9/16 - Stretching for Impaired Mobility

Question 1

what questions do you ask to define an impairment

Answer 1

how much of a limitation is present?
which tissue is responsible for the limitation?

Question 2

why is it important to quantify the limitation

Answer 2

need know if the intervention is actually working
- can see change in sx but want to see change in tissues

Question 3

what are 3 ways to quantify a limitation

Answer 3

goniometry/inclometer
length testing
joint play assessment

Question 4

what are indications for PROM

Answer 4

acute injury & inflamed tissue
pt unable to perform AROM

Question 5

what is the goal of PROM

Answer 5

maintain balance and homeostasis, prevent complications from immobilization

Question 6

what are 6 goals/ways that PROM prevents complications from immobilization

Answer 6

1. mobility of joint & connective tissue
2. prevent contractures
3. maintain elasticity of ms
4. promote circulation
5. cartilage nutrition
6. dec pain

Question 7

what is an indication for AROM and AAROM

Answer 7

able to contract ms and move segment independently (AROM) or w assistance (AAROM)

Question 8

what are 5 goals for AROM

Answer 8

1. maintain elasticity & contractility of ms
2. sensory feedback from contracting ms
3. stim for bone & joint tissue integrity
4. inc circulation
5. improve coordination & motor skill

Question 9

precautions & contraindications of ROM exercises

Answer 9

motion is disruptive to healing process
- pain is indicator of too aggressive

post-op presentations & orders
- ex: s/p Bankart repair

Question 10

what are 3 benefits of CPM

Answer 10

1. prevent adhesions/contractures
2. dec pain
3. assist healing
   - tendons/ligaments
   - skin incisions
   - articular cartilage

Question 11

what are 2 guidelines for CPM

Answer 11

immediate application
gradual inc in ROM (5-15deg/day)

Question 12

what is flexibility

Answer 12

ability to move joint(s) thru unrestricted, pain-free ROM

Question 13

what are 2 types of flexibility

Answer 13

dynamic
passive

Question 14

dynamic flexibility

Answer 14

amt of motion as result of ms contraction

Question 15

passive flexibility

Answer 15

amt of motion as result of PROM

Question 16

hypomobility

Answer 16

dec mobility / restricted motion

Question 17

contracture

Answer 17

adaptive shortening of ms - tendon unit & other soft tissues

designated by location
- action of shortened ms

Question 18

what are 4 types of contractures

Answer 18

1. myostatic
2. pseudomyostatic
3. arthrogenic & periarticular
4. fibrotic & irreversible

Question 19

what is a myostatic contracture

Answer 19

adaptive shortening of musculotendinous unit w/o ms pathology

Question 20

what is a pseudomyostatic contracture

Answer 20

apparent contracture from constant contraction
- hypertonicity (CVA, TBI, SCI), ms spasm

Question 21

what are arthrogenic & periarticular contractures

Answer 21

d/t intra-articular pathology

• ex: meniscal tear in knee doesn’t allow for normal mobility -» leading to flexion contracture

Question 22

what are fibrotic and irreversible contractures caused by

Answer 22

prolonged immobilization

Question 23

what are 7 interventions to inc mobility

Answer 23

1. manual / mechanical / assisted stretching
2. self-stretching
3. nm facilitation/inhibition techniques
4. ms energy techniques
5. joint mob/manip
6. soft tissue mob/manip
7. neural tissue mob

Question 24

depending on the soft tissue, what are 3 possible responses to immobilization and stretch

Answer 24

elasticity
viscoelasticity
plasticity

Question 25

what is elasticity

Answer 25

ability of soft tissue to return to pre-stretch resting length

Question 26

what is viscoelasticity

Answer 26

soft tissue initially resists deformation sustained force over time change in length occurs

Question 27

what is plasticity

Answer 27

soft tissue assumes new & inc length following a stretch

Question 28

what 4 properties of soft tissues can determine the response to immobilization and stretch

Answer 28

1. mechanical properties of contractile tissue 2. neurophysiological properties of contractile tissue 3. mechanical properties of noncontractile soft tissue 4. stress and strain

Question 29

what are contractile elements of ms (4)

Answer 29

ms fibers myofibrils sarcomeres actin & myosin myofilaments

Question 30

describe the mechanical response of the contractile unit to stretch

Answer 30

mechanical disruption of cross bridges & sarcomeres lengthen

Question 31

describe the mechanical response of the contractile unit to immobilization

Answer 31

morphological changes atrophy occurs in <1wk

Question 32

what are the 2 main neurophysiological elements in contractile tissue

Answer 32

ms spindle golgi tendon organ

Question 33

describe the ms spindle's neurophysiological role in contractile tissue

Answer 33

receive/convey info ab changes in length & velocity contains afferent sensory and efferent motor fiber endings

Question 34

describe the GTO's neurophysiological role in contractile tissue

Answer 34

monitors changes in tension

Question 35

where are GTOs located

Answer 35

musculotendinous junctions of extrafusal fibers

Question 36

what are 4 main components of connective tissue

Answer 36

collagen fibers elastin fibers reticulin fibers ground substance

Question 37

what is the role of collagen fibers in connective tissue

Answer 37

strength and stiffness

Question 38

what is the role of elastin fibers in connective tissue

Answer 38

extensibility

Question 39

what is the role of reticulin fibers in connective tissue

Answer 39

provide bulk

Question 40

what is the role of ground substance in connective tissue

Answer 40

proteoglycans glycoproteins

Question 41

describe the progression of the stress and strain curve

Answer 41

toe region elastic range / linear phase elastic limit / yield point plastic range ultimate strength failure

Question 42

what is the toe region in the stress and strain curve

Answer 42

nothing is really happening free motion won't see a change using available motion

Question 43

what is happening in the elastic range of the stress strain curve

Answer 43

start to load tissue and get tissue resistance

Question 44

what is the yield point (elastic limit)

Answer 44

where you start to get to start to make change

Question 45

what is happening in the plastic region

Answer 45

stretching with enough force to be in the plastic region leads to lasting changes in tissue length

Question 46

what is the ultimate strength on the stress strain

Answer 46

most amt of stress/strain tolerated before point of failure

Question 47

what does failure mean on the stress strain curve

Answer 47

external forces will probably push tissue to failure point - tissue will rupture or tear

Question 48

what are 7 components of stretching interventions

Answer 48

1. alignment - isolate desired ms 2. stabilization 3. intensity - magnitude 4. duration - how long to hold 5. speed 6. frequency 7. types of stretch

Question 49

what are 3 types of stretch

Answer 49

static stretching manual PNF

Question 50

how long do we want to hold a stretch for

Answer 50

30-60sec - not necessarily a linear benefit after this time - just want to maintain in plastic region for some duration of time

Question 51

why do you avoid bouncing w stretching

Answer 51

first contraction can limit amt of stretch

Question 52

once you do something to inc mobility, what do you do next

Answer 52

do something to actively engage the ms now using that new ROM