Download Lecture 7 ROM & Flexibility 2016

Restoring ROM and
Improving Flexibility
Definitions
 Flexibility
Musculotendinous unit
ability to elongate
with application of a
stretching force
 Rom
 The amount of
mobility of a joint
 Flexibility usually
effects ROM – as does
capsule , skin, nerves ,
blood vessels
 Contracture of
flexor
ROM
 Active
 Passive
 Active Assisted (pulleys)
 Measuring ROM ( goniometry)
Immobilization
 Connective tissue normally tends to shorten
 To combat this – daily activity
 Restrict normal activity and rapid changes in structure
and function of connective tissue will occur
 Depending on length of immobilization changes
maybe permanent or reversible
 Remobilization enhances recovery , prevents
abnormal collagen crosslinking and increases fluid
content in extra cellular matrix
Mechanical properties of
connective tissue
 Collagen is elastic, visoelastic and plastic
 When stretched all three qualities may be affected
 Effectiveness of a stretch depends on the amount of
collagen and elastin in the structure
 elasticity--Ability to return to normal after a stretch (
rubber band)
 Viscoelasticity – elastic and viscous propertiesresistance to outside forces but can stretch but does
not return to original shape
 Plasticity – ability of substance to undergo permanent
change in size of shape ( putty )
 Understanding healing – best time to influence
change during firbroplastic or early remodeling
Definitions continued
 Agonist
 Muscle contracts to produce a movement
 Also referred to as prime movers ( bicep in
elbow flexion)
 Antagonist
the muscle being stretched in response to
contraction of the agonist ( triceps in elbow
flexion)
Synergists
 muscles perform, or assist in performing, the
same set of joint motion as the agonists.
 Gastrocs are synergists to knee flexion, they assist
the hamstrings
Neuromuscular Influences
Muscle spindle
Message ( afferent) to the Spinal
cords that muscle being stretched
Sensitive to stretch and the speed
of the stretch
Message( efferent) back to
muscle to produce a muscle
contraction
Stimulates the synergistic muscles
and inhibition of the antagonistic
muscle
Neuromuscular Influences
 Golgi Tendon Organs
 Sensitive to contraction and tension in
muscle
 Located in the distal and proximal MT
junction
 causes a inhibition of its own muscle( agonist)
– activation of antagonistic
 This relaxation serves as a protective
mechanism that will allow the muscle to
stretch through relaxation with out exceeding
the extensibility limits, which could damage
the muscle fibers
Mechanical Properties
 Neutral/resting position
 Little/no resistance to passive movement
 Tissue crimp
 Elastic zone
 Tissue tension felt
 Tissue will return to original shape when force
removed
 Plastic zone
 Tension in tissue overcomes elastic recoil
 Tissue does not return to original shape
How permanent is stretching?
Debatable…
Elastic stretching lasts about 90 min
Plastic stretching more permanent
Measuring ROM
 Measured using a goniometer – protractor
 Tape measures
 Accuracy – reliable –consistent – repeatable
 Recording ROM
 AROM
 PROM
 0 degrees neutral ( anatomical)
 Planes – sagittal( flexion /extension) , frontal (abduction
and adduction ) , or transverse (pronation and
supination )
Stretching Techniques
Active
 Flexibility exercises performed by person or equipment
with out outside assistance
 Increased frequency
 Stretch performed 15- 30 seconds 4-5 reps 3- 4
times a day
 reciprocal inhibition
 Agonist inhibition increasing flexibility
 Exercise – standing – touch toes – evaluate
flexibility – now touch toes with knees bent ,
with hands on toes , tighten quads by
straightening knees – 3-4 times , now stand up
again and retest you hamstring flexibility
Stretching Techniques
Passive
 Use of another person or equipment
 Patient does not assist in the stretch
 Most effective involve the steady
application of a force over a length of
time ( plastic deformation) ( suggest1520 minutes )
 Patient should be warned of stiffness of
joint after prolonged stretching – gentle
ROM activities should follow this
prolonged stretch
Stretching Techniques
Ballistic
Repeated bouncing movement
Tissue rapidly lengthened and
immediately returns to prestretched length
Is the oldest form of stretching
Very functional with respect to sport
Concern: causes small micro tears in
the tissue because of “over
stretching” of the tissue/ bouncing
past the normal limits of extensibility.
Has been know to cause pain/muscle
soreness in sedentary individuals.
Therapeutic methods
Progressive Neuromuscular Facilitation
 Contract relax ( normal ) (stretching antagonist)
 Move the body part passively into the agonist
pattern ( knee ext and hip flexion)
 Isometrically contract antagonist ( muscle
that will be stretched, hamstring) 5-10 sec
 Athlete relaxes the antagonist while therapist
moves part through as much ROM( knee ext
and hip flexion ( to where limit is felt)
 Repeat several times
 Good for muscle tightness
Contract relax stretching
Therapeutic methods
PNF continued
 Hold-Relax Contract
 Isometric contraction of the antagonist
(muscle that is to be stretched,
hamstring ) 5-10 sec
This is followed by concentric
contraction of the agonist muscle(
quads) ( non tight muscle) with light
passive pressure from the therapist to
stretch of antagonist
Repeat
Assistive devices
 Continuous Passive Motion Machines (CPM)
 Often used with surgeries
 Helps with mobilization , reduce pain and edema
 Rom restored more quickly , can begin exercises
sooner
 Splints
 Prolonged stretching
 Worn for several hours at a time – most often worn
overnight
Guidelines for stretching
 Warm up using exercise before stretching
 To increase flexibility the muscle must be overloaded
 Stretch only to point of tightness or resistance to stretch (
or discomfort) ( should not be painful)
 Inexperienced athletes should begin with static stretching
 Stretching should be specific to ranges in activity e.g..
Rotational stretching for LB in golfers ( increase ROM is
very specific)
 Exercise caution when stretching back and neck
 Stretch from a seated position to take stresses off the
back
 Breath normally
 ballistic stretching should be done by those accustomed
to stretching ( do after static)
 Static stretching to improve ROM used initially than
progress to PNF type stretching
 4- 5 reps 4-5 times a day