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Restoring ROM and Improving Flexibility

Restoring ROM and Improving Flexibility. Flexibility Ability of neuromuscular system to allow movement of a joint or series of joints through non-restricted pain-free ROM Contracture Adaptive shortening of muscle or other soft tissue that results in limited ROM. Contracture of flexor.

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Restoring ROM and Improving Flexibility

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  1. Restoring ROM and Improving Flexibility

  2. Flexibility Ability of neuromuscular system to allow movement of a joint or series of joints through non-restricted pain-free ROM Contracture Adaptive shortening of muscle or other soft tissue that results in limited ROM Contracture of flexor Definitions

  3. ROM • Active • Passive • Active Assisted (pulleys) • Measuring ROM ( goniometry) • ROM exercises • Assignment #2

  4. 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 agontist ( 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

  5. Neurophysiologic Principles • Muscle spindle • Message to CNS that muscle being stretched • Message back to muscle via interneurons in spinal cord • Protective mechanism

  6. Neurophysiologic Principles • Golgi Tendon Organs • If stretch ≥ 6 seconds, GTOs override muscle spindle, to cause a reflex relaxation of the agonist muscle. • 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

  7. Mechanical Properties • Collagen fibers– resists mechanical forces and deformation • Elastin fibers– assist in recovery from deformation • Elasticity • Capability to recover normal length after deformation • Plasticity • Permanent change/deformation

  8. 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

  9. How permanent is stretching? • Debatable… • Elastic stretching lasts about 90 min • Plastic stretching more permanent

  10. Therapeutic methods Static (Passive) • 15-60 sec (sufficient time to for the GTO to begin responding to increased tension) • 3-5 repetitions • GTO can override the impulses coming from the muscle spindle , allowing the muscle to reflexively relax after initial reflex resistance to the change in length • Thus lengthening the muscle and allowing it to remain in a stretched position for extended period of time , and unlikely to produce any injury

  11. Therapeutic methods Ballistic • Repeated bouncing movement • Tissue rapidly lengthened and immediately returns to pre-stretched length • Is the oldest form of stretching • Very functional with respect to sport • Concern: causes small microtears 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.

  12. Therapeutic methods Progressive Neuromuscular Facilitation • Contract relax (Hold Relax)( normal ) (stretching antagonist) • Move the body part passively into the agonist pattern • Isometrically contract antagonist ( muscle that will be stretched) 5-10 sec • Athlete relaxes the antagonist while therapist moves part through as much ROM ( to where limit is felt) • Good for muscle tightness

  13. Contract relax stretching

  14. Therapeutic methods PNF continued • Hold-Relax Contract ( similar to contract relax) • Isometric contraction of the antagonist ( muscle that is to be stretched) 5-10 sec • This is followed by concentric contraction of the agonist muscle ( non tight muscle) with light passive pressure from the therapist to stretch of antagonist • Repeat

  15. 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 • 3 times per week ( min ) 5-6 times to see improvement)

  16. Guidelines for stretching • Why warm-up prior to stretching? • By increasing the tissue Temp, it allows for the non-contractile components of the M-T units (collagen/elastin) to deform easier

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