Flexibility/ROM Flashcards
1
Q
Flexibility vs. ROM
A
- Flexibility
~ Musculotendinous unit’s ability to
elongate with application of force - ROM
~ Amount of mobility of a joint
~ Determined by soft tissues and bony
structures - ROM may be limited due to a lack of
flexibility
2
Q
Flexibility/ROM Importance
A
- Allows for proper quantity and quality of
movement
~ Decreases compensations in the
Kinetic Chain
> Allows all links to contribute to the
activity
~ Allows for greater “forgiveness” in
prevention of injury
3
Q
Flexibility/ROM Limiting Factors
A
- Muscle spasm
~ Natural reaction to pain/injury
~ Part of the pain/spasm/stasis cycle
~ Body’s way of bracing the area to
protect the injured structures - Scar tissue
~ Both positive and negative
~ Scar tissue is less flexible than other
tissue = limiting
~ Can be modified with stress to avoid
limitation
~ Adhesion
> Scar tissue formation between
layers of soft tissue
~ Joint Contracture
> Loss of ROM typically due to scar
tissue formation or lack of
flexibility in joint capsule - Neural Factors
~ Nervous system is continuous
> Impingement at any site can cause
tension throughout the system - Tension
~ Nervous system is enclosed in Fascia
that can be injured or tightened with
immobilization - Effects of Immobilization
4
Q
Flexibility/ROM Limiting Factors: Effects of Immobilization
A
- Connective Tissues
~ Tissue Composition
> Collagen
> Elastin
> Fibroblasts
> Ground Substance
• Organic gel that lubricates and
maintains space between fibers
~ Immobilization decreases the amount
of Ground Substance decreasing
space and lubrication
> CT becomes tight - Muscle
~ Fibers and bundles are wrapped in
CT that can tighten
> Due to decreased Ground
Substance
~ Muscle will adapt to immobilized
position by changing its resting
length
5
Q
Techniques to Increase Flexibility/ROM
A
- ROM Exercise
~ PROM
> Causes scar tissue to be laid down
in a more organized way
> Moves synovial fluid to nourish
cartilage
> No output
> Must use care to not disrupt
healing~ Once done, AROM > Causes scar tissue to be laid down in an even more organized way > Moves synovial fluid to nourish cartilage > Output occurs > Must use care to not disrupt healing ~ Once done, RROM and or Functional Activity
6
Q
Stretching Techniques: Static
A
- Lengthening or decreasing tone of a
muscle by placing it in a position of
stretch (tension) and holding it for an
extended amount of time
~ Holding it activates the GTO causing
the muscle to relax
~ Causes habituation of the MS,
decreasing their activation due to
repeated or prolonged stimulation
~ Duration of Hold Time: 15-30 seconds
is optimal - Can’t be done too early, it can disrupt
healing if a muscle strain is present
7
Q
Stretching Techniques: Balistic
A
- Repetitive bouncing motions
~ Antagonist is inhibited by contraction
of the agonist allowing for greater
degree of movement
> Reciprocal Inhibition (RS)
> Retraining/Neurological Effects
• Closely mimics the way muscles
function during activity: Muscles
are eccentrically loaded before
contracting concentrically during
functional activity - does not
contribute to lengthening, but
prepares muscles to work
efficiently
8
Q
Stretching Techniques: Proprioceptive Neuromuscular Facilitation (PNF)
A
- Techniques use the GTO, MS, and RS to
increase flexibility
9
Q
PNF Contract Relax Technique: GTO
A
- Limb is passively moved to a position
where resistance is sensed - Pt. is instructed to perform an isotonic
contraction against resistance for
5-10 seconds - The muscle being treated is relaxed and
the limb is passively moved to a new
point of resistance - This process is repeated a total of 3 times
10
Q
PNF Hold Relax Technique: GTO
A
- Limb is passively moved to a position
where resistance is sensed - Pt. is instructed to perform an isometric
contraction (GTO) against resistance for
5-10 seconds - The muscle being treated is relaxed and
the limb is passively moved to a new
point of resistance - This process is repeated a total of 3 times
11
Q
PNF Slow Reversal Hold Relax Technique: RI & GTO
A
- Limb is actively moved to a position
where resistance is sensed - Pt. is instructed to perform an isometric
contraction (GTO) against resistance for
5-10 seconds - The muscle being treated is relaxed and
