Download Chapter 4 - PHT 1227 Therapeutic Exercise I

Therapeutic Exercise I
Chapter 4
Stretching for Impaired Mobility
Selective Stretching
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Mobility
Functional Mobility
Flexibility
Contractures
Overstretching
Tightness
Selective Stretching
ROM needs vary among individuals
Stretching as an integral
component to rehab
• The supervising PT will determine what structures are
restricted and what type of stretches to be implemented
• Designed to increase the extensibility of soft tissues
• Includes: manual, self, and mechanical stretching
• There must be a balance between mobility and stability
for MAXIMUM FUNCTION
Hypomobility
• Prolonged immobilization
• Sedentary lifestyle
• Postural malalignment & muscle
imbalances
• Impaired muscle performance (weakness)
associated with musculoskeletal or
neuromuscular disorders
• Tissue trauma resulting in inflammation &
pain
• Congenital or acquired deformities
Types of Contractures
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Myostatic Contractures
Pseudomyostatic Contractures
Arthrogenic and Periarticular Contractures
Fibrotic Contracture and Irreversible
Contracture
Goals of Stretching
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Increased flexibility & ROM
General Fitness – warm up & cool down
Prevention/reduction of soft tissue injuries
Decreased post exercise soreness
Enhanced performance
Properties of Soft Tissue
• Elasticity- the ability of soft tissue to its pre-stretch resting length directly after
a short-duration stretch force has been removed
• Viscoelasticity- Time dependent property of soft tissue that initially resists
deformation, such as change in length, of the tissue when a stretch is first applied.
But if the stretch is sustained…it allows a change in the length of the tissue and then
enables the tissue to return gradually to its pre-stretched state after the stretch force
has been removed
• Plasticity- is the tendency of soft tissue to assume a new and greater length
after the stretch force has been removed
Muscles (contractile and non-contractile) have both elastic and plastic
qualities; however, only the connective tissues have viscoelastic qualities
Mechanical Properties of
Contractile Tissue
• When contractures develop, adhesions in and
between collagen fibers resist and restrict
movement
• If a muscle is immobilized for a prolonged period
of time, the outcome is atrophy or
weakness….which can result in an increase in
fibrous and fatty tissue in the muscle, and
disorganizes collagen
• Atrophy can occur in days/weeks and duration
plays a major part in the severity of the atrophy
Neurophysiological Properties
of Contractile Tissue
• Muscle Spindles – changes in length &
velocity of length changes
• Golgi Tendon Organs – changes in
tension;
– Autogenic inhibition
– Reciprocal inhibition
Mechanical Properties of
Non-Contractile Soft Tissue
• Non-contractile soft tissue comes in
various types of connective tissue:
ligaments, tendons, joint capsule, fascia,
non-contractile tissue in muscles, and skin
(adhesions)
• Creep can occur- amount of deformation
will depend on the severity of the position
and the period of time in the position i.e.:
significant thoracic kyphosis
Non-contractile Tissue
• Only way to increase extensibility is to
remodel its basic structure
• Collagen – strength & stiffness; resists
tensile deformation
• Elastin – provides extensibility
• Reticulin – provides tissue bulk
• PG’s & GP’s – reduce friction, transports
nutrients, maintains space between fibers
Stress Strain Curve
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Toe Region
Elastic Range
Elastic Limit
Plastic Range
Failure
Determinants of Stretching
Interventions
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Alignment
Stabilization
Intensity
Duration
Speed
Frequency
Mode
Mode (types) of Stretching
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Manual
Self
Mechanical
PNF
Types of Proprioceptive Neuromuscular
Facilitation (PNF)
Stretching Techniques
• Hold Relax (HR) or Contract Relax (CR)
• Agonist Contraction
• Hold-Relax with Antagonist Contraction (HR-AC)
Stabilize Proximal versus Distal
• When being stretched by the supervising
PT/PTA it is common for them to stabilize the
proximal attachment and move the distal
attachment
• When performing a self-stretch often the distal
attachment is stabilized as the proximal segment
moves
• Duration of Stretch-30 second stretch has been
identified as the median time frame
• Types of stretching: static (static progressive
stretching), cyclic (intermittent), ballistic (rapid
force)
Adjuncts to Stretching Interventions
• Relaxation Training (autogenic training,
progressive relaxation, awareness through
movement)
• Heat (warming of the tissue) – see article
• Exercise
• Massage (warming of the tissue with a manual
technique)
• Biofeedback (audio or visual awareness)
• Joint traction or oscillation (any joint mobilization
techniques to be done by the PT only)
• Ice should be used after stretching-preferred in a
lengthened
Indications
• Limited ROM – adhesions, contractures,
scar tissue formation
• Structural deformities caused by restricted
motion
• Muscle weakness & shortening of
opposing muscle groups
• Total fitness/sports conditioning
• Warm up & cool down to decrease
soreness
Contraindications
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Bony block
Fracture/incomplete union
Acute inflammation/infection
Sharp acute pain with movement
Hematoma
Hypermobility
Shortened soft tissue necessary for
function
• Shortened soft tissue providing joint
stability
Break for Lab with Lecture on UE
Stretching Techniques in Anatomical
Planes of Motion
(If time permits may review LE’s)