5 - Stretching and Tone

Stretching

• Any therapeutic maneuver designed to increased mobility of soft tissues

• Improves ROM by elongating structures that have shortened

What are the two types of flexibility?

Dynamic and passive

Contracture

• A shortening of tissue that limits mobility

• Decreased ROM and function

• Named by the location it impacts

What is selective stretching?

• Allowing hypomobility to develop to improve function

• Allowing some hypermobility can improve function in some cases

Benefits of stretching

• Inc flexibility and ROM

• General fitness

• Injury prevention

• Reduced post-exercise soreness

• Enhanced performance

Indications for stretching

• Adhesions, contractures, scar tissue that limits ROM

• Potential for structural deformity due to limited ROM

• Muscle weakness due to shortening of opposing muscles

• Part of a total fitness program or sport specific program

• Pre and post vigorous exercise

Precautions for stretching

General:

• Don’t force joint beyond its ROM

• Osteoporosis, prolonged bedrest, age, use of steroids

• Newly united fractures

• Aggressive stretching of muscles that were immobilized for a long time

• Progress gradually (duration, intensity, frequency)

• Avoid stretching edematous tissue (tissue with edema)

• Avoid overstretching weak muscles

Common errors and potential problems

• Poorly balanced stretching activities

• Insufficient warm-up

• Ineffective stabilization

• Use of ballistic stretching

• Excessive intensity

• Abnormal biomechanics

• Insufficient info about age-related differences

Contraindications for stretching ex.

• Bony blocks

• Recent fracture or non-union fracture

• Acute inflammation or infection

• If stretching will delay or restrict healing

• Sharp or acute pain with elongation

• Hematoma or tissue trauma

• Hypermobility

• Hypomobility provides stability or neuromuscular control

Soft tissue

Made up of contractile and non-contractile tissue

Contractile tissue

• Easily contracts and relaxes

• Ex. muscle

Non-contractile tissue

• Tissue that does not contract and does not easily relax

• Ex. connective tissue (ligaments, tendons, joint capsules, fascia, skin, nerves, cartilage)

Elasticity

• Contractile and non-contractile

• The ability of soft tissue to return to its pre-stretch resting length directly after a short-duration stretch force has been removed

Viscoelasticity

• Non-contractile

• The time dependent property of soft tissue that initially resist deformation of the tissue when a stretch force is applied but will slowly lengthen if the stretch is sustained; when the force is removed, it will go back to its original length

Plasticity

• Contractile and non-contractile

• The tendency of soft tissue to assume a new greater length after the stretch force has been removed

Muscle spindle

Sensory organ found in muscle belly

 Detects and relays info about muscle length and velocity

changes

 Made up of afferent sensory fiber endings, efferent motor

fiber endings, and intrafusal muscle fibers

 Type 1a afferent fibers respond to quick and sustained

stretches

 Type II afferent fibers respond to sustained stretches

Golgi Tendon Organ (GTO)

• Continuously monitors tension at the musculotendinous junctions

  • Adjusts the tension in a muscle during passive stretch

  • Adjusts the force of an active contraction during movement

• Encapsulated nerve endings in tendons

• Transmits sensory info to spinal cord to decrease tension to the muscle-tendon unit as a protective response to prevent tendon rupture

Stretch reflex

• Type 1a and II afferents of intrafusal muscle fibers are stimulated by quick length changes (quick stretches) and this increases muscle tension which resists lengthening

• Can be avoided by stretching slowly, smoothly, and for a prolonged time

Stretching components

• Alignment

• Stabilization

• Intensity (low intensity with low force is the best)

• Duration of stretch (less reps with longer stretches is better- up to 60 sec)

• Speed of stretch

• Frequency of stretch (2-5 times a week)

• Mode of stretch

Static stretching

• Stretch and hold for 30 seconds

• Static progressive - stet4ch and hold till you feel a give then stretch further

• Better after working out

Dynamic stretching

• Low velocity and low intensity

• Better before intense exercise

Cyclic (intermittent stretching)

Stretch 5-10 sec, release, stretch again

Ballistic stretching

• High velocity and high intensity

• Best for athletes (look up Olympic swimmers)

Interventions to increase mobility of soft tissues

• Manual stretching

• Mechanical stretching - uses devices like pulleys and it typically longer (15 min - 10 hrs)

• Self-stretching

• Neuromuscular facilitation and inhibition techniques

• Muscle energy techniques

• Joint mobilization/manipulation

• Soft tissue mobilization/ manipulation

• Neural tissue mobilization

Hold-Relax PNF

• Lengthen the tight muscle (agonist) to the point of resistance

• Can do isometric contraction of the agonist or antagonist

Hold-Relax Active

• Move the limb to the point of tissue resistance in the tight muscle (agonist)

• Pt performs resisted isometric contraction of the right muscle for 10 sec followed by relaxation of the muscle, the therapist then passively moves the muscle into the new ROM, lastly, the pt concentrically moves back to the starting position

Relaxation techniques

• Decreased mm tension in the entire body or to the area that is painful or restricted by using conscious thought

• Ex. autogenic training, progressive relaxation (Jacobson’s technique, awareness through movement)

Breathing techniques

• Deep

• Box or square

• Pursed lip

Adjunct stretching interventions

• Heat - relaxes muscles

• Cold - dec swelling

• Massage - inc circulation, dec muscle spasms

• Soft tissue mobilization/manipulation techniques - inc mobility of tissue

• Biofeedback - inc pt awareness and relaxation

• Joint traction or oscillation -

Tone

• The resistance of muscle to passive stretch

• Increase will limit ROM

• There is a slight residual contraction in normal innervated, resting muscle

• Influenced by: physical inertia, intrinsic mechanic elastic stiffness of muscles and connectives tissues

• Spinal reflex muscle contraction

• Emotions

• Temperature

Hypertonicity

• An increase in tone

• Two types: spasticity and rigidity

Spasticity

• Velocity dependent

• Muscle spasms are increased by movement

• ROM can trigger or increase this

Rigidity

• Not in velocity-dependent

• Muscles are stiff and resistant to movement

• Associated with lesions in the basal ganglia

• Different types: leadpipe, cogwheel, decorticate, decerebrate

Hypotonicity

• Decreased tone

• Limb feels heavy and responsive

• Prone to subluxation of joint so ROM must be done cautiously

Dystonia

• Impaired or disordered tone

• Characterized by twisting or writhing repetitive movement or increased muscle tone

• Caused from a CNS lesion usually in the basal ganglia and can inherited

• Can affect one or multiple parts of the body