Stretching

Question 1

The ability of the body structures or segments to move so that ROM for functional activities is allowed

Answer 1

MOBILITY

Question 2

The most effective means of stretching the latissimus dorsi in order to increase flexion of the shoulder is to:
Select one:
a. Place the patient in a prone position; stabilize the scapula and hyperextend the shoulder.
b. Place the patient in a supine position; stabilize the lateral border of the scapula as you flex the shoulder.
c. Place the patient in the supine position with hips and knees flexed; stabilize the pelvis at the iliac crest and flex the shoulder.

Answer 2

c. Place the patient in the supine position with hips and knees flexed; stabilize the pelvis at the iliac crest and flex the shoulder.

Question 3

The goal of this exercise is to increase the flexibility (extensibility) of the pectoralis major muscle. You teach the patient to stand facing a corner with the shoulders abducted to 90°, elbows flexed to 90°, and hands and forearms placed on the walls. You tell the patient to relax into the stretch (by leaning into the corner) for 30 seconds; push his forearms into the walls for a count of six; then relax and lean forward toward the corner again and hold for 30 seconds. The self-stretching technique the patient is using is:

Answer 3

Hold–relax (contract–relax).

Question 3

During a stretching maneuver, you apply a 30-second stretch of a shortened muscle group just up to the point of tissue resistance. After this maneuver, rather than relaxing with the patient and returning the body segment to a neutral position, you move the body segment into the newly gained range to apply another stretch of the same muscle group and hold the stretch for an additional 30 seconds. What term best describes this type of stretching?

Answer 3

Static-progressive

Question 4

Each of the following is a contraindication to stretching adaptively shortened tissues except:
Select one:
a. Sharp, acute pain during ROM.
b. When ROM is limited because scar tissue has reduced soft tissue extensibility.
c. A bony block.
d. When tight (shortened) soft tissues provide functional stability of a body segment affected by paralysis.

Answer 4

b. When ROM is limited because scar tissue has reduced soft tissue extensibility.

Question 5

T or F
Functional ROM; ROM required for functional activities
Functional mobility; ability of a community to initiate, control, sustain active

Answer 5

FALSE
Functional ROM; ROM required for functional activities
Functional mobility; ability of an individual to initiate, control, sustain active

Question 6

FACTORS LEADING TO HYPOMOBILITY

Answer 6

Prolonged immobilization of a segment
Sedentary lifestyle
Postural malalignment with muscle length alterations
Impaired muscle performance
Tissue trauma resulting in inflammation and pain
Congenital or acquired deformities

Question 7

The three interactions that brings flexibility

Answer 7

Involves interaction of the following:
muscle length
joint integrity
periarticular soft tissue extensibility (soft tissue surrounding the joint)

Question 7

Ability to rotate a single joint or series of joints smoothly and easily through an unrestricted, pain-free ROM.

Answer 7

FLEXIBILITY

Question 7

T or F
Mobility is Maximized when the muscle-tendon units that cross a joint have adequate extensibility to deform and yield to a stretch force.

Answer 7

FALSE
Flexibility Maximized when the muscle-tendon units that cross a joint have adequate extensibility to deform and yield to a stretch force.

Question 8

Each of the following is true about joint mobilization/manipulation techniques except:
Select one:
a. Techniques can be applied using gliding or oscillation techniques that involve low or high amplitudes and velocities.
b. Techniques involve the application of accessory joint movements but not physiological movements.
c. They are appropriate to use if a joint is painful or inflamed to decrease or inhibit the perception of pain.

Answer 8

c. They are appropriate to use if a joint is painful or inflamed to decrease or inhibit the perception of pain.

Question 8

To achieve permanent lengthening of connective tissue:
Select one:
a. The collagen fibers must line up in a parallel fashion.
b. The region of necking, or macrofailure, must be reached.
c. Bonds between collagen fibers must be remodeled in the lengthened position.
d. The ground substance between the fibers must be reduced.

Answer 8

c. Bonds between collagen fibers must be remodeled in the lengthened position.

Question 8

The glycosaminoglycans and water in the ground substance of connective tissue are important for connective tissue health because:

Answer 8

They reduce friction and transport nutrients and metabolites.

Question 8

To increase terminal knee extension, you position the patient prone so the lower leg is not supported on the treatment table. The patient relaxes while the lower leg and foot “hang” off the end of the table. The therapist adds a cuff weight around the ankle. What type of stretching procedure is being applied?

Answer 8

Mechanical

Question 9

Stress within the elastic range of tissue deformation may cause all of the following except:
Select one:
a. Straining of bonds (cross-links) between collagen fibers.
b. Microfailure between collagen bonds.
c. squeezing water out of the ground substance.
d. Grade II ligament injuries.

Answer 9

d. Grade II ligament injuries.

Question 9

Based on the neurophysiological properties of the contractile components of muscle, a high-intensity, quick stretch of a muscle-tendon unit is believed to create phasic elevation of tension in the stretched muscle by:

Answer 9

Facilitating the muscle spindle via the Ib fibers.

