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Restoring ROM and Improving Flexibility
Definitions
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
ROM
Active Passive Active Assisted (pulleys) Measuring ROM ( goniometry)
ROM exercises Assignment #2
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
Neurophysiologic Principles
Muscle spindle Message to CNS that muscle being stretched Message back to muscle via interneurons in
spinal cord Protective mechanism
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
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
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
How permanent is stretching?
Debatable…
Elastic stretching lasts about 90 min Plastic stretching more permanent
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
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.
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
Contract relax stretching
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
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)
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