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Mobility can be described based on two different but interrelated parameters: _____ + ____

• Functional ROM

• Functional Mobility

Ability of structures or segments of the body to move or be moved to allow the presence of range of motion for functional activities

Functional ROM

Ability of an individual to initiate, control, or sustain active movements of the body to perform simple to complex motor skills

functional mobility

True/False: The ROM needed for performance of functional activities does not necessarily mean full or normal ROM

True

Sufficient mobility of soft tissues and ROM of joints must be supported by a requisite level of _______

muscle strength and endurance, and neuromuscular control

Caused by adaptive shortening of soft tissues as a result or disorders or situations

Hypomobility

Factors that contribute to Hypomobility

1. Prolonged immobilization of a body segment

2. Sedentary lifestyle

3. Postural malalignment and muscle imbalances

4. Impaired muscle performance

5. Tissue Trauma

6. Congenital or acquired deformities

hypomobility can result to _______ and ______ in a person’s life

activity limitations and participation restriction

Ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain-free ROM

Flexibility

Dynamic Flexibility is AKA

Active mobility or Active ROM

Dependent on the degree to which a joint can be moved by a muscle contraction and the amount of tissue resistance met during the active movement

Dynamic Flexibility

Passive Flexibility is AKA

Passive mobility or Passive ROM

Passive Flexibility is dependent on?

Extensibility of muscles and connective tissues that cross and surround a joint

This type of flexibility is a prerequisite for the other type of flexibility

Passive flexibility is a prerequisite for dynamic flexibility

Adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint resulting in significant resistance to passive or active and limitation of ROM

Contracture

Term used to denote partial loss of motion

Shortness

This term is discouraged to describe restricted motion due to adaptive shortening of soft tissue

Tightness

If a patient has shortened elbow flexors and cannot fully extend the elbow, he is said to have an __________ contracture

elbow flexion contracture

In this type of contracture, there is musculotendinous unit shortening and significant loss of ROM, but there is no specific muscle pathology

Myostatic contracture

In myostatic contracture, there is a reduction in the number of _________

sarcomere units

True/False: There is no decrease in sarcomere length in myostatic contracture

True

True/False: It takes a considerable amount of time to resolve myostatic contractures with stretching exercises

False; Relatively short time

Type of contracture where the muscles appear t be in a constant state of contraction; Due to hypertonicity associated with CNS lesion

Pseudomyostatic contracture

Procedures to reduce muscle tension temporarily are applied, full, passive elongation of the apparently shortened muscle is then possible for those with pseudomyostatic contracture

Neuromuscular inhibition procedures

Contracture resulting from intra-articular pathology

Arthrogenic Contacture

This type of contracture develops when connective tissues that cross or attach to a joint or the joint capsule lose mobility, thus restricting normal arthrokinematic motion

Periarticular Contracture

Contracture resulting from fibrous changes in the connective tissue of muscle and periarticular structure causing adherence of these tissues

Fibrotic Contracture

True/False: It is difficult to re-establish optimal tissue length for those with fibrotic contracture

True

The longer a ________ contracture exists, the more difficult it becomes to regain optimal mobility of soft tissues

Fibrotic contracture or greater replacement of normal muscle and connective tissue with nonextensible adhesions and scar tissue or bone

Applying stretching techniques selectively to some muscles and joints but allowing limitation of motion to develop in other muscles or joints

Selective Stretching

Selective Stretching is typically used in patients with _______

permanent paralysis (ex. SCI patients)

Stretch well beyond the normal length of muscle and ROM of a joint and the surrounding soft tissues

Overstretching

True/False: Creating selective hypermobility by overstretching may be necessary for certain healthy individuals

True

instability of a joint often causes ______ and may predispose a person to __________

pain → musculoskeletal injury

Type of stretching where a sustained or intermittent external, end-range stretch force, applied with overpressure and by manual contact or a mechanical device

Manual or Mechanical / Passive or Assisted

Any stretching exercise that is carried out independently by a patient after instruction and supervision by a therapist

Self-Stretching

Procedures purported to relax tension in shortened muscles reflexively prior to or during muscle elongation

Neuromuscular Facilitation and Inhibition

Other terms for Neuromuscular Facilitation and Inhibition procedures

PNF stretching, active inhibition, active stretching, or facilitated stretching

Procedures that employ a voluntary muscle contraction by the patient in a precisely controlled direction and intensity against a counterforce applied by the practitioner

Muscle energy techniques

Other term for Muscle Energy Techniques

Postisometric Relaxation

Skilled manual therapy interventions applied to joint structures to modulate pain and treat joint impairments that limit ROM

Joint Mobilization / Manipulation

Techniques designed to improve muscle extensibility and involves the application of specific and progressive manual forces

Soft Tissue Mobilization / Manipulation

Indications for Use of Stretching

Contraindications to Stretching

Primary effect and expected outcome of a program of stretching exercise

Increased Flexibility and ROM

True/False: Acute Stretching increases muscle performance immediately following the stretching session

False

This approach to stretching has been found to improve strength or power

Chronic Stretching

program of stretching exercises performed on a regular basis over a period of weeks

Chronic Stretching

The ability of the body to move freely with control during functional activities is dependent on _______ + _________

on the passive extensibility of soft tissues as well as active neuromuscular control.

