Range of Motion

1. Range of Motion Flexibility Training

2. ROM • Flexibility: ability of a neuromuscular system to allow movement of a joint or series of joints through non-restricted pain-free ROM • Affected by: shape of joint, capsule, ligaments, muscle flexibility, NMC, Neural Tissue, skin/scars, excess tissue

3. Soft Tissue • 4 types: • Epithelial Tissue- skin, lining of vessels/ organs • Connective Tissue- tendons, ligaments, cartilage, fat • Muscle- skeletal, cardiac, smooth • Nervous Tissue- brain, spinal cord, nerves

4. ROM • Range of Joint Motion: the number of degrees of motion that are present in a joint • Range of muscle length: refers to the length of the muscle • It is necessary to allow the muscle to be slack over one joint to determine the full range of joint motion in the other • Ex. Hip Flexed to measure knee flexion

5. Muscle Length Tests • Determine whether the range of muscle length is normal, limited, excessive • Muscles excessive in length- usually weak and allow adaptive shortening of opposing muscles • Muscles that are too short- usually strong and maintain opposing muscles in a lengthened position • Can be passive or active-assisted movements • Use Goniometer

6. ROM • Passive ROM- Static Flexibility- degree to which a joint can be passively moved to end points in ROM • Static/ Passive stretching= 15-60 second holds 3- 5 repetitions most effective for increasing flexibility 3-5x/week • Active ROM- Dynamic Flexibility- degree to which a joint can be moved by a muscle contraction • Dynamic stretching- no longer than 6 sec holds, do not want to relax the muscle • There are many times a mm is forced to stretch beyond its normal active limits , if there isn’t enough elasticity to compensate= injury

7. Flexibility • Intramuscular temperature should be increased prior to stretching • Positive effects on collagen and elastin components within the musculotendinous unit to deform • Capability of GTO to reflexively relax is enhanced when heated • Low intensity warm up

8. Hamstring flexibility • Test length of Hamstring with no warm up or previous stretching then: • Day 1: Complete a 5 minute warm up on bike, treadmill, elliptical, rower, test Hamstring length • Day 2: Complete Static stretching for Hamstring 3 x 30 seconds holds each side, test Hamstring length • Day 3: Complete Dynamic Stretching/ Warm up, test Hamstring length • Day 4: Complete Myofascial Release with Foam roller/ Ball, 3 x 30 seconds, test Hamstring length • Day 5: Complete PNF stretching 3 x/ side, test Hamstring length • Which one helped the most?

9. static stretching • Reflex Autogenic Inhibition: Golgi Tendon Organs = relaxation in antagonist mm, Contraction of agonist causes a reflex relaxation in the antagonist muscle • After stretching for 6 seconds GTOs override muscle spindle to cause muscle to relax. (cause reflex relaxation of antagonist mm) • Reflex relaxation is a protective mechanism that will allow the mm to stretch without exceeding extensibility limits • Flexibility can be lost quickly • Can be maintained with 1 session/week, Need 3-5 sessions a week to improve

10. Dynamic stretching • Used as a Warm up, revs up the motor and nervous system • As little as 5 mins- as long as 20 mins • Hopping, bounding, skipping, footwork drills • Jog forward, backward, walking calf stretch/ hamstring stretch, lateral shuffle, lateral lunges, skipping, walking lunge, walking quadriceps stretch, jogging butt kicks, open/ close the gate exercise, carioca, high knees, forward sprint • COOLDOWN: often ignored, should last 5 mins, allowing body to cool and return to resting state. People who stretch during cooldown tend to have fewer problems with muscle soreness after strenuous activity

11. Importance of Flexibility • Essential to normal daily living • Lack of flexibility can be affected at one joint, or several- either way can affect the entire kinetic chain • Lack of flexibility can create uncoordinated and awkward movement patterns resulting from lost neuromuscular control • Good flexibility reduces the likelihood of injury • Essential for improving performance in physical activities

12. Weakness vs Restriction • Weakness must be distinguished from restriction of ROM • If a muscle can not complete the normal ROM, it may be that the muscle is too weak to complete the ROM, or the ROM is restricted because of shortness of the muscle, capsule, ligaments

13. Stability vs Flexibility • Good body mechanics requires the range of joint motion be adequate but not excessive • The more flexibility, the less stability • The more stability, the less flexibility • Sport, Dance, acrobatic activities require excessive flexibility and muscle length • “The more the better” may apply to improving the skill of performance, but may adversely affect the well being of the performer

14. Posture • Postural faults can give rise to discomfort, pain or disability- range of effects often related to severity and persistence of the faults • Need therapeutic exercises to strengthen weak muscles and stretch tight muscles= restore muscle imbalance • Ex. Tight psoas= inhibition of gluteus maximus, TA, interneal oblique, and multifidus= decrease in stability and compensation

15. Muscle imbalance • Crossed Pelvis Syndrome/ Lower Cross Syndrome= weak abdominal wall and weak gluteals are counterbalanced with tight hamstrings and hip flexors • Proximal Crossed Syndrome/Upper Crossed Syndrome= weak cervical flexors and medial/ inferior traps are counterbalanced with tight upper trap, levator scapula, and pectoralis major

16. Postural stretching • Posterior Neck Stretch: Supine, bend knees, place feet flat on floor. Elbows bent and hands up beside head, tilt pelvis posteriorly (flatten low back). Press head back, chin down and in, try to flatten neck. • Shoulder Adductor Stretch- Supine, bend knees, feet flat on floor. Tilt pelvis, flatten low back, hold. Place arms overhead, try to reach arms to table with elbows straight. Bring upper arms as close to side of head as possible. DO NOT arch back. • Wall Standing Postural Exercise- Stand with back against wall, heels 3 inches from wall. Straighten upper back, press head back with chin down and in. Flatten low back against wall, pulling up and in with lower abdominals. Place hands up beside head with elbows touching wall, start with elbows at 90*. Keep arms in contact with wall and move arms slowly to a diagonal overhead position.

17. Myofascial Release • Used to relieve soft tissue from the abnormal grip of tight fascia • Fascia- type of connective tissue, continuous from head to toe, attached to tendons, muscles, nerves bones, organs • Releasing myofascial restrictions over a large treatment area can have a significant impact on joint mobility. • Superficial-> deep Complete 3x/week Graston Technique, Strain/ Counterstrain, Soft Tissue Mobilization, Massage, Foam Roller

18. Proprioceptive neuromuscular facilitation (pnf) • Stretching techniques that involve combinations of alternating contractions and stretches • Slow-reversal- hold- relax • Patient lies supine, knee extended, ankle at 90*, partner passively flexes hip to where there is slight discomfort • Patient actively pushes against partners resistance (ISOMETRIC), contracting hamstring, hold for 10 seconds • Relax hamstrings and contract QUADS while partner passively flexes the hip more, hold for 10 seconds • Repeat contraction of Hamstrings, complete this cycle 3x

19. Pnf • Contract- Relax • Patient lies supine, knee extended, ankle at 90*, partner passively flexes hip to where there is slight discomfort • Patient contracts Hamstrings, as Partner resists for 10 seconds • Patient relaxes for 10 seconds, partner moves them passively further into a new stretch position • Repeat 3x