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77 Cards in this Set
- Front
- Back
Mobility |
-ability of structures/segments of body to move or be moved to allow functional ROM -ability of individual to initiate, control, or sustain active movements of the body to perform functional mobility -associated with joint integrity and flexibility |
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Hypomobility |
-restricted motion caused by adaptive shortening of soft tissues -can lead to activity limitations and participation restrictions |
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Common Causes of Hypomobility |
-prolonged immobilization of a body part -sedentary lifestyle -postural malalignment -muscle imbalances -impaired muscle performance -tissue trauma resulting in inflammation/pain -congenital/acquired deformities |
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Stretching |
-any therapeutic maneuver designed to increase extensibility of soft tissues -improves flexibility and ROM by elongating structures that have adaptively shortened over time |
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Flexibility |
-ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain-free ROM -determined by muscle length, joint integrity, and extensibility of periarticular soft tissues |
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Dynamic Flexibility |
-AKA active mobility/active ROM -degree to which an active muscle contraction moves a body segment through available ROM -dependent on the degree to which a joint can be moved by a muscle contraction and amount of tissue resistance met during active movement |
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Passive Flexibility |
-AKA passive mobility/passive ROM -degree to which a body segment can be passively moved through the available ROM -dependent on extensibility of muscles and connective tissues that cross and surround a joint |
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Contracture |
-adaptive shortening of muscle-tendon unit and other soft tissues that cross/surround a joint -results in significant resistance to passive/active stretch and limitation of ROM -may compromise functional abilities -described by identifying the action of the shortened muscle |
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Myostatic Contracture |
-no specific muscle pathology present -musculotendinous unit has adaptively shortened -significant loss of ROM -can be resolved with stretching exercises |
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Pseudomyostatic Contracture |
-impaired mobility and limited ROM -may be result of hypertonicity -associated with CNS lesion -may also be caused by spasm or guarding -resolved with neuromuscular inhibition |
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Arthrogenic and Periarticular Contracture |
-result of intra-articular pathology -changes may include adhesions, synovial proliferation, joint effusion, articular cartilage irregularities, or osteophyte formation -connective tissues that cross or attach to a joint or joint capsule lose mobility -restricts normal arthrokinematic motion |
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Fibrotic Contracture and Irreversible Contracture |
-cannot be reversed -normal tissue is replaced by adhesions, scar tissue, or heterotopic bone -also occurs after long periods of immobilization -difficult to regain optimal mobility |
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Selective Stretching |
-applying stretching techniques selectively to some muscles and joints but allowing limitation of motion to develop in other muscles/joints -keep in mind functional needs of patient -used in SCI patients to build trunk stability, tenodesis in hand/wrist |
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Overstretching and Hypermobility |
-stretch well beyond normal length of muscle and ROM -results in excessive mobility -creates joint instability -may be necessary for some athletes |
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Manual or Mechanical Stretching |
-external, end-range force applied with overpressure -elongates shortened muscle-tendon unit -can be active or passive depending on patient |
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Self-Stretching |
any stretching carried out independently after instruction and supervision by a therapist |
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Neuromuscular Facilitation and Inhibition Techniques |
-relax tension in shortened muscles prior to or during muscle elongation -associated with PNF (hold-relax, contract-relax) |
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Muscle Energy Techniques |
-AKA postisometric relaxation -lengthen muscle/fascia and mobilize joint -voluntary muscle contractions by patient in a controlled direction and intensity against a counterforce applied by practitioner |
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Joint Mobilization/Manipulation |
-skilled manual therapy interventions specifically applied to joint structures -modulate pain and treat joint impairments that limit ROM |
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Soft Tissue Mobilization/Manipulation |
-improve muscle extensibility -specific and progressive manual forces to effect change in myofascial structures that bind soft tissues and impair mobility -Ex: STM, friction massage, myofascial release, acupressure, and trigger point therapy |
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Neural Tissue Mobilization |
-AKA neuromeningeal mobilization -reduce adhesions/scar tissue that form around meninges/nerve roots after trauma/surgery |
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Indications for Use of Stretching |
-ROM is limited b/c soft tissues have lost extensibility -adhesions, contractures, scar tissue -structural deformities that are preventable -muscle weakness/shortening of antagonist -prevent/reduce risk of injury -potentially reduce postexercise soreness |
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Contraindications to Stretching |
-bony block limits joint motion -recent fracture/incomplete bony union -acute inflammation or infection -sharp, acute pain with movement -hematoma or tissue trauma -hypermobility -hypomobility provides necessary stability/neuromuscular control |
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Potential Benefits and Outcomes of Stretching |
