Restoring ROM and Improving Flexibility

Definitions Flexibility Contracture Contracture of flexor Ability of neuromuscular system to allow movement of a joint or series of joints through non-restricted pain-free ROM Contracture Adaptive shortening of muscle or other soft tissue that results in limited ROM Contracture of flexor

ROM Active Passive Active Assisted (pulleys) Measuring ROM ( goniometry) ROM exercises Assignment #2

Definitions continued Agonist Muscle contracts to produce a movement Also referred to as prime movers ( bicep in elbow flexion) Antagonist the muscle being stretched in response to contraction of the agontist ( triceps in elbow flexion) Synergists muscles perform, or assist in performing, the same set of joint motion as the agonists. Gastrocs are synergists to knee flexion, they assist the hamstrings

Neurophysiologic Principles Muscle spindle Message to CNS that muscle being stretched Message back to muscle via interneurons in spinal cord Protective mechanism

Neurophysiologic Principles Golgi Tendon Organs If stretch ≥ 6 seconds, GTOs override muscle spindle, to cause a reflex relaxation of the agonist muscle. This relaxation serves as a protective mechanism that will allow the muscle to stretch through relaxation with out exceeding the extensibility limits, which could damage the muscle fibers

Mechanical Properties Collagen fibers– resists mechanical forces and deformation Elastin fibers– assist in recovery from deformation Elasticity Capability to recover normal length after deformation Plasticity Permanent change/deformation

Mechanical Properties Neutral/resting position Little/no resistance to passive movement Tissue crimp Elastic zone Tissue tension felt Tissue will return to original shape when force removed Plastic zone Tension in tissue overcomes elastic recoil Tissue does not return to original shape

How permanent is stretching? Debatable… Elastic stretching lasts about 90 min Plastic stretching more permanent

Therapeutic methods Static (Passive) 15-60 sec (sufficient time to for the GTO to begin responding to increased tension) 3-5 repetitions GTO can override the impulses coming from the muscle spindle , allowing the muscle to reflexively relax after initial reflex resistance to the change in length Thus lengthening the muscle and allowing it to remain in a stretched position for extended period of time , and unlikely to produce any injury

Therapeutic methods Ballistic Repeated bouncing movement Tissue rapidly lengthened and immediately returns to pre-stretched length Is the oldest form of stretching Very functional with respect to sport Concern: causes small microtears in the tissue because of “over stretching” of the tissue/ bouncing past the normal limits of extensibility. Has been know to cause pain/muscle soreness in sedentary individuals.

Therapeutic methods Progressive Neuromuscular Facilitation Contract relax (Hold Relax)( normal ) (stretching antagonist) Move the body part passively into the agonist pattern Isometrically contract antagonist ( muscle that will be stretched) 5-10 sec Athlete relaxes the antagonist while therapist moves part through as much ROM ( to where limit is felt) Good for muscle tightness

Contract relax stretching

Therapeutic methods PNF continued Hold-Relax Contract ( similar to contract relax) Isometric contraction of the antagonist ( muscle that is to be stretched) 5-10 sec This is followed by concentric contraction of the agonist muscle ( non tight muscle) with light passive pressure from the therapist to stretch of antagonist Repeat

Guidelines for stretching Warm up using exercise before stretching To increase flexibility the muscle must be overloaded Stretch only to point of tightness or resistance to stretch ( or discomfort) ( should not be painful) Inexperienced athletes should begin with static stretching Stretching should be specific to ranges in activity e.g.. Rotational stretching for LB in golfers ( increase ROM is very specific) Exercise caution when stretching back and neck Stretch from a seated position to take stresses off the back Breath normally ballistic stretching should be done by those accustomed to stretching ( do after static) Static stretching to improve ROM used initially than progress to PNF type stretching 3 times per week ( min ) 5-6 times to see improvement)

Guidelines for stretching Why warm-up prior to stretching? By increasing the tissue Temp, it allows for the non-contractile components of the M-T units (collagen/elastin) to deform easier