Question 9

In a patient’s medical record you see “knee flexion contracture.” What does it mean?
Select one:
a. The patient is unable to actively extend the knee through the full range of motion (ROM) despite full passive knee extension.
b. The quadriceps muscle group is tight and limits full, passive knee flexion.
c. Full, passive knee extension is not possible.

Answer 9

c. Full, passive knee extension is not possible.

Question 9

What is Dynamic Flexibility?

Answer 9

Active mobility, active ROM
Axtent to which an active muscle contraction can rotate a joint through its available ROM

Question 10

Flexibility that is limited by ability of a muscle to contract through ROM
degree and quality of tissue extensibility

Answer 10

Dynamic

Question 10

What is Static Flexibility?

Answer 10

passive mobility, passive ROM
extent to which a joint can be passively rotated through its available ROM
Passive flexibility is a prerequisite for—but does not ensure—dynamic flexibility.

Question 10

Type of flexibility that depends on the extensibility of soft tissues that cross and surround a joint

Answer 10

STATIC/PASSIVE FLEXIBILITY

Question 10

Significant resistance to stretch

Answer 10

CONTRACTURE

Question 10

Adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint, resulting in significant resistance to passive or active stretch and limited ROM.

Answer 10

CONTRACTURE

Question 10

Contracture vs Shortness

Answer 10

Contracture: almost complete loss of motion
Shortness: partial loss of motion

Question 10

clinical and fitness settings to describe restricted motion due to adaptive shortening of soft tissue, in particular, mild muscle shortening

Answer 10

Tightness

Question 11

How DESIGNATION OF CONTRACTURES BY LOCATION

Answer 11

Joint - motion - contracture Elbow flexors contracture

Question 11

Types of contractures

Answer 11

Myostatic/Myogenic Pseudomyostatic /apparent Atherogenic Periarticular Fibrotic Irreversible

Question 11

Myostatic vs pseudomyostatic contracture

Answer 11

pseudomyostatic has a muscle pathology, resolved with neuromuscular inhibition myostatic is resolved with stretching

Question 11

intra-articular pathology problem is within the joint changes within the joint: adhesions, synovial proliferation, joint effusion, irregularities in articular cartilage, or osteophyte formation

Answer 11

Atherogenic

Question 11

connective tissue of muscle and periarticular structures can cause adherence of these tissues

Answer 11

Fibrotic

Question 12

T or F Fibrotic contractures are possible to stretch a fibrotic contracture and eventually increase ROM, it is often difficult to re-establish optimal tissue length.

Answer 12

TRUE

Question 12

A process whereby the overall function of a patient may be improved by applying stretching techniques to some muscles and joints while allowing motion limitations to develop in other muscles or joints.

Answer 12

SELECTIVE STRETCHING

Question 12

: a process whereby the overall function of a patient may be improved by applying stretching techniques to some muscles and joints while allowing motion limitations to develop in other muscles or joints.

Answer 12

Overstretching

Question 12

T or F An end-range stretch force will elongate shortened muscle-tendon units and/or periarticular connective tissues when a restricted joint is rotated just beyond its available ROM

Answer 12

TRUE

Question 12

Passive vs assisted stretching

Answer 12

passive: relaxed as possible during the stretch assisted: patient assists in moving the joint through a greater range

Question 13

Any stretching exercise that is carried out independently by a patient after instruction and supervision by a therapist

Answer 13

SELF-STRETCHING:

Question 14

founded on the concept of reflexively decreasing tension in shortened muscles prior or during the stretch

Answer 14

NEUROMUSCULAR FACILITATION AND INHIBITION

Question 15

manipulative procedures that evolved out of osteopathic medicine designed to lengthen muscle and fascia and to mobilize joints. employ voluntary muscle contractions by the patient in a precisely controlled direction and intensity against a counterforce applied by the practitioner

Answer 15

MUSCULAR ENERGY TECHNIQUES:

Question 16

Skilled manual therapy interventions specifically applied to joint structures by the clinician to modulate pain and treat joint impairments that limit ROM.

Answer 16

JOINT MOBILIZATION/MANIPULATION

Question 16

: initially resists deformation, such as a change in length, when a stretch force is applied but will slowly lengthen if the force is sustained. The viscoelastic tissue will gradually return to its prestretch configuration after the stretch force is removed

Answer 16

VISCOELASTICITY

Question 16

T or F Both contractile and noncontractile tissues have elastic, plastic qualities, and viscoelastic properties.

Answer 16

FASLE Both contractile and noncontractile tissues have elastic and plastic qualities, while only noncontractile connective tissues have viscoelastic properties.

Question 16

What force does these fibers resist: COLLAGEN FIBERS GROUND SUBSTANCE; proteoglycans

Answer 16

COLLAGEN FIBERS; Tensile strength Proteoglycans; Compressive Forces

Question 16

Application of specific and progressive manual forces using sustained manual pressure or slow, deep stroking.