-increased flexibility and ROM -general fitness -injury prevention -reduced postexercise muscle soreness -enhanced performance |
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Soft Tissue Response to Stretch |
-elasticity: ability of soft tissue to return to pre-stretch resting length directly after a short-duration stretch force has been remove -viscoelasticity: initially resists deformation, but will allow change in length of tissue and then enable tissue to return to prestretch state -plasticity: tendency to assume new/greater length after stretch force is removed |
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Contractile Elements of Muscle |
-sarcomere is the contractile unit of the myofibril -sarcomere gives a muscle its ability to contract and relax |
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Response of Sarcomere to Stretch |
-filaments slide apart, leading to abrupt lengthening of sarcomeres (sarcomere give) -when stretch force is released, sarcomeres return to normal resting length (elasticity) |
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Response of Sarcomere to Immobilization |
-decreased contractile protein, fiber diameter, number of myofibrils, and capillary density leads to atrophy and weakness -in shortened position, reduction in muscle length and number of sarcomeres (absorption) -in lengthened position, number of sarcomeres increases and can be maintained if muscle is used on a regular basis |
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Muscle Spindle |
-major sensory organ of muscle -sensitive to quick and sustained stretch -receive and convey info about changes in muscle length and velocity of length changes -composed of afferent sensory fibers, efferent motor fibers, and intrafusal fibers |
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Golgi Tendon Organ |
-monitors changes in tension of muscle-tendon units -sensitive to even slight changes -continuously monitors and adjusts force of active muscle contractions or tension in muscle during passive stretch |
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Neurophysiological Response of Muscle to Stretch |
-increased tension in muscle being stretched -inhibition in the muscle on the opposite side of the joint may occur -a slowly applied, low-intensity, prolonged stretch is preferable |
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Composition of Connective Tissue |
-collagen fibers: strength, stiffness, resist tensile deformation -elastin fibers: provide extensibility -reticulin fibers: provide tissue with bulk -ground substance: reduces friction b/w fibers and transports nutrients |
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Mechanical Behavior of Noncontractile Tissue |
-determined by proportion of collagen and elastin fibers and their structure -tissue high in collagen fibers resist high tensile loads (tendons) -tissue high in ground substance withstand greater compressive loads (cartilage) -ligaments, joint capsules, and fasciae have a combo of both depending on stressors |
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Stress |
-force (load) per unit area -mechanical stress is the internal reaction or resistance to an external load |
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Strain |
amount of deformation or lengthening that occurs when a load (or stretch force) is applied |
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Tension |
-a force applied perpendicular to the cross-sectional area of the tissue in a direction away from the tissue -Ex: stretching force |
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Compression |
-a force applied perpendicular to the cross-sectional area of the tissue in a direction toward the tissue -Ex: muscle contraction, loading of a joint during WB |
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Shear |
a force applied parallel to the cross-sectional area of the tissue |
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Stress-Strain Curve |
-used to interpret what is happening to connective tissue under stress loads -toe region -elastic range -elastic limit -plastic range -ultimate strength -failure |
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Toe Region |
-considerable deformation w/o use of much force -most functional activity normally occurs |
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Elastic Range |
-strain is directly proportional to ability of tissue to resist force -occurs when tissue is taken to end of ROM and gentle stretch is applied -complete recovery from this deformation if stress is not maintained for any length of time |
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Elastic Limit |
the point beyond which the tissue does not return to its original shape and size |
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Plastic Range |
-range beyond elastic limit extending to point of rupture -permanent deformation of tissue when released -heat is released and absorbed in tissue -rupturing of fibers results in increased length |
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Ultimate Strength |
-greatest load the tissue can sustain -increased strain w/o an increase in stress required -necking: considerable weakening of tissue and it rapidly fails -tissue could completely tear if stress is maintained |
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Failure |
rupture of integrity of tissue |
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Creep |
-load is applied for extended period of time, tissue elongates and doesn't return to original length -low loads, usually in elastic range, and applied for long periods increase deformation of connective tissue |
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Stress-Relaxation |
-after initial creep, decrease in force required to maintain that length -tension in tissue decreases -recovery versus permanent change in length is dependent on amount of deformation and length of time the deformation is maintained |
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Effects of Immobilization on Collagen |
-weakening of tissue -adhesion formation -rate of return to normal tensile strength is slow |
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Effects of Inactivity on Collagen |
-decrease in size and amount of collagen fibers -weakening of tissue |
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Effects of Age on Collagen |
