PTA/148 Study Notes

Contact Information

  • Office Hours: Posted Outside Office HR-116
  • Email: joeso@cos.edu
  • Cell phone: 679.9868
  • Quizzes: Every Friday 7:30 AM

Syllabus Overview

  • Duration: 14 week course
  • Components:
    • Lab Skills, Check-off, Skills Check/Test
    • Lab Practical
    • Assignment 148
  • Details: To be provided in subsequent class sessions.

Course Objectives

  • Differentiate between range of motion (ROM) and flexibility.
  • Explain the difference between stress and strain.
  • Describe the difference between plastic and elastic deformation.
  • List three beneficial effects of warm-up.
  • Identify the critical components for stretching soft tissue contractures.
  • Outline various methods to measure flexibility.
  • Describe and contrast the differences and similarities between scar tissue and adhesions.
  • Examine, compare, and contrast clinical applications for stretching soft tissue contractures.

Benefits of Flexibility & Stretching

  • Efficiency: More efficient movement patterns.
  • Muscle Balance: Improved balance of muscles around joints.
  • Training Compatibility: Easier to conduct strength and endurance training.
  • Injury Prevention: Reduced risk of injuries through better mobility.
  • Recovery: Quicker recovery from physical activity.
  • Soreness Reduction: Reduced post-exercise soreness.
  • Facilitation of Relaxation: Facilitates relaxation and stress relief.

Consequences of Insufficient Flexibility

  • Decreased Range of Motion (ROM): Can lead to multiple issues.
  • Muscular Imbalances: Result from inadequate flexibility.
  • Faulty Postural Alignment: Incorrect posture leading to dysfunction.
  • Injuries: Further injury and joint dysfunction can occur as a chain reaction.

Properties of Connective Tissue

  • Tropocollagen:
    • Building block of collagen.
  • Collagen:
    • Essential component of connective tissues including bone, tendon, muscle, skin, cartilage, and joints.
    • Provides strength and can withstand tension and force during movement.
    • Type I:
      • Thick fibers in bundles.
      • Shows little elongation and resists pulling forces.
    • Type II:
      • Thinner with less tensile strength, located in articular cartilage and the nucleus pulposus.
    • Type III:
      • Found in fast-growing and healing tissues, providing supportive structure.
  • Elastin:
    • A protein present in tendons in small amounts, associated with increased flexibility, and assists collagen in tissue recovery post-stress.

Stress and Strain

  • Stress:
    • Refers to the intensity of the internal force. It is calculated as force divided by area.
    • Categories include compressive, tensile, or shear, with units in pounds per square inch or Newtons per square centimeter.
  • Strain:
    • Represents the relative deformation of a body resulting from loading, defined as the change in length divided by the original length of the tissue.
  • Viscoelasticity:
    • Refers to stress-strain behavior that is dependent on the rate of application of the stress.
  • Stress and strain are interconnected, and their relationship varies based on the magnitude of stress and its application rate.

Stress-Strain Curve Features

  • Toe Region:
    • Initial phase where tissue is taut without slack.
  • Elastic Region:
    • Stress can be applied, allowing the tissue to return to its original shape without damage.
    • Slope indicates stiffness; a higher slope indicates greater stiffness (compliant tissues are less stiff).
  • Plastic Region:
    • Area where the tissue cannot return to its original shape post deformation.
  • Yield Point:
    • The point at which the material begins to deform plastically.
  • Physiologic Range:
    • Range of functional movement without damage occurring.
  • Ultimate Failure Point:
    • The point where the tissue fails completely.

Viscoelasticity

  • Elasticity:
    • The ability to return to the original state after strain or deformation (e.g., like a rubber band).
  • Viscosity:
    • The resistance against form change or shear forces.
  • Rate of Stretch Affects Strain:
    • Slower rates yield greater strains; faster rates result in less elongation.