the limb is actively (RI) moved to a new
point of resistance - This process is repeated a total of 3 times
12
Q
Active Isolated Stretching: RI
A
- Limb is moved to the end ROM by one
muscle group and a 2 second stretch is
applied with external assistance - Increases flexibility by stretching CT and
lengthening it to a new length
13
Q
Joint Mobilization
A
- Used when limitation for Flexibility/ROM
is associated with the CT of the joint
~ Joint capsule
~ Ligaments
~ Caused by tight CT due to inactivity
and or scar tissue - Can also be used to reduce pain
14
Q
Joint Mobilization Characteristics
A
- Passive
- Technique may be oscillatory or a
sustained stretch - Techniques typically uses accessory
movements to enhance physiological
movement
~ Physiological
> Movements the pt. can do
voluntarily (In/Ex rotation of
shoulder)
~ Accessory
> Movements that are necessary for
normal ROM but can’t be
performed by pt.
> Occurs during physiological
movements (Ex rotation and
translation of humeral head
during Ex rotation of shoulder)
15
Q
Joint Shapes
A
- Ovoid
~ One surface is convex and the other is
concave
~ Tibiofemoral Joint - Sellar/Saddle
~ One surface is concave in one
direction and convex in the other with
the other bone being convex and
concave, respectively
~ Articulation between thumb and
trapezium carpal bone
16
Q
Joint Mobilization: Accessory Motions
A
- Rolling
~ New points of one surface meet new
points on the opposing surface
~ Never alone - Sliding
~ Same point on one surface comes into
contact with new points on the
opposing surface
~ Gets taken of advantage of during
Joint Mobilization
~ Never alone - Spinning
~ Rotation around a stationary axis
~ Same point on the moving surface
creates an arc on the opposing
surface
~ Never alone - Compression and Distraction
17
Q
Concave - Convex Rule: Concave on Convex Movement
A
- Key to knowing in which direction to
mobilize a joint - Concave surface moving on convex
surface moves in in the same direction as
the moving bone
~ Slide occurs in the same direction as
the physiological movement
> Posterior rolling = posterior
sliding
> Ex: Open chain knee extension to
flexion
18
Q
Concave - Convex Rule: Convex on Concave Movement
A
- Convex surface moving on concave
surface - Convex surface moves in the different
direction as the moving bone - Slide occurs in the opposite direction as
the physiological movement
~ Inferior sliding = superior rolling
~ Ex: shoulder abduction/adduction
19
Q
How do you increase flexion or extension in the knee?
A
- Flexion
~ Mobilize the Tibia posterior - Extension
~ Mobilize the Tibia anteriorly
20
Q
When would you use Joint Mobilization?
A
- Pain is preset
- Joint Capsule Limitation
~ Capsular Pattern Demonstrated
> Specific and predictable
limitations in PROM
> Due to tight joint capsule
~ Abnormal “Capsular” Joint End Feel
> Similar to tissue stretch, but
occurs earlier in the ROM and has
a firmer feeling
> Due to tight joint capsule - If AROM and PROM are both limited =
Capsular pattern or abnormal capsular
joint end feel
21
Q
Dosages of Joint Mobilization: Graded Oscillation Techniques (Maitland) and its Grades
A
- Dosage: amount of joint translation into
tight tissues> Grade 1 - Small amplitude, rhythmic oscillations at the beginning of the range of joint play > Grade 2 - Large amplitude, rhythmic oscillations within the range of joint play > Grade 3 - Large amplitude, rhythmic oscillations stressed into tissue resistance > Grade 4 - Small amplitude, rhythmic oscillations stressed into tissue resistance > Grade 5 - Small amplitude with stress past resistance. Manipulation - Quick stretch and release
- The higher the grade, the higher the
tension - Mobilization means turning liquid in the
joint into gas = popping sounds - Grades 1 and 2 are for pain management
and not ROM - Joint Mobilization is also good at sending
more sensory impulses to brain
22
Q
Dosages of Joint Mobilization: Sustained Translatory Techniques and its Grades
A
- Grade 1 - Small amplitude distraction
without stress to capsule - Grade 2 - Distraction with or without a
glide to tighten the capsule - Grade 3 - Distraction and glide with an
amplitude large enough to place a
stretch on the capsule - Holds stretch
- Lower grades can be used to see pt.
