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CHAPTER 5
Range of Motion and Flexibility
I.
II.
III.
Definition of flexibility and range of motion
A. Flexibility
1.
B. Range of motion
1.
2.
3.
Connective-tissue composition
A. Composed of
B. Quantities of these substances vary according to the structure and
determine the characteristics of the structure
C.
Definitions and roles of substances
1. Collagen
2. Elastin
3. Reticulin
4. Ground substance
D.
Areolar (loose) versus dense connective tissue
Effects of immobilization
A. General changes in soft tissue
1. Ground substance is reduced, leading to
2.
3. With injury, new collagen formation encourages
4.
5.
With edema and immobilization,
6.
7.
8.
B.
Collagen fibers bind to other structures and
Without stress,
9. End result is
Effects on muscle
1.
C.
D.
2.
3.
4.
5.
6.
7. With prolonged immobilization,
8. Histological changes =
9. Clinical changes =
Effects on articular cartilage
1. Changes dependent on
2. Reduced
3.
4.
5. Increased fibrofatty tissue within the joint that becomes
6.
Effects on periarticular connective tissue
1. This is soft tissue surrounding the joint, such as
2.
3.
4.
IV.
V.
Connective tissue becomes
Reduced GAG and
Diminished tissue mobility secondary to changes in
5. Clinical result is
Effects of remobilization
A. Effects on muscle fibers
B.
Effects on articular cartilage
C.
Effects on periarticular connective tissue
Mechanical properties and tissue behavior in range of motion
A. Mechanical properties of connective tissue
1. Elasticity
2.
Viscoelasticity
3.
Plasticity
B.
VI.
Physical properties of connective tissue
1. Force deformation
2. Creep
a.
3. Stress-strain
a. Hooke's law
b. Types of stress
i.
ii.
iii.
c.
Strain
d. Stress-strain curve
e. Additional factors influencing failure point
i.
ii.
iii.
iv.
Hysteresis (see figure 5.9)
v.
Failure load (see figure 5.10)
Neuromuscular influences on range of motion
A. Muscle spindle
1. Definition -
2.
3.
B.
Muscle spindles are sensitive to changes in
Two types of intrafusal fibers
a. Nuclear bag fibers:
b. Nuclear chain fibers:
Muscle spindle innervation
1. Two sensory (afferent) nerves
a. Ia nerve fibers (primary/annulospiral ending):
b.
2.
3.
4.
IIa nerve fibers (flower-spray ending):
One motor (efferent) nerve
Muscle spindle stimulus transmission
Result is simultaneous stimulation/facilitation of synergistic
and agonistic muscles and inhibition of antagonistic muscles
C.
GTOs
1. Definition:
2.
II.
III.
3.
4.
B. Effects of muscle spindle and GTO
1.
2. If stretch is applied too quickly,
3. When stretch is applied slowly,
4.
Determining normal range of motion
A.
B. Determined by
C.
Also based on
D.
Measuring range of motion
A. Equipment
1.
2. Other instruments: Leighton flexometer, inclinometer,
electrogoniometer, flexion-extension range-of-motion test
with tape measure, fingertip-to-floor method, side-bending
B. Application
1. Correct placement
2.
3. Measurements based on either a 180° or 360° system, with
C.
Accuracy
1. Careful attention to
2.
3. Factors influencing interpretation of range-of-motion
measure
a.
b.
c.
d.
e.
f.
D.
IV.
V.
Recording
1.
2.
Terminology in goniometry
A. Sagittal
B. Frontal
C.
Transverse
D.
Functional activities involve oblique planes of motion that include all
three conventional planes
Stretching techniques
A. Basic principles
1.
2.
B. Active stretching
1.
2.
3.
4.
5.
C.
Passive stretching
1.
2.
3.
4.
5.
D.
PNF
1.
2. Hold-relax
3. Contract-relax
4. Reversal-hold-relax
5.
6. See table 5.3 for summary of PNF stretching
E. Ballistic stretching
1.
2.
3.
4.
F.
G.
VI.
Assistive devices
1. Continuous passive motion machines (CPMs)
2. Splints
Indications, contraindications, and precautions
Exercise progression
A. After first week of injury or surgery
1.
2.
3.
B. In remodeling phase
1.
2.
C.
When scar tissue is more than three to four months old
1.
2.