Creep and Stress-Relaxation Phenomena

  • Creep:
    • Gradual increase in tissue length when maintaining a constant stress over time.
    • The longer the force applied, the greater the tissue deformation.
  • Stress-Relaxation:
    • Occurs when a material experiences constant strain with no change in length, leading to reduced stress but without deformation.
  • Clinical Implication:
    • When a muscle is held at a length over time, stress decreases while length remains unchanged.

Effect of Temperature on Connective Tissue

  • Higher temperatures increase the rate of creep; tissues stretch more before failure.
  • Therapeutic Limit:
    • The temperature of about 45°C is recommended for effective tissue stretching.

Flexibility Definition and Types

  • Flexibility:
    • The ability of a muscle to relax and yield to a stretch force, allowing full joint movement through its range of motion (ROM).
  • Types of Flexibility:
    • Static Flexibility: Holding a muscle in an elongated position.
    • Dynamic Flexibility: Ability to move through a range actively.

Measuring Flexibility

  • Utilize standard goniometric instruments to measure ROM at specific joints.

Joint Stability vs Flexibility

  • These concepts are distinct; a flexible joint may not necessarily be stable.
  • Example Tests:
    • Sit-and-reach test
    • Seated hip external rotation test
    • Standing knee recurvatum assessment

Factors Affecting Flexibility

  • Stretching Principles:
    • Critical for increasing ROM and reducing stiffness in muscle-tendon units.
  • Stress Tolerance:
    • Ability to tolerate stretching discomfort over time.

Warm-up Implications

  • Proper warm-up prepares tissues for activity, ideally including stretching and exercise.
    • Increased blood flow, tissue temperature, and breakdown of oxyhemoglobin enhance performance.
    • A warm-up duration of 10 to 25 minutes is recommended.

Stretching Techniques

  • Static Stretching:
    • Placing muscle in fully elongated position and holding; can be passive or actively done.
    • Advantages: Reduced chance of strain exceedance, lower energy use, and is easy to teach.
  • Goals of Static Stretching:
    • Minimize injury risk and enhance flexibility and movement efficiency without eliciting pain.

Variants of Stretching Techniques

  • Passive Static Stretch:
    • Force applied through an external agent (partner, gravity).
  • Active Static Stretch:
    • Involves opposition muscle action assisting the stretch.

Ballistic Stretching

  • Least Desirable:
    • Riskier for patients; involves jerky or bouncing movements, stimulating muscle spindles, resulting in resistive contractions.

Dynamic Stretching

  • Utilization:
    • Muscular contractions stretch muscles dynamically, serving to prepare for specific athletic activities.

Proprioceptive Neuromuscular Facilitation (PNF)

  • Techniques:
    • Uses various methods to enhance neuromuscular responses and improve ROM.
    • Involves isometric contraction before stretching, utilizing diagonal or straight-plane patterns.
    • Goal: Stimulation of proprioceptors like Golgi tendon organs and muscle spindles.

PNF Stretching Methods

  • Method 1 (GTO/Spindle):
    • Activates proprioceptors in Golgi tendon organs and muscle spindles to facilitate muscle elongation.
  • Method 2 (Remove Inhibition):
    • Targets inhibition of stretch reflex pathways to improve ROM.

Contract-Relax Techniques in PNF

  • Autogenic Inhibition Protocol:
    • Patient contracts the target muscle before relaxation; PTA moves limb into stretch.
  • Reciprocal Inhibition Protocol:
    • Patient contracts the opposite muscle before the PTA stretches the target muscle.

Stretching Duration and Frequency

  • Static Stretches:
    • Hold each stretch for 30 seconds; recommend 3-5 repetitions.
    • A minimum of 3 sessions/week for improvements, with maintenance at 1 session/week.

Proposed Stretching Benefits

  • Enhanced flexibility and muscle relaxation.
  • Injury prevention and overall performance enhancement.

Clinical Applications of Stretching

  • Addressing muscle, capsule, tendon, ligaments, and skin to alleviate soft tissue contractures.
  • Techniques may include long-duration, low-load static stretching for healing and scar tissue remodeling.
  • Contracture Definition:
    • A permanent or temporary limitation of movement; rigid scar tissue can lead to contractures.