tolerance
23
Q
Joint Mobilization Procedures: Position
A
- Pt. and joint in a position of relaxation
- Begin with joint in a resting position and
not closed packed - Closed packed (tight/full extension)
~ Position in which both the articular
surfaces are in maximum congruency
resulting in the greatest mechanical
stability for that joint
~ Most ligaments and capsules
surrounding the joint are taut
~ Doesn’t allow for movement
ultimately not allowing for proper
joint mobilization
24
Q
Joint Mobilization Procedures: Stabilization and Treatment Force
A
- Stabilization
~ Stabilize the proximal bone
~ Belt, hands, Pad, or Table - Treatment force
~ Apply force as close to the joint line as
possible
~ Use large of a contact surface as
possible
> Don’t use thumbs, use whole
palm of hand
25
Joint Mobilization Procedures: Direction of Force
- Joint traction is applied perpendicular to
the treatment plane
- Gliding is applied parallel to the
treatment plane
- If possible, apply traction before gliding
26
Joint Mobilization Treatment Initiation and Progression
- Treatment Initiation
~ Purpose is to see how the technique
will be tolerated
~ Follow up the next day
> Increased pain? Reduce treatment
to Grade 1 or discontinue
> Same it Reduced Pain? Progress
using technique for desired results
- Progression
~ As range of plateaus position the
joint towards the end of the available
ROM
~ Avoid mobilization in fully closed
packed positions: can cause instability
> Goal is to increase ROM not
decrease it
27
Specifics of Oscillations and Sustained Techniques
- Oscillations
~ Rate: 2-3 per second
~ Duration: 1-2 minutes
- Sustained
~ 7-10 second hold with a few seconds
of rest, repeated several times
28
Joint Mobilization Considerations
- What is this accomplishing?
~ Decreased Pain: sensory input
~ Increased ROM: puts tension on
tissues and stretches them which
allows for more gliding
~ Neurological: CNS senses what’s
going on
~ Tissue Repair: applies stress
- Where do I go from here?
~ Have pt. actively move
29
Muscle Energy
- Utilizes concepts associated with the
Golgi Tendon Organ (GTO), Reciprocal
Inhibition (RI), and the Muscle Spindle
(MS) to lengthen shortened muscles
- If tight, uses MET
- Relaxes muscle and makes them move
better
30
Why do muscles shorten?
