, it cannot recoil back to its original position. ○ Titin holds myosins in place Recall physiology of muscle contraction Troponin binds/holds the MBS to the tropomyosin to regulate calcium influx to the proteins (?) MECHANICAL RESPONSE OF CONTRACTILE UNIT TO IMMOBILIZATION Muscle atrophy and weakness Immobilization leads to decrease in muscle proteins and mitochondria = atrophy Immobilization in lengthened position = sarcomeres increase (Myofibrillogenesis) ○ Can develop Stretch weakness Immobilization in shortened position = increase in connective tissue (or non contractile tissues) or sarcomere absorption ○ Can develop Tight weakness Example: Scoliosis – stretch weakness on convex side; tight weakness in concave side Kyphosis - same as above NOTES: Muscle spindle - Inhibitory; triggered during quick stretch; it will tell EF fibers to contract more; quick stretch generates more tension, therefore a slow and gradual approach is more ideal when stretching; parallel to the EF fibers GTO - Excitatory; Inhibits contraction when active thus relaxing the muscle; Located in musculotendinous unit (Transition b/w muscle and tendon); when the tension is too much, the GTO lengthens; once overstretched, it will send signals to the motor fibers causing relaxation of the muscle to prevent muscle from generating more force causing injury. TIME AND RATE INFLUENCES ON TISSUE DEFORMATION Rate dependence – quick or slow; the speed of stretching depends on how you want the muscle to behave like. Creep – phenomenon where the muscle does not go back to its original length right away after being stretched; improves with heat application Stress-relaxation – applying constant stretching/loading to a particular segment, therefore improving the length; when you don't have to apply the same amount of force you have applied before but that muscle has gained the strength/length to hold that load. EFFECTS: ○ Constant load ○ Improve muscle length leading to decreased internal tension until plateau Cycling loading and connective tissue fatigue – constant force/load to a muscle over time will result in an increase in tissue length until it adapts to the length and reach an equilibrium/plateau. CHANGES IN COLLAGEN AFFECTING STRESS-STRAIN RESPONSE Effects of immobilization – weakening of soft tissue d/t collagen turnover and weak bonding b/w the new non-stressed fibers ○ A single collagen fiber can stretch up to 7-8% ○ A whole ligament can stretch up to 20-40% Effects of inactivity – decrease in size and amount of collagen fibers = weakening Effects of age – decrease in the maximum tensile strength, rate of adaptation is slower Effect of corticosteroids – decrease in tensile strength STRETCHING AND MOBILIZATION: INTERVENTIONS Manual vs. Mechanical Passive vs. Assisted Self-stretching (Active stretching) Neuromuscular facilitation and inhibition (PNF) ○ Contract-relax method; stretching the limb then asking the patient to actively return it to the original position – this causes an increase in ROM for patients with limited ROM. ○ Hold-relax method – stretch then ask the patient to push against your supporting hand for a certain period of time then stretch a little beyond the allowable ROM – this activates a stretch reflex ○ Post-isometric relaxation – ask the patient to perform contraction but resist the motion so the muscle remains isometric (?) Joint mobilization Soft tissue mobilization Neural tissue mobilization – stretching the nerve Selective stretching - applying stretching techniques selectively but allowing LOM to develop in other muscles or joints; function over stretching ○ When you believe that the tightness is functional to the patient, you leave it as is. (e.g Tenodesis in stroke patients) INDICATIONS CONTRAINDICATIONS Limited ROM causing activity or A bony block limiting ROM participation limitations Recent fracture Restricted motion leading to structural Acute inflammation – perform when patient deformities is out of inflammatory phase Muscle weakness and shortening of When sharp, acute pain upon movement is opposing tissue have led to limited ROM present – wait until the pain subsides May be a component of fitness/sport Hematoma or bruising in the area conditioning program designed to reduce Hypermobility already exists – only stretch risk of MSK injuries when HYPOmobile Prior to and after vigorous exercises Shortened tissues provide necessary joint (reduces lactic acid produced) stability Shortened tissues enable the patients to perform specific functional skills otherwise not possible due to their condition (e.g tenodesis of the hand allows stroke patients to grasp objects). BENEFITS Increased flexibility and ROM Improved fitness Injury prevention Enhanced performance DETERMINANTS OF STRETCHING INTERVENTIONS Alignment positioning Stabilization – to avoid bias when stretching Intensity Duration – long duration > high magnitude quick stretch ○ Long duration – static, sustained, prolonged ○ Short duration – cyclic, intermittent, ballistic (beneficial for patients with neurologic conditions) Speed – prolonged > quick Frequency – 2 to 5 sessions a week Mode – static, ballistic, cyclic ALIGNMENT AND STABILIZATION STATIC STRETCHING Manual - 5 seconds to 5 minutes per rep Mechanical – an hour to several days or weeks STATIC-PROGRESSIVE STRETCHING Joint Active Systems (JAS) Uses stress-relaxation properties of tissue Shortened soft tissues are held in a comfortably lengthened position until a degree of relaxation is felt. CYCLIC STRETCHING Short duration stretch force that is repeatedly but gradually applied, released, then reapplied Multiple reps, low intensity (5-10 secs; 15,30,60 seconds) MANUAL STRETCHING External force SELF-STRETCHING Teach the patient and have them perform it themselves Low-load stretching is recommended for stroke patients (uses creep, stress-relaxation and sarcomere give concepts)