Flexibility . Definition The ROM available in a jt. or group of jts. The ability of a m. to relax & yield to a stretching force. The freedom or ability to move part or parts of body in a wide R of purposeful movs at the required speed.
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The ROM available in a jt. or group of jts.
The ability of a m. to relax & yield to a stretching force.
The freedom or ability to move part or parts of body in a wide R of purposeful movs at the required speed.
The ability to move a jt. Through a normal ROM with undue stress to musculo-tendinous unit.
Normal ROM associated with bouncing & rhythmic movements.
Activities that need certain angle to certain joints. & particular patterns (usual activities).
Each one has unique qualities affecting its extensibility (ability to elongate).
Ability of soft tissue to return to its resting length after passive stretching.
Tendency of soft tissue to assume new & greater length after the stretch force has been removed.
* Tight muscle must be elongated before weak m. can be effectively strengthened.
1.To regain or re-establish normal joint. ROM & mobility of soft tissue surrounding a jt..
2. To prevent irreversible contractures.
4. To prevent or minimize risk of musculo-tendinous injuries related to specific physical activities & sports.
(Remember that normal ROM varies among normal individuals).
c. Aging d. Prolonged use of steroids (cortisone)
Acute infections. changes occur
Signs of inflammation.
Pain at the site to be stretched.
Osteomyelites (acute stage).
7. Severe spasticity.
8. Pain that isn’t yet evaluated by the PT or physician.
Joint laxity (hypermobility).
10. Joint subluxation.
11. Joint dislocation.
12. Joint fusion.
13. Joint deformity.
14. Tissue adhesions (contractures).
15.Acute TraumasContraindications to Stretching
7. The pt. must be completely relaxed throughout stretching ,employ relaxation techniques before stretching.
10. Degree of stretch can be ↑or↓ depending on time of stretch & external force applied.
11. Tension produced shouldn’t cause pain, the pt should only feel a slight tension, which ↓ with stretching. (due to adaptation)
12. Stretch ↑gradually, building to a max. as the tissues release.
13. Stretch should be removed gradually to prevent rebouncing ortighteningof the ms.
1direction, 2speed, 3intensity & 4duration to the tight m..
MANUAL PASSIVE STRETCH changes occur
HIGH INTENSITY STRETCHMaintained versus Ballistic Stretch
Inhibit stretch reflex
Facilitate muscle contraction
(low intensity mechanical stretch).
It was suggested that 20 min or longer stretch is more effective to ↑ ROM & has a more permanent basis.
(Plastic changes in contractile & non-contractile tissues)has been reported with long duration stretch.
Pt performs an isometric contraction of tight muscle before it is
passively stretched (lengthened).
M. will relax as a result of ”autogenic inhibition” (Golgi tendon organ may fire at ↓ tension).
inhibition of tight m.).
In a study, the contract-relax-contract produced a greater ↑ in ankle dorsiflexion > contract-relax tech. (in short calf m ).
* Both techs produce ↑ ROM > manual stretching.
Peripheral joint mobilization (PJM) is the use of skilled graded forces to mobilize joints:to improve motion & normalize joint function.
To regain the lost motion
2. Sustained stretch
Physiologic movements changes occur
Movs. that the pt can perform voluntarily as flex, ext, abd, add & rot.
2. Described as (Osteokinematic). i.e. mov of bones in relation to each others
Movs within the jt & surrounding tissues that are necessary for normal ROM,can’tbe doneby pt.
2. Described as a.Component motionsb.joint play.Mobilization Techniques
Accessory motions changes occur
Motions that accompany active mov, but
Aren’t under voluntary control
Component mov is the often used term with accessory mov.
As: upward rot. of scapula & clavicle occurring in sh. flex.
B. Joint Play
Motions that occur in jts & distensibilityorgive in of the jt capsule, which allow bones to move.
Are necessary for normal functioning through the ROM.
Can be demonstrated passively,
Can’t be performed actively by the pt.
Include:distraction, sliding, compression, rolling, spinning of the jt surfaces.
Arthrokinematic is used to describe these motions of bone surfaces within the jt.Accessory motions
THRUST changes occur
A sudden mov performed with a high velocity.
Short amplitude motion, can’t be prevented by the pt.
Performed At end of pathologic limit(end of available ROM, when there’s restriction).
Using:1. Physiologic, or 2. Accessory movs.
1. Snaps adhesions.
2. Stimulates jt receptors.
MANIPULATION UNDER ANAESTHESIA
Medical procedure used to restore full ROM by breaking adhesions surrounding jt.
Performedthrough:1. Rapid thrust, or 2. Passive stretch.
Using:1. Physiologic, or 2. Accessory movs.B. Manipulation
A. Jt. shape.
B. Types of Motion.
C. Other Accessory motions.
A. Joint Shape
The type of motion is influenced by jt. shape.
- Measured in degrees. - Called ROM.
2.Motion of the bony surfaces- Within jt is a combination of rolling, sliding & spinning.
- These accessory motions allow greater angulation of bone as it swings.
- This needs adequate capsule laxity or jt. play.
(e.g. metatarsals & metacarpals)
(e.g. hip & sh)
Sliding changes occur
Is used to
Restore jt. play
Reverse jt. Hypomobility
Is not used, as
E.g. hip abd &add
sh abd &addFor Joint Mobilization Techniques
1.Control pain or 2.Stretch capsule
If applied gently If with stretch force
f. Traction (A&B).
All can be treated with gentle jt play tech to stim. neurophysiological&mechanical effects.
Can be treated with:
1. Progressive vigorous jt. play stretching techs.→ elongate hypomobile structures.
2.Sustained or oscillatory stretch forces→mechanically distend shortened tissues.
Progressive Limitations in the direction in which the slide normally occurs
Diseases that progressively limit movement can be treated by jt. play techs to:
1.Maintain available motion.
2. Retard progressive mechanical restrictions.
4.Functional Immobility(obligatory bedriddeness)
In this case the aim is to:
1. Maintainavailable jt. play.
2. Prevent degenerating.
3. Delay or reduce the effects of immobility.
(Hypermobile pts may benefit from jt. play tech.if kept within the limits of motion).
2. in the direction in which the slide normally occursJoint Effusion
!!!! While moving or mobilizing & found!!!!
2 systems of techniques:
1. Graded oscillation.
2. Sustainedtranslatory jt. Play.
Graded oscillation technique in the direction in which the slide normally occurs
1- Physiologic (osteokinematic) motions.
2- Jt. play (arthrokinematic) techs.
Small amplitude distraction, applied where no stress is placed on the capsule.
Distractionor glide applied to tightend tissues around jt.
Distraction or glide with large enough amplitude to place
a stretch on jt. capsule & surrounding peri-articular structures.
Sustained translatory joint-play technique in the direction in which the slide normally occurs
This grading system describes jt. play techniques that separate or glide (slide) jt surfaces.
2. The jt. is positioned so that the capsule has greatest laxity.
→ the more comfortable procedurewill be.
e.g. use flat surface of the hand instead of forcing with the thumb.
The entire bone is moved → jt surfaces are separated.
This is determined by using the convex-concave rule.
- If the surface of moving bone is convex -→ opposite direction glide.
- If the surface of moving bone is concave → glide in the same direction.
The entire bone is moved, so there’s gliding of one jt. surface on the other.
No swing of the bone that causes rolling & compression of the jt. surfaces