- Injury/Pain
~ Protection, pain-spasm-stasis, and
scar tissue
- Postural Deviation
~ Tight muscles that adjusted to new
positions
- Physiological Imbalances
~ Electrolytes, muscle fibers, nerves, or
water
- Connective Tissue Changes
~ Becomes tight with injury and scar
tissue builds up
31
Muscle Energy Components
- Postisometirc Relaxation
~ After a muscle is contracted for a
period of time the GTO is activated
> The muscle is then in a relaxed
state for a brief period of time
- Reciprocal Inhibition
~ When one muscle is contracted, its
antagonist is automatically inhibited
~ Ex: Contraction of quads causes
inhibition of the hamstrings
- Muscle Spindle Reset
~ Isometric contraction at maximal
length causes the MS to accept the
new length
> MS won’t initiate muscle
contraction to shorten the
muscle past the new length
32
Muscle Energy General Procedure
- Each muscle is first tested to determine if
shortening has occurred
~ Involves observation of limitation and
palpitation of tightness
- Followed by MET is indicated
33
Testing Procedure for Tightness
- Practitioner controls the body part being moved and palpates the muscle being assessed if possible
- The body part is moved until the practitioner feels the first signs of tightness
- The practitioner notes the degree of movement and determines if any limitation is present
34
Muscle Energy: Acute Technique General Guidlines
- Pts. limb is positioned where resistance is first perceived
- The pt. is asked to produce an Isometric contraction (GTO) with no ore than 20% effort for 7-10 seconds
- The limb is moved to a new point of resistance
- Process is repeated 3 times
35
Muscle Energy: Chronic Technique General Guidlines
- Pts. limb is positioned short of resistance
- The pt. is asked to produce an Isometric (GTO) contraction with no more than 20% effort for 7-10 seconds
- Antagonist (RI) and or over pressure are
used to move the limb to a point of stretch
- Process is repeated until no more gains in length are achieved
36
Lower Crossed Syndrome
- Long periods of sitting causes the hip flexors to shorten/tighten
- Which also causes the hip extensors to under activate (weak) = inhibits RI
- Tight lumbar muscles = weak abdominals
- Weak glutes = tight psoas
- If muscles are tight, stretch them
- If muscle are weak, strengthen them
37
Upper Crossed Syndrome
- Tight traps and legatos scapula = weak neck flexors
- Weak rhomboids and serrated anterior = Tight pectorals
38
Muscle Energy for the Spine
- Deepest muscle layer:
~ Multifidus
> Causes spinal segments to extend,
lateral flex, and rotate to the
opposite side
> If tight, won’t be able to flex
~ Rotatores
> Causes spinal segments to extend
and rotate to the opposite side
- Shortening of the muscles is determined by palpation of the transverse processes in a neutral spine position and with movement of the spine
- Techniques that fuse an Isometric contraction of the deep muscles are used to induce relaxation and restore minimal movement
39
Muscle Energy for the Pelvis
- Muscles attached are still assessed, but muscle contraction is used to pull the pelvis into alignment
~ Can pull the innominate back to the
correct position
40
What general muscle groups attach to the pelvis?
- Hamstrings: posteriorly
- Hip Flexors: anteriorly
41
Muscle Energy for the Pelvis: Dysfunctions and ways to identify them
- Dysfunctions
~ Innominate Rotations
~ Pubic Dysfunction
~ Innominate Shears
- Ways to identify them
~ Observation/palpation of Landmarks
~ Movement dysfunction tests
42
Muscle Energy for the Pelvis: Anteriorly Rotated Innominate
- Observation/Palpation
- Movement Dysfunction Tests
~ Gillet’s/Stork
~ Standing flexion
~ Seated flexion
- What muscle group can be used to correct this?
~ Hamstrings
43
Muscle Energy for the Pelvis: Posteriorly Rotated Innominate
- Observation/Palpation
- Movement Dysfunction Tests
~ Gillet’s/Stork
~ Standing flexion
~ Seated flexion
- Which muscle group can be used to correct this?
~ Hip flexors: Rectus Femoris and
Iliacus
44
Muscle Energy for the Pelvis: Pubic Dysfunction
- Observation/Palpation
~ Assumption due to vulnerable/
private area
- Shotgun approach
- Which muscle group can be used to correct this?
~ Adductors (Distraction) and
Abductors (Compression)
~ Activating the abductors will caused
the adductors to relax = RI and vice
versa
45
Muscle Energy for the Pelvis: Innominate Sheer
- Observation/Palpation
- Movement Dysfunction Tests
~ Gillet’s/Stork
~ Standing flexion
~ Seated flexion
- Uses more of a postisometric approach
- Which muscle group can be used to correct this?
~ Quadratus Lumborum
> Hikes the hip
- Closed pack position to target the SI joint
