Week 7 - Flexibility Training

Question 1

What is flexibility?

Answer 1

amount of range of motion (ROM) about a joint or multiple joints at any age

Question 2

Can flexibility exercises improve joint ROM at any age?

Answer 2

Yes! and flexibility is important at all ages.

Question 3

The greatest decline in ROM with age is observed in…

Answer 3

spinal extension

Question 4

What is range of motion (ROM)?

Answer 4

total excursion possible at a joint from the beginning of movement to end of it

Question 5

Between the ages of 20-70, joint ROM in spinal extension, hip extension and knee flexion will decline by…

Answer 5

• spinal extension = 50%
• hip extension = 20%
• knee flexion = 2%

Question 6

Why a loss of only 2% in knee flexion?

Answer 6

Because we use it every day when walking

Question 7

On average, is the decrease in ROM greater in lower or upper extremity?

Answer 7

Lower.

Question 8

In men and women, by how much does hamstring flexibility decrease per decade?

Answer 8

~14% per decade

Question 9

What is joint stiffness?

Answer 9

sensation of difficulty moving a joint or the apparent loss of ROM. It often accompanies joint pain and swelling.

Question 10

Does joint stiffness increase with age?

Answer 10

Yes

Question 11

What does joint stiffness lead to?

Answer 11

decrease in ROM

Question 12

Is joint stiffness one of the most common complaints of OA?

Answer 12

Yes

Question 13

What is the vicious joint stiffness cycle?

Answer 13

joint pain –> decrease joint movement –> disuse atrophy –> joint stiffness –> joint pain

Question 14

How do we break the joint stiffness vicious cycle?

Answer 14

Join pain –> maintain joint movement –> no or limited disuse atrophy –> no or limited joint stiffness –> maintain function

Question 15

When is it better for OA to train flexibility?

Answer 15

in the afternoon. This is the window where symptoms go down.

Question 16

What age-related factors contribute to stiffness in OA?

Answer 16

• decrease in muscle mass due to decrease in number of fibers
• increase in connective tissue surrounding and within muscle
• change in the chemical composition of the connective tissue matrix and collagen

Question 17

What are the connective tissues involved in mobility (joint movement)?

Answer 17

ligament, tendons, fascia, joint capsules

Question 18

Which changes in the connective tissue matrix and collagen chemical composition occur?

Answer 18

• loss of water content
• less extensible connective tissues
• connective tissues are more resistant to being deformed

Question 19

What factors contribute to stiffness in OA?

Answer 19

breakdown or articular surfaces in the weight-bearing joints.

Question 20

By age of 75, what is the percentage of OA that have osteoarthritic changes?

Answer 20

85% but some people do not report pain

Question 21

Is pain directly coming from the breakdown or articular cartilage?

Answer 21

No, pain receptors are located in connective tissues + bones

Question 22

What are the functional consequences of a loss of flexibility?

Answer 22

Affects ADLs:
- getting out of a car
- stepping off or on a curb
- bending down to pick smth up
- putting clothes on

Increase in number of functional limitations leads to loss of independence

Question 23

Basic ADLs (self-care tasks)

Answer 23

DEATH:
- dressing/bathing
- eating
- ambulating (walking)
- toileting
- hygiene

Question 24

Give examples of instrumental ADLs (not necessary for fundamental functioning but let an individual live independently in a community). Recall accronym.

Answer 24

SHAFT:
- shopping
- housekeeping
- accounting (managing money)
- food preparation/taking medications as prescribed
- telephone/transportation

Question 25

When OA improve flexibility, they typically improve on...

Answer 25

muscular strength

Question 26

What is the mechanism behind improvement of strength when training flexibility?

Answer 26

- effort spent to gain ROM is sufficient to challenge surrounding musculature and slightly increase strength - increasing joint's ROM may release the muscles to such an extent that they can be used more readily and more efficiently

Question 27

What are critical ranges?

Answer 27

- absolute minimum ROM required to perform a certain activity - important when designing PA programs to improve OA's function

Question 28

What are special considerations for critical ranges after knee/hip replacement surgery?