Primary cause of restricted ROM in both healthy individuals an patients with impaired mobility

Decreased extensibility of connective tissue (NOT contractile elements of muscle tissue)

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

Elasticity

time-dependent property of soft tissue that initially resists deformation, such as a change in length, of the tissue when a stretch force is first applied

Viscoelasticity

allows a change in the length of the tissue and then enables the tissue to return gradually to its prestretch state after the stretch force has been removed

Viscoelasticity

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

Plasticity

Act as the harness of a muscless

Connective tissue structures - Endomysium → Perimysium → epimysium

primary source of a muscle’s resistance to passive elongation.

Connective tissue framework of muscle

When contractures develop, adhesions in and between _______ resist and restrict movement

collagen fibers

Response of Muscle to Passive Stretch

Initial Lengthening: occurs in series elastic component (connective tissue) - Tension rises sharply

Mechanical Disruption: filaments slide apart - sarcomere give

Release: Sarcomeres return to their resting length

Muscle Morphological changes as a response to Immobilization and remobilization

• decay of contractile protein in the immobilized muscle

• decreases in muscle fiber diameter the number of

  myofibrils, and intramuscular capillary density

• increase in fibrous and fatty tissue in muscle also occurs

Atrophy occurs more quickly and more extensively in this type of muscle

Slow Twitch (postural muscles)

when a muscle is immobilized in a shortened position for several weeks, which is often necessary after a fracture or surgical repair of a muscle tear or tendon rupture, there is a _________

Reduction in the length of the muscle and its fibers and in the number of sarcomeres in series with myofibrils as the result of sarcomere absorption

True/False: Muscle immobilized in a shortened position atrophies and weakens at a faster rate than if it is held in a lengthened position

True

There is a shift to the _____ in the length-tension curve of a shortened muscle

Left

increasing the number of sarcomeres in series

Myofibrillogenesis

True/False: The adaptation of the contractile units of muscle to prolonged positioning in either lengthened or shortened positions is permanent

False

major sensory organ of muscle and is sensitive to quick and sustained (tonic) stretch

Muscle Spindle

Muscle spindle is sensitive to ________

quick and sustained tonic stretch

The main function of muscle spindles is to receive and convey information about

changes in the length of a muscle and the velocity of the length changes

Which part of an intrafusal fiber is contractile

Polar regions (not equatorial region)

These innervate the contractile polar regions of intrafusal muscle fibers

Gamma motor neurons - adjust the sensitivity of muscle spindles

These neurons innervate the extrafusal fibers

Alpha motor neurons

Two general types of intrafusal fibers

1. Nuclear bag fibers

2. Nuclear chain fibers

arise from nuclear bag fibers, sense and cause muscle to respond to

both quick and sustained (tonic) stretch

Primary afferent endings (type Ia fiber)

Fibers that are from the nuclear chain fibers which are sensitive only to tonic stretch

Type II

sensory organ located near the musculotendinous junctions of extrafusal muscle fibers.

Golgi Tendon Organ

Function GTO

Monitor changes in tension of muscle-tendon units

GTO are sensitive to slight changes of tension on a muscle-tendon unit as a result of _________ or __________

passive stretch of a muscle or with active muscle contractions during normal movement

Effect of GTO

inhibits alpha motoneuron activity → decreases tension in

the muscle-tendon unit being stretched

True/False: GTO has a low threshold for firing

True

How is the stretch reflex minimized during stretching procedures?

slowly applied, low-intensity, prolonged stretch is considered preferable to a quickly applied, short-duration stretch.

GTO causes ______ inhibition

autogenic

Muscle Spindle causes ______ inhibition

Reciprocal

Connective tissue is composed of three types of fibers:

Collagen, elastin, reticulin, and nonfibrous ground substance

responsible for the strength and stiffness of tissue and resist tensile deformation

Collagen Fibers

These form the building blocks of collagen microfibrils

Tropocollagen crystals

The fibers of tendons and ligaments mostly contain _____ collagen

Type I collagen - highly resistant to tension

______ fibers provide extensibility

Elastin

_____ fibers provide tissue with bulk

reticulin

an organic gel containing water that reduces friction between fibers, transports nutrients and metabolites, and may help prevent excessive cross-linking between fibers by maintaining space between fiber

Ground Substance

structural element that absorbs most of the tensile stress.

Collagen

Mechanical Behavior of Collagen

• elongate quickly under light loads (wavy fibers align and straighten)

• With increased loads, tension in the fibers increases, and the fibers stiffen

Alignment of collagen fibers in tendons

Parallel = resist the greatest tensile load

Alignment of collagen gibers in skin

Random = weakest in resisting tension

Alignment of collagen fibers in ligaments, joint capsules, fascia

Vary between parallel and random = resist multidirectional forces

internal reaction or resistance to an external load

Mechanical Stress

Amount of deformation or lengthening that occurs when a load is applied

Strain

Force applied perpendicular to the cross-sectional area of the tissue in a direction away from the tissue

Tension

A stretching force is a ____ stress

tension stress

force applied perpendicular to the cross sectional area of the tissue in a direction toward the tissue.

Compression

Force applied parallel to the cross-sectional area of the tissue

Shear