chaoter 3 + 4

Purpose of ROM

Maintain mobility, prevent contracture, promote circulation/synovial movement, preserve movement patterns (not for increasing strength)

PROM

Movement produced entirely by external force

AROM

Movement produced by muscle contraction

A-AROM

Patient contracts muscles with assistance

PROM indications

Acute inflammation, severe weakness/paralysis, post-op protection, pain with active motion

PROM does NOT improve

Strength, endurance, coordination, cardiovascular fitness

Self-ROM goal

Promote independence and maintain mobility safely

Functional ROM

Multi-plane, task-specific movement patterns

CPM purpose

Maintain mobility, reduce stiffness, improve cartilage nutrition

Contracture

Adaptive shortening causing loss of passive ROM

Flexibility

Ability of soft tissue to lengthen and allow movement

Hypomobility

Restricted ROM

Selective stretching

Stretch restricted tissue while preserving stability

Overstretching consequence

Excessive mobility → instability

Primary indication for stretching

Restore mobility limited by shortened soft tissue

Contraindications to stretching

Bony block, acute inflammation, recent fracture, hypermobility, instability

Elastic deformation

Temporary tissue elongation

Plastic deformation

Permanent tissue length increase

Failure region

Tissue damage

Goal of stretching connective tissue

Reach plastic deformation without failure

Creep

Progressive tissue elongation under constant force

Stress relaxation

Decreasing force needed to maintain constant length

Low-load prolonged stretch advantage

Better tissue adaptation with less protective muscle response

Muscle spindle response

Resists rapid stretch

Golgi tendon organ response

Facilitates relaxation

Best speed of stretch

Slow and controlled

Most important factor during stretching

Stabilization

PNF hold-relax

Isometric contraction → relax → stretch

PNF contract-relax

Concentric contraction → relax → stretch

PNF hold-relax with agonist contraction

Add contraction of opposite muscle to increase ROM

Stretching gains should be followed by

Active control and strengthening

Loss of passive ROM suggests

Contracture/connective tissue restriction

Loss of active ROM with normal passive ROM suggests

Weakness or neuromuscular impairment

A patient lacks full passive knee extension. What impairment is present?

Knee flexion contracture

Patient has full PROM but limited AROM after surgery. Most likely cause?

Muscle weakness/inhibition

During ROM treatment, movement should stop when

Tissue resistance becomes abnormal or pain increases

Why does ROM often precede strengthening?

Motion must exist before force can be controlled

A patient’s shoulder is immobilized for 6 weeks. Most expected impairment?

Hypomobility and connective tissue shortening

A patient gains ROM during stretching but loses it immediately afterward. Most likely missing intervention?

Active movement/strengthening into new ROM

During a sustained stretch you move farther using same force. What property occurred?

Creep

To obtain permanent connective tissue lengthening, what must occur?

Collagen bond remodeling in lengthened position

A patient demonstrates excessive flexibility and instability. What intervention should be avoided?

Stretching

After tendon repair, why avoid end-range stretch?

Healing collagen cannot tolerate tensile stress

A patient performs wall calf stretching with body weight as force. What type of stretching?

Self-stretch

Why is ballistic stretching often avoided in rehab?

Activates muscle spindle and increases protective contraction

Patient improves ankle dorsiflexion when knee flexes. Tight structure?

Gastrocnemius

Patient cannot achieve passive knee extension. Tissue classification?

Contracture

During wrist extension + ulnar deviation, which muscle is maximally elongated?

Flexor carpi radialis

Following biceps repair, what motion combination is most protective?

Avoid end-range elbow extension + shoulder extension + supination

Patient with neurological injury develops limited ROM. Mechanism?

Altered tone + prolonged positioning

A patient with RA develops ROM loss. Why?

Inflammation → fibrosis → contracture

What causes greater long-term gains: high force short duration or low force prolonged duration?

Low force prolonged duration

Why should stabilization occur during stretching?

Prevent compensation and direct force to target tissue

A patient gains passive ROM but cannot use it functionally. What is missing?

Motor control and strengthening

How do you know tissue entered failure instead of plastic deformation?

Pain and structural damage occur

Which adapts more slowly: muscle or connective tissue?

Connective tissue

Clinical goal of mobility interventions

Functional movement, not maximal ROM