Transcript Therapeutic Exercise: Foundations and Techniques, 6th Edition

Stretching for Impaired
Mobility
Chapter 4
Part II: Applied Science of Exercise and
Techniques
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Stretching: Definition and Purpose
 A general term used to describe any
therapeutic maneuver designed to increase
mobility of soft tissues and subsequently
improve ROM by elongating (lengthening)
structures that have adaptively shortened and
have become hypomobile over time
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Definitions of Terms Related to
Mobility and Stretching
 Flexibility
– Dynamic flexibility
– Passive flexibility
 Hypomobility
– Hypomobility may be allowed selectively to
improve function
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Definitions of Terms Related to
Mobility and Stretching (cont'd)
 Contracture
– Designation of contracture by location
– Contracture versus contraction
– Types of contracture
• Myostatic contracture
• Pseudomyostatic contracture
• Arthrogenic and periarticular contractures
• Fibrotic contracture and irreversible contractures
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Definitions of Terms Related to
Mobility and Stretching (cont'd)
 Selective Stretching
– Hypomobile structures to develop to improve
function
 Overstretching and Hypermobility
– Hypermobility improves function in some
circumstances
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Interventions to Increase Mobility
of Soft Tissues
 Manual or Mechanical Stretching
– Utilizes an external force
 Passive Stretching
– No patient assistance
 Assisted Stretching
– Patient assistance
 Self-Stretching
– Patient performs the stretch
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Interventions to Increase Mobility
of Soft Tissues (cont'd)
 Neuromuscular Facilitation and Inhibition
Techniques
 Muscle Energy Techniques
 Joint Mobilization/Manipulation
 Soft Tissue Mobilization and Manipulation
 Neural Tissue Mobilization (Neuromeningeal
Mobilization)
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Indications for Stretching Exercises
 Adhesions, Contractures, Scar Tissue Limit
ROM
 Potential for Structural Deformity d/t Limited
ROM
 Muscle Weakness, Shortening of Muscles
 Part of a Total Fitness Program
 Pre and Post Vigorous Exercise
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Contraindications for Stretching
Exercises
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Bony Block
Non-Union Fracture
Acute Inflammation or Infection
Sharp or Acute Pain With Elongation
Hematoma or Tissue Trauma
Hypermobility
Hypomobility Provides Stability or Neuromuscular Control
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Potential Benefits and Outcomes
for Stretching Exercises
 Increased Flexibility and ROM
 General Fitness
 Other Potential Benefits
– Injury prevention
– Reduced post-exercise soreness
– Enhanced performance
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Properties of Soft Tissue: Response
to Immobilization and Stretch
 Contractile and Non-Contractile Tissue
Changes
– Elasticity
– Viscoelasticity
• Only non-contractile connective tissue
– Plasticity
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Mechanical Properties of
Contractile Tissue
 Contractile Elements of Muscle
 Mechanical Response of the Contractile Unit
to Stretch and Immobilization
– Response to stretch
– Response to immobilization and remobilization
• Morphological changes
• Immobilization in a shortened position
• Immobilization in a lengthened position
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Neurophysiological Properties of
Contractile Tissue
 Muscle Spindle
 Golgi Tendon Organ
 Neurophysiological Response of Muscle to
Stretch
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Types of Connective Tissue
 Ligaments
 Tendons
 Joint Capsules
 Fasciae
 Non-Contractile Tissue in Muscles
 Skin
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Mechanical Properties of NonContractile Soft Tissue
 Composition of Connective Tissue
– Collagen fibers
– Elastin fibers
– Reticulin fibers
– Ground substance
 Mechanical Behavior of Non-Contractile
Tissue
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Mechanical Properties of NonContractile Soft Tissue (cont'd)
 Interpreting Mechanical Behavior of
Connective Tissue: The Stress-Strain Curve
 Stress and Strain
– Tension
– Compression
– Shear
– Strain
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Mechanical Properties of NonContractile Soft Tissue (cont'd)
 Regions of the Stress-Strain Curve
– Toe region
– Elastic range/linear phase
– Elastic limit
– Plastic range
– Ultimate strength
• Necking
– Failure
– Structural stiffness
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Mechanical Properties of NonContractile Soft Tissue (cont'd)
 Time and Rate Influences on Tissue
Deformation
– Creep
– Stress-relaxation
– Cyclic loading and connective tissue fatigue
 Summary of Mechanical Principles for
Stretching Connective Tissue
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Mechanical Properties of NonContractile Soft Tissue (cont'd)
 Changes in Collagen Affecting Stress–Strain
Response
– Effects of immobilization
– Effects of inactivity (decrease of normal activity)
– Effects of age
– Effects of corticosteroids
– Effects of injury
– Other conditions affecting collagen
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Determinants and Types of
Stretching Exercises
 Alignment and Stabilization
 Intensity of Stretch
 Duration of Stretch
– Static stretching
• Static progressive stretching
– Cyclic (intermittent) stretching
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Determinants and Types of
Stretching Exercises (cont'd)
 Speed of Stretch
– Importance of a slowly applied stretch
– Ballistic stretching
– High-velocity stretching in conditioning programs
and advanced-phase rehabilitation
 Frequency of Stretch
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Mode of Stretch
 Manual Stretching
 Self-Stretching
 Mechanical Stretching
– Duration of mechanical stretch
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Proprioceptive Neuromuscular
Facilitation Stretching Techniques
 Types of PNF Stretching
– Hold–relax and contract–relax
– Agonist contraction
– Hold–relax with agonist contraction
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Integration of Function into
Stretching
 Importance of Strength and Muscle Endurance
 Use of Increased Mobility for Functional
Activities
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Procedural Guidelines for Application
of Stretching Interventions
 Examination and Evaluation of the Patient
 Preparation for Stretching
 Application of Manual Stretching Procedures
 After Stretch Procedures
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Precautions for Stretching
 General Precautions
 Special Precautions for Mass-Market Flexibility Programs
– Common errors and potential problems
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Nonselective or poorly balanced stretching activities
Insufficient warm-up
Ineffective stabilization
Use of ballistic stretching
Excessive intensity
Abnormal biomechanics
Insufficient information about age-related differences
– Strategies for risk reduction
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Adjuncts to Stretching
Interventions
 Complementary Exercise Approaches
– Relaxation training
• Common elements of relaxation training
• Examples of approaches to relaxation training
– Autogenic training
– Progressive relaxation
– Awareness through movement
• Sequence for progressive relaxation techniques
– Pilates
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Adjuncts to Stretching
Interventions (cont'd)
 Heat
– Methods of warm-up
– Effectiveness of warm-up methods
 Cold
 Massage
– Massage for relaxation
– Soft tissue mobilization/manipulation techniques
 Biofeedback
 Joint Traction or Oscillation
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Manual Stretching Techniques in
Anatomical Planes of Motion
 Upper Extremity Stretching
– Hand placement
– Patient position
– Procedure
 Lower Extremity Stretching
– Hand placement
– Patient position
– Procedure
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Independent Learning Activities
 Critical Thinking and Discussion
 Laboratory Practice
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