Answer 16

SOFT TISSUE MOBILIZATION/MANIPULATION

Question 16

POTENTIAL BENEFITS AND OUTCOMES OF STRETCHING

Answer 16

INCREASED FLEXIBILITY AND ROM GENERAL FITNESS Injury prevention Reduced post-exercise muscle soreness Enhanced performance

Question 16

improve or restore nerve tissue mobility restricted by tissue adhesions or scar tissue following trauma or surgical procedures

Answer 16

NEURAL TISSUE MOBILIZATION (NEUROMENINGEAL MOBILIZATION):

Question 17

T or F Soft tissues that can become restricted and impair mobility include muscles with their contractile and noncontractile elements and various types of connective tissue (tendons, ligaments, joint capsules, fascia, and skin)

Answer 17

TRUE

Question 17

if it returns to its prestretch resting length directly after a short-duration stretch force is removed.

Answer 17

ELASTICITY

Question 18

is the tendency of soft tissue to assume a new and greater length after a stretch force is removed

Answer 18

PLASTICITY

Question 18

provide linkage between the main tissue matrix components and between the cells and the matrix opponents

Answer 18

Glycoproteins

Question 19

Responsible for the strength and stiffness of tissue and resist tensile deformation. Erranged in an organized relationship and dimension Tissue with a larger proportion of collagen provides greater stability

Answer 19

COLLAGEN FIBERS

Question 19

Great deal of elongation with small loads and fail abruptly without deformation at higher loads. Tissues with higher amounts of elastin have greater flexibility.

Answer 19

ELASTIC FIBERS

Question 19

MECHANICAL PROPERTIOES OF NONCONTRACTILE SOFT TISSUE Summary

Answer 19

When load is applied, Collagen fibers Elongate -> Stiffen -> begins to break -> failure

Question 19

Provide tissue with bulk.

Answer 19

RETICULAR FIBERS

Question 20

Force (or load) per unit area. Mechanical stress is the internal reaction or resistance to an externally applied load. reaction or resistance

Answer 20

Stress

Question 21

The amount of deformation or lengthening that occurs when an external load (such as a stretch force) is applied to a structure change in length

Answer 21

Strain

Question 21

resistance to a force applied in a manner that approximates tissue. Weight-bearing through a joint will produce compression stresses.

Answer 21

Compression

Question 21

the resistance to a force applied in a manner that will lengthen the tissue. A stretching force results in tension stress.

Answer 21

Tension

Question 21

Regions of the Stress-Strain Curve

Answer 21

Toe Elastic - Elastic Limit Plastic - Necking Failure

Question 21

first response to loading is to straighten and align. occurs with minimally applied force and results in small increases in tissue stress. functional

Answer 21

TOE REGION

Question 21

resistance to two or more forces that are applied in opposing direction

Answer 21

Shear

Question 22

end of the linear region and the point beyond which the tissue does not return to its original shape and size.

Answer 22

ELASTIC LIMIT

Question 22

reached when the tissue rupture sand loses its integrity

Answer 22

FAILURE

Question 22

Strain beyond the elastic limit begins to cause permanent tissue deformation. Plastic deformation results from sequential failure (micro failure) of the bonds between collagen fibrils and eventually of collagen fibers

Answer 22

PLASTIC RANGE

Question 22

With respect to stretching, tissue stress beyond the toe region aligned collagen fibers in the direction of applied force.

Answer 22

ELASTIC RANGE/LINEAR PHASE

Question 22

The maximum strain the tissue can sus- tain is its ultimate strength. Once this point is reached, further increase in strain does not result in increased stress due to tissue macro failure.

Answer 22

ULTIMATE STRENGTH

Question 22

Effects of immobilization:

Answer 22

Weakening of the tissue Adhesion formation Slow rate of return for tensile strength Reduction in energy absorption Increase in Compliance (decreased stiffness

Question 22

is reached in which there is considerable weakening of the tissue, and it rapidly fails.

Answer 22

region of necking

Question 22

Effects of inactivity

Answer 22

Decrease in the size and amount of collagen fibers Proportional increase in the predominance of elastin fibers Slower recover

Question 22

These responds to what? Muscle Spindle Golgi Tendon Organ

Answer 22

Muscle Spindle - respond to stretch (quick stretch); Golgi Tendon Organ - respond to tension (prolonged tension)

Question 22

T or F Firing of the GTO causes inhibition of gamma motor neuron

Answer 22

FALSE Firing of the GTO causes inhibition of alpha motor neuron

Question 22

T or F Type III collagen is weaker than Type I collagen

Answer 22

TRUE

Question 22

Intrafusal vs Extrafusal Muscle fibers in terms of innervation

Answer 22

Intrafusal: innervated by gamma motor neurons (small-diameter) Extrafusal: alpha motor neurons

Question 23

Nuclear bag vs nuclear chain

Answer 23

Nuclear Bag: sensitive to quick & sustained (tonic stretch) Nuclear Chain: sensitive only to tonic stretch