Active Care- Exam 1- Mobility and Soft Tissue Treatments

What is the difference between mobility and flexibility?

Mobility is active range of motion

Flexibility is passive range of motion

What is useless flexibility

The ability to get a certain angle (ROM) but not able to use the angle (ROM) in daily life

-essentially you have great flexibility but lack mobility

What can cause reduced ROM from an active tension standpoint?

Nervous system tone (hypertonicity)

-commonly see this

-its a protection mechanism

What can cause reduced ROM from a passive tension standpoint?

Immobilization

What are the 2 types of tissue tension restricting ROM

Active tension

Passive tension

What happens when we have joint hyper-mobility?

Brian senses instability

Responds by creating stability through active stabilization by increasing neuromuscular tone

-feel like they have tight muscles

What is the relationship between flexibility and injuries?

U shaped curve

The very flexible have more joint related injuries (dislocations)

The very tight have more soft tissue injures

What difference does we see between those with tight muscles versus those with flexible muscles?

Less flexible tend to have mores soft tissue injuries

More flexible tend to have more joint related injuries

Tight muscles are more prone to?

Delayed onset muscle soreness (DOMS)

-more often a neurological problem not physiological

Tight muscles are better at what?

Storing energy and releasing energy

Reduction in flexibility of about _____ per decade from what ages?

About 10% per decade from ages 20-49

What most likely causes the feeling of muscle tightness?

Fascial and neurological tension

Why do we experience tightness and stiffness?

Prolonged postures, lack of movement

Stress, diet, sleep, emotional state, etc.= sensitization

How does neuromuscular dysfunction lead to tightness and restricted ROM?

Nervous system dysfunction

Nothing physically wrong with the tissues

Apparent reduces mobility

What are the different types of treatments that are optimal for neuromuscular dysfunction?

Inhibitory techniques (PIR/IR stretching) and or muscle activation techniques

Rapid changes that are often short term changes

What specific types of treatments do physically remodeled/shortened tissues require?

Load over time with progression of forces over a long time frame

What does fascia communicate and remodel in response to?

LOAD

What major structure (s) in the body provide a significant amount of afferent feedback necessary for allowing proper movement expression?

Fascial connections

Why is performing an adjustment before active care exercises recommended?

Greatest degree of afferent and proprioceptive input that can be passively applied is through joint manipulation

Indications for stretching

Decreased motion leads to structural deformities

Muscle weakness and shortening of opposing tissue

Used as part of total fitness program designed multifactoral injury

Prior vigorous exercise to minimize soreness

Contraindications for stretching

Bony block limits motion

Recent fraction, non inion incomplete

Acute inflammatory or infections process

Soft tissue healing could be disrupted due to stretch

Sharp acute pain with joint movement or muscle elongation

(Strains and sprains)

Hematoma

Hypermobility

What does stretching actually do?

Affects change in the nervous system through facilitation or inhibition of neuromuscular tone

Fascial tension/contraciton and vicoelastity

How long do the effects of stretching endure?

5 to 30 minutes

Which important factor is most important to modify in order to counter the short term effects of stretching?

Repetition and consistency= Increase in frequency

What causes the acute increase in ROM seen with static stretching?

Analgesic response

Inhibited nervous system tone

Short term increase in flexibility of muscles

During what timeframe of stretching do the majority of increased ROM occur?

Within the first 5-30 minutes

What are optimal stretching recommendations

3-4 sets for 15-30 seconds for optimal gains

Multiple times per day

6-10 weeks

What is the ideal duration a stretch should be held?

15-30 seconds

What is the ideal frequency for stretching?

Multiple times per day for 6-10 weeks

What is the ideal number of repetitions a stretch should be performers for maximal benefit

3-4 sets for 30 seconds each

What is the primary factor for increasing tendon flexibility?

Heavy slow resistance over long periods of time

How long do you need to stretch a tendon to see length improvements

Help up to 10 minutes

What is stretch-induced strength loss?

Stretching causes an acute inhibition of maximal force produced by the muscle

How can someone mitigate the effects of stretch-induced strength loss?

Maximal contraction of the muscle prior to static stretch

What types of activities does stretching-induced strength loss primarily effect?

More pronounced in activities with relatively slow velocities

What effects does stretching have on economy of movement and perceived exertion for steady state endurance training such as running?

Reducing the perception of effort and making the training sessions more enjoyable

What is the difference between static stretching and strength training for increasing ROM

Static stretching and strength training showed no difference in the effects on ROM gains

-Load and time play a role here

What is DOMS?

Delayed onset muscles soreness

What causes DOMS?

Neural feedback

Free radicals

Swelling

What is recommended in terms of stretching for DOMS?