-decrease in maximum tensile strength -rate of adaptation to stress is slower -increased tendency for overuse syndromes, fatigue, failures, and tears with stretching |
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Effect of Corticosteroids on Collagen |
decrease in tensile strength |
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Effects of Injury on Collagen |
-rupture of ligaments and tendons -remodeling can take 3 weeks-12 months depending on size of tissue and magnitude of tear |
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Other Conditions Affecting Collagen |
-nutritional deficiencies -hormonal imbalances -dialysis |
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Determinants of Stretching Interventions |
-alignment and stabilization -intensity of stretch -duration of stretch -speed of stretch -frequency of stretch -mode of stretch |
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Alignment and Stabilization |
-positioning a limb or the body such that the stretch force is directed to the appropriate muscle group -fixation of one site of attachment of the muscle as the stretch force is applied to the other bony attachment |
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Intensity of Stretch |
magnitude (load) of stretch force applied |
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Duration of Stretch |
length of time the stretch force is applied during a stretch cycle |
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Speed of Stretch |
speed of initial application of the stretch force |
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Frequency of Stretch |
number of stretching sessions per day/week |
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Mode of Stretch |
-form or manner in which the stretch is applied (static, ballistic, cyclic) -degree of patient participation (passive, assisted, active) -source of stretch force (manual, mechanical, self) |
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Proprioceptive Neuromuscular Facilitation Stretching |
-AKA active stretching/facilitative stretching -inhibit or facilitate muscle activation -increase likelihood that the muscle to be lengthened remains as relaxed as possible as it is stretched -increase flexibility and ROM |
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Types of PNF Stretching |
-hold-relax (HR) and contract-relax (CR) -agonist contraction (AC) |
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Hold-Relax and Contract-Relax |
-muscle is first lengthened to point of tissue resistance or patient comfort -patient performs pre-stretch, end-range, isometric contraction followed by relaxation -limb is then passively moved into new range as muscle is elongated |
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Agonist Contraction |
-refers to the muscle opposite the range-limiting target muscle -patient concentrically contracts agonist and holds end-range position for several seconds -movement is controlled by patient and is deliberate and slow |
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Hold-Relax with Agonist Contraction |
-move the limb to the point that tissue resistance is felt -have patient perform a resisted, prestretch, isometric contraction followed by relaxation -immediately concentrically contract the muscle opposite the range-limiting muscle |
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Importance of Strength and Muscle Endurance |
-low-load resistance to improve muscle performance as early as possible in a stretching program -develop neuromuscular control and strength of agonist as well -use recently gained ROM |
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Use of Increased Mobility for Functional Activities |
-integrate functional activities into a stretching program to use gained ROM on a regular basis -lends diversity and interest to a stretching program |
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Guidelines for Application of Stretching |
-examination and evaluation of patient -preparation for stretching: warm-up, explain procedure, clear area -application of manual stretching -after stretching: apply cold, have patient perform active ROM |
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Precautions for Stretching |
-do not force a joint past normal ROM -osteoporosis, prolonged bed rest, age, steroids -recent fractures -immobilization -gradual progression -edema -weak muscles (especially postural muscles) |
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Common Problems for Mass-Market Flexibility Programs |
-poorly balanced stretching activities -insufficient warm-up -ineffective stabilization -ballistic stretching -excessive intensity -abnormal biomechanics -insufficient information about age differences |
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Relaxation Training |
-using methods of general relaxation (total body relaxation) which reduces muscle tension -help patients relieve/reduce pain, muscle tension, anxiety/stress, and other impairments |
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Examples of Relaxation Training |
-autogenic: conscious relaxation, meditation -progressive: systematic, distal-to-proximal progression of voluntary contraction and relaxation of muscles -awareness through movement: alter muscle imbalances and abnormal postural alignment |
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Heat & Stretching |
-as temp increases, so does extensibility of contractile and non-contractile tissues -warm-up: hot packs, paraffin, US, diathermy; low-intensity, active exercises also increase body temp |
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Cold & Stretching |
-pre-stretch: decrease muscle tone, make muscle less sensitive -post-stretch: decreases pain and muscle spasm -cooling soft tissues in a lengthened position after stretching = more lasting increases in length and minimized soreness |
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Massage & Stretching |
-helps relaxation -increases circulation to muscles -decreases muscle spasm -increase mobility of shortened tissues -break up adhesions -increase mobility of scar tissue |
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Biofeedback & Stretching |
-help a patient learn and practice the process of relaxation -by reducing muscle tension, pain can be decreased and flexibility increased |
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Joint Traction/Oscillation & Stretching |
inhibit joint pain and spasm of muscles around a joint |