Scar Tissue Characteristics

  • Scar tissue becomes poorly organized with changes over time; immature, adaptable tissue can remodel for up to 8 weeks, while older tissues become unadaptable around 14 weeks.
  • Stress-reactive nature aids in remolding when appropriate stress is placed.

Low-Load, Prolonged Stretching Technique

  • Steps include:
    • Preheating areas
    • Applying stress gradually with a moist heat application.
    • Allowing recovery time post-load to initiate further stretching measures.

Use of Commercial Products in Stretching

  • Patient selection and skin integrity are crucial.
  • Everyday tools such as canes or broomsticks can be utilized for shoulder flexibility.

Functional Tests and Evaluation

  • Piriformis Test:
    • Evaluates for piriformis tightness or syndrome with a specific setup involving hip flexion and leg drop.
  • Tripod Sign:
    • Assesses hamstring contractures with a seated knee extension test, observing lumbar spine movement.
  • Q-Angle Measurement:
    • Involves measuring angles to assess knee alignment and tracking.

Parameters for Passive and Active ROM

  • PROM:
    • Should be performed at least every hour and must be pain-free.
  • AAROM:
    • Should follow PROM without painful AROM preceding it.

Introduction to Strength Training

  • The aim is to enhance muscle strength and mass as a critical aspect of physical recovery.
  • Utilizes various contractions including isometric, isotonic, and isokinetic exercises.

Factors Determining Muscle Strength

  • Influencing factors include:
    • Neural control, cross-sectional area, muscle fiber arrangement, muscle length, angle of pull, fiber type distribution, and other variables including age and gender.

General Muscle Biology

  • Components of Muscle:
    • Epimysium, endomysium, perimysium, fascicles, myofibrils, sarcomeres, etc.

Muscle Fiber Types

  • Slow Twitch (Type I):
    • Aerobic endurance fibers, rich in mitochondria and low in speed.
  • Fast Twitch (Type II):
    • Anaerobic fibers that contract quickly and are beneficial for sprinting activities.
    • Subtypes include Fast Fatigable (FF) and Fast Fatigue-Resistant (FR).

Types of Muscle Contractions

  • Concentric:
    • Muscle shortening while lifting a load.
  • Eccentric:
    • Muscle lengthening while controlling a load.
  • Isometric:
    • Tension without movement.
  • Isotonic:
    • Variable tension with constant load.
  • Isokinetic:
    • Constant speed regardless of force.

Principles for Strength Training

  • Overload Principle: Exceed metabolic capacity for gains.
  • SAID Principle: Specific adaptations to imposed demands.
  • Progression Principle: Gradually increase program intensity.
  • Reversibility Principle: Maintain training improvements to avoid loss.

Delayed Onset Muscle Soreness (DOMS)

  • Characterized by diffuse pain, swelling, and reduced ROM following intense resistance training.
  • Theories include skeletal muscle and connective tissue damage; lactic acid involvement lacks evidence.

Management of DOMS

  • Recommended Treatments:
    • Use of NSAIDs, icing, and hydration.
    • Other alternative therapies are inconsistent in findings.

Velocity of Muscle Contractions

  • Tension varies in response to speed; control is crucial during exercise to manage intensity effectively.

Clinically Relevant Exercise Programs

  • DeLorme Program: Progressive resistance with set percentage increases.
  • Oxford Program: Reverses DeLorme method, considering fatigue.
  • Knight DAPRE: Variable repetitions based on patient performance.

National Strength & Conditioning Association Guidelines

  • Goals set for various training types with prescribed load percentages and repetitions.

Circuit Training

  • Organized exercise sequence focusing on fitness conditioning with adequate rest periods between sets.

Strength Training for Older and Younger Populations

  • Special considerations for age-related strength training to promote functionality while minimizing risk.

General Recommendations for Patient Safety

  • Close monitoring of patients during initial training phases and consideration of individual capabilities in exercise programs.

End of Lecture

  • Reminder for upcoming online lecture due soon.