Should not be performed during DOMS

-avoid stretching following high-intensity sessions or strengthening session

-avoid positions that involve high intensity contractions

How does neural feedback cause DOMS

Muscle stretched during resistance training

Spindle fibers stretch and actives in order to regular level of tension

Pressure is applied to the nerve endings of the muscle spine causing pain

How do free radicals cause DOMS

Released from mitochondria

How does swelling cause DOMS

Relate back to pressure around the nerve endings

What are the different categories of stretching techniques

Static stretching

Dynamic stretching (active dynamic and ballistic stretching)

Muscle energy technique (PIR and RI)

PNF stretching (contact-relax, hold-relax, CRAC)

What is static stretching? How can it be performed individually or with a partner

"Relaxing into a ROM"

Slow and constant

Self assisted (bands, straps, etc)

Have someone else move you into position for with a partner

What is the underlying reasoning behind the push against performing ballistic stretching?

Increased injury risk

-difficult to control moment

-NOT SAFE OR INDICATED FOR INJURY RECOVERY

-constant, repetitive tension on muscle spindles

What is ballistic stretching

Rapid altering moments to end range

-bouncing at end range

Does ballistic stretching result in sustain increases in ROM

NO

How is active dynamic stretching performed

Contorted movement through a full range

Start slow and gradually pick up speed and increase ROM

Prepares and "warms up" the body for specific demand or task

What is propioceptive neuromuscular facilitation (PNF)

Concept of patient management

-all human beings have untapped existing potential

What are the PNF basics for inhibition? (I.e. the goes of PNF inhibitory techniques)

Integrated approach

Positive approach

Help the patient achieve highest level of function

Motor control and learning principles

What is integrated approach with PNF

Each session directed to total human not just specific problem or segment

What is positive approach with PNF

Focus on and reinforce tasks the patient can do

What are the 3 PNF inhibitory techniques

Irradiation

Reciprocal inner actions

Inhibition

What is the spread excitation in the CNS that causes contraction of the synergistic muscles in a specific pattern

Irradiation

-contracting from your toes up one muscle group at a time

Simple way of explaining irradiation and the final result of it

Contraction in "A" excites synergistic "B" and "C"

Result- both facilitate the movement

Which PNF stretching technique uses reciprocal inhibition? Which other technique uses the same concept of reciprocal inhibition?

PNF technique of "hold relax"

Same idea as PIR from MET

Which PNF stretching technique uses post contraction inhibits? Which other technique uses the same concept?

Contract relax anatagonist contract (CRAC) from PNF

Same idea as RI from MET

What is the main difference between hold-relax, contract-relax and CRAC?

All 3 start with the same basic steps but

Contract relax after the isometric contraction you ask the patient to concentrically contract the muscle being stretched while providing light resistance until neural

And then in CRAC they contract the opposite muscle to increase stretch further into barrier

What is muscle energy technique (MET)?

Stretching that involves voluntary contraction of a muscle in precise and controlled direction and variations in intensity

What technique uses a muscles own energy in the form of gentle isometric contractions to relax the muscles via autogenic or reciprocal inhibitor and lengthen the muscle?

Muscle energy technique (MET)

What are the benefits of MET

Super helpful for postural muscles (good for facilitating adjustments)

What technique utilizes golgi tendon organs

Autogenic inhibits (PIR) from MET

What technique utilizes muscle spindles

Reciprocal inhibition (RI) from MET

During PIR from MET stretching technique, yo are contracting which muscle during the stretch

Antagonist

How is autogenic inhibition used during stretching? Which MET technique uses autogenic inhibition

PIR stretching technique

-muscle taken to resistance point

-10-20% contraction for 5-10 seconds with applied force from doctor in opposite direction (patient inhales during this)

-after isometric contraction, patient exhales and relaxes, pushing further into stretch

-repeat 2-4 times

How id reciprocal inhibition used during stretching? Which MET technique uses this?

RI from MET

-muscle taken to resistance pint

-contract the antagonist muscle (opposite one being stretched) with 10-20% effort for 5-10 seconds

-apply force in opposite direction (patient should inhale)

-relax and exhale while applied more stretch

Repeat 2-4 times

What is Post-Facilitation Stretch (PFS)? How does it differ from other stretching techniques?

Howled muscle midway between neutral and point of tension

Contract with near maximum effort for about 10 seconds

Relax completely

Move quickly and carefully to new point of tension

Hold stretch for about 15 seconds

Move back to midrange and rest 20-30 seconds

Repeat 3-5 times

What is Active Isolated Stretching (AIS)? How does it differ from other stretching techniques discussed?

Doc applies 1 pound pressure

Patient contracts for 1-2 seconds once barrier reached

Stretch no more than 2 seconds

Return to start position

Repeat 15-20 reps, 1-2 sets