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Lecture 4: Stretching for Impaired Mobility
Transcript of Lecture 4: Stretching for Impaired Mobility
PTA 105 A
Progressive relaxation techniques
Gentle non fatiguing cycling, walking etc
US, diathermy..not so much…more for small areas
Jt traction and oscillations
Adjuncts to stretching interventions
Do not force a jt beyond its normal ROM please.
Be aware of age related changes in flexibility
Use caution with osteoporosis
Avoid vigorous stretching to tissue that has been immobilized for a long time. SLOW
Don’t stretch swollen tissues
Avoid overstretching weak muscles
Move extremity SLOWLY to the pt of restriction
Grasp proximal and distal to the jt in which motion occurs
Stabilize prox segment
Stretch muscle over 1 jt at a time if it’s a 2 jt muscle
To avoid compression, apply Gr I distraction
Apply low intensity stretch in slow, sustained manner.
The force is OPPOSITE the line of pull of the limited muscle
Maintain for 30 seconds
If pt does not tolerate sustained stretch, do slow gentle stretches. DON’T TRY TO REGAIN IT ALL AT ONCE!
Application of manual stretch
Integrates active muscle contraction into stretching
Only contractile elements will be relaxed
4 general techniques
Hold-relax with agonist contraction
PNF Stretching Techniques
Form or manner in which stretching exercises are carried out.
Mode of Stretch
Alignment and Stabilization
Elements of Stretching Interventions
Passive vs. Assisted
Neuromuscular Inhibition Techniques, e.g. PNF, Muscle Energy techniques
Soft Tissue Mobilization & Manipulation
Neural Tissue Mobilization
Interventions to Increase Soft Tissue Mobility
Recent fracture has not yet healed
Evidence of acute inflammation or infection.
Sharp acute pain with joint movement or muscle elongation
Hypermobility already exists.
When contractures or shortened tissue might be providing support to increase joint stability.
When contractures or shortened tissue might be the basis for increased functional abilities.
Contraindications to Stretching
ROM limited because soft tissue has lost its extensibility as the result of adhesions, contractures and scar tissue formation, causing functional limitations or disabilities.
Restricted motion may lead to deformity.
Muscle weakness and shortening of opposing muscle tissue.
Part of a total fitness program.
Prior to or after vigorous exercise to potentially reduce muscle soreness.
Indications for Use of Stretching
Myostatic – Musculotendinous tissue shortened without muscle pathology present. Stretching techniques used to tx.
Pseudomyostatic – Caused by spasticity or rigidity associated with CNS lesions. Inhibition techniques result in full excursion of the muscle.
Arthrogenic or Periarticular – result of intraarticular pathology. Includes adhesions, irregularities in articular cartilage or osteophyte formation.
Fibrotic and irreversible contractures. Difficult to re-establish optimal length in the muscle tissue.
Cannot be reversed by non-surgical means.
Large amounts of adhesions and scar tissue buildup.
Changes on the Tissue Involved Describe the Type of Contracture
Caused by adaptive shortening of soft tissues
May be caused by:
Impaired muscle performance
Types of contractures
Definitions of Terms Related to Mobility and Stretching
The ability of structures or segments of the body to move or be moved to allow the range of motion necessary for functional activities (functional ROM)
The ability to initiate, control, or sustain active movements of the body to perform simple to complex motor skills (functional mobility)
ROM needed for performing functional activities does not necessarily mean full or “normal” ROM
A general term used to describe any therapeutic maneuver designed to increase extensibility of soft tissue and subsequently improve flexibility/ROM by elongating (lengthening) structures that have adaptively shortened and become hypomobile over time.
Stretching Definition & Purpose
Review Goals w pt.
Chose most effective technique
Use correct plane of motion for stretch
Give clear directions
No restrictive clothing
Tell pt to RELAX
Preparation for stretching
Permanent increases in ROM occur with integration into functional activities.
Emphasize the use of ADL’s to improve movement patterns and ROM
Integration of Function into Stretching
Variation of the hold-relax technique. Uses a pre-stretch isometric contraction of the range limiting muscle in a lengthened position followed by a concentric contraction of the muscle opposite the range-limiting muscle.
Hold Relax with Agonist Contraction
HR & CR used synonymously.
In classic PNF, contract relax occurs during the patterns.
Makes passive elongation of muscle more comfortable.
GTO stimulation – autogenic inhibition
Pre-stretch, end range, isometric contraction for 10 seconds.
Also used in muscle energy techniques to mobilize joints by overcoming restrictive barriers to specific joint motions.
Number of bouts or sessions per day or per week stretching regimen is carried out.
No research to support optimal numbers.
Frequency of Stretch
Slow – applied and released gradually.
Ballistic stretch –rapid forceful, intermittent stretch.
Difficult to control
Tissues easily injured if weak or diseased
Contractures do not yield with rapid stretch.
High-velocity stretch such as in Plyometric (jump training
Speed of Stretch
Refers to the time stretch force is applied (single cycle).
Research is inconclusive as to the ideal length of time or total time for stretching.
15, 30, 45, 60 or 2 minutes have all been effective at producing significant gains.
Static vs. Static- Progressive stretching
Duration of Stretch
Intensity determined by the load placed on soft tissue as it is being elongated.
Low intensity = low load
More comfortable, minimizes muscle guarding and danger of exposing possibly weakened tissue from immobilization to excessive loads.
Intensity of Stretch
Necessary for patient comfort and effectiveness.
Stabilization necessary to achieve effectiveness. Stabilize either the proximal or distal attachment site of the muscle-tendon unit being elongated.
E.g. when stretching the rectus femoris, knee flexion with hip extension and L spine in neutral.
Fixation can come from manual contacts, from body weight or firm surfaces.
Alignment & Stabilization
Going beyond normal ROM
Excessive mobility may be necessary for certain sporting activities.
Overstretching can become detrimental and creates joint instability
Over Stretching & Hypermobility
Adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint.
This results in significant resistance to passive or active stretch and limitation of ROM.
Described by identifying the action of the shortened muscle, e.g. elbow flexion contracture.
Ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain-free ROM.
Dynamic vs. Passive or static flexibility
Prime mover (agonist) contracts opposite the range limiting muscle (antagonistic).
Concentrically contract the muscle opposite the muscle limiting range of motion.
Creates “reciprocal inhibition” of the antagonist.
Agonist Contraction (AC)
Overall function of a pt. May be improved by applying stretching selectively to some muscles or joints but allowing a limitation of motion to develop in other muscles or joints.
Stability of the trunk in SC pts. Is necessary for independent sitting. Lack trunk control, stretch hamstrings and allow moderate hypo-mobility to develop in the extensors of the low back,
Allows pt. to lean into shortened structures and will have stability in long sitting.
Static Stretching: tissues elongated just past the point of tissue resistance and held in the lengthened position with a sustained stretch force and held for a period of time
Also referred to as sustained, maintained or prolonged stretch
Safer and more effective than ballistic stretching (less tension created, non contractile tissue yields easier, less tissue trauma and post ex muscle soreness
Static Progressive Stretching: shortened soft tissues are held in a comfortably lengthened position until a degree of relaxation is felt by the pt or PT/PTA
Shortened tissues are incrementally lengthened even further and again held in the new end range position for additional duration of time
Involves continuous displacement of a limb by varying the stretch force
Ex: dynamic orthosis
apply cold in lengthened position.
Do AROM and strengthening in newly gained ROM