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What are some effects of prolonged bed rest?
- muscle atrophy from disuse
- joint contractures
- pressure necrosis-> ischemia-> tissue death
- disuse osteoporosis
- phlebothrombosis (formation of cloth adhering to wall of a vein (+) homans sign)
- postural hypotension
- hypostatic pneumonia-in secretion in lungs at night
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How do you test for a homans sign?
- force foot into DF
- if they have a sharp pain in their leg, probably positive for homans (dvt)
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What happens when a body is immoblized for any length of time?
- CT becomes dense/hard and loses its properties
- hypomobility
- contractures
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What are some factors promoting formation of dense fibrosis (decreased ROM)?
- immobilization
- edema
- trauma
- impaired circulation
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Joint restrictions may be present secondary to what?
- pain
- jt inflammation
- congential anomaly (birth defect)
- prolonged immoblization
- prolonged m. contraction (spasticity, contracture)
- trauma
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What is the therapeutic technique to lengthen (pathophysiology) shortened soft tissue?
stretching
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What is the ability of a m. to relax and yield to a stretch force?
flexibility
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What is plasticity?
muscle keeps some of the new gained length
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What is elasticity?
muscle must recoil after stretch
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What does normal ROM involve?
mobility and flexibility of soft tissues that surround a jt (muscles, CT, skin), and joint play (laxity)
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Full ROM is not possible without what?
joint play
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What are the goals for stretching?
- regain normal ROM of joints and soft tissue mobility
- prevent irreversible contractures
- increase general flexibility prior to exers
- prevent/minimize risk of muscle/tendon injuries in sports
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What are some indications for stretching?
- limitation of motion secondary to contractures, adhesions, scar tissue
- when limitations may lead to structural deformities
- when contractures interfere with normal ADLs
- muscle weakness and opposing tissue tightness is present
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What are contraindications of stretching?
- bony blocks limiting motion
- acute inflammatory process(RA, fibromyalgia)
- cyanosis, dyspnea
- when the contracture benefits the pt
- after recent fracture
- sharp pain with mvmt
- irregular vitals
- when you have no orders
- if theyre hypermobile
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What are precautions for stretching?
- prolonges disuse, paralysis, anesthesia
- stretching of tight jts, not just tight mm.
- edematous tissue
- post op pts in ICU (can do PROM)
- very young pts
- do not force beyond normal ROM
- prolonged use of steroids
- osteoporosis
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How should you apply a stretch to a pt?
- stabilize on each side of jt
- apply force in precise direction to produce tension in right muscles
- use gentle and low intensity stretching so the pt can relax
- hold at least 20 seconds
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What is static stretching?
what we want
soft tissues are lengthened just past point of tissue resistance and held for extended period of time
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What is ballistic stretching?
bouncing, rapid, forceful, high speed mvmts
doesnt elongate, initates m. contraction, doesnt increase flexibility
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What is the active stretching contract-relax technique?
- move extremity to comfortable lengthed position
- isometrically contract tight m. 6 seconds
- relax
- lengthens m. passively moving into gained range
- repeat
*hold relax
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What active stretching technique uses sherringtons law of autogenic inhibition?
contract-relax (hold relax)
m. can relax more fully after a contraction occurs....max resistance, max relaxation of same m.
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What active stretching technique uses sherringtons law of reciprocal approach?
contract relax contract (hold relax contract)
contracting the antagonist allows the tight agonist to relax
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What is the active stretching technique of contract relax contract?
- move extremity to comfortable stretch
- isometrically contract tight m. 6 seconds
- relax
- pt isotonically contracts the antagonist of the tight muscle and actively moves thru gained range
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How is reciprocal inhibition performed?
- move extremity to comfortable position of stretch
- isotonic contraction of antagonist of tight muscle against mild resistance
- elongation is achieved with relaxation of agonist (tight muscle)
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What is passive stretching?
pt is relaxed or the muscle is an an external force is applied manually or mechanically to lengthen soft tissues
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What type of stretching does the therapist applies external force and controls the speed, direction, intensity, and duration of stretch?
manual passive stretch
- pt relaxed
- force applied 20-30 seconds, repeated 2-3 times
- intensity and duration depends on pt tolerance
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How is prolonged mechanical passive stretching performed?
- pt relaxed
- weight applied for prolonged period of time or splints, casts, or pulley system used
- 15-30 mins (depends)
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What type of stretch has the pt allowing their body weight or gravity to lengthen soft tissues (20-30ish minutes daily)?
positioning for static stretch
- hip flexors-prone
- knee flexors-prone
- fingers-serial casting
do not do on elbows, itll cause myositis ossificans
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What can happen if motion is not maintained in the presence of inflammation?
irreversible contractures
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What are some things to remember while performing mobility exers?
- focus pts attention of what theyre doing
- make sure theyre doing it right
- they have good posture
- modalities may help facilitate desired effect (best to have pt stretch with heat on)
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What does stretching the muscle prior to mvmt help do?
recruit more motor fibers and prepare the muscle to work
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What is the spray and stretch technique?
evaporative cooling...draws moisture out of the muscle so its easier to stretch
rapid cooling, m. less sensitive to stretch, decreased pain and nerve conduction
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What are the 2 types of spray and stretch?
- ethyl chloride
- fluromethane
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What are some uses and advantages of spray and stretch?
local anesthetic, trigger point therapy, M/S pain due to trigger points
simple and effective, enhances stretch by decreasing pain, immediate results
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What are some precautions/disadvantages of spray and cool?
- loss of pain response
- more expensive than traditional forms
- effects of freezing
- do not inhale fumes, use in ventilated area
- protect eyes
- no more than 3 times per muscle
- may need 2 clinicians
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How should you explain the feeling of spray and stretch to a pt?
transient and CBAN
- 1-2 feet from body part
- perpendicular
- 2-3 times over same muscle
- 1/4-1" apart from origin to insertion
- go in same direction (4"/sec)
- spray as you stretch
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