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Stretching for Impaired Mobility

Stretching for Impaired Mobility. Chapter 4. Stretching: Definition and Purpose.

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Stretching for Impaired Mobility

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  1. Stretching for Impaired Mobility Chapter 4

  2. 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

  3. Definitions of Terms Related to Mobility and Stretching • Flexibility • Dynamic flexibility • Passive flexibility • Hypomobility • Hypomobility may be allowed selectively to improve function

  4. 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

  5. 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

  6. 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

  7. 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)

  8. 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

  9. Contraindications for Stretching Exercises • Bony Block • Non-Union Fracture • Acute Inflammation or Infection • Sharp or Acute Pain With Elongation • Hematoma or Tissue Trauma • Hypermobility • Hypomobility Provides Stability or Neuro-muscular Control

  10. Potential Benefits and Outcomes for Stretching Exercises • Increased Flexibility and ROM • General Fitness • Other Potential Benefits • Injury prevention • Reduced post-exercise soreness • Enhanced performance

  11. Properties of Soft Tissue: Response to Immobilization and Stretch • Contractile and Non-Contractile Tissue Changes • Elasticity • Viscoelasticity • Only non-contractile connective tissue • Plasticity

  12. 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

  13. Neurophysiological Properties of Contractile Tissue • Muscle Spindle • Golgi Tendon Organ • Neurophysiological Response of Muscle to Stretch

  14. Types of Connective Tissue • Ligaments • Tendons • Joint Capsules • Fasciae • Non-Contractile Tissue in Muscles • Skin

  15. Mechanical Properties of Non-Contractile Soft Tissue • Composition of Connective Tissue • Collagen fibers • Elastin fibers • Reticulin fibers • Ground substance • Mechanical Behavior of Non-Contractile Tissue

  16. Mechanical Properties of Non-Contractile Soft Tissue (cont'd) • Interpreting Mechanical Behavior of Connective Tissue: The Stress-Strain Curve • Stress and Strain • Tension • Compression • Shear • Strain

  17. Mechanical Properties of Non-Contractile 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

  18. Mechanical Properties of Non-Contractile 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

  19. Mechanical Properties of Non-Contractile 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

  20. Determinants and Types of Stretching Exercises • Alignment and Stabilization • Intensity of Stretch • Duration of Stretch • Static stretching • Static progressive stretching • Cyclic (intermittent) stretching

  21. 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

  22. Mode of Stretch • Manual Stretching • Self-Stretching • Mechanical Stretching • Duration of mechanical stretch

  23. Proprioceptive Neuromuscular Facilitation Stretching Techniques • Types of PNF Stretching • Hold–relax and contract–relax • Agonist contraction • Hold–relax with agonist contraction

  24. Integration of Function into Stretching • Importance of Strength and Muscle Endurance • Use of Increased Mobility for Functional Activities

  25. Procedural Guidelines for Application of Stretching Interventions • Examination and Evaluation of the Patient • Preparation for Stretching • Application of Manual Stretching Procedures • After Stretch Procedures

  26. Precautions for Stretching • General Precautions • Special Precautions for Mass-Market Flexibility Programs • Common errors and potential problems • 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

  27. 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

  28. 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

  29. Manual Stretching Techniques in Anatomical Planes of Motion • Upper Extremity Stretching • Hand placement • Patient position • Procedure • Lower Extremity Stretching • Hand placement • Patient position • Procedure

  30. Independent Learning Activities • Critical Thinking and Discussion • Laboratory Practice

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