Answer 28

Knee: rarely flex past **110 degrees** Hip: - no hip flexion past **90 degrees** - no internal rotation - no hip adduction past midline (no leg crossing)

Question 29

What is the purpose of OA sleeping with a pillow between their legs?

Answer 29

To prevent legs from crossing or internally rotating in the middle of the night

Question 30

What are critical ranges of flexibility for putting on clothes overhead and which joint is used?

Answer 30

Shoulder joint: flexion, abduction and external rotation

Question 31

What are critical ranges of flexibility for fastening or unfastening clothes in the back and which joint is used?

Answer 31

Shoulder joint: abduction, internal rotation, extension

Question 32

What are critical ranges of flexibility for walking at 3mph (4.8 km/h) and which joint is used?

Answer 32

Hip joint: flexion and extension Knee joint: flexion Ankle joint: dorsiflexion

Question 33

What are critical ranges of flexibility for ascending stairs and which joint is used?

Answer 33

Hip joint: flexion Knee joint: flexion Ankle joint: dorsiflexion

Question 34

What are critical ranges of flexibility for getting down onto and up from floor, in and out of tub and which joint is used?

Answer 34

Hip joint: flexion Knee joint: flexion Ankle joint: dorsiflexion

Question 35

How to put on a shirt with shoulder limitation?

Answer 35

1. locate front of side and place shirt with this side down on lap 2. Full sleeve all the way up along weak arm, past elbow 3. Insert strong hand/arm into sleeve and also past the elbow 4. Lean forward slightly and pull collar over head

Question 36

Who benefits from the shirt trick?

Answer 36

OA with one-sided weakness or injury (painful shoulders) to done a shirt with ease. Help people with a frozen shoulder or people that are hemiparesis.

Question 37

Can OA with ROM deficits improve their flexibility?

Answer 37

Yes

Question 38

What mode of flexibility exercises are used to improve ROM?

Answer 38

- traditional stretching exercises - dance - tai chi - aquatic exercise (water reduces spasms)

Question 39

What is the most important when performing flexibility exercises?

Answer 39

stressing the end range of joint motion (maximal distance a joint can be moved until a point of discomfort)

Question 40

2 types of stretching

Answer 40

Static and dynamic

Question 41

What are the characteristics of static stretching and when is it best used?

Answer 41

- targeting 1 muscle group - moving into a specific range until end range - holding 10-90sec. - very safe type of stretching - best for improving range of motion (best to do during cool-down)

Question 42

What are the characteristics of dynamic stretching and when is it best used?

Answer 42

- moving through specific ROM + holding for 2-5 sec then returning to start position - progressively increases joint ROM with each rep - more functional to ADLs which are usually dynamic and require movement in multiple planes (reaching down into dishwasher, cleaning windows, etc.) Best for warming up body and muscles

Question 43

Static vs PNF: YA respond better to contract-relax stretching (PNF) while OA...

Answer 43

benefit more from static stretching

Question 44

Dynamic stretches can be introduced...

Answer 44

- when muscles are **warmer** - to participants with **poor body awareness** | (repeated limb movements seems to be helpful)

Question 45

Examples of seated activities

Answer 45

- **floor reach**: bend forward toward floor - **seated tucked**: slowly rotate trunk and head to right until you can see an imaginary car in right line. repeat with left - **seated abduction** - **alternate knee to chest**

Question 46

Examples of standing activities.

Answer 46

- reach and curl - picking apples - climbing rope - knees up, mother brown: exaggerate march - side lunges with (a) spinal flexion, (b) arm reach across body and (c) forward arm reach - walking with 6 to 7 alternating bouts of long and short strides

Question 47

What are the 4 flexibility exercise guidelines?

Answer 47

- emphasize **joints that have significant decreases in joint ROM** (recall more likely to be lower limb joints) - stretch to a point of gentle tension, but not pain - *do not jerk, bounce or force a stretch because this could lead to injury* - **breathing**

Question 48

Should we breath during stretching?

Answer 48

1. inhale before start of the stretch 2. exhale during stretch 3. breath evenly while holding the stretch