Treatments - Stretching

Question 1

Managing abnormal tone

Answer 1

> Maintain soft tissue length
Maintain joint alignment
Prevent muscle shortening
Regain muscle length + alignment if possible

Question 2

Treatment options for tone

Answer 2

> Stretching
- Passive
- Active (PNF)
> Passive movements
> Positioning
> Massage 
> Medication
> Heath therapy 
> Hydrotherapy

Question 3

Stretching

Answer 3

> Process of elongating connective tissue/muscles etc.
Claims to;
- prevent MSK injuries
- reduce muscle soreness post exercise
- increase RoM
- prevent structural deformities
- prevent muscle shortening - aids opposing muscle (less resistance)
*Not enough evidence to support these claims

Question 4

Elastic vs plastic changes

Answer 4

> In managing tone/spasticity we want plastic changes to reduce the tone over the long term

• muscle assumes greater length even after stretch is removed (golgi-tendon has been stimulated to allow autogenic inhibition = greater stretch)
• Effective plastic stretch requires TIME/FORCE/SPEED (slow to prevent triggering muscle spindle reflex)
• Achieved through positioning/splinting

> Elastic changes (short term increases)
- Can allow us to practice more desirable movement patterns - may aid neuroplastic changes within brain (evidence isn’t there yet)

Question 5

Contraindications

Answer 5

> Bony Block - should only be at elbow extension
Recent fracture (damage consolidation)
Acute inflammatory process (disrupt healing/cause greater damage)
Acute pain - something may be damaged
Hypermobility - no need
If tone/tightness aid day to day lives - tenodesis grip or adductor tone for walking

Question 6

Precautions

Answer 6

> Don’t take beyond normal RoM
suspected osteoporosis
newly united fractures - load tolerance
swollen tissue - skin can’t stretch

*Muscle pain for longer than 24 hours shows too much force was put on the stretch - triggered inflam response

Question 7

Tone Patterns

Answer 7

> LL = extensor pattern

• hip flexors/adductors/medial rotators (psoas/rec fem/adductors)
• knee extensors (quads)
• ankle plantarflexors (gastroc/soleus)
• foot inverters (tib ant/post)

> UL = Flexor Pattern

• Shoulder Girdle = elevated (upper traps)
• Shoulder joint = flexed/adducted/medial rotated (pec major)
• elbow = flexed (biceps)
• RUJ’s pronated (pronator teres)
• Wrist = flexed (fdp/fds/fcu/fcr/pl)
• Fingers = flexed + adducted (fdp/fds)

Question 8

Environment for tone

Answer 8

> High tone

• relaxed
• quiet
• soothing

> Low tone

• fast
• motivating
• stimulating

Question 9

Active Stretching Theory

Answer 9

> PNF = Proprioceptive Neuromuscular facilitation
- promote response of neuromuscular mechanism via stimulating proprioceptors
Used for
- Strength
- RoM
- Endurance
- Co-ordination
- Mobility/Stability
*Relies on correct sensory input from therapist

Question 10

Active Stretching method

Answer 10

> Upper Limb = diagonal pattern
- Pec Major goes from med rotation/adduction/extension(thumb in opposite pocket) to Lateral rotation/abduction/flexion (thumb pointed behind)

Question 11

PNF - Contract Relax

Answer 11

> Take towards resistance
have maximally contract vs. resistance (Isometrically)
back towards starting position
Idea is that maximal contraction leads to maximal relaxation so better RoM can be achieved

Question 12

PNF - Reciprocal Inhibition

Answer 12

> Isotonic - contraction vs resistance into range

> Agonist contracting causes antagonist to relax (have to think what we are trying to get to relax)

Question 13

PNF - Contract/Relax/Contract

Answer 13

> Isometric contraction of tight muscle
Isotonic contraction of opposing muscle to tight muscle
Mix of contract relax and reciprocal inhibition to encourage full relaxation of tight muscle